2020 ADVANCED

PATHOPHYSIOLOGY HESI RN

QUESTIONS and ANSWERS

1. Following routine colonoscopy

screening, a client is told that he had

several polyps 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 flowB)

Providing essential nutrientsC)

Liberating enzymes and toxinsD)

Forming fibrous membranesAns:

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 capsuleB) Developed a

distant infiltrationC) Not crossed the

basement membrane, so it can be

surgically removed with little chance of

growing backD) Grown undifferentiated

cells that no longer look like the tissue

from which it aroseAns: C Feedback:

Cancer in situ is a localized

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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 chemocertified, 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

communicationB) Availability of

nutrientsC) An intact protein capsidD)

Individual cell motilityAns: 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.

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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.”

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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 Twave 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.

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