HESI RN ADVANCED PATHOPHYSIOLOGY
QUESTIONS and ANSWERS, 2000
1. Following routine colonoscopy screening, a client is told that he had several polyps
... [Show More] removed.
The client began crying stating, “I just can't deal with cancer. I'm too young.” The nurse responds:
A) “Don't worry. We have some great cancer doctors on staff. I'm sure chemo will help you fight it.”
B)“Maybe if you're lucky, they have stopped it from metastasizing to your liver.”
C) “A simple intestinal surgery will cure you.”
D) “Most colon polyps are not cancerous. The biopsy results will direct your care.”
Ans: D Feedback:A polyp is a growth that projects from a mucosal surface, such as the
intestine.
Although the term usually implies a benign neoplasm, some malignant tumors also appear as polyps.
Adenomatous polyps are considered precursors to adenocarcinomas of the colon.
2. A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung
tumor in a client. Which of the following characteristics is associated with this client's neoplasm?
A)The tumor will grow by expansion and is likely encapsulated.
B) The cells that constitute the tumor are undifferentiated, with atypical structure.
C)If left untreated, the client's tumor is likely to metastasize.
D) The tumor is likely to infiltrate the lung tissue that presently surrounds it.
Ans: A Feedback:Benign neoplasms typically grow by expansion rather than invasion. As well,
they are usually contained within a fibrous capsule. Malignant tumors are associated with
undifferentiated cells, metastasis, and infiltration of surrounding tissue.
3. A newly diagnosed lung cancer client asks how his tumor spread (metastasized) so fast without
displaying many signs/symptoms. The nurse responds that malignant tumors affect area tissues by:
A)Increasing tissue blood flow
B) Providing essential nutrients
C) Liberating enzymes and toxins
D) Forming fibrous membranes
Ans: C
Feedback: Malignant tumors affect area tissues by liberating enzymes and toxins that destroy
tumor tissue and normal tissue. In addition, the malignant cells compress area vessels, causing ischemia
and tissue necrosis. The high metabolic rate of tumor growth causes the tumor to deprive the normal
tissues of essential nutrients.
4. A client had a positive Pap smear. The surgeon diagnosed “cancer in situ of the cervix.” The
client asks, “What does this mean?” From the following statements, which is most appropriate in
response to this question? The tumor has:
A) Been walled off within a strong fibrous capsule
B) Developed a distant infiltration
C) Not crossed the basement membrane, so it can be surgically removed with little chance of
growing back
D) Grown undifferentiated cells that no longer look like the tissue from which it arose
Ans: C Feedback:
Cancer in situ is a localized preinvasive lesion. As an example, in breast ductal carcinoma, in situ the cells
have not crossed the basement membrane. Depending on its location, an in situ lesion usually can be
removed surgically or treated so that the chances of recurrence are small. For example, cancer in situ of
the cervix is essentially 100% curable.
5. While studying to become chemo- certified, the nurse reviews some basic concepts about
cancer cells. When a client asks about why the tumor grows so fast, the nurse will respond based on
which of the following physiological principles? Select all that apply.
A) Cancer cells have shorter cell cycle times than normal cells.
B) Cancer cells do not die when they are programmed to die.
C)Growth factors prevents cancer cells from entering resting (G0) cell cycle phase.
D) Cancer cells will reach a balance between cell birth and cell death rate.
E) Cancer cells never reach a flattened growth rate.
Ans: B, C
Feedback: One of the reasons cancerous tumors often seem to grow so rapidly relates to the size
of the cell pool that is actively engaged in cycling. It has been shown that the cell cycle time of cancerous
tissue cells is not necessarily shorter than that of normal cells. Rather, cancer cells do not die on
schedule, and growth factors prevent cells from exiting the cell cycle and entering the G0 or noncycling
phase. The ratio of dividing cells to resting cells in a tissue mass is called the growth fraction. The
doubling time is the length of time it takes for the total mass of cells in a tumor to double. As the growth
fraction increases, the doubling time decreases. When normal tissues reach their adult size, an
equilibrium between cell birth and cell death is reached. Cancer cells, however, continue to divide until
limitations in blood supply and nutrients inhibit their growth. When this occurs, the doubling time for
cancer cells decreases.
The initial growth rate is exponential and then tends to decrease or flatten out over time.
6. Although growth rate is variable among types of bacteria, the growth of bacteria is dependent
on:
A) Biofilm communication
B) Availability of nutrients
C) An intact protein capsid
D)
Individual cell motility
Ans: B
Feedback:
Bacterial growth is dependent upon the availability of nutrients and physical growth conditions. Bacteria
prefer to colonize as biofilm and communicate with other bacteria within the biofilm, but biofilm is not
necessary for growth. Viruses (not bacteria) form a capsid. Although some bacteria have projections for
motility, these are not necessary for growth.
7. Which of the following outpatients are at a greater risk for developing Treponema pallidum, the
cause of syphilis? Select all that apply.
A) A homeless adolescent female performing oral sex for money
B) A male who frequents clubs catering to exotic dancers and sexual favors
C) A homosexual male couple who have had a monogamous relationship for the past 20 years
D) An older adult female living in a condominium who regularly has sex with three to four different
men/week
Ans: A, B, D
Feedback:
Treponema pallidum is a sexually transmitted infection that is spread by direct physical contact. The
Borrelia type of spirochete is spread from animals to humans through lice or tick bites.
