2020 HESI Advanced Pathophysiology Practice Exam With Answers (100 Solved Questions)

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HESI ADVANCED PATHOPHYSIOLOGY V2( 100PRACTICE QUESTIONS ANDANSWERS)ALL CORRECT.1.Upon admission assessment, the nurse hears amurmur located at the fifth intercostal space,midclavicularline.Theclientasks,“Whatdoesthatmean?”Thenursewillbase her answer on whichof the following physiologicprinciples?A)“Youhavebeenexposedtoaninfectionthatwentintoyour bloodstream.”B)“Youhaveaheartvalvethatisdiseased.”C)“Youhearthasbeenpumpingyourbloodsohard,thatthe pressurehas damagedyourvalves.”D)“Yourhearthasenlarged,sonaturallyyourvalveshadtoenlarge as well.”Ans:BFeedback:Turbulence is oftenaccompanied byvibrations of the blood and surroundingcardiovascularstructures.Someofthesevibrationsareintheaudiblerangeand can be heard using astethoscope. For example, a heartmurmur results from turbulent flow through a diseasedheartvalve.The otherdistractors arenotfeasible.2.Aclientisdiagnosedwithanabdominalaorticaneurysmthatthephysicianjustwantsto“watch”fornow.When teaching the client aboutsigns/symptoms to watchfor, the nurse will base the teaching on whichof thefollowingphysiologicalprinciples?A)Smalldiameterofthisvesselwillcauseittorupturemore readily.B)Thelargertheaneurysm,thelesstensionplacedonthe vessel.C)Astheaneurysmgrows,moretensionisplacedonthevesselwall,whichincreases therisk forrupture.D)Theprimarycauseforrupturerelatestoincreasein abdominal pressure such as straining tohave a bowelmovement.Ans:CFeedback:Because the pressure is equalthroughout, the tension in the part of the balloon withthesmallerradiusisless thanthetension inthesectionwiththelarger radius. The same holds truefor an arterial aneurysmin which the tension and risk of rupture increase as theaneurysm grows insize. Walltension is inversely related towallthickness, such that the thicker the vessel wall, thelower the tension, and vice versa. Although arteries have athicker muscular wall than veins, theirdistensibility allowsthem to store some of the blood that is ejected from theheart during systole,providing for continuous flow throughthecapillariesas theheart relaxesduring diastole.

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3.A client has entered hypovolemic shock aftermassive blood loss in a car accident. Many ofthe client'speripheralbloodvesselshaveconsequentlycollapsed.Howdoes the Laplace lawaccount for this pathophysiologicphenomenon?A)Bloodpressureisnolongerable toovercomevesselwalltension.B)Decreasingvesselradiihascausedadecreaseinbloodpressure.C)Wall thickness of small vessels has decreased duetohypotension.D)Decreasesinwalltensionandbloodpressurehavecauseda suddenincreaseinvesselradii.Ans:AFeedback:In circulatory shock, there is a decreasein blood volume and vessel radii, along with adrop in bloodpressure. As a result, many ofthe small vessels collapse asblood pressure drops tothe point where it can no longerovercome the wall tension. Decreases in vessel wall radii donotcausethedecreaseinblood pressure,andwallthicknessgenerallyremains static.4.Whichofthefollowingstatementsaboutvascularcomplianceis accurate?A)Arteriesaremuchmoredistensiblethanveins.B)Veins can act as a reservoir for storing largequantitiesof blood.C)Arterieshavethickmuscularwallsthatconstricttightly, thereby ejecting bloodwithoutstoring it for lateruse.D)Acontinuousflowthroughthecapillariesoccursprimarilyduring systole.Ans:BFeedback:The most distensible of all vessels are theveins, which can increase their volume withonly slightchangesinpressure,allowingthemtofunctionasareservoirfor storing large quantitiesof blood that can be returned tothe circulation when it is needed. Although arteries have athickermuscular wall than veins, their distensibility allowsthem to store some of the blood that isejectedfrom theheart during systole, providing for continuous flow throughthecapillariesas theheartrelaxesduring diastole.5.In the days following a tooth cleaning and rootcanal, a client has developed an infection ofthe thin, three-layered membrane that lines the heart and covers thevalves.What isthisclient'smost likelydiagnosis?

