WGU D027 PATHOPHYSIOLOGY AND PHARMACOLOGY
Course Material Questions from the End of the Units, as well as the
Unit Quizzes
2026/2027 With Verified Answers
Complete Unit Review Examination - 170 Questions - Units 1 through 8
Section 1: Unit 1 - Cellular Function, Injury, and Adaptation (End-of-Unit
Questions & Unit Quiz Items) - Q1-18
Q1: Which mechanism produces cellular swelling during the earliest stage of hypoxic injury?
A. Failure of the sodium-potassium pump from ATP depletion [CORRECT]
B. Rupture of lysosomal membranes with enzyme release
C. Activation of caspases that fragment nuclear DNA
D. Increased protein synthesis by the endoplasmic reticulum
Correct Answer: A
Rationale: Hypoxia quickly depletes ATP, so the sodium-potassium ATPase pump fails and sodium
accumulates inside the cell; water follows osmotically, producing reversible cellular swelling. Lysosomal
membrane rupture and caspase activation occur later with irreversible injury or apoptosis. Verified against WGU
D027 Unit 1 learning objectives on hypoxic cell injury.
Q2: A client has right-sided paralysis after a stroke and spends most of the day in bed. Which client
statement indicates correct understanding of how to prevent disuse atrophy of the affected leg?
A. I will keep the leg elevated on pillows most of the day.
B. I will avoid moving the leg until strength returns on its own.
C. I will do passive range-of-motion exercises with help every day. [CORRECT]
D. I will restrict fluids to reduce swelling in the leg.
Correct Answer: C
Rationale: Skeletal muscle shrinks with immobility because a decreased workload reduces protein synthesis and
increases protein degradation; regular passive or active movement supplies the workload signals that preserve
muscle mass. Elevation and fluid restriction do not stimulate muscle, and waiting lets atrophy progress. Verified
against WGU D027 Unit 1 learning objectives on cellular adaptation to decreased use.
WGU D027 - 2026/2027 Edition - With Verified Answers 1
,WGU D027 Pathophysiology and Pharmacology - Unit Review Exam 2026/2027
Q3: A 62-year-old client with a 20-year history of poorly controlled hypertension has an
echocardiogram showing a thickened left ventricular wall with a normal chamber size. Which cellular
adaptation best explains this finding?
A. Hyperplasia of endocardial cells
B. Hypertrophy of cardiac myocytes [CORRECT]
C. Metaplasia of myocardial tissue
D. Dysplasia of vascular smooth muscle
Correct Answer: B
Rationale: Chronic pressure overload forces individual cardiac myocytes to enlarge by adding sarcomeres in
parallel; because adult cardiac muscle cells cannot divide, the ventricular wall thickens through hypertrophy.
Hyperplasia requires cell division and does not occur in cardiac muscle, while metaplasia and dysplasia involve
replacement or disordered growth of other cell types. Verified against WGU D027 Unit 1 learning objectives on
myocardial adaptation to pressure overload.
Q4: Which statement correctly distinguishes hypertrophy from hyperplasia?
A. Hypertrophy increases cell number, whereas hyperplasia increases cell size.
B. Both processes require cell division to occur.
C. Hyperplasia is the main response of cardiac muscle to increased workload.
D. Hypertrophy increases cell size, whereas hyperplasia increases cell number. [CORRECT]
Correct Answer: D
Rationale: Hypertrophy enlarges individual cells from increased workload, which is physiologic in the athlete's
heart and pathologic in the chronically hypertensive ventricle, while hyperplasia multiplies cell number, as in
compensatory liver regrowth after partial hepatectomy. Reversing the two definitions is a common error because
both enlarge the organ. Verified against WGU D027 Unit 1 learning objectives on adaptive cellular responses.
Q5: A 68-year-old man reports urinary hesitancy and a weak urine stream. Examination shows a
symmetrically enlarged prostate, and biopsy reveals an increased number of normal-appearing
epithelial cells. Which cellular adaptation caused this enlargement?
A. Hyperplasia of prostatic glandular cells [CORRECT]
B. Hypertrophy of individual prostatic cells
C. Metaplasia of prostatic transitional cells
D. Dysplasia of prostatic stromal cells
Correct Answer: A
Rationale: Dihydrotestosterone-driven growth factors stimulate mitotic division of prostatic epithelial cells, so
the gland enlarges through hyperplasia, a hormone-driven increase in cell number like endometrial hyperplasia
with unopposed estrogen. The biopsy finding of increased normal-appearing cells rules out enlargement by cell
size, replacement, or disordered growth. Verified against WGU D027 Unit 1 learning objectives on hyperplastic
disorders.
