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UNDERSTANDING PATHOPHISOLOGY FINALS

UNDERSTANDING PATHOPHISOLOGY FINALS
Chapter 03: Altered Cellular and Tissue Biology
3.When planning care for a cardiac patient, the nurse knows that in response to an increased workload, cardiac
myocardial cells will:
a. Increase in size
b. Decrease in length
c. Increase in excitability
d. Increase in number
ANS: A
Organ cells respond to increased workload by increasing in size, much as a muscle when it is exercised.
Organ cells increase in size with increased workload; they do not decrease in length.
A deficiency of electrolytes or minerals could lead to an increase in excitability; it is not due to increased
workload.
Increase in cell numbers is referred to as hyperplasia and is not related to increased workload.
REF: p. 62
4. A 55-year-old male with a 30-year history of smoking is examined for respiratory disturbance.
Examination of his airway (bronchial) reveals that stratified squamous epithelial cells have replaced the
normal columnar ciliated cells. This type of cellular adaptation is called:
a. Anaplasia
b. Hyperplasia
c. Metaplasia
d. Dysplasia
ANS: C
Metaplasia is the reversible replacement of one mature cell type by another, sometimes a less
differentiated cell type.
Anaplasia is loss of cellular differentiation.
Hyperplasia is an increase in the number of cells resulting from an increased rate of cellular division.
Dysplasia refers to abnormal changes in the size, shape, and organization of mature cells.
REF: p. 63
8.A 40-year-old female is diagnosed with cervical cancer after a Pap smear. Which of the following cellular
changes would the nurse most likely see on the report?
a. Metaplasia
b. Atrophy
c. Hypertrophy
d. Dysplasia
ANS: D
When cervical cells become cancerous, they have undergone dysplasia, a change in the size and shape of
cells.
The cells have changed; they have not been replaced, so metaplasia is not the correct choice.
The cells have not decreased in size; therefore, atrophy is incorrect.
The cells have not increased in size; therefore, they have not hypertrophied.
REF: p. 63
9. A 75-year-old male presents with chest pain on exertion. The chest pain is most likely due to hypoxic
injury secondary to:
a. Malnutrition
b. Free radicals
c. Ischemia
d. Chemical toxicity
ANS: C
The cardiac cells are deprived of oxygen leading to ischemia, a reduction in blood supply to tissues.
The cells are deprived of oxygen; they are not malnourished.
Free radicals are electrically uncharged atoms or groups of atoms that have an unpaired electron.
Chemical toxicity is not a factor in the chest pain; the pain is related to a lack of oxygen.
REF: p. 65
10. A patient has a heart attack that leads to progressive cell injury that causes cell death with severe cell
swelling and breakdown of organelles. What term would the nurse use to define this process?
a. Adaptation
b. Pathologic calcification
c. Apoptosis
d. Necrosis
ANS: D
Necrosis is the sum of cellular changes after local cell death.
Cellular adaptation is a reversible, structural, or functional response to both normal or physiologic
conditions and adverse or pathologic conditions.
Calcification is an accumulation of calcium salts.
Apoptosis is an active process of cellular self-destruction.
REF: p. 67
14.A family presents to their primary care provider reporting headache, nausea, weakness, and vomiting. Which
of the following would be the most likely explanation for these symptoms?
a. Lead exposure
b. Carbon monoxide poisoning
c. Ethanol exposure
d. Mercury poisoning
ANS: B
Symptoms related to carbon monoxide poisoning include headache, giddiness, tinnitus (ringing in the
ears), nausea, weakness, and vomiting.
Although nausea and vomiting can occur with lead exposure, lead toxicity is primarily manifested by
convulsions and delirium and, with peripheral nerve involvement, wrist, finger, and sometimes foot
paralysis.
Ethanol exposure has CNS effects and would not affect the whole family.
Mercury poisoning is manifested by CNS effects and would not lead to nausea and vomiting.
REF: p. 72
15. A common pathway of irreversible cell injury involves increased intracellular:
a. Sodium
b. Potassium
c. Magnesium
d. Calcium
ANS: D
Irreversible cellular injury is due to increased intracellular calcium and loss of calcium steady state.
