WGU D027 Final Exam ACTUAL
EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1: A 68-year-old patient with COPD presents with acute exacerbation. Arterial blood
gases show: pH 7.32, PaCO2 65 mmHg, PaO2 48 mmHg, HCO3- 32 mEq/L. Which acid-base
disorder is present?
A. Respiratory alkalosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory acidosis with metabolic compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: C
Rationale: The pH is acidotic (normal 7.35-7.45), PaCO2 is elevated (normal 35-45) indicating
respiratory acidosis, and HCO3- is elevated (normal 22-26) showing metabolic compensation. This
is consistent with chronic COPD exacerbation where kidneys retain bicarbonate to compensate for
chronic CO2 retention.
Question 2: A patient with heart failure presents with bilateral pitting edema, jugular venous
distension, and hepatomegaly. Which compensatory mechanism is most responsible for the fluid
retention?
A. Sympathetic nervous system activation
B. Renin-angiotensin-aldosterone system activation
C. Atrial natriuretic peptide release
D. Ventricular remodeling
Correct Answer: B
Rationale: RAAS activation leads to aldosterone secretion, causing sodium and water retention in
the kidneys. This compensatory mechanism attempts to maintain perfusion but contributes to fluid
overload in heart failure. The other options don't directly cause fluid retention.
,Question 3: A 45-year-old with diabetes presents with microalbuminuria, retinopathy, and
peripheral neuropathy. Which pathophysiological mechanism underlies all these complications?
A. Advanced glycation end products accumulation
B. Increased insulin production
C. Enhanced glucose uptake by cells
D. Decreased inflammatory cytokines
Correct Answer: A
Rationale: AGEs form when glucose binds non-enzymatically to proteins, causing structural and
functional changes in blood vessels, nerves, and basement membranes. This leads to the
microvascular complications seen in diabetes including nephropathy, retinopathy, and neuropathy.
Question 4: A patient with septic shock has BP 78/42 mmHg, HR 125 bpm, urine output 15 mL/hr,
and lactate 4.8 mmol/L. Which cellular dysfunction is primarily responsible for the elevated lactate?
A. Increased pyruvate dehydrogenase activity
B. Mitochondrial dysfunction and anaerobic metabolism
C. Enhanced gluconeogenesis
D. Decreased glycolysis
Correct Answer: B
Rationale: In septic shock, mitochondrial dysfunction prevents aerobic metabolism, forcing cells to
rely on anaerobic glycolysis. This produces lactate as an end product when pyruvate cannot enter
the Krebs cycle, leading to lactic acidosis.
Question 5: A patient with cirrhosis develops hepatic encephalopathy. Which neurotransmitter
imbalance contributes to the altered mental status?
A. Decreased GABA
B. Increased dopamine
C. Increased serotonin
D. Increased ammonia affecting glutamate metabolism
Correct Answer: D
Rationale: In liver failure, ammonia accumulates and crosses the blood-brain barrier, affecting
astrocyte glutamate metabolism and causing swelling. This leads to altered neurotransmission and
the characteristic neuropsychiatric symptoms of hepatic encephalopathy.
Question 6: A patient with acute respiratory distress syndrome (ARDS) has a PaO2/FiO2 ratio of
180. Which pathophysiological change is most responsible for the impaired oxygenation?
A. Increased surfactant production
B. Alveolar collapse and consolidation
C. Bronchial smooth muscle relaxation
,D. Increased lung compliance
Correct Answer: B
Rationale: ARDS causes alveolar damage with protein-rich exudate formation, leading to alveolar
collapse, consolidation, and impaired gas exchange. The inflammatory response damages type II
pneumocytes, reducing surfactant and worsening collapse.
Question 7: A patient with chronic kidney disease stage 4 presents with anemia. Which mechanism
is most responsible for the decreased hemoglobin?
A. Iron deficiency from poor dietary intake
B. B12 deficiency from malabsorption
C. Decreased erythropoietin production
D. Increased red blood cell destruction
Correct Answer: C
Rationale: The kidneys produce erythropoietin, which stimulates bone marrow red blood cell
production. In CKD, damaged kidneys produce insufficient erythropoietin, leading to normocytic,
normochromic anemia. This is the primary mechanism in CKD-related anemia.
Question 8: A patient with Addison's disease presents with hypotension, hyperkalemia, and
hyponatremia. Which hormone deficiency is primarily responsible for the electrolyte imbalances?
A. Cortisol
B. Aldosterone
C. ACTH
D. ADH
Correct Answer: B
Rationale: Aldosterone deficiency in Addison's disease causes decreased sodium reabsorption
and potassium excretion in the distal nephron, leading to hyponatremia and hyperkalemia. Cortisol
deficiency contributes to hypotension but doesn't directly cause these electrolyte changes.
