PrepU CH. 4

A client with severe peripheral artery disease (PAD) has been educated about the various growth factors and their functions. This client is hoping that the growth factor, fibroblast growth factor (FGF), will be able to repair the circulation to his lower extremities because this growth factor's function is to:

grow new vessels into the damaged area (angiogenesis).

A client with COPD controlled with long-term corticosteroids has developed an infection following bowel surgery. The nurse anticipated this complication since steroids:

impair the phagocytic property of leukocytes.

A client with diabetes has a wound that will not heal. The client has been prescribed hyperbaric oxygen therapy. The client asks why he is going in an oxygen chamber instead of just having dressing changes and IV antibiotic therapy. The nurse knows that hyperbaric oxygen is currently used in wounds that have: Select all that apply.

limited oxygen supply which is common in clients with diabetes. an infection that is interfering with healing.

When discussing cellular replication with a client with chronic kidney disease, the client asks, "Can't my body just repair or grow a new kidney?" The nurse responds, "The kidney is a stable tissue and has only limited replicative capacity. In humans, the exception to this is the:

liver."

An infant was born with facial nerve paralysis that occurred with delivery. As the infant ages, it becomes apparent that the facial muscles affected by the nerve damage are not moving. Seeking surgical repair, the family asks why the damage to the child's face is not being repaired by the body. The healthcare provider states that neurons [connected to the facial muscles] are highly specialized cells that:

lose their ability to proliferate once development of the nervous system is complete.

One of the pathophysiology students recognized hyaluronic acid (a component of the extracellular matrix) as a supplement she buys at the health store following a knee injury. Knowing what this substance is, the student shares with her peers that it:

lubricates joints and serves as a supportive structure in the extracellular space throughout the body.

While discussing the various types of cells, the instructor points out that cells that renew constantly throughout life also have specialized cells that are unable to divide without:

progenitor cells that are differentiated so their daughter cells are limited to the same cell line.

After many years of cigarette smoking, a client is admitted to have a "mass" removed from the lung. When explaining the surgery and recovery, the physician notes that the client is likely to have a good amount of fibrosis develop at the surgical area. After the physician leaves the room, the client asks the nurse what was meant by "fibrosis" in the lung. The nurse bases the response on the fact that tissue repair can:

result in replacement tissue in the form of connective (fibrous) tissue which leads to scar formation or fibrosis of the lung.

A hospital patient has a large, superficial wound on her elbow that was the result of shearing action when she was moved up in her bed. The patient's husband mentions that the wound looks infected and irritated because the wound bed is completely red. Which of the following responses would be inappropriate?

"A thin sheet of blood clotting is actually desirable and not a sign that your wife's wound is infected."

Following surgery for appendicitis, a teenaged client notes four small "stab" wounds on the abdomen. The client is obviously worried about body appearance. The nurse explains, "Your body will heal quickly and tissue repair will allow for regeneration of any cells needed." The client asks, "What does regeneration mean?" The nurse responds that tissue repair by regeneration means:

"Any injured cells are replaced with cells of the same time. Therefore, after healing, the wound will look like your surrounding skin."

The nurse is providing discharge instructions for a postoperative client. The nurse determines that teaching about the wound was effective when the client states:

"I will regain tensile strength of unwounded skin at the end of 3 months."

A nurse is changing the wound dressing on the coccyx-region pressure ulcer of an immobilized patient. The existing dressing is saturated with both watery, clear discharge and foul, grayish-colored liquid. Which of the following entries in the patient's chart best captures this?

"Large amounts of supperative and serous exudates noted."

The student nurse is removing sutures on client after abdominal surgery, and the wound begins to pull apart. The student asks the instructor, "Did I do something wrong?" The instructor reviews wound healing and replies:

"Maybe the wound edges were not close enough together to allow epithelialization of the wound to occur."