WGU D027 - 2026/2027 Edition - With Verified Answers 2
,WGU D027 Pathophysiology and Pharmacology - Unit Review Exam 2026/2027
Q6: A client who has smoked one pack of cigarettes daily for 25 years undergoes bronchoscopy, and
the provider reports that normal ciliated columnar bronchial epithelium has been replaced by squamous
epithelium. Which client statement indicates correct understanding of this finding?
A. This change means my lung tissue has already become malignant.
B. If I stop smoking, this change may reverse to normal tissue. [CORRECT]
C. Squamous cells will help my lungs clear mucus better.
D. This finding is a normal age-related change in the airways.
Correct Answer: B
Rationale: Chronic tobacco smoke irritation reprograms bronchial epithelium into squamous epithelium, a
protective but maladaptive metaplasia that loses cilia and mucus production; if the irritant is removed before
dysplasia develops, the tissue can generally revert. The change is not yet malignant and does not improve airway
clearance. Verified against WGU D027 Unit 1 learning objectives on metaplasia and reversibility.
Q7: Which statement accurately differentiates metaplasia from dysplasia?
A. Metaplasia is irreversible, whereas dysplasia always regresses.
B. Dysplasia replaces one mature cell type with another mature cell type.
C. Metaplasia replaces one mature cell type with another, whereas dysplasia is disordered growth
with variation in cell size and shape. [CORRECT]
D. Metaplasia is a malignant change, whereas dysplasia is always benign.
Correct Answer: C
Rationale: Metaplasia is an adaptive substitution of one mature cell type for another better able to withstand
irritation, such as Barrett esophagus replacing squamous mucosa, while dysplasia is disorganized, atypical growth
that is pre-neoplastic. Metaplasia is usually reversible, and dysplasia may progress to cancer rather than always
regressing. Verified against WGU D027 Unit 1 learning objectives on adaptive versus pre-neoplastic change.
Q8: A 29-year-old client receives a Pap test result of high-grade squamous intraepithelial lesion, and
the nurse explains that this represents cervical dysplasia. Which statement best describes the
significance of this result?
A. The cells are malignant and have already invaded nearby tissue.
B. The cells show normal maturation with an increased cell number.
C. The finding results from replacement of squamous cells by glandular cells.
D. The cells show disordered growth that may progress to cancer if untreated. [CORRECT]
Correct Answer: D
Rationale: Cervical dysplasia consists of disordered, atypical epithelial growth with variation in cell size, shape,
and nuclear appearance; it is pre-neoplastic, so it may persist, regress, or progress to invasive cancer, which is
why surveillance and treatment matter. It has not invaded surrounding tissue and is not an increase in normal cell
number. Verified against WGU D027 Unit 1 learning objectives on dysplasia as a pre-neoplastic change.
WGU D027 - 2026/2027 Edition - With Verified Answers 3
, WGU D027 Pathophysiology and Pharmacology - Unit Review Exam 2026/2027
Q9: A client with an acute myocardial infarction undergoes successful percutaneous coronary
intervention with full restoration of coronary blood flow. Within hours, troponin rises further and the
infarcted area enlarges despite a widely patent vessel. Which process best explains this deterioration?
A. Extension of coagulative necrosis from ongoing ischemia
B. Reperfusion injury from reactive oxygen species generated during reoxygenation
[CORRECT]
C. Reocclusion of the stent by fresh thrombus
D. Conversion of the infarct to liquefactive necrosis
Correct Answer: B
Rationale: Restoring blood flow reoxygenates previously ischemic myocytes, and the sudden burst of reactive
oxygen species along with inflammatory mediators damages membranes and mitochondria, extending injury
despite vessel patency. The artery is open, so reocclusion is unlikely, and liquefactive necrosis is characteristic of
brain, not cardiac, tissue. Verified against WGU D027 Unit 1 learning objectives on hypoxic and reperfusion
injury.
Q10: A young adult is admitted 36 hours after ingesting a large amount of acetaminophen. Serum AST
and ALT are in the thousands, and the provider diagnoses acute hepatic centrilobular necrosis. Which
mechanism explains this injury?
A. A toxic metabolite that depletes glutathione and generates free radical injury [CORRECT]
B. Direct cholinergic toxicity to hepatocyte cell membranes
C. Immune complex deposition in the hepatic portal triads
D. Obstruction of bile canaliculi by crystallized drug metabolites
Correct Answer: A
Rationale: Acetaminophen is normally conjugated in the liver, but in overdose the cytochrome P450 pathway
produces the reactive metabolite NAPQI, which depletes glutathione and causes oxidative free radical damage to
centrilobular hepatocytes, the zone richest in P450 activity. The injury is metabolic, not immune or obstructive.
Verified against WGU D027 Unit 1 learning objectives on chemical and drug-induced cell injury.
