2024 Pathophysiology midterm
exam updated
A client presented to the emergency department of the hospital with a swollen, reddened, painful leg wound
and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The client's physician
has ordered a complete blood count and white cell differential. Which blood component would the physician
most likely anticipate to be elevated? A. Basophils B. Eosinophils C. Platelets D. Neutrophils
Answer: D Explanation; Increased neutrophils are associated with inflammation, in general, and bacterial
infections in particular. Platelets play a role in inflammation but their levels would not rise to the same extent as
would neutrophils. Eosinophils are not strongly associated with bacterial infection and basophils would not
increase to the same degree as neutrophils.
A 16-year-old girl has broken her arm while snowboarding and is shocked at the amount of swelling at the injury
site. Which statement best explains the physiologic rationale for her swelling? A. Migration and proliferation of
mast cells, neutrophils, and platelets to the injury site occupy an increased volume of tissue. B. Potent
vasodilation increases the total volume of vascular space at the site of inflammation. C. Osmotic flow of plasma
into the intravascular space causes increased blood volume and interstitial fluid. D. Loss of plasma proteins
causes an increase in interstitial osmotic pressure.
Explanation; Swelling is the result of plasma proteins leaving the interstitial space, resulting in increased osmotic
pressure of interstitial fluid and movement of fluid into tissues. Neither blood components, vasodilation, nor
increased intravascular volume account for swelling.
Which phenomena best accounts for the increased presence of leukocytes at the site of inflammation? A.
Existing leukocytes stick to the epithelial cells and move along blood vessel walls. B. Increased numbers of
leukocytes are released into circulation via cytokine stimulation. C. Leukocytes are osmotically drawn from the
circulation into the interstitial space as a result of swelling. D. Epithelium expresses leukocyte stimulation
factors in response to cell injury.
Answer: A Explanation; During inflammation, leukocytes accumulate at the point of epithelial contact in the
processes of margination, adhesion, and transmigration. This is not directly achieved by way of increased
leukocyte production or release, nor by osmotic pressure. The epithelium does not produce leukocyte
stimulation factors.
When explaining the final stages of the inflammatory response to pathogens, the nurse should include which
educational topics? PRIMEXAM.COM A. How the body can kill the pathogen by generating toxic oxygen and
nitrogen products, producing such things as nitric oxide and hydrogen peroxide B. Margination, which is a
,2024 Pathophysiology midterm
exam updated
process whereby white cells (leukocytes) stick to the endothelium and accumulate along the blood vessel C. The
increase in vascular permeability, which lets fluids leak into the extravascular tissues D. The promotion of tissue
regeneration, whereby monocytes and macrophages produce potent prostaglandins and leukotrienes.
Answer: A Explanation; The latter stages of phagocytosis result in intracellular killing of pathogens,
accomplished by several mechanisms, including toxic oxygen and nitrogen products, lysozymes, proteases, and
defensins. The metabolic burst pathways generate toxic oxygen and nitrogen products (e.g., nitric oxide,
hydrogen peroxide, and hypochlorous acid). Margination is the early stages of the inflammatory response.
Vascular changes occur with inflammation but are prior to the final stage. Macrophages arrive within hours at
the inflammation site.
A deficiency in which of these would result in an inhibition of the inflammatory response? A. Histamine B.
Helper T cells C. B cells D. Vitamin K
Explanation; Histamine is a key mediator in the inflammatory system, unlike helper T cells, B cells, or vitamin K.
When educating a client with a wound that is not healing, the nurse should stress which dietary modifications to
ward off some of the negative manifestations that can occur with inflammation? A. Increase the amount of
calcium in the diet, especially drinking milk and eating cheese. B. This is the one time whereby you should eat
more fat (both polyunsaturated and saturated) so you can absorb more fat-soluble vitamins. C. Since there is a
loss of plasma proteins, you should increase your intake of organ meats like liver. D. Increase your intake of oily
fish and fish oil so that you will increase absorption of omega-3 polyunsaturated fatty acids.
Answer: D Explanation; Dietary modification of the inflammatory response through the use of omega-3
polyunsaturated fatty acids, specifically eicosatetraenoic acid and docosahexaenoic acid, which are present in
oily fish and fish oil, may be effective in preventing some negative manifestations of inflammation.
Tumor necrosis factor-α and IL-1 are major cytokines that mediate inflammation. If the client is developing a
systemic response to an infection, the nurse will likely assess which clinical manifestations? Select all that apply.
A. Elevated temperature B. Hypertension C. Tachycardia D. Decrease in urine output E. Anorexia
Answer: A, C, E Explanation; IL-1 and TNF-α are mediators of the acute-phase responses associated with
infection or injury. Features of these systemic responses include fever [elevated temperature], hypotension,
tachycardia [increased heart rate], anorexia, increase in neutrophil count, and increased levels of corticosteroid
hormones.
