WESTERN GOVERNORS UNIVERSITY
WGU D236 —
Pathophysiology
Practice Question Bank
Pathophysiology — NCLEX-Style Practice Questions with Rationales
Comprehensive Review: Fluids & Electrolytes, Immunology, Neurology,
Oncology & More
Edition 1 · July 2026
Table of Contents
1. Instructions for Use 2
2. Practice Questions with Answers & Rationales 2
WGU D236 · Western Governors University Page 1
,WGU D236 PATHOPHYSIOLOGY PRACTICE GUIDE INSTRUCTIONS & PRACTICE QUESTIONS
How to Use This Guide
Read each stem, choose your answer, then check the rationale directly below it. The correct
option is marked, and each wrong option is explained so you understand why it's wrong — not
just that it is.
Category: Pathophysiology — Comprehensive Review
1 What happens to the various anion levels in the bloodstream during diabetic
ketoacidosis?
A Anion gap increases and HCO₃⁻ decreases
B Anion gap decreases and HCO₃⁻ increases
C Both anion gap and HCO₃⁻ increase
D Both anion gap and HCO₃⁻ decrease
Why A is correct: In diabetic ketoacidosis, the anion gap increases due to ketone
accumulation, and bicarbonate (HCO₃⁻) decreases as it buffers the excess acid.
B — This is the opposite of what occurs in DKA.
C — HCO₃⁻ decreases, not increases.
D — The anion gap increases, not decreases.
, 2 How do kidneys compensate for alkalosis?
A Retain H⁺ and excrete HCO₃⁻
B Excrete H⁺ and retain HCO₃⁻
C Retain both H⁺ and HCO₃⁻
D Excrete both H⁺ and HCO₃⁻
Why A is correct: In alkalosis, the kidneys retain hydrogen ions (H⁺) and excrete
bicarbonate (HCO₃⁻) to lower pH back toward normal.
B — This is the response to acidosis.
C — This would worsen alkalosis.
D — This is not a compensatory mechanism.
3 Patient presents with altered mental status and decreased fluid intake, diagnosed
with UTI. Labs show Na⁺ 167 and K⁺ 4.0. What is the electrolyte balance?
A Hypernatremia
B Hyponatremia
C Hypokalemia
D Hyperkalemia
Why A is correct: Serum sodium of 167 mEq/L is elevated above normal (135–145 mEq/L),
indicating hypernatremia.
B — Sodium is elevated, not decreased.
C — Potassium is normal (4.0).
D — Potassium is normal (4.0).
WGU D236 —
Pathophysiology
Practice Question Bank
Pathophysiology — NCLEX-Style Practice Questions with Rationales
Comprehensive Review: Fluids & Electrolytes, Immunology, Neurology,
Oncology & More
Edition 1 · July 2026
Table of Contents
1. Instructions for Use 2
2. Practice Questions with Answers & Rationales 2
WGU D236 · Western Governors University Page 1
,WGU D236 PATHOPHYSIOLOGY PRACTICE GUIDE INSTRUCTIONS & PRACTICE QUESTIONS
How to Use This Guide
Read each stem, choose your answer, then check the rationale directly below it. The correct
option is marked, and each wrong option is explained so you understand why it's wrong — not
just that it is.
Category: Pathophysiology — Comprehensive Review
1 What happens to the various anion levels in the bloodstream during diabetic
ketoacidosis?
A Anion gap increases and HCO₃⁻ decreases
B Anion gap decreases and HCO₃⁻ increases
C Both anion gap and HCO₃⁻ increase
D Both anion gap and HCO₃⁻ decrease
Why A is correct: In diabetic ketoacidosis, the anion gap increases due to ketone
accumulation, and bicarbonate (HCO₃⁻) decreases as it buffers the excess acid.
B — This is the opposite of what occurs in DKA.
C — HCO₃⁻ decreases, not increases.
D — The anion gap increases, not decreases.
, 2 How do kidneys compensate for alkalosis?
A Retain H⁺ and excrete HCO₃⁻
B Excrete H⁺ and retain HCO₃⁻
C Retain both H⁺ and HCO₃⁻
D Excrete both H⁺ and HCO₃⁻
Why A is correct: In alkalosis, the kidneys retain hydrogen ions (H⁺) and excrete
bicarbonate (HCO₃⁻) to lower pH back toward normal.
B — This is the response to acidosis.
C — This would worsen alkalosis.
D — This is not a compensatory mechanism.
3 Patient presents with altered mental status and decreased fluid intake, diagnosed
with UTI. Labs show Na⁺ 167 and K⁺ 4.0. What is the electrolyte balance?
A Hypernatremia
B Hyponatremia
C Hypokalemia
D Hyperkalemia
Why A is correct: Serum sodium of 167 mEq/L is elevated above normal (135–145 mEq/L),
indicating hypernatremia.
B — Sodium is elevated, not decreased.
C — Potassium is normal (4.0).
D — Potassium is normal (4.0).