Question 9: A patient with myocardial infarction develops cardiogenic shock. Which hemodynamic
parameter is most consistent with this diagnosis?
A. Cardiac index > 2.5 L/min/m²
B. Pulmonary capillary wedge pressure < 8 mmHg
C. Systemic vascular resistance > 1200 dynes·sec/cm⁵
D. Mixed venous oxygen saturation > 70%
Correct Answer: C
, Rationale: Cardiogenic shock is characterized by decreased cardiac output and compensatory
vasoconstriction, leading to elevated systemic vascular resistance. The cardiac index is typically <
2.2 L/min/m², PCWP is elevated (> 15 mmHg), and SvO2 is decreased (< 65%).
Question 10: A patient with pulmonary embolism develops acute right ventricular failure. Which
pathophysiological change contributes to the decreased cardiac output?
A. Increased left ventricular preload
B. Decreased right ventricular afterload
C. Ventricular interdependence causing leftward septal shift
D. Increased pulmonary venous return
Correct Answer: C
Rationale: Acute RV failure from PE causes RV dilation and pressure overload. Through ventricular
interdependence, the dilated RV shifts the interventricular septum leftward, reducing LV filling and
cardiac output. This is known as the "reverse Bernheim effect."
Question 11: A patient with type 1 diabetes develops diabetic ketoacidosis. Which metabolic
process is most responsible for the acidosis?
A. Increased ketone body production from fatty acid oxidation
B. Decreased gluconeogenesis
C. Enhanced glycogen synthesis
D. Increased protein synthesis
Correct Answer: A
Rationale: Absolute insulin deficiency leads to increased lipolysis and fatty acid oxidation,
producing ketone bodies (acetoacetate, β-hydroxybutyrate) that accumulate and cause metabolic
acidosis. This is the hallmark of diabetic ketoacidosis.
Question 12: A patient with Cushing's syndrome develops glucose intolerance. Which mechanism
contributes to the hyperglycemia?
A. Decreased gluconeogenesis
B. Enhanced insulin sensitivity
C. Increased protein catabolism providing amino acids for gluconeogenesis
D. Decreased lipolysis
Correct Answer: C
Rationale: Excess cortisol increases protein catabolism, providing amino acids for hepatic
gluconeogenesis. Cortisol also decreases insulin sensitivity and promotes lipolysis, all contributing
to glucose intolerance and hyperglycemia.
EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1: A 68-year-old patient with COPD presents with acute exacerbation. Arterial blood
gases show: pH 7.32, PaCO2 65 mmHg, PaO2 48 mmHg, HCO3- 32 mEq/L. Which acid-base
disorder is present?
A. Respiratory alkalosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory acidosis with metabolic compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: C
Rationale: The pH is acidotic (normal 7.35-7.45), PaCO2 is elevated (normal 35-45) indicating
respiratory acidosis, and HCO3- is elevated (normal 22-26) showing metabolic compensation. This
is consistent with chronic COPD exacerbation where kidneys retain bicarbonate to compensate for
chronic CO2 retention.
Question 2: A patient with heart failure presents with bilateral pitting edema, jugular venous
distension, and hepatomegaly. Which compensatory mechanism is most responsible for the fluid
retention?
A. Sympathetic nervous system activation
B. Renin-angiotensin-aldosterone system activation
C. Atrial natriuretic peptide release
D. Ventricular remodeling
Correct Answer: B
Rationale: RAAS activation leads to aldosterone secretion, causing sodium and water retention in
the kidneys. This compensatory mechanism attempts to maintain perfusion but contributes to fluid
overload in heart failure. The other options don't directly cause fluid retention.
,Question 3: A 45-year-old with diabetes presents with microalbuminuria, retinopathy, and
peripheral neuropathy. Which pathophysiological mechanism underlies all these complications?
A. Advanced glycation end products accumulation
B. Increased insulin production
C. Enhanced glucose uptake by cells
D. Decreased inflammatory cytokines
Correct Answer: A
Rationale: AGEs form when glucose binds non-enzymatically to proteins, causing structural and
functional changes in blood vessels, nerves, and basement membranes. This leads to the
microvascular complications seen in diabetes including nephropathy, retinopathy, and neuropathy.
Question 4: A patient with septic shock has BP 78/42 mmHg, HR 125 bpm, urine output 15 mL/hr,
and lactate 4.8 mmol/L. Which cellular dysfunction is primarily responsible for the elevated lactate?
A. Increased pyruvate dehydrogenase activity
B. Mitochondrial dysfunction and anaerobic metabolism
C. Enhanced gluconeogenesis
D. Decreased glycolysis
Correct Answer: B
Rationale: In septic shock, mitochondrial dysfunction prevents aerobic metabolism, forcing cells to
rely on anaerobic glycolysis. This produces lactate as an end product when pyruvate cannot enter
the Krebs cycle, leading to lactic acidosis.
