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Basic Concepts of Pathophysiology > Pathophysiology

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Question 1:

A. An induration of 5 mm or more B. An induration of 10 mm or more C. An induration of 15 mm or more D. An induration of 20 mm or more

Answer and Explanation

Choice A:

This is an incorrect answer because an induration of 5 mm or more is considered a positive reaction only for certain high-risk groups, such as people who are HIV-positive, have recent contact with a person with active tuberculosis, or have chest radiograph findings consistent with prior tuberculosis.

Choice B:

This is a correct answer because an induration of 10 mm or more is considered a positive reaction for most people, including those who are recent immigrants from high-prevalence countries, injection drug users, residents or employees of high-risk settings, children younger than 4 years old, or people with certain medical conditions that increase the risk of tuberculosis.

Choice C:

This is an incorrect answer because an induration of 15 mm or more is considered a positive reaction only for people who have no known risk factors for tuberculosis.

Choice D:

This is an incorrect answer because an induration of 20 mm or more is not a criterion for a positive reaction, as it exceeds the maximum threshold for any group.

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Question 2:

A. Cardiogenic shock B. Pulmonary embolism C. Right-sided heart failure D. Left-sided heart failure

Answer and Explanation

Choice A:

This is an incorrect answer because cardiogenic shock is a severe form of heart failure that occurs when the heart cannot pump enough blood to maintain adequate tissue perfusion and oxygenation, resulting in hypotension, tachycardia, oliguria, altered mental status, and cold and clammy skin.

Choice B:

This is an incorrect answer because pulmonary embolism is a condition in which a blood clot travels to the lungs and blocks one or more pulmonary arteries, causing sudden dyspnea, chest pain, hemoptysis, tachypnea, and hypoxia.

Choice C:

This is a correct answer because right-sided heart failure occurs when the right ventricle of the heart fails to pump blood effectively to the lungs, causing blood to back up in the systemic circulation and leading to fluid accumulation in the lungs, neck veins, and extremities.

Choice D:

This is an incorrect answer because left-sided heart failure occurs when the left ventricle of the heart fails to pump blood effectively to the body, causing blood to back up in the pulmonary circulation and leading to pulmonary congestion, dyspnea, orthopnea, coughing, and fatigue.

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Question 3:

A. Healing of ulcers B. Relief of pain C. Eradication of H. pylori D. Prevention of bleeding E. Reduction of inflammation

Answer and Explanation

Choice A:

This is a correct answer because healing of ulcers is an expected outcome of PPI therapy for PUD, as it occurs when the acid-induced damage to the mucosa is repaired and the ulcer is closed.

Choice B:

This is a correct answer because relief of pain is an expected outcome of PPI therapy for PUD, as it occurs when the acid-induced irritation and inflammation of the mucosa and the nerve endings are reduced.

Choice C:

This is an incorrect answer because eradication of H. pylori is not an expected outcome of PPI therapy for PUD, as it requires a combination of antibiotics and bismuth compounds to kill the bacteria and prevent its recurrence.

Choice D:

This is a correct answer because prevention of bleeding is an expected outcome of PPI therapy for PUD, as it occurs when the acid-induced erosion and perforation of the mucosa and the blood vessels are prevented.

Choice E:

This is a correct answer because reduction of inflammation is an expected outcome of PPI therapy for PUD, as it occurs when the acid-induced activation of inflammatory mediators and immune cells are inhibited.

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Question 4:

A. Increased hydrostatic pressure in the portal vein B. Decreased oncotic pressure in the plasma C. Increased aldosterone secretion by the adrenal glands D. All of the above

Answer and Explanation

Choice A:

Increased hydrostatic pressure in the portal vein is one factor that causes ascites. The portal vein carries blood from the digestive organs to the liver for processing. However, when the liver is damaged by alcohol abuse, it becomes scarred and fibrotic, creating resistance to blood flow. This results in increased pressure in the portal vein and its branches, which forces fluid out of the capillaries into the abdominal cavity.