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A)PericarditisB)EndocarditisC)MyocarditisD)VasculitisAns:BFeedback:The endocardium is a thin, three-layered membrane thatlinestheheartandcoversthevalves;infectionofthis partoftheheartisconsequentlyreferredtoasendocarditis.6.Followingseveralweeksofincreasingfatigueanda subsequent diagnostic workup, a clienthas beendiagnosed with mitral valve regurgitation. Failure ofthisheart valve would have which ofthe followingconsequences?A)Backupofbloodfromtherightatriumintothesuperiorvena cavaB)Backflow from the right ventricle to the rightatriumduring systoleC)InhibitionoftheSA node'snormalactionpotentialD)BackflowfromtheleftventricletotheleftatriumAns:DFeedback:The mitral valve separates the left ventricle from the leftatrium;failureofthisvalvewouldcausebackflowfromtheformertothelatterduringsystole.Valvefunctiondoesnotdirectlyaffect cardiaccontractility.7.Heartmusclediffersfromskeletalmuscletissuebybeingable togenerate:A)ContractionsB)CalciuminfluxC)ActionpotentialsD)SarcomerebindingAns:CFeedback:

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Heartmuscle,orthemyocardium,isuniqueamongothermusclesinthatitiscapableofgeneratingandrapidly

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conducting its own electrical impulses or action potentials.These action potentials result in excitationof muscle fibersthroughoutthemyocardium.Similaritiestoskeletalmuscleincludecontractility,calcium influx, and actin–myosin(sarcomeres)binding.8.When discussing the AV node's role in theelectricalconductionoftheheartwithaclientnewlydiagnosed with an AV block, which of the followingstatementsareaccurate?Select allthatapply.A)TheAVnodeoffersatwo-wayconductionareabetweenthe atria andtheventricles.B)The velocity of conduction through the AVjunctionalfibersisveryfast,whichgreatlyincreasesimpulsetransmission.C)AblockattheAVbundleofHisinterfereswiththenormal delay of the impulse, therebyinterfering withcomplete ejection of blood from the atria prior toventricularcontraction.D)WhenthereisanAVblock,impulsesfromtheatriaand ventricles beat independently of eachother so, theheartrhythmisusually chaoticandnot regular.Ans:C,DFeedback:The AV node connects the atrial and ventricular systemsand normally provides for a one-wayconduction betweenthe atria and ventricles. The velocity of conduction throughthe AVjunctionalfibers is very slow, which greatly delaysimpulse transmission. A further delay occurs as the impulsetravels through the transitional fibers and into the AVbundle, known as the bundle of His. Thisdelay provides amechanicaladvantagewherebytheatriacancompletetheirejectionofbloodbeforeventricularcontractionbegins.Under normal circumstances, the AV node provides the onlyconnection between the atrial andventricular conductionsystems. The atria and ventricles would beat independentlyofeachotherifthetransmission ofimpulsesthroughthe AVnodewere blocked.9.If the parasympathetic neurotransmitter releasesacetylcholine, the nurse should anticipateobserving whatchangesinthe ECG pattern?A)Heart rate 150 beats/minute,labeled assupraventriculartachycardiaB)Disorganizedventricularfibrillation

