HESI PATHOPHYSIOLOGY EXIT EXAM 2020/2021
1. The nurse is caring for a client with liver cirrhosis. Which diagnostic test
will most likely be altered
... [Show More] because of liver damage?
A Bone scan.
B Serum glucose. C MRI of the chest. D Colonoscopy.
With liver cirrhosis, there is an alteration in the function of liver tissue. One function of the liver is to either breakdown glycogen into glucose in response to
glucagon or produce glycogen in response to insulin. For the client with liver cirrhosis, the blood glucose level could be either too high or too low. Choices A,
C, and D are not specifically altered in liver cirrhosis.
2. A client recovering from a kidney transplant has an 8 mm area of induration after an intradermal PPD tuberculin test. What will need to be
done prior to treating this client for active tuberculosis? A Nothing since this is a diagnostic indication of active disease. B Determine active disease present through a chest x-ray.
C Conduct a multiple-puncture tine test. D Evaluate results of liver function tests.
A positive tuberculin test alone does not indicate active disease. A chest x- ray
will be done to evaluate for the presence of dense lesions in the apical and posterior segments of the upper lobe and possible cavity formation. Choice A is
incorrect because a positive tuberculin skin test alone does not indicate active
disease. Choice C is incorrect because a multiple-puncture tine test is less accurate than the PPD test. Choice D is incorrect because liver function tests are
obtained prior to treating with isoniazid. The client needs to be diagnosed with
active tuberculosis first.
3. The nurse determines that a client is at risk for the development of
osteoporosis because of which assessment findings?
A African American female aged 45.
B Diagnosed with inflammatory bowel disease. C Infrequent alcohol intake.
D Participates in walking 5 times a week for 30 minutes.
A malabsorption disorder, such as inflammatory bowel disease, is a nonmodifiable
risk for the development of osteoporosis. This disorder will affect
calcium absorption. Choice A is incorrect because African American females have greater bone density than other ethnic backgrounds. Choice C is incorrect
because heavy alcohol intake suppresses bone formation and contributes to nutritional deficiencies associated with osteoporosis. Choice D is incorrect because walking increases blood flow to the bones and increases osteoblast growth and activity.
4. A client’s latest electrocardiogram waveform is demonstrating changes
in the ST segment. The nurse is concerned that the client will begin to
demonstrate:
A Ventricular dysrhythmias. B Atrial dysrhythmias.
C Atrioventricular conduction blocks. D Sinus arrhythmias.
Ventricular dysrhythmias originate in the ventricles. One characteristic of this waveform is an abnormal ST segment. Choice B is incorrect because P wave changes are seen in atrial dysrhythmias. Choice C is incorrect because changes
would be seen in the QRS complex and P waves. Choice D is incorrect because
a sinus arrhythmia is a sinus rhythm that fluctuates with respirations. There are
no specific waveform changes with this arrhythmia.
5. A client with type 2 diabetes mellitus has microalbuminuria. The nurse
should prepare to instruct the client on which treatment for this clinical
finding? (Select all that apply.)
A Weight management.
B Hypertension treatment. C Exercise.
D Reduce salt intake.
E Postural hypotension.
Microalbuminuria is an abnormal level of albumin in the urine. For the client with
type 2 diabetes mellitus, management of this finding includes weight management, control of hypertension, exercise, and reduce salt intake.
Choice E
is incorrect because postural hypotension is a finding consistent with autonomic
neuropathies or another type of complication of diabetes mellitus.
6. A client with type 2 diabetes mellitus is surprised to learn of a wound on
the bottom of the left heel. What would be the reason why this client is not
aware of this wound?
A Microvascular changes in the skin.
B Sensory loss from peripheral neuropathy. C Elevated blood lipid levels.
D Autonomic neuropathy.
Peripheral neuropathy is associated with diabetes mellitus. This disorder appears
first in the toes and feet and progresses upwards. The client with this disorder
has distal paresthesias and impaired sensations of pain, light touch, and vibration. Choice A is not correct because microvascular changes in the skin may
contribute to the development of wound but, however, would not be the reason
why the client was unaware of the wound. Choice C is incorrect because elevated blood lipid levels do not cause sensory changes in those with diabetes
mellitus. Choice D is incorrect because autonomic neuropathy affects sweating
and pupillary, cardiovascular, gastrointestinal, and genitourinary functioning.
7. The nurse is providing dietary instruction for a client with diverticular
disease. What should the nurse instruct the client to avoid eating?
A Unpeeled raw fruit. B Popcorn and berries. C Cooked cereals.
D Raw vegetables.
The client with diverticular disease is instructed to avoid food with small seeds
such as popcorn and berries which could obstruct diverticula. Choices A, C, and
D are foods that are recommended to increase the fiber and residue in the client
with diverticular disease.
