HESI Pathophysiology Exam V1 All 55 Answers

2020/2021

HESI Pathophysiology Exam

1. The nurse is caring for a client with liver cirrhosis. Which diagnostic test

will most likely be altered 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.

16. A client is diagnosed with a cardiac dysrhythmia. How should the nurse

explain the normal conduction system of the heart to the client? (Place in

order the sequence of the electrical impulse beginning with the top of the

heart to the bottom.)

A. Atrioventricular node.

B. Bundle of His.

C. Purkinje fibers.

D. Internodal pathways.

E. Right and left bundle branches.

F. Sinoatrial node right atrium.

The sinoatrial node is the normal pacemaker of the heart and is located in the

right atrium. This impulse travels across internodal pathways to the

atrioventricular node. It then passes through the bundle of His and continues

down the interventricular septum through the right and left bundle branches and

out to the Purkinje fibers.

17. A client is experiencing rapid respirations and difficulty swallowing.

The nurse determines the client is having an alteration in which

physiologic structure?

A Cerebral cortex.

B Brain stem.

C Cerebellum.

D Diencephalon.

The brain stem is the physiologic structure that controls cardiac and respiratory

function and the swallowing, gag, and cough reflexes. Choice A is the center for

motor function, communication, judgment, and abstract thought processes.

Choice C is the structure responsible for processing information, coordination,

and balance. Choice D regulates autonomic nervous system function, regulates

and produces hormones, and mediates emotional responses.

18. While recovering from surgery, a client is diagnosed as third-spacing

fluid. Which intervention would be the most appropriate for the client at

this time?

A Implement a fluid restriction.

B Suggest increasing intravenous infusion.

C Withhold prescribed diuretic.

D Encourage increasing high sodium foods.

Third spacing is the sequestering of fluid within interstitial spaces. This additional

fluid can lead to fluid overload and lead to renal and heart failure. One

appropriate intervention for the client at this time would be to implement a fluid

restriction. Choice B could add additional fluid to the already overloaded

circulatory system. Choice C would not help remove the excess fluid from the

overloaded circulatory system. Choice D would encourage fluid to stay within the

circulatory system, potentially causing more symptoms of fluid overload.

19. The nurse instructs a client that the cause of cardiovascular problems

is due to thick and stiff arteries. For which physiological process is the

nurse instructing the client?

A Varicose veins.

B Aneurysm.

C Arteriosclerosis.

D Embolism.

Arteriosclerosis is the thickening and stiffening of the arteries that lead to a loss

of elasticity within the arterial walls. Choice A is the term used for tortuous and

dilated veins that have incompetent valves. Choice B is the term used for an

abnormal dilation of a blood vessel at a site of a weakness or tear in the vessel

wall. Choice D is the term used to describe a sudden obstruction of a blood

vessel by a clot or other debris.

20. A client with chronic renal failure develops bilateral pleural effusions.

Which laboratory value would help determine the cause of this new health

problem?

A Hemoglobin.

B Albumin.

C Ammonia.

D Creatinine.

Albumin is a measure of the amount of protein in the body. Protein helps

maintain the colloidal osmotic pressure within the vasculature by preventing fluid

molecules to enter interstitial spaces. When the albumin level is too low, fluid will

enter interstitial spaces, such as the pleura, leading to pleural effusions. Choices

A and C would not be used to determine why a pleural effusion has occurred.

Choice D would be used to determine the effectiveness of dialysis and not be

used to explain the onset of pleural effusions.

21. While reviewing laboratory values, the nurse learns that a young client

has the hormone chorionic gonadotropin in the urine. What does this

information suggest to the nurse?

A The client is breastfeeding.

B The client is menstruating.

C The client is pregnant.

D The client is going through menopause.

The hormone chorionic gonadotropin in urine indicates that the client is pregnant.

Choice A is incorrect because the hormone lactogen is needed for breastfeeding.

Choices B and D are incorrect because the hormone chorionic gonadotropin is

not present during menstruation or menopause.

22. A client is diagnosed with an acute respiratory condition that is causing

airway inflammation and thick exudate. Upon auscultation crackles are

heard. The nurse would instruct the client about which health problem?

A Asthma.

B Emphysema.

C Acute bronchitis.

D Pneumonia.

Pneumonia can be described as an acute inflammation where the lungs are

blocked with thick exudate. Crackles are the typical sound of pneumonia. Choice

A is characterized by recurrent spasms of the airways with edema and mucus

production. During an acute asthma attack lung sounds are usually diminished

over all lung fields. Choice B is a condition where the surface area of the lungs is

reduced by rupture or other damage to the alveoli. Choice C is either an acute or

chronic inflammation of the bronchi or both bronchi and trachea that is caused by

an infection. The client is usually coughing. The typical lung sound is wheezing.

23. The nurse assesses an erratic heart rate and fluctuating blood pressure

in a client who has experienced a stroke. The nurse suspects that which

area of the brain is being affected with this client’s health problem?