While studying for a pathophysiology exam on cells and tissue repair, a student asks, "What happens if, in the process of going through the cell cycle, a cell is damaged?" Which is the best response?

"There are built in checkpoints in the cell cycle to allow for defects to be edited and repaired."

A patient who is recovering from burn injuries is discussing his prognosis with a physician. Which of the following teaching points about expectations for healing should the physician include?

"You may find that the scar is a bit smaller than the area of the wound."

The basement membrane surrounding a patient's foot wound remains intact, a fact that bodes well for the wound-healing process. Which of the following components constitute this form of the extracellular matrix (ECM)? Select all that apply.

1. Fibrous structural proteins 2. water-hydrated gels 3. glycoproteins

Which of the following patients would have a very poor response related to tissue regeneration of their injured area?

54 year old male who had a massive MI 4 days ago and came to the ED today for treatment.

Which patient is at greatest risk for decreased wound healing?

A 30-year-old patient with type 1 diabetes and a foot ulcer

Of the following list of patients, which would likely benefit the most from hyperbaric oxygen therapy?

A trauma patient who developed Clostridium spp., an anaerobic bacterial infection in their femur.

A continuing education nurse in a long-term care facility is discussing wound healing in elderly patients. Due to elderly patients being more likely to have co-morbidities like problems with mobility, diabetes, or vascular problems, the nurses should assess the patients for: Select all that apply.

A. • Pressure wounds on buttocks. C. • Impaired healing related to diabetes. E. • Ischemic ulcer formation in feet.

A client on peritoneal dialysis awakens one night to find that the end of the catheter has become disconnected and is contaminated by microbes on the bed sheets. The client develops peritonitis and is admitted for IV antibiotic therapy. Of the following possible complications related to this situation, which should the nurse be educating the client to watch for? Select all that apply.

Adhesions trapping bowel loops Intestinal obstruction

Which of the following is an example of wound healing by secondary intention?

An infected burn of the arm

The nurse is evaluating the wounds of four clients. Select the client most likely to be treated with hyperbarically delivered oxygen.

An infected foot wound on a 45-year-old patient with peripheral vascular disease

The nurse is educating a client who is about to undergo a stem cell transplant. The nurse mentions that a single stem cells can give rise to many cells needed for normal tissue repair. What type of replication is this process?

Asymmetric

The microbiologist is explaining cell communication. Which of the following statements is accurate?

Autocrine signaling occurs when a cell releases a chemical into the extracellular fluid that affects its own activity.

Researchers wish to reactivate the cell cycle in nonproliferating cells to assist the body to repair tissue. To reactivate the cycle, which substance will the researchers need to remove from the cell?

CDK inhibitors

During a review session discussing cells, a student asks, "What do you call it when a cell undergoes a process of increasing cell numbers by mitotic division?" Which response answers the question correctly?

Cell proliferation

While reviewing all the functions pertaining to growth factors, the study group of students will be discussing which cellular processes? Select all that apply.

Cellular proliferation • Production by leukocytes activated at the site by the inflammatory process • Ability to attract neutrophils and monocytes • Stimulate angiogenesis

While explaining to a young child why he should be careful with a wound, the nurse reviews healing with the parent. The nurse educates the parent about how strength in the healing wound site is developed based on which substance being available?

Collagen synthesis

While reviewing a pathophysiology chapter on cell proliferation and tissue repair, the study group notices that the transition from G2 to M in the cell cycle is an important checkpoint and requires which proteins to be available to complete the process? Select all that apply.

Cyclin B Cyclin-depentend kinases 1 (CDK1)

A 79-year-old female resident of an assisted living facility receives care from a community nurse on a regular basis for treatment of a chronic venous leg ulcer. Which of the following factors would the nurse be most justified in ruling out as a contributing factor to the client's impaired wound healing?

Decreased antibody levels

Select the option that most accurately describes the process resulting in specialized cells.

