HESI ADVANCED PATHOPHYSIOLOG Y FNP V1 100 2019 - Questions and Answers
2019 HESI
In the negative feedback mechanism that controls blood
glucose levels, an increase in blood glucose stimulates an increase in
insulin, which enhances removal of glucose from the blood. When
ADVANCED glucose has been taken up by cells and blood glucose levels fall, insulin
secretion is inhibited and glucagon and other counterregulatory
mechanisms stimulate release of glucose from the liver, which causes
PATHOPHYSIOLOG blood glucose levels to return to normal.
3. A client presents to the emergency department following a
Y FNP V1 100 major traffic accident. Though outwardly there are no apparent
physical injuries found, the client is experiencing chest pain and
heightened alertness, which the health care worker attributes to the
Practice first stage of general adaptation syndrome (GAS). The health care
worker concludes the client is experiencing manifestations related to
Questions and
the release of:
A) Aldosterone, which interferes with sodium absorption
Answers B)
C)
Epinephrine
Too little cortisol
1. According to Walter B. Cannon, homeostasis is a stable
D) Thyroid-stimulating hormone
internal environment achieved through a system of:
Ans: B
A) Interdependent system-wide adaptive responses
Feedback:
B) Variable internal and external conditioning factors
The general adaptation syndromes has three stages—the first
C) Coordinated physiologic processes that oppose change
is alarm (fight or flight); second is resistance (fight); and the third is
D) Compatibility between cells and the internal environment exhaustion. The alarm stage is characterized by a generalized
stimulation of the sympathetic nervous system (SNS) and the HPA,
Ans: C resulting in release of catecholamines and cortisol. Increased insulin
release or TSH release is not part of the GAS.
Feedback:
Walter B. Cannon identified homeostasis, achieved by a
coordinated physiologic process that opposes change. Claude Bernard 4. Although stress exposure initiates integrated responses by
recognized the importance of compatibility between cells and the multiple systems, the functional results are first manifested as: Select
internal environment. Hans Selye identified the general (systemic) all that apply.
adaptive and interdependent responses to stress. According to Selye,
stressors produce different responses due to the influence of adaptive A) Enhanced respiratory rate/depth
internal or external factors (conditioning factors).
B) Cravings for high-carbohydrate foods
2. A child has been experiencing hypoglycemic episodes. “How
C) Increased alertness and focus
does the body know when to secrete insulin and when to stop
secreting it?” The best response by the nurse, explaining the D) Increased glucose utilization
physiologic background, would be:
E) Increased GI peristalsis
A) “The body knows that if the blood glucose level falls, it will
inhibit insulin secretion and release glycogen to release glucose from Ans: A, C, D
the liver.”
Feedback:
B) “It's just a big guessing game; first we give sugar like orange
Exposure to stress activates an immediate response by the
juice, and then we withhold the carbohydrates if the blood glucose
neuroendocrine system that plays a role in most of the responses to
level is too high.”
stress and attempts to adapt. Results of the coordinated release of
C) “Your pituitary gland in the brain is the 'master gland,' and it these neurohormones include mobilization of energy, a sharpened
controls and regulates all the hormones.” focus and awareness, increased cerebral blood flow and glucose
utilization, enhanced cardiovascular and respiratory functioning,
D) “Once the child starts getting confused, the brain will send a redistribution of blood flow to the brain and muscles, modulation of
message to the pancreas to stop producing insulin.” the immune response, inhibition of reproductive function, and a
decrease in appetite.
Ans: A
Feedback:
,5. A client is experiencing significant stress while awaiting the D) Proteolytic enzymes
results of her recent lymph node biopsy. Among the hormonal
contributors to this response is a release of aldosterone, resulting in Ans: B
which of the following physiologic effects? Feedback:
A) Decreased release of insulin Many tumors secrete growth factors, which trigger and
B) Increased cardiac contractility regulate the angiogenesis process. Tumor cells express various cell
surface attachment factors, for anchoring. Tumor cells secrete
C) Potentiating effects of epinephrine proteolytic enzymes to degrade the basement membrane and migrate
into surrounding tissue. Cancer cells may produce procoagulant
D) Increased sodium absorption materials that affect clotting mechanisms.
Ans: D
Feedback: 8. Which of the following processes characterizes an epigenetic
Mineralocorticoids such as aldosterone increase sodium contribution to oncogenesis?
absorption by the kidneys. Changes in insulin release and cardiac A) A DNA repair mechanism is disrupted.
contractility are mediated by catecholamines, whereas cortisol
potentiates the action of epinephrine. B) A tumor suppressor gene is present, but it is not expressed.
