Mastery quiz questions Ch.4 – Flashcards
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While the nurse is performing a skin assessment on an African American 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 which of the following?
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Keloid -The nurse doucments the existence of excess of scar tissue on a healed wound as a Keloid. These are more common in African Americans. Proud flesh is an excess of granulation tissue in a healing wound. Remodeling is the third phase of wound healing. Epithelialization is the migtation, proliferation, and diffentiation of epeithilial cess on th wound edges and occurs during the proliferative phase of wound healing.
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Which responsibility of the extracellular matrix (ECM) most accurate?
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The ECM provides the scaffolding for tissue renewal. -The ECM provides the scaffolding for tissue renewal. Although the cells in many tissues are capable of regeneration, injury does not always result in restoration of normal structure unless the ECM is intact. Some of the proteases, such as the collagenases, are highly specific, cleaving particular proteins at a small number of sites. This allows for the structural integrity of the ECM to be retained while healing occurs.
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Which of the following is an example of wound healing by secondary intention?
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An infected burn of the arm -A sutured surgical incision is an example of healing by primary intention. Larger wounds (e.g., burns and large surface wounds) that have a greater loss of tissue and contamination heal by secondary intention. Healing by secondary intention is slower than healing by primary intention and results in the formation of larger amounts of scar tissue.
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During a review session discussing cells, a student asks, "What do you call it when a cell becomes more specialized in terms of structure?" Which response answers the question correctly?
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Cell differentiation -Cell differentiation is the process whereby a cell becomes more specialized in terms of structure and function. Cell proliferation refers to the process of increasing cell numbers by mitotic division. Mitosis is the actual splitting of a cell into two separate daughter cells.
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Following hip replacement surgery, the client has had many weeks of physical therapy. Upon assessing the wound, it is still red and draining thick, green, odoriferous secretions. The client has limited range-of-motion and is constantly reporting pain. The physician explains that the hip device needs to be removed. Why is removal required?
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The body considers the hip replacement device a foreign body and an infection has developed around the joint. -Wound infections are of special concern in persons with implantation of foreign bodies such as orthopedic devices (e.g., pins, stabilization devices), cardiac pacemakers, and shunt catheters. These infections are difficult to treat and may require removal of the device.
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All wounds are considered contaminated at the time they occur. Usually, the natural defenses in our bodies can deal with the invading microorganisms; however, there are times when a wound is badly contaminated and host defenses are overwhelmed. What happens to the healing process when host defenses are overwhelmed by infectious agents?
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The formation of granulation tissue is impaired. -Infection impairs all dimensions of wound healing. It prolongs the inflammatory phase, impairs the formation of granulation tissue, and inhibits proliferation of fibroblasts and deposition of collagen fibers. All wounds are contaminated at the time of injury. Although body defenses can handle the invasion of microorganisms at the time of wounding, badly contaminated wounds can overwhelm host defenses. Trauma and existing impairment of host defenses can also contribute to the development of wound infections.
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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:
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result in replacement tissue in the form of connective (fibrous) tissue which leads to scar formation or fibrosis of the lung. -Tissue repair can take the form of replacement by connective (fibrous) tissue, which leads to scar formation or fibrosis in organs such as the liver or lung. Regeneration of tissue results with injured cells being replaced with cells of the same type. Although age does play a role in tissue healing, it is not the only factor that can result in scar formation.
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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?
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Collagen synthesis -Collagen synthesis is important to the development of strength in the healing wound site. Plasma, exudate, and stable cells do not give strenth to the healing tissue.
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Select the option that most accurately describes the process resulting in specialized cells.
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Differentiation
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Of the following list of patients, which would likely benefit the most from hyperbaric oxygen therapy?
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A trauma patient who developed Clostridium spp., an anaerobic bacterial infection in their femur. -Hyperbaric oxygen is a treatment that has demonstrated improved wound healing in multiple types of injuries. It enhances wound healing by a number of mechanisms, including the increased killing of bacteria by neutrophils, impaired growth of anaerobic bacteria, and the promotion of angiogenesis.
