Oregon State University
A nurse is teaching a group of students about hydropic swelling as a reversible cell injury. Which of the following best describes the cause of hydropic swelling?
A. Accumulation of calcium in the mitochondria
B. Failure of the sodium-potassium pump, leading to sodium retention in the cell
C. Increased lipid accumulation in the cytoplasm
D. Fragmentation of the cell membrane
B. Failure of the sodium-potassium pump, leading to sodium retention in the cell, and as a result water retention and cell swelling. Failure of pump often due to ATP depletion.
The nurse observes that a patient with a significant injury is denying pain. They recognize this as stress induced analgesia which is due in part to this neurotransmitter.
Endorphins
A nurse is assessing a patient with Cushing's syndrome. Which of the following findings would most likely be expected in this patient due to elevated cortisol levels?
A. Weight loss, muscle weakness, and hypoglycemia
B. Increased blood pressure, moon face, and hyperglycemia
C. Decreased skin integrity, slow wound healing, and hypotension
D. Decreased appetite, nausea, and hyponatremia
B.
Cushing's syndrome is characterized by prolonged elevated cortisol levels, which can lead to increased blood pressure, characteristic moon face, and hyperglycemia due to the glucose-raising effects of cortisol. Other signs may include weight gain, muscle weakness, and thinning skin. Elevated cortisol can lead to hypernatremia due to its actions on the kidneys that leads to sodium and water retention.
A nurse is caring for a patient with a systemic infection and notices significant muscle wasting. Which of the following best explains this manifestation?
A. Increased oxygen delivery to muscles during infection
B. Release of inflammatory cytokines and increased metabolic demand
C. Direct bacterial invasion of muscle tissue
D. Increased production of growth hormones during stress
B.
In systemic infection, inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukins (e.g., IL-1) promote protein breakdown in skeletal muscles to provide amino acids for gluconeogenesis and immune response. This, combined with increased metabolic demands, leads to muscle catabolism and wasting.
Chronic irritation or inflammation is a common trigger for this reversible cellular adaptation, which may progress to dysplasia if the stress persists.
metaplasia
A nurse is teaching students about the role of cytokines in the inflammatory response. Which statement by a student indicates the need for further teaching?
A. "Cytokines are signaling molecules that mediate and regulate immunity and inflammation."
B. "Cytokines can recruit white blood cells to the site of injury or infection."
C. "Cytokines are only involved in suppressing the immune response."
D. "Cytokines include interleukins, interferons, and tumor necrosis factors."
C.
Cytokines play diverse roles in the immune system, including promoting and suppressing inflammation, recruiting immune cells, and enhancing the immune response. They are not limited to immune suppression.
A nurse is reviewing the arterial blood gas (ABG) results of a patient. The pH is 7.48, PaCO2 is 30 mmHg, and HCO3- is 24 mEq/L. Which of the following is the most likely diagnosis?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
B.
The pH of 7.48 is alkalotic, and the low PaCO2 (30 mmHg) indicates respiratory alkalosis. In respiratory alkalosis, carbon dioxide is exhaled excessively, causing a decrease in PaCO2 and an increase in pH.
A patient with chronic hypertension has been diagnosed with left ventricular hypertrophy (LVH). The nurse understands that LVH is most often a result of:
A. Increased workload on the heart due to sustained high blood pressure
B. Decreased oxygen demand in the left ventricle
C. Dilatation of the left ventricle due to fluid overload
D. Impaired filling of the left ventricle due to valve dysfunction
A.
Chronic hypertension causes the heart to work harder to pump blood, leading to increased pressure in the left ventricle. Over time, this increased workload causes the myocardial fibers to enlarge, resulting in left ventricular hypertrophy (LVH).
A nurse is assessing a patient with a history of heart failure. The patient exhibits symptoms of fluid volume overload, including edema, increased blood pressure, and shortness of breath. Which of the following causes is most likely contributing to the patient's condition?
A. Increased sodium intake, leading to fluid retention
B. Decreased blood pressure causing compensatory fluid retention
C. Excessive fluid loss due to diuretic therapy
D. Impaired kidney function leading to inadequate fluid excretion
D.
In patients with heart failure, kidney function is often impaired due to decreased perfusion, which can lead to inadequate excretion of fluid. This results in fluid retention, contributing to fluid volume overload. Additionally, the impaired kidneys are less able to balance sodium and water, further exacerbating the overload. While excessive sodium intake and other factors can contribute to fluid retention, kidney dysfunction is a primary cause in many cases of fluid volume overload.
