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Hesi Pathophysiology Practice Exam
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Terms in this set (50)
After talking w/ the HCP, a male pt continues to have questions about the results of a prostatic surface antigen (PSA) screening test and asks the nurse how the PSA levels become elevated. The nurse should explain which pathophysiological mechanism?
As the prostate gland enlarges, its cells contribute more PSA in the circulating blood
PSA is a glycoprotein found in prostatic epithelial cells, and elevations are used as a specific tumor markers. Elevations in PSA are r/t gland volume, ie. benign BPH, prostatitis, and cancer of the prostate, indicating tumor cell load. PSA levels are also used to monitor response to therapy
A 26 yr old male client w/ Hodgkin's disease is scheduled to undergo radiation therapy. The clinet expresses concern about the effect of radiation on his ability to have children. What info should the nurse provide?
Permanent sterility occurs in the male client who receive radiation
Low sperm count and loss of motility are seen in males w/ Hodgkin's disease b/f any therapy. Radiotherapy often results in permanent aspermia, or sterility
The nurse hears short, high-pitched sounds just b/f the end of inspiration in the right and left lower lobes when auscultating a client's lungs. How should this finding be recorded?
Crackles in the right and left lower lobes
Fine crackles - short, high-pitched sounds heard just b/f the end of inspiration that are the result of rapid equalization of pressure when collaped alveoli or terminal bronchioles suddenly snap open
Wheezing is a continuous high-pitched squeaking or musical sound caused by rapid vibration of bronchial walls that are 1st evident on expiration and may be audible
A client is admitted to the ER w/ a tension pneumothorax. Which assessment should the nurse expect to ID?
A deviation of the trachea toward the side opposite of the pneumothorax
Tension pneumothorax is caused by rapid accumulation of air in the pleural space, causing severely high intrapleural pressure. This results in collapse of the lung, and the mediastinum shifts toward the unaffected side, which is subsequently compressed
A client who is receiving a whole blood transfusion dv's chills, fever, and a HA 30 min after the transfusion is started. The nurse shold recognize these sx as characteristic of what rxn?
A febrile transfusion reaction
Sx of a febrile reaction include sudden chills, fever, HA, flushing, and muscle pain.
An allergic rxn is the response of histamine release which is characterized by flushing, itching, and urticaria. It exhibits an exaggerated allergic response that progresses to shock and possible cardiac arrest
an acute hemolytic reaction presents w/ fever, chills, but is hallmarked by the onset of low back pain, tachycardia, tachypnea, vascular collapse, hemoglobinuria, dark urine, ARF, shock, cardiac arrest, and even death
The nurse is analyzing the waveforms of a client's ECG. What finding indicates a disturbance in electrical conduction in the ventricles?
QRS interval of 0.14 second
the normal duration of the QRS is 0.04 - 0.12 sec
T wave is 0.16 sec;
PR is 0.12 - 0.20 sec;
QT is 0.31-0.38 sec
Several hrs after surgical repair of an AAA, the client dvps left flank pain. the nurse determines the client's urinary output is 20 m.;hr for the past 2 hrs. The nurse should conclude that these findings support which complication?
Renal artery embolization
Post-op complications of surgical repair of AAA are r/t the location of resection, graft, or stent placement along the abd'l aorta. Embolization of a fragment of thrombus or plaque from the aorta into a renal artery can compromise blood flow in 1 of the renal arteries, resulting in renal ischemia that precipitates unilateral flank pain
A client w/ markedly distended bladder is dx w/ hydronephroosis and left hydroureter after an IV pyelogram. The nurse catheterizes the client and obtains a residual urine vol of 1650 ml. this finding supports which pathophysiological cause of the client's urinary tract obstruction?
Obstruction at the urinary bladder neck
Hydroureter (dilation of the renal pelvis), vesicoureteral reflux (backward mvmt of urine from the lower to upper urinary tracts), and hydronephrosis (dilation or enlargement of the renal pelvis and calyces) result from post-renal obstruction which can consequently result in chronic pyelonephritis and renal atrophy. Ascending urinary reflux occurs when normal ureteral peristaltic pressure is met w/ an increase in urinary pressure occurring during bladder filling if the urinary bladder neck is obstructed
The nurse is planning care for a client who has a right hemispheric stroke. Which nsg dx should the nurse include in the POC?