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The nurse is caring for a client with an accumulation of 2.5 cm. of darkened tissue scar over the area of a 3 mm. injury. How does the nurse correctly document this finding in the medical record?
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Keloid -Keloids are tumor-like masses caused by excess production of scar tissue. The tendency toward development of keloids is more common in African Americans and seems to have a genetic basis.
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When caring for a postoperative client, in order to promote wound healing, which of these nutrients does the nurse encourage the client to consume?
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Vitamin C -Vitamins are essential cofactors for the daily functions of the body; vitamins A and C play an essential role in the healing process. Vitamin C is needed for collagen synthesis. Vitamin K plays an indirect role in wound healing by preventing bleeding disorders that contribute to hematoma formation and subsequent infection. Proteins, fats, carbohydrates and microminerals such as zinc are required for wound healing as well.
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While studying for a pathophysiology exam on cells and tissue repair, a student asks, "What happens if, in the process of going through the cell cycle, a cell is damaged?" Which is the best response?
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"There are built in checkpoints in the cell cycle to allow for defects to be edited and repaired." -Within the cell cycle are checkpoints where pauses or arrests can be made if the specific events in the phases of the cell cycle have not been completed. There are also opportunities for ensuring the accuracy of DNA replication. These DNA damage checkpoints allow for any defects to be edited and repaired, thereby ensuring that each daughter cell receives a full complement of genetic information, identical to that of the parent cell.
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Metalloproteinase requires which mineral to be present before degraduation of collagen occurs?
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Zinc -The degradation of collagen and other ECM proteins is achieved through a family of metalloproteinases, which require zinc for their activity. Their synthesis may be suppressed pharmacologically by corticosteroids.
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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?
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Tissue Hypoxia -Impaired wound healing may occur due to poor blood flow (e.g., swelling) or preexisting health problems. In situations of trauma, a decrease in blood volume may cause a reduction in blood flow to injured tissues. Hyperbaric oxygen is a treatment that delivers 96% to 100% oxygen at greater than twice the normal atmospheric pressure at sea level to improve wound healing. Keloids are masses produced from excess scar tissue; scar tissue formation is the final phase of wound healing
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When discussing cellular replication with a client with chronic kidney disease, the client asks, "Can't my body just repair or grow a new kidney?" The nurse responds, "The kidney is a stable tissue and has only limited replicative capacity. In humans, the exception to this is the:
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liver -Stable tissues contain cells that normally stop dividing when growth ceases. Cells in these tissues remain quiescent in the G0 stage of the cell cycle. However, these cells are capable of undergoing regeneration when confronted with an appropriate stimulus. With the exception of the liver, stable cells have only limited replicative capacity. The heart, lungs, and pancrease are considered permanent tissues that do not proliferate.
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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:
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Vitamin C and Zinc supplements -Vitamins play an essential role in the healing process. Vitamin C is needed for collagen synthesis. Zinc has been found to aid in reepithelialization. Vitamin C and zinc supplements are often ordered for clients with chronic wounds to promote wound healing. Steroid therapy would decrease wound healing. A diet high in proteins and carbohydrates would be ordered to promote wound healing.
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A client sustained an injury 3 days ago. The nurse is assessing the status of the wound. The nurse anticipates the phase of healing to be:
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Proliferative -The proliferative phase begins within 2 to 3 days of an injury and focuses on building new tissue to fill the wound. The inflammatory phase begins at the time of the injury occurrence. The remodeling phase occurs approximately 3 weeks after the injury, and there is not a collagen phase
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A family member asks the nurse, "What do they mean when they start taking about stem cells?" Which is the nurse's best response?
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Stem cells are undifferentiated cells with the capacity to generate multiple different cell types.
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The nurse is caring for a post operative patients documents that the surgical incision is healing by which of the following?