Leptospira spirochetes spread from animals to humans through contact with infected animal urine.
Spirochetes are anaerobic; therefore, they would not invade the host through oxygen-filled aerobic
lungs.
8. Chlamydiaceae have characteristics of both viruses and bacteria and are a rather common
sexually transmitted infectious organism. After entry into the host, they transform into a reticulate
body. The health care provider should monitor which of the following clients for this possible infection?
Select all that apply.
A) An adult male who raises a number of exotic birds in his home
B) A drug abuser looking to share needles/syringes
C) A newborn with a noticeable eye infection
D) A teenager who swims in the lake regularly
Ans: A, B, C
Feedback:
Chlamydiaceae are in the form of an elementary body when infectious and outside of the host cell. Once
an organism enters the cell, it transforms into a large reticulate body. This undergoes active replication
into multiple elementary bodies, which are then shed into the extracellular environment to initiate
another infectious cycle. Chlamydial diseases of humans include sexually transmitted genital infections
(Chlamydophila trachomatis); ocular infections and pneumonia of newborns (C. trachomatis); upper and
lower respiratory tract infections in children, adolescents, and young adults
(Chlamydophilapneumoniae); and respiratory disease acquired from infected birds
(Chlamydophilapsittaci).
9. A client has been diagnosed with Coxiellaburnetii infection. She asked the health care provider
how she could have gotten this disease. The health care provider's best response is:
A) “Probably while walking outside without your shoes on.”
B) “While swimming in an unsanitary pond.”
C) “Drinking contaminated milk.”
D) “Eating undercooked fish.” Ans: C
Feedback:
In humans, Coxiella infection produces a disease called Q fever, characterized by a nonspecific febrile
illness often accompanied by headache, chills, arthralgias, and mild pneumonia. The organism produces
a highly resistant sporelike stage that is transmitted to humans when contaminated animal tissue is
aerosolized (e.g., during meat processing) or by ingestion of contaminated milk.
10. A teenage male develops a severe case of “athlete's foot.” He asks, “How did I get this?” The
health care worker explains that certain fungi become infectious (called dermatophytes) and exhibit
which of the following characteristics?
A) Prefer to grow in warm environments like shoes/socks
B) Like a moist environment
C) Limited to cooler cutaneous surfaces
D) Need higher blood flow to survive Ans: C
Feedback:
Dermatophytes are not able to grow at core body temperature, preferring the cooler surface skin areas
instead of moist skin folds. Diseases caused by these organisms, including ringworm, athlete's foot, and
jock itch, are collectively called superficial mycoses.
11. A male client with a history of angina has presented to the emergency department with
uncharacteristic chest pain, and his subsequent ECG reveals T- wave elevation. This finding suggests an
abnormality with which of the following aspects of the cardiac cycle?
A) Atrial depolarization
B) Ventricular depolarization
C) Ventricular repolarization
D) Depolarization of the AV node Ans: C
Feedback:
The T wave on electrocardiography (ECG) corresponds to ventricular repolarization. Atrial depolarization
is represented by the P wave and ventricular depolarization by the QRS complex. The isoelectric or zero
line between the P wave and the Q wave represents depolarization of the AV node, bundle branches,
and Purkinje system.
12. During ventricular systole, closure of the atrioventricular (AV) valves coincides with:
A) Atrial chamber filling
B) Aortic valve opening
C) Isovolumetric contraction
D) Semilunar valves opening Ans: C
Feedback:
Ventricular systole is divided into two parts: isovolumetric contraction when the AV valves close and
ventricles fill; and the ejection period, when the semilunar valves open and blood is ejected through the
aortic valve into circulation.
Immediately after closure of the AV valves, there is a 0.02- to 0.03-second period during which the
pulmonic and aortic valves remain closed. During this period, the ventricular volume remains the same
while the ventricles contract, producing an abrupt increase in pressure. At the end of systole, the
ventricles relax, causing a precipitous fall in intraventricular pressures. As this occurs, blood from the
large arteries flows back toward the ventricles, causing the aortic and pulmonic valves to snap shut—an
event marked by the second heart sound.
13. A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of
40%. The nurse knows this EF is below normal and explains to the client:
A) “This means you have a lot of pressure built-up inside your heart.”
B) “This means your heart is not pumping as much blood out of the heart with each beat.”
C) “You need to increase the amount of exercise you do to get your heart muscle back in shape.”
D) “Your ventricular muscle is getting too stiff to beat normally.”
Ans: B Feedback:
Ejection fraction is the percentage of diastolic volume ejected from the heart [left ventricle] during
systole. Stroke volume is determined by the difference between end-diastolic and end-systolic volumes.
Cardiac output is determined by stroke volume and heart rate. Cardiac reserve refers to the maximum
percentage of increase in cardiac output that can be achieved above the normal resting level.
14. A client with a history of heart failure has been referred for an echocardiogram. Results of this
diagnostic test reveal the following findings: heart rate 80 beats/minute; end-diastolic volume 120 mL;
and end-systolic volume 60 mL. What is this client's [Show Less]