Essentials Of Pathophysiology Concepts of Altered States 4th Edition By Porth – Test Bank

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Essentials Of Pathophysiology Concepts of Altered States 4th Edition By Porth – Test Bank

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Chapter 2- Cellular Responses to Stress, Injury, and Aging

1.	Which of the following clients would be an example of cellular atrophy?
	A)	A middle-aged female experiencing menopause due to loss of estrogen stimulation
	B)	A postnephrectomy client whose remaining kidney enlarges to compensate for the loss
	C)	A hypertensive, noncompliant client who has developed a progressive increase in left ventricular mass
	D)	A female client with the change in uterine size as a result of pregnancy
	Ans:	A
	Feedback:
	In women, the loss of estrogen stimulation during menopause results in atrophic changes in the reproductive organs. Compensatory hypertrophy is the enlargement of a remaining organ or tissue after a portion has been surgically removed or rendered inactive. For instance, if one kidney is removed, the remaining kidney enlarges to compensate for the loss. In hypertension, for example, the increased workload required to pump blood against an elevated arterial pressure results in a progressive increase in left ventricular muscle mass and need for coronary blood flow. The pregnant uterus undergoes both hypertrophy and hyperplasia as a result of estrogen stimulation.

 

 

2.	A client has experienced significant decreases in mobility and stamina during a 3-week hospital stay for the treatment of a femoral head fracture. Which of the following phenomena most likely accounts for the client’s decrease in muscle function?
	A)	Impaired muscle cell metabolism resulting from metaplasia
	B)	Dysplasia as a consequence of inflammation during bone remodeling
	C)	Disuse atrophy of muscle cells during a prolonged period of immobility
	D)	Ischemic atrophy resulting from vascular changes while on bedrest
	Ans:	C
	Feedback:
	Disuse atrophy frequently occurs as a consequence of prolonged periods of muscle inactivity. Metaplasia and dysplasia are not common consequences of immobility and muscle disuse. Similarly, infrequent muscle use does not typically cause vascular changes that result in ischemic atrophy.

 

 

3.	The client is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to the reduced size of the liver leads to which phenomenon in the remaining liver cells?
	A)	Metaplasia
	B)	Organ atrophy
	C)	Compensatory hyperplasia
	D)	Physiologic hypertrophy
	Ans:	C
	Feedback:
	Compensatory hyperplasia can be stimulated in response to loss of vital tissue that is capable of regeneration, such as liver cells. Metaplasia involves replacement of one existing cell type with another fully differentiated cell type. Organ atrophy is caused by irreversible loss of cells. Physiologic hypertrophy is increased size of existing cells resulting from increased workload.

 

 

4.	A client presents for a scheduled Papanicolaou (Pap) smear. The clinician who will interpret the smear will examine cell samples for evidence of:
	A)	Changes in cell shape, size, and organization
	B)	The presence of unexpected cell types
	C)	Ischemic changes in cell samples
	D)	Abnormally high numbers of cells in a specified field
	Ans:	A
	Feedback:
	A Pap smear is an example of a diagnostic procedure that tests for the presence of cell dysplasia, that is, deranged cell growth of a specific tissue that results in cells that vary in size, shape, and organization. Unexpected cell types are evidence of metaplasia, whereas ischemic changes are associated with cell hypertrophy. Increases in the number of cells are characterized as hyperplasia.

 

 

5.	When performing an assessment on a school-aged child, the nurse notes that the mucous membranes along the gum margins have a noticeable blue-colored line. At this point, the nurse should ask the parents about possible:
	A)	Liver problems as an infant
	B)	Congenital heart problems
	C)	Exposure to lead
	D)	Second-hand smoke exposure
	Ans:	C
	Feedback:
	The formation of a blue lead line along the margins of the gum is one of the diagnostic features of lead poisoning. Liver problems are usually displayed as jaundice (yellowing of the skin/sclera). Congenital heart problems may exhibit cyanosis, but this would not be just in the gum margins. Second-hand smoke exposure may cause accumulation in the lungs.

