, HESI Advanced Pathophysiology Final
Exam 2026/2027 | 100 Verified
Questions & Answers | Elsevier HESI
Nursing Prep | 7 Core Domains |
Instant Download | rated 100%
correct.
DOMAIN 1: CELLULAR ADAPTATION, INJURY &
GENETICS
1. What is the primary mechanism of cellular injury caused by hypoxia?
A. Enhanced ATP activity
B. Loss of intracellular calcium
C. ATP depletion leading to failure of sodium-potassium pumps and cellular
swelling
D. Increased pH
Correct Answer: C (ATP depletion leading to failure of sodium-
potassium pumps and cellular swelling)
Rationale: Hypoxia impairs oxidative phosphorylation, depleting ATP and
causing failure of membrane ion pumps, which leads to cellular swelling.
Without adequate ATP, the plasma membrane's Na+/K+ ATPase pump fails,
allowing sodium to accumulate inside the cell, creating an osmotic gradient
that draws water inward .
Teaching Point: Hypoxia = ATP depletion → Na+/K+ pump failure → cellular
swelling.
Source: HESI RN Advanced Pathophysiology 2026/2027 Final Exam ;
McCance & Huether 9th Edition
,2. Which type of cellular adaptation occurs when cells increase in size in
response to increased workload?
A. Hyperplasia
B. Dysplasia
C. Hypertrophy
D. Metaplasia
Correct Answer: C (Hypertrophy)
Rationale: Hypertrophy is an increase in cell size, commonly seen in skeletal
and cardiac muscle under increased demand. Left ventricular thickening in
response to chronic high systemic vascular resistance is caused by
myocardial hypertrophy. Because permanent myocardial cells cannot divide
to replicate, they adapt to increased mechanical workloads by increasing the
synthesis of structural proteins .
Teaching Point: Hypertrophy = increase in cell SIZE due to increased
workload.
Source: HESI Pathophysiology Comprehensive Examination 2026/2027 ;
McCance & Huether 9th Edition
3. What is apoptosis?
A. Uncontrolled cell death causing inflammation
B. Programmed cell death that does not typically provoke inflammation
C. Passive, non-energy-dependent process
D. Cell death due to severe mechanical trauma
Correct Answer: B (Programmed cell death that does not typically
provoke inflammation)
Rationale: Apoptosis is a regulated process of cell death that eliminates cells
without eliciting a significant inflammatory response. It is active, energy-
dependent, and involves programmed cell death of scattered single cells .
Teaching Point: Apoptosis = programmed, energy-dependent, no
inflammation.
Source: HESI Pathophysiology Comprehensive Examination 2026/2027 ;
HESI RN Advanced Pathophysiology Final Exam
, 4. A 45-year-old smoker undergoes bronchoscopy revealing replacement of
normal ciliated columnar epithelium with stratified squamous epithelium.
Which process has occurred?
A. Anaplasia
B. Hyperplasia
C. Metaplasia
D. Necrosis
Correct Answer: C (Metaplasia)
Rationale: Metaplasia is a reversible adaptive substitution of one mature cell
type for another better suited to tolerate chronic irritation. Smoking
commonly causes respiratory epithelium to transform into stratified
squamous epithelium. This is a reversible cellular adaptation where one
mature differentiated cell type is replaced by another mature cell type better
able to withstand chronic irritation or inflammation .
Teaching Point: Metaplasia = reversible replacement of one mature cell
type with another.
Source: McCance & Huether 9th Edition ; Advanced Pathophysiology HESI
Final Exam
5. What is dysplasia?
A. Increase in cell number only
B. Disordered growth and maturation of cells, often a precursor to
malignancy
C. Decrease in cell size
D. Reversible replacement of one cell type by another
Correct Answer: B (Disordered growth and maturation of cells, often
a precursor to malignancy)
Rationale: Dysplasia involves atypical hyperplasia with disordered
architecture and is considered a premalignant change. It represents
disordered growth and maturation of cells .