Differentiation

The surgeon has documented that a client is developing proud flesh at the postoperative wound site. The nurse recognizes this as:

Excessive granulation tissue

Tissues are composed primarily of cells in the M phase.

False

While explaining to a chemotherapy client the effect the medications have on bone marrow cells, the nurse mentions that bone marrow stem cells have been shown to not only generate blood cells but also which other type of cells? Select all that apply.

Fat cells Cartilage cells Bone cells Muscle cells

Following an injury, scar formation builds on the granulation tissue framework. Proliferation of fibroblasts occur with the assistance of which growth factors that have been released from enothelial and inflammatory cells at the site of injury? Select all that apply.

Fibroblast growth factor (FGF) Transforming growth factor-beta (TGF-beta)

When caring for a client during the proliferative phase of wound healing, the nurse teaches the client that which of these processes is taking place?

Fibroblasts secrete collagen for wound healing.

A client asks the nurse why a scar developed after an injury. The best response would be:

Fibrous tissue

A client fell off his motorcycle, receiving several large abrasion-related surface wounds. What physiologic phenomenon will the client first experience?

Healing by secondary intention

A school-aged child asks the nurse why his wound has a scab on it. The nurse walks the child through the inflammatory phase of wound healing. Place the steps of the inflammatory phase in proper sequence.

Injury occurs on playground. Injured blood vessels vasoconstrict. Platelet activation initiates blood clotting. Following brief period of constriction, vessels dilate. Capillaries increase permeability, allowing plasma to leak into the area. Clot loses fluid and becomes hard (scab protects the area).

While reviewing how tissue repairs itself after injury, the students note that it follows a certain pattern. Place the steps of the repair of tissue in their proper sequence of events.

Injury to connective tissue occurs. Fibroblasts migrate. Induction of fibroblast occurs and endothelial cell proliferate. Granulation tissue appears. Formation of a scar develops. Remodeling occurs with the reorganization of the fibrous tissue

In which of the following stages of mitosis does the cell not undergo division but does double its mass?

Interphase

The rehabilitation nurse is caring for a client who is recovering from a cerebrovascular accident (CVA) with hemiplegia. The family asks the nurse if the paralysis will be permanent. Upon which of these physiologic rationales should the nurse base the response?

It is likely that paralysis is permanent, as nerve cells do not normally regenerate.

The nurse is caring for a client with an accumulation of 2.5 cm. of darkened tissue scar over the area of a 3 mm. injury. How does the nurse correctly document this finding in the medical record?

Keloid

While the nurse is performing a skin assessment on an African American client, the nurse notes that the client has a healed wound on the leg but that the wound has an excess of scar tissue. The nurse documents this as which of the following?

Keloid

When caring for a client who has developed bacterial pneumonia, the nurse assesses for which of these abnormalities that supports presence of infection?

Leukocytosis

An oncology class is reviewing the cell cycle as it pertains to tumor growth. When talking about the M phase, the instructor describes the processes occuring at this time include:

Nuclear division occurs.

Tissue repair through regeneration occurs in which cells?

Parenchymal

The nurse is assessing the wound of a postoperative client. The client has a 6-inch abdominal wound that is well approximated and closed with surgical suture. The wound does not display any redness or drainage. The nurse would document the healing process as:

Primary intention

The nurse is caring for a post operative patients documents that the surgical incision is healing by which of the following?

Primary intention

A client sustained an injury 3 days ago. The nurse is assessing the status of the wound. The nurse anticipates the phase of healing to be:

Proliferative

The nurse is assessing a 9 day old wound. The nurse notes that the edema surrounding the wound has diminished and that the wound is now blanchable. The nurse doucments that the wound is in which stage of the healing process?

Proliferative

The professor is describing multipotent stem cells, mentioning that these hematopoietic stem cells give rise to a family of cells. Which cells are in this family? Select all that apply.