A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her
body. Which physiologic process could best underlie her care provider's teaching about her new diet? A. Free
,2024 Pathophysiology midterm
exam updated
radicals act as direct mediators in the inflammatory process. B. Free radicals inhibit the inflammatory response,
limiting pre-adaptive response to infection. C. Free radicals increase cytokine expression and adhesion molecule
levels, resulting in increased inflammation. D. Free radicals contribute to atherosclerosis and decreased immune
response.
Answer: C Explanation; Free radicals are thought to bring about an inappropriate inflammatory response by
increasing cytokine and numbers of adhesion molecules. They are not direct mediators of inflammation and are
not associated with decreased immune response, but rather inappropriate inflammation. Free radicals are not
associated with inhibition of the inflammatory response.
A nurse is changing the wound dressing on a coccyx-region pressure injury of an immobilized client. The existing
dressing is saturated with both watery, clear discharge and foul, grayish-colored liquid. Which entry in the
client's chart most accurately documents these findings?
A. "Large amounts of suppurative and serous exudates noted." B. "Purulent discharge and fibrinous exudates
noted on existing dressing." C. "Abscess activity noted to coccyx wound." D. "Plasma proteins and membranous
exudates present on existing dressing."
Answer: A Explanation; Serous discharge is clear and low in plasma proteins, while suppurative (or purulent)
exudates are a mass of degraded cells. An abscess would be physically contained with no discharge, and the
exudate is neither fibrinous nor membranous.
Which aspect of a client's site of inflammation would help the care provider rule out chronic inflammation?
A. High levels of macrophages B. Increased neutrophils C. Proliferation of fibroblasts D. Infiltration of
lymphocytes
Answer: B Explanation; Chronic inflammation lacks the sudden and marked proliferation of neutrophils that is
associated with acute inflammation. Chronic inflammation is associated with increased presence and action of
fibroblasts, macrophages, and lymphocytes.
A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates
neutrophilia with a shift to the left. She most likely has:
A. A mild parasitic infection B. A severe bacterial infection C. A mild viral infection D. A severe fungal infection
Answer: B Explanation; Fever and painful, palpable lymph nodes are nonspecific inflammatory conditions;
leukocytosis is also common but is a particular hallmark of bacterial infection. Neutrophilia also indicates a
bacterial infection, whereas increased levels of other leukocytes would indicate other etiologies. The shift to the
left—the presence of many immature neutrophils—indicates that the infection is severe, because the demand
for neutrophils exceeds the supply of mature cells.
, 2024 Pathophysiology midterm
exam updated
.
Which client would have a very poor response related to tissue regeneration of his or her injured area?
A. 21-day-old infant undergoing a diaphragmatic hernia repair B. 54-year-old male who had a massive MI 4 days
ago and came to the ED today for treatment. C. 73-year-old female who is undergoing lithotripsy for kidney
stones. D. 33-year-old athlete undergoing surgery to repair a torn MCL in the right knee
Answer: B Explanation; Permanent or fixed cells cannot undergo mitotic division. The fixed cells include nerve
cells, skeletal muscle cells, and cardiac muscle cells.
A hospital client has a large, superficial wound on her elbow that was the result of shearing action when she was
moved up in her bed. The client's husband mentions that the wound looks infected and irritated since it is
completely red. Which response by the nurse would be inappropriate?
A. "Even though it is red, it doesn't mean that the wound is infected." B. "The red areas show that there is
enough circulation to facilitate healing." C. "Those are fresh blood vessels that are a sign of healthy healing." D.
"A thin sheet of blood clotting is actually desirable and not a sign that your wife's wound is infected."
Answer: D Explanation; Granulation tissue indicates sufficient circulation and angiogenesis associated with
healthy wound healing. Granulation tissue consists of new blood vessels, not clotted cellular components.
Which process would most likely be considered an anomaly during the cellular phase of inflammation?
A. Platelet aggregation B. Vasoconstriction C. Migration of phagocytic white cells D. Macrophage activity
Answer: B Explanation; While vasoconstriction is a component of the immediate inflammatory response, the
later cellular phase of inflammation is accompanied by vasodilation. Platelet aggregation, migration of
phagocytic white cells, and macrophage activity are all associated with the cellular phase.
.