Choice B:

Decreased oncotic pressure in the plasma is another factor that causes ascites. Oncotic pressure is the force exerted by proteins in the plasma that attracts fluid into the capillaries from the interstitial space. However, when the liver is damaged by alcohol abuse, it cannot produce enough proteins, such as albumin and globulin, which are essential for maintaining oncotic pressure. This results in decreased oncotic pressure in the plasma and increased fluid movement into the interstitial space and the abdominal cavity.

Choice C:

Increased aldosterone secretion by the adrenal glands is another factor that causes ascites. Aldosterone is a hormone that regulates the balance of sodium and water in the body. It acts on the kidneys to increase the reabsorption of sodium and water from the urine into the blood. However, when the liver is damaged by alcohol abuse, it cannot metabolize aldosterone properly, leading to its accumulation in the blood. This results in increased sodium and water retention in the body and increased fluid movement into the interstitial space and the abdominal cavity.

Choice D:

Ascites is caused by a combination of factors that affect the fluid balance in the abdominal cavity.

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Question 5:

A. Atrophy B. Hypertrophy C. Hyperplasia D. Dysplasia

Answer and Explanation

Choice A:

Atrophy is a decrease in cell size or number in response to adverse stimuli, such as disuse, ischemia, or malnutrition. It does not increase the risk of cancer, but it can impair the function of tissues and organs.

Choice B:

Hypertrophy is an increase in cell size in response to normal or abnormal stimuli, such as exercise, hormones, or hypertension. It does not increase the risk of cancer, but it can affect the function of tissues and organs.

Choice C:

Hyperplasia is an increase in cell number in response to normal or abnormal stimuli, such as hormones, inflammation, or wound healing. It does not increase the risk of cancer, but it can cause excessive growth of tissues and organs.

Choice D:

Dysplasia is an abnormal and potentially reversible change in cell size, shape, and organization in response to persistent stressors. It can be a precursor to cancer if it is not detected and treated early.

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Question 6:

A nurse is caring for a client who has an open abdominal wound with moderate drainage. Which of the following types of dressings should the nurse use to promote moist wound healing?

A. Hydrocolloid dressing B. Transparent film dressing C. Calcium alginate dressing D. Hydrogel dressing

Answer and Explanation

Choice B:

Transparent film dressing is a type of dressing that consists of a thin sheet of polyurethane with an adhesive coating. It allows oxygen and moisture vapor to pass through but prevents bacteria and water from entering the wound. It is suitable for wounds with minimal drainage, such as superficial abrasions or donor sites.

Choice C:

Calcium alginate dressing is a type of dressing that consists of fibers derived from seaweed that form a gel-like substance when they come in contact with wound exudate. It absorbs large amounts of drainage and supports autolytic debridement of necrotic tissue. It is suitable for wounds with heavy drainage, such as pressure ulcers or venous ulcers.

Choice D:

Hydrogel dressing is a type of dressing that consists of water or glycerin-based gel that provides moisture to dry wounds and supports autolytic debridement of necrotic tissue. It is suitable for wounds with minimal to moderate drainage, such as partial-thickness burns or radiation injuries.

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Question 7:

A nurse is caring for a client who has an infected surgical wound on his abdomen. The nurse notes that the wound has redness, warmth, swelling, pain, and purulent drainage. The nurse recognizes these findings as indicative of what stage of inflammation?

A. Vascular stage B. Cellular stage C. Exudative stage D. Resolution stage

Answer and Explanation

Choice A:

Vascular stage is the stage of inflammation that involves the changes in blood flow and vascular permeability at the site of injury or infection. It manifests as redness and warmth due to vasodilation and increased blood flow, and swelling due to fluid leakage from the vessels into the interstitial space.

Choice B:

Cellular stage is the stage of inflammation that involves the migration of white blood cells from the vessels into the tissues to eliminate the causative agent and remove the damaged tissue. It manifests as pain due to the release of chemical mediators that stimulate nerve endings, and purulent drainage due to the accumulation of dead cells and microorganisms.

Choice D:

Resolution stage is the stage of inflammation that involves the restoration of normal tissue structure and function after the elimination of the causative agent and the removal of the damaged tissue. It manifests as decreased redness, warmth, swelling, pain, and drainage due to the cessation of inflammatory response.

