Pathophysiology HESI

An initial disturbance in a system sets off a chain of events that does not favor stability and often abruptly displaces a system from its steady state: what is that?

a. Positive Feedback

b. Negative Feedback

c. Disease

d. Homeostasis

a. positive feedback

What organ shrinks with age?

a. Prostate

b. Gums

c. Heart

d. All of the above

b. gums

Which of the following is true?

a. An infant will have a slower heart rate than an adult

b. The elderly have better temperature sensations

c. There are more sweat glands in an elderly person

d. There is less thirst perception in the elderly

d. there is less thirst perception in the elderly

Which of the following is true?

a. Women snore more than men

b. Men have higher calcium levels

c. Women have a lower hemoglobin than men

d. Men have a lower creatinine level than women

c. Women have a lower hemoglobin than men

An increase in normal adaptive response to the decreased availability of oxygen at high altitude is termed which?

a. Circadian

b. Acclimatization

c. Population

d. Diurnal

b. Acclimatization

What does it mean when the cause of the disease is unwanted medical treatment?

a. Idiopathic

b. Ecogenetic

c. Genotypical

d. Iatrogenic

d. Iatrogenic

Which term is used for the first two months of life?

a. Infancy

b. Childhood

c. Prenatal

d. Neonatal

d. Neonatal

Which is an objectively identifiable aberration of the disease?

a. Symptom

b. Syndrome

c. Stage

d. Sign

d. Sign

Which of the following is true regarding catecholamines?

a. They are from the parasympathetic nervous system

b. They cross the blood brain barrier

c. They include epinephrine and norepinephrine

d. They cause of decrease in heart rate

c. They include epinephrine and norepinephrine

Which of the following is a true statement?

a. Antidiuretic hormone is not important for blood volume regulation

b. Endorphins increase with stress, resulting in a decrease in pain perception

c. Epinephrine and cortisol act very differently

d. Cortisol negates epinephrine's activity

b. Endorphins increase with stress, resulting in a decrease in pain perception

By what mechanism do lipid molecules cross cell membranes?

a. They use channel proteins as a membrane transport system

b. They are transported across the plasma membrane by endocytosis and exocytosis

c. They use voltage-gated ion channels

d. They cross by diffusion

d. They cross by diffusion

Which of the following metabolic processes is a component of anabolic metabolism?

a. Protein synthesis

b. Glycolysis

c. Citric acid cycle

d. Oxidative phosphorylation

a. Protein synthesis

Which of the following electrochemical mechanism is responsible for maintaining cell volume?

a. The calcium pump

b. Glucose transporters

c. The sodium-potassium pump

d. ATP-binding cassette (ABC) transporters

c. The sodium-potassium pump

Cellular hypoxia results in:

a. Enhanced ATP activity

b. Loss of intracellular calcium

c. Increased pH

d. Failure of the sodium-potassium pump

d. Failure of the sodium-potassium pump

A 75 yo woman develops weakness in her lower extremities after a prolonged period of bed rest. This is most likely caused by:

a. Atrophy of her leg muscles

b. Dysplasia of her leg muscles

c. Hypertrophy of her leg muscles

d. Hyperplasia of her leg muscles

a. Atrophy of her leg muscles

Which of the following types of cellular adaption is most likely to occur from chronic ischemia?

a. Hypertrophy

b. Metaplasia

c. Atrophy

d. Hyperplasia

c. Atrophy

What is the mechanism of cellular injury that occurs when deep sea divers get 'the bends'?

a. Free radicals form abnormal chemical bonds which destroy the cellular membranes

b. Carbon monoxide binds tightly to hemoglobin, preventing the RBCs from carrying O2

c. Intracellular calcium accumlation create muscle tetany

d. Gas bubbles from in the blood, blocking circulation and resulting in ischemia

d. Gas bubbles from in the blood, blocking circulation and resulting in ischemia

Which type of cellular adaption would create the greatest concern if found on a biopsy report?

a. Dysplasia

b. Metaplasia

c. Hyperplasia

d. Atrophy

a. Dysplasia

Which of the following is the process by which mRNA is synthesized from single stranded DNA?

a. Sense stranding

b. Replication

c. Translation

D. Transcription

d. Transcription

Which of the following is not one of the 4 cell types found in adult humans?