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Primary intention -The nurse would document the surgical wound as healing by primary intention as there is no tissue loss. Wounds healing form secondary intention are larger and have a greater loss of tissue and contamination. Wounds do not heal by tertiary intention or systemic intention.
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The nurse is caring for four clients. Select the client who is at greatest risk for decreased wound healing.
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An 80-year-old diabetic client with a foot ulcer -Any client with an autoimmune disease (i.e., diabetes) is at greater risk for decreased wound healing because the healing process relies on the immune reaction. The client also has the added risk factor that age presents. While nutrition and age both play a role in wound healing, the remaining options have only one of the several factors that can affect wound healing.
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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 from normal?
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70% of normal -Tensile strength increases rapidly over the weeks and then slows, reaching a plateau of approximately 70% to 80% of the tensile strength of unwounded skin at the end of 3 months.
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When completing a dressing change, the nurse notes that the wound has proud flesh. Which is the appropriate action by the nurse?
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Request surgical consult -The most appropriate action by the nurse is to request a surgical consult as proud flesh refers to an excess of granulation tissue that will require surgical removal or chemical cauterization of the defect to allow healing to proceed.
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Which statements are true regarding the contraction and remodeling of a wound? Select all that apply.
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• This phase generally begins about 3 weeks after the injury. • The development of a fibrous scar is important to the success of the process. • This phase can take up to 6 months or longer to complete. -This phase begins approximately 3 weeks after injury with the development of the fibrous scar, and can continue for 6 months or longer, depending on the extent of the wound. During this phase, there is a decrease in vascularity and continued remodeling of scar tissue by simultaneous synthesis of collagen by fibroblasts and lysis by collagenase enzymes. As a result of these two processes, the architecture of the scar is capable of increasing its tensile strength, and the scar shrinks so it is less visible.
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Which of the following clients would be considered a good candidate for hyperbaric oxygen therapy?
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An older adult with history of diabetes and intermittent claudication (poor circulation in the legs) who received a laceration while on the lawnmower -Hyperbaric oxygen therapy delivers 100% oxygen at two to three times the normal atmospheric pressure at sea level. The goal of hyperbaric oxygen therapy is to increase oxygen delivery to tissues by increasing the partial pressure of oxygen dissolved in the plasma. Hyperbaric oxygen is currently reserved for the treatment of problem wounds in which hypoxia and infection interfere with healing.
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A client with diabetes has a wound that will not heal. The client has been prescribed hyperbaric oxygen therapy. The client asks why he is going in an oxygen chamber instead of just having dressing changes and IV antibiotic therapy. The nurse knows that hyperbaric oxygen is currently used in wounds that have: Select all that apply.
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• limited oxygen supply which is common in clients with diabetes. • an infection that is interfering with healing. -Hyperbaric oxygen therapy delivers 100% oxygen at two to three times the normal atmospheric pressure at sea level. The goal of hyperbaric oxygen therapy is to increase oxygen delivery to tissues by increasing the partial pressure of oxygen dissolved in the plasma. Hyperbaric oxygen is currently reserved for the treatment of problem wounds in which hypoxia and infection interfere with healing. Plasma drainage, eschar, and ineffective topical O2 are not reasons to institute hyperbaric oxygen therapy.
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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:
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Removal of device -Wound infections are of special concern in persons with implantation of foreign bodies such as orthopedic devices (e.g., pins, stabilization devices), cardiac pacemakers, and shunt catheters. These infections are difficult to treat and may require removal of the device.
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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: Select all that apply.
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• cells on the surface of your skin." • cells in your mouth." • cells lining your GI tract." -Continuously dividing or labile tissues are those in which the cells continue to divide and replicate throughout life, replacing cells that are continually being destroyed. They include the surface epithelial cells of the skin, oral cavity, vagina, and cervix; the columnar epithelium of the gastrointestinal tract, uterus, and fallopian tubes; the transitional epithelium of the urinary tract; and bone marrow cells. Neurons lose their ability to proliferate once development of the nervous system is complete. Heart muscle cells were believed to not regenerate, however recent finding suggest that about half of your heart's muscle cells are normally replaced over a lifetime. However, it is a slow process and these cells are not continuously dividing.
