NURS 618 Advanced Pathophysiology Exam 1: Multiple Choice Questions and Answers, Exams of Nursing

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NURS 618 ADVANCED PATHOPHYSIOLOGY

EXAM 1 LATEST 2024/2025 100% ACCURATE

NURS 618 Pathophysiology for Advanced Practice.

SOUTHEASTERN LOUISIANA UNIVERSITY

If a tissue specimen of myocardial cells were obtained for examination from Mr. Forbes, which of the following findings would indicate irreversible cell injury? a. cellular swelling b. decreased ATP production c. decreased intracellular calcium d. dissolution of nuclear material D The accumulation of lactic acid that occurs with impaired energy production results from which of the following? a. increased intracellular glucose b. increased anaerobic metabolism c. decreased metabolic rate d. increased oxidative phosphorylation B A mountain climber is stranded at 23,000 feet in the Swiss Alps and has lost all his equipment and supplies in an avalanche. Subsequently, he suffers cell injury due to impaired ATP production. The reason for the decrease in ATP is which of the following? a. enzyme inhibition b. uncoupling c. hypoxia d. none of the above C

There is a disease of the spleen, which results in an excessive destruction of RBCs. This increase in RBC destruction can lead to which of the following? a. hypoxia b. hypobilirubinemia c. an increase in platelets d. all of the above A Your body has developed an increased demand for thyroid hormones. This will lead to ____________ of the thyroid gland. a. atrophy b. hypertrophy c. dysplasia d. metaplasia B You palpate a gangrenous leg and note the presence of crepitus. Crepitus is associated with which of the following? a. wet gangrene b. dry gangrene c. gas gangrene d. all of the above C

Direct cell membrane destruction may result from which of the following? a. complement activation b. bacterial enzymes c. free radicals d. all of the above D Which of the following is true regarding apoptosis? a. It occurrence may be physiological or pathological. b. It does not stimulate the inflammatory process. c. It results in phagocytosis of the apoptotic cell. d. all of the above. D Insufficient blood flow to a part of the body is defined as: a. hypoxia. b. hypoxemia. c. necrosis. d. ischemia. D A cellular change, which is often precancerous, is called: a. hyperplasia. b. metaplasia.

c. stable molecules that have an affinity for iron in the cytoplasm of the cell d. none of the above B The usual fate of apoptotic cells is which of the following? a. metaplastic transformation b. calcification c. hypertrophy d. phagocytosis e. neoplastic transformation D Which of the following statements is true regarding the difference between cell necrosis and apoptosis? a. Apoptosis is a more rapid process. b. Apoptosis is usually initiated by ischemia-induced cell injury. c. Apoptosis is genetically controlled. d. Apoptosis characteristically involves rupture of the cell membrane. C You are a nurse practitioner working in an outpatient clinic. Your patient's echocardiogram shows moderate aortic stenosis (narrowing of the aortic valve). You know that the stenotic valve creates an increased resistance against which the left ventricle contracts. The cellular adaptation most likely to occur in the left ventricle is which of the following? a. atrophy

b. hypertrophy c. hyperplasia d. metaplasia B Select the condition that is an example of physiologic hyperplasia. a. breast enlargement during puberty b. endometrial hyperplasia from excessive estrogen stimulation c. prostatic hyperplasia occurring as men age d. none of the above are physiologic A Your patient has a long history of mitral stenosis (narrowing of the mitral valve). As the years go by, the left atrium, which contracts against the increased resistance of the stenotic valve, begins to fail--and output from the left ventricle begins to decline. If the left ventricle were to undergo adaptation, what would it most likely be? a. atrophy. b. hypertrophy. c. hyperplasia. d. metaplasia. A Which of the following is not characteristic of cellular dysplasia? a. variation in size and shape of cells b. small, pale nuclei

d. decreased binding of cholesterol, triglycerides, and phospholipids to apoproteins A Which of the following is the primary difference between wet and dry gangrene? a. Infection and inflammation are present in wet gangrene. b. Wet gangrene results from arterial occlusion and dry gangrene from venous stasis. c. Dry gangrene involves the presence of Clostridium perfringens. d. Wet gangrene occurs only in internal organs. E Which of the following components is not involved in apoptosis? a. Bcl- 2 b. apaf- 1 c. caspase 9 d. cytochrome c e. HLA 2 E Some cancer-causing viruses are able to protect the cells that they transform from undergoing apoptosis by interfering with the action of the apoptosis promoter called: a. TNF-alpha. b. Fas. c. p53. d. IL-2.

