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NRS 232 Pathophysiology Final Exam Latest Exam 100% Accurate Fall-
Spring Term
What is pathophysiology? Book Definition: "Pathology is the study and diagnosis of disease through examination of organs, tissues, cells, and bodily fluids. Physiology is the study of the mechanical, physical, and biochemical functions of living organisms. Together, as pathophysiology, the term refers to the study of abnormalities in physiologic functioning of living beings. How are etiology and pathogenesis used to predict clinical manifestations and response to therapy? Book Definition: "pathogenesis is a description of how etiologic factors are thought to alter physiologic function and lead to the development of clinical manifestations that are observed in a particular disorder or disease." We have an expert-written solution to this problem! Knowledge Question: A healthcare provider is caring for a person with an inborn error of metabolism. Which would be an expected finding? Metabolite accumulation in the cells Which statement indicates cell death from apoptosis as opposed to necrosis? Cells dismantle and cell blebs are phagocytized by macrophages. Which finding indicates that a person has wet gangrene, instead of an infarction, in a lower extremity wound? Bacteria in the wound Somatic death refers to death: to the death of the entire organism.
A change in a tissue marked by cells that vary quite a bit in size and shape, and with increased mitotic divisions indicates which of the following: dysplasia. What term should you use when talking with professional colleagues to describe a change from squamous to columnar epithelium in the esophageal lining due to chronic acid reflux? Metaplasia When a cell is injured from lack of oxygen it may recover if oxygen is restored before the injury is irreversible. Hypertrophy is beneficial because it: causes cells to become larger and stronger. You are preparing a poster on cell aging for an educational poster day at your home health agency. Which of the following terms should you use to explain the concept that most cells have a limited number of divisions? Telomere Billy, age 10, will have his cast removed from his broken arm later today. You explain to Billy that his arm will probably look different when the cast is removed. It probably will be: smaller, due to muscle atrophy from lack of use. Of the following situations, which one would be an example of a maladaptive cellular change? 44 - year-old male with a 60 pack/year smoking history who was diagnosed with a histological grade-3 lung cancer. A client is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which factor has most likely contributed to the atrophy of the client's muscle cells? A reduction of skeletal muscle use secondary to the traction treatment.
The nurse is caring for a client with arterial insufficiency of the left leg with gangrenous wounds on the second and third toes. What characteristics of the wounds should the nurse evaluate as expected? Select all that apply. A clear demarcation between the healthy and affected tissue Diminished pulse strength Atrophy to the affected toes Darkened appearance of affected tissue Which change exemplifies physiologic hypertrophy? Muscle mass increase with exercise. The nurse is counseling a heavy smoker about the dangers of smoking. The nurse tells the smoker that due to persistent irritation of the lungs from carcinogens, the normal ciliated columnar epithelial cells of the trachea may transform into stratisfied squamous epithelial cells as a method of adaptation known as: Metaplasia. We have an expert-written solution to this problem! The client is found to have liver disease, resulting in the removal of a lobe of the liver. Adaptation to the reduced size of the liver leads to which phenomenon in the remaining liver cells? Compensatory hyperplasia. The obstetric nurse explains to the client that when she stops breast feeding, her breast tissue will reduce in size. The nurse understands that this regression is due to which physiologic process? Apoptosis. We have an expert-written solution to this problem! A client's lab report returns and a nurse is explaining to the client the significance of the changes. The nurse states the finding is implicated as a precursor to cancer. Which finding was most likely on the lab report?
Dysplasia. Which condition is an example of physiologic hyperplasia? Uterine enlargement in pregnancy. A 23-year-old man has received a recent diagnosis of appendicitis. The nurse providing care for the man is explaining that the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which teaching points should the nurse eliminate from client education? "Inflammation helps your body to produce the right antibodies to fight the infection." We have an expert-written solution to this problem! A client presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The client's physician has ordered a complete blood count and white cell differential. Which blood component would the physician most likely anticipate to be elevated? Neutrophils. We have an expert-written solution to this problem! Which phenomena best accounts for the increased presence of leukocytes at the site of inflammation? Existing leukocytes stick to the epithelial cells and move along blood vessel walls. A deficiency in which of these would result in an inhibition of the inflammatory response? Histamine. We have an expert-written solution to this problem! Which aspect of a client's site of inflammation would help the care provider rule out chronic inflammation? Increased neutrophils.
