Porth’s Pathophysiology 10th Edition By Norris Test Bank

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Chapter 1- Concepts of Health and Disease

1. At an international nursing conference, many discussions and breakout sessions focused on the World Health Organization (WHO) views on health. Of the following comments made by nurses during a discussion session, which statements would be considered a good representation of the WHO definition? Select all that apply.

A) Interests in keeping the elderly population engaged in such activities as book reviews and word games during social time

B) Increase in the number of chair aerobics classes provided in the skilled care facilities

C) Interventions geared toward keeping the elderly population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes

D) Providing transportation for renal dialysis patients to and from their hemodialysis sessions

E) Providing handwashing teaching sessions to a group of young children

2. A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual's health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report?

A) The client has a diverse background by being of Asian and Native American descent and practices various alternative therapies to minimize effects of stress.

B) The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime.

C) The client has a good career with exceptional preventative health care benefits.

D) The client lives in an affluent, clean, suburban community with access to many health care facilities.

3. A physician is providing care for a number of patients on a medical unit of a large, university hospital. The physician is discussing with a colleague the differentiation between diseases that are caused by abnormal molecules and diseases that cause disease. Which of the following patients most clearlydemonstrates the consequences of molecules that cause disease?

A) A 31-year-old woman with sickle cell anemia who is receiving a transfusion of packed red blood cells

B) A 91-year-old woman who has experienced an ischemic stroke resulting from familial hypercholesterolemia

C) A 19-year-old man with exacerbation of his cystic fibrosis requiring oxygen therapy and chest physiotherapy

D) A 30-year-old homeless man who has Pneumocystis carinii pneumonia (PCP) and is HIV positive.

4. A member of the health care team is researching the etiology and pathogenesis of a number of clients who are under his care in a hospital context. Which of the following aspects of clients' situations best characterizes pathogenesis rather than etiology?

A) A client who has been exposed to the Mycobacterium tuberculosis bacterium

B) A client who has increasing serum ammonia levels due to liver cirrhosis

C) A client who was admitted with the effects of methyl alcohol poisoning

D) A client with multiple skeletal injuries secondary to a motor vehicle accident

5. A new myocardial infarction patient requiring angioplasty and stent placement has arrived to his first cardiac rehabilitation appointment. In this first session, a review of the pathogenesis of coronary artery disease is addressed. Which statement by the patient verifies to the nurse that he has understood the nurse's teachings about coronary artery disease?

A) “All I have to do is stop smoking, and then I won't have any more heart attacks.”

B) “My artery was clogged by fat, so I will need to stop eating fatty foods like French fries every day.”

C) “Sounds like this began because of inflammation inside my artery that made it easy to form fatty streaks, which lead to my clogged artery.”

D) “If I do not exercise regularly to get my heart rate up, blood pools in the veins causing a clot that stops blood flow to the muscle, and I will have a heart attack.”

6. A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronic obstructive pulmonary disease (COPD), and a respiratory therapist (RT) is assessing the client for the first time. Which of the following aspects of the patient's current state of health would be best characterized as a symptom rather than a sign?

A) The patient's oxygen saturation is 83% by pulse oxymetry

B) The patient notes that he has increased work of breathing when lying supine

C) The RT hears diminished breath sounds to the patient's lower lung fields bilaterally

D) The patient's respiratory rate is 31 breaths/minute.

7. Which of the following situations would be classified as a complication of a disease or outcome from the treatment regimen? Select all that apply.

A) Massive pulmonary emboli following diagnosis of new-onset atrial fibrillation

B) Burning, intense incision pain following surgery to remove a portion of colon due to intestinal aganglionosis

C) Development of pulmonary fibrosis following treatment with bleomycin, an antibiotic chemotherapy agent used in treatment of lymphoma

D) Gradual deterioration in ability to walk unassisted for a patient diagnosed with Parkinson disease

E) Loss of short-term memory in a patient diagnosed with Alzheimer disease

8. Laboratory testing is ordered for a male patient during a clinic visit for a routine followup assessment of hypertension. When interpreting lab values, the nurse knows that

A) a normal value represents the test results that fall within the bell curve.

