HESI PATHOPHYSIOLOGY MONITORED FINAL EXAM
UPDATED 2025//WITH 150+ QUESTIONS AND A-GRADED
ANSWERS
Acid-Base Values VERIFIED ANSWER Normal values — The range
of normal values varies among laboratories. In general, normal values
for acidity (pH), the partial pressure of carbon dioxide (PaCO2) and
bicarbonate concentration (HCO3) are as follows:
●pH - 7.35 to 7.45
●PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
●HCO3 - 21 to 27 mEq/L
Respiratory acidosis VERIFIED ANSWER excess CO2 retention, pH
<7.35, HCo3 >45, PaCO2 >45
S/S: anxiety, apprehension, confusion/coma, excessive sweating,
headache, restlessness, tachycardia
Respiratory alkalosis VERIFIED ANSWER excess CO2 excretion, pH
>7.45, HCO3 <35, PaCO2 <35
,S/S: anxiety, fear, lightheadedness, paresthesias, rapid deep breathing,
twitching
Metabolic Acidosis VERIFIED ANSWER HCO3 loss and acid
retention, pH <7.35, HCO3<22, PaCO2 >35
S/S: coma (in severe cases), drowsiness, fatigue, fruity breath (if DKA),
headache, lethargy, nausea, rapid deep breathing, vomiting.
Metabolic Alkalosis VERIFIED ANSWER HCO3 retention, acid loss,
pH>77.45, HCO3 >28, PaCO2 > 45
S/S: coma (in severe cases), confusion, irritability, hypertonic muscles,
mental apathy, restlessness, seizures, slow shallow breathing, tetany,
twitching
Amputation Indications VERIFIED ANSWER ●An unsalvageable
extremity due to critical limb ischemia in patients with vascular disease.
Primary amputation may be the only option for patients without an
anatomic option for revascularization or those with medical risk factors
that contraindicate revascularization.
•Peripheral artery disease.
•Acute arterial thrombosis or thromboembolism.
,●Trauma resulting in a mangled extremity or failed attempt at limb
salvage.
●Severe infections with extensive soft tissue or bony destruction, or
osteomyelitis.
●Locally unresectable malignant tumors of the musculoskeletal system
[6].
●Frostbite-related gangrene.
●Failed management of acute compartment syndrome.
●Failed management of Charcot's degenerative osteoarthropathy.
●Debilitating extremity paralysis, which can be unilateral but is
frequently bilateral (eg, paraplegia), from infection or pressure-related
complications.
Amputation Medical Risks VERIFIED ANSWER ●Myocardial
infarction is the most common cause of death following lower extremity
amputation in patients with peripheral artery disease
, ●Pulmonary complications, including atelectasis and pneumonia,
complicate 5 percent of major lower extremity amputations
●The incidence of new-onset renal failure after a lower extremity major
amputation is 0.6 to 2.6 percent. Renal failure is associated with
increased operative and long-term mortality
Amputation Complications VERIFIED ANSWER -Deep vein
thrombosis — Deep vein thrombosis (DVT) has been reported in up to
50 percent of patients following major lower extremity amputation
without prophylaxis [32]. The incidence of deep vein thrombosis is
higher for above-knee amputation compared with below-knee
amputation (37.5 versus 21.2 percent, respectively) [47]. This difference
may contribute to the increased incidence of sudden death due to
thromboembolism in patients with above-knee amputation. Thus, it is
important to provide thromboprophylaxis. (See 'Thromboprophylaxis'
above and 'Perioperative mortality' below.)
-Stump hematoma — Postoperative bleeding that requires reoperation
occurs in 3 to 9 percent of major lower extremity amputations, and
stump hematoma may lead to stump wound breakdown [9,48]. Patients
on antithrombotic therapy, including DVT prophylaxis, are at a higher
risk for stump hematoma. Patients with stump hematoma causing pain
and stump swelling with or without drainage should have the wound
opened partially, the hematoma evacuated, and the wound washed out
and packed with a moist saline dressing.
