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WGU D115 – ADVANCED PATHOPHYSIOLOGY FOR THE APRN Cram Study Guide 4 | Latest
2026/2027 Updated Questions with Detailed Rationales | A+ Graded
Question 1
A patient has a prolonged ischemic event causing irreversible
cell injury. Which of the following is the earliest sign of
irreversible cell death?
A. Cellular swelling
B. Nuclear pyknosis
C. Decreased ATP production
D. Mitochondrial vacuolization
E. Plasma membrane blebbing
Answer: B
Rationale: Nuclear pyknosis (chromatin condensation) is an
early sign of irreversible cell death. Cellular swelling, decreased
ATP, and mitochondrial changes are reversible. Plasma
membrane blebbing may occur in apoptosis but is not the
earliest nuclear sign.
Question 2
Which type of cellular adaptation is characterized by an
increase in cell size due to increased workload?
A. Hyperplasia
B. Hypertrophy
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C. Atrophy
D. Metaplasia
E. Dysplasia
Answer: B
Rationale: Hypertrophy is an increase in cell size, often in
response to increased workload or hormonal stimulation (e.g.,
cardiac hypertrophy in hypertension). Hyperplasia is an increase
in cell number.
Question 3
A patient with chronic gastroesophageal reflux develops Barrett
esophagus. This is an example of which adaptive change?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
E. Atrophy
Answer: C
Rationale: Barrett esophagus is metaplasia—replacement of
squamous epithelium with columnar epithelium in response to
chronic acid exposure. It is a reversible adaptive change but
carries risk of dysplasia.
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Question 4
Which of the following is a cardinal sign of inflammation?
A. Cyanosis
B. Swelling
C. Pallor
D. Decreased temperature
E. Numbness
Answer: B
Rationale: The five cardinal signs of inflammation are rubor
(redness), tumor (swelling), calor (heat), dolor (pain), and loss
of function. Swelling is from vasodilation and increased vascular
permeability.
Question 5
What is the primary type of necrosis that results from ischemic
injury in the myocardium?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
E. Fibrinoid necrosis
Answer: C
Rationale: Coagulative necrosis occurs in most organs (heart,
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kidney, liver) after ischemic injury, except the brain, which
undergoes liquefactive necrosis.
Question 6
Which cell type is the first to arrive at the site of acute
inflammation?
A. Macrophages
B. Neutrophils
C. Lymphocytes
D. Plasma cells
E. Eosinophils
Answer: B
Rationale: Neutrophils are the first leukocytes to migrate to the
site of acute inflammation, typically within 6–24 hours.
Macrophages predominate later.
Question 7
A patient has a chronic inflammatory condition. Which cell type
predominates?
A. Neutrophils
B. Macrophages and lymphocytes
C. Basophils
WGU D115 – ADVANCED PATHOPHYSIOLOGY FOR THE APRN Cram Study Guide 4 | Latest
2026/2027 Updated Questions with Detailed Rationales | A+ Graded
Question 1
A patient has a prolonged ischemic event causing irreversible
cell injury. Which of the following is the earliest sign of
irreversible cell death?
A. Cellular swelling
B. Nuclear pyknosis
C. Decreased ATP production
D. Mitochondrial vacuolization
E. Plasma membrane blebbing
Answer: B
Rationale: Nuclear pyknosis (chromatin condensation) is an
early sign of irreversible cell death. Cellular swelling, decreased
ATP, and mitochondrial changes are reversible. Plasma
membrane blebbing may occur in apoptosis but is not the
earliest nuclear sign.
Question 2
Which type of cellular adaptation is characterized by an
increase in cell size due to increased workload?
A. Hyperplasia
B. Hypertrophy
, Page |2
C. Atrophy
D. Metaplasia
E. Dysplasia
Answer: B
Rationale: Hypertrophy is an increase in cell size, often in
response to increased workload or hormonal stimulation (e.g.,
cardiac hypertrophy in hypertension). Hyperplasia is an increase
in cell number.
Question 3
A patient with chronic gastroesophageal reflux develops Barrett
esophagus. This is an example of which adaptive change?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
E. Atrophy
Answer: C
Rationale: Barrett esophagus is metaplasia—replacement of
squamous epithelium with columnar epithelium in response to
chronic acid exposure. It is a reversible adaptive change but
carries risk of dysplasia.
, Page |3
Question 4
Which of the following is a cardinal sign of inflammation?
A. Cyanosis
B. Swelling
C. Pallor
D. Decreased temperature
E. Numbness
Answer: B
Rationale: The five cardinal signs of inflammation are rubor
(redness), tumor (swelling), calor (heat), dolor (pain), and loss
of function. Swelling is from vasodilation and increased vascular
permeability.
Question 5
What is the primary type of necrosis that results from ischemic
injury in the myocardium?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
E. Fibrinoid necrosis
Answer: C
Rationale: Coagulative necrosis occurs in most organs (heart,
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kidney, liver) after ischemic injury, except the brain, which
undergoes liquefactive necrosis.
Question 6
Which cell type is the first to arrive at the site of acute
inflammation?
A. Macrophages
B. Neutrophils
C. Lymphocytes
D. Plasma cells
E. Eosinophils
Answer: B
Rationale: Neutrophils are the first leukocytes to migrate to the
site of acute inflammation, typically within 6–24 hours.
Macrophages predominate later.
Question 7
A patient has a chronic inflammatory condition. Which cell type
predominates?
A. Neutrophils
B. Macrophages and lymphocytes
C. Basophils
