2026 HESI RN Pathophysiology NGN Exam Prep | HESI RN
Pathophysiology Specialty Exam | NGN Nursing Questions, Practice
Answers & Detailed Rationales | HESI Pathophysiology Study Guide |
Disease Processes, Cellular Adaptation & Injury, Inflammation, Fluid &
Electrolyte Balance, Acid-Base Balance, Cardiovascular Disorders,
Respiratory Disorders, Renal & Urinary Disorders, Endocrine Disorders,
Neurological Disorders, Gastrointestinal Disorders, Immune Disorders,
Hematologic Disorders, Musculoskeletal Disorders, Cancer & Genetic
Disorders | Clinical Judgment & Case-Based Practice | 2026–2027 Nursing
Exam Review
Question 1: A client with chronic hypertension develops left ventricular
hypertrophy. This cellular adaptation is best classified as which of the
following?
A. Hyperplasia
B. Metaplasia
C. Atrophy
D. Hypertrophy
CORRECT ANSWER: D. Hypertrophy
Rationale: Hypertrophy is an increase in cell size that results in an enlarged organ
or tissue. In chronic hypertension, the left ventricle must pump against increased
resistance, leading to increased workload and subsequent enlargement of
myocardial cells without an increase in cell number.
Question 2: A client with Barrett's esophagus undergoes an endoscopic biopsy.
The pathology report indicates a change from normal squamous epithelium to
columnar epithelium. This finding is most consistent with which cellular
adaptation?
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
CORRECT ANSWER: B. Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with
another mature cell type. In Barrett's esophagus, chronic exposure to stomach
,acid causes squamous cells to be replaced by columnar cells, which are more
resistant to acid injury.
Question 3: A client's arm was immobilized in a cast for eight weeks. After cast
removal, the muscles appear visibly smaller. This finding is best explained by
which pathophysiologic process?
A. Necrosis
B. Apoptosis
C. Atrophy
D. Dystrophy
CORRECT ANSWER: C. Atrophy
Rationale: Atrophy is a decrease in cell size resulting from reduced workload or
disuse. Immobilization leads to decreased muscle use, causing protein
degradation via the ubiquitin-proteasome system and subsequent reduction in
muscle mass.
Question 4: In the ubiquitin-proteasome system of cellular atrophy, what is the
primary role of ubiquitin?
A. It directly degrades cellular proteins
B. It tags damaged proteins for proteasomal degradation
C. It synthesizes new proteins to replace damaged ones
D. It inhibits the proteasome to prevent excessive protein breakdown
CORRECT ANSWER: B. It tags damaged proteins for proteasomal degradation
Rationale: The ubiquitin-proteasome system is a major mechanism for protein
degradation in atrophy. Ubiquitin molecules attach to proteins destined for
breakdown, marking them for recognition and degradation by the proteasome.
Question 5: A client with sickle cell anemia has red blood cells that assume a
crescent shape under low oxygen conditions. This morphologic change is an
example of which of the following?
A. Cellular hypertrophy
B. Cellular atrophy
,C. Cellular metaplasia
D. Cellular dysplasia
CORRECT ANSWER: D. Cellular dysplasia
Rationale: Sickle cell anemia involves a genetic mutation that produces abnormal
hemoglobin (HbS), which polymerizes under deoxygenated conditions, distorting
the RBC into a sickle shape. This represents a form of cellular dysplasia—
abnormal cell morphology.
Question 6: The plasma membrane of a human cell is primarily composed of
which of the following?
A. A single layer of phospholipids with embedded proteins
B. A phospholipid bilayer containing cholesterol and proteins
C. A rigid cellulose wall with glycolipid channels
D. A protein capsid surrounding a lipid core
CORRECT ANSWER: B. A phospholipid bilayer containing cholesterol and
proteins
Rationale: The plasma membrane is a phospholipid bilayer with hydrophilic heads
facing outward and hydrophobic tails facing inward. Cholesterol modulates
membrane fluidity, and proteins serve as receptors, channels, and transporters.
Question 7: A client is prescribed a medication that inhibits the sodium-
potassium pump (Na+/K+-ATPase). What is the most direct consequence of this
inhibition?
A. Increased intracellular sodium and decreased intracellular potassium
B. Increased intracellular potassium and decreased intracellular sodium
C. Increased intracellular calcium and decreased intracellular magnesium
D. No change in intracellular ion concentrations
CORRECT ANSWER: A. Increased intracellular sodium and decreased
intracellular potassium
Rationale: The Na+/K+-ATPase pump normally moves three sodium ions out of
the cell and two potassium ions into the cell against their concentration gradients.
, Inhibition of this pump leads to intracellular sodium accumulation and potassium
depletion.
Question 8: A client with diabetic ketoacidosis has a blood pH of 7.20. Which
acid-base disturbance does this value represent?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
CORRECT ANSWER: D. Metabolic acidosis
Rationale: A pH below 7.35 indicates acidosis. In diabetic ketoacidosis, excessive
production of ketone bodies (beta-hydroxybutyric acid and acetoacetic acid)
consumes bicarbonate buffer, resulting in metabolic acidosis.
Question 9: A client's arterial blood gas reveals pH 7.30, PaCO2 55 mm Hg, and
HCO3- 26 mEq/L. Which acid-base imbalance is most likely?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
CORRECT ANSWER: B. Respiratory acidosis
Rationale: A low pH with an elevated PaCO2 indicates respiratory acidosis. The
HCO3- is within normal range, suggesting no renal compensation has occurred
yet. This pattern is typical of hypoventilation.