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Question 8:

A nurse is planning interventions for a client who has a chronic wound on his lower leg. Which of the following actions should the nurse include in the plan? (Select all that apply.)

A. Apply a moist dressing to the wound B. Assess the wound for signs of infection C. Debride necrotic tissue from the wound D. Elevate the affected leg above the heart level E. Massage the wound edges gently

Answer and Explanation

Choice A:

Applying a moist dressing to the wound provides a moist environment for wound healing and protects the wound from contamination and trauma. Moisture prevents dehydration and necrosis of the wound bed and promotes cell migration and growth.

Choice B:

Assessing the wound for signs of infection is important to detect and treat any infection that may impair wound healing or cause systemic complications. Signs of infection include increased redness, warmth, swelling, pain, drainage, odor, fever, or leukocytosis.

Choice C:

Debriding necrotic tissue from the wound is essential to remove any dead or devitalized tissue that may interfere with wound healing or serve as a source of infection. Debridement can be done by surgical, mechanical, enzymatic, or autolytic methods.

Choice D:

Elevating the affected leg above the heart level reduces edema and improves blood circulation to the wound. Edema can impair wound healing by causing tissue hypoxia, increasing bacterial growth, and delaying granulation tissue formation.

Choice E:

Massaging the wound edges gently is not recommended for chronic wounds, as it may cause trauma or bleeding to the wound bed or delay epithelialization. Massaging may be beneficial for preventing hypertrophic scars or contractures in healed wounds.

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Question 9:

A nurse is caring for a client who has contact dermatitis after exposure to poison ivy. The nurse recognizes that this condition is mediated by what type of cells?

A. B cells B. T cells C. T cells D. Mast cells

Answer and Explanation

Choice A:

B cells are not involved in contact dermatitis, as they do not produce antibodies or form immune complexes.

Choice B:

T cells are the type of cells that mediate contact dermatitis, which is a type of type IV hypersensitivity. T cells recognize the poison ivy antigens that bind to the skin proteins and release cytokines that recruit macrophages and other inflammatory cells. This leads to a delayed and localized reaction that manifests as erythema, edema, vesicles, and pruritus.

Choice C:

T cells are not the same as B cells, as they have different receptors and functions in the immune system.

Choice D:

Mast cells are not involved in contact dermatitis, as they do not express IgE antibodies or release histamine.

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Question 10:

A nurse is caring for a client who has Graves' disease. The nurse understands that this condition is caused by what type of hypersensitivity? (Select all that apply.)

A. Type I hypersensitivity B. Type II hypersensitivity C. Type III hypersensitivity D. Type IV hypersensitivity E. Type V hypersensitivity

Answer and Explanation

Choice A:

Type I hypersensitivity is not involved in Graves' disease, as it does not involve IgE antibodies or mast cells.

Choice B:

Type II hypersensitivity is involved in Graves' disease, as it involves IgG antibodies that bind to the thyroid-stimulating hormone (TSH) receptors on the thyroid gland and stimulate the production of thyroid hormones. This leads to hyperthyroidism and manifestations such as goiter, exophthalmos, tachycardia, weight loss, or tremors.

Choice C:

Type III hypersensitivity is not involved in Graves' disease, as it does not involve immune complexes or complement activation.

Choice D:

Type IV hypersensitivity is not involved in Graves' disease, as it does not involve cytotoxic T cells or helper T cells.

Choice E:

Type V hypersensitivity is also involved in Graves' disease, as it involves the stimulation of target cells by antibodies that act as agonists for cell surface receptors. This leads to an increased function of the target organ or tissue.

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Question 11:

A nurse is caring for a client who has an infection caused by Streptococcus pyogenes. The nurse understands that this microorganism belongs to what group of bacteria?

A. Gram-positive cocci B. Gram-negative cocci C. Gram-positive bacilli D. Gram-negative bacilli

Answer and Explanation

Choice A:

Gram-positive cocci are bacteria that have a spherical shape and stain purple with Gram stain due to their thick peptidoglycan cell wall. Streptococcus pyogenes is an example of gram-positive cocci that can cause infections such as pharyngitis, impetigo, cellulitis, necrotizing fasciitis, or rheumatic fever.