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The nurse is caring for a client with an infected wound that is left to heal by secondary intention. Which of these observations does the nurse expect to make during assessment of the wound area?
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The wound is healing slowly with epithelial and scar tissues present. -Wounds healing by secondary intention undergo wound contraction resulting in a scar considerably smaller than the original wound. Cosmetically, this may be desirable because it reduces the size of the visible defect. Keloids result from abnormal wound healing, resulting in tumor-like masses caused by excess production of scar tissue. Sutures are present in wounds healing by primary intention.
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While explaining to a client who is about to undergo a stem cell transplant, the nurse mentions that a single stem cells can give rise to many cells needed for normal tissue repair. The process is called __________replication
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asymmetric -Asymmetric replication means that after each cell division, some progeny of the stem cell enter a differentiation pathway, while others remain undifferentiated, retaining their self-renewal capacity. The progeny of each progenitor cell follows a more restricted genetic program, with the differentiating cells undergoing multiple mitotic divisions in the process of becoming a more mature cell type, and with each generation of cells becoming more specialized. In this way, a single stem cell can give rise to the many cells needed for normal tissue repair or blood cell production. Totipotent stem cells are those produced by a fertilized ovum. Totipotent stem cells give rise to pluripotent stem cells that can differentiate into the three germ layers of the embryo. Embryonic stem cells are pluripotent cells derived from the inner cell mass of the blastocyst stage of the embryo.
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A client with COPD controlled with long-term corticosteroids has developed an infection following bowel surgery. The nurse anticipated this complication since steroids:
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impair the phagocytic property of leukocytes -The therapeutic administration of corticosteroid drugs decreases the inflammatory process and may delay the healing process. These hormones decrease capillary permeability during the early stages of inflammation, impair the phagocytic property of the leukocytes, and inhibit fibroblast proliferation and function. Steroid side effects usually cause hyperglycemia, muscle wasting, and hypertension.
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A client asks the nurse why a scar developed after an injury. The best response would be:
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Fibrous tissue -Replacement of damaged tissue by connective (fibrous tissue) tissue leads to scar formation. Parenchymal tissue repair would not result in scar formation. Cell apoptosis refers to cell death, while stem cells are undifferentiated cells.
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A continuing education nurse in a long-term care facility is discussing wound healing in elderly patients. Due to elderly patients being more likely to have co-morbidities like problems with mobility, diabetes, or vascular problems, the nurses should assess the patients for: Select all that apply.
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• Pressure wounds on buttocks. • Ischemic ulcer formation in feet. • Impaired healing related to diabetes. -The elderly are more vulnerable to chronic wounds, chiefly pressure, diabetic, and ischemic ulcers, than younger persons, and these wounds heal more slowly. However, these wounds are more likely due to other disorders such as immobility, diabetes mellitus, or vascular disease, rather than aging.
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A client with a complete tear of the rotator cuff in the right shoulder was given the choice between surgery and stem cell transplant. The client chose to try the stem cell injection. The client asked the health care provider, "How does this work on my shoulder?" The best response would be:
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Bone marrow stem cells have been shown to generate cartilage, bone, and muscle when injected directly into the injured site. -Whether adult stem cells have a differentiation capacity similar to that of embryonic stem cells remains the subject of current debate and research. Thus far, bone marrow stem cells have been shown to have very broad differentiation capabilities, being able to generate not only blood cells but also fat, cartilage, bone, endothelial, and muscle cells.
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A client with a torn rotator cuff has been asked by his physician, a regenerative specialist, to consider allowing transplantation of his own stem cells into his area of injury. This is an example of:
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Therapeutic cloning -One of the most exciting prospects in regenerative medicine is a type of stem cell therapy known as therapeutic cloning. Other potential therapeutic strategies that use stem cells involve the transplantation of stem cells into areas of injury, mobilization of stem cells from the bone marrow into injured tissues, and use of stem cell culture systems to produce large amounts of differentiated stem cells for transplantation into injured tissue. It does not involve surgical repair, steroid injections, or bone grafting.