WGU D027 - 2026/2027 Edition - With Verified Answers 4
Course Material Questions from the End of the Units, as well as the
Unit Quizzes
2026/2027 With Verified Answers
Complete Unit Review Examination - 170 Questions - Units 1 through 8
Section 1: Unit 1 - Cellular Function, Injury, and Adaptation (End-of-Unit
Questions & Unit Quiz Items) - Q1-18
Q1: Which mechanism produces cellular swelling during the earliest stage of hypoxic injury?
A. Failure of the sodium-potassium pump from ATP depletion [CORRECT]
B. Rupture of lysosomal membranes with enzyme release
C. Activation of caspases that fragment nuclear DNA
D. Increased protein synthesis by the endoplasmic reticulum
Correct Answer: A
Rationale: Hypoxia quickly depletes ATP, so the sodium-potassium ATPase pump fails and sodium
accumulates inside the cell; water follows osmotically, producing reversible cellular swelling. Lysosomal
membrane rupture and caspase activation occur later with irreversible injury or apoptosis. Verified against WGU
D027 Unit 1 learning objectives on hypoxic cell injury.
Q2: A client has right-sided paralysis after a stroke and spends most of the day in bed. Which client
statement indicates correct understanding of how to prevent disuse atrophy of the affected leg?
A. I will keep the leg elevated on pillows most of the day.
B. I will avoid moving the leg until strength returns on its own.
C. I will do passive range-of-motion exercises with help every day. [CORRECT]
D. I will restrict fluids to reduce swelling in the leg.
Correct Answer: C
Rationale: Skeletal muscle shrinks with immobility because a decreased workload reduces protein synthesis and
increases protein degradation; regular passive or active movement supplies the workload signals that preserve
muscle mass. Elevation and fluid restriction do not stimulate muscle, and waiting lets atrophy progress. Verified
against WGU D027 Unit 1 learning objectives on cellular adaptation to decreased use.
WGU D027 - 2026/2027 Edition - With Verified Answers 1
,WGU D027 Pathophysiology and Pharmacology - Unit Review Exam 2026/2027
Q3: A 62-year-old client with a 20-year history of poorly controlled hypertension has an
echocardiogram showing a thickened left ventricular wall with a normal chamber size. Which cellular
adaptation best explains this finding?
A. Hyperplasia of endocardial cells
B. Hypertrophy of cardiac myocytes [CORRECT]
C. Metaplasia of myocardial tissue
D. Dysplasia of vascular smooth muscle
Correct Answer: B
Rationale: Chronic pressure overload forces individual cardiac myocytes to enlarge by adding sarcomeres in
parallel; because adult cardiac muscle cells cannot divide, the ventricular wall thickens through hypertrophy.
Hyperplasia requires cell division and does not occur in cardiac muscle, while metaplasia and dysplasia involve
replacement or disordered growth of other cell types. Verified against WGU D027 Unit 1 learning objectives on
myocardial adaptation to pressure overload.
Q4: Which statement correctly distinguishes hypertrophy from hyperplasia?
A. Hypertrophy increases cell number, whereas hyperplasia increases cell size.
B. Both processes require cell division to occur.
C. Hyperplasia is the main response of cardiac muscle to increased workload.
D. Hypertrophy increases cell size, whereas hyperplasia increases cell number. [CORRECT]
Correct Answer: D
Rationale: Hypertrophy enlarges individual cells from increased workload, which is physiologic in the athlete's
heart and pathologic in the chronically hypertensive ventricle, while hyperplasia multiplies cell number, as in
compensatory liver regrowth after partial hepatectomy. Reversing the two definitions is a common error because
both enlarge the organ. Verified against WGU D027 Unit 1 learning objectives on adaptive cellular responses.
Q5: A 68-year-old man reports urinary hesitancy and a weak urine stream. Examination shows a
symmetrically enlarged prostate, and biopsy reveals an increased number of normal-appearing
epithelial cells. Which cellular adaptation caused this enlargement?
A. Hyperplasia of prostatic glandular cells [CORRECT]
B. Hypertrophy of individual prostatic cells
C. Metaplasia of prostatic transitional cells
D. Dysplasia of prostatic stromal cells
Correct Answer: A
Rationale: Dihydrotestosterone-driven growth factors stimulate mitotic division of prostatic epithelial cells, so
the gland enlarges through hyperplasia, a hormone-driven increase in cell number like endometrial hyperplasia
with unopposed estrogen. The biopsy finding of increased normal-appearing cells rules out enlargement by cell
size, replacement, or disordered growth. Verified against WGU D027 Unit 1 learning objectives on hyperplastic
disorders.