Question 5: A patient with cirrhosis develops hepatic encephalopathy. Which neurotransmitter
imbalance contributes to the altered mental status?
A. Decreased GABA
B. Increased dopamine
C. Increased serotonin
D. Increased ammonia affecting glutamate metabolism
Correct Answer: D
Rationale: In liver failure, ammonia accumulates and crosses the blood-brain barrier, affecting
astrocyte glutamate metabolism and causing swelling. This leads to altered neurotransmission and
the characteristic neuropsychiatric symptoms of hepatic encephalopathy.
Question 6: A patient with acute respiratory distress syndrome (ARDS) has a PaO2/FiO2 ratio of
180. Which pathophysiological change is most responsible for the impaired oxygenation?
A. Increased surfactant production
B. Alveolar collapse and consolidation
C. Bronchial smooth muscle relaxation
,D. Increased lung compliance
Correct Answer: B
Rationale: ARDS causes alveolar damage with protein-rich exudate formation, leading to alveolar
collapse, consolidation, and impaired gas exchange. The inflammatory response damages type II
pneumocytes, reducing surfactant and worsening collapse.
Question 7: A patient with chronic kidney disease stage 4 presents with anemia. Which mechanism
is most responsible for the decreased hemoglobin?
A. Iron deficiency from poor dietary intake
B. B12 deficiency from malabsorption
C. Decreased erythropoietin production
D. Increased red blood cell destruction
Correct Answer: C
Rationale: The kidneys produce erythropoietin, which stimulates bone marrow red blood cell
production. In CKD, damaged kidneys produce insufficient erythropoietin, leading to normocytic,
normochromic anemia. This is the primary mechanism in CKD-related anemia.
Question 8: A patient with Addison's disease presents with hypotension, hyperkalemia, and
hyponatremia. Which hormone deficiency is primarily responsible for the electrolyte imbalances?
A. Cortisol
B. Aldosterone
C. ACTH
D. ADH
Correct Answer: B
Rationale: Aldosterone deficiency in Addison's disease causes decreased sodium reabsorption
and potassium excretion in the distal nephron, leading to hyponatremia and hyperkalemia. Cortisol
deficiency contributes to hypotension but doesn't directly cause these electrolyte changes.
Question 9: A patient with myocardial infarction develops cardiogenic shock. Which hemodynamic
parameter is most consistent with this diagnosis?
A. Cardiac index > 2.5 L/min/m²
B. Pulmonary capillary wedge pressure < 8 mmHg
C. Systemic vascular resistance > 1200 dynes·sec/cm⁵
D. Mixed venous oxygen saturation > 70%
Correct Answer: C
, Rationale: Cardiogenic shock is characterized by decreased cardiac output and compensatory
vasoconstriction, leading to elevated systemic vascular resistance. The cardiac index is typically <
2.2 L/min/m², PCWP is elevated (> 15 mmHg), and SvO2 is decreased (< 65%).
Question 10: A patient with pulmonary embolism develops acute right ventricular failure. Which
pathophysiological change contributes to the decreased cardiac output?
A. Increased left ventricular preload
B. Decreased right ventricular afterload
C. Ventricular interdependence causing leftward septal shift
D. Increased pulmonary venous return
Correct Answer: C
Rationale: Acute RV failure from PE causes RV dilation and pressure overload. Through ventricular
interdependence, the dilated RV shifts the interventricular septum leftward, reducing LV filling and
cardiac output. This is known as the "reverse Bernheim effect."
Question 11: A patient with type 1 diabetes develops diabetic ketoacidosis. Which metabolic
process is most responsible for the acidosis?
A. Increased ketone body production from fatty acid oxidation
B. Decreased gluconeogenesis
C. Enhanced glycogen synthesis
D. Increased protein synthesis
Correct Answer: A
Rationale: Absolute insulin deficiency leads to increased lipolysis and fatty acid oxidation,
producing ketone bodies (acetoacetate, β-hydroxybutyrate) that accumulate and cause metabolic
acidosis. This is the hallmark of diabetic ketoacidosis.
Question 12: A patient with Cushing's syndrome develops glucose intolerance. Which mechanism
contributes to the hyperglycemia?
A. Decreased gluconeogenesis
B. Enhanced insulin sensitivity
C. Increased protein catabolism providing amino acids for gluconeogenesis
D. Decreased lipolysis
Correct Answer: C
Rationale: Excess cortisol increases protein catabolism, providing amino acids for hepatic
gluconeogenesis. Cortisol also decreases insulin sensitivity and promotes lipolysis, all contributing
to glucose intolerance and hyperglycemia.
