WGU D236 PATHOPHYSIOLOGY OBJECTIVE
ASSESSMENT EXAM 2026/2027 | Grade A
Preparation | Verified Q&A | Pass Guaranteed - A+
Graded
Section 1: Cellular Adaptation, Injury & Neoplasia (Q1-10)
Q1. A 45-year-old male with a history of heavy alcohol use presents with liver
enlargement. Liver biopsy reveals hepatocytes that are enlarged with abundant
cytoplasm. The nurse recognizes this cellular adaptation as:
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
B. Hypertrophy [CORRECT]
Rationale: Hypertrophy is an increase in cell size resulting in enlarged tissue mass,
characteristic of alcoholic hepatomegaly where individual hepatocytes enlarge. A is
incorrect (atrophy is decreased cell size). C is incorrect (hyperplasia is increased cell
number, not size). D is incorrect (metaplasia is replacement of one cell type by
another).
Correct Answer: B
Q2. A 62-year-old female with chronic gastroesophageal reflux disease undergoes
endoscopy. Biopsy reveals columnar epithelium replacing the normal squamous
epithelium in the distal esophagus. This cellular adaptation is termed:
A. Dysplasia
B. Hyperplasia
,C. Metaplasia
D. Anaplasia
C. Metaplasia [CORRECT]
Rationale: Metaplasia is the reversible replacement of one differentiated cell type by
another, as seen in Barrett esophagus where squamous epithelium is replaced by
columnar epithelium due to chronic acid exposure. A is incorrect (dysplasia involves
abnormal cell growth and loss of polarity). B is incorrect (hyperplasia is increased cell
proliferation). D is incorrect (anaplasia is loss of differentiation in malignancy).
Correct Answer: C
Q3. A 28-year-old female has her left kidney surgically removed. Six months later,
ultrasound reveals the remaining right kidney has increased in size. The cellular
adaptation responsible for this change is:
A. Compensatory hypertrophy
B. Physiologic atrophy
C. Pathologic hyperplasia
D. Metaplastic transformation
A. Compensatory hypertrophy [CORRECT]
Rationale: Compensatory hypertrophy occurs when an organ enlarges to compensate
for loss or decreased function of a paired organ, as seen in the remaining kidney
after nephrectomy. B is incorrect (atrophy is decreased size, not enlargement). C is
incorrect (this is not abnormal proliferation). D is incorrect (no cell type
transformation occurs).
Correct Answer: A
Q4. A 55-year-old male smoker presents with a persistent cough. Sputum cytology
reveals squamous cells with enlarged hyperchromatic nuclei, increased nuclear-to-
cytoplasmic ratio, and loss of normal maturation pattern. These findings are
consistent with:
,A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Hypertrophy
B. Dysplasia [CORRECT]
Rationale: Dysplasia is characterized by disordered cell growth with nuclear
pleomorphism, hyperchromatism, and loss of polarity—precancerous changes often
seen in smokers. A is incorrect (metaplasia is reversible cell type replacement without
nuclear atypia). C is incorrect (hyperplasia is increased cell number without atypia). D
is incorrect (hypertrophy is increased cell size without atypia).
Correct Answer: B
Q5. A 70-year-old male with prostate cancer is receiving androgen deprivation
therapy. Over 6 months, his skeletal muscle mass decreases significantly. This change
represents:
A. Physiologic atrophy
B. Pathologic atrophy
C. Disuse atrophy
D. Neurogenic atrophy
B. Pathologic atrophy [CORRECT]
Rationale: Pathologic atrophy results from disease processes or hormonal changes,
such as androgen deprivation causing decreased protein synthesis and muscle
wasting. A is incorrect (physiologic atrophy occurs with normal aging or
development). C is incorrect (disuse atrophy results from immobilization). D is
incorrect (neurogenic atrophy follows nerve damage).
Correct Answer: B
Q6. A 35-year-old female presents with a breast lump. Biopsy reveals ducts filled with
multiple layers of epithelial cells that maintain normal polarity and maturation. This
finding represents:
, A. Ductal carcinoma in situ
B. Atypical hyperplasia
C. Usual ductal hyperplasia
D. Lobular carcinoma
C. Usual ductal hyperplasia [CORRECT]
Rationale: Usual ductal hyperplasia is a benign proliferation of cells within ducts with
maintained polarity and maturation, without significant cytologic atypia. A is
incorrect (DCIS shows malignant cells confined to ducts). B is incorrect (atypical
hyperplasia shows cytologic and architectural atypia). D is incorrect (lobular
carcinoma is malignant with characteristic single-file pattern).
Correct Answer: C
Q7. A 50-year-old male with chronic hypertension has left ventricular wall thickening
on echocardiogram. The myocardial cells demonstrate increased size with preserved
nuclear-to-cytoplasmic ratio. This adaptation is:
A. Concentric hypertrophy
B. Eccentric hypertrophy
C. Myocardial hyperplasia
D. Myocardial atrophy
A. Concentric hypertrophy [CORRECT]
Rationale: Chronic pressure overload from hypertension causes concentric
hypertrophy—parallel addition of sarcomeres resulting in thickened walls without
chamber dilation. B is incorrect (eccentric hypertrophy occurs with volume overload
and chamber dilation). C is incorrect (cardiac myocytes have limited regenerative
capacity). D is incorrect (atrophy is decreased size, opposite of what is described).
Correct Answer: A
Q8. A 40-year-old female with chronic iron deficiency anemia has spoon-shaped nails
(koilonychia) and esophageal webs. These findings are associated with which
precancerous condition?
