HESI Exit Advanced Pathophysiology 2026 – Complete System-Based Disease Review, Cellular & Tissue Mechanisms, Clinical Manifestations, Diagnostic Interpretation, Pharmacologic Correlations, NCLEX-Style Practice Questions, Critical Thinking Scenarios, High

HESI ExIt AdvAncEd PAtHoPHySIology 2026 –
comPlEtE SyStEm-BASEd dISEASE REvIEw,
cEllulAR & tISSuE mEcHAnISmS, clInIcAl
mAnIfEStAtIonS, dIAgnoStIc IntERPREtAtIon,
PHARmAcologIc coRRElAtIonS, nclEx-StylE
PRActIcE QuEStIonS, cRItIcAl tHInkIng
ScEnARIoS, HIgH-yIEld ExAm PREP foR nuRSIng
StudEntS And HEAltHcARE PRofESSIonAlS
Question 1:
Which of the following is a primary pathological feature of chronic obstructive
pulmonary disease (COPD)?
A) Alveolar collapse
B) Airflow obstruction
C) Bronchial hyperresponsiveness
D) Pulmonary edema
CORRECT ANSWER: B) Airflow obstruction
Rationale: In COPD, airflow obstruction results from a combination of emphysema and
chronic bronchitis, leading to decreased airflow.


Question 2:
What is the primary mechanism of action of angiotensin-converting enzyme (ACE)
inhibitors in the treatment of hypertension?
A) Decreased heart rate
B) Increased renal perfusion
C) Vasodilation
D) Decreased production of angiotensin II
CORRECT ANSWER: D) Decreased production of angiotensin II
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II,
resulting in decreased vasoconstriction and lowered blood pressure.


Question 3:
In the context of diabetes mellitus, which of the following laboratory findings is
indicative of ketoacidosis?
A) Increased blood pressure
B) Low serum potassium
C) Elevated fasting blood glucose
D) Presence of ketones in urine

,CORRECT ANSWER: D) Presence of ketones in urine
Rationale: Ketones in urine indicate that the body is in a state of fat metabolism due to
insufficient insulin.


Question 4:
What is the primary cause of acute glomerulonephritis?
A) Viral infection
B) Post-streptococcal infection
C) Chronic hypertension
D) Diabetes mellitus
CORRECT ANSWER: B) Post-streptococcal infection
Rationale: Acute glomerulonephritis is often a result of an immune response following
a streptococcal infection.


Question 5:
Which of the following changes is most commonly observed in patients with heart
failure?
A) Decreased preload
B) Increased afterload
C) Enhanced myocardial contractility
D) Decreased heart rate
CORRECT ANSWER: B) Increased afterload
Rationale: Heart failure often leads to increased systemic vascular resistance,
increasing the afterload that the heart must work against.
Question 6:
Which electrolyte imbalance is commonly associated with acute renal failure?
A) Hypercalcemia
B) Hyperkalemia
C) Hyponatremia
D) Hypomagnesemia
CORRECT ANSWER: B) Hyperkalemia
Rationale: Acute renal failure often leads to the inability to excrete potassium, resulting
in hyperkalemia.


Question 7:
What is the most significant long-term consequence of untreated hypertension?

,A) Heart failure
B) Asthma
C) Anemia
D) Hyperthyroidism
CORRECT ANSWER: A) Heart failure
Rationale: Untreated hypertension can lead to hypertensive heart disease, which can
eventually result in heart failure.


Question 8:
In which type of shock is the cardiac output typically decreased?
A) Neurogenic shock
B) Anaphylactic shock
C) Cardiogenic shock
D) Septic shock
CORRECT ANSWER: C) Cardiogenic shock
Rationale: Cardiogenic shock occurs due to the heart's inability to pump effectively,
leading to decreased cardiac output.


Question 9:
What is the primary defect in patients with cystic fibrosis?
A) Defective chloride channels
B) Insulin deficiency
C) Vascular endothelial dysfunction
D) Myelin sheath degradation
CORRECT ANSWER: A) Defective chloride channels
Rationale: Cystic fibrosis results from mutations in the CFTR gene that leads to
defective chloride channel function.


Question 10:
Which type of hypersensitivity reaction involves immune complex formation?
A) Type I
B) Type II
C) Type III
D) Type IV
CORRECT ANSWER: C) Type III
Rationale: Type III hypersensitivity involves immune complexes that deposit in tissues,
causing inflammation and damage.

, Question 11:
Which of the following is a hallmark sign of Parkinson’s disease?
A) Increased heart rate
B) Resting tremor
C) Hyper-reflexia
D) Diplopia
CORRECT ANSWER: B) Resting tremor
Rationale: A resting tremor is a classic symptom of Parkinson’s disease, associated
with basal ganglia dysfunction.


Question 12:
What is the characteristic histological feature of rheumatoid arthritis?
A) Formation of granulomas
B) Eosinophilic infiltration
C) Pannus formation
D) Fibrin deposition
CORRECT ANSWER: C) Pannus formation
Rationale: Pannus is a characteristic destructive granulation tissue that invades joint
spaces in rheumatoid arthritis.


Question 13:
What is the primary clinical manifestation of myocardial infarction?
A) Chest tightness
B) Cyanosis
C) Chest pain
D) Nausea
CORRECT ANSWER: C) Chest pain
Rationale: Chest pain, often described as crushing or pressure-like, is a classic
symptom of a myocardial infarction.


Question 14:
Which of the following conditions is primarily characterized by excessive cortisol
production?
A) Addison's disease
B) Cushing's syndrome