C) Cells lose their normal contact inhibition.
6. While looking at cancer cells under a microscope, the D) Regulation of apoptosis in impaired, resulting in
instructor asks the students to describe the cells. Which of the student accumulation of cancer cells.
answers are accurate? Select all that apply.
Ans: B
A) The cells are in different sizes and shapes.
Feedback:
B) The nucleoli are larger than normal.
Epigenetic mechanisms of cancer growth involve changes in
C) The cells are contact inhibited. the patterns of gene expression without a change in the DNA.
Epigenetic mechanisms may “silence” genes, such as tumor suppressor
D) The cells do not resemble the tissue of origin. genes, so that even though the gene is present, it is not expressed and
E) The cells are attached to an extracellular matrix. a cancer-suppressing protein is not made. Disruption of DNA repair
may contribute to cancer, but this process is not particular to
Ans: A, B, D epigenetics. Similarly, loss of contact inhibition and impaired apoptosis
are associated with cancer but are not specific manifestations of
Feedback: epigenetic mechanisms.
Undifferentiated cancer cells are marked by a number of
morphologic changes. Both the cells and nuclei display variations in
size and shape. Their nuclei are variable in size and bizarre in shape, 9. An oncology nurse is caring for a client with newly diagnosed
their chromatin is coarse and clumped, and their nucleoli are often B-cell lymphoma. Extensive blood work has been drawn and sent to
considerably larger than normal. The cells of malignant tumors are the lab. Results reveal an elevated antiapoptotic protein BCL-2 level.
characterized by wide changes of parenchymal cell differentiation from The client/family asks, “What does this mean?” The health care
well differentiated to completely undifferentiated. Normal cells that provider bases his or her response on the fact that:
are grown in culture tend to display a feature called cell density–
dependent inhibition, in which they stop dividing after the cell A) The client's immune system is trying to kill the cancer cell by
population reaches a particular density. This is sometimes referred to sending this protein to engulf it.
as contact inhibition since cells often stop growing when they come B) This is a good result. Normal cells undergo apoptosis if DNA
into contact with each other. In contrast to normal cells, cancer cells is damaged in any way.
often survive in microenvironments different from those of the normal
cells. They frequently remain viable and multiply without normal C) This means the cancer cells have found a way to survive and
attachments to other cells and the extracellular matrix. grow even with damaged DNA.
D) The client's body is trying to limit the blood supply to the
cancer cells by producing high levels of this protein.
7. The angiogenesis process, which allows tumors to develop
new blood vessels, is triggered and regulated by tumor-secreted: Ans: C
A) Procoagulants Feedback:
B) Growth factors Alterations in apoptotic and antiapoptotic pathways have
been found in many cancers. One example is the high levels of the
C) Attachment factors antiapoptotic protein BCL-2 that occur secondary to a chromosomal
translocation in certain B-cell lymphomas. The mitochondrial
, membrane is a key regulator of the balance between cell death and B) Large, protruding ears
survival. Proteins in the BCL-2 family reside in the inner mitochondrial
membrane and are either proapoptotic or antiapoptotic. Since C) Large tongue sticking out the mouth
apoptosis is considered a normal cellular response to DNA damage, D) Long fingers with extra creases
loss of normal apoptotic pathways may contribute to cancer by
enabling DNA-damaged cells to survive. E) Flat facial profile
Ans: A, C, E
10. A farmer's long-term exposure to pesticides has made the Feedback:
cells in his alveoli and bronchial tree susceptible to malignancy. Which
of the following processes has taken place in the farmer's lungs? The physical features of a child with Down syndrome are
distinctive, and therefore the condition usually is apparent at birth.
A) Promotion These features include growth failure and a small and rather square
head. There is a flat facial profile, small nose, and somewhat
B) Progression depressed nasal bridge; upward slanting of the eyes; small, low-set,
C) Initiation and malformed ears; and a large, protruding tongue. The child's hands
usually are short and stubby, with fingers that curl inward, and there
D) Differentiation usually is only a single palmar crease (simian crease).
