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HESI PATHOPHYSIOLOGY EXAM 2 HU NSG120 –
HERZING UNIVERSITY FALL C 2026 ACTUAL EXAM
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES GRADED A+
SECTION 1: CELLULAR INJURY, INFLAMMATION, & IMMUNITY
1. A client is diagnosed with an autoimmune disorder. Which cellular process is
most likely contributing to the disease?
A) Apoptosis
B) Necrosis
C) Failure of self-tolerance
D) Increased cell proliferation
✔✔ Correct Answer✔✔C
Rationale: Autoimmune disorders occur when the immune system fails to
distinguish self from non-self (loss of self-tolerance), leading to attack on the
body's own tissues. Apoptosis is programmed cell death; necrosis is
unprogrammed cell death; increased proliferation may occur in cancer.
2. Which type of white blood cell is the first to arrive at the site of acute
inflammation?
A) Lymphocytes
B) Monocytes
C) Neutrophils
D) Eosinophils
✔✔ Correct Answer✔✔C
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Rationale: Neutrophils are the first leukocytes to migrate to an inflammatory site,
usually within 6-12 hours. They phagocytose pathogens and release inflammatory
mediators. Lymphocytes and monocytes appear later; eosinophils are associated
with allergic reactions and parasites.
3. A patient experiences a bee sting and develops localized redness, swelling,
and itching. These manifestations are primarily due to:
A) Vasoconstriction and decreased capillary permeability
B) Histamine release causing vasodilation and increased capillary permeability
C) Activation of the complement cascade leading to cell lysis
D) Release of pyrogens causing fever
✔✔ Correct Answer✔✔B
Rationale: Histamine released from mast cells causes vasodilation (redness,
warmth) and increased capillary permeability (edema, swelling). It also stimulates
nerve endings (itching). The other options are not primary in a localized allergic
reaction.
4. Which immunoglobulin is primarily involved in allergic reactions and binds to
mast cells?
A) IgA
B) IgG
C) IgM
D) IgE
✔✔ Correct Answer✔✔D
Rationale: IgE binds to Fc receptors on mast cells and basophils; cross-linking by
allergens triggers degranulation and release of histamine and other mediators.
IgA is mucosal; IgG is the most abundant in blood; IgM is the first antibody
produced in an immune response.
,3
5. A client with a history of systemic lupus erythematosus (SLE) presents with
fatigue, joint pain, and a butterfly rash. The underlying pathophysiology of SLE
involves:
A) Type I hypersensitivity reaction
B) Formation of immune complexes that deposit in tissues
C) Direct destruction of cells by cytotoxic T cells
D) Deficiencies in complement proteins
✔✔ Correct Answer✔✔B
Rationale: SLE is a type III hypersensitivity disorder characterized by the
formation of autoantibodies (e.g., anti-DNA) that combine with antigens to form
immune complexes. These complexes deposit in tissues (kidneys, skin, joints) and
activate complement, leading to inflammation and tissue damage.
6. A patient is diagnosed with rheumatoid arthritis (RA). Which of the following
pathophysiological processes is most characteristic of this disease?
A) Degeneration of articular cartilage due to wear and tear
B) Synovial inflammation leading to pannus formation and joint destruction
C) Uric acid crystal deposition in joints
D) Autoantibodies against acetylcholine receptors
✔✔ Correct Answer✔✔B
Rationale: RA is a chronic autoimmune inflammatory disorder where the
synovium becomes inflamed, forming pannus (granulation tissue) that erodes
cartilage and bone. Osteoarthritis involves wear and tear; gout involves uric acid
crystals; myasthenia gravis involves antibodies against acetylcholine receptors.
7. Which type of hypersensitivity reaction is mediated by T cells and causes
contact dermatitis (e.g., poison ivy)?
A) Type I
B) Type II
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C) Type III
D) Type IV
✔✔ Correct Answer✔✔D
Rationale: Type IV hypersensitivity is a delayed, cell-mediated reaction involving
sensitized T lymphocytes. Contact dermatitis, tuberculin skin tests, and graft
rejection are examples. Types I-III are antibody-mediated.
8. A client has a wound infected with bacteria. The nurse notes purulent
drainage. This exudate is primarily composed of:
A) Lymphocytes and plasma
B) Dead neutrophils, bacteria, and tissue debris
C) Red blood cells and fibrin
D) Serous fluid and protein
✔✔ Correct Answer✔✔B
Rationale: Purulent (suppurative) exudate contains dead neutrophils, bacteria,
liquefied tissue debris, and is often thick and yellow/green. Serous exudate is
clear; hemorrhagic contains RBCs.