B) if the lab result is above the 50% distribution, the result is considered elevated.

C) all lab values are adjusted for gender and weight.

D) if the result of a very sensitive test is negative, that does not mean the person is disease free

9. The laboratory technologists are discussing a new blood test that helps establish a differential diagnosis between shortness of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is purported to indicate a cardiac etiology The marketers of the test report that 99.8% of patients who have confirmed cardiac etiologies test positive in the test. However, 1.3% of patients who do not have cardiac etiologies for their shortness of breath also test positive. Which of the following statements best characterizes this blood test?

A) Low validity; high reliability

B) High sensitivity; low specificity

C) High specificity; low reliability

D) High sensitivity; low reliability

10. As part of a screening program for prostate cancer, men at a senior citizens' center are having their blood levels of prostate-specific antigen (PSA) measured. Which of the following statements would best characterize a high positive predictive value but a low negative predictive value for this screening test?

A) All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer.

B) All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer.

C) Men who had low PSA levels also displayed false-positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer.

D) The test displayed low sensitivitybut high specificity.

11. A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the United States, he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the man would be classified as being in

A) the preclinical stage of disease.

B) remission and unlikely to develop hepatitis C.

C) the clinical disease stage of hepatitis C

D) the chronic phase of hepatitis C.

12. As of November 1, 2012, there were a total of 10 confirmed cases of Hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 people with Hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of

A) what the anticipated mortality rate would be if a familyof five were planning to vacation in Yosemite National Park.

B) the prevalence of Hantavirus one can anticipate if he or she is going to vacation in Yosemite National Park.

C) the low rate of morbidity one can expect while traveling to Yosemite National Park.

D) the incidence of people who are at risk for developing Hantavirus while staying in Yosemite National Park.

13. A particular disease has a debilitating effect on the ability of sufferers to perform their activities of daily living and is a significant cause of decreased quality of life. However, few people die as a result of the disease's direct effects. There are hundreds of thousands of Americans living with the disease but relatively few new cases in recent years. Which of the following statements best conveys an accurate epidemiological characterization of the disease?

A) Low mortality; high morbidity; low prevalence; high incidence

B) Low mortality; high morbidity; high incidence; low prevalence

C) High mortality; low morbidity; high incidence; low prevalence

D) High morbidity; low mortality; high prevalence, low incidence

14. An epidemiologist is conducting a program of research aimed at identifying factors associated with incidence and prevalence of congenital cardiac defects in infants. The researcher has recruited a large number of mothers whose infants were born with cardiac defects as well as mothers whose infants were born with healthy hearts. The researcher is comparing the nutritional habits of all the mothers while their babies were in utero. Which of the following types of study is the epidemiologist most likely conducting?

A) Cohort study

B) Cross-sectional study

C) Case–control study

D) Risk factor study

15. A nurse practitioner is working in a crowded neighborhood where the population is primarily immigrants from China. The nurse has designed a research study to follow children from kindergarten to the age of 25. She is going to be looking at their diet, successful progression in school, health practices, and development of disease, to name a few items. This type of research is known as

A) cohort study.

B) cross-sectional study

C) case–control study.

D) epidemiological study

16. As part of a community class, student nurses are developing a class to teach expectant parents the importance of having their child properly secured in a child safety seat. During the class, the students are going to have a safety officer examine the car seats that the parents have installed in their vehicles. This is an example of which type of prevention?

A) Primary prevention

B) Secondary prevention

C) Tertiary prevention

D) Prognosis enhancement

17. A multidisciplinary health care team operates a program aimed at the prevention, identification, and treatment of diabetes on a large Indian reservation. Which of the following aspects of the program would be most likely to be classified as secondary prevention?