Ans: C
Feedback: 13. A 41-year-old woman has made the recent decision to start a
family and is eager to undergo testing to mitigate the possibility of
Initiation involves the exposure of cells to appropriate doses having a child with Down syndrome. Which of the following tests is
of a carcinogenic agent that makes them susceptible to malignant most likely to provide the data the woman seeks?
transformation, whereas promotion involves the induction of
unregulated accelerated growth in already initiated cells. Progression A) Genetic testing of the woman
is the later process whereby tumor cells acquire malignant phenotypic
changes, and differentiation is the process of specialization whereby B) Genetic testing of the woman and the father
new cells acquire the structural, microscopic, and functional C) Prenatal blood tests
characteristics of the cells they replace.
D) Ultrasonography
Ans: C
11. Which of the following practitioners is most likely to be of
immediate assistance in the first 24 hours following delivery of an Feedback:
infant with a cleft lip?
Down syndrome is a result of chromosomal abnormality and
A) Lactation consultant is not a single-gene disorder. As a result, genetic testing of the mother
and/or father is not relevant. Ultrasonography does not have
B) Respiratory therapist predicative value for Down syndrome, but blood tests such as -
C) Occupational therapist fetoprotein, human chorionic gonadotropin (HCG), unconjugated
estriol, inhibin A, and pregnancy-associated plasma protein A have
D) Social worker helped ascertain the risks.
Ans: A
Feedback: 14. Aneuploidy of the X chromosome can result in a monosomy
or polysomy disorder. The clinical manifestations of a female with
Infants with a cleft lip typically have difficulty with feeding, monosomy X include: Select all that apply.
and the assistance of a lactation consultant may be of help in
establishing feeding patterns. Oxygenation is not a typical problem, A) A short-stature female individual
while activities of daily living and assistive devices are not relevant
considerations. While social work is often of assistance when a child is B) Difficulty with fine motor skills
born with a congenital condition, a cleft lip has fewer implications than C) Large heavy breasts
most other inherited disorders.
D) Early-onset (age 8) puberty
E) Nonpitting lymphedema of the feet
12. The newborn has been born with distinctive physical features
of trisomy 21, Down syndrome. The mother asks the nurse, “What is Ans: A, B, E
wrong? My baby looks different than his brother.” The nurse assesses
the infant and notes which of the following characteristics that Feedback:
correlate with trisomy 21? Select all that apply. Turner syndrome produces a female individual who is short,
A) Upward slanting of eyes has no secondary sex characteristics, has normal intelligence, and fails
2019 HESI
In the negative feedback mechanism that controls blood
glucose levels, an increase in blood glucose stimulates an increase in
insulin, which enhances removal of glucose from the blood. When
ADVANCED glucose has been taken up by cells and blood glucose levels fall, insulin
secretion is inhibited and glucagon and other counterregulatory
mechanisms stimulate release of glucose from the liver, which causes
PATHOPHYSIOLOG blood glucose levels to return to normal.
3. A client presents to the emergency department following a
Y FNP V1 100 major traffic accident. Though outwardly there are no apparent
physical injuries found, the client is experiencing chest pain and
heightened alertness, which the health care worker attributes to the
Practice first stage of general adaptation syndrome (GAS). The health care
worker concludes the client is experiencing manifestations related to
Questions and
the release of:
A) Aldosterone, which interferes with sodium absorption
Answers B)
C)
Epinephrine
Too little cortisol
1. According to Walter B. Cannon, homeostasis is a stable
D) Thyroid-stimulating hormone
internal environment achieved through a system of:
Ans: B
A) Interdependent system-wide adaptive responses
Feedback:
B) Variable internal and external conditioning factors
The general adaptation syndromes has three stages—the first
C) Coordinated physiologic processes that oppose change
is alarm (fight or flight); second is resistance (fight); and the third is
D) Compatibility between cells and the internal environment exhaustion. The alarm stage is characterized by a generalized
stimulation of the sympathetic nervous system (SNS) and the HPA,
Ans: C resulting in release of catecholamines and cortisol. Increased insulin
release or TSH release is not part of the GAS.
Feedback:
Walter B. Cannon identified homeostasis, achieved by a
coordinated physiologic process that opposes change. Claude Bernard 4. Although stress exposure initiates integrated responses by
recognized the importance of compatibility between cells and the multiple systems, the functional results are first manifested as: Select
internal environment. Hans Selye identified the general (systemic) all that apply.
adaptive and interdependent responses to stress. According to Selye,
stressors produce different responses due to the influence of adaptive A) Enhanced respiratory rate/depth
internal or external factors (conditioning factors).
