WGU D115 OA / D115 OA PREP —Multiple-Choice Exam
Questions with Correct Answers & Rationales
Course: D115 — Advanced Pathophysiology for the
Advanced Practice Nurse (WGU)
.
Source alignment: Questions reflect the WGU D115 Objective Assessment blueprint and high-
yield topics from verified D115 OA study resources covering cellular adaptation, genetics,
immunology, neurology, endocrine, reproductive, pulmonary, cardiovascular, hematology, and
renal pathophysiology.
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH (Q1–Q35)
Q1. Which term describes a decrease in cell size due to reduced workload or decreased blood
flow?
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Correct Answer: C) Atrophy
Rationale: Atrophy is the decrease in cell size and function due to disuse, ischemia, or nutrient
deficiency. Hypertrophy is cell enlargement; hyperplasia is increased cell number; metaplasia is
one cell type replacing another.
Q2. A patient's heart muscle thickens due to chronic hypertension. This adaptive change is
called:
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Dysplasia
Correct Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in cell size without cell division, typically in response to
increased workload on non-dividing cells like cardiac myocytes. Chronic hypertension increases
left ventricular afterload, causing hypertrophy.
Q3. The nurse is caring for a patient with chronic anemia. Which cellular adaptation is most
likely occurring in the patient's bone marrow?
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,A) Atrophy
B) Dysplasia
C) Metaplasia
D) Hyperplasia
Correct Answer: D) Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells due to increased physiologic
demand or hormonal stimulation. In chronic anemia, erythrocyte production increases via
erythropoietin stimulation, causing bone marrow hyperplasia.
Q4. Metaplasia is best described as:
A) Reversible replacement of one differentiated cell type by another
B) Increase in cell size
C) Decrease in cell number
D) Abnormal changes in cell size and shape
Correct Answer: A) Reversible replacement of one differentiated cell type by another
Rationale: Metaplasia is a reversible adaptation where one adult cell type replaces another in
response to chronic irritation, often as a protective mechanism (e.g., squamous metaplasia in the
bronchi of smokers).
Q5. Reversible cell injury is characterized by all of the following EXCEPT:
A) Cellular swelling
B) Fatty change
C) Necrosis
D) Loss of microvilli
Correct Answer: C) Necrosis
Rationale: Necrosis is irreversible cell death, not a feature of reversible injury. Reversible injury
includes cellular swelling, fatty change, and loss of specialized surface features like microvilli.
Q6. What is the hallmark microscopic finding of apoptosis?
A) Cell shrinkage with chromatin condensation
B) Cellular swelling with membrane rupture
C) Karyolysis and pyknosis
D) Inflammatory cell infiltration
Correct Answer: A) Cell shrinkage with chromatin condensation
Rationale: Apoptosis is programmed cell death characterized by cell shrinkage, nuclear
fragmentation, and formation of apoptotic bodies without inflammation. Necrosis involves
cellular swelling, membrane rupture, and inflammation.
Q7. Which type of necrosis is most commonly seen in the brain following a stroke?
A) Coagulative necrosis
B) Caseous necrosis
C) Liquefactive necrosis
D) Fat necrosis
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,Correct Answer: C) Liquefactive necrosis
Rationale: Liquefactive necrosis occurs in the central nervous system due to ischemic injury,
resulting in enzymatic breakdown of dead tissue into a liquid viscous mass. Coagulative necrosis
(kidney/heart) preserves tissue architecture; caseous necrosis (TB) has a cheese-like appearance.
Q8. A patient with acute pancreatitis develops chalky white lesions in the abdominal fat. This
represents:
A) Coagulative necrosis
B) Fat necrosis
C) Caseous necrosis
D) Fibrinoid necrosis
Correct Answer: B) Fat necrosis
Rationale: Fat necrosis occurs when lipases release from damaged pancreatic cells, causing
saponification of fat with calcium, producing chalky white deposits. It is classically seen in acute
pancreatitis.
Q9. Which cellular adaptation is most likely to occur in the left ventricle due to chronic
hypertension?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Correct Answer: B) Hypertrophy
Rationale: Hypertrophy is the increase in cell size seen in cardiac muscle as it works harder
against high afterload from hypertension. Cardiac myocytes cannot significantly divide, so the
heart compensates by increasing cell size rather than cell number.
Q10. Which of the following lab findings indicates metabolic acidosis?