 

 

6.	An elderly client asks her health care provider if the reason she has developed aortic stenosis is because she drank so much milk as a child growing up on a farm. Which of the following responses is most accurate?
	A)	“Drinking lots of real milk as a child may have contributed to the damage in your valve.”
	B)	“Atherosclerosis is a long process that eventually results in calcification of heart valves.”
	C)	“This calcification of your aortic valve is more than likely due to an undiagnosed thyroid problem.”
	D)	“More than likely, calcium has left your bones and collected on your aortic valve.”
	Ans:	B
	Feedback:
	Dystrophic calcification represents the macroscopic deposition of calcium salts in injured tissue. Dystrophic calcification is commonly seen in atheromatous lesions of advanced atherosclerosis, in areas of injury in the aorta and large blood vessels, and in damaged heart valves. For example, calcification of the aortic valve is a frequent cause of aortic stenosis in the elderly. Drinking milk, undiagnosed thyroid problems, and calcium loss from bone causing osteoporosis do not cause damaged heart valves.

 

 

7.	Which of the following pathophysiologic processes is most likely to result in metastatic calcification?
	A)	Benign prostatic hyperplasia
	B)	Liver cirrhosis
	C)	Impaired glycogen metabolism
	D)	Hyperparathyroidism
	Ans:	D
	Feedback:
	Metastatic calcification is a result of markedly increased serum calcium levels. Because the parathyroid gland is responsible for the regulation of serum calcium levels, hyperparathyroidism creates a risk for hypercalcemia and consequent metastatic calcification. Benign prostatic hypertrophy, cirrhosis, and impaired glycogen metabolism are not implicated in cases of metastatic calcification.

 

 

8.	Despite the low levels of radiation used in contemporary radiologic imaging, a radiology technician is aware of the need to minimize her exposure to ionizing radiation. What is the primary rationale for the technician’s precautions? Radiation:
	A)	Stimulates pathologic cell hypertrophy and hyperplasia
	B)	Results in the accumulation of endogenous waste products in the cytoplasm
	C)	Interferes with DNA synthesis and mitosis
	D)	Decreases the action potential of rapidly dividing cells
	Ans:	C
	Feedback:
	Radiation has a damaging effect on DNA synthesis and mitosis, a process that is especially harmful to rapidly dividing cells. Radiation does not directly influence the action potential of cells or the accumulation of endogenous waste products. Cell changes such as hypertrophy or hyperplasia may result from radiation exposure, but such changes are secondary to interference with DNA synthesis and mitosis.

 

 

9.	A mother rushes her 4-year-old child to the emergency department after she found an empty Tylenol (acetaminophen) bottle beside her child. The nurse is trying to explain why it is so important to give the child Ipecac to induce vomiting in order to prevent:
	A)	Renal failure
	B)	Seizures
	C)	Liver failure
	D)	Hemorrhage
	Ans:	C
	Feedback:
	Acetaminophen, a commonly used over-the-counter analgesic drug, is detoxified in the liver, where small amounts of the drug are converted to a highly toxic metabolite. This metabolite is detoxified by a metabolic pathway that uses a substance normally present in the liver. When large amounts of the drug are ingested, this pathway becomes overwhelmed and toxic metabolites accumulate, causing massive liver necrosis.

 

 

10.	The parents of a 4-year-old girl have sought care because their daughter has admitted to chewing and swallowing imported toy figurines that have been determined to be made of lead. Which of the following blood tests should the care team prioritize?
	A)	White blood cell levels with differential
	B)	Red blood cell levels and morphology
	C)	Urea and creatinine levels
	D)	Liver function panel
	Ans:	B
	Feedback:
	Anemia is a cardinal sign of lead toxicity. Consequently, assessment of the quantity and morphology of RBCs is paramount in cases of suspected lead toxicity. White blood cell and liver studies are not central to the care of this client. Lead is indeed nephrotoxic, and urea and creatinine levels are relevant to assessment, but the priority blood test is assessment of the RBCs.

 

 

11.	A pregnant client is attending a nutrition class for first-time moms. During the class, the instructor stressed that they should avoid consumption of which food that may cause brain damage from methyl mercury exposure?
	A)	Tuna
	B)	Raw hamburger
	C)	Fresh milk
	D)	Beets
	Ans:	A
	Feedback:
	The main source of methyl mercury exposure is from consumption of long-lived fish, such as tuna and swordfish. Fish concentrate mercury from sediment in the water. Because the developing brain is more susceptible to mercury-induced damage, it is recommended that young children and pregnant and nursing women should avoid consumption of fish known to contain high mercury content. None of the other foods listed pose a threat of mercury toxicity.

