WGU D236 OBJECTIVE ASSESSMENT
PATHOPHYSIOLOGY EXAM (LATEST
2026/2027 UPDATE) QUESTIONS AND
VERIFIED ANSWERS| GRADE A
WGU D236 OBJECTIVE ASSESSMENT
PATHOPHYSIOLOGY
WGU D236 Objective Assessment – Pathophysiology
(2026/2027 Update)
1. Consequence of hyperglycemia
Which of the following is a major consequence of prolonged hyperglycemia?
A. Decreased blood viscosity
B. Increased vascular permeability
C. Reduced endothelial damage
D. Increased insulin sensitivity
Rationale: Chronic hyperglycemia leads to the formation of advanced glycation end
products (AGEs), which damage vascular endothelial cells. This damage disrupts the
integrity of blood vessels, increasing vascular permeability. As a result, fluid and
proteins leak into surrounding tissues, contributing to complications such as diabetic
retinopathy and nephropathy. These vascular changes are a central mechanism
behind many diabetic complications.
2. Electrolyte imbalance condition
Which condition is most likely to cause increased calcium and decreased phosphate
levels?
A. Hyperparathyroidism
B. Hypoparathyroidism
,C. Chronic kidney disease
D. Vitamin D deficiency
Rationale: Hyperparathyroidism causes excessive secretion of parathyroid hormone
(PTH). PTH increases calcium release from bones and enhances calcium reabsorption
in the kidneys while promoting phosphate excretion. This results in hypercalcemia and
hypophosphatemia. These electrolyte shifts can lead to bone pain, kidney stones, and
neuromuscular symptoms.
3. Aortic dissection
A 70-year-old male with chronic hypertension presents with sudden severe chest pain
radiating to the back. What is the most common site of the tear in aortic dissection?
A. Ascending aorta
B. Descending thoracic aorta
C. Abdominal aorta
D. Aortic arch
Rationale: The ascending aorta is the most common site of aortic dissection due to
the high pressure and shear stress in this region. Chronic hypertension weakens the
vessel wall, making it susceptible to tearing. Blood enters the intimal layer, creating a
false lumen. This condition is life-threatening and requires immediate medical
intervention.
4. Characteristic feature of cirrhosis
Which of the following is a hallmark feature of liver cirrhosis?
A. Increased albumin production
B. Reduced bilirubin levels
C. Portal hypertension
D. Increased hepatic blood flow
Rationale: Cirrhosis causes extensive fibrosis and scarring of liver tissue, obstructing
normal blood flow through the liver. This obstruction increases pressure in the portal
venous system, resulting in portal hypertension. Portal hypertension leads to
complications such as ascites, splenomegaly, and esophageal varices. It is a defining
pathophysiologic feature of advanced liver disease.
5. Pathophysiology of emphysema
,Which best describes the underlying pathophysiology of emphysema?
A. Destruction of alveolar walls and loss of elastic recoil
B. Increased mucus production
C. Acute bronchoconstriction
D. Thickening of alveolar membranes
Rationale: Emphysema involves permanent destruction of alveolar walls, reducing
the surface area available for gas exchange. Loss of elastic recoil leads to air trapping
and difficulty with exhalation. Smoking is the most common cause due to chronic
inflammation and protease-mediated tissue damage. These changes result in
progressive dyspnea and hypoxia.
6. Hallmark feature of chronic renal failure
Which finding is most characteristic of chronic renal failure?
A. Decreased glomerular filtration rate (GFR)
B. Acute oliguria
C. Reversible kidney damage
D. Increased erythropoietin production
Rationale: Chronic renal failure is marked by a progressive and irreversible decline in
kidney function. A decreased GFR reflects reduced ability of the kidneys to filter waste
products. This leads to accumulation of urea, creatinine, and electrolytes in the blood.
Over time, complications such as anemia, bone disease, and fluid overload develop.
7. Cellular adaptation
Which cellular adaptation occurs when cells increase in size due to increased
workload?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Rationale: Hypertrophy refers to an increase in cell size, resulting in enlargement of
the affected tissue or organ. It commonly occurs in muscle cells, such as cardiac
hypertrophy in response to chronic hypertension. This adaptation helps cells meet
increased functional demands. However, prolonged hypertrophy can lead to impaired
function.
, 8. Apoptosis
Which statement best describes apoptosis?
A. Always associated with inflammation
B. Programmed cell death without inflammation
C. Caused by acute ischemia only
D. Results in cell swelling and rupture
Rationale: Apoptosis is a regulated, programmed form of cell death that removes
damaged or unnecessary cells. It does not trigger inflammation because cellular
contents are contained and safely removed. This process is essential for normal
development and tissue homeostasis. In contrast, necrosis causes inflammation and
tissue injury.
9. Necrosis
Which feature distinguishes necrosis from apoptosis?
A. DNA fragmentation
B. Cell shrinkage
C. Inflammatory response
D. Energy-dependent process
Rationale: Necrosis is an uncontrolled form of cell death typically caused by severe
injury such as hypoxia or toxins. It results in cell swelling, membrane rupture, and
release of intracellular contents. This triggers a significant inflammatory response in
surrounding tissues. Apoptosis, by contrast, avoids inflammation.
10. Hyperkalemia
Why is hyperkalemia considered life-threatening?
A. Causes hypoglycemia
B. Leads to metabolic alkalosis
C. Can cause fatal cardiac arrhythmias
D. Results in muscle wasting
Rationale: Elevated potassium levels interfere with normal cardiac electrical activity.