A Cerebrum.

B Brainstem.

C Diencephalon.

D Cerebellum.

The brainstem consists of the midbrain, pons, and medulla oblongata. Nuclei

within the medulla oblongata play a role in controlling the heart rate, blood

pressure, respirations, and swallowing. Choice A controls sensory input and

muscular activity. Choice C regulates the autonomic nervous system and

hormones. Choice D processes information and coordinates balance, posture,

and muscle movement.

24. While calculating the cardiac ejection fraction, the nurse determines a

client’s end-diastolic volume. What occurs during myocardial diastole?

A The ventricles refill, the atria contract, and the myocardium is perfused.

B The ventricles contract and eject blood into the pulmonary and systemic circuits.

C An electrical stimulus is generated that causes myocardial cells to respond.

D The resting membrane potential of cardiac cells spontaneously depolarizes.

In myocardial diastole, the ventricles refill, the atria contract, and the myocardium

is perfused. Choice B described myocardial systole. Choice C describes what

occurs immediately prior to myocardial systole. Choice D describes what occurs

in the sinoatrial node to initiate an electrical impulse.

25. The nurse is preparing medications for a client with diabetes insipidus.

Which medication will the nurse most likely administer to this client?

A Insulin.

B Dextrose 50%.

C Vasopressin.

D Potassium.

Diabetes insipidus is a deficiency of antidiuretic hormone that causes polyuria,

dehydration, and polydipsia. The nurse will most likely administer vasopressin

which supplies the antidiuretic hormone that the client needs to achieve fluid

balance. Choice A would be provided to a client with diabetes mellitus. Choice B

would be provide for hypoglycemia. Choice D might be provided to correct

electrolyte imbalances in a client with diabetic ketoacidosis.

26. The nurse is caring for a client with glomerulonephritis. Which

laboratory value would provide the most information about the client’s

renal status?

A Serum calcium.

B Serum glucose.

C Urine culture and sensitivity.

D Urine protein level.

Glomerulonephritis is a disorder that affects the glomeruli of the kidney. When

the glomeruli are damaged, protein molecules can escape from the blood stream

and appear in the urine. This finding can impact the client’s long-term renal

status. The other choices will not provide specific information about the client’s

renal status.

27. A client with urinary retention is diagnosed with glandular tissue

compressing the urethra. For which health problem should the nurse

provide teaching?

A Prostatitis.

B Prostate cancer.

C Benign prostatic hypertrophy.

D Bladder cancer.

Benign prostatic hypertrophy is caused by enlarged prostatic tissue that

compresses the urethra and leads to urinary retention. Choice A is an

inflammation of the prostate gland which may or may not affect urinary output.

Choice B is the presence of cancerous cells within prostate tissue. Choice D is

the presence of cancerous cells within the bladder.

28. A client, prescribed oxygen 4 liters per nasal cannula, has a respiratory

rate of 8 per minute. Which health problem could be causing this change in

the client’s respiratory rate?

A Congestive heart failure.

B Chronic obstructive pulmonary disease.

C Asthma.

D Pulmonary edema.

In chronic obstructive pulmonary disease, the drive to breathe is initiated by the

level of carbon dioxide in the blood. If provided with oxygen at 4 liters, the

amount of oxygen in the blood is higher than the concentration of carbon dioxide

causing the respiratory rate to decrease. Choice A would not cause the

respiratory rate to decrease. Choice C would most likely cause an increase in the

respiratory rate. Choice D would cause the respiratory rate to increase.

29. A client is admitted with a closed head injury to the frontal lobe region.

What might the nurse most likely assess in this client?

A Visual impairment.

B Inability to read.

C Poor memory.

D Loss of motor movements.

The frontal lobes of the brain control motor movements and verbal expression.

An injury to this brain area could lead to the loss of motor movements in the

client. Choices A and B would be assessed in the client with an injury to the

occipital lobe. Choice C would be assessed in the client with an injury to the

temporal lobe.

30. A client with diabetic ketoacidosis is demonstrating an improvement in

polydipsia. Which intervention contributed to the improvement in this

client’s health status?

A Intravenous fluid administration.

B Control of blood glucose with insulin.

C Correction of electrolytes with potassium.

D Improved tissue perfusion with oxygen.

One symptom of hyperglycemia is polydipsia or increased thirst. In diabetic

ketoacidosis the blood glucose levels are elevated. With the administration of

insulin to correct the elevated blood glucose level, the symptom of polydipsia will

improve. Choice A will not correct polydipsia in the client with diabetic

ketoacidosis. Choice C will not correct polydipsia in this client. Choice D will not

improve polydipsia in the client with diabetic ketoacidosis.

31. When explaining the pathophysiology of multiple sclerosis to a client,

what should the nurse include as cause for the disorder?

A An autoimmune response.

B An electrolyte imbalance.

C A disorder of lipid metabolism.

D An imbalance of neurotransmitters.