A patient with a history of chronic kidney disease is diagnosed with anemia. The nurse understands that the most likely cause of this patient’s anemia is:
A. A deficiency in iron, leading to impaired hemoglobin synthesis.
B. Vitamin B12 deficiency, which inhibits RBC maturation.
C. Decreased erythropoietin production by the kidneys, which impairs red blood cell production.
D. Excessive destruction of red blood cells due to hemolysis.
C.
Chronic kidney disease often leads to decreased erythropoietin production, a hormone essential for stimulating the production of red blood cells in the bone marrow. Without adequate erythropoietin, RBC production is reduced, leading to anemia.
Cell shrinking is a result of this electrolyte imbalance
Hypernatremia
The extracellular fluid becomes hypertonic compared to the inside of the cells. Water moves out of the cells to balance the osmotic pressure and cells shrink.
Treatment for hypernatremia typically involves the gradual administration of fluids to rehydrate the cells and dilute the high sodium levels, often using hypotonic solutions like 0.45% sodium chloride.
A nurse is teaching a group of students about the role of mast cells in inflammation. Which of the following functions do mast cells perform during the inflammatory response?
A. They release histamine and other chemicals that initiate the inflammatory process.
B. They directly destroy pathogens by phagocytosis.
C. They repair tissue damage by synthesizing collagen.
D. They suppress the immune response to prevent excessive inflammation.
A.
Mast cells play a crucial role in the inflammatory response by releasing histamine, cytokines, and other mediators that promote vasodilation, increase vascular permeability, and recruit immune cells to the site of injury or infection. This helps initiate and amplify the inflammatory response.
This term describes the type of cell injury caused by a lack of oxygen, leading to ATP depletion and potential cell death.
Hypoxia
The nurse is caring for an 80 year old patient. They recognize the patient is at risk for a maladaptice response to stress due to the following changes seen in seen in older adults?
A. Increased efficiency of the sympathetic nervous system in responding to stress
B. Enhanced ability to activate the hypothalamic-pituitary-adrenal (HPA) axis
C. Diminished ability to adapt to stress due to reduced reserve capacity
D. Increased production of catecholamines and cortisol in response to stress
C.
As individuals age, their physiological reserve capacity decreases, which means they may have a diminished ability to cope with and adapt to stress. Aging is associated with changes in the function of the sympathetic nervous system, HPA axis, and other systems involved in stress responses, leading to a slower and less efficient response to stressors. This can result in prolonged stress responses that may contribute to age-related health issues.
A nurse is caring for a patient with a large, deep wound that has jagged edges and shows signs of infection. Which of the following best describes how this wound will heal?
A. The wound will heal rapidly with minimal scarring
B. The wound will heal with tissue loss, and granulation tissue will form to fill the defect.
C. The wound will heal by primary intention leaving a small scar.
D. The wound will heal without inflammation or scarring.
B.
Wounds healing by secondary intention typically have a larger tissue defect and may be contaminated or infected. The healing process involves the formation of granulation tissue, contraction, and reepithelialization. This type of healing takes longer and results in more scarring compared to primary intention.
A nurse is caring for a patient diagnosed with heart failure. Which of the following statements best describes the pathophysiology of heart failure?
A. Heart failure occurs when the heart is unable to pump enough blood to meet the body's demands, often due to weakened cardiac muscle or increased afterload.
B. Heart failure results from a bacterial infection of the heart muscle, leading to decreased cardiac output and systemic symptoms.
C. Heart failure is caused by excessive fluid retention in the body, which causes the heart to become enlarged.
D. Heart failure is due to a decrease in blood volume, leading to inadequate tissue perfusion and hypoxia.
A.
Heart failure occurs when the heart cannot pump sufficient blood to meet the body’s needs, often due to weakened cardiac muscle (such as in systolic heart failure) or increased afterload (as seen in hypertension or aortic stenosis)
A patient with sickle cell anemia is admitted to the hospital with severe pain and an episode of vaso-occlusion. The nurse understands that the pathophysiology of sickle cell anemia is primarily related to:
A. Destruction of red blood cells by the spleen, leading to anemia.
B. A deficiency of intrinsic factor, leading to vitamin B12 deficiency and ineffective red blood cell production.
C. A lack of iron, which impairs hemoglobin synthesis in red blood cells.
D. The presence of abnormally shaped hemoglobin, which causes red blood cells to become rigid and block blood flow.
D.