Risk for injury r/t denial of deficits and impulsiveness
Right-brain damage - a client experience difficulty in judgment and spatial perception and is more likely to be impulsive and move quickly, which placing the client at risk for falls
the nurse is teaching a client w/ maple syrup urine disease, an autosomal recessive DO about the inheritance pattern. Which info should the nurse provide?
both genes of a pair must be abnormal for the DO to occur
A female client tells the nurse that she does not know which day of the month is best to do breast self exams. Which instruction should the nurse provide?
5-7 days after menses cease
this is because the physiologic alterations in breast size and activity reach their minimal level after menses
A client reports unprotected sex 1 wk ago and is worried about HIV exposure. An initial HIV antibody screen (ELISA) is obtained. The nurse teaches the client that seroconversion to HIV positive relies on antibody production by B lymphocytes after exposure to the virus. When should the nurse recommend the client return for repeat blood testing?
although the HIV antigen is detectable appx 2 wks after exposure, seroconversion to HIV positive may take up to 6-12 wks after exposure
A nurse is planning to teach self care measures to a female client about prevention of yeast infections. Which instructions should the nurse provide?
avoid tight fitting clothing and do not use bubble bath or bath salts
Which rxn should the nurse ID in a client who is responding to stimulation of the sympathetic nervous system (SNS)?
any stressor that is perceived as threatening to homeostasis acts to stimulate the SNS and manifests as a flight or flight response, which includes an increased HR
Parasympathetic Nervous System: pupil constriction, bronchial constriction, decreased BP
A client w/ asthma receives a prescription for high BP during a clinic visit. Which prescription should the nurse anticipate the client to receive that is least likely to exacerbate asthma?
the nurse is preparing to administer atropine, an anticholinergic, to a client who is scheduled for a cholecystectomy. The client asks the nurse to explain the reason for the prescribed med. What response is best for the nurse to provide?
decrease the risk of bradycardia during sugery
it us used to increase the automaticity of the sinoatrial node and prevent a dangerous reduction in HR during surgical anesthesia
A deficiency of intrinsic factor should alert the nurse to assess a client's hx for which condition?
the most common cause is lack of instrinsic factor, a glucoprotein produced by the parietal cells of the gastric lining
the nurse is assessing an older client and determines that the client's left upper eyelid droops, covering more of the iris than the right eyelid. Which description should the nurse use to document this finding?
ptosis on the left eyelid
A client w/ aortic valve stenosis dvps HF. Which pathophys finding occurs in the myocardial cells as a result of the increased cardiac workload?
Increase in size
HTN and incompetent or stenotic heart valves cause an increase in the workload of the heart by increasing afterload which requires an increase in the force of cxn to pump blood out of the heart. Myocardial hypertrophy results because the cells increase in surface area or size by increasing the amt of contractile proteins, but the quantity of fibers remain constant. As myocardial hypertrophy progresses, the heart becomes ineffective as a pump because the ventricular wall cannot dvp enough tension to cause effective contraction, which causes myocardial irritability due to hypoxia
The nurse is measuring BP on all 4 ext's of a child w/ coarctation of the aorta. Which BP finding should the nurse expect to obtain?
Lower in thelegs than in the arms
In coarctation of the aorta, a congenital constriction is found at the aorta near the ductus arteriosus region that lies past the left subclavian arteries, which perfuses the upper extremities.
What is the underlying phathophys process b/w free radicals and destruction of a cell membrane?
Enzyme release from lysosomes
Oxidative damage to cells is thought to be a causative factor in disease and aging. If free radicals bind to polyunsaturated fatty acids found in the lysosome membrane, the lysosome, nicknamed "suicide bags" leaks its protein catalytic enzymes intracellularly and the cell is destroyed
Which clinical finding shojuld the nurse ID in a client who is admitted w/ cardiac cirrhosis?
4 types of cirrhosis: alcoholic, post-necrotic, biliary, and cardiac. Cardiac is associated w/ severe right sided heart failure, so peripheral edema is most consistant
While the nurse obtains a male client's hx, review of systems, and physical exam, the client tells the nurse that his breast drains fluid secretions from the nipple. The nurse should seek further eval of which endocrine land fxn?