A) pH 7.48, HCO3 30 mEq/L
B) pH 7.32, HCO3 18 mEq/L
C) pH 7.45, PaCO2 30 mm Hg
D) pH 7.36, PaCO2 50 mm Hg
Correct Answer: B) pH 7.32, HCO3 18 mEq/L
Rationale: Metabolic acidosis is characterized by a low pH (< 7.35) and low bicarbonate (<22
mEq/L). Option A shows metabolic alkalosis, option C suggests respiratory alkalosis, and option
D indicates respiratory acidosis.
Q11. 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
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, Correct Answer: C) Metabolic alkalosis
Rationale: Vomiting causes loss of gastric hydrochloric acid, increasing serum bicarbonate
levels. This leads to metabolic alkalosis.
Q12. Which ECG finding is commonly associated with hyperkalemia?
A) U waves
B) Peaked T waves
C) Prolonged QT interval
D) ST elevation
Correct Answer: B) Peaked T waves
Rationale: Hyperkalemia alters cardiac conduction and commonly produces tall, peaked
("tented") T waves. This is the earliest and most characteristic ECG change seen in
hyperkalemia.
Q13. Which disorder is inherited in an autosomal recessive pattern?
A) Huntington disease
B) Marfan syndrome
C) Cystic fibrosis
D) Neurofibromatosis
Correct Answer: C) Cystic fibrosis
Rationale: Cystic fibrosis requires inheritance of two defective CFTR genes, making it
autosomal recessive. Huntington disease and neurofibromatosis are autosomal dominant, while
Marfan syndrome follows autosomal dominant inheritance.
Q14. A male patient develops hemophilia A. Which inheritance pattern is most likely?
A) Autosomal dominant
B) Autosomal recessive
C) X-linked recessive
D) Mitochondrial
Correct Answer: C) X-linked recessive
Rationale: Hemophilia A is an X-linked recessive disorder that commonly affects males because
they possess only one X chromosome. Since males have only one X and one Y, if the affected
chromosome has the illness, it will be expressed.
Q15. Which type of genetic disease affects males more frequently than females?
A) Autosomal dominant
B) Autosomal recessive
C) Sex-linked recessive
D) Mitochondrial
Correct Answer: C) Sex-linked recessive
Rationale: Sex-linked recessive disorders affect males more frequently because males have only
one X chromosome. If the X chromosome carries the mutation, the condition will be expressed
since there is no second X to compensate.
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Questions with Correct Answers & Rationales
Course: D115 — Advanced Pathophysiology for the
Advanced Practice Nurse (WGU)
.
Source alignment: Questions reflect the WGU D115 Objective Assessment blueprint and high-
yield topics from verified D115 OA study resources covering cellular adaptation, genetics,
immunology, neurology, endocrine, reproductive, pulmonary, cardiovascular, hematology, and
renal pathophysiology.
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH (Q1–Q35)
Q1. Which term describes a decrease in cell size due to reduced workload or decreased blood
flow?
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Correct Answer: C) Atrophy
Rationale: Atrophy is the decrease in cell size and function due to disuse, ischemia, or nutrient
deficiency. Hypertrophy is cell enlargement; hyperplasia is increased cell number; metaplasia is
one cell type replacing another.
Q2. A patient's heart muscle thickens due to chronic hypertension. This adaptive change is
called:
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Dysplasia
Correct Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in cell size without cell division, typically in response to
increased workload on non-dividing cells like cardiac myocytes. Chronic hypertension increases
left ventricular afterload, causing hypertrophy.
Q3. The nurse is caring for a patient with chronic anemia. Which cellular adaptation is most
likely occurring in the patient's bone marrow?
P a g e 1 | 68
,A) Atrophy
B) Dysplasia
C) Metaplasia
D) Hyperplasia
Correct Answer: D) Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells due to increased physiologic
demand or hormonal stimulation. In chronic anemia, erythrocyte production increases via
erythropoietin stimulation, causing bone marrow hyperplasia.
Q4. Metaplasia is best described as:
A) Reversible replacement of one differentiated cell type by another
B) Increase in cell size
C) Decrease in cell number
D) Abnormal changes in cell size and shape
Correct Answer: A) Reversible replacement of one differentiated cell type by another
Rationale: Metaplasia is a reversible adaptation where one adult cell type replaces another in
response to chronic irritation, often as a protective mechanism (e.g., squamous metaplasia in the
bronchi of smokers).
Q5. Reversible cell injury is characterized by all of the following EXCEPT:
A) Cellular swelling
B) Fatty change
C) Necrosis
D) Loss of microvilli
Correct Answer: C) Necrosis
Rationale: Necrosis is irreversible cell death, not a feature of reversible injury. Reversible injury
includes cellular swelling, fatty change, and loss of specialized surface features like microvilli.
