HESI RN Pathophysiology Exam
2025/2026 – Actual Exam 80 Questions
with Verified Correct Answers and
Detailed Rationales
Question 1
A client with type 1 diabetes mellitus presents with polyuria and dehydration. What is the
primary pathophysiological mechanism?
A. Increased glucagon secretion
B. Osmotic diuresis from hyperglycemia
C. Decreased insulin receptor sensitivity
D. Hypoaldosteronism
B. Osmotic diuresis from hyperglycemia
Rationale: In type 1 diabetes, absolute insulin deficiency leads to hyperglycemia, causing
glucose to spill into urine, drawing water and electrolytes, resulting in polyuria and
dehydration.
Question 2
A client with chronic obstructive pulmonary disease (COPD) has a PaCO2 of 55 mmHg. What
acid-base imbalance is likely?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
B. Respiratory acidosis
Rationale: COPD impairs CO2 exhalation, leading to hypercapnia (elevated PaCO2),
which decreases pH, causing respiratory acidosis.
Question 3
,Which cellular change is most associated with cervical cancer?
A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Atrophy
B. Dysplasia
Rationale: Dysplasia involves abnormal cell growth and is a hallmark of precancerous
changes in cervical tissue, often linked to HPV infection.
Question 4
A client with heart failure exhibits jugular vein distension. What is the primary cause?
A. Left ventricular dysfunction
B. Right ventricular failure
C. Pulmonary edema
D. Systemic hypotension
B. Right ventricular failure
Rationale: Right ventricular failure causes blood to back up into the systemic venous
system, leading to jugular vein distension.
Question 5
In rheumatoid arthritis, what is the primary pathophysiological process in the joints?
A. Cartilage erosion by osteophytes
B. Autoimmune synovial inflammation
C. Bone resorption by osteoclasts
D. Fibrosis of joint capsule
B. Autoimmune synovial inflammation
Rationale: Rheumatoid arthritis involves autoimmune attack on synovial tissue, causing
inflammation, pannus formation, and joint destruction.
Question 6
A client with acute kidney injury (AKI) has oliguria. What is the most likely cause?
, A. Increased glomerular filtration rate
B. Tubular necrosis
C. Hypervolemia
D. Postrenal obstruction
B. Tubular necrosis
Rationale: AKI often results from acute tubular necrosis due to ischemia or toxins,
impairing urine production and causing oliguria.
Question 7
Which electrolyte imbalance is most common in Addison’s disease?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
A. Hyperkalemia
Rationale: Addison’s disease causes adrenal insufficiency, reducing aldosterone, which
leads to potassium retention and hyperkalemia.
Question 8
A client with cirrhosis develops portal hypertension. What is a direct consequence?
A. Ascites
B. Jaundice
C. Hepatomegaly
D. Hypoalbuminemia
A. Ascites
Rationale: Portal hypertension increases hydrostatic pressure in the portal vein, forcing
fluid into the peritoneal cavity, causing ascites.
Question 9
In septic shock, what is the primary trigger of systemic vasodilation?
2025/2026 – Actual Exam 80 Questions
with Verified Correct Answers and
Detailed Rationales
Question 1
A client with type 1 diabetes mellitus presents with polyuria and dehydration. What is the
primary pathophysiological mechanism?
A. Increased glucagon secretion
B. Osmotic diuresis from hyperglycemia
C. Decreased insulin receptor sensitivity
D. Hypoaldosteronism
B. Osmotic diuresis from hyperglycemia
Rationale: In type 1 diabetes, absolute insulin deficiency leads to hyperglycemia, causing
glucose to spill into urine, drawing water and electrolytes, resulting in polyuria and
dehydration.
Question 2
A client with chronic obstructive pulmonary disease (COPD) has a PaCO2 of 55 mmHg. What
acid-base imbalance is likely?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
B. Respiratory acidosis
Rationale: COPD impairs CO2 exhalation, leading to hypercapnia (elevated PaCO2),
which decreases pH, causing respiratory acidosis.
Question 3
,Which cellular change is most associated with cervical cancer?
A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Atrophy
B. Dysplasia
Rationale: Dysplasia involves abnormal cell growth and is a hallmark of precancerous
changes in cervical tissue, often linked to HPV infection.
Question 4
A client with heart failure exhibits jugular vein distension. What is the primary cause?
A. Left ventricular dysfunction
B. Right ventricular failure
C. Pulmonary edema
D. Systemic hypotension
B. Right ventricular failure
Rationale: Right ventricular failure causes blood to back up into the systemic venous
system, leading to jugular vein distension.
Question 5
In rheumatoid arthritis, what is the primary pathophysiological process in the joints?
A. Cartilage erosion by osteophytes
B. Autoimmune synovial inflammation
C. Bone resorption by osteoclasts
D. Fibrosis of joint capsule
B. Autoimmune synovial inflammation
Rationale: Rheumatoid arthritis involves autoimmune attack on synovial tissue, causing
inflammation, pannus formation, and joint destruction.
Question 6
A client with acute kidney injury (AKI) has oliguria. What is the most likely cause?
, A. Increased glomerular filtration rate
B. Tubular necrosis
C. Hypervolemia
D. Postrenal obstruction
B. Tubular necrosis
Rationale: AKI often results from acute tubular necrosis due to ischemia or toxins,
impairing urine production and causing oliguria.
Question 7
Which electrolyte imbalance is most common in Addison’s disease?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
A. Hyperkalemia
Rationale: Addison’s disease causes adrenal insufficiency, reducing aldosterone, which
leads to potassium retention and hyperkalemia.
Question 8
A client with cirrhosis develops portal hypertension. What is a direct consequence?
A. Ascites
B. Jaundice
C. Hepatomegaly
D. Hypoalbuminemia
A. Ascites
Rationale: Portal hypertension increases hydrostatic pressure in the portal vein, forcing
fluid into the peritoneal cavity, causing ascites.
Question 9
In septic shock, what is the primary trigger of systemic vasodilation?