A) Regularly scheduled wound dressing changes for clients who have foot ulcers secondary to peripheral neuropathy and impaired wound healing

B) Teaching school children how a nutritious, traditional diet can lessen their chances of developing adult-onset diabetes

C) Staffing a booth where community residents who are attending a baseball tournament can have their blood glucose levels checked

D) Administering oral antihyperglycemic medications to clients who have a diagnosis of diabetes

18. An occupational therapist conducts a group therapy program called MindWorks with older adults who have diagnoses of dementia and Alzheimer disease. The goal of the group is to slow the cognitive decline of clients by engaging them in regular, organized mental activity such as reading maps and solving puzzles. How would the program most likely be characterized?

A) Primary prevention

B) Secondary prevention

C) Tertiary prevention

D) Prognosis enhancement

19. The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which of the following statements most accurately captures a guiding principle of the nurse's task?

A) Evidence-based practice guidelines will be rooted in research rather than nurses' subjective practice preferences and experiences.

B) Guidelines are synonymous with systematic research reviews.

C) The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable.

D) The guidelines will combine individual expertise with external systematic evidence.

20. The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals that the patient maybe exhibiting clinical manifestations of a cerebrovascular accident (CVA). Which of the following statements about clinical practice guidelines are accurate? Select all that apply.

A) Step-by-step guidelines are usually developed and based primarily on “how it has always been done before.”

B) The development of evidence-based practice guidelines requires a research review from different studies to develop the most accurate diagnostic method to implement.

C) Once developed, practice guidelines onlyneed to be reviewed if a national committee sends out an update on new research.

D) When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback.

E) A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method.

Answer Key

CHAPTER 2: Cell and Tissue Characteristics

1. During a discussion on cellular components and their function, a student asked the instructor the purpose of messenger RNA (mRNA). Of the following, which is the most accurate answer?

A) Transports amino acids to the site of protein synthesis

B) Acts as an inner nuclear support membrane for a rigid network of protein filaments that bind DNA to the nucleus

C) Performs an active role of protein synthesis, where mRNA molecules direct the assembly of proteins on ribosomes to the cytoplasm

D) Assists cells in forming neoplastic progression by altering the response of chromatin in the nuclear matrix

Ans: C

Feedback:

The nucleus is the site for the synthesis of three types of RNA that move to the cytoplasm and carry out the actual synthesis of proteins. Messenger RNA copies and carries the DNA instructions for protein synthesis to the cytoplasm. Ribosomal RNA is the site of actual protein synthesis; transfer RNA transports amino acids to the site of protein synthesis.

2. The nurse is providing care for a client with a diagnosis of cirrhosis, and she notes that the client's sclerae are jaundiced. The nurse recalls that jaundice is a pigment that can accumulate in which part of the cell?

A) Nucleus

B) Cytoplasm

C) Golgi apparatus

D) Rough endoplasmic reticulum (ER) Ans: B

Feedback:

Pigments such as bilirubin and melanin can accumulate in the cytoplasm, resulting in the characteristic yellow skin tones associated with jaundice. Pigments do not tend to accumulate in the nucleus, Golgi apparatus, or rough ER.

3. A 14-year-old female has been experiencing severe internal cramps in the region of the pelvis and weight loss.She has been admitted with rectal bleeding.The physician has diagnosed her with inflammatory bowel disease (IBD). She asks the nurse what causes this disease. The nurse will base her response knowing that IBD has been linked to

A) liver involvement in faulty glycogen stores.

B) endoplasmic reticulum stress in the gastrointestinal system.

C) oversecretion of insulin from the beta cells in the pancreas.

D) infiltration of the gastrointestinal tract bybacterial toxins.