In sickle cell anemia, the hemoglobin (hemoglobin S) is abnormal, causing red blood cells to become rigid and sickle-shaped. These sickle-shaped cells can block blood flow in small blood vessels, leading to pain, organ damage, and other complications, such as vaso-occlusion.
A nurse is assessing a patient with asthma during an exacerbation. Which of the following pathophysiological processes is primarily responsible for the mucus production that contributes to the patient’s wheezing?
A. Increased permeability of the bronchial blood vessels, leading to fluid accumulation in the airway.
B. Activation of mast cells, leading to the release of histamine and inflammatory mediators.
C. Overproduction of surfactant in the alveoli, causing airway obstruction.
D. Constriction of the smooth muscles in the bronchi, leading to airflow limitation.
B.
In asthma, mast cell activation triggers the release of histamine and other inflammatory mediators. These substances promote bronchoconstriction and mucus production, which contribute to wheezing and airway obstruction.
A patient with cystic fibrosis presents to the clinic with a history of salty-tasting skin, frequent respiratory infections, and difficulty gaining weight. The nurse understands that the salty skin is due to:
A. Decreased sweating due to abnormal thermoregulation and dehydration.
B. Excessive loss of potassium through sweat, leading to electrolyte imbalance.
C. Increased sodium and chloride secretion through the sweat glands, due to defective chloride channels.
D. Impaired renal function, causing increased sodium reabsorption in the sweat glands.
C.
In cystic fibrosis, defective chloride channels cause increased sodium and chloride secretion in sweat, leading to the characteristic salty-tasting skin.
This defect also leads to thick sticky mucus which leads to the respiratory manifestations in CF.
A patient with a suspected pulmonary embolism (PE) is being evaluated using a ventilation-perfusion (V/Q) scan. The nurse understands that a V/Q mismatch in PE typically results in:
A. Low ventilation and low perfusion in the affected lung regions.
B. High ventilation and low perfusion in the affected lung regions.
C. High ventilation and high perfusion in the affected lung regions.
D. Low ventilation and high perfusion in the affected lung regions.
B.
In a pulmonary embolism, blood flow to the affected lung regions is blocked, leading to a low perfusion in those areas. However, the ventilation remains high because the airways are open, resulting in a high ventilation, low perfusion (V/Q) mismatch.
This electrolyte imbalance can cause symptoms such as muscle weakness, fatigue, and life-threatening cardiac arrhythmias, and is often associated with diuretic use.
Hypokalemia
Potassium is especially important for maintaining proper cardiac rhythm. Low levels can lead to muscle weakness, fatigue, and life-threatening arrhythmias. Diuretic medications, particularly loop and thiazide diuretics, are common causes of hypokalemia because they increase potassium excretion through the kidneys.
This term refers to the process of achieving stability through physiological or behavioral change in response to stress.
Allostasis
The nurse is caring for a patient who exhibits a positive Chvostek sign, They know this could indicate this electrolyte imbalance. (2 correct answers)
Hypocalcemia or hypomagnesiemia
Both calcium and magnesium play critical roles in regulating neuromuscular function. Calcium helps stabilize neuronal membranes and inhibits excessive nerve cell firing. Magnesium acts as a cofactor for many enzymatic reactions that help regulate the release of neurotransmitters and the excitability of nerve cells. When levels are low, this stabilization is reduced, increasing the likelihood of spontaneous nerve firing and resulting in muscle twitching, such as that seen with a positive Chvostek sign.
When reviewing tissue injury, the nurse recognizes this describes a characteristic of necrosis?
A. Programmed cell death without inflammation
B. Cellular swelling and rupture with inflammation
C. Maintenance of cellular membrane integrity
D. Controlled energy-dependent cell disassembly
B.
Necrosis is an uncontrolled process of cell death characterized by cell swelling, membrane rupture, and inflammation in the surrounding tissue. It is distinct from apoptosis, which is a controlled process without inflammation.
A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas (ABG) result showing a pH of 7.34, PaCO2 of 50 mmHg, and HCO3- of 28 mEq/L. What is the likely interpretation of these ABG results?
A. Respiratory acidosis with metabolic compensation
B. Respiratory alkalosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
A.
In respiratory acidosis, the primary issue is the retention of carbon dioxide, which lowers pH. In chronic respiratory acidosis (as in COPD), the kidneys compensate by increasing bicarbonate retention, resulting in an elevated HCO3- level. The pH is slightly low (7.34), indicating acidosis, and the elevated PaCO2 (50 mmHg) is consistent with respiratory acidosis.