Question 10: A client with prolonged vomiting has a blood pH of 7.48 and HCO3-
of 32 mEq/L. Which acid-base disorder is most consistent with these findings?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
CORRECT ANSWER: C. Metabolic alkalosis
Pathophysiology Specialty Exam | NGN Nursing Questions, Practice
Answers & Detailed Rationales | HESI Pathophysiology Study Guide |
Disease Processes, Cellular Adaptation & Injury, Inflammation, Fluid &
Electrolyte Balance, Acid-Base Balance, Cardiovascular Disorders,
Respiratory Disorders, Renal & Urinary Disorders, Endocrine Disorders,
Neurological Disorders, Gastrointestinal Disorders, Immune Disorders,
Hematologic Disorders, Musculoskeletal Disorders, Cancer & Genetic
Disorders | Clinical Judgment & Case-Based Practice | 2026–2027 Nursing
Exam Review
Question 1: A client with chronic hypertension develops left ventricular
hypertrophy. This cellular adaptation is best classified as which of the
following?
A. Hyperplasia
B. Metaplasia
C. Atrophy
D. Hypertrophy
CORRECT ANSWER: D. Hypertrophy
Rationale: Hypertrophy is an increase in cell size that results in an enlarged organ
or tissue. In chronic hypertension, the left ventricle must pump against increased
resistance, leading to increased workload and subsequent enlargement of
myocardial cells without an increase in cell number.
Question 2: A client with Barrett's esophagus undergoes an endoscopic biopsy.
The pathology report indicates a change from normal squamous epithelium to
columnar epithelium. This finding is most consistent with which cellular
adaptation?
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
CORRECT ANSWER: B. Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with
another mature cell type. In Barrett's esophagus, chronic exposure to stomach
,acid causes squamous cells to be replaced by columnar cells, which are more
resistant to acid injury.
Question 3: A client's arm was immobilized in a cast for eight weeks. After cast
removal, the muscles appear visibly smaller. This finding is best explained by
which pathophysiologic process?
A. Necrosis
B. Apoptosis
C. Atrophy
D. Dystrophy
CORRECT ANSWER: C. Atrophy
Rationale: Atrophy is a decrease in cell size resulting from reduced workload or
disuse. Immobilization leads to decreased muscle use, causing protein
degradation via the ubiquitin-proteasome system and subsequent reduction in
muscle mass.
Question 4: In the ubiquitin-proteasome system of cellular atrophy, what is the
primary role of ubiquitin?
A. It directly degrades cellular proteins
B. It tags damaged proteins for proteasomal degradation
C. It synthesizes new proteins to replace damaged ones
D. It inhibits the proteasome to prevent excessive protein breakdown
CORRECT ANSWER: B. It tags damaged proteins for proteasomal degradation
Rationale: The ubiquitin-proteasome system is a major mechanism for protein
degradation in atrophy. Ubiquitin molecules attach to proteins destined for
breakdown, marking them for recognition and degradation by the proteasome.
Question 5: A client with sickle cell anemia has red blood cells that assume a
crescent shape under low oxygen conditions. This morphologic change is an
example of which of the following?
A. Cellular hypertrophy
B. Cellular atrophy
,C. Cellular metaplasia
D. Cellular dysplasia
CORRECT ANSWER: D. Cellular dysplasia
Rationale: Sickle cell anemia involves a genetic mutation that produces abnormal
hemoglobin (HbS), which polymerizes under deoxygenated conditions, distorting
the RBC into a sickle shape. This represents a form of cellular dysplasia—
abnormal cell morphology.
Question 6: The plasma membrane of a human cell is primarily composed of
which of the following?
A. A single layer of phospholipids with embedded proteins
B. A phospholipid bilayer containing cholesterol and proteins
C. A rigid cellulose wall with glycolipid channels
D. A protein capsid surrounding a lipid core
CORRECT ANSWER: B. A phospholipid bilayer containing cholesterol and
proteins
Rationale: The plasma membrane is a phospholipid bilayer with hydrophilic heads
facing outward and hydrophobic tails facing inward. Cholesterol modulates
membrane fluidity, and proteins serve as receptors, channels, and transporters.
Question 7: A client is prescribed a medication that inhibits the sodium-
potassium pump (Na+/K+-ATPase). What is the most direct consequence of this
inhibition?
A. Increased intracellular sodium and decreased intracellular potassium
B. Increased intracellular potassium and decreased intracellular sodium
C. Increased intracellular calcium and decreased intracellular magnesium
D. No change in intracellular ion concentrations
CORRECT ANSWER: A. Increased intracellular sodium and decreased
intracellular potassium
Rationale: The Na+/K+-ATPase pump normally moves three sodium ions out of
the cell and two potassium ions into the cell against their concentration gradients.
, Inhibition of this pump leads to intracellular sodium accumulation and potassium
depletion.
Question 8: A client with diabetic ketoacidosis has a blood pH of 7.20. Which
acid-base disturbance does this value represent?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
CORRECT ANSWER: D. Metabolic acidosis
Rationale: A pH below 7.35 indicates acidosis. In diabetic ketoacidosis, excessive
production of ketone bodies (beta-hydroxybutyric acid and acetoacetic acid)
consumes bicarbonate buffer, resulting in metabolic acidosis.
Question 9: A client's arterial blood gas reveals pH 7.30, PaCO2 55 mm Hg, and
HCO3- 26 mEq/L. Which acid-base imbalance is most likely?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
CORRECT ANSWER: B. Respiratory acidosis
Rationale: A low pH with an elevated PaCO2 indicates respiratory acidosis. The
HCO3- is within normal range, suggesting no renal compensation has occurred
yet. This pattern is typical of hypoventilation.
Question 10: A client with prolonged vomiting has a blood pH of 7.48 and HCO3-
of 32 mEq/L. Which acid-base disorder is most consistent with these findings?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
CORRECT ANSWER: C. Metabolic alkalosis