Ans: B

Feedback:

Researchers are determining links between the endoplasmic reticulum (ER) and various disease processes. For examples, ER stress in the GI system has been found to be related to intestinal inflammations such as those occur with inflammatory bowel disease. The smooth ER of the liver is involved in glycogen stores. Insulin is synthesized as a large, inactive proinsulin molecule cut apart to produce a smaller, active insulin molecule within the Golgi complex of the beta cells. Bacterial toxins have exploited the retrograde transport mechanism

4 A professor is teaching a group of students about the role of mitochondria within the cell. Which of the following statements is true of mitochondria?

A) They are the site of adenosine triphosphate (ATP) production.

B) The number of mitochondria in a cell is equal to the number of nuclei.

C) They are replicated within the smooth endoplasmic reticulum (ER).

D) Mitochondrial DNA is inherited patrilineally.

Ans: A

Feedback:

Consistent with their characterization as the “power plants” of the cell, mitochondria are the site of ATP synthesis for the cell. The number of mitochondria in a given cell type varies, according to the energydemands of the particular cell. They are self-replicating rather than being produced in the smooth ER, and they are inherited matrilineally

5. A patient has been diagnosed with a neurodegenerative disease called multiple sclerosis (MS). The physician explains to the patient that this disease may be caused by dysregulated apoptosis. Later that day, the patient asks the nurse what this means. The nurse should reply,

A) “The cells around your nerves don't know how to die correctly.”

B) “The cytoplasm should neutralize the various apoptotic inhibitors but isn't working correctly.”

C) “Dysregulated apoptosis has caused an excessive rate of programmed cell death along the neuropathways.”

D) “There is an inappropriately low rate of apoptosis occurring within the cells.”

Ans: C

Feedback:

Dysregulated apoptosis can mean too little or too much and has been implicated in neurodegenerative diseases, in which there is an increased or excessive rate of apoptosis.

6. A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication?

A) Epistaxis resulting from loss of cilia in the nasal passageway

B) Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract

C) Sterilitycaused by inabilityof the sperm to swim downstream

D) Inability to hear soft sounds related to kinocilium on the hair cells in the inner ear

Ans: B

Feedback:

Immotile cilia syndrome immobilizes the cilia of the respiratory tract, thus interfering with clearance of inhaled bacteria, leading to the chronic lung disease called bronchiectasis.

7. A community health care worker is explaining to a group of factory workers the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which of the following characteristics of cell membranes underlies the nurse's teaching?

A) Cell membranes are impermeable to all but lipid-soluble substances.

B) Cell membranes have a hydrophilic head and a hydrophobic tail.

C) Cell membranes contain receptors for hormones and biologically active substances.

D) Transmembrane proteins can pass through the cell membrane into the intracellular environment.

Ans: A

Feedback:

Because cell membranes are soluble to some lipid-soluble substances such as organic solvents, such substances should be kept from direct contact with skin cells. The facts that cell membranes have a hydrophilic head and a hydrophobic tail and contain receptors for hormones and biologically active substances do not have a bearing on the nurse's teaching. While transmembrane proteins can indeed pass into the intracellular environment, the nurse is not referring to proteins in the teaching

8. The nurse is explaining the workings of selective serotonin reuptake inhibitors to a client with a diagnosis of depression. Within the teaching, the nurse mentions that in the nervous system, the transmission of information by neurotransmitters is

A) synaptic signaling

B) endocrine signaling.

C) autocrine signaling.

D) paracrine signaling.

Ans: A

Feedback:

Synaptic signaling occurs in the nervous system, where neurotransmitters act only on adjacent nerve cells through special contact areas called synapses. Endocrine signaling relies on hormones carried in the bloodstream to cells throughout the body. Autocrine signaling occurs when a cell releases a chemical into the extracellular fluid that affects its own activity. With paracrine signaling, enzymes rapidly metabolize the chemical mediators and therefore act mainly on nearby cells.

9. The nurse is teaching a group of colleagues about the cell division cycle as background to oncology nursing Which of the following statements is true of the cell cycle?

A) Some cells lack a G0 phase

B) Mitosis is a process that occurs in steps over 1 to 2 days.