We have an expert-written solution to this problem! A nurse educator is describing the way that cells involved in the inflammatory response find their way to the site of injury. Which description best reflects this physiologic mechanism? "The process of chemotaxis is the process where cells wander through the tissue guided by secreted chemoattractants." We have an expert-written solution to this problem! What is the initial step in the process of phagocytosis to degrade any bacteria and cellular debris? Recognition and adherence. We have an expert-written solution to this problem! What is the primary purpose of tissue regeneration in wound healing? Remodel the area to preinjury appearance. Which one of the following interventions would best address the imbalances that are affecting your friend W.W. who has clinical dehydration? Feeding him salty soup and some fruit juice. During a period of extreme excess fluid volume, a renal dialysis client may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell? 3% sodium chloride. The nurse at a long-term care facility encourages the older adults to drink even though they may not feel thirsty at the time. Which statement supports the nurse's actions? Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high. A client has been diagnosed with a brain tumor that cannot be removed surgically. During each office visit the nurse will be assessing the client for syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment would alert the clinic nurse that the client may be developing this complication?
Report of decreased urine output, no edema noted in ankles, increasing headache. A 77-year-old female hospital client has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which statement best conveys a risk that this woman faces? She is susceptible to isotonic fluid volume deficit. The nurse volunteering in the medical tent for a road race on a hot, humid day is asked to see a runner who has collapsed on the road. The nurse notes he has sunken eyes, a temperature of 100°F (37.7°C), and dizziness. These are signs of a fluid volume deficit. Recognizing fluid volume deficit, which of these interventions does the nurse carry out first? Give him an electrolyte solution by mouth. We have an expert-written solution to this problem! A client is brought to the emergency department with reports of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. The nurse notifies the physician to obtain orders for which of these problems? Fluid volume excess. A client with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Which finding does the nurse anticipate uncovering related to this problem? Muscle weakness, lethargy and headaches. The nurse is assessing a client for early manifestation of hyponatremia. The nurse would assess the client for: Muscle weakness. A client is admitted to the hospital with fluid volume deficit. The nurse should be aware that compensatory mechanisms will include: Activation of the renin-angiotensin-aldosterone system (RAAS).
The nurse on the cardiac unit has noted that the client's potassium level is 6.1 mEq/L (high). The nurse notified the physician and removed the banana from the client's meal tray. When explaining the nursing actions to the client, which statement is appropriate? "Your potassium level is high so I need you to let me know if you feel numbness, tingling, or weakness." A client with hypercalcemia and hypercalciuria has just passed a kidney stone. The nurse recognizes which of these laboratory studies should also be assessed? Parathyroid hormone level. The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. The nurse observes which clinical manifestations in this client? Muscular spasms and reports of tingling in hands/feet. A nurse is caring for a client admitted with diabetic ketoacidosis who is being treated with intravenous (IV) insulin administration. The client develops symptoms of anorexia, nausea, vomiting, constipation, and abdominal distention. Bowel sounds are hypoactive. Based on these symptoms, which electrolyte alteration should the nurse monitor for? Hypokalemia. Which diagnostic signs might be seen in a client whose serum calcium level is 7.1 mg/dL? Select all that apply. Trousseau Chvostek A client who is postoperative day 1 following a total thyroidectomy is reporting "twitchy" muscles and tingling in his fingertips and around his lips. The nurse's assessment reveals a positive Chvostek sign. The nurse should: Prepare to administer IV calcium gluconate, as ordered. We have an expert-written solution to this problem! The nurse teaches the client with hyperparathyroidism that he is at risk for:
Developing kidney stones. A nurse suspects that a client with a plasma magnesium level of 1.2 mg/dL (low) may have which condition in his or her history? Alcohol use disorder. The nurse is caring for a client who is 1 day postoperative for a thyroidectomy. The client complains of tingling of the hands and feet and around his mouth. The nurse suspects these symptoms are a manifestation of which electrolyte disturbance? Hypocalcemia. The nurse suspects that a client who had a colon resection 4 days ago, is unable to pass flatus, and has no audible bowel sounds has a paralytic ileus. The nurse recognizes that which abnormal laboratory result is consistent with this problem? Potassium level of 2.8 mEq/L A nurse notices that a client's neck dressing is saturated with blood following thyroid surgery. The nurse suspects the client may be experiencing which electrolyte disturbance? Hypocalcemia. A teenager presents to his physician with reports of generalized muscle weakness, muscle cramps, nausea, vomiting, and diarrhea. Based on these symptoms, the nurse anticipates that the client may have which problem? Hyperkalemia. A client admitted to the hospital with severe diarrhea has a K+ level of 6.7 mEq/L (high) and symptoms of paresthesia, restlessness, and dyspnea. Which intervention will the nurse anticipate administering to correct this condition? Intravenous (IV) insulin.
