Western Governors University
AO · 8 1 1 D
D118 — Advanced Practice Nursing
A UNIVERSITY FOR THE REAL WORLD
WGU
NURSING
WGU D118 Practice OA Exam
CO M P R E H E N S I V E R E V I E W — A DVA N C E D P RACT I C E N U RS I N G
INSTITUTION Western Governors University PROGRAM Advanced Practice Nursing
COURSE CODE D118 COURSE TITLE Advanced Practice Nursing —
Practice OA Exam
ACADEMIC YEAR EXAM TITLE WGU D118 Practice OA Exam
TOTAL QUESTIONS 96 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Cardiovascular, pulmonary, endocrine, rheumatologic, neurologic, and renal conditions are all testable
content.
▸ Understanding clinical presentation, diagnostic reasoning, and evidence-based management is
emphasized.
▸ Correct answers and rationales appear below each question for review purposes.
▸ All content reflects current evidence-based practice and D118 curriculum standards.
, SECTION I — ADVANCED PRACTICE NURSING: CLINICAL
Questions 1 – 96
REASONING & EVIDENCE-BASED MANAGEMENT
1. A 63-year-old man presents with progressive exertional dyspnea, orthopnea, and bilateral
lower extremity edema. Exam reveals bibasilar crackles and S3 gallop. Echo shows EF
32%. Which regimen is most appropriate to begin long-term mortality-reducing
treatment?
A. Furosemide only
B. ACE inhibitor plus evidence-based beta blocker
C. Digoxin plus spironolactone only
D. Diltiazem plus hydrochlorothiazide
CORRECT ANSWER B — ACE inhibitor plus evidence-based beta blocker
RATIONALE HFrEF mortality reduction starts with guideline-directed therapy such as an ACE
inhibitor plus evidence-based beta blocker. This combination has been shown to
reduce mortality in heart failure with reduced ejection fraction.
2. A 54-year-old woman with fatigue has the following labs: Hgb 9.8 g/dL, MCV 69, ferritin
low, TIBC high. What is the most likely diagnosis?
A. Anemia of chronic disease
B. Iron deficiency anemia
C. Thalassemia
D. Vitamin B12 deficiency
CORRECT ANSWER B — Iron deficiency anemia
RATIONALE Iron deficiency anemia presents with microcytic anemia (low MCV), low ferritin,
and high TIBC. This is the classic laboratory pattern.
,3. A 28-year-old woman presents with dysuria, urinary frequency, and urgency for 2 days. No
fever, flank pain, vaginal discharge, or pregnancy. UA is positive for nitrites and leukocyte
esterase. Best first-line treatment?
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin-clavulanate
D. Metronidazole
CORRECT ANSWER A — Nitrofurantoin
RATIONALE Nitrofurantoin is first-line for uncomplicated cystitis. It is effective against
common uropathogens and has minimal systemic side effects.
4. A 72-year-old smoker presents with painless gross hematuria. No dysuria or fever. What is
the next best step?
A. Treat empirically for UTI
B. Repeat urinalysis in 1 month
C. CT urogram and urology referral
D. PSA level
CORRECT ANSWER C — CT urogram and urology referral
RATIONALE Painless hematuria in a smoker is urinary tract malignancy until proven
otherwise. CT urogram and urology referral is the appropriate next step.
, 5. A 37-year-old woman presents with fatigue, salt craving, weight loss, hyperpigmentation,
hypotension, hyponatremia, and hyperkalemia. Which diagnosis is most likely?
A. Cushing syndrome
B. Primary adrenal insufficiency
C. Hyperthyroidism
D. SIADH
CORRECT ANSWER B — Primary adrenal insufficiency
RATIONALE Classic Addison disease presentation includes fatigue, salt craving, weight loss,
hyperpigmentation, hypotension, hyponatremia, and hyperkalemia.
6. A patient with suspected primary adrenal insufficiency needs confirmatory testing. Which
test is most appropriate?
A. TSH and free T4
B. ACTH stimulation test
C. Overnight dexamethasone suppression test
D. Plasma renin alone
CORRECT ANSWER B — ACTH stimulation test
RATIONALE The ACTH stimulation test is the confirmatory test for adrenal insufficiency. It
measures cortisol response to synthetic ACTH.
