HESI ADVANCED PATHOPHYSIOLOGY EXAM WITH
QUESTIONS AND CORRECT ANSWERS WITH SOLUTIONS
Which of the following outpatients are at a greater risk for developing Treponema pallidum, the
cause of syphilis? Select all that apply.
A) A homeless adolescent female performing oral sex for money
B) A male who frequents clubs catering to exotic dancers and sexual favors
C) A homosexual male couple who have had a monogamous relationship for the past 20 years
D) An older adult female living in a condominium who regularly has sex with three to four
different men/week - CORRECT ANSWER-Ans: A, B, D
Feedback:
Treponema pallidum is a sexually transmitted infection that is spread by direct physical contact.
The Borrelia type of spirochete is spread from animals to humans through lice or tick bites.
Leptospira spirochetes spread from animals to humans through contact with infected animal
urine. Spirochetes are anaerobic; therefore, they would not invade the host through oxygen-
filled aerobic lungs.
Chlamydiaceae have characteristics of both viruses and bacteria and are a rather common
sexually transmitted infectious organism. After entry into the host, they transform into a
reticulate body. The health care provider should monitor which of the following clients for this
possible infection? Select all that apply.
A) An adult male who raises a number of exotic birds in his home
B) A drug abuser looking to share needles/syringes
C) A newborn with a noticeable eye infection
D) A teenager who swims in the lake regularly - CORRECT ANSWER-Ans: A, B, C
Feedback:
Chlamydiaceae are in the form of an elementary body when infectious and outside of the host
cell. Once an organism enters the cell, it transforms into a large reticulate body. This undergoes
active replication into multiple elementary bodies, which are then shed into the extracellular
environment to initiate another infectious cycle. Chlamydial diseases of humans include sexually
,transmitted genital infections (Chlamydophila trachomatis); ocular infections and pneumonia of
newborns (C. trachomatis); upper and lower respiratory tract infections in children, adolescents,
and young adults (Chlamydophila pneumoniae); and respiratory disease acquired from infected
birds (Chlamydophila psittaci).
A client has been diagnosed with Coxiella burnetii infection. She asked the health care provider
how she could have gotten this disease. The health care provider's best response is:
A) "Probably while walking outside without your shoes on."
B) "While swimming in an unsanitary pond."
C) "Drinking contaminated milk."
D) "Eating undercooked fish." - CORRECT ANSWER-Ans: C
Feedback:
In humans, Coxiella infection produces a disease called Q fever, characterized by a nonspecific
febrile illness often accompanied by headache, chills, arthralgias, and mild pneumonia. The
organism produces a highly resistant sporelike stage that is transmitted to humans when
contaminated animal tissue is aerosolized (e.g., during meat processing) or by ingestion of
contaminated milk.
A teenage male develops a severe case of "athlete's foot." He asks, "How did I get this?" The
health care worker explains that certain fungi become infectious (called dermatophytes) and
exhibit which of the following characteristics? A) Prefer to grow in warm environments like
shoes/socks
B) Like a moist environment
C) Limited to cooler cutaneous surfaces
D) Need higher blood flow to survive - CORRECT ANSWER-Ans: C
Feedback:
Dermatophytes are not able to grow at core body temperature, preferring the cooler surface
skin areas instead of moist skin folds. Diseases caused by these organisms, including ringworm,
athlete's foot, and jock itch, are collectively called superficial mycoses.
,A male client with a history of angina has presented to the emergency department with
uncharacteristic chest pain, and his subsequent ECG reveals T-wave elevation. This finding
suggests an abnormality with which of the following aspects of the cardiac cycle?
A) Atrial depolarization
B) Ventricular depolarization
C) Ventricular repolarization
D) Depolarization of the AV node - CORRECT ANSWER-Ans: C
Feedback:
The T wave on electrocardiography (ECG) corresponds to ventricular repolarization. Atrial
depolarization is represented by the P wave and ventricular depolarization by the QRS complex.
The isoelectric or zero line between the P wave and the Q wave represents depolarization of the
AV node, bundle branches, and Purkinje system.
During ventricular systole, closure of the atrioventricular (AV) valves coincides with:
A) Atrial chamber filling
B) Aortic valve opening
C) Isovolumetric contraction
D)Semilunar valves opening - CORRECT ANSWER-Ans: C
Feedback:
Ventricular systole is divided into two parts: isovolumetric contraction when the AV valves close
and ventricles fill; and the ejection period, when the semilunar valves open and blood is ejected
through the aortic valve into circulation. Immediately after closure of the AV valves, there is a
0.02- to 0.03-second period during which the pulmonic and aortic valves remain closed. During
this period, the ventricular volume remains the same while the ventricles contract, producing
an abrupt increase in pressure. At the end of systole, the ventricles relax, causing a precipitous
fall in intraventricular pressures. As this occurs, blood from the large arteries flows back toward
the ventricles, causing the aortic and pulmonic valves to snap shut—an event marked by the
second heart sound.