Multiple sclerosis is believed to occur as a result of an autoimmune response to a

protein in the central nervous system which destroys the myelin sheath of

nerves. Choices B, C, or D are not considered causes of the multiple sclerosis.

32. A client with cholelithiasis is prescribed a low fat diet. What should the

nurse instruct the client as to the purpose of this diet?

A “It will help reduce the amount of hydrochloric acid in your system.”

B “It will reduce the amount of gallbladder stimulation needed to emulsify fats.”

C “It is necessary prior to gallbladder surgery.”

D “It will give your liver some rest.”

The purpose of a low fat diet is to reduce the stimulation of the gallbladder by

cholecystokinin which stimulates the gallbladder to contract and release bile in

order to emulsify fats. Choices A, C, and D are not the purposes of a low fat diet

in the client with cholelithiasis.

33. A client is diagnosed with atrial fibrillation. For which complication

should the nurse instruct the client if this disorder is left untreated?

A Myocardial infarction.

B Peripheral vascular disease.

C Diabetes mellitus.

D Cerebral vascular accident.

Uncontrolled atrial fibrillation is a common cause of a cerebral vascular accident.

Choices A, B, and C are incorrect because uncontrolled atrial fibrillation does not

cause a myocardial infarction, peripheral vascular disease, or diabetes mellitus.

34. A client with a total body surface area burn of 45% is experiencing

hypovolemic shock. How can the nurse explain this type of shock to the

client’s family?

A Inflammation causes hyperemia.

B Decreased peristalsis increases the risk of aspiration.

C Antidiuretic hormone is released from the posterior pituitary gland.

D Fluids shift from capillaries into interstitial compartments reducing circulating fluid

volume.

Hypovolemic shock or burn shock occurs when a massive amount of fluid shifts

from the intracellular and intravascular compartments into the interstitium causing

third-spacing. Choice A describes what occurs to the respiratory system with a

major burn injury. Choice B describes the gastrointestinal effects of a major burn

injury. Choice C describes the urinary system effects of a major burn injury.

35. A client’s white blood cell differential reveals an elevated monocyte

count. What does this elevation indicate to the nurse?

A Acute infection.

B Hypersensitivity reaction.

C Chronic inflammatory disorder.

D Chronic bacterial infection.

An elevated monocyte count is seen in chronic inflammatory disorders. Choice A

would have an elevation in neutrophils. Choice B would show an elevation in

eosinophils. Choice D would show an elevation in lymphocytes.

36. The nurse is administering an injection of erythropoietin (Procrit) to a

client with chronic renal failure. This medication aids in the prevention of

which health problem?

A Hypertension.

B Hypercalcemia.

C Hyperphosphatemia.

D Anemia.

Erythropoietin is produced by the kidneys and is needed to form red blood cells.

In chronic renal failure, this hormone will not be produced. This can cause the

client to develop anemia. Choices A, B, and C are incorrect because

erythropoietin does not help prevent hypertension, hypercalcemia, or

hyperphosphatemia.

37. The nurse is concerned that a client, recovering from coronary artery

bypass graft surgery, is developing cardiac tamponade when what is

assessed? (Select all that apply.)

A Central venous pressure increased from 10 mm Hg to 12 mm Hg.

B Distant heart sounds.

C Thready radial pulse.

D Decreased electrocardiogram waveform amplitude.

E Distended neck veins.

Manifestations of cardiac tamponade include a rising central venous pressure,

distant heart sounds, decreased electrocardiogram waveform amplitude, and

distended neck veins. These manifestations are caused by the accumulation of

blood or fluid in the pericardium which compresses the atria and ventricles.

Choice C is not an indication of cardiac tamponade.

38. A client is prescribed eplerenone (Inspra) for hypertension. What

should the nurse instruct the client about the mechanism of action for this

medication?

A This medication blocks aldosterone to inhibit sodium reabsorption in the kidney.

B This medication enhances the effects of glucocorticoids.

C This medication aids the thyroid gland to regulate the metabolic rate.

D This medication helps the parathyroid gland to decrease serum calcium.

Eplerenone (Inspra) is aldosterone receptor antagonist and blocks sodium

reabsorption in the kidney. Choice B is incorrect because this medication does

not enhance the effects of glucocorticoids. Choices C and D are incorrect

because this medication does not interact with the thyroid or parathyroid glands.

39. The nurse determines that a client with alcohol detoxification is

experiencing central nervous system excitability when what is assessed?

A Elevated blood pressure.

B Elevated blood glucose level.

C Agitation and hallucinations.

D Paranoid ideations.

Central nervous system excitability with alcohol detoxification occurs because of

a disruption in the balance of an inhibitory neurotransmitter gamma-aminobutyric

acid (GABA) and N-methyl-D-asparate (NMDA) an excitatory neurotransmitter. A

change in this balance can lead to agitation and hallucinations. Choice A is

incorrect because hypertension in the client recovering from alcohol abuse is not

because of central nervous system excitability but rather an alteration in

vasomotor response. Choice B is incorrect because an elevated blood glucose

level would be seen in the client ingesting alcohol and not withdrawing from

alcohol use. Choice D is incorrect because paranoid ideations are associated

with schizophrenia and elevated dopamine levels.

