PATHOPHYSIOLOGY — NURSING & HEALTH SCIENCES
WGU D236 OBJECTIVE ASSESSMENT A+
AND PRACTICE EXAM
2026/2027
Pathophysiology — Official-Style Objective Assessment
A+ QUESTIONS
VERIFIED
5 SECTIONS
COVERED
100% RATIONALES
INCLUDED
CATEGORIES
■ Section 1 — Homeostasis, Fluids, Electrolytes & Acid-Base
■ Section 2 — Cellular Adaptation, Inflammation, Immunity & Neoplasia
■ Section 3 — Cardiovascular & Respiratory Pathophysiology
■ Section 4 — Renal, Gastrointestinal & Endocrine Disorders
■ Section 5 — Neurologic, Musculoskeletal, Integumentary & Reproductive
STUVIAACTUALEXAM
Passing Score: 75% | 1 mark per question | Upper-Level Undergraduate | Application/Analysis
, Section 1: Homeostasis, Fluids, Electrolytes & Acid-Base
Q1. A 68-year-old client with heart failure develops bilateral pitting edema and a serum albumin of 2.1 g/dL. The nurse recognizes that the
edema is primarily driven by which alteration in Starling forces?
A. Increased capillary hydrostatic pressure from hypervolemia only
B. Decreased plasma oncotic pressure allowing fluid to remain in the interstitial space
C. Increased interstitial oncotic pressure from protein leakage
D. Decreased capillary permeability preventing fluid movement
Correct Answer: B
Rationale: Low albumin reduces plasma oncotic (colloid osmotic) pressure, the force that pulls fluid back into the capillary. When this force falls, fluid accumulates in the
interstitium, producing edema.
Q2. A client presents with confusion, serum sodium 118 mEq/L, and concentrated urine. The history includes recent head trauma. The
nurse anticipates the most likely diagnosis and fluid status is
A. Dehydration with hypernatremia
B. Diabetes insipidus with hypernatremia
C. SIADH with euvolemic hyponatremia
D. Hyperaldosteronism with hypernatremia
Correct Answer: C
Rationale: SIADH causes inappropriate water retention, diluting serum sodium while the urine remains concentrated. Post-traumatic SIADH is a classic etiology of
euvolemic hyponatremia.
Q3. A client’s arterial blood gas shows pH 7.28, PaCO2 58 mm Hg, HCO3 24 mEq/L. The nurse interprets this result as
A. Metabolic alkalosis with respiratory compensation
B. Acute respiratory acidosis
C. Fully compensated metabolic acidosis
D. Acute metabolic acidosis
Correct Answer: B
Rationale: Low pH with elevated PaCO2 and normal HCO3 indicates acute (uncompensated) respiratory acidosis; the kidneys have not yet retained bicarbonate.
Q4. A client with severe vomiting develops metabolic alkalosis. The nurse expects which compensatory respiratory response?
A. Hyperventilation to eliminate CO2 and raise pH
B. Hypoventilation to retain CO2 and lower pH toward normal
C. No change in respiratory rate
D. Kussmaul respirations to blow off acid
Correct Answer: B
Rationale: In metabolic alkalosis the respiratory system compensates by hypoventilating, allowing PaCO2 to rise and thereby reducing pH toward the normal range.
Q5. A client receiving loop diuretics develops muscle weakness and U waves on the ECG. The priority electrolyte imbalance to correct is
A. Hypercalcemia
B. Hypernatremia
C. Hypokalemia
D. Hypermagnesemia
Correct Answer: C
Rationale: Loop diuretics cause urinary potassium wasting. Hypokalemia produces muscle weakness and characteristic ECG changes including U waves and flattened
T waves.
Q6. Activation of the renin-angiotensin-aldosterone system is triggered primarily by
A. Elevated serum sodium concentration
B. Decreased renal perfusion pressure sensed by the juxtaglomerular apparatus
C. Increased atrial natriuretic peptide release
D. High blood volume stretching the atria
Correct Answer: B
Rationale: Low renal blood flow or low sodium delivery to the distal tubule stimulates renin release, initiating the cascade that raises blood volume and pressure.
Q7. A client with chronic kidney disease has a serum potassium of 6.4 mEq/L and peaked T waves. The nurse anticipates that the most
immediate pharmacologic intervention to protect the heart is
A. Intravenous calcium gluconate to stabilize cardiac membranes
B. Oral sodium polystyrene sulfonate only
C. High-dose loop diuretic without cardiac monitoring
D. Insulin and glucose without calcium
Correct Answer: A
Rationale: Calcium antagonizes the cardiac effects of hyperkalemia within minutes, buying time for measures that actually lower serum potassium.