WGU D027 - 2026/2027 Edition - With Verified Answers 2
,WGU D027 Pathophysiology and Pharmacology - Unit Review Exam 2026/2027
Q6: A client who has smoked one pack of cigarettes daily for 25 years undergoes bronchoscopy, and
the provider reports that normal ciliated columnar bronchial epithelium has been replaced by squamous
epithelium. Which client statement indicates correct understanding of this finding?
A. This change means my lung tissue has already become malignant.
B. If I stop smoking, this change may reverse to normal tissue. [CORRECT]
C. Squamous cells will help my lungs clear mucus better.
D. This finding is a normal age-related change in the airways.
Correct Answer: B
Rationale: Chronic tobacco smoke irritation reprograms bronchial epithelium into squamous epithelium, a
protective but maladaptive metaplasia that loses cilia and mucus production; if the irritant is removed before
dysplasia develops, the tissue can generally revert. The change is not yet malignant and does not improve airway
clearance. Verified against WGU D027 Unit 1 learning objectives on metaplasia and reversibility.
Q7: Which statement accurately differentiates metaplasia from dysplasia?
A. Metaplasia is irreversible, whereas dysplasia always regresses.
B. Dysplasia replaces one mature cell type with another mature cell type.
C. Metaplasia replaces one mature cell type with another, whereas dysplasia is disordered growth
with variation in cell size and shape. [CORRECT]
D. Metaplasia is a malignant change, whereas dysplasia is always benign.
Correct Answer: C
Rationale: Metaplasia is an adaptive substitution of one mature cell type for another better able to withstand
irritation, such as Barrett esophagus replacing squamous mucosa, while dysplasia is disorganized, atypical growth
that is pre-neoplastic. Metaplasia is usually reversible, and dysplasia may progress to cancer rather than always
regressing. Verified against WGU D027 Unit 1 learning objectives on adaptive versus pre-neoplastic change.
Q8: A 29-year-old client receives a Pap test result of high-grade squamous intraepithelial lesion, and
the nurse explains that this represents cervical dysplasia. Which statement best describes the
significance of this result?
A. The cells are malignant and have already invaded nearby tissue.
B. The cells show normal maturation with an increased cell number.
C. The finding results from replacement of squamous cells by glandular cells.
D. The cells show disordered growth that may progress to cancer if untreated. [CORRECT]
Correct Answer: D
Rationale: Cervical dysplasia consists of disordered, atypical epithelial growth with variation in cell size, shape,
and nuclear appearance; it is pre-neoplastic, so it may persist, regress, or progress to invasive cancer, which is
why surveillance and treatment matter. It has not invaded surrounding tissue and is not an increase in normal cell
number. Verified against WGU D027 Unit 1 learning objectives on dysplasia as a pre-neoplastic change.
WGU D027 - 2026/2027 Edition - With Verified Answers 3
, WGU D027 Pathophysiology and Pharmacology - Unit Review Exam 2026/2027
Q9: A client with an acute myocardial infarction undergoes successful percutaneous coronary
intervention with full restoration of coronary blood flow. Within hours, troponin rises further and the
infarcted area enlarges despite a widely patent vessel. Which process best explains this deterioration?
A. Extension of coagulative necrosis from ongoing ischemia
B. Reperfusion injury from reactive oxygen species generated during reoxygenation
[CORRECT]
C. Reocclusion of the stent by fresh thrombus
D. Conversion of the infarct to liquefactive necrosis
Correct Answer: B
Rationale: Restoring blood flow reoxygenates previously ischemic myocytes, and the sudden burst of reactive
oxygen species along with inflammatory mediators damages membranes and mitochondria, extending injury
despite vessel patency. The artery is open, so reocclusion is unlikely, and liquefactive necrosis is characteristic of
brain, not cardiac, tissue. Verified against WGU D027 Unit 1 learning objectives on hypoxic and reperfusion
injury.
Q10: A young adult is admitted 36 hours after ingesting a large amount of acetaminophen. Serum AST
and ALT are in the thousands, and the provider diagnoses acute hepatic centrilobular necrosis. Which
mechanism explains this injury?
A. A toxic metabolite that depletes glutathione and generates free radical injury [CORRECT]
B. Direct cholinergic toxicity to hepatocyte cell membranes
C. Immune complex deposition in the hepatic portal triads
D. Obstruction of bile canaliculi by crystallized drug metabolites
Correct Answer: A
Rationale: Acetaminophen is normally conjugated in the liver, but in overdose the cytochrome P450 pathway
produces the reactive metabolite NAPQI, which depletes glutathione and causes oxidative free radical damage to
centrilobular hepatocytes, the zone richest in P450 activity. The injury is metabolic, not immune or obstructive.
Verified against WGU D027 Unit 1 learning objectives on chemical and drug-induced cell injury.
WGU D027 - 2026/2027 Edition - With Verified Answers 4