It is calcium, not sodium, that is involved in cellular injury.
It is calcium, not potassium, that is involved in cellular injury.
It is calcium, not magnesium, that is involved in cellular injury.
REF: p. 71
16. A 50-year-old male sustained a closed head injury as a result of a motor vehicle accident. CT scan
revealed a collection of blood between the inner surface of the dura mater and the surface of the brain.
Which type of injury will the nurse be caring for?
a. Subdural hematoma
b. Epidural hematoma
c. Contusion
d. Abrasion
ANS: A
A subdural hematoma occurs when blood is between the inner surface of the dura mater and the
surface of the brain; it can result from blows, falls, or sudden acceleration/deceleration of the head.
An epidural hematoma is a collection of blood between the inner surface of the skull and the dura; it is
most often associated with a skull fracture.
A contusion is bleeding into the skin or underlying tissues.
An abrasion (scrape) results from removal of the superficial layers of the skin caused by friction between
the skin and injuring object.
REF: p. 78
17. A 20-year-old male presents to the emergency department with a jagged sharp-force injury that is longer
than it is deep. Which type of wound will the nurse be caring for?
a. Stab wound
b. Incised wound
c. Puncture wound
d. Chopping wound
ANS: B
An incised wound is a cut that is longer than it is deep.
A stab wound is a penetrating sharp-force injury that is deeper than it is long.
A puncture wound is without sharp edges and is made with an instrument like a nail.
Heavy, edged instruments (axes, hatchets, propeller blades) produce wounds with a combination of
sharp and blunt force characteristics.
REF: p. 78
18. A 30-year-old female presents with a gunshot wound to the head. The wound has seared edges and a
deep penetration of smoke and gunpowder fragments. This wound would be documented as a(n) _____
wound.
a. Exit
b. Intermediate range entrance
c. Contact range entrance
d. Indeterminate range entrance
ANS: C
Contact range entrance wound is a distinctive type of wound when the gun is held so the muzzle rests on
or presses into the skin surface; in addition to the hole, there is searing of the edges of the wound from
flame and soot or smoke on the edges of the wound.
It is unlikely it is an exit wound since there is only one wound and it has seared edges and gunpowder
fragments.
Intermediate range entrance wound is surrounded by gunpowder tattooing or stippling.
Indeterminate range entrance wound occurs when flame, soot, or gunpowder does not reach the skin
surface, but the bullet does.
REF: p. 79
19. A 15-year-old female presents to the ER following a physical assault. She has internal damage to the neck
with deep bruising. X-ray reveals fractures of the hyoid bone and tracheal and cricoid cartilage. Which of
the following most likely caused her injuries?
a. Chemical asphyxiation
b. Choking asphyxiation
c. Ligature strangulation
d. Manual strangulation
ANS: D
Squeezing of the neck as with strangulation would fraction the hyoid bone.
Chemical asphyxiation would lead to breathing problems but would not result in fracture.
Choking asphyxiation would lead to swelling of tissues but would not result in fracture.
In ligature strangulation, the mark on the neck is horizontal without the inverted V pattern seen in
hangings. It would not lead to fracture.
REF: p. 75
23.A 23-year-old male develops a black eye following a fight. When the aide asks the nurse why this occurred, the
nurse’s best response is that the bruising is due to an accumulation of:
a. Transferrin
b. Bilirubin
c. Albumin
d. Hemosiderin
ANS: D
Hemosiderin is responsible for the color changes in a black eye.
Transferrin is a transport protein responsible for iron transport.
Bilirubin is the normal, yellow-to-green pigment of bile derived from the porphyrin structure of
hemoglobin.
Albumin is the protein in the serum, responsible for cellular integrity.
REF: p. 83
26.A group of prison inmates developed tuberculosis following exposure to an infected inmate. On examination,
tissues were soft and granular (like clumped cheese). Which of the following is the most likely cause?
a. Coagulative necrosis
b. Liquefactive necrosis
c. Caseous necrosis
d. Autonecrosis
ANS: C
Caseous necrosis results from tuberculosis pulmonary infection.
Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands and commonly results
from hypoxia.
Liquefactive necrosis results from ischemic injury to neurons and glial cells in the brain.