Hypothalamus and anterior pituitary
Breast fluid and milk production are induced by the presence of prolactin secreted from the anterior pituitary gland, which is regulated by the hypothalmus' secretion of prolactin-inhibiting hormone in both men and women. further eval of the hypothalamus and anterior pituitary gland should provide additional info about the secretions or lactation
The nurse is assessing the lab results for a client who is admitted w/ renal failure and osteodystrophy. Which findings are consistent w/ the client's clinical picture?
K+ 5.5 mEq and total Ca+ 6 mg/dL
In renal failure, normal serum electrolyte balance is altered because the kidneys fail to acitvate vitamin D, Ca+ absorption is impaired, and serum Ca+ decreases, which stimulates the release of PTH causing resorption of Ca+ and phosphate from the bone. A decreased tubular excretion and a decreased glomerular filtration rate results in hypocalcemia, hyperphosphatemia, and hyperkalemia
Which HC practice is most important for the nurse to teach a postmenapausal client?
consume adequate foods rich in Ca+
A mid-aged male client asks the nurse what findings from his digital rectal exam prompted the HCP to prescribe a repeat serum prostatic surface antigen (PSA) level. What info should the nurse provide?
stony, irregular nodules palpated on the prostate should be further evaluated
Which condition is associated w/ an over-secretion of renin?
renin is an enzyme synthesized and secreted by the juxtaglomerular cells of the kidney in response to renal artery blood volume and pressure chgs. Low renal perfusion stimulates the release of renin, which is converted by angiotensinogen into angiotensin 1, which causes the secretion of aldosterone, resulting in renal reabsorption of sodium, water, and subsequently increases BP
What info should the nurse include in a teaching plan about the onset of menopause?
b. Oophorectomy w/ hysterectomy
c. Early menarche
d. Genetic influence
e. Chemotherapy exposure
A client is brought to the ER after a snow skiing accident. Which intervention is most important for the nurse to implement?
Review the ECG tracing
Airway, Breathing, and Circulation are priorities in client assessment and tx. Continuous cardiac monitoring is indicated because hypothermic clients have an increased risk for dysrhythmias
Which client is at highest risk for CKD secondary to DM?
Type 1 DM and retinopathy and mild vision loss
Diabetic retinopathy and nephropathy are r/t prolonged hhyperglycemia and HTN which damage the microvasculature of the eyes and kidneys , so a client w/ DM1 and retinopathy is most likely to dvp nephropathy and CDK
A male client who has never smoked but has had COPD for the past 5 yrs is now being assessed for CA of the lung. The nurse knows that he is most likely to dvp which type of lung CA?
this is the only lung CA not r/t cigarette smoking. It has been found to be directly r/t to lung scarring and fibrosis from preexisting and pulmonary disease such as TB or COPD
The nurse reviews the CBC findings of an adolescent w/ acute myelogenous leukemia. the Hgb is 13.8, Hct is 36.7, WBC is 8,200, and platelet count is 115,000. Based on these findings, what is the priority nsg dx for this client's POC?
Risk for injury
a client w/ AML is at risk for anemia, neutropenia, and thrombocytopenia. These CBC findings indicate that the platelet count is low, which places him at an increased risk for injury
The parents of a child w/ hemophillia A ask the nurse about their probability of having another child w/ it. Which info is the basis for the nurse's response?
a. Sons of female carriers have a 50% chance of inheriting hemophillia
b. Hemophillia is an X-linked recessive disorder
Hemophillia is an inherited disease that manifests in male children whose mom is a carrier. With each pregnancy there is a 50% chance that a male child will inherit the defective gene and manifest hemophillia A
The nurse is caring for a client who had an excision of malignant pituitary tumor. Which findings should the nurse document that indicate the client is dvp'g Syndrome of Inappropriate Antidiuretic Hormone (SIADH) ?
Wt gain w/ low serum sodium
SIADH most frequently occurs when cancer cells manufacture and release ADH, which is manifested by water retention causing wt gain and hyponatremia
A man who was recently dx'd w/ Huntington's disease asks the nurse if his adolescent son should be tested for the disease. What response is best for the nurse to provide?
