lOMoARcPSD|26582732
Lomoarcpsd|26582732
2025 advanced pathophysiology
hesi rn questions and answers
Advanced Pathophysiology (Chamberlain University)
1. What is TPA? What are at least 2 conditions where you might see it given as a
medication? Why would we not give it? Tpa: clot busting agent used to reduce
the effects of CVA (stroke) in some individuals. It is contraindicated for
anticoagulant drugs.
The release of tissue plasminogen (tpa) from injured blood vessels and tissues,
converts plasminogen to plasmin. Plasmin is a potent enzyme that digests fibrin
strands (this leads to clot dissolution).
2. Know the triad that would lead you to conclude your patient is experiencing
cardiac tamponade
Fluid compresses the heart, prevents stretching & filling, reduces CO
Arterial pressure falls, venous pressures rise, pulse pressure narrows
Beck’s Triad: Distant, muffled heart sounds (like under water, fluid),
JVD, decreased BP
= EMERGENCY
Pericardiocentesis with surgical repair as appropriate is needed (16-18 gauge
needle inserted into pericardial space to relieve pressure and analyze fluid)
Manifestations include heavy feelings over the chest, shortness of breath,
tachycardia, cough, dysphagia, hiccups, hoarseness, nausea, vomiting, excessive
perspiration, decreased level of consciousness, pulses paradoxes, distant or
muted heart sounds, and extreme anxiety, neck vein distension
3. The 3 Ps of diabetes
Polydipsia: osmolality, polyuria: osmotic diuresis, and polyphagia: cell starvation
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4. What electrolyte is of most concern with kidney failure patients? Potassium:
cardiac
5. Review the signs of hypokalemia and hyperkalemia
Hypokalemia: muscle cramps, weakness, cardiac arrhythmias, flattening of the
T wave, confusion and drowsiness, and irritability Hyperkalemia: peaked T
wave, v-fib, cardiac arrest, muscle weakness, respiratory distress
6. Right sided heart failure versus left sided heart failure
CHF: Occurs when the heart is unable to pump sufficient blood to meet the
metabolic needs of the body; usually occurs secondary; may present as an acute
episode but usually is a chronic condition; may result from an infarction or a
valve defects may arise from increased demands on the heart, such as those
imposed by hypertension or lung disease; Left-Sided Heart Failure:
Characterized by impaired pumping ability of left side of heart; Eventually backs
blood up into pulmonary circulation (crackles)- THIS IS BAD-FLUID IN THE LUNGS
MEANS LESS AIR IN THE LUNGS; Results in elevated pressure and congestion in
pulmonary veins/capillaries; Symptoms: Fatigue, activity intolerance, shortness
of breath, cough, orthopnea, paroxysmal nocturnal dyspnea
**tripod position (leaning over: usually seen); **Pulmonary congestion: pink
frothy sputum, cough, crackles, wheezes, tachypnea
Right-Sided Heart Failure: Characterized by impairment of pumping ability on
right side of heart; Backup of blood followed by congestion and elevated
pressure in systemic veins and capillaries; Most common cause is left-sided
dysfunction; Symptoms result from volume overload leading to ascites and
edema; Patients may complain of abnormal bloating and discomfort, with poor
appetite and sometimes nausea and vomiting
7. Can you tell the difference between diabetes insipidus, diabetes mellitus type 1 &
type 2?
DI: lack of ADH action, dehydration
DM1: complete lack of insulin, usually diagnosed young; Absolute absence of
insulin – must have injections or insulin pump for life. NOT oral meds; Two types:
immune mediated (most common, especially in children; Latent autoimmune
diabetes (LADA) in adults
Genetic disposition + trigger (eg infection) + T cell hypersensitivity to beta cell
antigen) and idiopathic (less common, no autoimmune component)
DM2: lifestyle changes, accounts for 90% of diabetes, strong correlation with
diabetes, genetic component, cellular resistance to insulin, deranged insulin
secretion: beta cells fail, increased glucose production by liver; diagnosed later
d/t insidious onset; frequent infections, slow wound healing, blurred vision;
Usually oral meds as initial pharmacotherapy but often require insulin therapy
later; often require insulin when acutely ill on temporary basis
Downloaded by NELSON KIIRU ()
Lomoarcpsd|26582732
2025 advanced pathophysiology
hesi rn questions and answers
Advanced Pathophysiology (Chamberlain University)
1. What is TPA? What are at least 2 conditions where you might see it given as a
medication? Why would we not give it? Tpa: clot busting agent used to reduce
the effects of CVA (stroke) in some individuals. It is contraindicated for
anticoagulant drugs.