C) The two broad phases of the cell cycle are mitosis and synthesis.

D) Nondividing cells such as nerve cells are said to be in the S0 phase

Ans: C

Feedback:

While consisting of several stages, cell division can be broadly divided into the two phases of mitosis and synthesis. Some cells lack a G1 stage, not a G0 phase, and mitosis is a fluid and continuous process over 1 to 1½ hours. Nondividing cells are said to be in the G0 phase.

10 A 62-year-old male collapsed while unloading a truck of heavy sacks of feed for his cattle. When he arrived in the emergency department, blood gases reveal a slightly acidic blood sample. The nurse caring for this patient is not surprise with this result based on which of the following pathophysiological rationales?

A) The skeletal muscles are producing large amounts of lactic acid and release it into the bloodstream during heavy work/exercise.

B) During exercise, catabolism will break down stored nutrients and body tissues to produce energy

C) Large amounts of free energyare released when ATP is hydrolyzed and then converted into adenosine diphosphate.

D) Within the mitochondria, energy from reduction of oxygen is used for phosphorylation of ADP to ATP.

Ans: A

Feedback:

Heart muscle is efficient in converting lactic acid to pyruvic acid and then using the pyruvic acid for fuel. Pyruvic acid is an important source of fuel for the heart during heavy exercise when the skeletal muscles are producing large amounts of lactic acid and releasing it into the bloodstream. Therefore, the blood sample would be acidic bynature. Catabolism will break down stored nutrients and body tissues to produce energy. ATP conversion into ADP and phosphorylation of ADP to ATP are both aerobic metabolism processes.

11. The health caregiver is explaining the rationale for administering a hypotonic intravenous solution (lower concentration of solutes in its surroundings) to a client. Which of the following mechanisms of membrane transport most likely underlies this action?

A) Facilitated diffusion

B) Active transport

C) Diffusion

D) Osmosis

Ans: D

Feedback:

The fact that body cells are permeable to water but not all solute particles, and the amount of solute relative to water content, underlies the choice of intravenous fluid, in health care. Water moves through water channels in a semipermeable membrane along a concentration gradient, moving from an area of higher to an area of lower concentration. This is the essence of osmosis, and the other mechanisms of membrane transport do not have as significant a bearing on the nurse's action.

12. A nurse is teaching a client with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the body cell in order to provide energy for the client. The nurse knows that which of the following processes allows glucose to enter body cells?

A) Osmosis

B) Facilitated diffusion

C) Active transport

D) Diffusion

Ans: B

Feedback:

Facilitated diffusion involves the movement of a substance like glucose from an area of high concentration, such as the bloodstream, to an area of low concentration, such as the intracellular space, through the use of a transport protein. Osmosis, active transport, and diffusion do not bring about the movement of glucose into body cells.

13. An end-stage renal disease patient has been on peritoneal dialysis at home. Based on his lab work, he regulates the type of solution to infuse into his abdomen. When there is a high concentration of potassium inside the cell (hyperkalemia), the solution infused has a lower concentration so that the potassium ions will diffuse outward. At this point, the cellular membrane is said to be

A) at equilibrium potential in which no net movement of ions occurs.

B) charged with high voltage

C) filled with positive current.

D) polarized because of the presence of a negative membrane potential.

Ans: D

Feedback:

Because of the large concentration gradient existing across the cell membrane, potassium ions tend to diffuse outward. As they do so, they carry their positive charges with them, causing the inside to become negative in relation to the outside. This new potential difference repels further outward movement of the positively charged potassium ion. The membrane is said to be polarized.

14. A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which of the instructor's following statements best describes the process of cell differentiation?

A) “Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”

B) “A single stem cell differentiates into approximately200 different types of cells.”

C) “A fertilized ovum undergoes a series of divisions, yielding many different cell types.”

D) “Cells differentiate into necessary body cells peaking after conception and ceasing near the time of birth.”

