HESI PATHOPHYSIOLOGY PRACTICE QUESTIONS – NEWEST
2026 COMPLETE Q&A WITH DETAILED RATIONALES
PART 1 — QUESTIONS 1–100
Question 1. A 55-year-old male with a history of uncontrolled hypertension presents to
the clinic. An echocardiogram reveals concentric left ventricular hypertrophy. Which
cellular adaptation best describes this finding?
A. Hyperplasia of cardiac muscle cells
B. Hypertrophy of cardiac muscle cells
C. Metaplasia of cardiac muscle cells
D. Dysplasia of cardiac muscle cells
Correct Answer: B
Rationale: Cardiac myocytes are permanent cells that cannot undergo mitosis to divide
and increase in number (hyperplasia). To adapt to chronic hemodynamic overload from
hypertension, they increase in size, which is hypertrophy .
Question 2. A patient with severe COPD presents with an arterial blood gas showing pH
7.31, PaCO2 52 mmHg, and HCO3- 28 mEq/L. What is the correct interpretation?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic acidosis with respiratory compensation
Correct Answer: B
Rationale: The pH below 7.35 indicates acidosis. The elevated PaCO2 shows a
respiratory origin. The elevated HCO3- indicates the kidneys are actively retaining
bicarbonate to compensate, making this a partially compensated respiratory acidosis .
,Question 3. During inflammation, which sequence correctly describes the vascular
response?
A. Vasoconstriction → increased permeability → chemotaxis
B. Vasodilation → increased permeability → margination
C. Margination → vasodilation → phagocytosis
D. Increased permeability → vasoconstriction → emigration
Correct Answer: B
Rationale: The correct sequence of vascular events in acute inflammation begins with
vasodilation, followed by increased vascular permeability, which allows leukocytes to
marginate (adhere to the endothelium) and then emigrate into the tissues .
Question 4. A patient with liver cirrhosis develops ascites and generalized edema
(anasarca). Which laboratory finding would best explain these fluid shifts?
A. Elevated serum albumin
B. Decreased serum albumin
C. Elevated BUN and creatinine
D. Decreased antidiuretic hormone (ADH)
Correct Answer: B
Rationale: The liver synthesizes albumin. In cirrhosis, albumin production drops, leading
to decreased plasma oncotic pressure. This causes fluid to leak from the intravascular
space into the interstitial space, resulting in edema and ascites .
Question 5. A patient sustains a traumatic injury to the hypothalamus. Which hormonal
imbalance is most likely to occur?
A. Excess cortisol due to ACTH hypersecretion
B. Diabetes insipidus due to ADH deficiency
C. Hyperthyroidism due to TRH excess
D. Primary hyperaldosteronism
,Correct Answer: B
Rationale: The hypothalamus produces antidiuretic hormone (ADH), which is stored in
the posterior pituitary. Hypothalamic damage can cause central diabetes insipidus due
to a lack of ADH, leading to polyuria, polydipsia, and hypernatremia .
Question 6. A patient with septic shock has a high cardiac output but low systemic
vascular resistance. This hemodynamic profile is primarily due to:
A. Massive vasodilation from inflammatory mediators
B. Depressed myocardial contractility
C. Hypovolemia from capillary leak
D. Increased afterload
Correct Answer: A
Rationale: In septic shock, cytokines such as TNF and IL-1, along with nitric oxide, cause
profound vasodilation, leading to decreased systemic vascular resistance. Cardiac output
is initially normal or high as the heart compensates .
Question 7. In a patient with chronic renal failure, which electrolyte imbalance is most
immediately life-threatening?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Correct Answer: B
Rationale: The kidneys excrete approximately 90% of daily potassium. In renal failure,
potassium accumulates, leading to hyperkalemia, which poses a significant risk of fatal
cardiac arrhythmias and asystole .
, Question 8. A patient with sickle cell anemia presents with severe pain in the hands and
feet. What is the underlying pathophysiology of this pain?
A. Iron deficiency leading to inadequate hemoglobin synthesis
B. Sickling of RBCs causing vaso-occlusion and ischemia
C. Autoimmune destruction of platelets
D. Vitamin B12 deficiency causing abnormal RBC maturation
Correct Answer: B
Rationale: Sickle cell disease involves hemoglobin S, which polymerizes under low
oxygen conditions, causing red blood cells to deform into a sickle shape. These rigid
cells obstruct the microcirculation, leading to ischemia and pain crises .
Question 9. Which of the following terms best describes the symptoms of petechiae,
easy bruising, bleeding gums, occult hematuria, and retinal hemorrhage?
A. Neutropenia
B. Leukopenia
C. Anemia
D. Thrombocytopenia
Correct Answer: D
Rationale: These symptoms are characteristic of thrombocytopenia, a condition where
there is a deficiency of platelets. Platelets are essential for clot formation and
maintaining vascular integrity .
Question 10. What is the cellular response when a person receives a kidney transplant
from their sister?
