2022 - 2023 HESI - internal environment achieved through a system of:

2022 - 2023 HESI

Advanced Pathophysiolog FNP (Ver. 1 ) 100 Practice Q and A Included

• According to Walter B. Cannon, homeostasis is a stable

internal environment achieved through a system of:

• Interdependent system-wide adaptive responses

• Variable internal and external conditioning factors

• Coordinated physiologic processes that oppose change

• Compatibility between cells and the internal environment

Ans: C

Feedback:

Walter B. Cannon identified homeostasis, achieved by a coordinated physiologic process that opposes change. Claude Bernard recognized the importance of compatibility between cells and the internal environment. Hans Selye identified the general (systemic) adaptive and interdependent responses to stress. According to Selye, stressors produce different responses due to the influence of adaptive internal or external factors (conditioning factors).

• A child has been experiencing hypoglycemic episodes. “How

does the body know when to secrete insulin and when to stop secreting it?” The best response by the nurse, explaining the

physiologic background, would be:

• “The body knows that if the blood glucose level falls, it will

inhibit insulin secretion and release glycogen to release glucose from the liver.”

• “It's just a big guessing game; first we give sugar like orange

juice, and then we withhold the carbohydrates if the blood glucose level is too high.”

• “Your pituitary gland in the brain is the 'master gland,' and it

controls and regulates all the hormones.”

• “Once the child starts getting confused, the brain will send a

message to the pancreas to stop producing insulin.”

Ans: A

Feedback:

In the negative feedback mechanism that controls blood glucose levels, an increase in blood glucose stimulates an increase in insulin, which enhances removal of glucose from the blood. When glucose has been taken up by cells and blood glucose levels fall, insulin secretion is inhibited and glucagon and other counterregulatory mechanisms stimulate release of glucose from the liver, which causes blood glucose levels to return to normal.

• A client presents to the emergency department following a

major traffic accident. Though outwardly there are no apparent physical injuries found, the client is experiencing chest pain and heightened alertness, which the health care worker attributes to the first stage of general adaptation syndrome (GAS). The health care worker concludes the client is experiencing manifestations related to

the release of:

• Aldosterone, which interferes with sodium absorption

• Epinephrine

• Too little cortisol

• Thyroid-stimulating hormone

.

Ans: B

Feedback:

The general adaptation syndromes has three stages—the first is alarm (fight or flight); second is resistance (fight); and the third is exhaustion. The alarm stage is characterized by a generalized stimulation of the sympathetic nervous system (SNS) and the HPA, resulting in release of catecholamines and cortisol. Increased insulin release or TSH release is not part of the GAS.

• Although stress exposure initiates integrated responses by

multiple systems, the functional results are first manifested as: Select

all that apply.

• Enhanced respiratory rate/depth

• Cravings for high-carbohydrate foods

• Increased alertness and focus

• Increased glucose utilization

• Increased GI peristalsis

Ans: A, C, D

Feedback:

Exposure to stress activates an immediate response by the neuroendocrine system that plays a role in most of the responses to stress and attempts to adapt. Results of the coordinated release of these neurohormones include mobilization of energy, a sharpened focus and awareness, increased cerebral blood flow and glucose utilization, enhanced cardiovascular and respiratory functioning, redistribution of blood flow to the brain and muscles, modulation of the immune response, inhibition of reproductive function, and a decrease in appetite. 1 / 3

• A client is experiencing significant stress while awaiting the

results of her recent lymph node biopsy. Among the hormonal contributors to this response is a release of aldosterone, resulting in which of the following physiologic effects?

• Decreased release of insulin

• Increased cardiac contractility

• Potentiating effects of epinephrine

• Increased sodium absorption

Ans: D

Feedback:

Mineralocorticoids such as aldosterone increase sodium absorption by the kidneys. Changes in insulin release and cardiac contractility are mediated by catecholamines, whereas cortisol potentiates the action of epinephrine.

• While looking at cancer cells under a microscope, the

instructor asks the students to describe the cells. Which of the student answers are accurate? Select all that apply.

• The cells are in different sizes and shapes.

• The nucleoli are larger than normal.

• The cells are contact inhibited.

• The cells do not resemble the tissue of origin.

• The cells are attached to an extracellular matrix.

Ans: A, B, D

Feedback:

Undifferentiated cancer cells are marked by a number of morphologic changes. Both the cells and nuclei display variations in size and shape. Their nuclei are variable in size and bizarre in shape, their chromatin is coarse and clumped, and their nucleoli are often considerably larger than normal. The cells of malignant tumors are characterized by wide changes of parenchymal cell differentiation from well differentiated to completely undifferentiated. Normal cells that are grown in culture tend to display a feature called cell density– dependent inhibition, in which they stop dividing after the cell population reaches a particular density. This is sometimes referred to as contact inhibition since cells often stop growing when they come into contact with each other. In contrast to normal cells, cancer cells often survive in microenvironments different from those of the normal cells. They frequently remain viable and multiply without normal attachments to other cells and the extracellular matrix.

• The angiogenesis process, which allows tumors to develop

new blood vessels, is triggered and regulated by tumor-secreted:

• Procoagulants

• Growth factors

• Attachment factors
• Proteolytic enzymes

Ans: B

Feedback:

Many tumors secrete growth factors, which trigger and regulate the angiogenesis process. Tumor cells express various cell surface attachment factors, for anchoring. Tumor cells secrete proteolytic enzymes to degrade the basement membrane and migrate into surrounding tissue. Cancer cells may produce procoagulant materials that affect clotting mechanisms.