A client who is recovering from burn injuries is discussing his prognosis with a physician. Which teaching point
about expectations for healing should the physician offer? A. "Once your healing is complete, your skin will be
just as strong as before your accident." B. "You may find that the scar is a bit smaller than the area of the
wound." C. "You'll find that your new tissue is more elastic and fragile than the rest of your skin D. "The final
remodeling phase of healing may last up to 3 months in your case."
exam updated
A client presented to the emergency department of the hospital with a swollen, reddened, painful leg wound
and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The client's physician
has ordered a complete blood count and white cell differential. Which blood component would the physician
most likely anticipate to be elevated? A. Basophils B. Eosinophils C. Platelets D. Neutrophils
Answer: D Explanation; Increased neutrophils are associated with inflammation, in general, and bacterial
infections in particular. Platelets play a role in inflammation but their levels would not rise to the same extent as
would neutrophils. Eosinophils are not strongly associated with bacterial infection and basophils would not
increase to the same degree as neutrophils.
A 16-year-old girl has broken her arm while snowboarding and is shocked at the amount of swelling at the injury
site. Which statement best explains the physiologic rationale for her swelling? A. Migration and proliferation of
mast cells, neutrophils, and platelets to the injury site occupy an increased volume of tissue. B. Potent
vasodilation increases the total volume of vascular space at the site of inflammation. C. Osmotic flow of plasma
into the intravascular space causes increased blood volume and interstitial fluid. D. Loss of plasma proteins
causes an increase in interstitial osmotic pressure.
Explanation; Swelling is the result of plasma proteins leaving the interstitial space, resulting in increased osmotic
pressure of interstitial fluid and movement of fluid into tissues. Neither blood components, vasodilation, nor
increased intravascular volume account for swelling.
Which phenomena best accounts for the increased presence of leukocytes at the site of inflammation? A.
Existing leukocytes stick to the epithelial cells and move along blood vessel walls. B. Increased numbers of
leukocytes are released into circulation via cytokine stimulation. C. Leukocytes are osmotically drawn from the
circulation into the interstitial space as a result of swelling. D. Epithelium expresses leukocyte stimulation
factors in response to cell injury.
Answer: A Explanation; During inflammation, leukocytes accumulate at the point of epithelial contact in the
processes of margination, adhesion, and transmigration. This is not directly achieved by way of increased
leukocyte production or release, nor by osmotic pressure. The epithelium does not produce leukocyte
stimulation factors.
When explaining the final stages of the inflammatory response to pathogens, the nurse should include which
educational topics? PRIMEXAM.COM A. How the body can kill the pathogen by generating toxic oxygen and
nitrogen products, producing such things as nitric oxide and hydrogen peroxide B. Margination, which is a
,2024 Pathophysiology midterm
exam updated
process whereby white cells (leukocytes) stick to the endothelium and accumulate along the blood vessel C. The
increase in vascular permeability, which lets fluids leak into the extravascular tissues D. The promotion of tissue
regeneration, whereby monocytes and macrophages produce potent prostaglandins and leukotrienes.
Answer: A Explanation; The latter stages of phagocytosis result in intracellular killing of pathogens,
accomplished by several mechanisms, including toxic oxygen and nitrogen products, lysozymes, proteases, and
defensins. The metabolic burst pathways generate toxic oxygen and nitrogen products (e.g., nitric oxide,
hydrogen peroxide, and hypochlorous acid). Margination is the early stages of the inflammatory response.
Vascular changes occur with inflammation but are prior to the final stage. Macrophages arrive within hours at
the inflammation site.
A deficiency in which of these would result in an inhibition of the inflammatory response? A. Histamine B.
Helper T cells C. B cells D. Vitamin K
Explanation; Histamine is a key mediator in the inflammatory system, unlike helper T cells, B cells, or vitamin K.
When educating a client with a wound that is not healing, the nurse should stress which dietary modifications to
ward off some of the negative manifestations that can occur with inflammation? A. Increase the amount of
calcium in the diet, especially drinking milk and eating cheese. B. This is the one time whereby you should eat
more fat (both polyunsaturated and saturated) so you can absorb more fat-soluble vitamins. C. Since there is a
loss of plasma proteins, you should increase your intake of organ meats like liver. D. Increase your intake of oily
fish and fish oil so that you will increase absorption of omega-3 polyunsaturated fatty acids.
Answer: D Explanation; Dietary modification of the inflammatory response through the use of omega-3
polyunsaturated fatty acids, specifically eicosatetraenoic acid and docosahexaenoic acid, which are present in
oily fish and fish oil, may be effective in preventing some negative manifestations of inflammation.
Tumor necrosis factor-α and IL-1 are major cytokines that mediate inflammation. If the client is developing a
systemic response to an infection, the nurse will likely assess which clinical manifestations? Select all that apply.
A. Elevated temperature B. Hypertension C. Tachycardia D. Decrease in urine output E. Anorexia
Answer: A, C, E Explanation; IL-1 and TNF-α are mediators of the acute-phase responses associated with
infection or injury. Features of these systemic responses include fever [elevated temperature], hypotension,
tachycardia [increased heart rate], anorexia, increase in neutrophil count, and increased levels of corticosteroid
hormones.