40. While reviewing a client’s laboratory values, the nurse notes an

elevated thyroid stimulating hormone (TSH) level. Which

pathophysiological process is this client most likely experiencing?

A Hypocalcemia.

B Hypothyroidism.

C Hyperthyroidism.

D Hypokalemia.

An elevated thyroid stimulating hormone level occurs in response to a lack of

circulating thyroid hormone. The thyroid hypertrophies and the client experiences

hypothyroidism. Choice A would occur if the thyroid and parathyroid glands were

removed during surgery. Choice C would occur if circulating thyroid hormones

were elevated. Choice D would not occur because of an increase in thyroid

stimulating hormone.

41. While caring for a client recovering from a major burn injury, the nurse

notes a significant increase in urine output. The nurse will plan care for

which stage of burn treatment?

A Emergent.

B Acute.

C Rehabilitative.

D Resuscitative.

The acute stage begins with the start of diuresis and ends with the closure of the

burn wound. Choices A and D are incorrect because this phase begins from the

onset of injury and ends through successful fluid resuscitation as evidenced by

diuresis. Choice C is incorrect because the rehabilitative phase begins after the

burn wound has been closed and continues until the client is able to return to the

highest level of independence and functioning.

42. The nurse is planning to assess the anion gap for a client with

metabolic acidosis. Which laboratory values will the nurse use to make this

calculation? (Select all that apply.)

A Sodium.

B Chloride.

C Oxygen saturation.

D Carbon dioxide level.

E Bicarbonate.

The anion gap is calculated by subtracting the sum of chloride and bicarbonate

from the sodium level. The oxygen saturation (Choice C) and carbon dioxide

level (Choice D) are not used to calculate the anion gap.

43. A client develops sneezing, coughing, itchy eyes, and itchy skin when

in contact with animals. The nurse realizes that this immune response is

caused by which immune system cell?

A B cells.

B T cells.

C Natural killer cells.

D Cytokines.

T cells are activated in hypersensitivity reactions. Choice A produces antibodies

in response to specific antigens. Choice C kills tumor cells, fungi, viral-infected

cells, and foreign tissue. Choice D is incorrect because cytokines are hormonelike

polypeptides that act as messengers of the immune system and facilitate

communication between the different cells.

44. During the shock phase of an alarm reaction, the adrenal medulla

secretes epinephrine and norepinephrine in response to sympathetic

stimulation. When caring for a client in this phase, what will the nurse

assess? (Select all that apply.)

A Tachycardia.

B Elevated blood glucose level.

C Rapid respirations.

D Decreased urine output.

E Decreased blood pressure.

During times of stress, the adrenal medulla secretes hormones that will increase

myocardial contractility, bronchial dilation, and cellular metabolism. The client will

demonstrate tachycardia, an elevated blood glucose level, rapid respirations, and

a decrease in urine output because the blood flow to the kidney will be reduced.

Choice E is incorrect because renin is increased during this phase which causes

the release of angiotensin that increases the blood pressure.

45. A client with type 2 diabetes mellitus experiences lower extremity

edema at the end of the day. What should the nurse instruct the client

about this symptom?

A “Reduce the intake of carbohydrates after the evening meal.”

B “Limit the intake of fluids in the afternoon.”

C “Sit with the legs elevated to promote venous return.”

D “Take an additional dose of antihyperglycemic medication when this occurs.”

The client should be instructed to elevate the legs to promote venous return and

reduce the lower extremity edema. Choice A is incorrect because carbohydrate

intake will not cause lower extremity edema. Choice B is incorrect because

restricting fluids will not reduce this client’s lower extremity edema. Choice D is

incorrect because the nurse cannot prescribe medication nor direct the client to

take an antihyperglycemic medication that is not based upon the client’s blood

glucose level.

46. A client with type 2 diabetes mellitus has prolonged capillary refill of

the toes and reduced sensation along the base of the foot. For which

potential problem will the nurse plan interventions to address?

A Lower extremity edema.

B Skin breakdown.

C Lower extremity weakness.

D Albuminuria.

In the client with type 2 diabetes mellitus, a change in blood flow, as evidenced

by the prolonged capillary refill, and sensation could predispose the client to

developing skin breakdown in the form of a foot wound. Choice A is incorrect

because a change in sensation does not lead to lower extremity edema. Choice

C is incorrect because a change in capillary refill and sensation does not lead to

lower extremity weakness. Choice D is incorrect because a change in capillary

refill and lower extremity sensation will not lead to albuminuria.

47. The plan of treatment for a client with heart failure includes

interventions to reduce afterload and improve coronary artery perfusion.