Autonecrosis is a process of cellular self-digestion and is not due to infection such as tuberculosis.
REF: p. 87
29.A 50-year-old male intravenous drug user is diagnosed with hepatitis C. Examination of the liver reveals cell
death secondary to:
a. Fat necrosis
b. Physiologic apoptosis
c. Pathologic apoptosis
d. Pyknosis
ANS: C
With hepatitis C, the liver will demonstrate apoptosis that is pathologic.
Fat necrosis occurs with enzymatic action due to lipases.
Apoptosis is not a normal physiological process.
Pyknosis occurs when the nucleus shrinks and becomes a small, dense mass of genetic material.
REF: p. 88
31.When a nurse observes muscle stiffening occurring within 6 to 14 hours after death, the nurse should
document this finding as _____ present.
a. Livor mortis
b. Gangrene
c. Algor mortis
d. Rigor mortis
ANS: D
Rigor mortis occurs within 6 hours after death and is evidence by muscle stiffening.
Livor mortis is a purple discoloration.
Gangrene refers to death of tissue and results from severe hypoxic injury and does not lead to stiffening.
Algor mortis is postmortem reduction of body temperature.
REF: p. 95
Chapter 04: Fluids and Electrolytes, Acids and Bases
Chapter 05: Innate Immunity: Inflammation and Wound Healing
10.The directional migration of leukocytes along a chemical gradient is termed:
a. Chemotaxis
b. Endocytosis
c. Margination
d. Diapedesis
ANS: A
Chemotaxis is the process by which leukocytes undergo directed migration.
Endocytosis is a form of engulfment and a part of phagocytosis.
Margination occurs when leukocytes adhere to endothelial cells in the walls of vessels.
Diapedesis is the emigration of the cells through cell junctions that have loosened in response to
inflammatory mediators.
REF: p. 131
12.The predominant phagocyte of early inflammation is the:
a. Eosinophil
b. Neutrophil
c. Lymphocyte
d. Macrophage
ANS: B
Neutrophils are the predominant phagocytes in the early inflammatory site, arriving within 6 to 12 hours
after the initial injury.
Eosinophils help limit and control inflammation, but they are not the prominent phagocyte.
Lymphocytes are part of the innate immune response.
Macrophages kill microorganisms.
REF: p. 129
Chapter 07: Infection
2.A 5-year-old female takes a hike through the woods during a school field trip. Upon returning home, she hugs
her father, and he later develops poison ivy. Which of the following immune reactions is he
experiencing?
a. IgE-mediated
b. Tissue specific
c. Immune complex
d. Cell-mediated
ANS: D
Secondary contact activates a type IV cell-mediated reaction that causes dermatitis.
The father’s response is a secondary, cell mediated, not a primary type IgE mediated.
The father’s response is secondary, not tissue specific.
The father’s response is a type IV, not an immune complex response.
REF: p. 189
3. When the maternal immune system becomes sensitized against antigens expressed by the fetus, what
type of immune reaction occurs?
a. Autoimmune
b. Anaphylaxis
c. Alloimmune
d. Allergic
ANS: C
Alloimmunity can be observed during immunologic reactions against transfusions, transplanted tissue, or
the fetus during pregnancy.
Autoimmunity is a disturbance in the immunologic tolerance of self-antigens.
The most rapid and severe immediate hypersensitivity reaction is anaphylaxis.
An allergic response occurs related to exposure to an allergen.
REF: p. 190
develops pain, swelling, redness, and respiratory difficulties. He is suffering from:
a. Immunodeficiency
b. Autoimmunity
c. Anaphylaxis
d. Tissue-specific hypersensitivity
ANS: C
Anaphylaxis occurs within minutes of reexposure to the antigen and can be either systemic (generalized)
or cutaneous (localized).
Immunodeficiency is a decrease in the immune response.
Autoimmunity is a disturbance in the immunologic tolerance of self-antigens.
Tissue-specific reaction is an autoimmune reaction.
REF: p. 190
7. When a patient presents at the emergency department for an allergic reaction, the nurse recognizes the
most severe consequence of a type I hypersensitivity reaction is:
a. Urticaria
b. Hives
c. Anaphylaxis
d. Antibody-dependent cell-mediated cytotoxicity (ADCC)
ANS: C
The most rapid and severe immediate hypersensitivity type I reaction is anaphylaxis.