Red blood cells Leukocytes

The presence of granulation tissue at a wound site is identified by:

Red, moist tissue

When completing a dressing change, the nurse notes that the wound has proud flesh. Which is the appropriate action by the nurse?

Request surgical consult

The objective of tissue regeneration in wound healing is to:

Restore injured tissue to its original structure

Select the option that best describes the type of tissue that is capable of regeneration when appropriately stimulated.

Stable

Some tissues, such as the mucosal surface of the gastrointestinal tract, have cells that are capable of cell division and serve as a reserve source for specialized cells. These cells are which of the following?

Stem cells

A family member asks the nurse, "What do they mean when they start taking about stem cells?" Which is the nurse's best response?

Stem cells are undifferentiated cells with the capacity to generate multiple different cell types.

When caring for a client with a wound that is healing by primary intention the nurse recognizes which of these best describes this type of wound?

Surgical incision

A client recovering from an accident notices that she has developed excess tissue that extends above the edges of the wound. She asks "What can be done about this excess tissue?" The nurse responds that it can be removed by which procedures? Select all that apply.

Surgically removing the excess tissue Chemically cauterizing the defect

Which responsibility of the extracellular matrix (ECM) most accurate?

The ECM provides the scaffolding for tissue renewal.

Following hip replacement surgery, the client has had many weeks of physical therapy. Upon assessing the wound, it is still red and draining thick, green, odoriferous secretions. The client has limited range-of-motion and is constantly reporting pain. The physician explains that the hip device needs to be removed. Why is removal required?

The body considers the hip replacement device a foreign body and an infection has developed around the joint.

All wounds are considered contaminated at the time they occur. Usually, the natural defenses in our bodies can deal with the invading microorganisms; however, there are times when a wound is badly contaminated and host defenses are overwhelmed. What happens to the healing process when host defenses are overwhelmed by infectious agents?

The formation of granulation tissue is impaired.

Select the option that best describes why highly differentiated neuron cells are unable to increase their numbers after a certain point in time.

The stimuli to bring about mitosis are lacking.

The nurse is caring for a client with an infected wound that is left to heal by secondary intention. Which of these observations does the nurse expect to make during assessment of the wound area?

The wound is healing slowly with epithelial and scar tissues present.

Which statements are true regarding the contraction and remodeling of a wound? Select all that apply.

This phase generally begins about 3 weeks after the injury. The development of a fibrous scar is important to the success of the process. This phase can take up to 6 months or longer to complete. The scar site generally has less tensile strength than surrounding tissue.

The nurse is caring for a client who has experienced hypovolemic shock secondary to penetrating multiple trauma. When caring for the client postoperatively, which of these factors does the nurse recognize places the client at risk for poor wound healing?

Tissue hypoxia

Select the statement that best describes stem cells.

Undifferentiated cells of continuously dividing tissues that have the capacity to generate multiple cell types

A client with a diagnosed history of arthritis has experienced cartilage damage. The nurse recognizes this as resulting from:

Unregulated action of proteases

When caring for a postoperative client, in order to promote wound healing, which of these nutrients does the nurse encourage the client to consume?

Vitamin C

While educating a group of individuals about to undergo knee surgery, the nurse stresses the importance of eating a well-balanced diet, especially high in vitamins. Which vitamin promotes collagen synthesis to facilitate the wound to the knee to heal properly?

Vitamin C

The nurse is caring for a client with a chronic wound. The most important intervention for the nurse to include in the plan of care would be:

Vitamin C and Zinc supplements

Metalloproteinase requires which mineral to be present before degraduation of collagen occurs?