 

 

12.	A client has been diagnosed with a gram-negative bacillus in his blood cultures. The health care providers know these bacteria may produce clinical manifestations such as high temperature, high respiratory rate, and low blood pressure. These manifestations are primarily caused by:
	A)	Disrupting the sodium/potassium ATPase pump
	B)	Interrupting oxidative metabolism processes
	C)	The outer layer of the bacterial membrane acting as an endotoxin
	D)	The bacteria causing a decrease in protein synthesis and function
	Ans:	C
	Feedback:
	Bacteria and viruses can replicate within a cell, thus perpetuating the injuries. Gram-negative bacilli have unique characteristics in the structure of the outer membrane. The outer leaflet of the membrane has a lipid portion that acts as an endotoxin. If this bacillus enters the circulatory system, it causes a toxic reaction, with the sufferer developing a high temperature, high respiration rate, and low blood pressure. Other agents that are injurious to cells are unable to replicate in the cell, but they may disrupt the sodium/potassium pump, interrupt oxidative metabolism, or decrease protein synthesis.

 

 

13.	Which of the following diseases would be considered to be caused by a lack of a specific vitamin or mineral?
	A)	Anorexia nervosa
	B)	Scurvy
	C)	Sickle cell anemia
	D)	Atherosclerosis
	Ans:	B
	Feedback:
	Dietary deficiencies can occur because of a selective deficiency of a single nutrient. Iron deficiency anemia, scurvy, beriberi, and pellagra are examples of injury caused by a lack of specific vitamins or minerals. Anorexia nervosa, sickle cell anemia, and atherosclerosis are not caused by lack of a vitamin/mineral.

 

 

14.	Free radicals damage cells by:
	A)	Destroying phospholipids in the cell membrane
	B)	Altering the immune response of the cell
	C)	Disrupting calcium storage in the cell
	D)	Inactivation of enzymes and mitochondria
	Ans:	A
	Feedback:
	Free radicals are highly reactive and can damage cells in several ways. One way is by destroying lipids, which results in a loss of cell membrane integrity. Free radicals modify proteins but do not affect the immune function, calcium storage, or intracellular enzymes of cells.

 

 

15.	A 70-year-old male client has been admitted to a hospital for the treatment of a recent hemorrhagic stroke that has left him with numerous motor and sensory deficits. These deficits are most likely the result of which of the following mechanisms of cell injury?
	A)	Free radical injury
	B)	Hypoxia and ATP depletion
	C)	Interference with DNA synthesis
	D)	Impaired calcium homeostasis
	Ans:	B
	Feedback:
	Stroke is characterized by impaired cerebral circulation and consequent death of neurons from cellular hypoxia. Free radical injury, abnormal DNA synthesis, and impaired calcium homeostasis are not direct consequences of lack of blood flow to body cells.

 

 

16.	An elderly client has experienced some hypoxia as a result of chronic respiratory problems. Knowing that oxygen -deprived cells result in an accumulation of lactic acid in the cells, physiologically, the client may experience:
	A)	An increase in fat load
	B)	Altered cell membrane permeability
	C)	Retention of lysosomal enzymes
	D)	Cellular shrinkage and dehydration
	Ans:	B
	Feedback:
	Altered membrane permeability impairs the balance, allowing too much of some and not enough of other substances to flow in and out of the cell. The altered permeability, lack of ATP, and loss of functional surface receptors make it difficult for glucose to enter the cell. Excess fat accumulates because it is unable to move through the damaged membrane. Injury to the lysosomal membranes results in the leakage (not retention) of destructive lysosomal enzymes into the cytoplasm and enzymatic digestion of cell components.

 

 

17.	Injured cells become very swollen as a result of:
	A)	Increased cell protein synthesis
	B)	Altered cell volume regulation
	C)	Passive entry of potassium into the cell
	D)	Bleb formation in the plasma membrane
	Ans:	B
	Feedback:
	Altered cell volume regulation, caused by the impaired permeability of the cell membrane, leads to sodium retention and substance accumulation within the cell. Sodium attracts water, and the cell swells even more. Protein synthesis is decreased in injured cells. Potassium has difficulty entering the cell and accumulates in the serum, due to loss of the ATPase sodium/potassium pump. Bleb formation occurs in the cell that is already swollen and ready to burst.