-Infection — Wound infection following major lower extremity
amputation occurs in 13 to 40 percent of patients [26,27,49]. Patients
UPDATED 2025//WITH 150+ QUESTIONS AND A-GRADED
ANSWERS
Acid-Base Values VERIFIED ANSWER Normal values — The range
of normal values varies among laboratories. In general, normal values
for acidity (pH), the partial pressure of carbon dioxide (PaCO2) and
bicarbonate concentration (HCO3) are as follows:
●pH - 7.35 to 7.45
●PaCO2 - 35 to 45 mmHg (4.7 to 6 kPa)
●HCO3 - 21 to 27 mEq/L
Respiratory acidosis VERIFIED ANSWER excess CO2 retention, pH
<7.35, HCo3 >45, PaCO2 >45
S/S: anxiety, apprehension, confusion/coma, excessive sweating,
headache, restlessness, tachycardia
Respiratory alkalosis VERIFIED ANSWER excess CO2 excretion, pH
>7.45, HCO3 <35, PaCO2 <35
,S/S: anxiety, fear, lightheadedness, paresthesias, rapid deep breathing,
twitching
Metabolic Acidosis VERIFIED ANSWER HCO3 loss and acid
retention, pH <7.35, HCO3<22, PaCO2 >35
S/S: coma (in severe cases), drowsiness, fatigue, fruity breath (if DKA),
headache, lethargy, nausea, rapid deep breathing, vomiting.
Metabolic Alkalosis VERIFIED ANSWER HCO3 retention, acid loss,
pH>77.45, HCO3 >28, PaCO2 > 45
S/S: coma (in severe cases), confusion, irritability, hypertonic muscles,
mental apathy, restlessness, seizures, slow shallow breathing, tetany,
twitching
Amputation Indications VERIFIED ANSWER ●An unsalvageable
extremity due to critical limb ischemia in patients with vascular disease.
Primary amputation may be the only option for patients without an
anatomic option for revascularization or those with medical risk factors
that contraindicate revascularization.
•Peripheral artery disease.
•Acute arterial thrombosis or thromboembolism.
,●Trauma resulting in a mangled extremity or failed attempt at limb
salvage.
●Severe infections with extensive soft tissue or bony destruction, or
osteomyelitis.
●Locally unresectable malignant tumors of the musculoskeletal system
[6].
●Frostbite-related gangrene.
●Failed management of acute compartment syndrome.
●Failed management of Charcot's degenerative osteoarthropathy.
●Debilitating extremity paralysis, which can be unilateral but is
frequently bilateral (eg, paraplegia), from infection or pressure-related
complications.
Amputation Medical Risks VERIFIED ANSWER ●Myocardial
infarction is the most common cause of death following lower extremity
amputation in patients with peripheral artery disease
, ●Pulmonary complications, including atelectasis and pneumonia,
complicate 5 percent of major lower extremity amputations
●The incidence of new-onset renal failure after a lower extremity major
amputation is 0.6 to 2.6 percent. Renal failure is associated with
increased operative and long-term mortality
Amputation Complications VERIFIED ANSWER -Deep vein
thrombosis — Deep vein thrombosis (DVT) has been reported in up to
50 percent of patients following major lower extremity amputation
without prophylaxis [32]. The incidence of deep vein thrombosis is
higher for above-knee amputation compared with below-knee
amputation (37.5 versus 21.2 percent, respectively) [47]. This difference
may contribute to the increased incidence of sudden death due to
thromboembolism in patients with above-knee amputation. Thus, it is
important to provide thromboprophylaxis. (See 'Thromboprophylaxis'
above and 'Perioperative mortality' below.)
-Stump hematoma — Postoperative bleeding that requires reoperation
occurs in 3 to 9 percent of major lower extremity amputations, and
stump hematoma may lead to stump wound breakdown [9,48]. Patients
on antithrombotic therapy, including DVT prophylaxis, are at a higher
risk for stump hematoma. Patients with stump hematoma causing pain
and stump swelling with or without drainage should have the wound
opened partially, the hematoma evacuated, and the wound washed out
and packed with a moist saline dressing.
-Infection — Wound infection following major lower extremity
amputation occurs in 13 to 40 percent of patients [26,27,49]. Patients