a. Epithelium

b. Connective tissue

c. Hematopoietic tissue

d. Nervous tissue

c. Hematopoietic tissue

If a patient has a recessive trait, which of the following is the genotype of this patient?

a. aa

b. AA

c. Aa

d. aA

a. aa

Which of the following chromosomal abnormalities has been linked with Down Syndrome?

a. Translocation

b. Inversion

c. Deletion

d. Duplication

a. duplication

Which of the following refers to a deficiency of factor VIII that causes a bleeding disorder?

a. Marfan Syndrome

b. Phenylketonuria

c. Hemophilia

d. Huntington

c. Hemophilia

Which of the following is a retrovirus that causes cancer?

a. Rhinovirus

b. Parvovirus

c. Epstein-Barr virus

d. Poxvirus

c. Epstein-Barr virus

Which of the following genes contributes specifically to some breast cancer?

a. Rb

b. BRCA1

c. P53

d. VHL

b. BRCA1

Which is used to describe the histologic characteristics of tumor cells?

a. Staging

b. Cachexia

c. Grading

d. Angiogenesis

c. Grading

Which of the following offers the best prognosis for the cure of cancer?

a. Early detection

b. Aggressive chemotherapy

c. Adjunct radiation

d. Gene therapy

a. Early detection

Which of the following is true about cancer?

a. Most deaths occur in those over 75 years old

b. Men have 1 in 3 lifetime risk of cancer

c. The combined 5 year survival rate for cancer is 62%

d. It is the leading cause of death

c. The combined 5 year survival rate for cancer is 62%

What is the purpose of the TNM classification system?

a. It provides information for ongoing research efforts to develop a cure for cancer

b. It tracks the progress of the disease and the effectiveness of treatment

c. It enables the MD to determine the underlying cause of the malignancy

d. It provides tumor data for the Centers for Disease Control and Prevention

b. It tracks the progress of the disease and the effectiveness of treatment

Why do patients with advanced cancer develop cachexia?

a. Cancer cells produce an enzyme that robs normal cells of nutrients

b. They lack an adequate number of normal cells to support metabolism

c. They have an increased basal metabolic rate

d. The process of cancer cell destruction utilizes most of the body's nutrients

a. Cancer cells produce an enzyme that robs normal cells of nutrients

Which of the following explains the genetic basis for cancer development?

a. Exposure to ionizing radiation

b. Decreased immune function

c. Infection by oncogenic bacteria

d. Loss or defect of tumor suppressor genes

d. Loss or defect of tumor suppressor genes

Bacteria are categorized by their: (select all that apply)

a. Shape

b. Need for oxygen

c. Reaction to staining

d. Size

e. Color

a. Shape

b. Need for oxygen

c. Reaction to staining

If the host's immune system is compromised resident florae may become pathogenic resulting in:

a. Opportunistic infection

b. Salmonella infection

c. Otitis media

d. Myocarditis

a. Opportunistic infection

Patient education to reduce emergence of resistant infections includes:

a. Stop taking prescribed antibiotics when fever is gone to avoid overuse

b. Take antibiotics for viral infections that cause temperature elevation

c. Take all the antibiotics ordered even when feeling recovered

d. Share antibiotics with susceptible family members to prevent spread of infection

c. Take all the antibiotics ordered even when feeling recovered

Which of the following occurs first after cellular injury?

a. Vessel walls rupture

b. Neutrophils migrate to the injured area

c. Plasma proteins and water move from the intracellular space to the interstitial space

d. Vessel walls briefly constrict

d. Vessel walls briefly constrict

Which of the following is an example of active immunity?

a. Injection of pooled gamma globulin

b. Breast-feeding

c. Passed from mother to infant via the placenta

d. Pneumonia vaccine

d. Pneumonia vaccine

A patient's WBC count indicates a shift to the left. What should the nurse assess for?

a. Leukemia

b. Weakness

c. Infection

d. Immunosuppression

c. Infection

The lab analysis on a child with chronic nasal drainage show elevated numbers of eosinophils in the blood. What is the likely cause of the drainage?