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C)CompletecardiacstandstillD)Slowingofheartratetobelow60beats/minuteAns:DFeedback:Acetylcholine, the parasympathetic neurotransmitterreleased duringvagal stimulation of the heart,slows downthe heart rate by decreasing the slope of phase 4. Thecatecholamines, the sympatheticnervous systemneurotransmitters epinephrine and norepinephrine,increase the heart rate byincreasing the slope or rate ofphase 4 depolarization. Fibrillation is the result ofdisorganized currentflow within the ventricle (ventricularfibrillation).Fibrillationinterruptsthenormalcontractionoftheatria or ventricles. In ventricular fibrillation, theventricles quiver but do not contract. Thus, there isnocardiac output, and there are no palpable or audible pulses(i.e.,cardiacstandstill).10.Whenexplaininganewdiagnosisofcompleteheart block to a client/family, the nurseshould includewhichof the followingstatements?A)“This means that your atria are not contractingnormally,they are quivering.”B)“One consequence of this type of block is a veryslowheartratethat limitscirculationtothebrain.”C)“Thistypeofarrhythmiarequiresdefibrillation,whichwill occurinthecardiaccatheterlablater today.”D)“It'sprettycommonforeveryonetoexperiencethis arrhythmia, especially during times ofstress in theirlives.”Ans:BFeedback:In complete heart block, the atria and ventricles beatindependentlyof each other. The most seriouseffect ofsome forms of AV block is a slowing of heart rate to theextent that circulation to the brain iscompromised. Atriafibrillation is where there is interruption of the normalcontraction of the atria,and the atriaare quivering ratherthancontracting.Ventricularfibrillationrequiresimmediatedefibrillation for the client to survive. Complete heart blockis not common. However, PVCs do occurunder times ofstress.

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11.As a nurse working in the newborn nursery andintensivecareunit,whenaninfanthasbeendiagnosedwithfailure to thrive, which of the following statements abouthormones' effect on thebody will the nurse explain to thefamily?A)Thecatecholaminenorepinephrineisprimarilyresponsiblefor thefailuretothrive.B)CRFincreasessomatostatinlevels,whichinhibitssecretionof growthhormone.C)ACTHreleasefromthepituitarycausesbabiestonotgainweight.D)Antidiuretichormoneisinvolvedinthestressresponseandcanincrease waterretention.Ans:BFeedback:Although growth hormone is initially elevated with theonset of stress, prolonged presence ofcortisol leads tosuppressionofgrowthhormone,insulin-likegrowthfactor1(IGF-1), and othergrowth factors, exerting a chronicallyinhibitory effect on growth. In addition, CRF directlyincreasessomatostatin, which in turn inhibits growthhormone secretion. Although the connection isspeculative,effectsofstressongrowthhormonemayprovideone ofthevital linkstounderstandingfailuretothriveinchildren.Angiotensin II enhances CRF formation and release,contributes to the release of ACTH from thepituitary,enhances stress-induced release of vasopressin from theposteriorpituitary,andstimulatesreleaseofnorepinephrinefrom the locus ceruleus. Antidiuretic hormone (ADH)releasedfrom the posterior pituitary is also involved in thestress response, particularly in hypotensive stressor stressduetofluidvolume loss.12.A nursing student's current clinical placement hasbeen a source of stress due to high clientacuity combinedwithinterpersonalconflictwithsomeoftheunitstaff.Atthesametime,thestudenthasbeenfightingacoldformorethan2weeksandhasbeenunabletoregainanormalfeeling of health. Howmight these two phenomena berelated?A)Epinephrineandnorepinephrineinhibitthereleaseandactionoflymphocytes.B)Stressandillnesslackastatisticalcorrelation,thoughthey areoftenthought tocoexist.C)The effects of stress on the cerebelluminitiate adecreaseinimmunity.

