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University of Pennsylvania HESI Assessment Exam
Review 2025: Complete Study Guide with Practice
Questions, Detailed Answers, and Proven Test
Strategies for Nursing School Success
- A nurse is assessing a client with a history of prolonged immobility. The client’s calf muscles appear smaller than expected. This is an example of which cellular adaptation? A. Hypertrophy B. Atrophy C. Hyperplasia D. Metaplasia Answer: B. Atrophy Rationale: Atrophy is a decrease in cell size due to reduced use or demand, as seen in immobilized muscles. Hypertrophy is increased cell size, hyperplasia is increased cell number, and metaplasia is a change in cell type.
- Which process best describes the replacement of normal bronchial epithelial cells with squamous cells in a chronic smoker? A. Dysplasia B. Metaplasia C. Atrophy
D. Hyperplasia Answer: B. Metaplasia Rationale: Metaplasia is the reversible replacement of one mature cell type with another, often due to chronic irritation, as in smoking. Dysplasia involves abnormal cell growth, atrophy is reduced cell size, and hyperplasia is increased cell number.
- A nurse is caring for a client with liver enlargement due to chronic alcohol use. This is an example of which cellular adaptation? A. Atrophy B. Hypertrophy C. Hyperplasia D. Dysplasia Answer: B. Hypertrophy Rationale: Hypertrophy is an increase in cell size, often due to increased workload or stress, as seen in hepatocytes with chronic alcohol exposure. Atrophy is reduced size, hyperplasia is increased cell number, and dysplasia is abnormal growth.
- What is the primary cause of hypoxic cellular injury in a client with acute respiratory distress syndrome (ARDS)? A. Lack of oxygen delivery to tissues B. Excessive glucose metabolism C. Autoimmune destruction of cells D. Chemical toxin exposure Answer: A. Lack of oxygen delivery to tissues
- A nurse is teaching about cellular injury. Which condition is most likely to cause free radical damage? A. Chronic hypertension B. Radiation exposure C. Hypoglycemia D. Viral infection Answer: B. Radiation exposure Rationale: Radiation generates free radicals that damage cell membranes and DNA. Hypertension causes mechanical stress, hypoglycemia affects metabolism, and viral infections cause immune-mediated damage.
- A client with endometrial hyperplasia is at risk for which cellular change if untreated? A. Atrophy B. Metaplasia C. Dysplasia D. Hypertrophy Answer: C. Dysplasia Rationale: Hyperplasia (increased cell number) can progress to dysplasia (abnormal cell growth), a precancerous state, if untreated. The other options are unrelated to this progression.
- What is the primary effect of ischemia on cellular function? A. Increased ATP production B. Decreased oxygen delivery
C. Enhanced protein synthesis D. Reduced inflammation Answer: B. Decreased oxygen delivery Rationale: Ischemia, reduced blood flow, limits oxygen and nutrient delivery, impairing cellular metabolism. It does not increase ATP, enhance protein synthesis, or reduce inflammation.
- A nurse is assessing a client with a pressure ulcer. The tissue damage is primarily due to which type of injury? A. Hypoxic injury B. Chemical injury C. Mechanical injury D. Immunologic injury Answer: C. Mechanical injury Rationale: Pressure ulcers result from prolonged mechanical pressure, impairing blood flow and causing tissue damage. Hypoxic injury is secondary, while chemical and immunologic injuries are unrelated.
Inflammation and Immune Response (10 Questions)
- A nurse observes redness and swelling at a client’s wound site. These are hallmarks of which process? A. Chronic inflammation
Rationale: SLE is an autoimmune disorder where the immune system attacks self-tissues. The other options are not primary causes of SLE.
- What is the primary role of histamine in acute inflammation? A. Promotes scar formation B. Increases vascular permeability C. Inhibits neutrophil migration D. Reduces pain sensation Answer: B. Increases vascular permeability Rationale: Histamine, released during inflammation, causes vasodilation and increased vascular permeability, leading to swelling. It does not promote scarring, inhibit neutrophils, or reduce pain.