B) Cravings for high-carbohydrate foods
2. A child has been experiencing hypoglycemic episodes. “How
C) Increased alertness and focus
does the body know when to secrete insulin and when to stop
secreting it?” The best response by the nurse, explaining the D) Increased glucose utilization
physiologic background, would be:
E) Increased GI peristalsis
A) “The body knows that if the blood glucose level falls, it will
inhibit insulin secretion and release glycogen to release glucose from Ans: A, C, D
the liver.”
Feedback:
B) “It's just a big guessing game; first we give sugar like orange
Exposure to stress activates an immediate response by the
juice, and then we withhold the carbohydrates if the blood glucose
neuroendocrine system that plays a role in most of the responses to
level is too high.”
stress and attempts to adapt. Results of the coordinated release of
C) “Your pituitary gland in the brain is the 'master gland,' and it these neurohormones include mobilization of energy, a sharpened
controls and regulates all the hormones.” focus and awareness, increased cerebral blood flow and glucose
utilization, enhanced cardiovascular and respiratory functioning,
D) “Once the child starts getting confused, the brain will send a redistribution of blood flow to the brain and muscles, modulation of
message to the pancreas to stop producing insulin.” the immune response, inhibition of reproductive function, and a
decrease in appetite.
Ans: A
Feedback:
,5. A client is experiencing significant stress while awaiting the D) Proteolytic enzymes
results of her recent lymph node biopsy. Among the hormonal
contributors to this response is a release of aldosterone, resulting in Ans: B
which of the following physiologic effects? Feedback:
A) Decreased release of insulin Many tumors secrete growth factors, which trigger and
B) Increased cardiac contractility regulate the angiogenesis process. Tumor cells express various cell
surface attachment factors, for anchoring. Tumor cells secrete
C) Potentiating effects of epinephrine proteolytic enzymes to degrade the basement membrane and migrate
into surrounding tissue. Cancer cells may produce procoagulant
D) Increased sodium absorption materials that affect clotting mechanisms.
Ans: D
Feedback: 8. Which of the following processes characterizes an epigenetic
Mineralocorticoids such as aldosterone increase sodium contribution to oncogenesis?
absorption by the kidneys. Changes in insulin release and cardiac A) A DNA repair mechanism is disrupted.
contractility are mediated by catecholamines, whereas cortisol
potentiates the action of epinephrine. B) A tumor suppressor gene is present, but it is not expressed.
C) Cells lose their normal contact inhibition.
6. While looking at cancer cells under a microscope, the D) Regulation of apoptosis in impaired, resulting in
instructor asks the students to describe the cells. Which of the student accumulation of cancer cells.
answers are accurate? Select all that apply.
Ans: B
A) The cells are in different sizes and shapes.
Feedback:
B) The nucleoli are larger than normal.
Epigenetic mechanisms of cancer growth involve changes in
C) The cells are contact inhibited. the patterns of gene expression without a change in the DNA.
Epigenetic mechanisms may “silence” genes, such as tumor suppressor
D) The cells do not resemble the tissue of origin. genes, so that even though the gene is present, it is not expressed and
E) The cells are attached to an extracellular matrix. a cancer-suppressing protein is not made. Disruption of DNA repair
may contribute to cancer, but this process is not particular to
Ans: A, B, D epigenetics. Similarly, loss of contact inhibition and impaired apoptosis
are associated with cancer but are not specific manifestations of
Feedback: epigenetic mechanisms.
Undifferentiated cancer cells are marked by a number of
morphologic changes. Both the cells and nuclei display variations in
size and shape. Their nuclei are variable in size and bizarre in shape, 9. An oncology nurse is caring for a client with newly diagnosed
their chromatin is coarse and clumped, and their nucleoli are often B-cell lymphoma. Extensive blood work has been drawn and sent to
considerably larger than normal. The cells of malignant tumors are the lab. Results reveal an elevated antiapoptotic protein BCL-2 level.
characterized by wide changes of parenchymal cell differentiation from The client/family asks, “What does this mean?” The health care
well differentiated to completely undifferentiated. Normal cells that provider bases his or her response on the fact that:
are grown in culture tend to display a feature called cell density–
dependent inhibition, in which they stop dividing after the cell A) The client's immune system is trying to kill the cancer cell by
population reaches a particular density. This is sometimes referred to sending this protein to engulf it.
as contact inhibition since cells often stop growing when they come B) This is a good result. Normal cells undergo apoptosis if DNA
into contact with each other. In contrast to normal cells, cancer cells is damaged in any way.
often survive in microenvironments different from those of the normal
cells. They frequently remain viable and multiply without normal C) This means the cancer cells have found a way to survive and
attachments to other cells and the extracellular matrix. grow even with damaged DNA.
