HESI RN Pathophysiology — NGN Exam
HESI RN Pathophysiology
Next Generation NCLEX (NGN)
Questions and Answers| Latest Update
1. A nurse reviews a biopsy report showing that a client's uterine smooth
muscle cells have increased in size following pregnancy. Which cellular
adaptation does this represent?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Answer: B
Rationale: Hypertrophy is an increase in the SIZE of individual cells, seen in the
uterus during pregnancy due to hormonal stimulation and increased workload.
Hyperplasia is an increase in cell NUMBER. Atrophy is a decrease in cell
size/number. Metaplasia is replacement of one mature cell type with another.
2. A client who smokes has had chronic exposure to cigarette smoke. Bronchial
biopsy shows normal ciliated columnar epithelium replaced by stratified
squamous epithelium. This is an example of which adaptive cellular change?
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Anaplasia
Answer: B
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, HESI RN Pathophysiology — NGN Exam
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type with another that is better suited to withstand chronic irritation (e.g.,
squamous replacing columnar epithelium in smokers' airways). Dysplasia
involves disordered cell growth/atypia, not simply a substituted cell type.
Anaplasia is undifferentiated, cancerous cell growth.
3. The nurse is teaching about cell injury. Which statement best describes an
irreversible cell injury?
A. Cellular swelling with ATP depletion
B. Ribosomal detachment from the endoplasmic reticulum
C. Massive influx of calcium causing membrane and mitochondrial damage
D. Fatty infiltration of the cytoplasm
Answer: C
Rationale: Irreversible injury is marked by severe calcium influx that activates
destructive enzymes (phospholipases, proteases) and destroys mitochondria
and membranes, leading to cell death (necrosis). Cellular swelling, ribosomal
detachment, and fatty change are features of reversible injury.
4. A nurse notes a client's skin wound is healing with excessive scar tissue that
raises above the skin surface and extends beyond wound margins. This is best
described as:
A. Hypertrophic scar
B. Keloid formation
C. Contracture
D. Dehiscence
Answer: B
Rationale: A keloid is excess collagen deposition that extends BEYOND the
original wound borders. A hypertrophic scar stays within the wound boundaries.
Contracture is shrinkage/tightening of scar tissue restricting movement.
Dehiscence is separation of wound edges.
5. Which client is at greatest risk for developing dystrophic calcification?
A. A client with hyperparathyroidism
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, HESI RN Pathophysiology — NGN Exam
B. A client with chronic areas of tissue necrosis from atherosclerosis
C. A client with excessive vitamin D intake
D. A client with normal serum calcium and healthy tissue
Answer: B
Rationale: Dystrophic calcification occurs in dying or necrotic tissue (such as
atherosclerotic plaques) despite NORMAL serum calcium levels. Metastatic
calcification, in contrast, occurs in normal tissue due to elevated serum calcium
(as in hyperparathyroidism or vitamin D excess).
6. A client's liver biopsy reveals hepatocytes are undersized and reduced in
number after prolonged disuse and malnutrition. This finding represents:
A. Hyperplasia
B. Atrophy
C. Hypertrophy
D. Metaplasia
Answer: B
Rationale: Atrophy is a decrease in cell size and/or number as an adaptive
response to decreased workload, disuse, malnutrition, or reduced blood/nerve
supply, resulting in a reduction in organ size and function.
7. During cellular hypoxia, which sequence of events occurs first?
A. Anaerobic metabolism and lactic acid accumulation
B. Cellular swelling from sodium-potassium pump failure
C. Decreased ATP production
D. Ribosome detachment and protein synthesis failure
Answer: C
Rationale: Hypoxia decreases oxidative phosphorylation, causing an
immediate drop in ATP production. This triggers a cascade: the sodium-
potassium pump fails (causing cellular swelling), anaerobic glycolysis increases
(causing lactic acidosis), and ribosomes detach as protein synthesis fails.
8. A nurse caring for a client after a myocardial infarction understands that
necrotic cardiac tissue undergoes which type of necrosis?
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, HESI RN Pathophysiology — NGN Exam
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Answer: C
Rationale: Coagulative necrosis is characteristic of hypoxic death in solid
organs such as the heart and kidney; the tissue architecture is preserved
initially because protein denaturation, not enzymatic digestion, predominates.
Liquefactive necrosis occurs in the brain and with bacterial infections; caseous
necrosis is seen in TB; fat necrosis occurs in pancreatitis or breast tissue trauma.
9. The nurse is reviewing genetic terms. A client has two different alleles for a
given trait. This is best described as:
A. Homozygous
B. Heterozygous
C. Phenotype
D. Autosomal
Answer: B
Rationale: Heterozygous means the individual carries two different alleles for a
specific gene (one from each parent). Homozygous means both alleles are
identical. Phenotype is the observable expression of the genotype.
10. A nurse is explaining X-linked recessive inheritance to a family. Which
statement is accurate?
A. Fathers pass the trait to all of their sons.
B. Mothers who are carriers have a 50% chance of passing the gene to each
son.