Urticaria, or hives, is a dermal (skin) manifestation of allergic reactions.
Hives and urticaria are similar responses.
ADCC is a mechanism that involves natural killer (NK) cells. Antibodies on the target cell are recognized
by Fc receptors on the NK cells, which release toxic substances that destroy the target cell.
REF: p. 190
35.Which information indicates a good understanding of bacterial vaccines? Most bacterial vaccines contain:
a. Active bacteria
b. Synthetic bacteria
c. Dead bacteria
d. Bacterial toxins
ANS: C
Vaccines are biological preparations of weakened or dead pathogens that when administered stimulate
production of antibodies or cellular immunity against the pathogen without causing disease.
Vaccines are biological preparations of weakened or dead pathogens, not active bacteria.
Vaccines are biological preparations of weakened or dead pathogens, not synthetic bacteria.
D
Vaccines are biological preparations of weakened or dead pathogens, not bacterial toxins.
REF: p. 178
36. A nurse recalls bacteria become resistant to antimicrobials by:
a. Proliferation
b. Attenuation
c. Specialization
d. Mutation
ANS: D
Antibiotic resistance is usually a result of genetic mutations that can be transmitted directly to
neighboring microorganisms by plasmid exchange.
Antibiotic resistance is a result of mutations, not proliferation, which is increased growth.
Antibiotic resistance is a result of genetic mutations, not attenuation.
Antibiotic resistance is a result of genetic mutations, not specialization.
REF: p. 176
40.Which of the following is a characteristic of the human immunodeficiency virus (HIV), which causes AIDS?
a. HIV only infects B cells.
b. HIV is a retrovirus.
c. Infection does not require a host cell receptor.
d. After infection, cell death is immediate.
ANS: B
AIDS is an acquired dysfunction of the immune system caused by a retrovirus (HIV) that infects and
destroys CD4+ lymphocytes (T-helper cells).
HIV infection begins when a virion binds to CD4, not a B cell.
Infection requires a host cell receptor.
The cell remains dormant, but does not die.
REF: p. 184
41. A 30-year-old male was diagnosed with HIV. Which of the following treatments would be most effective?
a. Reverse transcriptase inhibitors
b. Protease inhibitors
c. Entrance inhibitors
d. Highly active antiretroviral therapy (HAART)
ANS: D
The current regimen for treatment of HIV infection is a combination of drugs, termed highly active
antiretroviral therapy (HAART).
Approved AIDS medications are classified by mechanism of action; nucleoside and nonnucleoside
inhibitors of reverse transcriptase (reverse transcriptase inhibitors).
Inhibitors of the viral protease (protease inhibitors) are also part of therapy for AIDS.
Inhibitors of viral entrance into the target cell (entrance inhibitors) are also part of the treatment of
AIDS.
REF: p. 186
42. When the immunologist says that pathogens possess infectivity, what is the immunologist explaining?
Infectivity allows pathogens to:
a. Spread from one individual to others and cause disease
b. Induce an immune response
c. Invade and multiply in the host
d. Damage tissue
ANS: C
Infectivity is the ability of the pathogen to invade and multiply in the host.
Communication is the ability to spread from one individual to others and cause disease.
Immunogenicity is the ability of pathogens to induce an immune response.
Damaging tissues is the pathogen’s mechanism of action.
REF: p. 167
Huether and McCance: Understanding Pathophysiology, 5th Edition
Chapter 09: Biology, Clinical Manifestations, and Treatment of Cancer
Test Bank
MULTIPLE CHOICE
1. A patient has a tissue growth that was diagnosed as cancer. Which of the following terms best describes
this growth?
a. Neoplasm
b. Lipoma
c. Meningioma
d. Hypertrophy
ANS: A
A neoplasm is a cancerous growth.
Lipomas are benign growths.
A meningioma is a benign tumor.
Hypertrophy refers to tissue overgrowth, but not cancer.
REF: p. 222
2. Which information indicates a nurse understands characteristics of malignant tumors?
a. Grows slowly
b. Has a well-defined capsule
c. Has a high mitotic index
d. Is well-differentiated
ANS: C
Malignant tumors have a high mitotic index.