8. A client, being treated with whole blood for a massive gastrointestinal
hemorrhage, continues to bleed and has a platelet count of 25,000.
Which
treatment should the nurse prepare to administer to this client?
A Albumin.
B Fresh frozen plasma. C Platelets.
D Packed red blood cells.
An infusion of platelets is indicated in the client with a platelet count between
20,000 – 50,000 who is hemorrhaging. Choice A is a blood volume expander that
is used in shock and trauma. Choice B is used to restore clotting factors. Choice
D is used to restore intravascular volume.
9. A client being treated for liver cirrhosis is demonstrating a change in
level of consciousness. Which laboratory test would most likely determine
the cause for this client’s symptom?
A Serum potassium. B Serum glucose.
C Serum calcium. D Serum ammonia.
The accumulation of nitrogenous wastes affects the mental status and thought
processes of the client with liver cirrhosis. A serum ammonia level would help determine the cause of the client’s change in level of consciousness. Choice A is
incorrect because a change in this value will not affect the client’s level of consciousness. Choice B is incorrect because in liver cirrhosis, the glucose level
is most likely elevated which will not alter the client’s level of consciousness. Choice C is incorrect because in liver cirrhosis, a change in this value will not affect the client’s level of consciousness.
10. A client, who continues to be successfully treated for liver disease, is
demonstrating signs of encephalopathy. What could be the cause for this
new manifestation?
A Impaired nutrient metabolism. B Impaired fat absorption.
C Impaired renal function. D Impaired bile synthesis.
For the client who is being successfully treated for liver disease, the new manifestation of encephalopathy would indicate a build up of ammonia in the blood. The liver detoxifies ammonia but converts it to urea for excretion by the
kidneys. If the kidneys are malfunctioning, the client will develop symptoms of
encephalopathy. Choices A, B, and D would not cause encephalopathy in the client with liver disease.
11. A client, being treated with chemotherapy for leukemia, is diagnosed
with splenomegaly. The nurse realizes this new finding is because of:
A A complication of chemotherapy. B Bone marrow suppression.
C Infiltration of leukemic cells into organs. D Metastasis.
With leukemia, splenomegaly is caused by the infiltration of leukemic cells into
the organs and tissues. Choice A is incorrect because splenomegaly is not a complication of chemotherapy. Choice B is incorrect because splenomegaly does
not occur with bone marrow suppression. Choice D is incorrect because splenomegaly is not an indication of metastasis.
12. A client’s pacemaker insertion site begins to slowly ooze blood.
For
which physiological process should this client be assessed?
A Hypertension.
B Hemothorax.
C Aortic dissection.
D Disseminated intravascular coagulation.
When a healing site begins to slowly ooze blood, this is an indication of a clotting
malfunction which is a manifestation of disseminated intravascular coagulation.
Oozing blood from a healing site is not a manifestation of Choice A, hypertension, Choice B, hemothorax, or Choice C, aortic dissection.
13. A client is diagnosed with cardiac left ventricular hypertrophy.
How
should the nurse explain the cause of this disorder to the client?
A “This happens when the heart has to work harder to pump blood.”
B “This occurs when more cells are made to do the same amount of work of the
heart.”
C “This is when other body cells change into heart cells.”
D “This is what happens when the heart cells are not used or are damaged.” Hypertrophy occurs when the myocardial cells of the left ventricle need to work
harder to move blood through the circulation. Choice B describes hyperplasia.
Choice C describes metaplasia. Choice D describes atrophy.
14. While observing a client’s respirations, the nurse notes the thoracic
region expands in size with inspiration and returns to the resting size with
expiration. The nurse determines that which anatomic structure is functioning adequately?
A Lungs. B Nose. C Thorax.
D Diaphragm.
For normal respiration to occur, the diaphragm needs to contract with inspiration
and relax with expiration. When contracting, the size of the thoracic cavity increases, lowering the pressure gradient, and pulling air into the lungs during
inspiration. When the diaphragm relaxes, the pressure gradient within the lungs
increases which causes air to leave the lungs during expiration. Choices A, B, and C are incorrect because these structures do not control inspiration and expiration.
15. A client’s foot wound has an increase in purulent drainage.
Which
laboratory value would need to be monitored for this assessment finding?
A Red blood cells. B White blood cells. C Platelets.
D Albumin.
White blood cells congregate in wounds to remove harmful organisms and toxins.
The presence of purulent drainage is an indication that white blood cells have
entered the wound. Choice A is used to evaluate the number of cells to transport
oxygen to and remove carbon dioxide from cells. Choice C is used to evaluate
the body’s ability to clot blood. Choice D is used to evaluate the amount of protein within the body. [Show Less]