a. Bacterial infection

b. Allergies

c. Viral infection

d. Sinus infection

b Allergies

A child with ill-fitting shoes develops a vesicle (small blister) that burst, releasing clear watery fluid. The school nurse would document this drainage as:

a. Serous

b. Vesicular

c. Purulent

d. Sanguineous

a. Serous

Which of the following specialized cells are associated with the immune response?

a. Neutrophils

b. Monocytes

c. Macrophages

d. Lymphocytes

d. Lymphocytes

A severe life-threatening type 1 hypersensitivity reaction is:

a. Angioedema

b. Urticarial

c. Anaphylaxis

d. Hives

c. Anaphylaxis

What pathophysiologic abnormality underlies systemic lupus erythematosus (SLE)?

a. Immune deficiency

b. Type 2 hypersensitivity

c. Autoimmunity

d. Immunosuppression

c. Autoimmunity

Which of the following terms best describes the symptoms of petechiae. easy bruising, bleeding gums, occult hematuria or retinal hemorrhage?

a. Neutropenia

b. Leukopenia

c. Anemia

d. Thrombocytopenia

d. Thrombocytopenia

If I get a kidney transplant from my sister, what is it called?

a. Allogenic transplant

b. 'Gift of Life'

c. Autologous transplant

d. peripheral stem cell transplant

a. Allogenic transplant

Which of the following is a malignant disorder of mature antibody-secreting B lymphocytes or plasma cells?

a. Multiple myeloma

b. Hairy cell leukemia

c. ALL

d. CML

a. Multiple myeloma

Which disease has the presence of Reed-Sternberg cells?

a. B-cell lymphoma

b. NK-cell lymphoma

c. Hodgkin lymphoma

d. T-cell lymphoma

c. Hodgkin lymphoma

Which of the following assists in the diagnosis of multiple myeloma?

a. Elevated liver enzymes

b. Bence Jones proteins

c. Hyperkalmia

d. Erythrocytosis

b. Bence Jones proteins

What statement is true regarding HIV-1?

a. It is a causative agent in the US

b. It produces a milder form of the disease

c. It is most commonly found in West Africa

d. The latency period is longer than HIV-2

a. It is a causative agent in the US

What is the result of increased hydrostatic pressure in blood vessels?

a. Increased levels of albumin

b. Fluid movement into interstitial space

c. Vasoconstriction

d. Hypertension

b. Fluid movement into interstitial space

Which is a manifestation of left heart failure?

a. Peripheral edema

b. Increased exercise tolerance

c. Pulmonary edema

d. Paroxysmal nocturnal dyspnea (PND)

c. Pulmonary edema

A patient develops compartment syndrome. Which of the following are expected manifestations? (select all that apply)

a. Pain

b. Paresthesia

c. Rubor

d. Ischemia

e. Inflammation

f. Coolness

g. Edema

a. Pain

b. Paresthesia

d. Ischemia

f. Coolness

Which are manifestations of increased intracranial pressure (ICP)?

a. Intense thirst

b. Projectile vomiting

c. Pinpoint pupils

d. Altered mental status

e. Decerbrate positioning

f. Bradycaridia

g. Hypotension

b. Projectile vomiting

d. Altered mental status

e. Decerebrate positioning

f. Bradycardia

What may unusual thirst in diabetic patient indicate?

a. Nephropathy

b. Hyperglycemia

c. Polyuria

d. Fluid overload

b. Hyperglycemia

Which of the following is true about chronic airway disease?

a. Chronic obstructive pulmonary disease (COPD) is characterized by progressive increase in ciliary function

b. Asthmatic attacks produce edema and increased mucus

c. COPD produces reversible constriction of airways

d. Asthma results in hyperinflation of alveoli

b. Asthmatic attacks produce edema and increased edema

Which hormone is elevated in early pregnancy, and is detected by pregnancy screening tests?

a. Estrogen

b. Follicle stimulating hormone

c. Beta chorionic gonadotropin

d. Prolactin

c. Beta chorionic gonadotropin

A patient with peripheral artery disease experiences intermittent pain with walking. What is the mechanism responsible?

a. Vein engorgement resulting in tissue compression

b.. Hyperglycemic damage to arterioles, resulting in intimal destruction

c. Arteriole occlusion results in ischemia to muscles

d. Thromboembolism in capillaries causes inflammation of blockage of blood drainage from legs

c. Arteriole occlusion results in ischemia to muscles

Which is the initial vital sign alteration expected when a patient has acute hypovolemia?