D) The client's body is trying to limit the blood supply to the
cancer cells by producing high levels of this protein.
7. The angiogenesis process, which allows tumors to develop
new blood vessels, is triggered and regulated by tumor-secreted: Ans: C
A) Procoagulants Feedback:
B) Growth factors Alterations in apoptotic and antiapoptotic pathways have
been found in many cancers. One example is the high levels of the
C) Attachment factors antiapoptotic protein BCL-2 that occur secondary to a chromosomal
translocation in certain B-cell lymphomas. The mitochondrial
, membrane is a key regulator of the balance between cell death and B) Large, protruding ears
survival. Proteins in the BCL-2 family reside in the inner mitochondrial
membrane and are either proapoptotic or antiapoptotic. Since C) Large tongue sticking out the mouth
apoptosis is considered a normal cellular response to DNA damage, D) Long fingers with extra creases
loss of normal apoptotic pathways may contribute to cancer by
enabling DNA-damaged cells to survive. E) Flat facial profile
Ans: A, C, E
10. A farmer's long-term exposure to pesticides has made the Feedback:
cells in his alveoli and bronchial tree susceptible to malignancy. Which
of the following processes has taken place in the farmer's lungs? The physical features of a child with Down syndrome are
distinctive, and therefore the condition usually is apparent at birth.
A) Promotion These features include growth failure and a small and rather square
head. There is a flat facial profile, small nose, and somewhat
B) Progression depressed nasal bridge; upward slanting of the eyes; small, low-set,
C) Initiation and malformed ears; and a large, protruding tongue. The child's hands
usually are short and stubby, with fingers that curl inward, and there
D) Differentiation usually is only a single palmar crease (simian crease).
Ans: C
Feedback: 13. A 41-year-old woman has made the recent decision to start a
family and is eager to undergo testing to mitigate the possibility of
Initiation involves the exposure of cells to appropriate doses having a child with Down syndrome. Which of the following tests is
of a carcinogenic agent that makes them susceptible to malignant most likely to provide the data the woman seeks?
transformation, whereas promotion involves the induction of
unregulated accelerated growth in already initiated cells. Progression A) Genetic testing of the woman
is the later process whereby tumor cells acquire malignant phenotypic
changes, and differentiation is the process of specialization whereby B) Genetic testing of the woman and the father
new cells acquire the structural, microscopic, and functional C) Prenatal blood tests
characteristics of the cells they replace.
D) Ultrasonography
Ans: C
11. Which of the following practitioners is most likely to be of
immediate assistance in the first 24 hours following delivery of an Feedback:
infant with a cleft lip?
Down syndrome is a result of chromosomal abnormality and
A) Lactation consultant is not a single-gene disorder. As a result, genetic testing of the mother
and/or father is not relevant. Ultrasonography does not have
B) Respiratory therapist predicative value for Down syndrome, but blood tests such as -
C) Occupational therapist fetoprotein, human chorionic gonadotropin (HCG), unconjugated
estriol, inhibin A, and pregnancy-associated plasma protein A have
D) Social worker helped ascertain the risks.
Ans: A
Feedback: 14. Aneuploidy of the X chromosome can result in a monosomy
or polysomy disorder. The clinical manifestations of a female with
Infants with a cleft lip typically have difficulty with feeding, monosomy X include: Select all that apply.
and the assistance of a lactation consultant may be of help in
establishing feeding patterns. Oxygenation is not a typical problem, A) A short-stature female individual
while activities of daily living and assistive devices are not relevant
considerations. While social work is often of assistance when a child is B) Difficulty with fine motor skills
born with a congenital condition, a cleft lip has fewer implications than C) Large heavy breasts
most other inherited disorders.
D) Early-onset (age 8) puberty
E) Nonpitting lymphedema of the feet
12. The newborn has been born with distinctive physical features
of trisomy 21, Down syndrome. The mother asks the nurse, “What is Ans: A, B, E
wrong? My baby looks different than his brother.” The nurse assesses
the infant and notes which of the following characteristics that Feedback:
correlate with trisomy 21? Select all that apply. Turner syndrome produces a female individual who is short,
A) Upward slanting of eyes has no secondary sex characteristics, has normal intelligence, and fails