Which action will the nurse prepare to provide to this client?

A Monitor the results of a beta-adrenergic antagonist.

B Monitor the results of a cardiac glycoside.

C Monitor the results of a diuretic.

D Monitor the intraaortic balloon pump.

The intraaortic balloon pump will mechanically reduce afterload to enhance

coronary artery perfusion during the diastolic phase of the cardiac cycle. Choice

A will block sympathetic innervation to reduce cardiac contractility. Choice B will

cause a slowing of the heart to reduce the cardiac workload. Choice C will

reduce intravascular volume and control excess sodium levels.

48. An older client recovering from a stroke during the last month is

demonstrating electrocardiogram changes consistent with an acute

myocardial infarction. Which medication treatment would be indicated for

this client? (Select all that apply.)

A Antidysrhythmics.

B Analgesics.

C Beta blockers.

D Fibrinolytics.

E Angiotensin-converting enzyme inhibitors.

Medications used in the treatment of an acute myocardial infarction include

antidysrhythmics, pain medication, beta blockers, and angiotensin-converting

enzyme inhibitors. Choice D is contraindicated for this client because of

experiencing a cerebral vascular accident within 2 months of the cardiac event.

49. A client, with acute respiratory distress syndrome (ARDS), is intubated

and placed on mechanical ventilation. Currently, the client’s PaO2 is 58.

What intervention would be indicated for this client?

A Positive end-expiratory pressure.

B Suctioning.

C Increase oxygen to 10 liters.

D Remove continuous positive airway pressure.

When the PaO2 cannot be maintained, there is a risk that oxygen toxicity will

accentuate the disease process. Often it is necessary to add positive end expiratory

pressure (PEEP) to mechanical ventilation settings to maintain blood

and tissue oxygenation. Choice B is incorrect because suctioning will not improve

this client’s oxygen saturation level. Choice C is incorrect since this amount of

oxygen could lead to oxygen toxicity. Choice D is incorrect because continuous

positive airway pressure may need to be added to improve the client’s

oxygenation level.

50. The nurse is explaining hormone feedback control to a client with type

1 diabetes mellitus. What explanation should the nurse use to explain this

hormonal mechanism?

A “This means that each specific hormone targets a specific organ.”

B “This means that hormones influence cells close to the site of hormone

production.”

C “This means that hormones are secreted in response to stressors.”

D “This means that hormones are released and stopped according to the response

received by the body.”

Hormonal feedback control means that hormones are released and stopped

based upon the response received from the body to the hormone. Choice A

describes target organ sensitivity. Choice B describes paracrine functioning.

Choice C describes the neuroendocrine response.

51. A client with increasing intracranial pressure is demonstrating an

alteration in body temperature and fluid balance. The nurse suspects which

brain structure is being affected?

A Thalamus.

B Hypothalamus.

C Cerebellum.

D Midbrain.

The hypothalamus regulates temperature and water metabolism. Choice A

processes sensory impulses before they ascend to the cerebral cortex. Choice C

provides information necessary for balance, posture, and coordinated muscle

movement. Choice D is a center for auditory and visual reflexes.

52. A client is diagnosed with Parkinson’s disease. The nurse would

instruct the client that there is an imbalance with which neurotransmitters?

(Select all that apply.)

A Dopamine.

B Norepinephrine.

C Epinephrine.

D Serotonin.

E Acetylcholine.

In Parkinson’s disease, the number of specific dopamine receptors in the basal

ganglia decreases. This leads to a decrease in the production of dopamine. The

usual balance of dopamine and acetylcholine in the brain is disrupted and

dopamine no longer inhibits acetylcholine. The failure to inhibit acetylcholine is

the underlying basis for the manifestations of Parkinson’s disease. Parkinson’s

disease is not caused by an imbalance of norepinephrine (Choice B),

epinephrine (Choice C), or serotonin (Choice D.

53. A client is diagnosed with a pulmonary embolism. Which

pathophysiological process can cause this client to develop right heart

failure?

A Decrease in alveolar surfactant.

B Bronchoconstriction in the affected area of the lung.

C Neurohumoral reflexes increasing pulmonary vascular resistance.

D Fibrinolytic system dissolving the clot.

In pulmonary embolism, neurohumoral reflexes triggered by obstruction cause

vasoconstriction that increases pulmonary vascular resistance. This can lead to

pulmonary hypertension and right ventricular heart failure. Choice A can lead to

atelectasis. Choice B can lead to dead spacing of the lung. Choice D is a process

that can occur if a small embolism does not infarct lung tissue. The fibrinolytic

system dissolves the clot and pulmonary function returns to normal.

54. A client with pancreatic disease is prescribed an enzyme replacement

containing trypsin. This enzyme is needed to digest which nutrient?

A Carbohydrates.

B Protein.

C Fats.

D Minerals.

The pancreatic enzymes trypsin and chymotrypsin break down proteins into

peptides. Choices A, C, and D are not digested with the pancreatic enzyme

trypsin.