Choice B:

Gram-negative cocci are bacteria that have a spherical shape and stain pink with Gram stain due to their thin peptidoglycan cell wall and outer membrane. Neisseria gonorrhoeae and Neisseria meningitidis are examples of gram-negative cocci that can cause infections such as gonorrhea, meningitis, or septicemia.

Choice C:

Gram-positive bacilli are bacteria that have a rod-shaped shape and stain purple with Gram stain due to their thick peptidoglycan cell wall. Bacillus anthracis and Clostridium botulinum are examples of gram-positive bacilli that can cause infections such as anthrax, botulism, or tetanus.

Choice D:

Gram-negative bacilli are bacteria that have a rod-shaped shape and stain pink with Gram stain due to their thin peptidoglycan cell wall and outer membrane. Escherichia coli and Pseudomonas aeruginosa are examples of gram-negative bacilli that can cause infections such as urinary tract infection, wound infection, or sepsis.

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Question 12:

A nurse is caring for a client who has an infection caused by Candida albicans. The nurse understands that this microorganism belongs to what group of microorganisms?

A. Bacteria B. Viruses C. Fungi D. Parasites

Answer and Explanation

Choice A:

Bacteria are microorganisms that have a cell wall composed of peptidoglycan and a cell membrane composed of phospholipids. They can be classified by their shape (cocci or bacilli), their Gram stain (positive or negative), or their oxygen requirement (aerobic or anaerobic).

Choice B:

Viruses are microorganisms that have a nucleic acid core (DNA or RNA) surrounded by a protein coat (capsid) and sometimes an envelope derived from the host cell membrane. They can only replicate inside living cells and cause various diseases such as influenza, herpes, hepatitis, or AIDS.

Choice C:

Fungi are microorganisms that have a cell wall composed of chitin and a cell membrane composed of ergosterol. They can exist as yeasts or molds depending on the environmental conditions. Candida albicans is an example of fungi that can cause infections such as thrush, vaginitis, or systemic candidiasis.

Choice D:

Parasites are microorganisms that live on or in another organism (host) and derive nutrients from it. They can be classified by their size (protozoa or helminths) or their mode of transmission (vector-borne or direct contact). They can cause infections such as malaria, giardiasis, or schistosomiasis.

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Question 13:

A nurse is caring for a client who has leukemia. The nurse understands that this condition is characterized by what type of neoplasia?

A. Benign neoplasia of blood cells B. Malignant neoplasia of blood cells C. Benign neoplasia of bone marrow cells D. Malignant neoplasia of bone marrow cells

Answer and Explanation

Choice A:

Benign neoplasia of blood cells is not a correct term for leukemia, as leukemia is a malignant condition that can invade and destroy normal blood cells and tissues. Benign neoplasia of blood cells is a rare condition that involves the overproduction of normal blood cells, such as polycythemia vera or essential thrombocythemia.

Choice B:

Malignant neoplasia of blood cells is not a correct term for leukemia, as leukemia does not originate from blood cells, but from bone marrow cells. Malignant neoplasia of blood cells is a term that can be used for lymphoma, which is a type of cancer that originates from lymphocytes in the lymphatic system.

Choice C:

Benign neoplasia of bone marrow cells is not a correct term for leukemia, as leukemia is a malignant condition that can spread to other organs or systems. Benign neoplasia of bone marrow cells is a term that can be used for myelodysplastic syndrome, which is a condition that involves the abnormal development and maturation of bone marrow cells.

Choice D:

Malignant neoplasia of bone marrow cells. Leukemia is a type of cancer that originates from the abnormal and uncontrolled growth of hematopoietic stem cells or progenitor cells in the bone marrow. These cells can proliferate and differentiate into various types of blood cells, such as lymphocytes, granulocytes, monocytes, or erythrocytes. Leukemia can be classified by the type of cell involved (myeloid or lymphoid) and the rate of progression (acute or chronic).

