Unit 2:Ch 3 (Porth's 5th Ed) - Cellular Adaptation, Injury, and Death

Question 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 extremely large 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

Answer 1

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.

Question 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

Answer 2

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.

Question 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) urinary incontinence following a cerebral vascular accident (CVA).
B) hypertension, obesity, and decreased activity tolerance.
C) peripheral edema secondary to heart failure (HF).
D) possible rejection symptoms following a liver transplant.

Answer 3

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.

Question 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

Answer 4

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.

Question 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.”

Answer 5

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.

Question 6

A community health care nurse is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that what fact underlies the rationale for this teaching?
A) The active substitution of normal cells in the cervix correlates to cancer risk.
B) Undifferentiated stem cells are an early indicator of cervical cancer.
C) Cancer of the uterine cervix develops incrementally at a cellular level.
D) Dysplasia in the connective tissue of the cervix is a strong precursor to cancer.

Answer 6

Ans: C
Feedback:
Cervical cancer is indicated by incremental epithelial changes, beginning with dysplasia. Dysplasia does not involve active cellular substitution, as in the case of metaplasia, nor does it include a role for stem cells. Dysplasia does not normally occur in connective tissue, nor is the cervical lining made up of connective tissue.

Question 7

A home health nurse is making a visit to a family with an 8-month-old infant with severe motor deterioration. The physician has diagnosed the infant with Tay-Sachs disease. The parents are asking the nurse why this happened. The nurse will base her answer knowing the root cause of Tay-Sachs is
A) high exposure to lead in the home environment.
B) an enzyme defect causing abnormal lipid accumulation in the brain.
C) hypoxia caused by placing the infant on their abdomen during sleep.
D) an increase in bilirubin retention leading to destruction of RBCs.

Answer 7

Ans: B
Feedback:
Tay-Sachs disease is a genetic disorder resulting from an enzyme defect that results in abnormal lipid accumulation in the brain and other tissues. Lead exposure, hypoxia, and bilirubin retention are not associated with Tay-Sachs disease.

Question 8

A 68-year-old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which of the following statements best captures an aspect of this client’s condition?
A) Paget disease, cancer with metastases, or excess vitamin D may have contributed to the problem.
B) Increased calcium intake over time may have contributed to the problem.
C) The client has possibly undergone damage as a result of calcification following cellular injury.
D) The client has possibly exhibited phosphate retention leading to calcium deposits.

Answer 8

Ans: C
Feedback:
Dystrophic calcification is a result of deposition of calcium following cellular injury, such as that which commonly occurs in heart valves. Answers A, B, and D all refer to the phenomena associated with metastatic calcification and the associated increases in serum calcium levels.

Question 9

A nurse in the emergency department admits a male client who has experienced severe frostbite to his hands and toes after becoming lost on a ski hill. The nurse recognizes that which of the following phenomena has contributed to his tissue damage?
A) Decreased blood viscosity has resulted in interstitial bleeding.
B) Reactive vasodilation has compromised perfusion.
C) Autonomic nervous stimulation has resulted in injury.
D) Decreased blood flow has induced hypoxia

Answer 9

Ans: D
Feedback:
Damage from exposure to cold results from hypoxia, ice crystal formation, and vasoconstriction. Blood viscosity increases, not decreases, and vasoconstriction occurs rather than vasodilation.

Question 10

As part of a first aid class, a health care instructor is teaching a group of industrial workers about how electrical injuries can cause cell damage. Which of the statements made by one of the workers indicates that further teaching is necessary?
A) “The greater the skin resistance, the greater the amount of deep and systemic damage a victim is likely to incur.”
B) “The particular pathway that a current takes through the body is very significant.”
C) “Resistance to flow is the phenomenon that transforms electrical energy into heat.”
D) “The most severe damage is likely to occur where the current enters and leaves the body.”

Answer 10

Ans: A
Feedback:
High skin resistance is associated with greater local and superficial burns, rather than deep and systemic damage. The pathway is indeed an important factor in the degree of injury, and this is a result of the transformation of current into heat. Damage is most severe at the point of entry and exit.

Question 11

A client who has had a diagnosis of lung cancer is scheduled to begin radiation treatment. The nurse knows that which of the following statements listed below about potential risks of radiation is most accurate?
A) “Some clients experience longer-term irritation of skin adjacent to the treatment site.”
B) “Sometimes you might find that your blood takes longer to clot than normal.”
C) “The changes that you might see are normally irreversible.”
D) “The unwanted effects will be limited to the exposed portions of your skin.”

Answer 11

Ans: A
Feedback:
Chronic radiation dermatitis is a consequence of cancer treatment with ionizing radiation. Hypocoagulation is not an identified consequence of radiation exposure, and changes can be both reversible and deeper than the surface of the skin.

Question 12

A young patient has just been diagnosed with xeroderma pigmentosum. When teaching the family about this disease, the nurse should emphasize which of the following points? Select all that apply.
A) “Wash hands thoroughly when working in the garden to prevent infection.”
B) “Wear long sleeves, long pants, gloves, a hat, sunglasses with side shields, and sunscreen while outdoors.”
C) “Apply antibacterial ointment to any break in the skin, and cover wounds with bandages.”
D) “The best time to allow the child to play outside is in the evening hours after the sun goes down.”
E) “The best time for the family to go to the beach is in the fall/winter months.”