55. A client is having sleep disturbances and changes in appetite and

behavior. What would be the pathophysiological cause for these behavior

changes?

A A decrease in serotonin.

B A decrease in dopamine.

C A decrease in acetylcholine.

D A decrease in norepinephrine.

The neurotransmitter, serotonin, controls sleep, hunger, behavior, and

consciousness. The client’s symptoms could be caused by a decrease in

serotonin. Choice B would be seen in the client with Parkinson’s disease. Choice

C would be seen in the client with myasthenia gravis. Choice D is needed for the

fight-or-flight or the rest-and-digest responses.

HESI Pathophysiology Exit Exam – Answer Key

1. 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 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. 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. 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. 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. 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 paresthesia 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 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. 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. 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. For the client who is being successfully treated for liver disease, the new

manifestation of encephalopathy would indicate a buildup 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. 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. 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. 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. 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. 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.

16. The sinoatrial node is the normal pacemaker of the heart and is located in the

right atrium. This impulse travels across internodal pathways to the

atrioventricular node. It then passes through the bundle of His and continues

down the interventricular septum through the right and left bundle branches and

out to the Purkinje fibers.

17. The brain stem is the physiologic structure that controls cardiac and

respiratory function and the swallowing, gag, and cough reflexes. Choice A is the

center for motor function, communication, judgment, and abstract thought

processes. Choice C is the structure responsible for processing information,

coordination, and balance. Choice D regulates autonomic nervous system

function, regulates and produces hormones, and mediates emotional responses.

18. Third spacing is the sequestering of fluid within interstitial spaces. This

additional fluid can lead to fluid overload and lead to renal and heart failure. One

appropriate intervention for the client at this time would be to implement a fluid

restriction. Choice B could add additional fluid to the already overloaded

circulatory system. Choice C would not help remove the excess fluid from the

overloaded circulatory system. Choice D would encourage fluid to stay within the

circulatory system, potentially causing more symptoms of fluid overload.

19. Arteriosclerosis is the thickening and stiffening of the arteries that lead to a

loss of elasticity within the arterial walls. Choice A is the term used for tortuous

and dilated veins that have incompetent valves. Choice B is the term used for an

abnormal dilation of a blood vessel at a site of a weakness or tear in the vessel

wall. Choice D is the term used to describe a sudden obstruction of a blood

vessel by a clot or other debris.

20. Albumin is a measure of the amount of protein in the body. Protein helps

maintain the colloidal osmotic pressure within the vasculature by preventing fluid

molecules to enter interstitial spaces. When the albumin level is too low, fluid will

enter interstitial spaces, such as the pleura, leading to pleural effusions. Choices

A and C would not be used to determine why a pleural effusion has occurred.

Choice D would be used to determine the effectiveness of dialysis and not be

used to explain the onset of pleural effusions.

21. The hormone chorionic gonadotropin in urine indicates that the client is

pregnant. Choice A is incorrect because the hormone lactogen is needed for

breastfeeding. Choices B and D are incorrect because the hormone chorionic

gonadotropin is not present during menstruation or menopause.

22. Pneumonia can be described as an acute inflammation where the lungs are

blocked with thick exudate. Crackles are the typical sound of pneumonia. Choice

A is characterized by recurrent spasms of the airways with edema and mucus

production. During an acute asthma attack lung sounds are usually diminished

over all lung fields. Choice B is a condition where the surface area of the lungs is

reduced by rupture or other damage to the alveoli. Choice C is either an acute or

chronic inflammation of the bronchi or both bronchi and trachea that is caused by

an infection. The client is usually coughing. The typical lung sound is wheezing.

23. The brainstem consists of the midbrain, pons, and medulla oblongata. Nuclei

within the medulla oblongata play a role in controlling the heart rate, blood

pressure, respirations, and swallowing. Choice A controls sensory input and

muscular activity. Choice C regulates the autonomic nervous system and

hormones. Choice D processes information and coordinates balance, posture,

and muscle movement.

24. In myocardial diastole, the ventricles refill, the atria contract, and the

myocardium is perfused. Choice B described myocardial systole. Choice C

describes what occurs immediately prior to myocardial systole. Choice D

describes what occurs in the sinoatrial node to initiate an electrical impulse.

25. Diabetes insipidus is a deficiency of antidiuretic hormone that causes

polyuria, dehydration, and polydipsia. The nurse will most likely administer

vasopressin which supplies the antidiuretic hormone that the client needs to

achieve fluid balance. Choice A would be provided to a client with diabetes

mellitus. Choice B would be provide for hypoglycemia. Choice D might be

provided to correct electrolyte imbalances in a client with diabetic ketoacidosis.

26. Glomerulonephritis is a disorder that affects the glomeruli of the kidney.

When the glomeruli are damaged, protein molecules can escape from the blood

stream and appear in the urine. This finding can impact the client’s long-term

renal status. The other choices will not provide specific information about the

client’s renal status.

