HESI PATHOPHYSIOLOGY EXIT EXAM
BANK 2024-2025 WITH ACTUAL CORREC
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The nurse is assessing a client with a ruptured small bowel and determines that the client has a
temperature of 102.8° F. Which assessment finding provides the earliest indication that the client is
experiencing septic shock?
A. Bilateral crackles.
B. Hyperpnea.
C. Mucus production.
D. Weak peripheral pulses.
B. Hyperpnea.
The interrelated pathophysiologic changes associated with the hypermetabolic state of sepsis and
septic shock produce a pathologic imbalance between cellular oxygen demand, supply, and
consumption. Hyperpnea (B), an increased depth of respirations, is an early manifestation of sepsis.
(A, C, and D) are signs of advanced shock.
Which signs and symptoms are associated with arterial insufficiency?
A. Pallor, intermittent claudication.
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,B. Pedal edema, brown pigmentation.
C. Blanched skin, lower extremity ulcers.
D. Peripheral neuropathy, cold extremities.
A. Pallor, intermittent claudication.
Pallor and intermittent claudication (A) are signs related to stage Il of peripheral vascular disease,
which results in arterial insufficiency. (B) are signs related to venous insufficiency. (C) are not specific
to arterial disease. Although (D) may be related to complications of diabetes mellitus resulting in poor
circulation, arterial insufficiency causes impaired perfusion resulting in hypoxic pain or intermittent
claudication.
The severity of diabetic retinopathy is directly related to which condition?
A. Poor blood glucose control.
B. Neurological effects of diabetes.
C. Susceptibility to infection.
D. Uncontrolled hypertension.
A. Poor blood glucose control.
Poor glucose control (A) worsens diabetic retinopathy, where as tight glucose control can lessen its
severity. (B, C, and D) do not affect the severity of diabetic retinopathy.
A client with a fractured right radius reports severe, diffuse pain that has not responded to the
prescribed analgesics. The pain is greater with passive movement of the limb than with active
movement by the client. The nurse recognizes that the client is most likely exhibiting symptoms of which
condition?
A. Acute compartment syndrome.
B. Fat embolism syndrome.
C. Venous thromboembolism.
D. Aseptic ischemic necrosis.
A. Acute compartment syndrome.
These signs are specific indications of Acute Compartment Syndrome (A), and should be treated as an
emergency situation. The signs do not indicate (B, C, or D).
When observing a client for symptoms of a large bowel obstruction, the nurse should assess for which
finding?
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,A. Distention of the lower abdomen.
B. Nausea with profuse vomiting.
C. Upper abdominal discomfort.
D. Fluid and electrolyte imbalances.
A. Distention of the lower abdomen.
Among findings characteristic of a large bowel obstruction is the distention of the lower abdomen (A).
(B, C, and D) are findings associated with small bowel obstruction.
The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH), which is
manifested by which symptoms?
A. Loss of thirst, weight gain.
B. Dependent edema, fever.
C. Polydipsia, polyuria.
D. Hypernatremia, tachypnea.
A. Loss of thirst, weight gain.
SIADH occurs when the posterior pituitary gland releases too much ADH, causing water retention, a
urine output of less than 20 ml/hour, and dilutional hyponatremia. Other indications of SIADH are loss
of thirst, weight gain (A), irritability, muscle weakness, and decreased level of consciousness. (B) is not
associated with SIADH. (C) is a finding associated with diabetes insipidus (a water metabolism
problem caused by an ADH deficiency), not SIADH. The increase in plasma volume causes an increase
in the glomerular filtration rate that inhibits the release of rennin and aldosterone, which results in an
increased sodium loss in urine, leading to greater hyponatremia, not (D).
The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). This
condition is most often related to which predisposing condition?
A. Small cell lung cancer.
B. Active tuberculosis infection.
C. Hodgkin's lymphoma.
D. Tricyclic antidepressant therapy.
A. Small cell lung cancer.
Cancer is the most common cause of the syndrome of inappropriate antidiuretic hormone (SIADH),
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, with small cell lung cancer (A) being the most common cancer that increases ADH, which causes
dilutional hyponatremia and fluid retention. (B, C, and D) are also possible causes, but secondary to
CNS trauma or disease.
The nurse is assessing a postmenopausal woman who is complaining of urinary urgency and frequency
and stress incontinence. She also reports difficulty in emptying her bladder. These complaints are most
likely due to which condition?
A. Cystocele.
B. Bladder infection.
C. Pyelonephritis.
D. Irritable bladder.
A. Cystocele.
This constellation of signs in a postmenopausal woman are characteristic of a cystocele (A). These
symptoms are not characteristic of (B, C, or D).
Which pathophysiological response supports a client's vomiting experience?
A. Sensory input of noxious stimuli relayed to the cognitive centers is associated with disgust and illicits
vomiting.
B. Response of stimulation of the posterior oropharynx results in reverse peristalsis of the
gastrointestinal tract.
C. Spasmodic reflex of respiratory and gastric movements results from stimulation of the chemoreceptor
trigger zone.
D. Increased gastric and colonic pressures move gastrointestinal contents to the orifice of least
resistance.
C. Spasmodic reflex of respiratory and gastric movements results from stimulation of the chemoreceptor
trigger zone.
Vomiting is a reflex of spasmodic respiratory movements against the glottis causing the forceful
expulsion of the contents of the stomach through the mouth. Stimulation of the emetic center results
from afferent vagal and sympathetic nerve pathways that activate the chemoreceptor trigger zone
(CTZ) (C). (A) is a learned response and influences nausea, but does not explain the mechanical
physiology. Although self-induced vomiting responds to tactile stimulation of the posterior
oropharynx (B), the physiological mechanism of vomiting coordinates actions required to empty the
gastric contents. (D) may occur, but does not explain reflex vomiting.
A client's family asks why their mother with heart failure needs a pulmonary artery (PA) catheter now
that she is in the intensive care unit (ICU). What information should the nurse include in the explanation
to the family?
A. A central monitoring system reduces the risk of complications undetected by observation.
B. A pulmonary artery catheter measures central pressures for monitoring fluid replacement.
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