Ans: C

Feedback:

Cell differentiation and consequent tissue types are the outcome of the series of cell divisions that occur in the fertilized ovum. It originates neither with a single stem cell nor in the hematopoietic system. Stem cells allow for limited differentiation throughout the life span, not only antepartum.

15. A nurse is providing care for a client with a diagnosis of Crohn disease. The nurse recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likelyinvolved in the client's pathology?

A) Simple columnar epithelium

B) Glandular epithelium

C) Simple cuboidal epithelium

D) Stratified epithelium

Ans: A

Feedback:

Simple columnar epithelium lines the intestine and has cilia and mucus-secreting goblet cells. The intestinal tract does not consist of glandular epithelium, simple cuboidal epithelium, or stratified epithelium.

16. During a crime scene investigation, the coroner confirms that rigor mortis has set in. This helps to confirm an approximate time of death. The forensic nurse can explain this process (rigor mortis) to a group of students based on the fact that

A) troponin is being prevented from forming a cross-bridge between the actin and myosin.

B) activated by ATP, cross-bridges become attached to the actin filament.

C) the myosin head catalyzes the breakdown of ATP to provide the energy need so that a cross-bridge can be formed.

D) at death, the body is unable to complete the actin/myosin cycle and release the coupling between the myosin and actin, creating a state of muscular contration.

Ans: D

Feedback:

As the muscle begins to degenerate after death, the sarcoplasmic cisternae release their calcium ions, which enable the myosin heads to combine with their sites on the actin molecule. As ATP supplies diminish, no energy source is available to start the normal interaction between the actin and myosin, and the muscle is in a state of rigor until further degeneration destroys the cross-bridges between the actin and myosin.

17. The homecare nurse is making a home visit to a 51-year-old female client with a long-standing diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process are ultimately manifested as a failure of what normal process in muscle tissue?

A) The contraction of the epimysium

B) The surrounding of fascicles byperimysium

C) Thick myosin and thin actin filaments sliding over each other

D) The contraction of fascicles within myofibrils

Ans: C

Feedback:

The contraction of skeletal muscle tissue can be characterized as the sliding action of myosin and actin. Epimysium surrounds and plays a supportive role in the skeletal muscle, and perimysium similarly provides support but does not actively produce locomotion. Myofibrils are found within fascicles, not the opposite.

18 An instructor is explaining to a group of students the way in which muscles and their associated tendons can be so strongly attached. The instructor makes references to the role of the basal lamina. Which of the following statements most accurately captures an aspect of the basal lamina?

A) It is produced by the connective tissue adjacent to it.

B) It is present where connective tissue contacts the tissue it supports.

C) It is found solelybetween connective tissue and muscle fibers.

D) It is also known as the basement membrane

Ans: B

Feedback:

The basal lamina is found where connective tissue is in contact with the tissue that it provides support for. It is produced by epithelial cells and is found on Schwann cells, adipose tissue, and other sites apart from muscle fibers. It is not synonymous with the basement membrane, which consists of the combination of basal lamina and the reticular layer.

19. A caregiver is working with a client who is having poorly controlled pain due to shingles. The associate pain travels to the client's nervous system via

A) synapses.

B) axons.

C) afferent neurons.

D) efferent neurons.

Ans: C

Feedback:

Afferent or sensory neurons carryinformation toward the CNS; they are involved in the reception of sensory information from the external environment and from within the body. Efferent or motor neurons carry information away from the CNS; they are needed for control of muscle fibers and endocrine and exocrine glands.

20. A 6-year-old child cuts his leg while playing outside. An inflammatory process begins the healing process by moving leukocytes and platelets through the endothelial lining of blood vessels. This process occurs because of which extracellular tissue component?

A) Extracellular matrix

B) Glycosaminoglycans

C) Selectins

D) Cadherins

Ans: C

Feedback:

Selectins are found on activated endothelial cells of blood vessels, on leukocytes, and on platelets. They, together with integrins and immunoglobulins, participate in leukocyte movement through the endothelial lining of blood vessels during inflammation.

