HESI PATHOPHYSIOLOGY
PRACTICE EXAM | 2025/2026
LATEST EDITION
All Comprehensive Questions with Detailed Answer
Breakdowns | 100% Alignment with Current Test
Blueprint | Graded A+
Introduction
This 300-question exam simulator features new 2025/2026 test items covering all body
systems with detailed rationales for every answer choice. Includes 45 complex scenario
questions, 25 medication-related items, and 30 high-yield lab interpretation questions
matching the current HESI emphasis on clinical judgment.
Answer Format
Correct answers marked in bold green with paragraph-length explanations for each
question.
HESI Pathophysiology Practice Exam Questions
Cardiovascular System (60 Questions)
1. A patient with heart failure reports bilateral leg swelling and dyspnea.
Which pathophysiological mechanism is primarily responsible?
a) Increased capillary permeability
b) Decreased oncotic pressure
c) Increased hydrostatic pressure
d) Lymphatic obstruction
c) Increased hydrostatic pressure
Rationale: Heart failure leads to reduced cardiac output, causing blood to back up in the
venous system, increasing hydrostatic pressure in capillaries, which forces fluid into tissues,
causing edema and dyspnea.
,2. A patient with chest pain has elevated cardiac troponin levels. What
condition is most likely?
a) Stable angina
b) Myocardial infarction
c) Pericarditis
d) Aortic dissection
b) Myocardial infarction
Rationale: Elevated troponin indicates myocardial cell damage, characteristic of myocardial
infarction due to ischemia.
3. Which medication is used to reduce preload in heart failure?
a) Digoxin
b) Nitroglycerin
c) Metoprolol
d) Lisinopril
b) Nitroglycerin
Rationale: Nitroglycerin is a vasodilator that reduces preload by dilating veins, decreasing
venous return to the heart.
4. A patient with hypertension develops left ventricular hypertrophy.
What is the primary cause?
a) Increased afterload
b) Decreased preload
c) Reduced cardiac output
d) Increased heart rate
a) Increased afterload
Rationale: Chronic hypertension increases afterload, causing the left ventricle to work harder,
leading to hypertrophy.
5. A patient with a history of atrial fibrillation is at risk for which
complication?
a) Pulmonary edema
b) Thromboembolism
c) Bradycardia
d) Heart block
,b) Thromboembolism
Rationale: Atrial fibrillation causes blood stasis in the atria, increasing the risk of clot
formation and thromboembolism.
6. A patient’s ECG shows ST elevation. What is the most likely diagnosis?
a) Stable angina
b) Pericarditis
c) STEMI
d) Heart failure
c) STEMI
Rationale: ST elevation on ECG indicates transmural myocardial infarction (STEMI) due to
complete coronary artery occlusion.
7. A patient with heart failure is prescribed furosemide. What is the
primary action of this medication?
a) Increases cardiac contractility
b) Reduces preload
c) Blocks beta receptors
d) Inhibits ACE
b) Reduces preload
Rationale: Furosemide, a loop diuretic, reduces preload by promoting diuresis, decreasing
fluid volume.
8. A patient with peripheral artery disease reports claudication. What is
the underlying cause?
a) Venous insufficiency
b) Arterial occlusion
c) Lymphatic obstruction
d) Muscle inflammation
b) Arterial occlusion
Rationale: Claudication results from reduced blood flow due to arterial occlusion in
peripheral artery disease.
9. A patient with a history of myocardial infarction develops cardiogenic
shock. What is the primary mechanism?
, a) Increased preload
b) Decreased cardiac output
c) Increased afterload
d) Vasodilation
b) Decreased cardiac output
Rationale: Cardiogenic shock occurs due to severe reduction in cardiac output from
myocardial damage.
10. A patient with deep vein thrombosis is prescribed heparin. What is
the primary action of this medication?
a) Dissolves existing clots
b) Inhibits thrombin
c) Reduces platelet aggregation
d) Increases fibrinolysis
b) Inhibits thrombin
Rationale: Heparin enhances antithrombin activity, inhibiting thrombin and preventing clot
formation.
11. A patient with heart failure has a BNP level of 800 pg/mL. What does
this indicate?
a) Normal cardiac function
b) Heart failure exacerbation
c) Hypovolemia
d) Renal failure
b) Heart failure exacerbation
Rationale: Elevated BNP (>400 pg/mL) indicates heart failure exacerbation due to
ventricular strain.