Increased capillary hydrostatic pressure is caused by increased extracellular volume and by venous congestion. Mr. S., age 68, has taken prednisone, a corticosteroid drug, for many years to control asthma. He had hernia surgery five days ago and went home. He lives 60 miles from the nearest doctor. You are talking by telephone and have already discussed pain management. Choose the best question to ask over the telephone to assess for the presence of a potential complication of wound healing. A. Has the pain at the incision site decreased? B. Who is helping you with the heavy lifting? C. Have you had a bowel movement today? D. Are the edges of the incision close together or are they separated? A. Has the pain at the incision site decreased? B. Who is helping you with the heavy lifting? C. Have you had a bowel movement today? D. Are the edges of the incision close together or are they separated? UNSURE BUT KNOW ITS NOT A. A person who has diabetic neuropathy and develops a foot ulcer has high risk for developing osteomyelitis from what process? Extension of contiguous infection. Analysis question: A 77-year-old female hospital client has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which statement best conveys a risk that this woman faces? She is susceptible to isotonic fluid volume deficit. Knowledge question: What is likely to lead to hyponatremia? Frequent gastrointestinal irrigation with distilled water. Application question: The nurse at a long-term care facility encourages older adults to drink even though they may not feel thirsty at the time. Which statement supports the nurse's action?
Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high. Application question: A client is brought to the emergency department with reports of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower lung fields bilaterally. The nurse recognizes these signs and symptoms are most likely associated with which diagnosis? Fluid volume excess. Application question: You are the nurse caring for a patient that was admitted with sepsis. In report you were told that the patient continues to have normal saline (NS) infusing at 150 mL/hr. You review the patient's history and discover yesterday's weight was 57 kg and today the weight is 62 kg. As the nurse, you recognize your priority is to: Stop the IV fluids and report your findings to the provider. What age group has more extracellular fluid than intracellular fluid? Infants. Which age group is most vulnerable to fluid imbalances? Neonates and infants. Older adults. Which of the following statements about capillary beds is correct? Filtration is more likely on the arterial side due to higher hydrostatic pressure. The most appropriate fluid to give a patient when aiming to hydrate them is: Isotonic solution. The most appropriate treatment for combined volume and concentration imbalance (clinical dehydration) includes: Replacement of salt and water.
What is the similarity between hypokalemia and hypomagnesemia? They may both result from loss of gastrointestinal fluids. People who abuse alcohol on a chronic basis frequently develop hypomagnesemia due to: Decreased magnesium intake. What is atrophy? Decreased cell size due to loss of cellular components. How is atrophy caused? Disuse, ischemia, nutrient deficiency, interrupted endocrine signals, persistent cell injury from chronic infection, inflammation, and aging. Examples: Immobility, arm in a cast. What is hypertrophy? Growth in cell size, not number of cells. What are benefits of hypertrophy? Allows for increased function. Examples: Biceps, and hypertension. What is hyperplasia? Increase in cell number by cell division. What are examples of hyperplasia? Callus, liver, skin, and blood cells. What is metaplasia?
Replacement of cell type to a cell that can withstand an environment, not cancer but continued irritant may cause cancer. What are examples if metaplasia? Smoking: ciliated epithelial cells replaced with stratified squamous gastric esophageal reflux disease (GERD). What is dysplasia? Disorder/disoriented growth, a response from a stressor. Is not cancer but is associated with an increased risk. What is an example of dysplasia? Cervical dysplasia from chronic infection. What are mechanisms of cell injury or cell death? Hypoxia, Physical agents, Chemicals, Reactive oxygen free radicals, Biological agent, Radiation, Nutritional imbalances. What happens to an injured cell? Intracellular accumulations (reversible & irreversible) Reversible cell swelling Irreversible cell death by necrosis Irreversible cell death by apoptosis What are the 5 stages of cell swelling? Ischemia (hypoxia) Lack O2, decrease in ATP
What are the steps of cell death by apoptosis? Cell receptor is no longer attached Caspase enzymes in cell activated- dismantle cell in an orderly fashion into the tidy membrane- bound packages Phagocytic cells clean up, component not released into interstitial space: No inflammatory response. What telomeres do in relation to cell aging? Can only divide so many times through mitosis. What is homeostasis? A steady range that the organism stays within. What is compensation? When an organism is outside of its normal range and the organism makes up for what it is lacking. What are somatic death terms? Rigor mortis Livor mortis Algor mortis Putrefaction What is rigor mortis? Stiffness of muscle that occurs shortly after death. What is livor mortis? Blood pooling to lowest portion of body, because of gravity. What is algor mortis?
Is the cooling of the body. What is putrefaction? The first part of decomposition, process of decay or rotting in a body or other organic matter, by bacteria from the environment. What is the process of how the body responds to an infection or injury? Chemokine signal for intention/damage > WBC leave the blood vessels and go to tissue
Selectin and integrin attach through rolling and adhesion WBC enter trough Diapedesis > Chemotaxis move the cells with concentration gradient > Phagocytosis occurs to clean up the microbes. Describe factors that can impair healing. Age, Smoking, Poor nutrition, Medication (Corticosteroids) Infections, Decreased vascular supply to an area, Ischemia Describe the stages of bone healing. Hematoma Fibrocartilage Callus Ossification Remodeling Explain the capillary mechanisms causing edema. Increased capillary hydrostatic pressure > decreased oncotic pressure > increased macrovascular permeability (results in more fluid outside of the capillaries)