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Question 14:

A nurse is evaluating the effectiveness of IV fluid therapy for a client who has hypovolemia. Which of the following findings should the nurse use as an indicator of improvement?

A. Decreased hematocrit B. Increased urine specific gravity C. Decreased central venous pressure D. Increased blood urea nitrogen

Answer and Explanation

Choice A:

Decreased hematocrit is an indicator of improvement for a client who has hypovolemia and is receiving IV fluid therapy. Hematocrit is the percentage of red blood cells in the blood. Hypovolemia causes hemoconcentration, which increases the hematocrit level. IV fluid therapy restores the blood volume and dilutes the red blood cells, which decreases the hematocrit level.

Choice B:

Increased urine specific gravity is not an indicator of improvement for a client who has hypovolemia and is receiving IV fluid therapy. Urine specific gravity is a measure of the concentration of solutes in the urine. Hypovolemia causes dehydration, which increases the urine specific gravity. IV fluid therapy rehydrates the body and lowers the urine specific gravity.

Choice C:

Decreased central venous pressure is not an indicator of improvement for a client who has hypovolemia and is receiving IV fluid therapy. Central venous pressure is a measure of the pressure in the right atrium and vena cava. Hypovolemia causes decreased preload, which lowers the central venous pressure. IV fluid therapy increases preload and raises the central venous pressure.

Choice D:

Increased blood urea nitrogen is not an indicator of improvement for a client who has hypovolemia and is receiving IV fluid therapy. Blood urea nitrogen is a measure of the amount of urea in the blood. Urea is a waste product of protein metabolism that is excreted by the kidneys. Hypovolemia causes decreased renal perfusion, which increases the blood urea nitrogen level. IV fluid therapy improves renal perfusion and lowers the blood urea nitrogen level.

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Question 15:

A nurse is caring for a client who has metabolic alkalosis due to prolonged vomiting. Which of the following interventions should the nurse implement? (Select all that apply.)

A. Administer antiemetics as prescribed B. Monitor serum potassium levels C. Administer sodium bicarbonate IV as prescribed D. Encourage intake of acidic foods and beverages E. Provide supplemental oxygen as needed

Answer and Explanation

Choice A:

Administering antiemetics as prescribed is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Antiemetics are medications that can prevent or treat nausea and vomiting, which are the main causes of metabolic alkalosis in this case. By stopping vomiting, antiemetics can help prevent further loss of gastric acid and bicarbonate retention, which can correct metabolic alkalosis.

Choice B:

Monitoring serum potassium levels is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Metabolic alkalosis can cause hypokalemia due to increased renal excretion of potassium and intracellular shift of potassium in exchange for hydrogen ions. Hypokalemia can worsen metabolic alkalosis by impairing renal acid excretion and increasing bicarbonate reabsorption. The nurse should monitor serum potassium levels regularly and report any abnormalities or signs of hypokalemia, such as muscle weakness, cramps, arrhythmias, or ECG changes.

Choice C:

Administering sodium bicarbonate IV as prescribed is not an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Sodium bicarbonate is an alkalinizing agent that can increase serum bicarbonate levels and pH, which can worsen metabolic alkalosis. Sodium bicarbonate IV should be avoided or used with caution in clients who have metabolic alkalosis, unless they have severe acid-base imbalance or coexisting metabolic acidosis.

Choice D:

Encouraging intake of acidic foods and beverages is not an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Acidic foods and beverages can lower the pH of the stomach, but they have little effect on the pH of the blood or urine, which are regulated by other mechanisms such as buffers, lungs, and kidneys. Acidic foods and beverages can also irritate the gastric mucosa and trigger more vomiting, which can aggravate metabolic alkalosis.

Choice E:

Providing supplemental oxygen as needed is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Metabolic alkalosis can cause respiratory compensation by decreasing the respiratory rate and depth, which can lead to hypoxemia and hypercapnia. Supplemental oxygen can help maintain adequate oxygenation and prevent tissue hypoxia and organ damage. The nurse should monitor the client's oxygen saturation and arterial blood gas levels and adjust the oxygen therapy accordingly.