, Following routine colonoscopy screening, a client is told that he had several polyps removed.
The client began crying stating, "I just can't deal with cancer. I'm too young." The nurse
responds: A) "Don't worry. We have some great cancer doctors on staff. I'm sure chemo will help
you fight it." B) "Maybe if you're lucky, they have stopped it from metastasizing to your liver." C)
"A simple intestinal surgery will cure you." D) "Most colon polyps are not cancerous. The biopsy
results will direct your care." - CORRECT ANSWER-Ans: D Feedback: A polyp is a growth that
projects from a mucosal surface, such as the intestine. Although the term usually implies a
benign neoplasm, some malignant tumors also appear as polyps. Adenomatous polyps are
considered precursors to adenocarcinomas of the colon.
A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung
tumor in a client. Which of the following characteristics is associated with this client's
neoplasm? A) The tumor will grow by expansion and is likely encapsulated. B) The cells that
constitute the tumor are undifferentiated, with atypical structure. C) If left untreated, the
client's tumor is likely to metastasize. D) The tumor is likely to infiltrate the lung tissue that
presently surrounds it. - CORRECT ANSWER-Ans: A Feedback: Benign neoplasms typically grow
by expansion rather than invasion. As well, they are usually contained within a fibrous capsule.
Malignant tumors are associated with undifferentiated cells, metastasis, and infiltration of
surrounding tissue.
3. A newly diagnosed lung cancer client asks how his tumor spread (metastasized) so fast
without displaying many signs/symptoms. The nurse responds that malignant tumors affect area
tissues by: A) Increasing tissue blood flow B) Providing essential nutrients
C)Liberating enzymes and toxinsD)Forming fibrous membranes - CORRECT ANSWER-Ans: C
Feedback: Malignant tumors affect area tissues by liberating enzymes and toxins that destroy
tumor tissue and normal tissue. In addition, the malignant cells compress area vessels, causing
ischemia and tissue necrosis. The high metabolic rate of tumor growth causes the tumor to
deprive the normal tissues of essential nutrients.
A client had a positive Pap smear. The surgeon diagnosed "cancer in situ of the cervix." The
client asks, "What does this mean?" From the following statements, which is most appropriate
in response to this question? The tumor has: A) Been walled off within a strong fibrous capsule
B) Developed a distant infiltration C) Not crossed the basement membrane, so it can be
surgically removed with little chance of growing back D) Grown undifferentiated cells that no
longer look like the tissue from which it arose - CORRECT ANSWER-Ans: C Feedback: Cancer in
QUESTIONS AND CORRECT ANSWERS WITH SOLUTIONS
Which of the following outpatients are at a greater risk for developing Treponema pallidum, the
cause of syphilis? Select all that apply.
A) A homeless adolescent female performing oral sex for money
B) A male who frequents clubs catering to exotic dancers and sexual favors
C) A homosexual male couple who have had a monogamous relationship for the past 20 years
D) An older adult female living in a condominium who regularly has sex with three to four
different men/week - CORRECT ANSWER-Ans: A, B, D
Feedback:
Treponema pallidum is a sexually transmitted infection that is spread by direct physical contact.
The Borrelia type of spirochete is spread from animals to humans through lice or tick bites.
Leptospira spirochetes spread from animals to humans through contact with infected animal
urine. Spirochetes are anaerobic; therefore, they would not invade the host through oxygen-
filled aerobic lungs.
Chlamydiaceae have characteristics of both viruses and bacteria and are a rather common
sexually transmitted infectious organism. After entry into the host, they transform into a
reticulate body. The health care provider should monitor which of the following clients for this
possible infection? Select all that apply.
A) An adult male who raises a number of exotic birds in his home
B) A drug abuser looking to share needles/syringes
C) A newborn with a noticeable eye infection
D) A teenager who swims in the lake regularly - CORRECT ANSWER-Ans: A, B, C
Feedback:
Chlamydiaceae are in the form of an elementary body when infectious and outside of the host
cell. Once an organism enters the cell, it transforms into a large reticulate body. This undergoes
active replication into multiple elementary bodies, which are then shed into the extracellular
environment to initiate another infectious cycle. Chlamydial diseases of humans include sexually
,transmitted genital infections (Chlamydophila trachomatis); ocular infections and pneumonia of
newborns (C. trachomatis); upper and lower respiratory tract infections in children, adolescents,
and young adults (Chlamydophila pneumoniae); and respiratory disease acquired from infected
birds (Chlamydophila psittaci).
A client has been diagnosed with Coxiella burnetii infection. She asked the health care provider
how she could have gotten this disease. The health care provider's best response is:
A) "Probably while walking outside without your shoes on."
B) "While swimming in an unsanitary pond."
C) "Drinking contaminated milk."
