Test Bank For Porth’s Pathophysiology, Concepts of Altered Health States, 9th Edition by Grossman, Sheila.

Test Bank For Porth’s Pathophysiology, Concepts of Altered Health States, 9th Edition by Grossman, Sheila. Ch 1- Concepts of Health and Disease 1. At an international nursing conference, many discussions and breakout sessions focused on the World Health Organization (WHO) views on health. Of the following comments made by nurses during a discussion session, which statements would be considered a good representation of the WHO definition? Select all that apply. A) Interests in keeping the elderly population engaged in such activities as book reviews and word games during social time B) Increase in the number of chair aerobics classes provided in the skilled care facilities C) Interventions geared toward keeping the elderly population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes D) Providing transportation for renal dialysis patients to and from their hemodialysis sessions E) Providing handwashing teaching sessions to a group of young children Ans: A, B, C, E Feedback: The WHO definition of health is defined as “a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.” Engaging in book reviews facilitates mental and social well-being; chair aerobics helps facilitate physical well-being; and assisting with tight control of diabetes helps with facilitating physical well-being even though the person has a chronic disease. Handwashing is vital in the prevention of disease and spread of germs. 2. A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual's health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report? A) The client has a diverse background by being of Asian and Native American descent and practices various alternative therapies to minimize effects of stress. B) The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime. C) The client has a good career with exceptional preventative health care benefits. D) The client lives in an affluent, clean, suburban community with access to many health care facilities. Ans: B Feedback: In Healthy People 2020, the focus is to promote good health to all (such as using alternative therapies to minimize effects of stress); achieving health equity and promoting health for all (which includes having good health care benefits); and promoting good health (which includes living in a clean community with good access to health care). A client's noncompliance with treatments to control high cholesterol levels within the presence of a family history of CV disease does not meet the “attaining lives free of preventable disease and premature death” determinant. 3. A physician is providing care for a number of patients on a medical unit of a large, university hospital. The physician is discussing with a colleague the differentiation between diseases that are caused by abnormal molecules and diseases that cause disease. Which of the following patients most clearly demonstrates the consequences of molecules that cause disease? A) A 31-year-old woman with sickle cell anemia who is receiving a transfusion of packed red blood cells B) A 91-year-old woman who has experienced an ischemic stroke resulting from familial hypercholesterolemia C) A 19-year-old man with exacerbation of his cystic fibrosis requiring oxygen therapy and chest physiotherapy D) A 30-year-old homeless man who has Pneumocystis carinii pneumonia (PCP) and is HIV positive. Ans: D Feedback: PCP is an example of the effect of a molecule that directly contributes to disease. Sickle cell anemia, familial hypercholesterolemia, and cystic fibrosis are all examples of the effects of abnormal molecules. 4. A member of the health care team is researching the etiology and pathogenesis of a number of clients who are under his care in a hospital context. Which of the following aspects of clients' situations b N es U t R ch S a I ra N ct G er T iz B e . s C pa O th M ogenesis rather than etiology? A) A client who has been exposed to the Mycobacterium tuberculosis bacterium B) A client who has increasing serum ammonia levels due to liver cirrhosis C) A client who was admitted with the effects of methyl alcohol poisoning D) A client with multiple skeletal injuries secondary to a motor vehicle accident Ans: B Feedback: Pathogenesis refers to the progressive and evolutionary course of disease, such as the increasing ammonia levels that accompany liver disease. Bacteria, poisons, and traumatic injuries are examples of etiologic factors. Ch 3- Cellular Adaptation, Injury, and Dea th 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 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. 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 a N nd U I R G S F I -1 N i G n T th B e . cl C ie O n M t'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 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. 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. 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. 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 Ans: C Feedback: In hypertension, the increased N w U o R r S kl I oa N d G r T eq B u . ir C ed O t M o 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. Ch 7- Stress and Adaptation 1. An 81-year-old male patient who has a diagnosis of orthostatic hypotension is experiencing an episode of particularly low blood pressure. The man's body has responded by increasing levels of angiotensin II in the bloodstream, a hormone that decreases the glomerular filtration rate in the kidneys and contributes to an increase in blood pressure. Which of the following phenomena best describes what has occurred? A) Positive feedback B) Adaptation C) Negative feedback D) Homeostasis Ans: C Feedback: his regulation and attempt to normalize blood pressure are an example of a negative feedback mechanism, in which physiological processes result in the maintenance of homeostasis. This process of normalization is not an example of positive feedback, and homeostasis is the goal rather than the process. This process involves adaptation, but negative feedback is a more precise characterization of the process. 2. A 61-year-old woman with a 40-pack-a year history of cigarette smoking and a diagnosis of chronic obstructive pulmonary disease (COPD) is experiencing an increase in arterial levels of CO 2 . This change has been detected in the client's medulla, aortic bodies, and carotid bodies, stimulating the inspiratory center in the medulla oblongata, which has in turn caused the diaphragm to contract more forcefully and increase the respiratory rate. Which of the N f U ol R lo S w I in N g G te T rm B. s C be O st M describes the role of the inspiratory center? A) Integrator/comparator B) Sensor C) Effector D) Feedback system Ans: A Feedback: An integrator/comparator sums and compares incoming data with a set point. In this case, the inspiratory center has determined the need for increased respiration and stimulated the effector (diaphragm) to respond. The sensor role is in the client's medulla, aortic bodies, and carotid bodies. This overall process is an example of a feedback system, but this does not characterize the particular role of the inspiratory center. 3. Which of the following physiological processes would be considered a positive feedback mechanism? A) The release of antidiuretic hormone (ADH) from the posterior pituitary gland B) Shivering in response to low environmental temperature C) The platelet aggregation mechanism for closing minute ruptures in very small blood vessels during accidental injury D) Increased production of white blood cells (WBCs) in response to a microorganism Ans: C Feedback: The release of hormones during labor increases rather than mitigates a physiological system. Specifically, uterine contraction stimulates the production of other relevant hormones that cause temporary instability that culminates in childbirth. ADH counters the potential instability of insufficient hydration and/or blood pressure, much as shivering is an attempt to counter low temperature. Increased production of WBCs is a response to the potential homeostatic instability of an infectious process. 4. An occupational health officer who works in the context of a large police force is attempting to understand the role that stress may play in the health of his clients. According to Selye, which of the following statements best captures an aspect of the phenomenon of stress? A) The alarm stage involves the release of cortisol and catecholamines. B) The nature of a stress response is determined by the objective severity of the stressor. C) Systemic illnesses can sometimes result from the resistance stage of stress response. D) Periods of stress can be developmentally positive or negative. Ans: D Feedback: Selye noted that stress can result in positive growth and development, and that stress is not unanimously detrimental to health and development. The alarm stage is associated with the release of cortisol and catecholamines, and a stress response is dependent on properties of the stressor and the individual's conditioning; the severity is not objectively determined. Illness is often a consequence of the exhaustion stage.