- A client with rheumatoid arthritis is experiencing chronic inflammation. Which cell type is most active in this process? A. Neutrophils B. Lymphocytes C. Erythrocytes D. Platelets Answer: B. Lymphocytes Rationale: Chronic inflammation, as in rheumatoid arthritis, is driven by lymphocytes (T and B cells) rather than neutrophils (acute inflammation). Erythrocytes and platelets are not primary immune cells.
- Which laboratory finding is most indicative of acute inflammation?
A. Elevated C-reactive protein B. Decreased hemoglobin C. Increased platelet count D. Reduced albumin Answer: A. Elevated C-reactive protein Rationale: C-reactive protein is an acute-phase reactant elevated in acute inflammation. The other findings are not specific to this process.
- A nurse is teaching about infection. Which microorganism is most likely to cause a pyogenic (pus-forming) infection? A. Staphylococcus aureus B. Influenza virus C. Candida albicans D. Mycobacterium tuberculosis Answer: A. Staphylococcus aureus Rationale: S. aureus is a common cause of pyogenic infections due to its ability to form abscesses. Viruses, fungi, and mycobacteria cause different infection patterns.
- What is a key feature of chronic inflammation? A. Rapid onset with resolution B. Predominance of neutrophils C. Tissue destruction and fibrosis D. Minimal immune response
Cardiovascular Pathophysiology (15 Questions)
- A nurse is assessing a client with atherosclerosis. Which finding is most likely? A. Tracheal deviation B. Carotid bruit C. Hyperglycemia D. Joint swelling Answer: B. Carotid bruit Rationale: Atherosclerosis narrows arteries, causing turbulent blood flow heard as a carotid bruit. The other findings are unrelated to atherosclerosis.
- What is the primary cause of left-sided heart failure? A. Pulmonary hypertension B. Systemic hypertension C. Right ventricular infarction D. Tricuspid valve stenosis Answer: B. Systemic hypertension Rationale: Systemic hypertension increases afterload, causing left ventricular strain and failure. Pulmonary hypertension affects the right heart, and the other options are less directly related.
- A client with heart failure develops pulmonary edema. This is primarily due to which process?
A. Increased preload in the left ventricle B. Decreased afterload in the aorta C. Right ventricular hypertrophy D. Decreased pulmonary vascular resistance Answer: A. Increased preload in the left ventricle Rationale: Left-sided heart failure causes blood to back up into the lungs, increasing preload and leading to pulmonary edema. The other options do not directly cause this.
- Which clinical manifestation is most indicative of right-sided heart failure? A. Dyspnea on exertion B. Peripheral edema C. Orthopnea D. Paroxysmal nocturnal dyspnea Answer: B. Peripheral edema Rationale: Right-sided heart failure causes systemic venous congestion, leading to peripheral edema. The other symptoms are more typical of left-sided failure.
- A nurse is caring for a client with cardiac tamponade. What is the primary pathophysiological effect? A. Increased cardiac output B. Decreased ventricular filling C. Enhanced coronary perfusion D. Reduced systemic vascular resistance
B. Troponin I C. C-reactive protein D. B-type natriuretic peptide Answer: B. Troponin I Rationale: Troponin I is highly specific for myocardial damage. CK can be elevated in other conditions, CRP indicates inflammation, and BNP reflects heart failure.
- A nurse is teaching about hypertension. Which organ is most at risk for damage? A. Lungs B. Kidneys C. Pancreas D. Spleen Answer: B. Kidneys Rationale: Hypertension causes renal vascular damage, leading to chronic kidney disease. The other organs are less directly affected.
- What is the primary pathophysiological mechanism of aortic aneurysm? A. Vessel wall weakening B. Increased venous pressure C. Platelet aggregation D. Immune complex deposition Answer: A. Vessel wall weakening
Rationale: Aortic aneurysms result from weakened arterial walls, often due to atherosclerosis or connective tissue disorders. The other mechanisms are unrelated.