D) "Eating undercooked fish." - CORRECT ANSWER-Ans: C
Feedback:
In humans, Coxiella infection produces a disease called Q fever, characterized by a nonspecific
febrile illness often accompanied by headache, chills, arthralgias, and mild pneumonia. The
organism produces a highly resistant sporelike stage that is transmitted to humans when
contaminated animal tissue is aerosolized (e.g., during meat processing) or by ingestion of
contaminated milk.
A teenage male develops a severe case of "athlete's foot." He asks, "How did I get this?" The
health care worker explains that certain fungi become infectious (called dermatophytes) and
exhibit which of the following characteristics? A) Prefer to grow in warm environments like
shoes/socks
B) Like a moist environment
C) Limited to cooler cutaneous surfaces
D) Need higher blood flow to survive - CORRECT ANSWER-Ans: C
Feedback:
Dermatophytes are not able to grow at core body temperature, preferring the cooler surface
skin areas instead of moist skin folds. Diseases caused by these organisms, including ringworm,
athlete's foot, and jock itch, are collectively called superficial mycoses.
,A male client with a history of angina has presented to the emergency department with
uncharacteristic chest pain, and his subsequent ECG reveals T-wave elevation. This finding
suggests an abnormality with which of the following aspects of the cardiac cycle?
A) Atrial depolarization
B) Ventricular depolarization
C) Ventricular repolarization
D) Depolarization of the AV node - CORRECT ANSWER-Ans: C
Feedback:
The T wave on electrocardiography (ECG) corresponds to ventricular repolarization. Atrial
depolarization is represented by the P wave and ventricular depolarization by the QRS complex.
The isoelectric or zero line between the P wave and the Q wave represents depolarization of the
AV node, bundle branches, and Purkinje system.
During ventricular systole, closure of the atrioventricular (AV) valves coincides with:
A) Atrial chamber filling
B) Aortic valve opening
C) Isovolumetric contraction
D)Semilunar valves opening - CORRECT ANSWER-Ans: C
Feedback:
Ventricular systole is divided into two parts: isovolumetric contraction when the AV valves close
and ventricles fill; and the ejection period, when the semilunar valves open and blood is ejected
through the aortic valve into circulation. Immediately after closure of the AV valves, there is a
0.02- to 0.03-second period during which the pulmonic and aortic valves remain closed. During
this period, the ventricular volume remains the same while the ventricles contract, producing
an abrupt increase in pressure. At the end of systole, the ventricles relax, causing a precipitous
fall in intraventricular pressures. As this occurs, blood from the large arteries flows back toward
the ventricles, causing the aortic and pulmonic valves to snap shut—an event marked by the
second heart sound.
, Following routine colonoscopy screening, a client is told that he had several polyps removed.
The client began crying stating, "I just can't deal with cancer. I'm too young." The nurse
responds: A) "Don't worry. We have some great cancer doctors on staff. I'm sure chemo will help
you fight it." B) "Maybe if you're lucky, they have stopped it from metastasizing to your liver." C)
"A simple intestinal surgery will cure you." D) "Most colon polyps are not cancerous. The biopsy
results will direct your care." - CORRECT ANSWER-Ans: D Feedback: A polyp is a growth that
projects from a mucosal surface, such as the intestine. Although the term usually implies a
benign neoplasm, some malignant tumors also appear as polyps. Adenomatous polyps are
considered precursors to adenocarcinomas of the colon.
A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung
tumor in a client. Which of the following characteristics is associated with this client's
neoplasm? A) The tumor will grow by expansion and is likely encapsulated. B) The cells that
constitute the tumor are undifferentiated, with atypical structure. C) If left untreated, the
client's tumor is likely to metastasize. D) The tumor is likely to infiltrate the lung tissue that
presently surrounds it. - CORRECT ANSWER-Ans: A Feedback: Benign neoplasms typically grow
by expansion rather than invasion. As well, they are usually contained within a fibrous capsule.
Malignant tumors are associated with undifferentiated cells, metastasis, and infiltration of
surrounding tissue.
3. A newly diagnosed lung cancer client asks how his tumor spread (metastasized) so fast
without displaying many signs/symptoms. The nurse responds that malignant tumors affect area
tissues by: A) Increasing tissue blood flow B) Providing essential nutrients
C)Liberating enzymes and toxinsD)Forming fibrous membranes - CORRECT ANSWER-Ans: C
Feedback: Malignant tumors affect area tissues by liberating enzymes and toxins that destroy
tumor tissue and normal tissue. In addition, the malignant cells compress area vessels, causing
ischemia and tissue necrosis. The high metabolic rate of tumor growth causes the tumor to
deprive the normal tissues of essential nutrients.
A client had a positive Pap smear. The surgeon diagnosed "cancer in situ of the cervix." The
client asks, "What does this mean?" From the following statements, which is most appropriate
in response to this question? The tumor has: A) Been walled off within a strong fibrous capsule
B) Developed a distant infiltration C) Not crossed the basement membrane, so it can be
surgically removed with little chance of growing back D) Grown undifferentiated cells that no
longer look like the tissue from which it arose - CORRECT ANSWER-Ans: C Feedback: Cancer in