 

 

18.	Ischemia and other toxic injuries increase the accumulation of intracellular calcium as a result of:
	A)	Release of stored calcium from the mitochondria
	B)	Improved intracellular volume regulation
	C)	Decreased influx across the cell membrane
	D)	Attraction of calcium to fatty infiltrates
	Ans:	A
	Feedback:
	Disruption of the normal intracellular functions causes the impaired mitochondria to release stored calcium. Cell injury disrupts intracellular volume regulation, allowing excessive influx of substances across the impaired cell membrane. Fatty infiltrate is an ominous sign of cell damage and does not interact with calcium.

 

 

19.	Which of the following processes associated with cellular injury is most likely to be reversible?
	A)	Cell damage resulting from accumulation of fat in the cytoplasm
	B)	Cellular changes as a result of ionizing radiation
	C)	Cell damage resulting from accumulation of free radicals
	D)	Apoptosis
	Ans:	A
	Feedback:
	Intracellular accumulation of fat leads to serious cell damage, but this is a potentially reversible effect. Ionizing radiation and damage from free radicals are more likely to be permanent, whereas apoptosis is defined as the permanent removal of injured and aged cells.

 

 

20.	A client with diabetes has impaired sensation, circulation, and oxygenation of his feet. He steps on a piece of glass, the wound does not heal, and the tissue area becomes necrotic. The necrotic cell death is characterized by:
	A)	Rapid apoptosis
	B)	Cellular breakage
	C)	Shrinkage and collapse
	D)	Chronic inflammation
	Ans:	B
	Feedback:
	Apoptosis is a programmed cell death, unrelated to cell injury, and occurs in a controlled, organized manner. Necrosis is an unorganized death of cells that initiates the acute inflammatory response with intracellular swelling and resulting cellular breakage (rupture).

 

 

21.	A client has been diagnosed with gram-negative pneumonia of the lower lobe. Knowing that gram-negative bacteria have a lipopolysaccharide endotoxin on their outer cell membrane, the health care provider should be assessing the client for which pathophysiological end result?
	A)	Damage to cellular mitochondria
	B)	Increased ATP levels
	C)	Activation of the p53 protein
	D)	Apoptosis
	Ans:	D
	Feedback:
	The extrinsic pathway of apoptosis involves extracellular signaling proteins that bind to cell surface molecules called death receptors and trigger apoptosis. The end result includes activation of endonucleases that cause fragmentation of DNA and cell death. In addition to TNF and Fas ligand, primary signaling molecules known to activate the extrinsic pathway include TNF-related apoptosis-inducing ligand (TRAIL); the cytokine interleukin-1 (IL-1); and lipopolysaccharide (LPS), the endotoxin found in the outer cell membrane of gram-negative bacteria. DNA damage, activation of the p53 protein, and decreased ATP levels are associated with the intrinsic pathway.

 

 

22.	A person eating peanuts starts choking and collapses. His airway obstruction is partially cleared, but he remains hypoxic until he reaches the hospital. The health care providers will be assessing this client for which of the following physiological events? Select all that apply.
	A)	Cerebral infarction
	B)	Coagulation necrosis
	C)	Rapid phagocytosis
	D)	Protein p53 deficiency
	Ans:	A, B
	Feedback:
	Tissue infarction is caused by prolonged oxygen deprivation, and the resulting large group of dead cells coagulates in the damaged area. During coagulation necrosis, acidosis develops and denatures the enzymatic and structural proteins of the cell. Phagocytosis occurs rapidly during apoptosis, so it does not elicit an inflammatory response. Protein p53 activation initiates apoptosis.

 

 

23.	A client with diabetes and severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. The client asks, “How this can happen?” Which of the following pathophysiologic processes should the nurse explain to this client? “More than likely, your gangrene is caused by:
	A)	Inappropriate activation of apoptosis, which means death of your cells.”
	B)	Bacterial invasion into the foot and toe.”
	C)	Impaired arterial blood supply to your toe.”
	D)	Metaplastic cellular changes in your toe.”
	Ans:	C
	Feedback:
	Dry gangrene is often a result of impaired arterial blood supply to the extremities. A bacterial etiology is more common in wet gangrene, whereas neither metaplasia nor activation of apoptosis is implicated in cases of dry gangrene.