27. Benign prostatic hypertrophy is caused by enlarged prostatic tissue that

compresses the urethra and leads to urinary retention. Choice A is an

inflammation of the prostate gland which may or may not affect urinary output.

Choice B is the presence of cancerous cells within prostate tissue. Choice D is

the presence of cancerous cells within the bladder.

28. In chronic obstructive pulmonary disease, the drive to breathe is initiated by

the level of carbon dioxide in the blood. If provided with oxygen at 4 liters, the

amount of oxygen in the blood is higher than the concentration of carbon dioxide

causing the respiratory rate to decrease. Choice A would not cause the

respiratory rate to decrease. Choice C would most likely cause an increase in the

respiratory rate. Choice D would cause the respiratory rate to increase.

29. The frontal lobes of the brain control motor movements and verbal

expression. An injury to this brain area could lead to the loss of motor

movements in the client. Choices A and B would be assessed in the client with

an injury to the occipital lobe. Choice C would be assessed in the client with an

injury to the temporal lobe.

30. One symptom of hyperglycemia is polydipsia or increased thirst. In diabetic

ketoacidosis the blood glucose levels are elevated. With the administration of

insulin to correct the elevated blood glucose level, the symptom of polydipsia will

improve. Choice A will not correct polydipsia in the client with diabetic

ketoacidosis. Choice C will not correct polydipsia in this client. Choice D will not

improve polydipsia in the client with diabetic ketoacidosis.

31. Multiple sclerosis is believed to occur as a result of an autoimmune response

to a protein in the central nervous system which destroys the myelin sheath of

nerves. Choices B, C, or D are not considered causes of the multiple sclerosis.

32. The purpose of a low fat diet is to reduce the stimulation of the gallbladder by

cholecystokinin which stimulates the gallbladder to contract and release bile in

order to emulsify fats. Choices A, C, and D are not the purposes of a low fat diet

in the client with cholelithiasis.

33. Uncontrolled atrial fibrillation is a common cause of a cerebral vascular

accident. Choices A, B, and C are incorrect because uncontrolled atrial fibrillation

does not cause a myocardial infarction, peripheral vascular disease, or diabetes

mellitus.

34. Hypovolemic shock or burn shock occurs when a massive amount of fluid

shifts from the intracellular and intravascular compartments into the interstitium

causing third-spacing. Choice A describes what occurs to the respiratory system

with a major burn injury. Choice B describes the gastrointestinal effects of a

major burn injury. Choice C describes the urinary system effects of a major burn

injury.

35. An elevated monocyte count is seen in chronic inflammatory disorders.

Choice A would have an elevation in neutrophils. Choice B would show an

elevation in eosinophils. Choice D would show an elevation in lymphocytes.

36. Erythropoietin is produced by the kidneys and is needed to form red blood

cells. In chronic renal failure, this hormone will not be produced. This can cause

the client to develop anemia. Choices A, B, and C are incorrect because

erythropoietin does not help prevent hypertension, hypercalcemia, or

hyperphosphatemia.

37. Manifestations of cardiac tamponade include a rising central venous

pressure, distant heart sounds, decreased electrocardiogram waveform

amplitude, and distended neck veins. These manifestations are caused by the

accumulation of blood or fluid in the pericardium which compresses the atria and

ventricles. Choice C is not an indication of cardiac tamponade.

38. Eplerenone (Inspra) is aldosterone receptor antagonist and blocks sodium

reabsorption in the kidney. Choice B is incorrect because this medication does

not enhance the effects of glucocorticoids. Choices C and D are incorrect

because this medication does not interact with the thyroid or parathyroid glands.

39. Central nervous system excitability with alcohol detoxification occurs because

of a disruption in the balance of an inhibitory neurotransmitter gammaaminobutyric

acid (GABA) and N-methyl-D-asparate (NMDA) an excitatory

neurotransmitter. A change in this balance can lead to agitation and

hallucinations. Choice A is incorrect because hypertension in the client

recovering from alcohol abuse is not because of central nervous system

excitability but rather an alteration in vasomotor response. Choice B is incorrect

because an elevated blood glucose level would be seen in the client ingesting

alcohol and not withdrawing from alcohol use. Choice D is incorrect because

paranoid ideations are associated with schizophrenia and elevated dopamine

levels.

40. An elevated thyroid stimulating hormone level occurs in response to a lack of

circulating thyroid hormone. The thyroid hypertrophies and the client experiences

hypothyroidism. Choice A would occur if the thyroid and parathyroid glands were

removed during surgery. Choice C would occur if circulating thyroid hormones

were elevated. Choice D would not occur because of an increase in thyroid

stimulating hormone.

41. The acute stage begins with the start of diuresis and ends with the closure of the

burn wound. Choices A and D are incorrect because this phase begins from the

onset of injury and ends through successful fluid resuscitation as evidenced by

diuresis. Choice C is incorrect because the rehabilitative phase begins after the

burn wound has been closed and continues until the client is able to return to the

highest level of independence and functioning.