AO · 8 1 1 D
D118 — Advanced Practice Nursing
A UNIVERSITY FOR THE REAL WORLD
WGU
NURSING
WGU D118 Practice OA Exam
CO M P R E H E N S I V E R E V I E W — A DVA N C E D P RACT I C E N U RS I N G
INSTITUTION Western Governors University PROGRAM Advanced Practice Nursing
COURSE CODE D118 COURSE TITLE Advanced Practice Nursing —
Practice OA Exam
ACADEMIC YEAR EXAM TITLE WGU D118 Practice OA Exam
TOTAL QUESTIONS 96 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Cardiovascular, pulmonary, endocrine, rheumatologic, neurologic, and renal conditions are all testable
content.
▸ Understanding clinical presentation, diagnostic reasoning, and evidence-based management is
emphasized.
▸ Correct answers and rationales appear below each question for review purposes.
▸ All content reflects current evidence-based practice and D118 curriculum standards.
, SECTION I — ADVANCED PRACTICE NURSING: CLINICAL
Questions 1 – 96
REASONING & EVIDENCE-BASED MANAGEMENT
1. A 63-year-old man presents with progressive exertional dyspnea, orthopnea, and bilateral
lower extremity edema. Exam reveals bibasilar crackles and S3 gallop. Echo shows EF
32%. Which regimen is most appropriate to begin long-term mortality-reducing
treatment?
A. Furosemide only
B. ACE inhibitor plus evidence-based beta blocker
C. Digoxin plus spironolactone only
D. Diltiazem plus hydrochlorothiazide
CORRECT ANSWER B — ACE inhibitor plus evidence-based beta blocker
RATIONALE HFrEF mortality reduction starts with guideline-directed therapy such as an ACE
inhibitor plus evidence-based beta blocker. This combination has been shown to
reduce mortality in heart failure with reduced ejection fraction.
2. A 54-year-old woman with fatigue has the following labs: Hgb 9.8 g/dL, MCV 69, ferritin
low, TIBC high. What is the most likely diagnosis?
A. Anemia of chronic disease
B. Iron deficiency anemia
C. Thalassemia
D. Vitamin B12 deficiency
CORRECT ANSWER B — Iron deficiency anemia
RATIONALE Iron deficiency anemia presents with microcytic anemia (low MCV), low ferritin,
and high TIBC. This is the classic laboratory pattern.
,3. A 28-year-old woman presents with dysuria, urinary frequency, and urgency for 2 days. No
fever, flank pain, vaginal discharge, or pregnancy. UA is positive for nitrites and leukocyte
esterase. Best first-line treatment?
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin-clavulanate
D. Metronidazole
CORRECT ANSWER A — Nitrofurantoin
RATIONALE Nitrofurantoin is first-line for uncomplicated cystitis. It is effective against
common uropathogens and has minimal systemic side effects.
4. A 72-year-old smoker presents with painless gross hematuria. No dysuria or fever. What is
the next best step?
A. Treat empirically for UTI
B. Repeat urinalysis in 1 month
C. CT urogram and urology referral
D. PSA level
CORRECT ANSWER C — CT urogram and urology referral
RATIONALE Painless hematuria in a smoker is urinary tract malignancy until proven
otherwise. CT urogram and urology referral is the appropriate next step.
, 5. A 37-year-old woman presents with fatigue, salt craving, weight loss, hyperpigmentation,
hypotension, hyponatremia, and hyperkalemia. Which diagnosis is most likely?
A. Cushing syndrome
B. Primary adrenal insufficiency
C. Hyperthyroidism
D. SIADH
CORRECT ANSWER B — Primary adrenal insufficiency
RATIONALE Classic Addison disease presentation includes fatigue, salt craving, weight loss,
hyperpigmentation, hypotension, hyponatremia, and hyperkalemia.
6. A patient with suspected primary adrenal insufficiency needs confirmatory testing. Which
test is most appropriate?
A. TSH and free T4
B. ACTH stimulation test
C. Overnight dexamethasone suppression test
D. Plasma renin alone
CORRECT ANSWER B — ACTH stimulation test
RATIONALE The ACTH stimulation test is the confirmatory test for adrenal insufficiency. It
measures cortisol response to synthetic ACTH.
