**The Science of Systems: HESI Pathophysiology
Nursing Exam 2025 NGN – Advanced Mechanisms
Edition**
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**Question 1**
A nurse is reviewing the pathophysiology of type 1 diabetes mellitus. Which statement correctly
describes the underlying mechanism?
A. Peripheral insulin resistance with compensatory hyperinsulinemia.
B. Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency.
C. Impaired insulin secretion due to pancreatic ductal obstruction.
D. Excessive glucagon secretion from alpha cells.
💫RATIONALE✔️✔️: Type 1 DM is autoimmune destruction of beta cells → no insulin. Type 2 is insulin
resistance. Option B correct.
💫ANSWER✔️✔️: B. Autoimmune destruction of pancreatic beta cells leading to absolute insulin
deficiency.
---
**Question 2**
A client with heart failure has increased preload. Which compensatory mechanism occurs initially?
A. Decreased heart rate.
B. Increased stroke volume (Frank-Starling mechanism).
C. Decreased contractility.
D. Peripheral vasodilation.
,💫RATIONALE✔️✔️: Frank-Starling: increased preload stretches cardiac muscle → increased stroke
volume. Initially compensatory, then maladaptive.
💫ANSWER✔️✔️: B. Increased stroke volume (Frank-Starling mechanism).
---
**Question 3**
A nurse is explaining the pathophysiology of disseminated intravascular coagulation (DIC). Which trigger
is most common?
A. Hemophilia A.
B. Sepsis or endotoxemia.
C. Vitamin K deficiency.
D. Thrombocytopenia.
💫RATIONALE✔️✔️: Sepsis releases endotoxins → widespread clotting factor activation, microthrombi,
then bleeding. Most common cause.
💫ANSWER✔️✔️: B. Sepsis or endotoxemia.
---
**Question 4**
A client with chronic kidney disease has decreased erythropoietin production. Which laboratory finding
is expected?
A. Hemoglobin 7.5 g/dL.
B. Hematocrit 55%.
C. Elevated reticulocyte count.
D. Polycythemia.
💫RATIONALE✔️✔️: Erythropoietin deficiency → normocytic normochromic anemia. Low hemoglobin.
Polycythemia not expected.
,💫ANSWER✔️✔️: A. Hemoglobin 7.5 g/dL.
---
**Question 5**
A nurse is teaching about the pathophysiology of asthma. Which cellular component is primarily
responsible for bronchospasm in the early phase?
A. Neutrophils.
B. Mast cells (histamine, leukotrienes).
C. Macrophages.
D. Eosinophils.
💫RATIONALE✔️✔️: Immediate phase: mast cell degranulation → histamine, leukotrienes →
bronchospasm. Eosinophils in late phase.
💫ANSWER✔️✔️: B. Mast cells (histamine, leukotrienes).
---
**Question 6**
A client with cirrhosis has portal hypertension. Which finding is a direct consequence?
A. Hepatocellular carcinoma.
B. Esophageal varices.
C. Hepatic encephalopathy.
D. Hypoalbuminemia.
💫RATIONALE✔️✔️: Portal hypertension → shunting → esophageal varices, caput medusae,
splenomegaly, ascites. Option B correct.
💫ANSWER✔️✔️: B. Esophageal varices.
, ---
**Question 7**
A nurse is reviewing the pathophysiology of myocardial infarction. Which event occurs after coronary
artery occlusion?
A. Immediate formation of collateral circulation.
B. Ischemia followed by necrosis if blood flow not restored.
C. Hypertrophy of the affected myocardium.
D. Complete recovery of all myocytes.
💫RATIONALE✔️✔️: Occlusion → ischemia → necrosis within 20-40 minutes if no reperfusion. Collaterals
take time. No hypertrophy.
💫ANSWER✔️✔️: B. Ischemia followed by necrosis if blood flow not restored.
---
**Question 8**
A client with Graves’ disease has which underlying mechanism?
A. Autoantibodies (TSI) stimulating TSH receptors, causing hyperthyroidism.
B. Destruction of thyroid follicles.
C. Pituitary adenoma secreting TSH.
D. Iodine deficiency.
💫RATIONALE✔️✔️: Graves’: thyroid-stimulating immunoglobulins (TSI) activate TSH receptors →
uncontrolled thyroid hormone production.
💫ANSWER✔️✔️: A. Autoantibodies (TSI) stimulating TSH receptors, causing hyperthyroidism.
