WGU D115 Advanced Pathophysiology OA
Exam 2025/2026 – Complete Exam Questions
and Answers
1. Which cellular adaptation is most likely to occur in the left ventricle due to
chronic hypertension?
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in cell size in response to increased
workload. Chronic hypertension increases the workload on the left ventricle,
causing myocardial cells to hypertrophy to meet the increased demand .
2. A patient with chronic obstructive pulmonary disease (COPD) develops
squamous metaplasia in the bronchial epithelium. Which of the following best
describes this cellular change?
A) An increase in cell size
B) A reversible replacement of one differentiated cell type with another
C) An increase in the number of cells
D) A decrease in cell size
Answer: B) A reversible replacement of one differentiated cell type with another
Rationale: Metaplasia is a reversible change in which one differentiated cell type
is replaced by another cell type. In COPD, the normal ciliated columnar epithelium
of the bronchi is replaced by stratified squamous epithelium due to chronic
irritation from smoking .
3. A child is born with an extra copy of chromosome 21. Which chromosomal
abnormality is present?
A) Turner syndrome (45, X)
B) Klinefelter syndrome (47, XXY)
,C) Down syndrome (Trisomy 21)
D) Edwards syndrome (Trisomy 18)
Answer: C) Down syndrome (Trisomy 21)
Rationale: Down syndrome is caused by the presence of an extra copy (trisomy) of
chromosome 21. Turner syndrome is a monosomy X, Klinefelter syndrome is XXY,
and Edwards syndrome is trisomy 18 .
4. A patient with severe vomiting is most likely to develop which acid-base
imbalance?
A) Metabolic acidosis
B) Respiratory acidosis
C) Metabolic alkalosis
D) Respiratory alkalosis
Answer: C) Metabolic alkalosis
Rationale: Vomiting causes the loss of gastric hydrochloric acid, which increases
serum bicarbonate levels, leading to metabolic alkalosis.
5. Which ECG finding is commonly associated with hyperkalemia?
A) U waves
B) Peaked T waves
C) Prolonged QT interval
D) ST elevation
Answer: B) Peaked T waves
Rationale: Hyperkalemia alters cardiac conduction and commonly produces tall,
peaked T waves on an electrocardiogram.
6. Which clinical finding is most consistent with left-sided heart failure?
A) Peripheral edema
B) Hepatomegaly
C) Pulmonary congestion
D) Jugular venous distension
Answer: C) Pulmonary congestion
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
,circulation, leading to pulmonary congestion, dyspnea, orthopnea, and crackles.
Right-sided failure leads to systemic signs like peripheral edema and JVD .
7. A patient with type 2 diabetes mellitus is being evaluated for microvascular
complications. Which assessment finding is most consistent with diabetic
nephropathy?
A) Proteinuria
B) Retinopathy
C) Hypertension
D) Neuropathy
Answer: A) Proteinuria
Rationale: Diabetic nephropathy is a microvascular complication characterized by
damage to the glomeruli, leading to proteinuria .
8. A 42-year-old patient presents with fatigue, pallor, and spoon-shaped nails.
Lab results show low hemoglobin and low mean corpuscular volume (MCV).
What is the most likely cause?
A) Vitamin B12 deficiency
B) Iron deficiency anemia
C) Folate deficiency
D) Hemolytic anemia
Answer: B) Iron deficiency anemia
Rationale: Iron deficiency anemia is microcytic (low MCV) and often presents with
fatigue, pallor, and koilonychia (spoon-shaped nails) .
9. A 58-year-old patient with chronic heart failure presents with shortness of
breath and edema. The NP notes jugular venous distension and an S3 heart
sound. Which pathophysiologic mechanism is primarily responsible for the
patient's symptoms?
A) Decreased preload
B) Increased afterload
C) Activation of the renin-angiotensin-aldosterone system (RAAS)
D) Decreased sympathetic nervous system activity
Answer: C) Activation of the renin-angiotensin-aldosterone system (RAAS)
, Rationale: In chronic heart failure, decreased cardiac output activates the RAAS to
retain sodium and water. This increases fluid volume, preload, and congestion—
leading to edema, JVD, and an S3 heart sound .
10. A patient is prescribed lisinopril for hypertension. Which side effect should
the NP monitor closely?
A) Bradycardia
B) Hyperkalemia
C) Hypoglycemia
D) Thrombocytopenia
Answer: B) Hyperkalemia
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia by reducing
aldosterone-mediated potassium excretion .
11. A patient with COPD has chronic hypoxemia. Which compensatory
mechanism is expected?
A) Decreased erythropoietin production
B) Polycythemia
C) Hypoventilation
D) Respiratory alkalosis
Answer: B) Polycythemia
Rationale: Chronic hypoxemia stimulates the production of erythropoietin, which
leads to polycythemia (an increase in red blood cells) to increase the blood's
oxygen-carrying capacity .
12. Which clinical sign is most indicative of hypocalcemia?
A) Trousseau’s sign
B) Kussmaul respirations
C) Jaundice
D) Bradycardia
Answer: A) Trousseau’s sign
Rationale: Trousseau’s sign (carpal spasm induced by inflation of a blood pressure
cuff) is a classic sign of hypocalcemia .