A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her
body. Which physiologic process could best underlie her care provider's teaching about her new diet? A. Free
,2024 Pathophysiology midterm
exam updated
radicals act as direct mediators in the inflammatory process. B. Free radicals inhibit the inflammatory response,
limiting pre-adaptive response to infection. C. Free radicals increase cytokine expression and adhesion molecule
levels, resulting in increased inflammation. D. Free radicals contribute to atherosclerosis and decreased immune
response.
Answer: C Explanation; Free radicals are thought to bring about an inappropriate inflammatory response by
increasing cytokine and numbers of adhesion molecules. They are not direct mediators of inflammation and are
not associated with decreased immune response, but rather inappropriate inflammation. Free radicals are not
associated with inhibition of the inflammatory response.
A nurse is changing the wound dressing on a coccyx-region pressure injury of an immobilized client. The existing
dressing is saturated with both watery, clear discharge and foul, grayish-colored liquid. Which entry in the
client's chart most accurately documents these findings?
A. "Large amounts of suppurative and serous exudates noted." B. "Purulent discharge and fibrinous exudates
noted on existing dressing." C. "Abscess activity noted to coccyx wound." D. "Plasma proteins and membranous
exudates present on existing dressing."
Answer: A Explanation; Serous discharge is clear and low in plasma proteins, while suppurative (or purulent)
exudates are a mass of degraded cells. An abscess would be physically contained with no discharge, and the
exudate is neither fibrinous nor membranous.
Which aspect of a client's site of inflammation would help the care provider rule out chronic inflammation?
A. High levels of macrophages B. Increased neutrophils C. Proliferation of fibroblasts D. Infiltration of
lymphocytes
Answer: B Explanation; Chronic inflammation lacks the sudden and marked proliferation of neutrophils that is
associated with acute inflammation. Chronic inflammation is associated with increased presence and action of
fibroblasts, macrophages, and lymphocytes.
A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates
neutrophilia with a shift to the left. She most likely has:
A. A mild parasitic infection B. A severe bacterial infection C. A mild viral infection D. A severe fungal infection
Answer: B Explanation; Fever and painful, palpable lymph nodes are nonspecific inflammatory conditions;
leukocytosis is also common but is a particular hallmark of bacterial infection. Neutrophilia also indicates a
bacterial infection, whereas increased levels of other leukocytes would indicate other etiologies. The shift to the
left—the presence of many immature neutrophils—indicates that the infection is severe, because the demand
for neutrophils exceeds the supply of mature cells.
, 2024 Pathophysiology midterm
exam updated
.
Which client would have a very poor response related to tissue regeneration of his or her injured area?
A. 21-day-old infant undergoing a diaphragmatic hernia repair B. 54-year-old male who had a massive MI 4 days
ago and came to the ED today for treatment. C. 73-year-old female who is undergoing lithotripsy for kidney
stones. D. 33-year-old athlete undergoing surgery to repair a torn MCL in the right knee
Answer: B Explanation; Permanent or fixed cells cannot undergo mitotic division. The fixed cells include nerve
cells, skeletal muscle cells, and cardiac muscle cells.
A hospital client has a large, superficial wound on her elbow that was the result of shearing action when she was
moved up in her bed. The client's husband mentions that the wound looks infected and irritated since it is
completely red. Which response by the nurse would be inappropriate?
A. "Even though it is red, it doesn't mean that the wound is infected." B. "The red areas show that there is
enough circulation to facilitate healing." C. "Those are fresh blood vessels that are a sign of healthy healing." D.
"A thin sheet of blood clotting is actually desirable and not a sign that your wife's wound is infected."
Answer: D Explanation; Granulation tissue indicates sufficient circulation and angiogenesis associated with
healthy wound healing. Granulation tissue consists of new blood vessels, not clotted cellular components.
Which process would most likely be considered an anomaly during the cellular phase of inflammation?
A. Platelet aggregation B. Vasoconstriction C. Migration of phagocytic white cells D. Macrophage activity
Answer: B Explanation; While vasoconstriction is a component of the immediate inflammatory response, the
later cellular phase of inflammation is accompanied by vasodilation. Platelet aggregation, migration of
phagocytic white cells, and macrophage activity are all associated with the cellular phase.
.
A client who is recovering from burn injuries is discussing his prognosis with a physician. Which teaching point
about expectations for healing should the physician offer? A. "Once your healing is complete, your skin will be
just as strong as before your accident." B. "You may find that the scar is a bit smaller than the area of the
wound." C. "You'll find that your new tissue is more elastic and fragile than the rest of your skin D. "The final
remodeling phase of healing may last up to 3 months in your case."