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D)Endocrine–immune interactions may suppress thestudent'simmune response.Ans:DFeedback:Although the exact mechanisms of the effects of stress onimmunity are not completelyunderstood, it is generallythought that endocrine–immune interactions suppressimmunity. Themost significant arguments for interactionbetween the neuroendocrine and immune systems derivefrom evidencethattheimmuneand neuroendocrinesystems share common signal pathways (i.e.,messengermoleculesandreceptors),that hormonesandneuropeptidescan alter the function ofimmune cells, and that the immunesystem and its mediators can modulate neuroendocrinefunction. Stress has the capacity to either enhance orsuppress immune function. Epinephrine andnorepinephrinedo not directly inhibit lymphocytes; the cerebellum is notcentrallyinvolvedinthestress response.13.A student is participating in an extended fast aspart of a charitable fundraising effort.Which of thefollowingisanexampleofthephysiologicreservethatwillfacilitate the student'sadaptation to the stress of thissuddenchange indiet?A)The student has experience in demonstratingperseverancefrompreviousparticipationincompetitivesports.B)The student'sadipose tissue contains large andaccessiblestores of energy.C)Thestudentisyoung,isamale, andhasnopreexistingmedicalconditions.D)Thestudentisutilizingguidedimagerytoachieveasenseof “mindover matter.”Ans:BFeedback:Theabilityofbodysystemstoincreasetheirfunctiongiventhe need to adapt is known as thephysiologic reserve, anexample of which is the energy stored in fat tissue. Previousexperience,health, and relaxation are all likely to foster thestudent's ability toadapt, but these are notdimensions ofphysiologicreserve.14.Which of the following clients will be more able toadapttoastressorbasedonanindividual'sabilitytoadapt?Selectallthat apply.

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A)AMuslimmaleexperiencingabnormalGIbleedingB)AninfantwithdecreasedwaterintakeduetodiarrheaC)Achildlivinginacrowdedapartmentwithhisfinanciallypoor,immediate familyD)Amaleclientproducingincreasedcorticotropin-releasingfactor (CRF)E)AclientwithknownCAD,expressingproblemsaffordingallhisprescribedmedicationAns:B,D,EFeedback:Anindividual'sabilitytoadapttoastressorisdeterminedby the interplay of numerous variables,including age,gender, and preexisting health status. Ethnicity andsocioeconomic statushave notbeen noted to directlyinfluencethe adaptationprocess.15.A nurse working at nights is constantlycomplainingofbeingtiredandsick.Itseemslikeshecatchesevery illness that is on the unit. One possible reason for thismayrelate to:A)Shedoes not contain the “hardiness” gene in hersystem.B)Alterationsinsleep–wakecyclehavedecreasedherimmune function.C)Sheisstressingtoomuchabout beingtiredandsleepy.D)Maybesheshouldgettestedforsleepapnea.Ans:BFeedback:Sleepdisorders and alterations in the sleep–wake cyclehave been shown to alter immunefunction, the normalcircadian pattern of hormone secretion, and physical andpsychologicalfunctioning. The concept of hardinessdescribes a personality characteristic thatincludes a senseofhaving control over the environment, a sense of having apurposeinlife,andanabilitytoconceptualizestressorsasachallenge rather than a threat. Lower levels of hardinesshave beenlinked with greater reaction to stress. Stressisprobably one of the primary factors interfering withsleep.At this time, we do not have enough data to speak to theneedfor a sleepapnea exam.

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16.Althoughclinicalmanifestationsvarywiththetypeof cancer and organs involved, theoncology nurses haveobserved that the most frequent side effects clients withcancerexperienceare:Select all that apply.A)CopiouslymphflowB)SleepdisturbancesC)InvoluntaryweightgainD)VisceralorganexpansionE)LackofenergyAns:B,EFeedback:Neoplasia is nearly always accompanied by sleepdisturbances and fatigue. Cancer-related fatigue ischaracterized by feelings of tiredness, weakness, and lack ofenergy and is distinct from the normaltirednessexperienced by healthy individuals in that itis not relievedby rest or sleep. Tissue growthoften compresses andobstructs lymph flow and compresses visceral organs andadjacent structures.The cachexia of cancer is associatedwith unplanned rapid weight loss and wasting of body fat astumor growthdemands more caloric energy than the bodycansupply.17.Paraneoplasticsyndromesaremanifestationsofcancerthat oftenresult from:A)RadiationandchemotherapyB)CompressionofareavesselsC)Tumor-relatedtissuenecrosisD)Inappropriate hormone releaseAns:DFeedback:Paraneoplastic syndromes are manifestations in sites thatare not directly affected by the disease;many are caused byexcessive or inappropriate peptide hormone synthesis andrelease by cancercells. Radiation and chemotherapy arecancertreatments that cause side effects unrelated to theparaneoplastic syndromes. Area vessel compression is adirectresultofthetumor'slocation;areatissuenecrosisisadirect result of area tissue destruction and death of healthycells.