---
**Question 9**
Nursing Exam 2025 NGN – Advanced Mechanisms
Edition**
---
**Question 1**
A nurse is reviewing the pathophysiology of type 1 diabetes mellitus. Which statement correctly
describes the underlying mechanism?
A. Peripheral insulin resistance with compensatory hyperinsulinemia.
B. Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency.
C. Impaired insulin secretion due to pancreatic ductal obstruction.
D. Excessive glucagon secretion from alpha cells.
💫RATIONALE✔️✔️: Type 1 DM is autoimmune destruction of beta cells → no insulin. Type 2 is insulin
resistance. Option B correct.
💫ANSWER✔️✔️: B. Autoimmune destruction of pancreatic beta cells leading to absolute insulin
deficiency.
---
**Question 2**
A client with heart failure has increased preload. Which compensatory mechanism occurs initially?
A. Decreased heart rate.
B. Increased stroke volume (Frank-Starling mechanism).
C. Decreased contractility.
D. Peripheral vasodilation.
,💫RATIONALE✔️✔️: Frank-Starling: increased preload stretches cardiac muscle → increased stroke
volume. Initially compensatory, then maladaptive.
💫ANSWER✔️✔️: B. Increased stroke volume (Frank-Starling mechanism).
---
**Question 3**
A nurse is explaining the pathophysiology of disseminated intravascular coagulation (DIC). Which trigger
is most common?
A. Hemophilia A.
B. Sepsis or endotoxemia.
C. Vitamin K deficiency.
D. Thrombocytopenia.
💫RATIONALE✔️✔️: Sepsis releases endotoxins → widespread clotting factor activation, microthrombi,
then bleeding. Most common cause.
💫ANSWER✔️✔️: B. Sepsis or endotoxemia.
---
**Question 4**
A client with chronic kidney disease has decreased erythropoietin production. Which laboratory finding
is expected?
A. Hemoglobin 7.5 g/dL.
B. Hematocrit 55%.
C. Elevated reticulocyte count.
D. Polycythemia.
💫RATIONALE✔️✔️: Erythropoietin deficiency → normocytic normochromic anemia. Low hemoglobin.
Polycythemia not expected.
,💫ANSWER✔️✔️: A. Hemoglobin 7.5 g/dL.
---
**Question 5**
A nurse is teaching about the pathophysiology of asthma. Which cellular component is primarily
responsible for bronchospasm in the early phase?
A. Neutrophils.
B. Mast cells (histamine, leukotrienes).
C. Macrophages.
D. Eosinophils.
💫RATIONALE✔️✔️: Immediate phase: mast cell degranulation → histamine, leukotrienes →
bronchospasm. Eosinophils in late phase.
💫ANSWER✔️✔️: B. Mast cells (histamine, leukotrienes).
---
**Question 6**
A client with cirrhosis has portal hypertension. Which finding is a direct consequence?
A. Hepatocellular carcinoma.
B. Esophageal varices.
C. Hepatic encephalopathy.
D. Hypoalbuminemia.
💫RATIONALE✔️✔️: Portal hypertension → shunting → esophageal varices, caput medusae,
splenomegaly, ascites. Option B correct.
💫ANSWER✔️✔️: B. Esophageal varices.
, ---
**Question 7**
A nurse is reviewing the pathophysiology of myocardial infarction. Which event occurs after coronary
artery occlusion?
A. Immediate formation of collateral circulation.
B. Ischemia followed by necrosis if blood flow not restored.
C. Hypertrophy of the affected myocardium.
D. Complete recovery of all myocytes.
💫RATIONALE✔️✔️: Occlusion → ischemia → necrosis within 20-40 minutes if no reperfusion. Collaterals
take time. No hypertrophy.
💫ANSWER✔️✔️: B. Ischemia followed by necrosis if blood flow not restored.
---
**Question 8**
A client with Graves’ disease has which underlying mechanism?
A. Autoantibodies (TSI) stimulating TSH receptors, causing hyperthyroidism.
B. Destruction of thyroid follicles.
C. Pituitary adenoma secreting TSH.
D. Iodine deficiency.
💫RATIONALE✔️✔️: Graves’: thyroid-stimulating immunoglobulins (TSI) activate TSH receptors →
uncontrolled thyroid hormone production.
💫ANSWER✔️✔️: A. Autoantibodies (TSI) stimulating TSH receptors, causing hyperthyroidism.
---
**Question 9**
