2020 HESI PATHOPHYSIOLOGY FNP V2 100 PRACTICE QUESTIONS AND ANSWERS

2020 HESI PATHOPHYSIOLOGY FNP V2 100 PRACTICE QUESTIONS AND ANSWERS 1. Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, “What does that mean?” The nurse will base her answer on which of the following physiologic principles? A) “You have been exposed to an infection that went into your blood stream.” B) “You have a heart valve that is diseased.” C) “You heart has been pumping your blood so hard, that the pressure has damaged your valves.” D) “Your heart has enlarged, so naturally your valves had to enlarge as well.” Ans: B Feedback: Turbulence is often accompanied by vibrations of the blood and surrounding cardiovascular structures. Some of these vibrations are in the audible range and can be heard using a stethoscope. For example, a heart murmur results from turbulent flow through a diseased heart valve. The other distractors are not feasible. 2. A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to “watch” for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which of the following physiological principles? A) Small diameter of this vessel will cause it to rupture more readily. B) The larger the aneurysm, the less tension placed on the vessel. C) As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture. D) The primary cause for rupture relates to increase in abdominal pressure such as straining to have a bowel movement. Ans: C Feedback: Because the pressure is equal throughout, the tension in the part of the balloon with the smaller radius is less than the tension in the section with the larger radius. The same holds true for an arterial aneurysm in which the tension and risk of rupture increase as the aneurysm grows in size. Wall tension is inversely related to wall thickness, such that the thicker the vessel wall, the lower the tension, and vice versa. Although arteries have a thicker muscular wall than veins, their distensibility allows them to store some of the blood that is ejected from the heart during systole, providing for continuous flow through the capillaries as the heart relaxes during diastole. 3. A client has entered hypovolemic shock after massive blood loss in a car accident. Many of the client's peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon? A) Blood pressure is no longer able to overcome vessel wall tension. B) Decreasing vessel radii has caused a decrease in blood pressure. C) Wall thickness of small vessels has decreased due to hypotension. D) Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii. Ans: A Feedback: In circulatory shock, there is a decrease in blood volume and vessel radii, along with a drop in blood pressure. As a result, many of the small vessels collapse as blood pressure drops to the point where it can no longer overcome the wall tension. Decreases in vessel wall radii do not cause the decrease in blood pressure, and wall thickness generally remains static. 4. Which of the following statements about vascular compliance is accurate? A) Arteries are much more distensible than veins. B) Veins can act as a reservoir for storing large quantities of blood. C) Arteries have thick muscular walls that constrict tightly, thereby ejecting blood without storing it for later use. D) A continuous flow through the capillaries occurs primarily during systole. Ans: B Feedback: The most distensible of all vessels are the veins, which can increase their volume with only slight changes in pressure, allowing them to function as a reservoir for storing large quantities of blood that can be returned to the circulation when it is needed. Although arteries have a thicker muscular wall than veins, their distensibility allows them to store some of the blood that is ejected from the heart during systole, providing for continuous flow through the capillaries as the heart relaxes during diastole. 5. In the days following a tooth cleaning and root canal, a client has developed an infection of the thin, three- layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis? A) Pericarditis B) Endocarditis C) Myocarditis D) Vasculitis Ans: B Feedback: The endocardium is a thin, three-layered membrane that lines the heart and covers the valves; infection of this part of the heart is consequently referred to as endocarditis. 6. Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences? A) Backup of blood from the right atrium into the superior vena cava B) Backflow from the right ventricle to the right atrium during systole C) Inhibition of the SA node's normal action potential D) Backflow from the left ventricle to the left atrium Ans: D Feedback: The mitral valve separates the left ventricle from the left atrium; failure of this valve would cause backflow from the former to the latter during systole. Valve function does not directly affect cardiac contractility. 7. Heart muscle differs from skeletal muscle tissue by being able to generate: A) Contractions B) Calcium influx C) Action potentials D) Sarcomere binding Ans: C Feedback: Heart muscle, or the myocardium, is unique among other muscles in that it is capable of generating and rapidly conducting its own electrical impulses or action potentials. These action potentials result in excitation of muscle fibers throughout the myocardium. Similarities to skeletal muscle include contractility, calcium influx, and actin–myosin (sarcomeres) binding. 8. When discussing the AV node's role in the electrical conduction of the heart with a client newly diagnosed with an AV block, which of the following statements are accurate? Select all that apply. A) The AV node offers a two-way conduction area between the atria and the ventricles. B) The velocity of conduction through the AV junctional fibers is very fast, which greatly increases impulse transmission. C) A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. D) When there is an AV block, impulses from the atria and ventricles beat independently of each other so, the heart rhythm is usually chaotic and not regular. Ans: C, D Feedback: The AV node connects the atrial and ventricular systems and normally provides for a one-way conduction between the atria and ventricles. The velocity of conduction through the AV junctional fibers is very slow, which greatly delays impulse transmission. A further delay occurs as the impulse travels through the transitional fibers and into the AV bundle, known as the bundle of His. This delay provides a mechanical advantage whereby the atria can complete their ejection of blood before ventricular contraction begins. Under normal circumstances, the AV node provides the only connection between the atrial and ventricular conduction systems. The atria and ventricles would beat independently of each other if the transmission of impulses through the AV node were blocked. 9. If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern? A) Heart rate 150 beats/minute, labeled as supraventricular tachycardia B) Disorganized ventricular fibrillation