HESI RN ADVANCED PATHOPHYSIOLOGY 2023 -2024 ACTUAL EXAM 160 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ (LATEST VERSION ) A child has been diagnosed with marasmus due to the fact that the parents have both lost their jobs and have very limited funds for food. Which of the following clinical manifestations would the school nurse assess that would confirm this diagnosis? Select all that apply. A) Discolored hair B) Bradycardia C) Enlarged liver D) Pitting edema E) Stunted growth pattern - ANSWER - Ans: B, E Rationale: Inadequate food intake, with equal deficiencies of calories and protein, is the cause of marasmus, which is characterized by low heart rate, blood pressure, and body temperature; dull hair; and an emaciated appearance. Hair discoloration, enlarged liver, and pitting edema are manifestations of kwashiorkor, which is a severe protein deficiency. A school nurse has identified a student with noticeable loss of lean tissues and muscle mass. More than likely, this is caused by protein -
calorie malnutrition. The nurse should ask the student if he is experiencing which of the following clinical manifesta tions that helps confirm this diagnosis? A) Respiratory muscle stimulation B) Excessive blood cell production C) Diarrhea D) Increased cardiac contractility - ANSWER - Ans: C Rationale: Protein -calorie malnutrition results in skeletal muscle loss and diarrh ea. This type of malnutrition is also characterized by respiratory muscle weakness and blood cell loss that impairs the immune response. A homeless client asks, "Why can't I get this wound on my foot to heal?" Knowing that the client is not receiving good nutrition on a regular basis, the nurse will reply: A) "Maybe if you could come to the clinic every day, we can help you change your dressing." B) "Right now your immune system is decreased because you are not eating a balanced diet." C) "Maybe if you cou ld find a place to sleep that is cleaner than where you usually sleep that will help." D) "We just need to make sure you are getting the right antibiotics." - ANSWER - Ans: B Rationale: As protein is lost from the liver, hepatic synthesis of proteins decline s, and plasma protein levels decrease. There also is a decrease in immune cells. Wound healing is poor, and the body is unable to fight off infection because of multiple immunologic malfunctions throughout the body. At the cellular level, cardiac muscle c ells respond to an increase in ventricular volume to the point of overload by: Select all that apply. A) Elongating the cardiac muscle cells B) Thickening of the individual myocytes C) Replicating the myofibrils D) Decreasing the ventricular wall thickness E) Symmetrically widening and lengthening the hypertrophy - ANSWER - Ans: A, D Rationale: At the cellular level, cardiac muscle cells respond to stimuli from stress placed on the ventricular wall by pressure and volume overload by initiating several differe nt processes that lead to hypertrophy. With ventricular volume overload, the increase in wall stress leads to replication of myofibrils in series, elongation of the cardiac muscle cells, and eccentric hypertrophy. Eccentric hypertrophy leads to a decrease in ventricular wall thickness or thinning of the wall with an increase in diastolic volume and wall tension. Production of a symmetric hypertrophy occurs with a proportionate increase in muscle length and width, as occurs in athletes; concentric hypertroph y with an increase in wall thickness, as occurs in hypertension; and eccentric hypertrophy with a disproportionate increase in muscle length, as occurs in dilated cardiomyopathy. When the primary stimulus for hypertrophy is pressure overload, the increase in wall stress leads to parallel replication of myofibrils, thickening of the individual myocytes, and concentric hypertrophy. Concentric hypertrophy may preserve systolic function for a time, but eventually the work performed by the ventricle exceeds the vascular reserve, predisposing to ischemia. From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply. A) A 48 -year-old client with uncontrolled hypertension B) A marathon run ner with history of chronic bradycardia whose pulse rate is 46 C) A 57 -year-old client with history of ischemic heart disease D) A 70 -year-old with enlarged left ventricle due to myocardial hypertrophy - ANSWER - Ans: A, D Rationale: Conditions that reduce the heart's ability to adequately fill during diastole, such as myocardial hypertrophy and tachycardia, can lead to heart failu re. Hypertension remains the leading cause of diastolic dysfunction. Ischemic heart disease is associated with systolic heart failure, or impaired contractile performance. It is normal for athletes, like marathon runners, to have slow pulses. The most com mon causes of left -sided heart failure include: A) Acute myocardial infarction B) Chronic pulmonary disease C) Impaired renal blood flow D)Tricuspid valve regurgitation - ANSWER - Ans: A Rationale: The most common causes of left -sided heart failure are acute myocardial infarction and hypertension. Acute or chronic pulmonary disease can cause right heart failure, referred to as cor pulmonale. The causes of right -sided heart failure include stenosis or regurgitation of the tricuspid or pulmonic valves, right ve ntricular infarction, and cardiomyopathy.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller johnkabiru. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $27.49. You're not tied to anything after your purchase.