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18.Aclientwithnonspecificsigns/symptomshasgoneto the primary health care provider. Theclient's chiefcomplaints revolve around extreme fatigue, unplannedweight loss, and being so weakin the muscles. Thediagnostic workup included a carcinoembryonic antigen(CEA)tumor marker.The CEA result was elevated. The nurseshould anticipate the physician will order which of thefollowing diagnostic tests related to the elevated CEA?Selectallthat apply.A)TesticularultrasoundB)ColonoscopyC)MammogramD)ThyroidscanE)BrainCTAns:B,CFeedback:CEAnormallyisproducedbyembryonictissueinthegut,pancreas, and liver and is elaborated by anumber ofdifferent cancers, including colorectal carcinomas,pancreatic cancers,andgastricandbreasttumors.19.Aclientisscheduledforabronchoscopyrelatedtoa history of “bronchitis” for the last 3months that has beenunresponsivetoantibiotics.The nurseshareswiththeclientthat a primarypurpose for this bronchoscopy is to helpdiagnosethe problemby:A)VisualizingairwayslookingforadhesionsB)OpeningairwayslookingforanyaspiratedfoodC)FlushingouttheairwaytoremovedebrisandsputumD)Takingtissuebiopsyandlooking forabnormalcellsAns:DFeedback:Tissuebiopsyinvolvestheremovalofatissuespecimenformicroscopic study. It is of criticalimportance in designingthe treatment plan should cancer cells be found. Biopsiesare obtained in anumber of ways, including needle biopsy;endoscopic methods, such as bronchoscopy orcystoscopy,which involve the passage of an endoscope through anorifice and into the involvedstructure; and laparoscopicmethods.

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20.A breast cancer client has just learned that hertumorclinicalstageisT3,N2,M0.Afterthephysicianleaves,the client asks thenurse to explain this to her again. Thenursewill usewhichofthefollowingstatementsinhisorheranswer? Your:A)Tumorisverysmallandhaszeronumberofmitoses.B)Tumor has metastasized to at least three distalsitesandyouhave cancerinyourlymphnodes.C)Tumorislargeandatleasttwolymphnodesarepositivefor cancer cells.D)Extentofdiseaseisunknown,butitlooks likeyourcancerhasstayedintactandnot spreadtothebloodstream.Ans:CFeedback:Tumorstaginggroupsclientsaccordingtotheextentandspread of the disease, using the TNM(tumor, node, andmetastasis) system. In the TNM system, T1, T2, T3, and T4describe tumor size,N0, N1, N2, and N3, lymph nodeinvolvement; and M0 or M1, the absence or presence ofmetastasis.21.Whichofthefollowingmealswouldbeconsideredhighinfolicacidintake?A)Deep-fried mushrooms with creamy horseradishsauce,hot dogs withoutbun,andpotatosaladB)Friedchicken,mashedpotatoeswithgravy,andcornonthe cobC)Greenleafy salad, beef and bean burrito on whole-wheatshellD)Steak,bakedpotatowithsourcream,andcheesecakeAns:CFeedback:To achieve an adequate intake of folic acid, pregnantwomenshouldcoupleadietthatcontainsfolate-richfoods(e.g., orangejuice; dark, leafy green vegetables; andlegumes) with sources ofsynthetic folic acid, such asfortifiedfoodproducts.22.A first-time pregnant mother asks, “Why do I needanultrasound?I'mworriedthatmyinsurancewon'tcover

