COMPLETE EXAMS FOR PATHOPHYSIOLOGY HESI EXIT

COMPLETE EXAMS FOR PATHOPHYSIOLOGY HESI EXIT A client who is receiving a whole blood transfusion develops chills, fever, and a headache 30 minutes after the transfusion is started. The nurse should recognize these symptoms as characteristic of what reaction? A. A mild allergic reaction. B. A febrile transfusion reaction. C. An anaphylactic transfusion reaction. D. An acute hemolytic transfusion reaction. - CORRECT ANSWER-B. A febrile transfusion reaction. The nurse is assessing a client with a ruptured small bowel and determines that the client has a temperature of 102.8o F. Which assessment finding provides the earliest indication that the client is experiencing septic shock? A. Bilateral crackles. B. Hyperpnea. C. Mucus production. D. Weak peripheral pulses. - CORRECT ANSWER-B. Hyperpnea. The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH), which is manifested by which symptoms? A. Loss of thirst, weight gain. B. Dependent edema, fever. C. Polydipsia, polyuria. D. Hypernatremia, tachypnea. - CORRECT ANSWER-A. Loss of thirst, weight gain. A client is brought to the Emergency Center after a snow-skiing accident. Which intervention is most important for the nurse to implement? A. Review the electrocardiogram tracing. B. Obtain blood for coagulation studies. C. Apply a warming blanket. D. Provide heated PO fluids. - CORRECT ANSWER-A. Review the electrocardiogram tracing. Which pathophysiological response supports a client's vomiting experience? A. Sensory input of noxious stimuli relayed to the cognitive centers is associated with disgust and illicits vomiting. B. Response of stimulation of the posterior oropharynx results in reverse peristalsis of the gastrointestinal tract. C. Spasmodic reflex of respiratory and gastric movements results from stimulation of the chemoreceptor trigger zone. D. Increased gastric and colonic pressures move gastrointestinal contents to the orifice of least resistance. - CORRECT ANSWER-C. Spasmodic reflex of respiratory and gastric movements results from stimulation of the chemoreceptor trigger zone. The nurse reviews the complete blood count (CBC) findings of an adolescent with acute myelogenous leukemia (AML). The hemoglobin is 13.8 g/dl, hematocrit is 36.7%, white blood cell count is 8,200 mm3, and platelet count is 115,000 mm3. Based on these findings, what is the priority nursing diagnosis for this client's plan of care? A. Impaired gas exchange. B. Risk for infection. C. Risk for injury. D. Risk for activity intolerance. - CORRECT ANSWER-C. Risk for injury. Which signs and symptoms are associated with arterial insufficiency? A. Pallor, intermittent claudication. B. Pedal edema, brown pigmentation. C. Blanched skin, lower extremity ulcers. D. Peripheral neuropathy, cold extremities. - CORRECT ANSWER-A. Pallor, intermittent claudication. A client's family asks why their mother with heart failure needs a pulmonary artery (PA) catheter now that she is in the intensive care unit (ICU). What information should the nurse include in the explanation to the family? A. A central monitoring system reduces the risk of complications undetected by observation. B. A pulmonary artery catheter measures central pressures for monitoring fluid replacement. C. Pulmonary artery catheters allow for early detection of lung problems. D. The healthcare provider should explain the many reasons for its use. - CORRECT ANSWER-B. A pulmonary artery catheter measures central pressures for monitoring fluid replacement. When observing a client for symptoms of a large bowel obstruction, the nurse should assess for which finding? A. Distention of the lower abdomen. B. Nausea with profuse vomiting. C. Upper abdominal discomfort. D. Fluid and electrolyte imbalances. - CORRECT ANSWER-A. Distention of the lower abdomen. The nurse is planning care for a client who has a right hemispheric stroke. Which nursing diagnosis should the nurse include in the plan of care? A. Impaired physical mobility related to right-sided hemiplegia. B. Risk for injury related to denial of deficits and impulsiveness. C. Impaired verbal communication related to speech-language deficits. D. Ineffective coping related to depression and distress about disability. - CORRECT ANSWER-B. Risk for injury related to denial of deficits and impulsiveness. 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? A. Lay the child down and ask the mother to stay near the child in the crib. B. Encourage the mother to take a break and leave the room to stop crying. C. Keep all light sources off and close the window blinds to the room. D. Use calm, reassurance and understanding to comfort the mother. - CORRECT ANSWER-A. Lay the child down and ask the mother to stay near the child in the crib. What information should the nurse include in a teaching plan about the onset of menopause? (Select all that apply). Select all that apply A. Smoking. B. Oophorectomy with hysterectomy. C. Early menarche. D. Cardiac disease. E. Genetic influence. F. Chemotherapy exposure. - CORRECT ANSWER-A. Smoking. B. Oophorectomy with hysterectomy. C. Early menarche. E. Genetic influence. F. Chemotherapy exposure. A client is admitted to the Emergency Department with a tension pneumothorax. Which assessment should the nurse expect to identify? A. An absence of lung sounds on the affected side. B. An inability to auscultate tracheal breath sounds. C. A deviation of the trachea toward the side opposite the pneumothorax. D. A shift of the point of maximal impulse to the left, with bounding pulses. - CORRECT ANSWER-C. A deviation of the trachea toward the side opposite the pneumothorax. The nurse is caring for a client who had an excision of a malignant pituitary tumor. Which findings should the nurse document that indicate the client is developing syndrome of inappropriate antidiuretic hormone (SIADH)? A. Hypernatremia and periorbial edema. B. Muscle spasticity and hypertension. C. Weight gain with low serum sodium. D. Increased urinary output and thirst. - CORRECT ANSWER-C. Weight gain with low serum sodium.