Zinc

Critical to the wound healing process are the transitions in the composition of the extraceullular matrix (ECM). Place the following steps in the proper order from the transitional process of the ECM to delivery to site of injury.

a. ECM components are degraded by proteases (enzymes) b. Some of the proteases are highly specific and cleave particular proteins at a small number of sites c. Structural integrity of the ECM is retained while healing occurs d. Actions of proteases are tightly controlled by being produced in an inactive form e. Proteases is activated by certain chemicals present at the site of injury f. Chemicals are rapidly inactivated by tissue inhibitors once injury is healed

A client with diabetes has an admission hemoglobin A1c (HbA1c) level of 13 (goal is 6) and an abdominal wound that will not heal. The nurse knows that hyperglycemia (poor blood glucose control) has an effect on wound healing, especially related to neutrophils affecting:

ability to engulf and kill bacteria because of poor phagocytic function.

A class of student nurses is hearing a lecture on wound healing. The professor explains about primary and secondary healing. The professor continues to talk about the phases of wound healing and states that in both primary and secondary healing the phases of wound healing occur at different rates. What are the phases of wound healing? (Select all that apply.)

b; the proliferative phase d; the inflammatory phase e; the maturational phase

An oncology client on chemotherapy has had an episode of GI bleeding. The client has been receiving an erythropoietin stimulating agent, epoetin alfa. The client reports severe bone pain (arthralgia). Knowing the basic pathophysiologic principles, the nurse explains that the bone pain is related to:

bleeding that is stimulating the rapid proliferation of replacement cells by the blood-forming cells in the bone marrow.

What does it mean that some cell populations have self-renewing multipotent stems cells? Some cells:

can differentiate into different epithelial cell types throughout life.

An oncology client is about to begin chemotherapy. During the education, the nurse mentions that continuously dividing cells will be most affected by the chemotherapy. The client asks, "What are continuously dividing cells?" The nurse responds, "These are cells that continue to divide and replicate like: Select all that apply.

cells on the surface of your skin." • cells in your mouth." • cells lining your GI tract."

A nurse who had a needlestick injury 15 years ago has developed hepatitis C and now progressed to liver failure. This nurse was hoping that the growth factor, transforming growth factor-alpha (TGF-alpha), would have been able to repair her liver since this growth factor's function is to:

stimulate replication of hepatocytes.

Following a severe automobile accident, a client is scheduled to have surgery to either repair or remove his spleen, pancreas, and stomach. The patient wants the organs repaired and not removed if at all possible. However, the nursing staff understands that extensive regeneration in parenchymal organs can only occur if:

the residual tissue is structurally and functionally intact.

A client with a torn rotator cuff has been asked by his physician, a regenerative specialist, to consider allowing transplantation of his own stem cells into his area of injury. This is an example of:

therapeutic cloning.

A mature scar will likely be pale in color due to:

transformation from a highly vascular granulation tissue into an avascular scar.

During the synthesis phase of the cell cycle, the cell is:

undergoing a period of DNA synthesis and replication of the chromosomes.

A client with cancer who is experiencing severe malnutrition and dehydration due to chemotherapy asks the nurse why her skin is so dry and sloughing off. The nurses response is based on the pathophysiological principle that:

when the epithelium cells of the skin are not getting proper nutrients they exit the cell cycle and go to the resting state of G0.

A nurse conduction a staff inservice on wound healing in older adults determines that the participants are understanding the information when they state that older adults may experience delayed wound healing due to which of the following aging processes? (Select ALL that apply)

• Decreased collagen synthesis • Impaired wound contraction • Slower reepithelialization

The nurse admitting a client with an infected leg wound notes that the client has a history of peripheral vascular disease, COPD, and diabetes, and GERD. Which disorders increase the client's risk for wound complications? (Select ALL that apply)

• Diabetes • Peripheral vascular disease • COPD

During a lecture on stem cells, the professor mentions that the first few cells produced after fertilization are totipotent and divide into which types of cells? Select all that apply.

• Embryonic cells • Extraembryonic cells

The wound care nurse is teaching a group of nurses about wound healing. Presence of which of these situations that interfere with wound healing should the nurse include in the discussion? Select all that apply.

• Malnutrition • Hyperglycemia • Infections