ASSESSMENT EXAM 2026/2027 | Grade A
Preparation | Verified Q&A | Pass Guaranteed - A+
Graded
Section 1: Cellular Adaptation, Injury & Neoplasia (Q1-10)
Q1. A 45-year-old male with a history of heavy alcohol use presents with liver
enlargement. Liver biopsy reveals hepatocytes that are enlarged with abundant
cytoplasm. The nurse recognizes this cellular adaptation as:
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
B. Hypertrophy [CORRECT]
Rationale: Hypertrophy is an increase in cell size resulting in enlarged tissue mass,
characteristic of alcoholic hepatomegaly where individual hepatocytes enlarge. A is
incorrect (atrophy is decreased cell size). C is incorrect (hyperplasia is increased cell
number, not size). D is incorrect (metaplasia is replacement of one cell type by
another).
Correct Answer: B
Q2. A 62-year-old female with chronic gastroesophageal reflux disease undergoes
endoscopy. Biopsy reveals columnar epithelium replacing the normal squamous
epithelium in the distal esophagus. This cellular adaptation is termed:
A. Dysplasia
B. Hyperplasia
,C. Metaplasia
D. Anaplasia
C. Metaplasia [CORRECT]
Rationale: Metaplasia is the reversible replacement of one differentiated cell type by
another, as seen in Barrett esophagus where squamous epithelium is replaced by
columnar epithelium due to chronic acid exposure. A is incorrect (dysplasia involves
abnormal cell growth and loss of polarity). B is incorrect (hyperplasia is increased cell
proliferation). D is incorrect (anaplasia is loss of differentiation in malignancy).
Correct Answer: C
Q3. A 28-year-old female has her left kidney surgically removed. Six months later,
ultrasound reveals the remaining right kidney has increased in size. The cellular
adaptation responsible for this change is:
A. Compensatory hypertrophy
B. Physiologic atrophy
C. Pathologic hyperplasia
D. Metaplastic transformation
A. Compensatory hypertrophy [CORRECT]
Rationale: Compensatory hypertrophy occurs when an organ enlarges to compensate
for loss or decreased function of a paired organ, as seen in the remaining kidney
after nephrectomy. B is incorrect (atrophy is decreased size, not enlargement). C is
incorrect (this is not abnormal proliferation). D is incorrect (no cell type
transformation occurs).
Correct Answer: A
Q4. A 55-year-old male smoker presents with a persistent cough. Sputum cytology
reveals squamous cells with enlarged hyperchromatic nuclei, increased nuclear-to-
cytoplasmic ratio, and loss of normal maturation pattern. These findings are
consistent with:
,A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Hypertrophy
B. Dysplasia [CORRECT]
Rationale: Dysplasia is characterized by disordered cell growth with nuclear
pleomorphism, hyperchromatism, and loss of polarity—precancerous changes often
seen in smokers. A is incorrect (metaplasia is reversible cell type replacement without
nuclear atypia). C is incorrect (hyperplasia is increased cell number without atypia). D
is incorrect (hypertrophy is increased cell size without atypia).
Correct Answer: B
Q5. A 70-year-old male with prostate cancer is receiving androgen deprivation
therapy. Over 6 months, his skeletal muscle mass decreases significantly. This change
represents:
A. Physiologic atrophy
B. Pathologic atrophy
C. Disuse atrophy
D. Neurogenic atrophy
B. Pathologic atrophy [CORRECT]
Rationale: Pathologic atrophy results from disease processes or hormonal changes,
such as androgen deprivation causing decreased protein synthesis and muscle
wasting. A is incorrect (physiologic atrophy occurs with normal aging or
development). C is incorrect (disuse atrophy results from immobilization). D is
incorrect (neurogenic atrophy follows nerve damage).
Correct Answer: B
Q6. A 35-year-old female presents with a breast lump. Biopsy reveals ducts filled with
multiple layers of epithelial cells that maintain normal polarity and maturation. This
finding represents:
, A. Ductal carcinoma in situ
B. Atypical hyperplasia
C. Usual ductal hyperplasia
D. Lobular carcinoma
C. Usual ductal hyperplasia [CORRECT]
Rationale: Usual ductal hyperplasia is a benign proliferation of cells within ducts with
maintained polarity and maturation, without significant cytologic atypia. A is
incorrect (DCIS shows malignant cells confined to ducts). B is incorrect (atypical
hyperplasia shows cytologic and architectural atypia). D is incorrect (lobular
carcinoma is malignant with characteristic single-file pattern).
Correct Answer: C
Q7. A 50-year-old male with chronic hypertension has left ventricular wall thickening
on echocardiogram. The myocardial cells demonstrate increased size with preserved
nuclear-to-cytoplasmic ratio. This adaptation is:
A. Concentric hypertrophy
B. Eccentric hypertrophy
C. Myocardial hyperplasia
D. Myocardial atrophy
A. Concentric hypertrophy [CORRECT]
Rationale: Chronic pressure overload from hypertension causes concentric
hypertrophy—parallel addition of sarcomeres resulting in thickened walls without
chamber dilation. B is incorrect (eccentric hypertrophy occurs with volume overload
and chamber dilation). C is incorrect (cardiac myocytes have limited regenerative
capacity). D is incorrect (atrophy is decreased size, opposite of what is described).
Correct Answer: A
Q8. A 40-year-old female with chronic iron deficiency anemia has spoon-shaped nails
(koilonychia) and esophageal webs. These findings are associated with which
precancerous condition?