 

 

24.	A group of elderly residents were commenting on how many cell functions decline with age. One resident commented that many of his friends who lived under large electromagnetic towers seemed to experience aging at an accelerated rate in comparison with residents who lived nearby in lakefront housing. This observation is the basis for which theory on aging?
	A)	Theories of genetic influences
	B)	Programmed cell receptor theories
	C)	Insufficient telomerase enzyme theory
	D)	Error theory associated with DNA damage
	Ans:	D
	Feedback:
	Error theory suggests that aging results from DNA mutation or faulty repair. Another group of theories of aging focuses on programmed cell changes with genetic influences that systematically cause cell senescence. Elimination of receptor sites is not part of aging theory. Telomerase enzyme is thought to reduce the shortening of the chromosomes and loss of telomere DNA with each cell replication.

 

 

25.	Which of the following facts underlies the concept of replicative senescence?
	A)	Genes controlling longevity are present or absent in varying quantities among different individuals.
	B)	Telomeres become progressively shorter in successive generations of a cell.
	C)	The damaging influence of free radicals increases exponentially in later generations of a cell.
	D)	Aging produces mutations in DNA and deficits in DNA repair.
	Ans:	B
	Feedback:
	Replicative senescence implies that cells have limited capacity for reproduction, largely as a result of the shortening of telomeres and consequent chromosomal damage. Genetic theories, the influence of free radicals, and DNA mutation are not central to the concept of replicative senescence.

 

Chapter 4- Cell Proliferation and Tissue Regeneration and Repair

Chapter 4- Cell Proliferation and Tissue Regeneration and Repair

1.	During a discussion of different cell types in the body, the instructor mentions that which types of cells renew themselves continuously throughout life?
	A)	Liver cells
	B)	Neurons
	C)	Cells lining the GI tract
	D)	Osteoblasts
	Ans:	C
	Feedback:
	The process of differentiation is regulated by a combination of internal processes involving the expression of specific genes and external stimuli provided by neighboring cells, the ECM, and a variety of growth factors. The process occurs in orderly steps, with each progressive step being exchanged for a loss of ability to develop different cell characteristics. As a cell becomes more highly specialized, the stimuli that are able to induce mitosis become more limited. Neurons, which are highly specialized cells, lose their ability to proliferate once development of the nervous system is complete. In other, less specialized tissues, such as the skin and mucosal lining of the gastrointestinal tract, a high degree of cell renewal continues throughout life. Liver cells and osteoblasts (bone-forming cells) do not renew throughout life.

 

 

2.	Which of the following cells will likely stay in a permanent resting state known as G0, unless there is a change in nutrients, growth factors, or hormones that trigger cell renewal?
	A)	Stratified squamous epithelium of the skin
	B)	Cells lining the esophagus and intestines
	C)	Neurons
	D)	Cancerous cells
	Ans:	C
	Feedback:
	When environmental conditions are adverse, such as nutrient or growth factor unavailability, or cells become terminally differentiated (i.e., highly specialized), cells may exit the cell cycle, becoming mitotically quiescent and reside in a special resting state known as G0. Cells in G0 may reenter the cell cycle in response to extracellular nutrients, growth factors, hormones, and other signals such as blood loss or tissue injury that trigger cell renewal. Highly specialized and terminally differentiated cells, such as neurons, may permanently stay in G0. The skin, cells lining the GI tract, and cancer cells are continuously dividing and going through the cell cycle.

 

 

3.	A mutation has occurred during mitosis of an individual’s bone marrow cell. This event may be the result of the failure of which of the following?
	A)	Progenitor cells
	B)	Fibroblasts
	C)	Stem cells
	D)	Cyclins
	Ans:	D
	Feedback:
	The cyclins are a family of proteins that control the entry and progression of cells through the cell cycle, the failure or absence of which may result in mutations. Fibroblasts do not contribute to the cell cycle, and neither progenitor cells nor stem cells are likely to directly contribute to mutation.

 

 

4.	A client has arrived in the emergency department with massive blood loss from a lacerated liver. Knowing the physiological principles behind the capacity for cells to regenerate, the client’s body will likely:
	A)	Pull fluid from the tissues to maintain a reasonable blood pressure
	B)	Stimulate rapid proliferation of RBCs by the blood-forming progenitor cells of the bone marrow
	C)	Activate the tissue cells to start producing stem cells
	D)	Begin a cell cycle so stem cells can undergo numerous mitotic divisions
	Ans:	B
	Feedback:
	Continuously dividing tissues are those in which the cells continue to divide and replicate throughout life, replacing cells that are continually being destroyed. These tissues can readily regenerate after injury as long as a pool of stem cells is preserved. Bleeding, for example, stimulates the rapid proliferation of replacement cells by the blood-forming progenitor cells of the bone marrow. Another type of tissue cell, called a stem cell, remains incompletely differentiated throughout life. As mature cells die, the tissue is replenished by the differentiation of cells generated from stem cells.