a. Tachypnea

b. Hypotension

c. Tachycardia

d. Elevated temperature

c. Tachycardia

A patient has episodes of chest pain, shortness of breath with activity, and it is relieved by rest. What is this called?

a. Stable angina

b. Unstable angina

c. Myocardial infarction

d. Pericarditis

a. Stable angina

Which of the following may be risk factors associated with the development of gastric cancer? (select all that apply)

a. Eating bacon and other cured meats

b. Celiac disease

c. Ulcerative colitis

d. Helicobacter pylori infection

e. High carbohydrate diet

a. Eating bacon and other cured meats

d. Helicobacter pylori infection

What immunologic activity is seen in the development of chronic obstructive pulmonary disease (COPD)?

a. T cells attack healthy goblet cells in epithelium of trachea

b. B cells produce excessive immunoglobulins causing inflammation in lung parenchyma

c. Macrophages cause destruction of alveolar walls, resulting in loss of overall alveolar surface area

d. Antigen-antibody complexes are deposited in small airways causing widespread inflammation

c. Macrophages cause destruction of alveolar walls, resulting in loss of overall alveolar surface area

Why would protein be restricted for patients with liver and kidney disease?

a. Protein has a pro inflammatory effect on live tissue

b. Protein will be excreted by damaged nephrons and result in proteinuria

c. Less protein is needed as organ dysfunction results in reduced metabolic needs

d. Protein breakdown produces nitrogenous wastes that are excreted by liver and kidneys

d. Protein breakdown produces nitrogenous wastes that are excreted by liver and kidneys

What is the mechanism of end organ disease with diabetes mellitus?

a. Hyperglycemia results in microvascular damage to capillaries

b. Episodic hypoglycemia causes intermittent reduction of blood flow to organs

c.Buildup of nitrogenous wastes in blood is toxic to organs

d. Reduction in blood viscosity results in enhanced perfusion of organs

a. Hyperglycemia results in microvascular damage to capillaries

What is a way to diagnose pancreatitis?

a. Hard, dry stools

b. Right lower quadrant (RLQ) pain

c. Elevated serum lipase and amylase levels

d. Thrombocytopenia

c. Elevated serum lipase and amylase levels

Which of the following is caused by elevated plasma glucose?

a. Release of glucagon

b. Release of insulin

c. Release of glycogen

d. Release of potassium

b. Release of insulin

Which of the following lab values reflect NORMAL (expected) levels?

a. Low density lipoprotein (LDL) of 100 mg/dL

b. Potassium of 3.5-5.0 mEq/l

c. Hemoglobin of 12-17 gm/dL

d. Hematocrit <30%

e. High density lipoprotein (HDL) >40 mg/dL

f. Blood urea nitrogen of 15 mg/dL

a. Low density lipoprotein (LDL) of 100 mg/dL

b. Potassium of 3.5-5.0 mEq/l

c. Hemoglobin of 12-17 gm/dL

e. High density lipoprotein (HDL) >40 mg/dL

f. Blood urea nitrogen of 15 mg/dL

What is true of open angle glaucoma?

a. The angle of Schlemm is constricted, preventing drainage

b. It is sudden and acutely painful

c. The trabecular meshwork becomes blocked over time

d. There is reduced production of aqueous humor, resulting in eye ischemia

c. The trabecular meshwork becomes blocked over time

What is an expected feature of adult respiratory distress syndrome (ARDS)?

a. Extreme hypercapnia

b. Metabolic alkalosis

c. Hypoxia

d. Green or yellow sputum

c. Hypoxia

Which form of leukemia may be suppressed but is not likely to be cured?

a. Acute lymphocytic leukemia (ALL)

b. Chronic lymphocytic leukemia (CLL)

c. Hodgkin's lymphoma

d. Acute myelogenous leukemia (AML)

b. Chronic lymphocytic leukemia (CLL)

Why might a patient with benign prostatic hypertrophy (BPH) have urinary symptoms?

a. Inflammatory changes in bladder

b. Metastasis of tumor cells into urinary tract

c. Compression of urethra causing difficulty voiding

d. Formation of calculi resulting in urinary pain

c. Compression of urethra causing difficulty voiding

What is an expected finding in acute renal failure?