e. INF-beta. C Which of the following diseases is thought to be related to free radical damage? a. osteoarthritis b. detached retina c. cerebral aneurysm d. cancer D Which of the following enzymes, released from dying cells, may indicate problems in the liver? a. alanine aminotransferase b. aspartate aminotransferase c. alkaline phosphatase d. all of the above e. none of the above D Researchers hypothesize that the disappearance of dopamine-generating cells in the midbrain in Parkinson's Disease may be related to oxidative stress due to a decrease in the amount of glutathione in the midbrain. The best explanation for this theory is which of the following? a. DNA synthesis requires glutathione for optimal development. b. Dopamine synthesis requires glutathione to prevent free radical production. c. Free radicals produced via dopamine synthesis are neutralized by glutathione. d. Glutathione is needed for entry of dopamine into the cerebral circulation. C

risk factors and distribution in populations Incidence number of new cases Prevalence number of existing cases both new and old clinical manifestations signs, symptoms, and diagnostic criteria how are symptoms and signs different symptoms are what the patient reports signs are objective or measurable outcomes cure, remission, chronicity, or death primary prevention Efforts to prevent an injury or illness from ever occurring.

secondary prevention

• focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status
• examples: communicable disease screening and case finding; early detection and treatment of diabetes; exercise programs for older adult clients who are frail Tertiary prevention
• aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning
• examples: prevention of pressure ulcers as complication of a spinal cord injury; promoting independence for the client who has traumatic brain injury Atrophy Decrease or shrinkage in cellular size.Most common in skeletal muscle, heart, secondary sex organs, and brain. Physiologic atrophy occurs with early development. Ex. Thymus gland gets physiologic atrophy during childhood. pathologic atrophy occurs as a result of decreases in workload, pressure, use, blood supply, nutrition, hormonal stimulation, and nervous stimulation

Hormonal physiologic hyperplasia Hormonal occurs mainly from estrogen dependent organs such as uterus and breasts.Ex- after ovulation estrogen stimulates endometrium to grow/thicken for fertilized ovum. Pathologic hyperplasia he abnormal proliferation of normal cells and can occur as a response to excessive hormonal stimulation or the effects of growth factors on target cells. These cells have enlargement of the nucleus, clumping of chromatin (package and protect DNA), and the presence of one or more large nucleoli. Ex. Benign prostatic hyperplasia (BPH) and endometriosis-both the result of hormonal imbalance. Metaplasia reversible replacement of one mature cell type (epithelial or mesenchymal) by another, sometimes less differentiated, cell type. Cause of metaplasia develops from reprogramming of stem cells. Found in association with tissue damage, repair, and regeneration. pathophysiology of metaplasia Adaptive replacement cell may be more suitable to the changed conditions in the surrounding environment. Ex. GERD damages squamous epithelium of the esophagus, cells are replaced by glandular epithelium which may tolerate the acid better. Not always beneficial. Ex. Smoking causes changes in bronchi cells, which don't have cilia or secrete mucus, causing loss of protective mechanism.

What is the significance of metaplasia Can be reversed if stimulus is removed. If continues, can cause malignant transformation. Dysplasia abnormal changes in the size, shape, and organization of mature cells. mostly found in epithelia Significance of dysplasia can be reversed if it does not involve the entire epithelium. When dysplastic changes penetrate the basement membrane it is considered a preinvasive neoplasm (carcinoma in situ) mechanisms of cell injury ATP depletion, mitochondrial damage, accumulation of oxygen and oxygen-derived free radicals membrane damage protein folding defects DNA damage defects calcium level alterations reperfusion injury injury to tissue that occurs after blood flow is restored restoration of needed oxygen is accompanied by oxidative stress with the generation of toxic oxygen radicals which damage cellular membranes and mitochndria

Normally intracellular cytosolic calcium concentrations are very low; ischemia and certain chemicals can cause an increase in cytosolic Ca concentrations sustained levels of Ca continue to increase with damage to plasma membrane Ca causes intracellular damage by activating enzymes Cellular events that occur with ischemia-hypoxic injury

• Decrease in oxygen reaching the cell
• decrease in ATP production within mitochondria
• failed NA+/K pump
• Na, Ca enter cell, K leaves
• organelle swelling
• protein synthesis stops
• ATP via oxidative phosphorylation declines, glycolysis increases
• glycogen stores depleated
• lactic acid produced
• decrease in intracellular Ph declines
• rupture of lysosomes
• autodigestion of the cell contents and membrane Deleterious effects of free radicals on cells
• unstable compounds with an unpaired electron in outer ring
• anxious to "mate" with other substances affinity for lipid substances (there is a phospholipid bilayer membrane around cell)
• combine avidly with cell and organelle membranes

• lipid peroxidation - dissolution of the membrane
• "drills a hole" examples o diseases linked to oxygen-derived free radicals aging atherosclerosis brain disorders Cancer Cardiac myopathy Diabetes Eye disorders inflammatory disorders iron overload emphysema radiation injury reperfusion injury rheumatoid arthritis sleep apnea Burns Most types of cellular accumulations occur as a result of what 4 mechanisms 1 - insufficient removal of normal substance because of altered packaging/transport 2 - abnormal substance (result of mutated gene) accumulated because of deficits in protein folding, transport, or abnormal degredation 3 - endogenous substance not effectively catabolized because of lack of vital lysosomal enzyme