Q6. What is the hallmark microscopic finding of apoptosis?
A) Cell shrinkage with chromatin condensation
B) Cellular swelling with membrane rupture
C) Karyolysis and pyknosis
D) Inflammatory cell infiltration
Correct Answer: A) Cell shrinkage with chromatin condensation
Rationale: Apoptosis is programmed cell death characterized by cell shrinkage, nuclear
fragmentation, and formation of apoptotic bodies without inflammation. Necrosis involves
cellular swelling, membrane rupture, and inflammation.
Q7. Which type of necrosis is most commonly seen in the brain following a stroke?
A) Coagulative necrosis
B) Caseous necrosis
C) Liquefactive necrosis
D) Fat necrosis
P a g e 2 | 68
,Correct Answer: C) Liquefactive necrosis
Rationale: Liquefactive necrosis occurs in the central nervous system due to ischemic injury,
resulting in enzymatic breakdown of dead tissue into a liquid viscous mass. Coagulative necrosis
(kidney/heart) preserves tissue architecture; caseous necrosis (TB) has a cheese-like appearance.
Q8. A patient with acute pancreatitis develops chalky white lesions in the abdominal fat. This
represents:
A) Coagulative necrosis
B) Fat necrosis
C) Caseous necrosis
D) Fibrinoid necrosis
Correct Answer: B) Fat necrosis
Rationale: Fat necrosis occurs when lipases release from damaged pancreatic cells, causing
saponification of fat with calcium, producing chalky white deposits. It is classically seen in acute
pancreatitis.
Q9. Which cellular adaptation is most likely to occur in the left ventricle due to chronic
hypertension?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Correct Answer: B) Hypertrophy
Rationale: Hypertrophy is the increase in cell size seen in cardiac muscle as it works harder
against high afterload from hypertension. Cardiac myocytes cannot significantly divide, so the
heart compensates by increasing cell size rather than cell number.
Q10. Which of the following lab findings indicates metabolic acidosis?
A) pH 7.48, HCO3 30 mEq/L
B) pH 7.32, HCO3 18 mEq/L
C) pH 7.45, PaCO2 30 mm Hg
D) pH 7.36, PaCO2 50 mm Hg
Correct Answer: B) pH 7.32, HCO3 18 mEq/L
Rationale: Metabolic acidosis is characterized by a low pH (< 7.35) and low bicarbonate (<22
mEq/L). Option A shows metabolic alkalosis, option C suggests respiratory alkalosis, and option
D indicates respiratory acidosis.
Q11. 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
P a g e 3 | 68
, Correct Answer: C) Metabolic alkalosis
Rationale: Vomiting causes loss of gastric hydrochloric acid, increasing serum bicarbonate
levels. This leads to metabolic alkalosis.
Q12. Which ECG finding is commonly associated with hyperkalemia?
A) U waves
B) Peaked T waves
C) Prolonged QT interval
D) ST elevation
Correct Answer: B) Peaked T waves
Rationale: Hyperkalemia alters cardiac conduction and commonly produces tall, peaked
("tented") T waves. This is the earliest and most characteristic ECG change seen in
hyperkalemia.
Q13. Which disorder is inherited in an autosomal recessive pattern?
A) Huntington disease
B) Marfan syndrome
C) Cystic fibrosis
D) Neurofibromatosis
Correct Answer: C) Cystic fibrosis
Rationale: Cystic fibrosis requires inheritance of two defective CFTR genes, making it
autosomal recessive. Huntington disease and neurofibromatosis are autosomal dominant, while
Marfan syndrome follows autosomal dominant inheritance.
Q14. A male patient develops hemophilia A. Which inheritance pattern is most likely?
A) Autosomal dominant
B) Autosomal recessive
C) X-linked recessive
D) Mitochondrial
Correct Answer: C) X-linked recessive
Rationale: Hemophilia A is an X-linked recessive disorder that commonly affects males because
they possess only one X chromosome. Since males have only one X and one Y, if the affected
chromosome has the illness, it will be expressed.
Q15. Which type of genetic disease affects males more frequently than females?
A) Autosomal dominant
B) Autosomal recessive
C) Sex-linked recessive
D) Mitochondrial
Correct Answer: C) Sex-linked recessive
Rationale: Sex-linked recessive disorders affect males more frequently because males have only
one X chromosome. If the X chromosome carries the mutation, the condition will be expressed
since there is no second X to compensate.
P a g e 4 | 68