Answer 12

Ans: B, D
Feedback:
Xeroderma pigmentosum is a genetic disorder where the enzyme needed to repair sunlight-induced DNA damage is lacking. While washing hands and applying antibacterial products to open wounds are important teaching for parents with children, they are not specific for this disease diagnosis.

Question 13

A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the client's diagnosis?
A) Decreased deep tendon reflexes
B) Hemoglobin 9.9 g/dL
C) Diffuse muscle pain
D) White blood cells (WBC) 11,000/mm3

Answer 13

Ans: B
Feedback:
Anemia is the cardinal sign of lead toxicity. Muscle pain, decreased deep tendon reflexes, nor changes in WBC levels are associated with lead toxicity.

Question 14

The nurse is teaching a group of new mothers about postpartum nutrition, when one of the clients states that she was told to avoid eating fish too often due to the risk of mercury poisoning. Which of the nurse’s following responses most accurately addresses the clients concerns?
A) “You’re right. It’s best to avoid eating fish, especially while you are breast-feeding.”
B) “There are some modest risks, but they are only associated with some long-living fish.”
C) “Provided you avoid salmon, you likely won’t be putting yourself or your child at risk.”
D) “The risk of mercury toxicity from eating fish has been shown to be insignificant.”

Answer 14

Ans: B
Feedback:
Only long-living fish such as tuna and swordfish concentrate the mercury from sediment in quantities sufficient to pose a risk. It is not necessary to categorically avoid fish, and salmon poses a low risk. Risks are not insignificant, though they are not particularly high.

Question 15

A nurse is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the nurse’s advice?
A) Antioxidants inhibit the actions of reactive oxygen species.
B) Antioxidants prevent the formation of superoxide dismutase.
C) Antioxidants react nonspecifically with molecules.
D) Antioxidants prevent the occurrence of cell dysplasia.

Answer 15

Ans: A
Feedback:
Antioxidants inhibit the reactions of reactive oxygen species (ROS) with biological structures. Superoxide dismutase is an antioxidant itself, and ROS, not antioxidants, react nonspecifically with molecules. Antioxidants do not prevent the occurrence of cell dysplasia.

Question 16

During a myocardial infarction (MI), a patient with a 97% occlusion of his left descending artery develops ventricular arrhythmias due to the amount of ischemia occurring in the myocardium. While educating the patient about MIs, the nurse will base her teaching on the fact that
A) permanent damage will occur in the myocardium if the vessel is not opened within a 1- to 2-minute window following the occlusion.
B) treatment needs to be sought immediately so that the buildup of lactic acid is limited and cellular changes can be reversed.
C) once the oxygen supply has been occluded, cellular changes are irreversible even if oxygenation is restored.
D) the body will grow new genes through the process of angiogenesis, thereby avoiding any permanent damage to the myocardium.

Answer 16

Ans: B
Feedback:
Ischemia is characterized by impaired oxygen delivery and impaired removal of metabolic end products such as lactic acid. Ischemia commonly affects blood flow through limited numbers of vessels and produces local tissue injury. In some instances, the cellular changes due to ischemia are reversible if oxygenation is restored. If not restored, permanent damage can occur.

Question 17

Which of the following statements most accurately conveys an aspect of cell injury due to impaired calcium homeostasis?
A) Normal intracellular calcium ion levels are higher than extracellular levels.
B) Ischemia and certain toxins cause a decrease in cytosolic calcium.
C) Injured cells tend to accumulate calcium.
D) Low calcium levels cause an activation of damaging enzymes.

Answer 17

Ans: C
Feedback:
Injured cells tend to accumulate calcium, though it is unclear whether this is evidence of causation of cell injury. Intracellular calcium levels are normally lower than extracellular levels, and ischemia and certain toxins cause an increase in cytosolic calcium. High calcium levels may cause an activation of damaging enzymes.

Question 18

The nurse is providing care for a client with a diagnosis of amyotrophic lateral sclerosis (ALS). The nurse recognizes which of the following mechanisms is suspected to play a role in the cellular death associated with ALS?
A) Apoptosis
B) Liquefaction necrosis
C) Hypoxic cell injury
D) Caseous necrosis

Answer 18

Ans: A
Feedback:
Although the exact mechanisms of damage are undetermined, ALS is thought to be caused by apoptosis.

Question 19

The nurse is providing care for a 21-year-old female client with gas gangrene secondary to her compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a client with a diagnosis of gas gangrene?
A) Inflammation of the affected tissue
B) A positive culture for Staphylococcus
C) Spreading edema
D) Impaired alveolar gas exchange

Answer 19

Ans: C
Feedback:
Spreading edema is a cardinal sign f gas gangrene. It is often caused by Clostridium bacteria, not Staphylococcus. Inflammation may exist at the interface between affected and unaffected tissue, but not in the dead, affected tissue. Impaired gas exchange would not be a sign.

Question 20

Which of the following enzymes listed below is responsible for cancer cells' ability to prevent aging of the cells and contributes to cellular immortality that is so characteristic of this disease process?
A) Oxidoreductase
B) Telomerase
C) Hydrolase
D) Isomerase

Answer 20

Ans: B Feedback:
Some cells have telomerase, an enzyme that “rebuilds” telomeres and lessens or prevents shortening. Cancer cells have high levels of telomerase, which prevents senescence and contributes to the cellular immortality that characterizes cancer.