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it.” The nurse respondsthat an ultrasonography candiagnoseprenatalabnormalitieslikewhichofthefollowing?Selectallthat apply.A)CytogenicabnormalitiesB)SkeletaldefectslikefacialstructuralproblemsC)ChromosomaldeficitsD)Abnormallevelsof-fetoproteinE)CongenitalheartdefectsAns:B,EFeedback:Ultrasonography is the primary method for assessing fetalsizeandscreenforstructuralabnormalitiesthatincludetheheart, skeleton, face, diaphragm, and gastrointestinal tract.Cytogenicstudies and chromosomal analysis requireamniocentesis, chorionic villus sampling, or umbilicalcordblood.-Fetoprotein (AFP) requires a maternal bloodsample that is analyzed for serummarkers associated withneuraltube defects.23.A pregnant client's-fetoprotein (AFP) returnselevated. The couple ask the health careworker to explainwhat this means. Which of the following is the bestresponse?A)“Thismeansyouneedtodecreaseyourproteinintaketoprevent renalproblems inyourbaby.”B)“Elevated levels means your baby is atrisk ofhavinganeuraltubedefectlikespinabifida(anopeninginthespine).”C)“This means your baby has Down syndrome. Wewon'tknowhowsevere untilafteryougive birth.”D)“This is normal. The problem is if it is low, thatmeansyourbabywillbebornwithtrisomy18andwillberetarded.”Ans:BFeedback:Maternal and amniotic fluid levels of AFP are elevated inpregnancies where the fetus has a neuraltube defect (i.e.,anencephaly and open spina bifida) or certain othermalformations such as ananterior abdominal wall defect inwhich the fetal integument is not intact. Screening ofmaternalblood samples usually is done between weeks 16and18ofgestation.Althoughneuraltubedefects

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havebeen

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associatedwithelevatedlevelsofAFP,decreasedlevelshavebeenassociatedwithDownsyndrome.24.Anoldermother(age41)isworriedabouthavingababy with birth defects. She wants to gettested so she canbe prepared for the outcome. Which of the following testsshould the clinicnurseprepare the client for? Select all thatapply.A)Abloodtest(circulatingcell-freeDNA)willtellifthebaby is mentally retarded.B)Abdominalx-raycandetectskeletalabnormalities.C)Withdrawingasampleofamnioticfluidwillrevealanychromosomaldefects.D)Ultrasonography will reveal any single-genedisorderslike fragile Xsyndrome.E)PET scanning to see if there are any areas ofacceleratedgrowthof tissue.Ans:A,CFeedback:During pregnancy, there are cf-DNA fragments from boththe mother and fetus in maternalcirculation. It is possible toanalyzecf-DNAfrommaternalbloodtodetect commonfetaltrisomiessuchas Downsyndromeas earlyas10 weeks.Amniocentesis involves the withdrawal of a sample ofamniotic fluid from thepregnant uterus. Theprocedure isuseful in women older than 35 years of age, who have anincreased risk of giving birthto an infant with Downsyndrome, and in parents who have another child withchromosomalabnormalities. Ultrasonography allows thevisualization of body structures, revealing such defects asskeletal malformations. It is only able to identifychromosomaldisorders,geneticdisorders,andneuraltubedefects by way of their anatomic effects. PET scanning isused to assess for cancermetastasis or inflammatorydiseases.It is notusedinpregnancytesting.25.A pregnant mother (16 weeks' gestation) forgotand emptied her cat's litter box withoutgloves. She isextremelyanxiousandwantstestedrightaway.Whichtestwould the nurseprepareher for that would give rapidcytogenicanalysis?A)UltrasonographyB)FetalbiopsyC)Chorionicvillussampling

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