Malignant tumors grow rapidly.
Malignant tumors are not encapsulated.
Malignant tumors are poorly-differentiated.
REF: p. 223
3. A nurse is discussing preinvasive epithelial tumors of glandular or squamous cell origin. What is the
nurse describing?
a. Tumor in differentiation
b. Dysplastic
c. Cancer in situ
d. Cancer beyond (meta) situ
ANS: C
Early stage growths that are localized to the epithelium and have not invaded are called cancer in situ.
Cancer in situ is early stage growth and not a tumor in differentiation.
Cancer in situ is early stage growth and may contain dysplastic cells, but dysplastic cells do not define
cancer in situ.
Cancer in situ is early stage growth, and cancer beyond situ is more mature growth.
REF: p. 223
4. A 25-year-old male develops a tumor of the breast glandular tissue. What type of tumor will be
documented on the chart?
a. Carcinoma
b. Adenocarcinoma
c. Sarcoma
d. Lymphoma
ANS: B
Tumors that arise from or form ductal or glandular structures are named adenocarcinomas.
Cancers arising in epithelial tissue are called carcinomas.
Cancers arising from mesenchymal tissue (including connective tissue, muscle, and bone) usually have
the suffix sarcoma.
Cancers of lymphatic tissue are called lymphomas.
REF: p. 223
5. A 30-year-old female is diagnosed with cancer. Testing reveals that the cancer cells have spread to local
lymph nodes. A nurse realizes this cancer would be documented as stage:
a. 1
b. 2
c. 3
d. 4
ANS: C
Cancer that has spread to regional structures, such as lymph nodes, is stage 3.
Cancer confined to the organ of origin is stage 1.
Cancer that is locally invasive is stage 2.
Cancer that has spread to distant sites, such as a liver cancer spreading to lung or a prostate cancer
spreading to bone, is stage 4.
REF: p. 244
6. An oncologist is discussing when a cancer cell loses differentiation. Which of the following is the
oncologist describing?
a. Autonomy
b. Anaplasia
c. Pleomorphic
d. Metastasis
ANS: B
Anaplasia is the loss of differentiation.
The loss of differentiation is anaplasia, not autonomy.
Malignant cells are pleomorphic.
A malignant tumor’s ability to spread far beyond the tissue of origin is metastasis.
REF: p. 223
7. A primary care provider is attempting to diagnose cancer and is looking for a tumor marker. Which of the
following could be a possible marker?
a. Red blood cells
b. Apoptotic cells
c. Enzymes
d. Neurotransmitters
ANS: C
Tumor markers include hormones, enzymes, genes, antigens, and antibodies.
Tumor markers include hormones, enzymes, genes, antigens, and antibodies, but not red blood cells.
Tumor markers include hormones, enzymes, genes, antigens, and antibodies, but not apoptotic cells.
Tumor markers include hormones, enzymes, genes, antigens, and antibodies, but not neurotransmitters.
REF: p. 225
8. A 52-year-old male with hepatitis C recently developed hepatic cancer. Which of the following markers
should be increased?
a. Alpha-fetoprotein (AFP)
b. Catecholamines
c. Prostate-specific antigen
d. Homovanillic acid
ANS: A
Liver and germ cell tumors secrete a protein known as AFP.
Liver and germ cell tumors secrete a protein known as AFP, not catecholamines.
Prostate tumors secrete prostate-specific antigen.
Homovanillic acid is a catecholamine marker.
REF: p. 225
9. Which information should the nurse include when teaching about angiogenic factors? In cancer,
angiogenic factors stimulate:
a. Release of growth factors
b. Tumor regression
c. Apoptosis
d. New blood vessel growth
ANS: D
Cancers can secrete multiple factors that stimulate new blood vessel growth, which is called
angiogenesis.
Cancers can secrete multiple factors that stimulate new blood vessel growth called angiogenesis, not
release of growth factors.
Cancers can secrete multiple factors that stimulate new blood vessel growth called angiogenesis, not
tumor regression.
Apoptosis is cell death.
