McCance & Huether’s Pathophysiology
The Biologic Basis for Disease in Adults and Children
9th Edition
• Author(s)Julia Rogers
TEST BANK
1
Reference
Ch. 1 — Cellular Biology — Prokaryotes and Eukaryotes
Stem
A 32-year-old patient with recurrent urinary tract infections has
a urine culture showing a gram-negative rod and worsening
dysuria despite oral antibiotics. Urinalysis shows pyuria and few
epithelial cells. Which cellular characteristic most likely explains
the organism’s persistent virulence and resistance to host
defenses in this scenario?
Options
A. Presence of a nuclear membrane allowing rapid genetic
adaptation
B. A peptidoglycan-rich cell wall that resists phagocytosis
C. Outer membrane containing lipopolysaccharide and porins
that impede antibiotic entry
D. Membrane-bound organelles that sequester antibiotic
targets
,Correct Answer
C
Rationales
Correct (C): Gram-negative bacteria have an outer membrane
with lipopolysaccharide (LPS) and porin channels; LPS
contributes to virulence and porins can limit antibiotic
penetration, explaining persistent infection despite therapy.
This links microbial structure to systemic treatment failure and
host inflammatory response. NCLEX reasoning: identify
structural feature causing clinical resistance and risk of
endotoxin-mediated inflammation.
Incorrect (A): Prokaryotes lack a nuclear membrane; this is a
eukaryotic trait and cannot explain bacterial virulence.
Incorrect (B): A thick peptidoglycan wall is characteristic of
gram-positive bacteria; gram-negative organisms have thinner
peptidoglycan beneath the outer membrane.
Incorrect (D): Prokaryotes lack membrane-bound organelles;
sequestration of antibiotic targets is not a prokaryotic
mechanism.
Teaching Point
Gram-negative outer membrane (LPS, porins) reduces antibiotic
entry and increases virulence.
Citation
Rogers, J., et al. (2023). Pathophysiology: The Biologic Basis for
Disease in Adults and Children (9th ed.). Ch. 1.
,2
Reference
Ch. 1 — Cellular Biology — Cellular Functions
Stem
A postoperative patient develops hypotension and poor urine
output. Laboratory tests reveal elevated lactate and decreased
ATP production on cellular assays. Which cellular failure best
explains the sequence from decreased ATP to oliguria?
Options
A. Failure of endoplasmic reticulum protein synthesis causing
decreased oncotic pressure
B. Na⁺/K⁺-ATPase pump dysfunction leading to cellular swelling
in renal tubular cells
C. Increased oxidative phosphorylation increasing reactive
oxygen species that enhance diuresis
D. Mitochondrial hyperactivity causing excessive ATP and
vasodilation
Correct Answer
B
Rationales
Correct (B): Decreased ATP impairs Na⁺/K⁺-ATPase, causing
intracellular Na⁺ accumulation, cellular swelling, and
dysfunction of renal tubular epithelial cells — producing
decreased urine output (oliguria). Mechanistically aligns with
McCance’s emphasis on ATP-dependent ion pumps and cell
, volume regulation. NCLEX prioritization: recognize ATP
depletion as early red flag for organ dysfunction.
Incorrect (A): ER protein synthesis failure affects secretory
proteins but does not directly cause acute oliguria via ionic
dysregulation.
Incorrect (C): Increased oxidative phosphorylation would
typically raise ATP, not decrease it; ROS may injure cells but
would not explain immediate oliguria via increased diuresis.
Incorrect (D): Mitochondrial hyperactivity increasing ATP
contradicts the labs showing decreased ATP; it does not explain
hypotension and oliguria.
Teaching Point
ATP depletion → Na⁺/K⁺ pump failure → cellular swelling →
organ dysfunction (oliguria).
Citation
Rogers, J., et al. (2023). Pathophysiology: The Biologic Basis for
Disease in Adults and Children (9th ed.). Ch. 1.