a. Decreased specific gravity of urine

b. Reduced blood urea nitrogen (BUN)

c. Increased serum potassium

d. Normal blood creatinine level

c. Increased serum potassium

What is the mechanism of the development of extreme edema after a burn?

a. Burns cause heat damage to blood vessels and cause them to constrict

b. Burns cause tissue damage and initiate the inflammatory response

c. Burns cause increase in cardiac output, resulting in increased perfusion of kidneys

d. Burns cause pain with movement, causing decreased Mobily and dependent edema

b. Burns cause tissue damage and initiate the inflammatory response

What is the type of tissue injury caused by prolonged pressure on tissues, causing inflammation and ischemia?

a. Eczema

b. Psoriasis

c. Decubitus ulcers

d. Abrasions

c. Decubitus ulcers

A patient living with HIV has a non reactive TB skin test (in duration 5 mm) but is found to have active disease by sputum testing. What is the reason for the discrepancy?

a. Presence of HIV virus interferes with skin reaction

b. Anergic response because of immune system damage

c. Increase in T cells suppressed response

d. Sputum testing is not accurate with HIV

b. Anergic response because of immune system damage

A patient travels to a country with possibly contaminated water. Which infection(s) might be expected? (select all that apply)

a. Hepatitis B

b. Hepatitis A

c. Acute amoebic dysentery

d. Ulcerative colitis

e. Gluten enteropathy

b. Hepatitis A

c. Acute amoebic dysentery

Which of the following are true? (select all that apply)

a. Osteoporosis results in increased bone reabsorption and demineralization

b. Rheumatoid arthritis results in antigen-antibody deposition and inflammation of joint

c. Acute gout results in repetitive stress and destruction of articular cartilage

d. Osteoarthritis always affects joints symmetrically, and causes fevers and fatigue

a. Osteoporosis results in increased bone reabsorption and demineralization

b. Rheumatoid arthritis results in antigen-antibody deposition and inflammation of join

What kind of cells are associated with the development of atherosclerosis?

a. Foam cells (fatty macrophages)

b. Pluripotent stem cells

c. Reticulocytes

d. Myocytes

a. Foam cells (fatty macrophages)

Which patient should receive an emergency infusion of factor VII?

a. Patient with von Willebrand's disease having surgery

b. Patient with gunshot wound to chest

c. Patient with pernicious anemia

d. Patient with polycythemia vera

a. Patient with von Willebrand's disease having surgery

Which patient would be an appropriate candidate for a transfusion of whole blood?

a. Elderly woman with iron deficiency anemia

b. Septic patient with disseminated intravascular coagulopathy (DIC)

c. Trauma patient who is hemorrhaging

d. Patient with hemophilia A who is getting routine infusion

c. Trauma patient who is hemorrhaging

What is the expected progression of amyotrophic lateral sclerosis (ALS)

a. Dysfunction of substance nigra in the brain causes reduction in dopamine and development of progressive movement disorder

b. Acute inflammation of meninges causes nuchal rigidity, pain, headache and high fever

c. Loss of cholinergic receptors in muscles leads to early muscle fatigue and weakness

d. Destruction of motor neurons in brain and spinal cord cause progressive muscle weakness

d. Destruction of motor neurons in brain and spinal cord cause progressive muscle weakness

What would be expected if a patient with an abdominal aortic aneurysm (AAA) experiences a rupture of the aneurysm?

a. Sudden loss of circulation to one leg

b. Acute respiratory distress

c. Hypotension and shock

d. Proteinuria and edema

c. Hypotension and shock

Which of the following are risk factors for osteoporosis?

a. Repetitive stress to joint

b. Being overweight

c. Low BMI (body mass index)

d. Being Caucasian

e. Smoking

f. Being male

c. Low BMI (body mass index)

d. Being Caucasian

e. Smoking

What hormone, released in a stressful situation, will cause alteration in glucose metabolism?

a. Epinephrine

b. Renin

c. Erythropoietin

d. Cortisol

d. Cortisol

What is a true statement about the difference between diabetic ketonuria (DKA) and Hyperosmolar hyperglycemic state (HHS)?