Exam 2025/2026 – Complete Exam Questions
and Answers
1. Which cellular adaptation is most likely to occur in the left ventricle due to
chronic hypertension?
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in cell size in response to increased
workload. Chronic hypertension increases the workload on the left ventricle,
causing myocardial cells to hypertrophy to meet the increased demand .
2. A patient with chronic obstructive pulmonary disease (COPD) develops
squamous metaplasia in the bronchial epithelium. Which of the following best
describes this cellular change?
A) An increase in cell size
B) A reversible replacement of one differentiated cell type with another
C) An increase in the number of cells
D) A decrease in cell size
Answer: B) A reversible replacement of one differentiated cell type with another
Rationale: Metaplasia is a reversible change in which one differentiated cell type
is replaced by another cell type. In COPD, the normal ciliated columnar epithelium
of the bronchi is replaced by stratified squamous epithelium due to chronic
irritation from smoking .
3. A child is born with an extra copy of chromosome 21. Which chromosomal
abnormality is present?
A) Turner syndrome (45, X)
B) Klinefelter syndrome (47, XXY)
,C) Down syndrome (Trisomy 21)
D) Edwards syndrome (Trisomy 18)
Answer: C) Down syndrome (Trisomy 21)
Rationale: Down syndrome is caused by the presence of an extra copy (trisomy) of
chromosome 21. Turner syndrome is a monosomy X, Klinefelter syndrome is XXY,
and Edwards syndrome is trisomy 18 .
4. A patient with severe vomiting is most likely to develop which acid-base
imbalance?
A) Metabolic acidosis
B) Respiratory acidosis
C) Metabolic alkalosis
D) Respiratory alkalosis
Answer: C) Metabolic alkalosis
Rationale: Vomiting causes the loss of gastric hydrochloric acid, which increases
serum bicarbonate levels, leading to metabolic alkalosis.
5. Which ECG finding is commonly associated with hyperkalemia?
A) U waves
B) Peaked T waves
C) Prolonged QT interval
D) ST elevation
Answer: B) Peaked T waves
Rationale: Hyperkalemia alters cardiac conduction and commonly produces tall,
peaked T waves on an electrocardiogram.
6. Which clinical finding is most consistent with left-sided heart failure?
A) Peripheral edema
B) Hepatomegaly
C) Pulmonary congestion
D) Jugular venous distension
Answer: C) Pulmonary congestion
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
,circulation, leading to pulmonary congestion, dyspnea, orthopnea, and crackles.
Right-sided failure leads to systemic signs like peripheral edema and JVD .
7. A patient with type 2 diabetes mellitus is being evaluated for microvascular
complications. Which assessment finding is most consistent with diabetic
nephropathy?
A) Proteinuria
B) Retinopathy
C) Hypertension
D) Neuropathy
Answer: A) Proteinuria
Rationale: Diabetic nephropathy is a microvascular complication characterized by
damage to the glomeruli, leading to proteinuria .
8. A 42-year-old patient presents with fatigue, pallor, and spoon-shaped nails.
Lab results show low hemoglobin and low mean corpuscular volume (MCV).
What is the most likely cause?
A) Vitamin B12 deficiency
B) Iron deficiency anemia
C) Folate deficiency
D) Hemolytic anemia
Answer: B) Iron deficiency anemia
Rationale: Iron deficiency anemia is microcytic (low MCV) and often presents with
fatigue, pallor, and koilonychia (spoon-shaped nails) .
9. A 58-year-old patient with chronic heart failure presents with shortness of
breath and edema. The NP notes jugular venous distension and an S3 heart
sound. Which pathophysiologic mechanism is primarily responsible for the
patient's symptoms?
A) Decreased preload
B) Increased afterload
C) Activation of the renin-angiotensin-aldosterone system (RAAS)
D) Decreased sympathetic nervous system activity
Answer: C) Activation of the renin-angiotensin-aldosterone system (RAAS)
, Rationale: In chronic heart failure, decreased cardiac output activates the RAAS to
retain sodium and water. This increases fluid volume, preload, and congestion—
leading to edema, JVD, and an S3 heart sound .
10. A patient is prescribed lisinopril for hypertension. Which side effect should
the NP monitor closely?
A) Bradycardia
B) Hyperkalemia
C) Hypoglycemia
D) Thrombocytopenia
Answer: B) Hyperkalemia
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia by reducing
aldosterone-mediated potassium excretion .
11. A patient with COPD has chronic hypoxemia. Which compensatory
mechanism is expected?
A) Decreased erythropoietin production
B) Polycythemia
C) Hypoventilation
D) Respiratory alkalosis
Answer: B) Polycythemia
Rationale: Chronic hypoxemia stimulates the production of erythropoietin, which
leads to polycythemia (an increase in red blood cells) to increase the blood's
oxygen-carrying capacity .
12. Which clinical sign is most indicative of hypocalcemia?
A) Trousseau’s sign
B) Kussmaul respirations
C) Jaundice
D) Bradycardia
Answer: A) Trousseau’s sign
Rationale: Trousseau’s sign (carpal spasm induced by inflation of a blood pressure
cuff) is a classic sign of hypocalcemia .