42. The anion gap is calculated by subtracting the sum of chloride and bicarbonate

from the sodium level. The oxygen saturation (Choice C) and carbon dioxide

level (Choice D) are not used to calculate the anion gap.

43. T cells are activated in hypersensitivity reactions. Choice A produces antibodies

in response to specific antigens. Choice C kills tumor cells, fungi, viral-infected

cells, and foreign tissue. Choice D is incorrect because cytokines are hormonelike

polypeptides that act as messengers of the immune system and facilitate

communication between the different cells.

44. During times of stress, the adrenal medulla secretes hormones that will increase

myocardial contractility, bronchial dilation, and cellular metabolism. The client will

demonstrate tachycardia, an elevated blood glucose level, rapid respirations, and

a decrease in urine output because the blood flow to the kidney will be reduced.

Choice E is incorrect because renin is increased during this phase which causes

the release of angiotensin that increases the blood pressure.

45. The client should be instructed to elevate the legs to promote venous return and

reduce the lower extremity edema. Choice A is incorrect because carbohydrate

intake will not cause lower extremity edema. Choice B is incorrect because

restricting fluids will not reduce this client’s lower extremity edema. Choice D is

incorrect because the nurse cannot prescribe medication nor direct the client to

take an antihyperglycemic medication that is not based upon the client’s blood

glucose level.

46. In the client with type 2 diabetes mellitus, a change in blood flow, as evidenced

by the prolonged capillary refill, and sensation could predispose the client to

developing skin breakdown in the form of a foot wound. Choice A is incorrect

because a change in sensation does not lead to lower extremity edema. Choice

C is incorrect because a change in capillary refill and sensation does not lead to

lower extremity weakness. Choice D is incorrect because a change in capillary

refill and lower extremity sensation will not lead to albuminuria.

47. The intraaortic balloon pump will mechanically reduce afterload to enhance

coronary artery perfusion during the diastolic phase of the cardiac cycle. Choice

A will block sympathetic innervation to reduce cardiac contractility. Choice B will

cause a slowing of the heart to reduce the cardiac workload. Choice C will

reduce intravascular volume and control excess sodium levels.

48. Medications used in the treatment of an acute myocardial infarction include

antidysrhythmic, pain medication, beta blockers, and angiotensin-converting

enzyme inhibitors. Choice D is contraindicated for this client because of

experiencing a cerebral vascular accident within 2 months of the cardiac event.

49. When the PaO2 cannot be maintained, there is a risk that oxygen toxicity will

accentuate the disease process. Often it is necessary to add positive end expiratory

pressure (PEEP) to mechanical ventilation settings to maintain blood

and tissue oxygenation. Choice B is incorrect because suctioning will not improve

this client’s oxygen saturation level. Choice C is incorrect since this amount of

oxygen could lead to oxygen toxicity. Choice D is incorrect because continuous

positive airway pressure may need to be added to improve the client’s

oxygenation level.

50. Hormonal feedback control means that hormones are released and stopped

based upon the response received from the body to the hormone. Choice A

describes target organ sensitivity. Choice B describes paracrine functioning.

Choice C describes the neuroendocrine response.

51. The hypothalamus regulates temperature and water metabolism. Choice A

processes sensory impulses before they ascend to the cerebral cortex. Choice C

provides information necessary for balance, posture, and coordinated muscle

movement. Choice D is a center for auditory and visual reflexes.

52. In Parkinson’s disease, the number of specific dopamine receptors in the basal

ganglia decrease. This leads to a decrease in the production of dopamine. The

usual balance of dopamine and acetylcholine in the brain is disrupted and

dopamine no longer inhibits acetylcholine. The failure to inhibit acetylcholine is

the underlying basis for the manifestations of Parkinson’s disease. Parkinson’s

disease is not caused by an imbalance of norepinephrine (Choice B),

epinephrine (Choice C), or serotonin (Choice D.

53. In pulmonary embolism, neurohumoral reflexes triggered by obstruction cause

vasoconstriction that increases pulmonary vascular resistance. This can lead to

pulmonary hypertension and right ventricular heart failure. Choice A can lead to

atelectasis. Choice B can lead to dead spacing of the lung. Choice D is a process

that can occur if a small embolism does not infarct lung tissue. The fibrinolytic

system dissolves the clot and pulmonary function returns to normal.

54. The pancreatic enzymes trypsin and chymotrypsin break down proteins into

peptides. Choices A, C, and D are not digested with the pancreatic enzyme

trypsin.

55. The neurotransmitter, serotonin, controls sleep, hunger, behavior, and

consciousness. The client’s symptoms could be caused by a decrease in

serotonin. Choice B would be seen in the client with Parkinson’s disease. Choice

C would be seen in the client with myasthenia gravis. Choice D is needed for the

fight-or-flight or the rest-and-digest responses.