12. A patient with angina is prescribed nitroglycerin. What is the
expected effect?
a) Increased heart rate
b) Coronary vasodilation
c) Decreased blood pressure
d) Increased afterload
PRACTICE EXAM | 2025/2026
LATEST EDITION
All Comprehensive Questions with Detailed Answer
Breakdowns | 100% Alignment with Current Test
Blueprint | Graded A+
Introduction
This 300-question exam simulator features new 2025/2026 test items covering all body
systems with detailed rationales for every answer choice. Includes 45 complex scenario
questions, 25 medication-related items, and 30 high-yield lab interpretation questions
matching the current HESI emphasis on clinical judgment.
Answer Format
Correct answers marked in bold green with paragraph-length explanations for each
question.
HESI Pathophysiology Practice Exam Questions
Cardiovascular System (60 Questions)
1. A patient with heart failure reports bilateral leg swelling and dyspnea.
Which pathophysiological mechanism is primarily responsible?
a) Increased capillary permeability
b) Decreased oncotic pressure
c) Increased hydrostatic pressure
d) Lymphatic obstruction
c) Increased hydrostatic pressure
Rationale: Heart failure leads to reduced cardiac output, causing blood to back up in the
venous system, increasing hydrostatic pressure in capillaries, which forces fluid into tissues,
causing edema and dyspnea.
,2. A patient with chest pain has elevated cardiac troponin levels. What
condition is most likely?
a) Stable angina
b) Myocardial infarction
c) Pericarditis
d) Aortic dissection
b) Myocardial infarction
Rationale: Elevated troponin indicates myocardial cell damage, characteristic of myocardial
infarction due to ischemia.
3. Which medication is used to reduce preload in heart failure?
a) Digoxin
b) Nitroglycerin
c) Metoprolol
d) Lisinopril
b) Nitroglycerin
Rationale: Nitroglycerin is a vasodilator that reduces preload by dilating veins, decreasing
venous return to the heart.
4. A patient with hypertension develops left ventricular hypertrophy.
What is the primary cause?
a) Increased afterload
b) Decreased preload
c) Reduced cardiac output
d) Increased heart rate
a) Increased afterload
Rationale: Chronic hypertension increases afterload, causing the left ventricle to work harder,
leading to hypertrophy.
5. A patient with a history of atrial fibrillation is at risk for which
complication?
a) Pulmonary edema
b) Thromboembolism
c) Bradycardia
d) Heart block
,b) Thromboembolism
Rationale: Atrial fibrillation causes blood stasis in the atria, increasing the risk of clot
formation and thromboembolism.
6. A patient’s ECG shows ST elevation. What is the most likely diagnosis?
a) Stable angina
b) Pericarditis
c) STEMI
d) Heart failure
c) STEMI
Rationale: ST elevation on ECG indicates transmural myocardial infarction (STEMI) due to
complete coronary artery occlusion.
7. A patient with heart failure is prescribed furosemide. What is the
primary action of this medication?
a) Increases cardiac contractility
b) Reduces preload
c) Blocks beta receptors
d) Inhibits ACE
b) Reduces preload
Rationale: Furosemide, a loop diuretic, reduces preload by promoting diuresis, decreasing
fluid volume.
8. A patient with peripheral artery disease reports claudication. What is
the underlying cause?
a) Venous insufficiency
b) Arterial occlusion
c) Lymphatic obstruction
d) Muscle inflammation
b) Arterial occlusion
Rationale: Claudication results from reduced blood flow due to arterial occlusion in
peripheral artery disease.
9. A patient with a history of myocardial infarction develops cardiogenic
shock. What is the primary mechanism?
, a) Increased preload
b) Decreased cardiac output
c) Increased afterload
d) Vasodilation
b) Decreased cardiac output
Rationale: Cardiogenic shock occurs due to severe reduction in cardiac output from
myocardial damage.
10. A patient with deep vein thrombosis is prescribed heparin. What is
the primary action of this medication?
a) Dissolves existing clots
b) Inhibits thrombin
c) Reduces platelet aggregation
d) Increases fibrinolysis
b) Inhibits thrombin
Rationale: Heparin enhances antithrombin activity, inhibiting thrombin and preventing clot
formation.
11. A patient with heart failure has a BNP level of 800 pg/mL. What does
this indicate?
a) Normal cardiac function
b) Heart failure exacerbation
c) Hypovolemia
d) Renal failure
b) Heart failure exacerbation
Rationale: Elevated BNP (>400 pg/mL) indicates heart failure exacerbation due to
ventricular strain.
12. A patient with angina is prescribed nitroglycerin. What is the
expected effect?
a) Increased heart rate
b) Coronary vasodilation
c) Decreased blood pressure
d) Increased afterload