A. Allogenic transplant
B. Autologous transplant
C. Syngeneic transplant
D. Xenotransplant
2026 COMPLETE Q&A WITH DETAILED RATIONALES
PART 1 — QUESTIONS 1–100
Question 1. A 55-year-old male with a history of uncontrolled hypertension presents to
the clinic. An echocardiogram reveals concentric left ventricular hypertrophy. Which
cellular adaptation best describes this finding?
A. Hyperplasia of cardiac muscle cells
B. Hypertrophy of cardiac muscle cells
C. Metaplasia of cardiac muscle cells
D. Dysplasia of cardiac muscle cells
Correct Answer: B
Rationale: Cardiac myocytes are permanent cells that cannot undergo mitosis to divide
and increase in number (hyperplasia). To adapt to chronic hemodynamic overload from
hypertension, they increase in size, which is hypertrophy .
Question 2. A patient with severe COPD presents with an arterial blood gas showing pH
7.31, PaCO2 52 mmHg, and HCO3- 28 mEq/L. What is the correct interpretation?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic acidosis with respiratory compensation
Correct Answer: B
Rationale: The pH below 7.35 indicates acidosis. The elevated PaCO2 shows a
respiratory origin. The elevated HCO3- indicates the kidneys are actively retaining
bicarbonate to compensate, making this a partially compensated respiratory acidosis .
,Question 3. During inflammation, which sequence correctly describes the vascular
response?
A. Vasoconstriction → increased permeability → chemotaxis
B. Vasodilation → increased permeability → margination
C. Margination → vasodilation → phagocytosis
D. Increased permeability → vasoconstriction → emigration
Correct Answer: B
Rationale: The correct sequence of vascular events in acute inflammation begins with
vasodilation, followed by increased vascular permeability, which allows leukocytes to
marginate (adhere to the endothelium) and then emigrate into the tissues .
Question 4. A patient with liver cirrhosis develops ascites and generalized edema
(anasarca). Which laboratory finding would best explain these fluid shifts?
A. Elevated serum albumin
B. Decreased serum albumin
C. Elevated BUN and creatinine
D. Decreased antidiuretic hormone (ADH)
Correct Answer: B
Rationale: The liver synthesizes albumin. In cirrhosis, albumin production drops, leading
to decreased plasma oncotic pressure. This causes fluid to leak from the intravascular
space into the interstitial space, resulting in edema and ascites .
Question 5. A patient sustains a traumatic injury to the hypothalamus. Which hormonal
imbalance is most likely to occur?
A. Excess cortisol due to ACTH hypersecretion
B. Diabetes insipidus due to ADH deficiency
C. Hyperthyroidism due to TRH excess
D. Primary hyperaldosteronism
,Correct Answer: B
Rationale: The hypothalamus produces antidiuretic hormone (ADH), which is stored in
the posterior pituitary. Hypothalamic damage can cause central diabetes insipidus due
to a lack of ADH, leading to polyuria, polydipsia, and hypernatremia .
Question 6. A patient with septic shock has a high cardiac output but low systemic
vascular resistance. This hemodynamic profile is primarily due to:
A. Massive vasodilation from inflammatory mediators
B. Depressed myocardial contractility
C. Hypovolemia from capillary leak
D. Increased afterload
Correct Answer: A
Rationale: In septic shock, cytokines such as TNF and IL-1, along with nitric oxide, cause
profound vasodilation, leading to decreased systemic vascular resistance. Cardiac output
is initially normal or high as the heart compensates .
Question 7. In a patient with chronic renal failure, which electrolyte imbalance is most
immediately life-threatening?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Correct Answer: B
Rationale: The kidneys excrete approximately 90% of daily potassium. In renal failure,
potassium accumulates, leading to hyperkalemia, which poses a significant risk of fatal
cardiac arrhythmias and asystole .
, Question 8. A patient with sickle cell anemia presents with severe pain in the hands and
feet. What is the underlying pathophysiology of this pain?
A. Iron deficiency leading to inadequate hemoglobin synthesis
B. Sickling of RBCs causing vaso-occlusion and ischemia
C. Autoimmune destruction of platelets
D. Vitamin B12 deficiency causing abnormal RBC maturation
Correct Answer: B
Rationale: Sickle cell disease involves hemoglobin S, which polymerizes under low
oxygen conditions, causing red blood cells to deform into a sickle shape. These rigid
cells obstruct the microcirculation, leading to ischemia and pain crises .
Question 9. Which of the following terms best describes the symptoms of petechiae,
easy bruising, bleeding gums, occult hematuria, and retinal hemorrhage?
A. Neutropenia
B. Leukopenia
C. Anemia
D. Thrombocytopenia
Correct Answer: D
Rationale: These symptoms are characteristic of thrombocytopenia, a condition where
there is a deficiency of platelets. Platelets are essential for clot formation and
maintaining vascular integrity .
Question 10. What is the cellular response when a person receives a kidney transplant
from their sister?
A. Allogenic transplant
B. Autologous transplant
C. Syngeneic transplant
D. Xenotransplant