- A client with peripheral artery disease reports claudication. This is primarily due to which process? A. Venous stasis B. Arterial insufficiency C. Lymphatic obstruction D. Nerve compression Answer: B. Arterial insufficiency Rationale: Claudication is pain due to reduced arterial blood flow in peripheral artery disease. The other options do not cause this symptom.
- Which finding is most consistent with deep vein thrombosis (DVT)? A. Cool, pale skin B. Warm, swollen leg C. Tracheal deviation D. Carotid bruit Answer: B. Warm, swollen leg Rationale: DVT causes venous obstruction, leading to warmth and swelling in the affected limb. The other findings are unrelated.
- A nurse is assessing a client with endocarditis. What is the primary cause of this condition?
Rationale: Diuretics reduce fluid volume, decreasing preload and relieving heart failure symptoms. The other options are not primary goals.
Respiratory Pathophysiology (15 Questions)
- A nurse is assessing a client with a tension pneumothorax. Which finding is most likely? A. Tracheal deviation B. Carotid bruit C. Peripheral edema D. Joint swelling Answer: A. Tracheal deviation Rationale: Tension pneumothorax causes tracheal deviation away from the affected side due to pressure. The other findings are unrelated.
- What is the primary cause of hypoxia in chronic obstructive pulmonary disease (COPD)? A. Increased alveolar ventilation B. Impaired gas exchange C. Enhanced oxygen transport D. Reduced metabolic demand Answer: B. Impaired gas exchange
Rationale: COPD causes airway obstruction and alveolar damage, impairing gas exchange and leading to hypoxia. The other options are incorrect.
- A client with asthma experiences bronchoconstriction. This is primarily triggered by which process? A. Hypersensitivity reaction B. Bacterial infection C. Hypoxic injury D. Mechanical trauma Answer: A. Hypers utility reaction Rationale: Asthma involves a Type I hypersensitivity reaction, causing bronchoconstriction. The other causes are not primary.
- Which clinical manifestation is most indicative of acute respiratory distress syndrome (ARDS)? A. Hypertension B. Severe hypoxemia C. Hyperglycemia D. Bradycardia Answer: B. Severe hypoxemia Rationale: ARDS impairs gas exchange, leading to severe hypoxemia. The other findings are not specific to ARDS.
- A nurse is caring for a client with pulmonary embolism. What is the primary pathophysiological effect?
Answer: B. Prostaglandins Rationale: Prostaglandins induce fever in response to infection. The other mediators have different roles.
- Which condition is most likely to cause a barrel chest appearance? A. Asthma B. COPD C. Pneumothorax D. Pulmonary edema Answer: B. COPD Rationale: COPD causes air trapping, leading to a barrel chest. The other conditions do not typically cause this.
- A nurse is teaching about cystic fibrosis. What is the primary pathophysiological defect? A. Defective chloride transport B. Increased surfactant production C. Reduced airway inflammation D. Enhanced mucociliary clearance Answer: A. Defective chloride transport Rationale: Cystic fibrosis results from defective chloride transport, leading to thick mucus and airway obstruction. The other options are incorrect.
- What is the primary effect of hypoxia on cellular metabolism?
A. Increased ATP production B. Shift to anaerobic metabolism C. Enhanced protein synthesis D. Reduced lactic acid production Answer: B. Shift to anaerobic metabolism Rationale: Hypoxia forces cells to rely on anaerobic metabolism, producing less ATP and more lactic acid. The other options are incorrect.
- A client with acute bronchitis is at risk for which complication? A. Pneumothorax B. Pneumonia C. Pulmonary embolism D. Heart failure Answer: B. Pneumonia Rationale: Acute bronchitis can progress to pneumonia if untreated. The other complications are less directly related.
- Which finding is most indicative of pleural effusion? A. Increased breath sounds B. Decreased breath sounds C. Wheezing D. Crackles Answer: B. Decreased breath sounds