Exam 2026/2027 | 100 Verified
Questions & Answers | Elsevier HESI
Nursing Prep | 7 Core Domains |
Instant Download | rated 100%
correct.
DOMAIN 1: CELLULAR ADAPTATION, INJURY &
GENETICS
1. What is the primary mechanism of cellular injury caused by hypoxia?
A. Enhanced ATP activity
B. Loss of intracellular calcium
C. ATP depletion leading to failure of sodium-potassium pumps and cellular
swelling
D. Increased pH
Correct Answer: C (ATP depletion leading to failure of sodium-
potassium pumps and cellular swelling)
Rationale: Hypoxia impairs oxidative phosphorylation, depleting ATP and
causing failure of membrane ion pumps, which leads to cellular swelling.
Without adequate ATP, the plasma membrane's Na+/K+ ATPase pump fails,
allowing sodium to accumulate inside the cell, creating an osmotic gradient
that draws water inward .
Teaching Point: Hypoxia = ATP depletion → Na+/K+ pump failure → cellular
swelling.
Source: HESI RN Advanced Pathophysiology 2026/2027 Final Exam ;
McCance & Huether 9th Edition
,2. Which type of cellular adaptation occurs when cells increase in size in
response to increased workload?
A. Hyperplasia
B. Dysplasia
C. Hypertrophy
D. Metaplasia
Correct Answer: C (Hypertrophy)
Rationale: Hypertrophy is an increase in cell size, commonly seen in skeletal
and cardiac muscle under increased demand. Left ventricular thickening in
response to chronic high systemic vascular resistance is caused by
myocardial hypertrophy. Because permanent myocardial cells cannot divide
to replicate, they adapt to increased mechanical workloads by increasing the
synthesis of structural proteins .
Teaching Point: Hypertrophy = increase in cell SIZE due to increased
workload.
Source: HESI Pathophysiology Comprehensive Examination 2026/2027 ;
McCance & Huether 9th Edition
3. What is apoptosis?
A. Uncontrolled cell death causing inflammation
B. Programmed cell death that does not typically provoke inflammation
C. Passive, non-energy-dependent process
D. Cell death due to severe mechanical trauma
Correct Answer: B (Programmed cell death that does not typically
provoke inflammation)
Rationale: Apoptosis is a regulated process of cell death that eliminates cells
without eliciting a significant inflammatory response. It is active, energy-
dependent, and involves programmed cell death of scattered single cells .
Teaching Point: Apoptosis = programmed, energy-dependent, no
inflammation.
Source: HESI Pathophysiology Comprehensive Examination 2026/2027 ;
HESI RN Advanced Pathophysiology Final Exam
, 4. A 45-year-old smoker undergoes bronchoscopy revealing replacement of
normal ciliated columnar epithelium with stratified squamous epithelium.
Which process has occurred?
A. Anaplasia
B. Hyperplasia
C. Metaplasia
D. Necrosis
Correct Answer: C (Metaplasia)
Rationale: Metaplasia is a reversible adaptive substitution of one mature cell
type for another better suited to tolerate chronic irritation. Smoking
commonly causes respiratory epithelium to transform into stratified
squamous epithelium. This is a reversible cellular adaptation where one
mature differentiated cell type is replaced by another mature cell type better
able to withstand chronic irritation or inflammation .
Teaching Point: Metaplasia = reversible replacement of one mature cell
type with another.
Source: McCance & Huether 9th Edition ; Advanced Pathophysiology HESI
Final Exam
5. What is dysplasia?
A. Increase in cell number only
B. Disordered growth and maturation of cells, often a precursor to
malignancy
C. Decrease in cell size
D. Reversible replacement of one cell type by another
Correct Answer: B (Disordered growth and maturation of cells, often
a precursor to malignancy)
Rationale: Dysplasia involves atypical hyperplasia with disordered
architecture and is considered a premalignant change. It represents
disordered growth and maturation of cells .