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Question 16:

A nurse is caring for a client who has hypernatremia. Which of the following actions should the nurse take? (Select all that apply.)

A. Restrict fluid intake B. Monitor neurological status C. Administer hypotonic IV fluids D. Encourage foods high in sodium E. Provide oral hygiene frequently

Answer and Explanation

Choice A:

Restricting fluid intake is not an action that the nurse should take for a client who has hypernatremia. Fluid restriction can worsen hypernatremia by increasing the concentration of sodium in the blood. Fluid intake should be increased or replaced with isotonic or hypotonic fluids to dilute sodium and correct hypernatremia.

Choice B:

Monitoring neurological status is an action that the nurse should take for a client who has hypernatremia. Hypernatremia can cause neurological symptoms such as confusion, agitation, seizures, coma, and death due to cellular dehydration and brain shrinkage. The nurse should assess the client's level of consciousness, orientation, memory, behavior, and reflexes regularly and report any changes or deterioration.

Choice C:

Administering hypotonic IV fluids is an action that the nurse should take for a client who has hypernatremia. Hypotonic fluids have a lower concentration of solutes than normal body fluids and can help lower serum sodium levels by moving water into the cells from the blood vessels. The nurse should administer hypotonic fluids slowly and carefully to avoid fluid overload or cerebral edema.

Choice D:

Encouraging foods high in sodium is not an action that the nurse should take for a client who has hypernat

Choice E:

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Question 17:

A nurse is assessing a client who has septic shock. The nurse notes that the client has a blood pressure of 80/50 mmHg, a heart rate of 120 beats per minute, a respiratory rate of 28 breaths per minute, and a temperature of 39°C.

The nurse calculates that the client has a Sequential Organ Failure Assessment (SOFA) score of what value?

A. 1 B. 4 C. 6 D. 8 E. Provide supplemental oxygen as needed

Answer and Explanation

Choice A:

The SOFA score is a tool that assesses the degree of organ dysfunction or failure in septic shock. It is based on six parameters: blood pressure, Glasgow coma scale, PaO2/FiO2 ratio, platelet count, bilirubin level, and creatinine level. Each parameter is assigned a score from 0 to 4 based on the severity of the abnormality. The total SOFA score ranges from 0 to 24, with higher scores indicating worse organ dysfunction or failure.

The client's blood pressure of 80/50 mmHg corresponds to a SOFA score of 1, as it indicates hypotension.

The client's Glasgow coma scale is not given, so it is assumed to be normal (15), which corresponds to a SOFA score of 0.

The client's PaO2/FiO2 ratio is not given, so it is assumed to be normal (>400), which corresponds to a SOFA score of 0.

The client's platelet count is not given, so it is assumed to be normal (>150 x 10^9/L), which corresponds to a SOFA score of 0.

The client's bilirubin level is not given, so it is assumed to be normal (<20 micromol/L), which corresponds to a SOFA score of 0.

The client's creatinine level is not given, so it is assumed to be normal (<110 micromol/L), which corresponds to a SOFA score of 0.

The total SOFA score is the sum of the scores for each parameter: 1 + 0 + 0 + 0 + 0 + 0 = 1. Therefore, the client has a SOFA score of 1.

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Question 18:

A nurse is caring for a client who has rheumatoid arthritis (RA). The nurse understands that this condition is caused by what type of hypersensitivity?

A. Type I hypersensitivity B. Type II hypersensitivity C. Type III hypersensitivity D. Type IV hypersensitivity

Answer and Explanation

Choice A:

Type I hypersensitivity is not involved in RA, as it does not involve IgE antibodies or mast cells.

Choice B:

Type II hypersensitivity is not involved in RA, as it does not involve IgG or IgM antibodies or target cells.

Choice C:

RA is caused by type III hypersensitivity, which involves the formation and deposition of immune complexes in the synovial membranes of the joints. This triggers complement activation, inflammation, and tissue damage.

Choice D:

Type IV hypersensitivity is not involved in RA, as it does not involve cytotoxic T cells or helper T cells.

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