WGU D236 Pathophysiology 2026/2027 | WGU D236 Objective Assessment (OA)
Study Guide & Exam Prep | WGU D236 Pathophysiology Course Review | Cellular
Adaptation & Injury, Inflammation, Immunity, Fluid & Electrolyte Balance, Acid-Base
Disorders, Genetics, Neoplasia, Integumentary Disorders, Cardiovascular
Pathophysiology, Respiratory Disorders, Blood & Circulation, Lymphatic & Immune
Disorders, Gastrointestinal Disorders, Neurological Disorders, Renal & Urinary
Disorders, Endocrine Disorders, Musculoskeletal Disorders, Male & Female
Reproductive Disorders | Practice Questions & Detailed Rationales
Question 1: A patient with diabetic ketoacidosis presents with rapid, deep
breathing, elevated blood glucose, and positive serum ketones. Which acid-base
disturbance is most likely present?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
CORRECT ANSWER: C. Metabolic acidosis
Rationale: Diabetic ketoacidosis results from insulin deficiency, leading to lipolysis
and ketone body production. Ketones are acidic and consume bicarbonate,
producing metabolic acidosis with an elevated anion gap and decreased HCO₃⁻.
Question 2: Which cellular adaptation is characterized by an increase in the
number of cells in an organ or tissue?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
CORRECT ANSWER: B. Hyperplasia
Rationale: Hyperplasia is an increase in cell number, often in response to
hormonal stimulation or chronic irritation. Hypertrophy is an increase in cell size,
atrophy is a decrease in cell size, and metaplasia is the replacement of one
differentiated cell type with another.
Question 3: A patient with chronic GERD develops replacement of normal
esophageal squamous epithelium with columnar epithelium. This is an example
of which cellular adaptation?
,A. Dysplasia
B. Anaplasia
C. Metaplasia
D. Hyperplasia
CORRECT ANSWER: C. Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with
another in response to chronic stress. Barrett's esophagus is a classic example
where squamous epithelium is replaced by columnar epithelium due to chronic
acid exposure.
Question 4: Which term describes the reversible decrease in cell size and
metabolic activity due to reduced workload or diminished blood supply?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Dysplasia
CORRECT ANSWER: A. Atrophy
Rationale: Atrophy is a decrease in cell size and metabolic activity resulting from
reduced workload, denervation, diminished blood supply, inadequate nutrition,
or aging. It is a reversible adaptive response.
Question 5: Which type of cellular change is considered a precursor to
malignancy and features abnormal variation in cell size, shape, and nuclear
appearance?
A. Metaplasia
B. Dysplasia
C. Hypertrophy
D. Atrophy
CORRECT ANSWER: B. Dysplasia
Rationale: Dysplasia is characterized by pleomorphism, hyperchromatic nuclei,
and increased mitotic activity. It is not cancer but represents a precursor lesion
that may progress to malignancy if the stimulus persists.
,Question 6: A patient with long-standing hypertension develops thickening of
the left ventricular wall. Which cellular adaptation explains this finding?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Atrophy
CORRECT ANSWER: C. Hypertrophy
Rationale: Hypertrophy is an increase in cell size that leads to organ enlargement.
The left ventricle hypertrophies in response to chronic pressure overload from
hypertension as a compensatory mechanism.
Question 7: In diabetic ketoacidosis, what happens to the anion gap and
bicarbonate level?
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
CORRECT ANSWER: A. Anion gap increases and HCO₃⁻ decreases
Rationale: In DKA, ketone bodies are unmeasured anions that accumulate,
increasing the anion gap. Bicarbonate decreases as it buffers the excess acid.
Question 8: How do the 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⁻
CORRECT ANSWER: A. Retain H⁺ and excrete HCO₃⁻
Rationale: In alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate
to lower pH back toward normal. The opposite occurs in acidosis.
Question 9: Which electrolyte imbalance is present when serum sodium is 167
mEq/L?
, A. Hyponatremia
B. Hypernatremia
C. Hypokalemia
D. Hyperkalemia
CORRECT ANSWER: B. Hypernatremia
Rationale: Normal serum sodium is 135–145 mEq/L. A value of 167 mEq/L is
elevated, indicating hypernatremia, which can cause altered mental status and
neurologic symptoms.
Question 10: What is the primary metabolic adaptation in a cell with deficient
oxidative phosphorylation?
A. Increased fatty acid oxidation
B. Upregulation of anaerobic glycolysis
C. Enhanced ketone body synthesis
D. Activation of the pentose phosphate pathway
CORRECT ANSWER: B. Upregulation of anaerobic glycolysis
Rationale: Deficient oxidative phosphorylation shifts metabolism to anaerobic
glycolysis, producing ATP but also lactate. Lactate accumulation can cause lactic
acidosis.
Question 11: Which molecular change characterizes the transition from adaptive
hypertrophy to pathological remodeling in pressure-overloaded myocardium?
A. Switch to fetal β-myosin heavy chain and increased collagen deposition
B. Increased capillary density with reduced oxygen diffusion distance
C. Upregulation of SERCA2a and improved calcium reuptake
D. Apoptosis of fibroblasts and decreased extracellular matrix turnover
CORRECT ANSWER: A. Switch to fetal β-myosin heavy chain and increased
collagen deposition
Rationale: Pressure overload causes a switch from adult α-myosin to fetal β-
myosin (slower ATPase activity) and increased collagen deposition, leading to
fibrosis and reduced compliance. This maladaptive remodeling progresses to
heart failure.