STUVIAACTUALEXAM | Page 2 of 12
WGU D236 OBJECTIVE ASSESSMENT A+
AND PRACTICE EXAM
2026/2027
Pathophysiology — Official-Style Objective Assessment
A+ QUESTIONS
VERIFIED
5 SECTIONS
COVERED
100% RATIONALES
INCLUDED
CATEGORIES
■ Section 1 — Homeostasis, Fluids, Electrolytes & Acid-Base
■ Section 2 — Cellular Adaptation, Inflammation, Immunity & Neoplasia
■ Section 3 — Cardiovascular & Respiratory Pathophysiology
■ Section 4 — Renal, Gastrointestinal & Endocrine Disorders
■ Section 5 — Neurologic, Musculoskeletal, Integumentary & Reproductive
STUVIAACTUALEXAM
Passing Score: 75% | 1 mark per question | Upper-Level Undergraduate | Application/Analysis
, Section 1: Homeostasis, Fluids, Electrolytes & Acid-Base
Q1. A 68-year-old client with heart failure develops bilateral pitting edema and a serum albumin of 2.1 g/dL. The nurse recognizes that the
edema is primarily driven by which alteration in Starling forces?
A. Increased capillary hydrostatic pressure from hypervolemia only
B. Decreased plasma oncotic pressure allowing fluid to remain in the interstitial space
C. Increased interstitial oncotic pressure from protein leakage
D. Decreased capillary permeability preventing fluid movement
Correct Answer: B
Rationale: Low albumin reduces plasma oncotic (colloid osmotic) pressure, the force that pulls fluid back into the capillary. When this force falls, fluid accumulates in the
interstitium, producing edema.
Q2. A client presents with confusion, serum sodium 118 mEq/L, and concentrated urine. The history includes recent head trauma. The
nurse anticipates the most likely diagnosis and fluid status is
A. Dehydration with hypernatremia
B. Diabetes insipidus with hypernatremia
C. SIADH with euvolemic hyponatremia
D. Hyperaldosteronism with hypernatremia
Correct Answer: C
Rationale: SIADH causes inappropriate water retention, diluting serum sodium while the urine remains concentrated. Post-traumatic SIADH is a classic etiology of
euvolemic hyponatremia.
Q3. A client’s arterial blood gas shows pH 7.28, PaCO2 58 mm Hg, HCO3 24 mEq/L. The nurse interprets this result as
A. Metabolic alkalosis with respiratory compensation
B. Acute respiratory acidosis
C. Fully compensated metabolic acidosis
D. Acute metabolic acidosis
Correct Answer: B
Rationale: Low pH with elevated PaCO2 and normal HCO3 indicates acute (uncompensated) respiratory acidosis; the kidneys have not yet retained bicarbonate.
Q4. A client with severe vomiting develops metabolic alkalosis. The nurse expects which compensatory respiratory response?
A. Hyperventilation to eliminate CO2 and raise pH
B. Hypoventilation to retain CO2 and lower pH toward normal
C. No change in respiratory rate
D. Kussmaul respirations to blow off acid
Correct Answer: B
Rationale: In metabolic alkalosis the respiratory system compensates by hypoventilating, allowing PaCO2 to rise and thereby reducing pH toward the normal range.
Q5. A client receiving loop diuretics develops muscle weakness and U waves on the ECG. The priority electrolyte imbalance to correct is
A. Hypercalcemia
B. Hypernatremia
C. Hypokalemia
D. Hypermagnesemia
Correct Answer: C
Rationale: Loop diuretics cause urinary potassium wasting. Hypokalemia produces muscle weakness and characteristic ECG changes including U waves and flattened
T waves.
Q6. Activation of the renin-angiotensin-aldosterone system is triggered primarily by
A. Elevated serum sodium concentration
B. Decreased renal perfusion pressure sensed by the juxtaglomerular apparatus
C. Increased atrial natriuretic peptide release
D. High blood volume stretching the atria
Correct Answer: B
Rationale: Low renal blood flow or low sodium delivery to the distal tubule stimulates renin release, initiating the cascade that raises blood volume and pressure.
Q7. A client with chronic kidney disease has a serum potassium of 6.4 mEq/L and peaked T waves. The nurse anticipates that the most
immediate pharmacologic intervention to protect the heart is
A. Intravenous calcium gluconate to stabilize cardiac membranes
B. Oral sodium polystyrene sulfonate only
C. High-dose loop diuretic without cardiac monitoring
D. Insulin and glucose without calcium
Correct Answer: A
Rationale: Calcium antagonizes the cardiac effects of hyperkalemia within minutes, buying time for measures that actually lower serum potassium.
STUVIAACTUALEXAM | Page 2 of 12