Hyperkalemia alters membrane potentials, increasing the risk of arrhythmias and
PATHOPHYSIOLOGY EXAM (LATEST
2026/2027 UPDATE) QUESTIONS AND
VERIFIED ANSWERS| GRADE A
WGU D236 OBJECTIVE ASSESSMENT
PATHOPHYSIOLOGY
WGU D236 Objective Assessment – Pathophysiology
(2026/2027 Update)
1. Consequence of hyperglycemia
Which of the following is a major consequence of prolonged hyperglycemia?
A. Decreased blood viscosity
B. Increased vascular permeability
C. Reduced endothelial damage
D. Increased insulin sensitivity
Rationale: Chronic hyperglycemia leads to the formation of advanced glycation end
products (AGEs), which damage vascular endothelial cells. This damage disrupts the
integrity of blood vessels, increasing vascular permeability. As a result, fluid and
proteins leak into surrounding tissues, contributing to complications such as diabetic
retinopathy and nephropathy. These vascular changes are a central mechanism
behind many diabetic complications.
2. Electrolyte imbalance condition
Which condition is most likely to cause increased calcium and decreased phosphate
levels?
A. Hyperparathyroidism
B. Hypoparathyroidism
,C. Chronic kidney disease
D. Vitamin D deficiency
Rationale: Hyperparathyroidism causes excessive secretion of parathyroid hormone
(PTH). PTH increases calcium release from bones and enhances calcium reabsorption
in the kidneys while promoting phosphate excretion. This results in hypercalcemia and
hypophosphatemia. These electrolyte shifts can lead to bone pain, kidney stones, and
neuromuscular symptoms.
3. Aortic dissection
A 70-year-old male with chronic hypertension presents with sudden severe chest pain
radiating to the back. What is the most common site of the tear in aortic dissection?
A. Ascending aorta
B. Descending thoracic aorta
C. Abdominal aorta
D. Aortic arch
Rationale: The ascending aorta is the most common site of aortic dissection due to
the high pressure and shear stress in this region. Chronic hypertension weakens the
vessel wall, making it susceptible to tearing. Blood enters the intimal layer, creating a
false lumen. This condition is life-threatening and requires immediate medical
intervention.
4. Characteristic feature of cirrhosis
Which of the following is a hallmark feature of liver cirrhosis?
A. Increased albumin production
B. Reduced bilirubin levels
C. Portal hypertension
D. Increased hepatic blood flow
Rationale: Cirrhosis causes extensive fibrosis and scarring of liver tissue, obstructing
normal blood flow through the liver. This obstruction increases pressure in the portal
venous system, resulting in portal hypertension. Portal hypertension leads to
complications such as ascites, splenomegaly, and esophageal varices. It is a defining
pathophysiologic feature of advanced liver disease.
5. Pathophysiology of emphysema
,Which best describes the underlying pathophysiology of emphysema?
A. Destruction of alveolar walls and loss of elastic recoil
B. Increased mucus production
C. Acute bronchoconstriction
D. Thickening of alveolar membranes
Rationale: Emphysema involves permanent destruction of alveolar walls, reducing
the surface area available for gas exchange. Loss of elastic recoil leads to air trapping
and difficulty with exhalation. Smoking is the most common cause due to chronic
inflammation and protease-mediated tissue damage. These changes result in
progressive dyspnea and hypoxia.
6. Hallmark feature of chronic renal failure
Which finding is most characteristic of chronic renal failure?
A. Decreased glomerular filtration rate (GFR)
B. Acute oliguria
C. Reversible kidney damage
D. Increased erythropoietin production
Rationale: Chronic renal failure is marked by a progressive and irreversible decline in
kidney function. A decreased GFR reflects reduced ability of the kidneys to filter waste
products. This leads to accumulation of urea, creatinine, and electrolytes in the blood.
Over time, complications such as anemia, bone disease, and fluid overload develop.
7. Cellular adaptation
Which cellular adaptation occurs when cells increase in size due to increased
workload?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Rationale: Hypertrophy refers to an increase in cell size, resulting in enlargement of
the affected tissue or organ. It commonly occurs in muscle cells, such as cardiac
hypertrophy in response to chronic hypertension. This adaptation helps cells meet
increased functional demands. However, prolonged hypertrophy can lead to impaired
function.
, 8. Apoptosis
Which statement best describes apoptosis?
A. Always associated with inflammation
B. Programmed cell death without inflammation
C. Caused by acute ischemia only
D. Results in cell swelling and rupture
Rationale: Apoptosis is a regulated, programmed form of cell death that removes
damaged or unnecessary cells. It does not trigger inflammation because cellular
contents are contained and safely removed. This process is essential for normal
development and tissue homeostasis. In contrast, necrosis causes inflammation and
tissue injury.
9. Necrosis
Which feature distinguishes necrosis from apoptosis?
A. DNA fragmentation
B. Cell shrinkage
C. Inflammatory response
D. Energy-dependent process
Rationale: Necrosis is an uncontrolled form of cell death typically caused by severe
injury such as hypoxia or toxins. It results in cell swelling, membrane rupture, and
release of intracellular contents. This triggers a significant inflammatory response in
surrounding tissues. Apoptosis, by contrast, avoids inflammation.
10. Hyperkalemia
Why is hyperkalemia considered life-threatening?
A. Causes hypoglycemia
B. Leads to metabolic alkalosis
C. Can cause fatal cardiac arrhythmias
D. Results in muscle wasting
Rationale: Elevated potassium levels interfere with normal cardiac electrical activity.
Hyperkalemia alters membrane potentials, increasing the risk of arrhythmias and