a. DKA occurs with diabetics, HHS occurs in anyone

b. DKA is characterized by hyperglycemia, HHS is characterized by hypoglycemia

c. DKA patients have ketones in the urine and blood; HHS patients do not

d. DKA is very dangerous; HHS is less serious

c. DKA patients have ketones in the urine and blood; HHS patients do not

Exophthalmos is caused by what mechanism?

a. Decreased cardiac output results in activation of RAAS system and increased blood pressure

b. Increased inflammation of eyes affecting muscles and fatty tissue around eye

c. Increased pressure in anterior chamber of eye causes hardening of eyeball and blurring of vision

d. Inflammation of cornea causes intense pressure and pain in eye.

b. Increased inflammation of eyes affecting muscles and fatty tissue around eye

For what condition would a nurse teach a patient about 'stress dosing' of steriods?

a. Cushing's disease

b. Acromegaly

c. Addison's disease

d. Hypothyroidism

c. Addison's disease

What is seen in early infections ('shift to the left')?

a. Increased B cells

b. Lymphocytosis

c. Thrombocytopenia

d. Bandemia

d. Bandemia

What does Frank-Starling law predict about heart function?

a. More afterload, less perfusion

b. More preload, increased contraction

c. Less afterload, more ischemia

d. More contraction, less output

b. More preload, increased contraction

What is the function of the glomerulus?

a. Filter blood

b. Activate vitamin D

c. Actively reabsorb glucose

d. Regulate sodium excretion

a. Filter blood

What neurotransmitter changes in brain are associated with mood depression?

a. High dopamine

b. Low serotonin

c. Increase acetylcholine (ACh)

d. Low norepinephrine

b. Low serotonin

Which is true about HIV transmission? (select all that apply)

a. It is transmitted via breast milk

b. It has been transmitted via aerosol route

c. It cannot be transmitted during pregnancy until delivery

d. It can be transmitted by sharing needles

e. Saliva is a common route for transmission

f. It can live for 48 hrs on surfaces outside the body

a. It is transmitted via breast milk

d. It can be transmitted by sharing needles

Which of the following is associated with initial HIV infection?

a. Flulike symptoms and rash

b. Decreased CD4 T cells

c. Seroconversion within 3-6 days

d. CD4 T cell count < 200 per mcg/L

a. Flulike symptoms and rash

Which of the following statement is true regarding HIV testing?

a. The first test is the electrophoresis

b. The new rapid finger stick tests give results in 20 min

c. All patient's w/a positive test must have the ELISA performed

d. The Western blot is the initial test

b. The new rapid finger stick tests give results in 20 min

Which of the following are required for erythropoieses? (select all that apply)

a. Vitamin K

b. Vitamin B12

c. Folate

d. Vitamin E

e. Niacin

f. Ascorbic acid (Vitamin C)

b. Vitamin B12

c. Folate

e. Niacin

f. Ascorbic acid (Vitamin C)

What causes a shift of the oxyhemoglobin curve to the right?

a. Chronic disease.

b. Increased pH

c. Decreased H+ ions

d. Decreased temperature

a. Chronic disease

What is the term used for an excess of RBCs?

a. Anemia

b. Polycythemia

c. Pancytopenia

d. Granulocytosis

b. Polycythemia

What is false regarding aplastic anemia?

a. It runs in families

b. It causes overproduction of hematopoietic tissue

c. It is characterized by pancytopenia

d. It is caused by viral infections

b. It causes overproduction of hematopoietic tissue

Which of the following is a macrocytic anemia?

a. Thalassemia

b. Anemia of chronic renal failure

c. Iron deficiency anemia

d. Pernicious anemia

d. Pernicious anemia

Which of the following are appropriate for sickle cell anemia?

a. Early spleen removal

b. Acetaminophen (Tylenol) for fever

c. Dehydration to prevent vaso-occlusive crises

d. Maintain cool room temperature to prevent fever

b. Acetaminophen (Tylenol) for fever

Anemia of chronic disease is caused by lack of what hormone?

a. Estrogen

b. Erythropoietin

c. Parathyroid hormone

d. Adrenaline

b. Erythropoietin

S/Sx of anemia are: (select all that apply)

a. Pallor

b. Bradycardia

c. Shortness of breath

d. Reduced activity tolerance

e. Dry mucous membranes

a. Pallor

c. Shortness of breath

d. Reduced activity tolerance