Advanced Patho HESI Questions & Answers

The nurse hears short, high-pitched sounds just before the end of inspiration in the right and left lower lobes when auscultating a client's lungs. How should this finding be recorded? - ANSWERSFine crackles are short, high pitched sounds heard just before the end of inspiration that are the result of rapid equalization of pressure when collapsed alveoli or terminal bronchioles suddenly snap open. The nurse is assessing an older client and determines that the client's left upper eyelid droops, covering more of the iris than the right eyelid. Which description should the nurse use to document this finding? - ANSWERSPtosis is the term used to describe an eyelid droop that covers a large portion of the iris, which may result from oculomotor nerve or eyelid muscle disorder. A client's family asks why their mother with heart failure needs a pulmonary artery catheter now that she is in the ICU. What information should the nurse include in the explanation to the family? - ANSWERSPulmonary artery catheters are used to measure central pressures and fluid balance. Even though all clients in the ICU require close monitoring, they do not all need a PA catheter Several hours after surgical repair of an abdominal aortic aneurysm, the client develops left flank pain. The nurse determines the client's urinary output is 20 mL/hr for the past 2 hours. - ANSWERSPostoperative complications of surgical repair of AAA are related to the location of resection, graft, or stent placement along the abdominal aorta. Embolization of a fragment of thrombus or plaque from the aorta into a renal artery can compromise blood flow in one of the renal arteries, resulting in renal ischemia that precipitates unilateral flank pain. The nurse should conclude that these findings support which complication? - ANSWERSIntraoperative blood loss or rupture of the aorta anastomosis can cause acute renal failure related to hypovolemia. The nurse is assessing a postmenopausal woman who is complaining of urinary urgency and frequency and stress incontinence. She also reports difficulty emptying her bladder. These complaints are most likely due to which condition? - ANSWERSThis constellation of signs in a postmenopausal woman are characteristic of cystocele. A male client who has never smoked by has had COPD is now being assessed for cancer of the lung. The nurse knows that he is most likely to develop which type of lung cancer? - ANSWERSAdenocarcinoma is the only lung cancer not related to cigarette smoking. It has been found to be directly related to lung scarring and fibrosis from preexisting pulmonary disease such as TB or COPD. Muscular Dystrophy is characterized by which pathophysiological condition? - ANSWERSSkeletal muscle degeneration is a classic symptom of muscular dystrophy. The nurse is preparing to administer atropine, an anticholinergic, to a client who is scheduled for a cholecystectomy. The client asks the nurse to explain the reason for the prescribed medication. What is the best response for the nurse to provide? - ANSWERSAtropine may be prescribed to increase the automaticity of the SA node and prevent a dangerous reduction in HR during surgical anesthesia. What information should the nurse include in a teaching plan about the onset of menopause? - ANSWERSSmoking, Oophorectomy and hysterotomy, Early menarche, Genetic influence and Chemotherapy exposure. A patient with aortic valve stenosis develops heart failure. - ANSWERSHypertension and incompetent or stenotic heart valves cause an increase in the workload of the heart by increasing the afterload which requires an increase in the force of contraction to pump blood out of the heart. Which pathophysiological finding occurs in the myocardial cells as a result of the increased cardiac workload? - ANSWERSMyocardial hypertrophy results because the cells increase in surface area or size by increasing the amount of contractile proteins, but the quantity. Physical examination of a comatose patient reveals decorticate posturing. Which statement is accurate regarding this client's status based upon this finding? - ANSWERSDecorticate posturing adduction of arms and shoulders, flexion of arms on chest with wrists flexed and hands fisted and extension and adduction of extremities is seen with severe dysfunction of the cerebral cortex. Which client is at highest risk for chronic kidney disease secondary to diabetes mellitus? - ANSWERSDiabetic retinopathy and nephropathy are related to prolonged hyperglycemia and hypertension which damage the microvasculature of the eyes and kidneys, so a client with Type 1 DM and retinopathy is most likely to develop neuropathy and chronic kidney disease. A mother is crying as she holds and rocks her child with tetanus who is having muscular spasms and crying. After administering diazepam (Valium) to the child, what action should the nurse implement? - ANSWERSControlling environmental stimulation such as noise, light, or tactile stimuli helps reduce CNS irritability related to acute tetanus. The mother should be instructed to minimize handling of the child during episodes of muscle spasticity and to stay calmly near the child. The mother's presence with the child provides security and support, A female client tells the nurse that she does not know which day of the month is best to do self breast examinations. Which instruction should the nurse provide? - ANSWERSDue to the effect of cyclic ovarian changes on the breast, the best time to do a BSE is 5-7 days after menstruation stops. What histologic finding in an affected area of the body would suggest the presence of chronic inflammation? - ANSWERSA predominance of monocytes and macrophages in an inflamed area indicates the start of a chronic infection. After talking with the healthcare provider, a male client continues to have questions about the results of a prostatic surface antigen (PSA) screening test and asks the nurse how the PSA levels become elevated. The nurse should explain which pathophysiological mechanism? - ANSWERSPSA is a glycoprotein found in prostatic epithelial cells, and elevations are used as a specific tumor marker. Elevations in PSA are related to gland volume, i.e. benign prostatic hypertrophy, prostatitis, and cancer of the prostate, indicating (tumor) cell load. A 27 year old male client with Hodgkin's disease is scheduled to undergo radiation therapy. The client expresses concern about the effect of radiation on his ability to have children. What information should the nurse provide? - ANSWERSLow sperm count and loss of motility are seen in males with Hodgkin's disease before any therapy. Radiotherapy often results in permanent aspermia, or sterility. A client is admitted to the ER with a tension pneumothorax. Which assessment should the nurse expect to identify? - ANSWERSTension pneumothorax is caused by rapid accumulation of air in the pleural space, causing severely high intrapleural pressure. This results in collapse of the lung, and the mediastinum shifts toward the unaffected side, which is subsequently compressed. A client who is receiving a whole blood transfusion develops chills, fever, and a headache 30 minutes after the transfusion started. The nurse should recognize these symptoms as characteristic of what reaction? - ANSWERSSymptoms of a febrile transfusion reaction includes: sudden chills, fever, headache, flushing and muscle pain. An allergic reaction The nurse is analyzing the waveforms of a client's electrocardiogram. What finding indicates a disturbance in electrical conduction of the ventricles? - ANSWERSThe normal duration of QRS is 0.04-0.12 seconds, so a prolonged QRS indicates an electrical anomaly in the ventricles.