Cadherins link parts of the internal cytoskeleton (actin and catenins) with extracellular cadherins of an adjacent cell. Glycosaminoglycans are one of the components of the extracellular matrix.

CHAPTER 3: Cellular Adaptation, Injury, and Death

1 Of the following situations, which one would be an example of a maladaptive cellular change?

A) An 18-year-old body builder who has developed extremelylarge pectoral muscles following years of weight lifting

B) A 31-year-old marathon runner who has developed hypertrophied myocardial cells

C) A 54-year-old female who has developed ovarian atrophy following loss of estrogen stimulation during menopause

D) A 44-year-old male with a 60-pack-per year smoking history who was diagnosed with a histological grade 3 lung cancer

Ans: D

Feedback:

In many adaptive cellular responses, the expression of the differentiation genes is altered. When working with cancer patients, histological grade or differentiation refers to how much the tumor cells resemble normal cells of the same tissue type. In body builders and athletes, cells' hypertrophy is based on the increase in workload placed on the muscle. Reproductive atrophy is expected due to the loss of estrogen stimulation during menopause.

2. A client is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the client's muscle cells?

A) High levels of insulin and IGF-1 in the client's blood during immobilization

B) Denervation of the affected muscles during the time of traction

C) A reduction of skeletal muscle use secondary to the traction treatment

D) Reduced oxygen consumption and cellular function that ensures muscle cell survival

Ans: C

Feedback:

Disuse atrophy results from the reduction in skeletal muscle use such as that following encasement in plaster casts or traction. Low levels of insulin and IGF-1 contribute to atrophy, and denervation only occurs in paralyzed limbs. Reduced oxygen consumption and cellular function are the mechanisms of cell atrophy but not the causes of the process.

3. The nurse is teaching new nursing assistants on the unit about the phenomenon of muscle hypertrophy Which of the following clients on the unit is most likely to experience muscle hypertrophy? A client with

A) urinaryincontinence following a cerebral vascular accident (CVA).

B) hypertension, obesity, and decreased activity tolerance.

C) peripheral edema secondaryto heart failure (HF).

D) possible rejection symptoms following a liver transplant.

Ans: B

Feedback:

Hypertension is a common cause of adaptive hypertrophy, in which cardiac muscle cells increase in size in response to the increased work of circulation over time. The other diagnoses are not associated with muscle hypertrophy.

4 Which of the following clients is at a high risk for developing dilated cardiomyopathy?

A) A 17-year-old with a diving injury resulting in paraplegia

B) A 4-year-old child born with cerebral palsy and confined to a wheelchair

C) A 44-year-old noncompliant female who forgets to take her hypertensive medications

D) A 78-year-old patient with Alzheimer disease who received a third-degree burn following an oven fire

Ans: C

Feedback:

In hypertension, the increased workload required to pump blood against an elevated arterial pressure in the aorta results in a progressive increase in LV muscle mass and need for coronary blood flow. The pressure overload causes hypertrophied cells to have greater width and length. Paraplegia, cerebral palsy, and Alzheimer disease do not increase the workload of the cardiac muscle per se

5. Which of the following statements by a student demonstrates a sound understanding of the cellular processes of hypertrophy and hyperplasia?

A) “I know that cells like neurons have little capacity for hyperplastic growth.”

B) “A remaining kidney can sometimes undergo hyperplasia in response to one that has been removed.”

C) “When male patients experience 'an enlarged prostate,' they are describing a form of hypertrophy ”

D) “Clients with cardiomyopathy undergo myocardial hypertrophy with proportional increases in cell length and width.”

Ans: A

Feedback:

Because they do not normally divide, neurons do not undergo hyperplasia Remaining organs can display hypertrophy, not hyperplasia, and prostate enlargement is a form of hyperplasia. Cardiomyopathic hyperplasia involves greater increases in cell length than width.