 

 

5.	A client has experienced a myocardial infarction with accompanying necrosis of cardiac muscle, a permanent tissue. What are the ramifications of the fact that cardiac muscle is a permanent tissue?
	A)	The cardiac muscle cells will remain perpetually in the G1 stage of mitosis.
	B)	Regeneration of the client’s cardiac muscle will be exceptionally slow.
	C)	The necrotic cells will be replaced with muscle cells that have limited metabolism.
	D)	The cells will not proliferate and will be replaced with scar tissue.
	Ans:	D
	Feedback:
	The cells in permanent tissues do not proliferate and, if destroyed, are replaced with fibrous scar tissue. The G0 stage of mitosis, not the G1 stage, involves quiescence.

 

 

6.	A couple has chosen to pay for the harvesting and storage of umbilical cord blood after the delivery of their child to secure a future source of embryonic stem cells. What is the most likely rationale for the couple’s decision?
	A)	The stem cells may be able to produce a wide range of body cells.
	B)	The embryonic stem cells allow stable and permanent tissues to enter mitosis.
	C)	The stem cells can change the proliferative capacity of other cells.
	D)	The embryonic stem cells remove cyclin-dependent kinase inhibitors from the body.
	Ans:	A
	Feedback:
	Embryonic stem cells hold the potential for broad differentiation. They do not change the proliferative capacity of existing cells and they do not foster mitosis by removing CKIs.

 

 

7.	A client with a complete tear of the rotator cuff in the right shoulder was given the choice between surgery and stem cell transplant. The client chose to try the stem cell injection. The client asked the health care provider, “How does this work on my shoulder?” The best response would be:
	A)	Bone marrow stem cells have been shown to generate cartilage, bone, and muscle when injected directly into the injured site.
	B)	The stem cells will circulate through your arterial system and come to rest in any area that is inflamed and in need of repair.
	C)	Stem cell injection is similar to a blood transfusion in that the cells will bring more oxygen and nutrients to the damaged tissue.
	D)	In addition to stem cells, the physician will give you some growth factor to help your body build more muscle mass.
	Ans:	A
	Feedback:
	Whether adult stem cells have a differentiation capacity similar to that of embryonic stem cells remains the subject of current debate and research. Thus far, bone marrow stem cells have been shown to have very broad differentiation capabilities, being able to generate not only blood cells but also fat, cartilage, bone, endothelial, and muscle cells.

 

 

8.	The physiology instructor asks the students, “How does growth factor affect cell proliferation?” Which students have the most accurate responses? Growth factors: Select all that apply.
	A)	Regulate the inflammatory process
	B)	Act as a chemoattractant for many cells like neutrophils and macrophages
	C)	Inhibit the beginning stages of cell changes that can result in cancer
	D)	Stimulate new blood vessel growth
	E)	Inhibit cell proliferation
	Ans:	A, B, D
	Feedback:
	The term growth factor is generally applied to small proteins that increase cell size and cell division. In addition to cell proliferation, most growth factors have other effects. They assist in regulating the inflammatory process; serve as chemoattractants for neutrophils, monocytes (macrophages), fibroblasts, keratinocytes, and epithelial cells; stimulate angiogenesis; and contribute to the generation of the ECM.

 

 

9.	The basement membrane surrounding a client’s foot wound remains intact, a fact that bodes well for the wound-healing process. Which types of substances/cells are responsible for the synthesis of collagen and elastic fibers?
	A)	Prostaglandins
	B)	Fibroblasts
	C)	Lymphocytes
	D)	Glycoproteins
	Ans:	B
	Feedback:
	Fibroblasts are responsible for the synthesis of collagen, elastic, and reticular fibers. Prostagladins are inflammatory mediators. Lymphocytes are the smallest of the leukocytes, the major cellular components of the inflammatory response. Glycoproteins are responsible for maintaining the cell membrane.