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A mature scar will likely be pale in color due to:
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transformation from a highly vascular granulation tissue into an avascular scar. -As the scar matures, vascular degeneration eventually transforms the highly vascular granulation tissue into a pale, largely avascular scar. Lack of malanocytes or elastic tissue is not responsbile for the pale skin. Use of sunscreen is always a good idea but not the primary reason for new scars to be pale in color
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A child is brought to the emergency department after he fell and cut his leg on a piece of fencing. While explaining the process of normal tissue repair, the nurse explains that certain cells, like fibroblasts, proliferate at times like this with the production of:
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growth factors to help the cells respond and expand in numbers to repair the injury. -Several cell types proliferate during tissue repair including remnants of injured parenchymal tissue cells, vascular endothelial cells, and fibroblasts. The proliferation of these cell types is driven by proteins called growth factors. The production of growth factors and the ability of these cells to respond and expand in sufficient numbers are important determinants of the repair process. Glucocorticoids do not help foster tissue repair. Blood does form clots to stop the bleeding at the site of injury, however, it does not play a role in new tissue repair.
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While reviewing the phases of wound healing, the students note that the first cells to arrive after the injury are the:
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neutrophils -The cellular phase of inflammation follows and is evidenced by the migration of phagocytic white blood cells that digest and remove invading organisms, fibrin, extracellular debris, and other foreign matter. The neutrophils arrive within minutes and are usually gone by day 3 or 4. They ingest bacteria and cellular debris. Within 24 to 48 hours, macrophages, which are larger phagocytic cells, enter the wound area and remain for an extended period. These cells, arising from blood monocytes, are essential to the healing process. The final component of the proliferative phase is epithelialization, which is the migration, proliferation, and differentiation of the epithelial cells at the wound edges to form a new surface layer that is similar to that destroyed by the injury.
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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?
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It is likely that paralysis is permanent, as nerve cells do not normally regenerate. -Labile cells continue to divide and replicate throughout life, replacing cells that are continually being destroyed. Stable cells are those that normally stop dividing when growth ceases; however, they are capable of regeneration when confronted with an appropriate stimulus. Permanent or fixed cells, including nerve cells, skeletal muscle cells, and cardiac muscle cells cannot undergo mitotic division. Once destroyed, they are replaced with fibrous scar tissue. Exudate into a wound area is generally short-lived; however, once damaged, the nerve cells cannot regenerate.
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The student nurse is removing sutures on client after abdominal surgery, and the wound begins to pull apart. The students asks their instructor, "Did I do something wrong?" The instructor reviews wound healing and replies:
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"Maybe the wound edges were not close enough together to allow epithelialization of the wound to occur." -Approximation of the wound edges (i.e., suturing of an incision type of wound) greatly enhances healing and prevents infection. Epithelialization of a wound with closely approximated edges occurs within 1 to 2 days. Large, gaping wounds tend to heal more slowly because it is often impossible to effect wound closure with this type of wound. Mechanical factors such as increased local pressure or torsion can cause wounds to pull apart, or dehisce. There are no data to support the other distractors as being valid.
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Regulation of blood cells is thought to be controlled in part by which of the following hormonelike growth factors?
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Cytokines -Cytokines are hormonelike growth factors that are short-lived mediators that stimulate the proliferation, differentiation, and functional activation of various blood cells. None of the other options are hormonelike growth factors that regulate blood cells
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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 healthcare provider states that neurons [connected to the facial muscles] are highly specialized cells that:
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lose their ability to proliferate once development of the nervous system is complete. -Neurons, which are highly specialized cells, lose their ability to proliferate once development of the nervous system is complete. In constant renewing cell populations, like the GI tract, the more specialized cells are unable to divide and rely on parent cells of the same lineage. Growth factors aide in tissue repair, not repair of neurons.