REF: p. 235
10. A patient has been researching telomere caps on the Internet. Which statement indicates the patient has
a good understanding? Presence of telomere caps gives cancer cells:
a. The ability to divide over and over again
b. Clonal distinction
c. Limited mitosis
d. Mutation abilities
ANS: A
The presence of telomere caps gives cancer cells the ability to divide over and over.
The presence of telomere caps does not give cells clonal distinction.
Telomeres allow division over and over; thus, cancer cells have unlimited mitosis.
Mutation capability is a characteristic of cancer cells, but this property is not related to telomeres.
REF: pp. 235-236
11. Which of the following indicates a nurse understands a proto-oncogene? A proto-oncogene is best
defined as a(n) _____ gene.
a. Normal
b. Altered
c. Inactive
d. Tumor-suppressor
ANS: A
In its normal, nonmutant state, an oncogene is referred to as a proto-oncogene.
A proto-oncogene is a normal gene, not an altered gene.
A proto-oncogene is a normal gene, not an inactive gene.
A proto-oncogene is a normal gene, not a tumor-suppressor gene.
REF: p. 229
12. Of the following genetic lesions that cause cancer, which is the most common?
a. Insertions
b. Deletions
c. Point mutations
d. Amplification
ANS: C
Several types of genetic events can activate oncogenes. The most common are small scale changes in
DNA called point mutations.
Several types of genetic events can activate oncogenes. The most common are small scale changes in
DNA called point mutations, not insertions.
Several types of genetic events can activate oncogenes. The most common are small scale changes in
DNA called point mutations, not deletions.
Several types of genetic events can activate oncogenes. The most common are small scale changes in
DNA called point mutations, not amplification.
REF: p. 229
13. A 45-year-old female was recently diagnosed with cervical cancer. She reports a sexual history that
includes 43 partners. Which of the following is the most likely cause of her cancer?
a. Herpes virus
b. Rubella virus
c. Human papillomavirus (HPV)
d. Hepatitis B virus
ANS: C
The presence of HPV is a factor in cervical cancer.
The presence of HPV is a factor in cervical cancer, not herpes.
The presence of HPV is a factor in cervical cancer, not rubella.
The presence of HPV is a factor in cervical cancer, not hepatitis B.
REF: p. 241
14. A 30-year-old male with HIV is diagnosed with Epstein-Barr virus. After 2 months, the virus is still active.
Based upon the Epstein-Barr virus, which of the following cancers is most likely to develop in this
patient?
a. B cell lymphoma
b. Kaposi sarcoma
c. T cell leukemia
d. T cell lipoma
ANS: A
Epstein-Barr virus is associated with B cell lymphoma.
Kaposi sarcoma is associated with HIV.
Retroviruses are associated with leukemia.
Lipomas are not associated with HIV.
REF: p. 241
15. A 45-year-old male presents with persistent, severe stomach pain. Testing reveals a peptic ulcer. Further
laboratory tests reveal the presence of Helicobacter pylori. Which of the following is of concern for this
patient?
a. Gastric cancer
b. Leukemia
c. Lung cancer
d. Adenocarcinoma of the colon
ANS: A
The presence of Helicobacter pylori is associated with gastric cancer.
The presence of Helicobacter pylori is associated with gastric cancer, not leukemia.
The presence of Helicobacter pylori is associated with gastric cancer, not lung cancer.
The presence of Helicobacter pylori is associated with gastric cancer, not colon cancer.
REF: p. 241
16. Which statement indicates the patient has a correct understanding of metastasis? The most common
route of metastasis is through the blood vessels and:
a. Lung tissue
b. Body cavities
c. Lymphatics
d. Connective tissues
ANS: C
The most common route of metastasis is through the lymphatics.
The most common route of metastasis is through the lymphatics, not lung tissue.
The most common route of metastasis is through the lymphatics, not the body cavity.
The most common route of metastasis if through the lymphatics, not connective tissues.
REF: p. 242
17. A nurse is giving an example of inflammation as an etiology for cancer development. What is the best
example the nurse should give?
a. Pneumonia and lung cancer
b. Ulcerative colitis and colon cancer
c. Prostatic hypertrophy and prostate cancer
d. Hypercholesteremia and leukemia
ANS: B