Study Guide & Exam Prep | WGU D236 Pathophysiology Course Review | Cellular
Adaptation & Injury, Inflammation, Immunity, Fluid & Electrolyte Balance, Acid-Base
Disorders, Genetics, Neoplasia, Integumentary Disorders, Cardiovascular
Pathophysiology, Respiratory Disorders, Blood & Circulation, Lymphatic & Immune
Disorders, Gastrointestinal Disorders, Neurological Disorders, Renal & Urinary
Disorders, Endocrine Disorders, Musculoskeletal Disorders, Male & Female
Reproductive Disorders | Practice Questions & Detailed Rationales
Question 1: A patient with diabetic ketoacidosis presents with rapid, deep
breathing, elevated blood glucose, and positive serum ketones. Which acid-base
disturbance is most likely present?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
CORRECT ANSWER: C. Metabolic acidosis
Rationale: Diabetic ketoacidosis results from insulin deficiency, leading to lipolysis
and ketone body production. Ketones are acidic and consume bicarbonate,
producing metabolic acidosis with an elevated anion gap and decreased HCO₃⁻.
Question 2: Which cellular adaptation is characterized by an increase in the
number of cells in an organ or tissue?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
CORRECT ANSWER: B. Hyperplasia
Rationale: Hyperplasia is an increase in cell number, often in response to
hormonal stimulation or chronic irritation. Hypertrophy is an increase in cell size,
atrophy is a decrease in cell size, and metaplasia is the replacement of one
differentiated cell type with another.
Question 3: A patient with chronic GERD develops replacement of normal
esophageal squamous epithelium with columnar epithelium. This is an example
of which cellular adaptation?
,A. Dysplasia
B. Anaplasia
C. Metaplasia
D. Hyperplasia
CORRECT ANSWER: C. Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with
another in response to chronic stress. Barrett's esophagus is a classic example
where squamous epithelium is replaced by columnar epithelium due to chronic
acid exposure.
Question 4: Which term describes the reversible decrease in cell size and
metabolic activity due to reduced workload or diminished blood supply?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Dysplasia
CORRECT ANSWER: A. Atrophy
Rationale: Atrophy is a decrease in cell size and metabolic activity resulting from
reduced workload, denervation, diminished blood supply, inadequate nutrition,
or aging. It is a reversible adaptive response.
Question 5: Which type of cellular change is considered a precursor to
malignancy and features abnormal variation in cell size, shape, and nuclear
appearance?
A. Metaplasia
B. Dysplasia
C. Hypertrophy
D. Atrophy
CORRECT ANSWER: B. Dysplasia
Rationale: Dysplasia is characterized by pleomorphism, hyperchromatic nuclei,
and increased mitotic activity. It is not cancer but represents a precursor lesion
that may progress to malignancy if the stimulus persists.
,Question 6: A patient with long-standing hypertension develops thickening of
the left ventricular wall. Which cellular adaptation explains this finding?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Atrophy
CORRECT ANSWER: C. Hypertrophy
Rationale: Hypertrophy is an increase in cell size that leads to organ enlargement.
The left ventricle hypertrophies in response to chronic pressure overload from
hypertension as a compensatory mechanism.
Question 7: In diabetic ketoacidosis, what happens to the anion gap and
bicarbonate level?
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
CORRECT ANSWER: A. Anion gap increases and HCO₃⁻ decreases
Rationale: In DKA, ketone bodies are unmeasured anions that accumulate,
increasing the anion gap. Bicarbonate decreases as it buffers the excess acid.
Question 8: How do the 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⁻
CORRECT ANSWER: A. Retain H⁺ and excrete HCO₃⁻
Rationale: In alkalosis, the kidneys retain hydrogen ions and excrete bicarbonate
to lower pH back toward normal. The opposite occurs in acidosis.
Question 9: Which electrolyte imbalance is present when serum sodium is 167
mEq/L?
, A. Hyponatremia
B. Hypernatremia
C. Hypokalemia
D. Hyperkalemia
CORRECT ANSWER: B. Hypernatremia
Rationale: Normal serum sodium is 135–145 mEq/L. A value of 167 mEq/L is
elevated, indicating hypernatremia, which can cause altered mental status and
neurologic symptoms.
Question 10: What is the primary metabolic adaptation in a cell with deficient
oxidative phosphorylation?
A. Increased fatty acid oxidation
B. Upregulation of anaerobic glycolysis
C. Enhanced ketone body synthesis
D. Activation of the pentose phosphate pathway
CORRECT ANSWER: B. Upregulation of anaerobic glycolysis
Rationale: Deficient oxidative phosphorylation shifts metabolism to anaerobic
glycolysis, producing ATP but also lactate. Lactate accumulation can cause lactic
acidosis.
Question 11: Which molecular change characterizes the transition from adaptive
hypertrophy to pathological remodeling in pressure-overloaded myocardium?
A. Switch to fetal β-myosin heavy chain and increased collagen deposition
B. Increased capillary density with reduced oxygen diffusion distance
C. Upregulation of SERCA2a and improved calcium reuptake
D. Apoptosis of fibroblasts and decreased extracellular matrix turnover
CORRECT ANSWER: A. Switch to fetal β-myosin heavy chain and increased
collagen deposition
Rationale: Pressure overload causes a switch from adult α-myosin to fetal β-
myosin (slower ATPase activity) and increased collagen deposition, leading to
fibrosis and reduced compliance. This maladaptive remodeling progresses to
heart failure.