SECTION 2: FLUID, ELECTROLYTE, & ACID-BASE BALANCE
9. A patient with prolonged vomiting is at risk for which acid-base imbalance?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
✔✔ Correct Answer✔✔B
HESI PATHOPHYSIOLOGY EXAM 2 HU NSG120 –
HERZING UNIVERSITY FALL C 2026 ACTUAL EXAM
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES GRADED A+
SECTION 1: CELLULAR INJURY, INFLAMMATION, & IMMUNITY
1. A client is diagnosed with an autoimmune disorder. Which cellular process is
most likely contributing to the disease?
A) Apoptosis
B) Necrosis
C) Failure of self-tolerance
D) Increased cell proliferation
✔✔ Correct Answer✔✔C
Rationale: Autoimmune disorders occur when the immune system fails to
distinguish self from non-self (loss of self-tolerance), leading to attack on the
body's own tissues. Apoptosis is programmed cell death; necrosis is
unprogrammed cell death; increased proliferation may occur in cancer.
2. Which type of white blood cell is the first to arrive at the site of acute
inflammation?
A) Lymphocytes
B) Monocytes
C) Neutrophils
D) Eosinophils
✔✔ Correct Answer✔✔C
,2
Rationale: Neutrophils are the first leukocytes to migrate to an inflammatory site,
usually within 6-12 hours. They phagocytose pathogens and release inflammatory
mediators. Lymphocytes and monocytes appear later; eosinophils are associated
with allergic reactions and parasites.
3. A patient experiences a bee sting and develops localized redness, swelling,
and itching. These manifestations are primarily due to:
A) Vasoconstriction and decreased capillary permeability
B) Histamine release causing vasodilation and increased capillary permeability
C) Activation of the complement cascade leading to cell lysis
D) Release of pyrogens causing fever
✔✔ Correct Answer✔✔B
Rationale: Histamine released from mast cells causes vasodilation (redness,
warmth) and increased capillary permeability (edema, swelling). It also stimulates
nerve endings (itching). The other options are not primary in a localized allergic
reaction.
4. Which immunoglobulin is primarily involved in allergic reactions and binds to
mast cells?
A) IgA
B) IgG
C) IgM
D) IgE
✔✔ Correct Answer✔✔D
Rationale: IgE binds to Fc receptors on mast cells and basophils; cross-linking by
allergens triggers degranulation and release of histamine and other mediators.
IgA is mucosal; IgG is the most abundant in blood; IgM is the first antibody
produced in an immune response.
,3
5. A client with a history of systemic lupus erythematosus (SLE) presents with
fatigue, joint pain, and a butterfly rash. The underlying pathophysiology of SLE
involves:
A) Type I hypersensitivity reaction
B) Formation of immune complexes that deposit in tissues
C) Direct destruction of cells by cytotoxic T cells
D) Deficiencies in complement proteins
✔✔ Correct Answer✔✔B
Rationale: SLE is a type III hypersensitivity disorder characterized by the
formation of autoantibodies (e.g., anti-DNA) that combine with antigens to form
immune complexes. These complexes deposit in tissues (kidneys, skin, joints) and
activate complement, leading to inflammation and tissue damage.
6. A patient is diagnosed with rheumatoid arthritis (RA). Which of the following
pathophysiological processes is most characteristic of this disease?
A) Degeneration of articular cartilage due to wear and tear
B) Synovial inflammation leading to pannus formation and joint destruction
C) Uric acid crystal deposition in joints
D) Autoantibodies against acetylcholine receptors
✔✔ Correct Answer✔✔B
Rationale: RA is a chronic autoimmune inflammatory disorder where the
synovium becomes inflamed, forming pannus (granulation tissue) that erodes
cartilage and bone. Osteoarthritis involves wear and tear; gout involves uric acid
crystals; myasthenia gravis involves antibodies against acetylcholine receptors.
7. Which type of hypersensitivity reaction is mediated by T cells and causes
contact dermatitis (e.g., poison ivy)?
A) Type I
B) Type II
, 4
C) Type III
D) Type IV
✔✔ Correct Answer✔✔D
Rationale: Type IV hypersensitivity is a delayed, cell-mediated reaction involving
sensitized T lymphocytes. Contact dermatitis, tuberculin skin tests, and graft
rejection are examples. Types I-III are antibody-mediated.
8. A client has a wound infected with bacteria. The nurse notes purulent
drainage. This exudate is primarily composed of:
A) Lymphocytes and plasma
B) Dead neutrophils, bacteria, and tissue debris
C) Red blood cells and fibrin
D) Serous fluid and protein
✔✔ Correct Answer✔✔B
Rationale: Purulent (suppurative) exudate contains dead neutrophils, bacteria,
liquefied tissue debris, and is often thick and yellow/green. Serous exudate is
clear; hemorrhagic contains RBCs.
SECTION 2: FLUID, ELECTROLYTE, & ACID-BASE BALANCE
9. A patient with prolonged vomiting is at risk for which acid-base imbalance?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
✔✔ Correct Answer✔✔B