The release of tissue plasminogen (tpa) from injured blood vessels and tissues,
converts plasminogen to plasmin. Plasmin is a potent enzyme that digests fibrin
strands (this leads to clot dissolution).
2. Know the triad that would lead you to conclude your patient is experiencing
cardiac tamponade
Fluid compresses the heart, prevents stretching & filling, reduces CO
Arterial pressure falls, venous pressures rise, pulse pressure narrows
Beck’s Triad: Distant, muffled heart sounds (like under water, fluid),
JVD, decreased BP
= EMERGENCY
Pericardiocentesis with surgical repair as appropriate is needed (16-18 gauge
needle inserted into pericardial space to relieve pressure and analyze fluid)
Manifestations include heavy feelings over the chest, shortness of breath,
tachycardia, cough, dysphagia, hiccups, hoarseness, nausea, vomiting, excessive
perspiration, decreased level of consciousness, pulses paradoxes, distant or
muted heart sounds, and extreme anxiety, neck vein distension
3. The 3 Ps of diabetes
Polydipsia: osmolality, polyuria: osmotic diuresis, and polyphagia: cell starvation
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
4. What electrolyte is of most concern with kidney failure patients? Potassium:
cardiac
5. Review the signs of hypokalemia and hyperkalemia
Hypokalemia: muscle cramps, weakness, cardiac arrhythmias, flattening of the
T wave, confusion and drowsiness, and irritability Hyperkalemia: peaked T
wave, v-fib, cardiac arrest, muscle weakness, respiratory distress
6. Right sided heart failure versus left sided heart failure
CHF: Occurs when the heart is unable to pump sufficient blood to meet the
metabolic needs of the body; usually occurs secondary; may present as an acute
episode but usually is a chronic condition; may result from an infarction or a
valve defects may arise from increased demands on the heart, such as those
imposed by hypertension or lung disease; Left-Sided Heart Failure:
Characterized by impaired pumping ability of left side of heart; Eventually backs
blood up into pulmonary circulation (crackles)- THIS IS BAD-FLUID IN THE LUNGS
MEANS LESS AIR IN THE LUNGS; Results in elevated pressure and congestion in
pulmonary veins/capillaries; Symptoms: Fatigue, activity intolerance, shortness
of breath, cough, orthopnea, paroxysmal nocturnal dyspnea
**tripod position (leaning over: usually seen); **Pulmonary congestion: pink
frothy sputum, cough, crackles, wheezes, tachypnea
Right-Sided Heart Failure: Characterized by impairment of pumping ability on
right side of heart; Backup of blood followed by congestion and elevated
pressure in systemic veins and capillaries; Most common cause is left-sided
dysfunction; Symptoms result from volume overload leading to ascites and
edema; Patients may complain of abnormal bloating and discomfort, with poor
appetite and sometimes nausea and vomiting
7. Can you tell the difference between diabetes insipidus, diabetes mellitus type 1 &
type 2?
DI: lack of ADH action, dehydration
DM1: complete lack of insulin, usually diagnosed young; Absolute absence of
insulin – must have injections or insulin pump for life. NOT oral meds; Two types:
immune mediated (most common, especially in children; Latent autoimmune
diabetes (LADA) in adults
Genetic disposition + trigger (eg infection) + T cell hypersensitivity to beta cell
antigen) and idiopathic (less common, no autoimmune component)
DM2: lifestyle changes, accounts for 90% of diabetes, strong correlation with
diabetes, genetic component, cellular resistance to insulin, deranged insulin
secretion: beta cells fail, increased glucose production by liver; diagnosed later
d/t insidious onset; frequent infections, slow wound healing, blurred vision;
Usually oral meds as initial pharmacotherapy but often require insulin therapy
later; often require insulin when acutely ill on temporary basis
Downloaded by NELSON KIIRU ()
