Georgia Military College

PATHO HCR 240

Patho-Mod 4 (Ch 9-10) Quiz

CH 9

1)A client with a diagnosed history of arthritis has experienced cartilage damage. The nurse recognizes this may result from which physiologic factor?

2. A client has a splinter. The nurse expects a granulomatous inflammatory response. What does this involve?

3. The nurse is caring for a client with a stab wound. The nurse recognizes that deficiency of which of these elements of the blood will interfere with hemostasis at the site of injury?

4. A class of student nurses is hearing a lecture on wound healing. The professor explains about primary and secondary healing. What are the phases of wound healing?
   1. Proliferative phase
   2. Inflammatory phase
   3. Remodeling phase

5. Why do neonates and small children have problems with wound healing?

6. A client arrives with a large calf burn from contact with a motorcycle exhaust pipe. Inspection reveals the epidermis and dermis layers are affected with associated pain, redness, swelling, and blistering. What type of wound repair/healing will the nurse explain to this client?

7. Which wound is most likely to heal by secondary intention?

8. What should the nurse administer to a client who was bitten by a stray cat?

9. The nurse is caring for a client with an infected wound that is left to heal by secondary intention. Which observation does the nurse expect to make during assessment of the wound area?

10. Hyperbaric treatment for wound healing is used for wounds that have problems in healing due to hypoxia or infection. It works by raising the partial pressure of oxygen in plasma. How does hyperbaric oxygen treatment enhance wound healing?

11. A client with severe peripheral artery disease (PAD) has been educated about the various growth factors and their functions. This client is hoping that the growth factor, fibroblast growth factor (FGF), will be able to repair the circulation to his lower extremities because this growth factor's function is to:

12. The nurse is caring for a client diagnosed with systemic inflammatory response syndrome. Which illness is likely responsible for this diagnosis?

13. During a lecture on inflammation, the physiology instructor discusses the major cellular components involved in the inflammation response. The instructor asks, “Which cells arrive early in great numbers?” Which student response is correct?

14. Which body response to an acute inflammation will the nurse assess if the client is experiencing a systemic response?

15. A client in the acute stage of inflammation will experience vasodilation of the arterioles and congestion in the capillary beds. The nurse would assess the client’s skin for:

16. A nurse is assessing a client for the classic signs of acute inflammation. The nurse would assess the client for:

17. Which statements are true regarding chronic inflammation?
    1. It is usually a result of persistent irritants.
    2. The inflammatory agent is usually resistant to phagocytosis.
    3. It involves the presence of mononuclear cells like lymphocytes.

18. Which client would likely benefit the most from hyperbaric oxygen therapy?

19. The nurse is evaluating the bloodwork results of a client with an infected leg ulcer. The white blood cell count is 18,000 cells/uL. The nurse interprets this as:

20. The nurse caring for a postoperative client documents that the surgical incision is healing by:

21. The nurse is caring for a client who has experienced hypovolemic shock secondary to penetrating multiple trauma. When caring for the client postoperatively, which of these factors does the nurse recognize places the client at risk for poor wound healing?

22. The nurse is reviewing assessment documentation of a client’s wound and notes “purulent drainage.” The nurse would interpret this as:

23. The nurse is assessing the wound of a postoperative client. The client has a 6-inch abdominal wound that is well approximated and closed with surgical suture. The wound does not display any redness or drainage. The nurse would document the healing process as:

Following a severe automobile accident, a client is scheduled to have surgery to either repair or remove his spleen, pancreas, and stomach. The client wants the organs repaired and not removed if at all possible.

24. However, the nursing staff understands that extensive regeneration in parenchymal organs can only occur if:

25. While explaining to a young child why he should be careful with a wound, the nurse reviews healing with the parent. The nurse educates the parent about how strength in the healing wound site is developed based on which substance being available?

26. While reviewing the phases of wound healing, the students note that the first cells to arrive after the injury are the:

27. A continuing education nurse in a long-term care facility is discussing wound healing in older adult clients. Because older adult clients are more likely to have comorbidities like problems with mobility, diabetes, or vascular problems, the nurse should assess the clients for which problems?
    1. Pressure wounds on buttocks
    2. Impaired healing related to diabetes
    3. Ischemic ulcer formation in feet

28. A client has presented to the emergency department after he twisted his ankle while playing soccer. Which assessment findings are cardinal signs that the client is experiencing inflammation?
    1. The client's ankle is visibly red
    2. The ankle appears to be swollen
    3. The ankle is warmer than the unaffected ankle
    4. The client is experiencing pain

29. In the vascular phase of acute inflammation, initial vasoconstriction is followed rapidly by which assessment finding?