 

 

10.	A client with a history of several previous abdominal surgeries has been admitted to the hospital with several abdominal pains. Knowing that fibrous strands of collagen can form following abdominal surgery resulting in adhesions, the nurse should assess the client for:
	A)	Excess fluid in the abdomen
	B)	Intestinal obstruction causing constipation
	C)	Peritoneal fluid leaking from the umbilicus
	D)	Tight, rigid abdomen caused by bleeding from old surgical sites
	Ans:	B
	Feedback:
	If fibrosis occurs in any tissue space occupied by an inflammatory exudate, it is called organization. It occurs in serous cavities such as the pericardium and peritoneal cavities. Fibrous strands sometimes become organized within the peritoneal cavity following abdominal surgery or peritonitis. These strands of collagen, called adhesions, can trap loops of bowel and cause obstruction. Adhesions do not cause ascites (fluid in abdomen), leakage of serum from the umbilicus, or bleeding from old surgical scars.

 

 

11.	A nursing student is cleaning and changing the dressing on a client’s sacral ulcer. The student has vigorously cleansed the wound bed to remove all traces of the beefy, red tissue that existed in the wound bed. The student has most likely removed:
	A)	Necrotic tissue
	B)	Granulation tissue
	C)	Stem cells
	D)	The extracellular matrix
	Ans:	B
	Feedback:
	Granulation tissue is a glistening red, moist connective tissue that fills the injured area while necrotic debris is removed. Stem cells will not exist in a wound bed and necrotic tissue would not be bright red. The student has likely done the client a disservice by cleansing aggressively.

 

 

12.	A 12-year-old boy’s severe wound that he received from a dog bite has begun to heal and currently shows no signs of infection. Which of the following processes occurred first during this process of repair by connective tissue deposition?
	A)	Reorganization of fibrous tissue
	B)	Angiogenesis
	C)	Emigration of fibroblasts to the wound site
	D)	Deposition of the extracellular matrix
	Ans:	B
	Feedback:
	During the process of tissue repair by connective tissue deposition, angiogenesis precedes the emigration of fibroblasts, deposition of the extracellular matrix (ECM), and reorganization of the fibrous tissue.

 

 

13.	Which of the following wounds is most likely to heal by secondary intention?
	A)	A finger laceration that a cook received while cutting up onions
	B)	A boy’s “road rash” that he got by falling off his bicycle
	C)	A needle stick injury that a nurse received when injecting a client’s medication
	D)	The incision from a teenager’s open appendectomy
	Ans:	B
	Feedback:
	Incisions, cuts, and puncture wounds are likely to heal by primary intention, whereas larger wounds with loss of tissue and contamination (such as may be experienced in a bicycle crash) are likely to heal by secondary intention.

 

 

14.	A client has been brought to the emergency department with a large, gaping wound from a farming accident. The client is critically ill and has required blood products and surgery to clean and close the wound. Sharing with a student nurse the steps in wound healing, the nurse discusses the inflammatory phase, stating macrophages: Select all that apply.
	A)	Release growth factors that stimulate epithelial cell growth
	B)	Facilitate the body’s ability to grow new vessels in the injured area
	C)	Remove debris from the wound
	D)	Synthesize and secrete collagen
	E)	Proliferate to form the granulation tissue to serve as a foundation for scar tissue to form
	Ans:	A, B, C
	Feedback:
	Within 24 to 48 hours, macrophages, which are larger phagocytic cells, enter the wound area and remain for an extended period. These cells, arising from blood monocytes, are essential to the healing process. Their functions include phagocytosis and release of growth factors that stimulate epithelial cell growth, angiogenesis, and attraction of fibroblasts. When a large wound occurs in deeper tissues, neutrophils and macrophages are required to remove the debris and facilitate closure. Although a wound may heal in the absence of neutrophils, it cannot heal in the absence of macrophages. In the proliferative phase, the fibroblasts synthesize and secrete collagen and other intercellular elements needed for wound healing. Fibroblasts also produce numerous growth factors that induce angiogenesis and endothelial cell proliferation and migration.