3
Reference
Ch. 1 — Cellular Biology — Structure and Function of Cellular
Components (Mitochondria)
Stem
A 45-year-old woman presents with progressive muscle
weakness and lactic acidosis after a viral illness. Muscle biopsy
The Biologic Basis for Disease in Adults and Children
9th Edition
• Author(s)Julia Rogers
TEST BANK
1
Reference
Ch. 1 — Cellular Biology — Prokaryotes and Eukaryotes
Stem
A 32-year-old patient with recurrent urinary tract infections has
a urine culture showing a gram-negative rod and worsening
dysuria despite oral antibiotics. Urinalysis shows pyuria and few
epithelial cells. Which cellular characteristic most likely explains
the organism’s persistent virulence and resistance to host
defenses in this scenario?
Options
A. Presence of a nuclear membrane allowing rapid genetic
adaptation
B. A peptidoglycan-rich cell wall that resists phagocytosis
C. Outer membrane containing lipopolysaccharide and porins
that impede antibiotic entry
D. Membrane-bound organelles that sequester antibiotic
targets
,Correct Answer
C
Rationales
Correct (C): Gram-negative bacteria have an outer membrane
with lipopolysaccharide (LPS) and porin channels; LPS
contributes to virulence and porins can limit antibiotic
penetration, explaining persistent infection despite therapy.
This links microbial structure to systemic treatment failure and
host inflammatory response. NCLEX reasoning: identify
structural feature causing clinical resistance and risk of
endotoxin-mediated inflammation.
Incorrect (A): Prokaryotes lack a nuclear membrane; this is a
eukaryotic trait and cannot explain bacterial virulence.
Incorrect (B): A thick peptidoglycan wall is characteristic of
gram-positive bacteria; gram-negative organisms have thinner
peptidoglycan beneath the outer membrane.
Incorrect (D): Prokaryotes lack membrane-bound organelles;
sequestration of antibiotic targets is not a prokaryotic
mechanism.
Teaching Point
Gram-negative outer membrane (LPS, porins) reduces antibiotic
entry and increases virulence.
Citation
Rogers, J., et al. (2023). Pathophysiology: The Biologic Basis for
Disease in Adults and Children (9th ed.). Ch. 1.
,2
Reference
Ch. 1 — Cellular Biology — Cellular Functions
Stem
A postoperative patient develops hypotension and poor urine
output. Laboratory tests reveal elevated lactate and decreased
ATP production on cellular assays. Which cellular failure best
explains the sequence from decreased ATP to oliguria?
Options
A. Failure of endoplasmic reticulum protein synthesis causing
decreased oncotic pressure
B. Na⁺/K⁺-ATPase pump dysfunction leading to cellular swelling
in renal tubular cells
C. Increased oxidative phosphorylation increasing reactive
oxygen species that enhance diuresis
D. Mitochondrial hyperactivity causing excessive ATP and
vasodilation
Correct Answer
B
Rationales
Correct (B): Decreased ATP impairs Na⁺/K⁺-ATPase, causing
intracellular Na⁺ accumulation, cellular swelling, and
dysfunction of renal tubular epithelial cells — producing
decreased urine output (oliguria). Mechanistically aligns with
McCance’s emphasis on ATP-dependent ion pumps and cell
, volume regulation. NCLEX prioritization: recognize ATP
depletion as early red flag for organ dysfunction.
Incorrect (A): ER protein synthesis failure affects secretory
proteins but does not directly cause acute oliguria via ionic
dysregulation.
Incorrect (C): Increased oxidative phosphorylation would
typically raise ATP, not decrease it; ROS may injure cells but
would not explain immediate oliguria via increased diuresis.
Incorrect (D): Mitochondrial hyperactivity increasing ATP
contradicts the labs showing decreased ATP; it does not explain
hypotension and oliguria.
Teaching Point
ATP depletion → Na⁺/K⁺ pump failure → cellular swelling →
organ dysfunction (oliguria).
Citation
Rogers, J., et al. (2023). Pathophysiology: The Biologic Basis for
Disease in Adults and Children (9th ed.). Ch. 1.
3
Reference
Ch. 1 — Cellular Biology — Structure and Function of Cellular
Components (Mitochondria)
Stem
A 45-year-old woman presents with progressive muscle
weakness and lactic acidosis after a viral illness. Muscle biopsy