30. If a client has a bacterial infection in the blood, the nurse will note which laboratory value that correlates with this?

31. The parents of a 2-year-old child ask the nurse why their toddler's wounds do not seem to heal as quickly as their older children. Which response by the nurse is most accurate?

32. The nurse would identify the presence of granulation tissue at a wound site by which characteristic?

33. Which client is most likely to experience impaired (slow) wound healing?

34. A client sustained an injury 3 days ago. The nurse is assessing the status of the wound and anticipates the wound to be in which phase of healing?

35. Which condition is an example of wound healing by secondary intention?

36. A client is experiencing the early stages of an inflammatory process and develops leukocytosis. The nurse recognizes this as a/an:

37. The nurse is selecting a dressing for a vascular wound that has a dry wound surface. The most appropriate dressing for this wound is one that:

38. While the nurse is performing a skin assessment on a dark-skinned client, the nurse notes that the client has a healed wound on the leg but that the wound has an excess of scar tissue. The nurse documents this as:

39. When assessing a client's incision, the nurse notes that the edges of the once approximated incision has begun to pull apart. The nurse documents that the client's incision has:

40. When caring for a client with a wound that is healing by primary intention, the nurse recognizes which characterization best describes this type of wound?

41. When caring for a client during the proliferative phase of wound healing, the nurse teaches the client that which of these processes is taking place?

42. When caring for a postoperative client, in order to promote wound healing, which of these nutrients does the nurse encourage the client to consume?

43. The rehabilitation nurse is caring for a client who is recovering from a cerebrovascular accident (CVA) with hemiplegia. The family asks the nurse if the paralysis will be permanent. Upon which of these physiologic rationales should the nurse base the response?

44. The nurse is assessing a client with diabetes and notes an area on the client’s right foot as inflamed, necrotic, and eroded. The client states he accidentally slammed his foot in a door 2 weeks ago. The nurse would document this finding as a(n):

45. A client has experienced an acute inflammatory response with an elevation of white blood cells. The nurse is reviewing the client's most recent lab results to determine if the counts have returned to a normal range. Select the result that suggests the client is now within normal range.

46. A client states, “I heard that my healed wound tissue is stronger than my normal tissue. Is that true?” The nurse responds that roughly 3 months after a wound, the wound tensile strength is approximately what percentage of normal?

47. While reviewing how tissue repairs itself after injury, the students note that it follows a certain pattern. Place the steps of the repair of tissue in their proper sequence of events.
    1. Injury to connective tissue occurs.
    2. Fibroblasts migrate.
    3. Induction of fibroblast occurs and endothelial cells proliferate.
    4. Granulation tissue appears.
    5. Formation of a scar develops.
    6. Remodeling occurs with the reorganization of the fibrous tissue.

48. A client has just returned to the nursing unit following stent placement in her right femoral and popliteal artery related to severe peripheral artery disease. Upon assessment, the nurse is unable to palpate pulses in the right foot (pedal pulse and posterior tibial) or hear pulses with doppler. The nurse knows oxygen is required for which aspects of wound healing?
    1. Collagen synthesis
    2. Killing of bacteria by phagocytic white blood cells

1. 3. Destruction of microbes, neutrophils, and macrophages

49. A client presents with an oral temperature of 101.7°F (38.7°C) and painful, swollen cervical lymph nodes. Laboratory results indicate neutrophilia with a shift to the left. Which diagnosis is most likely?

50. Which child has the highest risk of experiencing a wound complication?

51. The nurse is caring for a client whose temperature is increasing. Which other vital sign/body response will the nurse monitor for an increase?

52. The nurse is evaluating the wounds of four clients. Select the client most likely to be treated with hyperbarically delivered oxygen.

53. Epithelialization, the first component of the proliferative phase of wound healing, is delayed in open wounds until what type of tissue has formed?

54. When the nurse is performing a skin assessment on a client, a small wound is noted on the client's right leg. The wound is covered with a desiccated scab. The appropriate action by the nurse is:

55. The wound care nurse is teaching a group of nurses about wound healing and, specifically, delays in wound healing. Which situations that interfere with wound healing, and could cause a delay in healing, should the nurse include in the discussion?
    1. Hyperglycemia
    2. Infections
    3. Malnutrition

56. When caring for a client who has developed bacterial pneumonia, the nurse assesses for which of these abnormalities that supports presence of infection?