C. Females are affected more often than males.
D. The trait always skips two generations.
Answer: B
Rationale: In X-linked recessive inheritance (e.g., hemophilia), a carrier mother
(heterozygous) has a 50% chance of passing the affected X chromosome to
each son (who would be affected) and a 50% chance of passing it to each
Page 4 of 40
HESI RN Pathophysiology
Next Generation NCLEX (NGN)
Questions and Answers| Latest Update
1. A nurse reviews a biopsy report showing that a client's uterine smooth
muscle cells have increased in size following pregnancy. Which cellular
adaptation does this represent?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Answer: B
Rationale: Hypertrophy is an increase in the SIZE of individual cells, seen in the
uterus during pregnancy due to hormonal stimulation and increased workload.
Hyperplasia is an increase in cell NUMBER. Atrophy is a decrease in cell
size/number. Metaplasia is replacement of one mature cell type with another.
2. A client who smokes has had chronic exposure to cigarette smoke. Bronchial
biopsy shows normal ciliated columnar epithelium replaced by stratified
squamous epithelium. This is an example of which adaptive cellular change?
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Anaplasia
Answer: B
Page 1 of 40
, HESI RN Pathophysiology — NGN Exam
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type with another that is better suited to withstand chronic irritation (e.g.,
squamous replacing columnar epithelium in smokers' airways). Dysplasia
involves disordered cell growth/atypia, not simply a substituted cell type.
Anaplasia is undifferentiated, cancerous cell growth.
3. The nurse is teaching about cell injury. Which statement best describes an
irreversible cell injury?
A. Cellular swelling with ATP depletion
B. Ribosomal detachment from the endoplasmic reticulum
C. Massive influx of calcium causing membrane and mitochondrial damage
D. Fatty infiltration of the cytoplasm
Answer: C
Rationale: Irreversible injury is marked by severe calcium influx that activates
destructive enzymes (phospholipases, proteases) and destroys mitochondria
and membranes, leading to cell death (necrosis). Cellular swelling, ribosomal
detachment, and fatty change are features of reversible injury.
4. A nurse notes a client's skin wound is healing with excessive scar tissue that
raises above the skin surface and extends beyond wound margins. This is best
described as:
A. Hypertrophic scar
B. Keloid formation
C. Contracture
D. Dehiscence
Answer: B
Rationale: A keloid is excess collagen deposition that extends BEYOND the
original wound borders. A hypertrophic scar stays within the wound boundaries.
Contracture is shrinkage/tightening of scar tissue restricting movement.
Dehiscence is separation of wound edges.
5. Which client is at greatest risk for developing dystrophic calcification?
A. A client with hyperparathyroidism
Page 2 of 40
, HESI RN Pathophysiology — NGN Exam
B. A client with chronic areas of tissue necrosis from atherosclerosis
C. A client with excessive vitamin D intake
D. A client with normal serum calcium and healthy tissue
Answer: B
Rationale: Dystrophic calcification occurs in dying or necrotic tissue (such as
atherosclerotic plaques) despite NORMAL serum calcium levels. Metastatic
calcification, in contrast, occurs in normal tissue due to elevated serum calcium
(as in hyperparathyroidism or vitamin D excess).
6. A client's liver biopsy reveals hepatocytes are undersized and reduced in
number after prolonged disuse and malnutrition. This finding represents:
A. Hyperplasia
B. Atrophy
C. Hypertrophy
D. Metaplasia
Answer: B
Rationale: Atrophy is a decrease in cell size and/or number as an adaptive
response to decreased workload, disuse, malnutrition, or reduced blood/nerve
supply, resulting in a reduction in organ size and function.
7. During cellular hypoxia, which sequence of events occurs first?
A. Anaerobic metabolism and lactic acid accumulation
B. Cellular swelling from sodium-potassium pump failure
C. Decreased ATP production
D. Ribosome detachment and protein synthesis failure
Answer: C
Rationale: Hypoxia decreases oxidative phosphorylation, causing an
immediate drop in ATP production. This triggers a cascade: the sodium-
potassium pump fails (causing cellular swelling), anaerobic glycolysis increases
(causing lactic acidosis), and ribosomes detach as protein synthesis fails.
8. A nurse caring for a client after a myocardial infarction understands that
necrotic cardiac tissue undergoes which type of necrosis?
Page 3 of 40
, HESI RN Pathophysiology — NGN Exam
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Answer: C
Rationale: Coagulative necrosis is characteristic of hypoxic death in solid
organs such as the heart and kidney; the tissue architecture is preserved
initially because protein denaturation, not enzymatic digestion, predominates.
Liquefactive necrosis occurs in the brain and with bacterial infections; caseous
necrosis is seen in TB; fat necrosis occurs in pancreatitis or breast tissue trauma.
9. The nurse is reviewing genetic terms. A client has two different alleles for a
given trait. This is best described as:
A. Homozygous
B. Heterozygous
C. Phenotype
D. Autosomal
Answer: B
Rationale: Heterozygous means the individual carries two different alleles for a
specific gene (one from each parent). Homozygous means both alleles are
identical. Phenotype is the observable expression of the genotype.
10. A nurse is explaining X-linked recessive inheritance to a family. Which
statement is accurate?
A. Fathers pass the trait to all of their sons.
B. Mothers who are carriers have a 50% chance of passing the gene to each
son.
C. Females are affected more often than males.
D. The trait always skips two generations.
Answer: B
Rationale: In X-linked recessive inheritance (e.g., hemophilia), a carrier mother
(heterozygous) has a 50% chance of passing the affected X chromosome to
each son (who would be affected) and a 50% chance of passing it to each
Page 4 of 40