• Which of the following processes characterizes an epigenetic

contribution to oncogenesis?

• A DNA repair mechanism is disrupted.

• A tumor suppressor gene is present, but it is not expressed.

• Cells lose their normal contact inhibition.

• Regulation of apoptosis in impaired, resulting in

accumulation of cancer cells.

Ans: B

Feedback:

Epigenetic mechanisms of cancer growth involve changes in the patterns of gene expression without a change in the DNA.Epigenetic mechanisms may “silence” genes, such as tumor suppressor genes, so that even though the gene is present, it is not expressed and a cancer-suppressing protein is not made. Disruption of DNA repair may contribute to cancer, but this process is not particular to epigenetics. Similarly, loss of contact inhibition and impaired apoptosis are associated with cancer but are not specific manifestations of epigenetic mechanisms.

• An oncology nurse is caring for a client with newly diagnosed

B-cell lymphoma. Extensive blood work has been drawn and sent to the lab. Results reveal an elevated antiapoptotic protein BCL-2 level.The client/family asks, “What does this mean?” The health care

provider bases his or her response on the fact that:

• The client's immune system is trying to kill the cancer cell by

sending this protein to engulf it.

• This is a good result. Normal cells undergo apoptosis if DNA

is damaged in any way.

• This means the cancer cells have found a way to survive and

grow even with damaged DNA.

• The client's body is trying to limit the blood supply to the

cancer cells by producing high levels of this protein.

Ans: C

Feedback:

Alterations in apoptotic and antiapoptotic pathways have been found in many cancers. One example is the high levels of the antiapoptotic protein BCL-2 that occur secondary to a chromosomal translocation in certain B-cell lymphomas. The mitochondrial 2 / 3

membrane is a key regulator of the balance between cell death and survival. Proteins in the BCL-2 family reside in the inner mitochondrial membrane and are either proapoptotic or antiapoptotic. Since apoptosis is considered a normal cellular response to DNA damage, loss of normal apoptotic pathways may contribute to cancer by enabling DNA-damaged cells to survive.

• A farmer's long-term exposure to pesticides has made the

cells in his alveoli and bronchial tree susceptible to malignancy. Which of the following processes has taken place in the farmer's lungs?

• Promotion

• Progression

• Initiation

• Differentiation

Ans: C

Feedback:

Initiation involves the exposure of cells to appropriate doses of a carcinogenic agent that makes them susceptible to malignant transformation, whereas promotion involves the induction of unregulated accelerated growth in already initiated cells. Progression is the later process whereby tumor cells acquire malignant phenotypic changes, and differentiation is the process of specialization whereby new cells acquire the structural, microscopic, and functional characteristics of the cells they replace.

• Which of the following practitioners is most likely to be of

immediate assistance in the first 24 hours following delivery of an infant with a cleft lip?

• Lactation consultant

• Respiratory therapist

• Occupational therapist

• Social worker

Ans: A

Feedback:

Infants with a cleft lip typically have difficulty with feeding, and the assistance of a lactation consultant may be of help in establishing feeding patterns. Oxygenation is not a typical problem, while activities of daily living and assistive devices are not relevant considerations. While social work is often of assistance when a child is born with a congenital condition, a cleft lip has fewer implications than most other inherited disorders.

• The newborn has been born with distinctive physical features

of trisomy 21, Down syndrome. The mother asks the nurse, “What is wrong? My baby looks different than his brother.” The nurse assesses the infant and notes which of the following characteristics that correlate with trisomy 21? Select all that apply.

• Upward slanting of eyes
• Large, protruding ears

• Large tongue sticking out the mouth

• Long fingers with extra creases

• Flat facial profile

Ans: A, C, E

Feedback:

The physical features of a child with Down syndrome are distinctive, and therefore the condition usually is apparent at birth.These features include growth failure and a small and rather square head. There is a flat facial profile, small nose, and somewhat depressed nasal bridge; upward slanting of the eyes; small, low-set, and malformed ears; and a large, protruding tongue. The child's hands usually are short and stubby, with fingers that curl inward, and there usually is only a single palmar crease (simian crease).

• A 41-year-old woman has made the recent decision to start a

family and is eager to undergo testing to mitigate the possibility of having a child with Down syndrome. Which of the following tests is most likely to provide the data the woman seeks?

• Genetic testing of the woman

• Genetic testing of the woman and the father

• Prenatal blood tests

• Ultrasonography

Ans: C

Feedback:

Down syndrome is a result of chromosomal abnormality and is not a single-gene disorder. As a result, genetic testing of the mother and/or father is not relevant. Ultrasonography does not have predicative value for Down syndrome, but blood tests such as - fetoprotein, human chorionic gonadotropin (HCG), unconjugated estriol, inhibin A, and pregnancy-associated plasma protein A have helped ascertain the risks.

• Aneuploidy of the X chromosome can result in a monosomy

or polysomy disorder. The clinical manifestations of a female with

monosomy X include: Select all that apply.

• A short-stature female individual

• Difficulty with fine motor skills

• Large heavy breasts

• Early-onset (age 8) puberty

• Nonpitting lymphedema of the feet

Ans: A, B, E

Feedback:

Turner syndrome produces a female individual who is short, has no secondary sex characteristics, has normal intelligence, and fails

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