 

 

15.	A client underwent an open cholecystectomy 4 days ago, and her incision is now in the proliferative phase of healing. What is the dominant cellular process that characterizes this phase of the client’s healing?
	A)	Hemostasis and vasoconstriction
	B)	Keloid formation
	C)	Collagen secretion by fibroblasts
	D)	Phagocytosis by neutrophils
	Ans:	C
	Feedback:
	The proliferative phase of wound healing is characterized by the action of fibroblasts. Hemostasis, vasoconstriction, and phagocytosis are characteristic of the inflammatory phase, whereas keloid formation is an abnormality in the remodeling phase.

 

 

16.	Epithelialization, the first component of the proliferative phase of wound healing, is delayed in open wounds until what type of tissue has formed?
	A)	Granulation tissue
	B)	Fibrinous meshwork
	C)	Capillary circulation
	D)	Collagenous layers
	Ans:	A
	Feedback:
	Epithelialization cannot occur until granulation tissue has formed in the wound area. Collagen is part of the remodeling phase, after epithelialization is complete. Fibroblasts are active during the remodeling phase, to synthesize collagen. New capillaries are not formed as part of the wound-healing process.

 

 

17.	A client states, “I heard that my healed wound tissue is stronger than my normal tissue. Is that true?” The nurse responds that roughly 3 months after a wound; the wound tensile strength is approximately what percentage from normal?
	A)	10% of normal
	B)	30% of normal
	C)	50% of normal
	D)	70% of normal
	Ans:	D
	Feedback:
	Tensile strength increases rapidly over the weeks and then slows, reaching a plateau of approximately 70% to 80% of the tensile strength of unwounded skin at the end of 3 months.

 

 

18.	Which of the following clients, who have undergone a major surgery to repair a “leaking” colon with associated peritonitis, is most likely to experience enhanced wound healing as a result of his or her presurgery diet history? A client who:
	A)	Eats a high-calorie diet and large amounts of red meat
	B)	Is a vegetarian and who eats organic foods when possible
	C)	Practices carefully calorie control and who avoids animal fats
	D)	Is receiving total parenteral nutrition due to recurrent nausea
	Ans:	A
	Feedback:
	Protein is important for many aspects of wound healing, including control of the inflammatory phase, fibroblast function, collagen and protein matrix synthesis, angiogenesis, and wound remodeling. A diet that is high in both calories and protein is known to enhance wound healing.

 

 

19.	Which of the following clients would be considered a good candidate for hyperbaric oxygen therapy?
	A)	A middle-aged adult who got in a fight and received a laceration above the eye
	B)	A motorcycle accident client with lots of “road rash” requiring scrubbing of the wounds with a brush to remove all the debris
	C)	An older adult with history of diabetes and intermittent claudication (poor circulation in the legs) who received a laceration while on the lawnmower
	D)	A fifth grade student who fell on the playground and broke his femur and developed large hematoma over the injured leg
	Ans:	C
	Feedback:
	Hyperbaric oxygen therapy delivers 100% oxygen at two to three times the normal atmospheric pressure at sea level. The goal of hyperbaric oxygen therapy is to increase oxygen delivery to tissues by increasing the partial pressure of oxygen dissolved in the plasma. Hyperbaric oxygen is currently reserved for the treatment of problem wounds in which hypoxia and infection interfere with healing.

 

 

20.	Which of the following clients is most likely to experience impaired wound healing?
	A)	A client with a diagnosis of type 1 diabetes and a history of poor blood sugar control
	B)	A child whose severe cleft lip and palate have required a series of surgeries over several months
	C)	A client who takes nebulized bronchodilators several times daily to treat chronic obstructive pulmonary disease
	D)	A client with persistent hypertension who takes a b-adrenergic blocker and a potassium-wasting diuretic daily
	Ans:	A
	Feedback:
	Diabetes mellitus is a significant barrier to wound healing. Serial surgeries, chronic obstructive pulmonary disease (COPD), hypertension, and related medications are not directly linked to impaired wound healing.

 

 

21.	A client who had an implantable cardioverter–defibrillator (ICD) returns the next week with a fever, chills, and elevated WBC. The physician suspects the wound is infected. If this wound does not respond to antibiotic therapy, the nurse can anticipate the client will undergo:
	A)	Debridement
	B)	Skin grafting
	C)	Removal of device
	D)	Whirlpool therapy
	Ans:	C
	Feedback:
	Wound infections are of special concern in persons with implantation of foreign bodies such as orthopedic devices (e.g., pins, stabilization devices), cardiac pacemakers, and shunt catheters. These infections are difficult to treat and may require removal of the device.