57. The nurse is caring for an obese client who has had abdominal surgery. The medical record states the wound has developed a dehiscence. Which finding does the nurse anticipate observing when changing the dressing?

58. The nurse is providing discharge instructions for a postoperative client. The nurse determines the teaching is effective when the client verbalizes which statement about wound healing?

59. Select the statement that best describes the formation of a keloid.

60. A client cuts herself with a sharp knife while cooking dinner. The client describes how the wound started bleeding and had a red appearance almost immediately. The nurse knows that in the vascular stage of acute inflammation, the vessels:

61. During a lecture on wound care, the instructor mentions the final stage of the cellular response of acute inflammation. Which statement describes what physiologically occurs in the final stage?

62. A client who had an implantable cardioverter–defibrillator (ICD) returns the next week with a fever, chills, and elevated WBC. The physician suspects the wound is infected. If this wound does not respond to antibiotic therapy, the nurse can anticipate the client will undergo:

63. The cardinal signs of inflammation include swelling, pain, redness, and heat. What is the fifth cardinal sign of inflammation?

64. Inflammation can be either local or systemic. What are the most prominent systemic manifestations of inflammation?

65. Following surgery for appendicitis, a teenaged client notes four small "stab" wounds on the abdomen. The client is obviously worried about body appearance. The nurse explains, "Your body will heal quickly and tissue repair will allow for regeneration of any cells needed." The client asks, "What does regeneration mean?" The nurse responds that tissue repair by regeneration means:

66. After many years of cigarette smoking, a client is admitted to have a "mass" removed from the lung. When explaining the surgery and recovery, the physician notes that the client is likely to have a good amount of fibrosis develop at the surgical area. After the physician leaves the room, the client asks the nurse what was meant by "fibrosis" in the lung. The nurse bases the response on the fact that tissue repair can:

67. An infant was born with facial nerve paralysis that occurred with delivery. As the infant ages, it becomes apparent that the facial muscles affected by the nerve damage are not moving. Seeking surgical repair, the family asks why the damage to the child's face is not being repaired by the body. The health care provider states that neurons (connected to the facial muscles) are highly specialized cells that:

68. An oncology client is about to begin chemotherapy. During the education, the nurse mentions that continuously dividing cells will be most affected by the chemotherapy. The client asks, "What are continuously dividing cells?" The nurse responds, "These are cells that continue to divide and replicate like:

1. 1. cells on the surface of your skin."
   2. cells in your mouth."
   3. cells lining your GI tract."

69. A client with COPD controlled with long-term corticosteroids has developed an infection following bowel surgery. The nurse anticipated this complication since steroids:

70. A client with environmental allergies is experiencing respiratory inflammation. Which mediator causes vasodilation during the vascular stage of the inflammatory response?

1. 1. Histamine

71. A nurse educator is describing the way that cells involved in the inflammatory response find their way to the site of injury. Which description best reflects this physiologic mechanism?
72. What is the primary purpose of tissue regeneration in wound healing?

73. What is the initial step in the process of phagocytosis to degrade any bacteria and cellular debris?

74. In contrast to acute inflammation, chronic inflammation is characterized by which physiologic phenomena?

75. Which clients have a pathophysiologic process capable of causing fever by inducing the production of pyrogens?
    1.                 A farmer who cut his arm while sharpening tools coming to clinic because of acute inflammation signs like fever and redness
    2. An older adult recuperating following a myocardial infarction
    3. A client newly diagnosed with Hodgkin lymphoma

76. A client underwent an open cholecystectomy 2 days ago, and the incision is now in the proliferative phase of healing. What is the dominant cellular process that characterizes this phase of the client's healing?

77. The nurse is caring for a client with a chronic wound. The most important intervention for the nurse to include in the plan of care would be:

78. A nurse conducting a staff inservice on wound healing in older adults determines that the participants are understanding the information when they state that older adults may experience delayed wound healing due to which aging process?
    1. Decreased collagen synthesis
    2. Slower re-epithelialization
    3. Impaired wound contraction

79. The nurse is assessing a client for acute inflammation of a wound. For which symptom of infection does the nurse assess?

80. The surgeon has documented that a client is developing "proud flesh" at the postoperative wound site. The nurse recognizes this as:

81. A group of teenagers spent an entire day on the beach without using sunscreen. The first night, their skin was reddened and painful to touch. The second day, they awoke to find large fluid-filled blisters over several body areas. The nurse recognizes the development of blisters as which type of inflammatory response?

82. During the acute inflammatory response, there is a period called the transient phase where there is increased vascular permeability. What is considered the principal mediator of the immediate transient phase?