Genetic counseling should be obtained prior to undertaking any genetic testing procedure
A mom is crying as she holds and rocks her child w/ tetanus who is having muscular spasms and crying. After administering diazepam to the child, what action should the nurse implement?
Lay the child down and ask the mom to stay near the child in the crib
Controlling environmental stimulation such as noise, light, or tactile stimuli helps reduce CNS irritability r/t acute tetanus. The mom shoujld be instructed to minimize handling of the child during episodes of muscle spasticity and to stay calmly near the child. Her presence w/ the child provides security and support
Which rationale best supports an older client's risk of complications r/t dysrhythmia?
An older client is intolerant of decreased cardiac output which may cause dizziness and falls
In an older client, CO is decreased and a loss of contractility and elasticity reduces systemic and cerebral blood flow, so dysrhythmias, such as bradycardia or tachycardia is poorly tolerated, and increases the client's risk for syncope, falls, transient ischemic attacks, and possibly dementia
MD is characterized by which pathophys condition?
Skeletal muscle degeneration
The nurse is assessing a client w/ a ruptured small bowel and determines that the client has a temp of 102.8F. Which assessment finding provides the earliest indication that the client is experiencing septic shock?
the interrelated pathophys chgs associated w/ the hypermetabolic state of sepsis and septic shock produce a pathologic imbalance b/w cellular O2 demand, supply, and consumption.
Which s/s are associated w/ arterial insufficiency?
Pallor, intermittent claudication
these are 2 signs r/t stage 2 peripheral vascular disease, which results in arterial insufficiency
the severity of diabetic retinopathy is directly r/t which condition?
Poor glucose control
a client w/ a fx'd right radius reports severe, diffuse pain that has not responded to the prescribed analgesics. The pain is greater w/ passive mvmt of the limb than w/ active mvmt by the client. The nurse recognizes that the client is most likely exhibiting sx of which condition?
Acute compartment syndrome
When observing a client for sx of a large bowel obstruction, the nurse should assess for which finding?
Distention of the lower abd
The nurse is caring for a client w/ SIADH (syndrome of inappropriate antidiuretic hormone), which is manifested by which sx?
loss of thirst, wt gain
SIADH occurs when the posterior pituitary gland releases too much ADH, causing water retention, a urine output of less than 20 ml/hr, and dilutional hyponatremia. Other indications are loss of thirst, wt gain, irritability, muscle weakness, and decreased LOC
The nurse is caring for a client w/ SIADH. this condition is most often r/t to which predisposing condition?
Small cell lung CA
The nurse is assessing a postmenapausal woman who is c/o urinary urgency and frequency and stress incontinence. She also reports difficulty in emptying her bladder. These c/o are most likely due to which condition?
Which pathophys response supports a client's vomiting experience?
Spasmodic reflex of respiratory and gastric mvmts results from stimulation of the chemoreceptor trigger zone
Vomiting is a reflex of spasmodic respiratory mvmts against the glottis causing the forceful expulsion of the contents of the stomach thru the mouth. Stimulation of the emetic center results from afferent vagal and sympathetic nerve pathways that activate the chemoreceptor trigger zone (CTZ)
A client's family asks why their mom w/ HF needs a pulmonary artery (PA) catheter now that she is in the ICU. What info should the nurse include in the explanation to the family?
A PA catheter measures central pressures for monitoring fluid replacement
What histologic finding in an affected area of the body would suggest the presence of chronic inflammation?
Increase in monocytes and macrophages
A predominance of monocytes and macrophages in an inflamed area indicates the start of a chronic infection. Macrophages are responsible for "cleaning up" the healing wound thru phagocytic and debridement actions and monocytes assist in the healing of the wound after neutrophils have entered the area
Physical exam of a comatose client reveals decorticate posturing. Which stmt is accurate regarding this client's status based upon this finding?
decorticate posturing (adduction of arms at shoulders, flexion of arms on chest w/ wrists flexed and hands fisted and extension and adduction of extremities) is seen w/ severe dysfunction of the cerebral cortex
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