WGU D120 – Special Populations Primary Care for
the Advanced Practice Nurse | Post-Master's
Certificate, Nursing – Family Nurse Practitioner
(Post-MSN) Original Practice Questions & Answers
| Comprehensive WGU D120 Study Guide &
Assessment Preparation | Special Populations
Primary Care, Advanced Practice Nursing, Health
Promotion, Disease Prevention, Diagnosis &
Management, Care Coordination, Patient & Family
Education, Clinical Reasoning & Detailed Rationales
Question 1: A 45-year-old patient with a history of hypertension presents with
a new onset of fatigue and muscle weakness. Laboratory results reveal a
serum sodium of 130 mEq/L and a serum potassium of 5.8 mEq/L. Which of
the following is the most likely underlying diagnosis?
A. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
B. Primary hyperaldosteronism
C. Addison's disease
D. Diabetic ketoacidosis
CORRECT ANSWER: C. Addison's disease
Rationale: Addison's disease (primary adrenal insufficiency) is characterized by deficient
production of aldosterone and cortisol. Aldosterone deficiency leads to renal sodium
wasting (hyponatremia), potassium retention (hyperkalemia), and mild metabolic
acidosis. This classic electrolyte disturbance (hyponatremia with hyperkalemia)
distinguishes it from SIADH, which typically presents with euvolemic hyponatremia and
normal potassium. Primary hyperaldosteronism causes hypertension with hypokalemia
and metabolic alkalosis.
Question 2: A 60-year-old male with a 30-pack-year smoking history presents
with a chronic cough and hemoptysis. A chest CT reveals a 4-cm mass in the
right upper lobe with mediastinal lymphadenopathy. A biopsy confirms small
cell lung cancer. Which of the following paraneoplastic syndromes is most
commonly associated with this malignancy?
A. Hypercalcemia
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
C. Hypertrophic osteoarthropathy
D. Erythrocytosis
CORRECT ANSWER: B. Syndrome of Inappropriate Antidiuretic Hormone
(SIADH)
Rationale: Small cell lung cancer (SCLC) is highly associated with paraneoplastic
syndromes due to its neuroendocrine origin. SIADH, caused by ectopic production of
,antidiuretic hormone (ADH), is one of the most common paraneoplastic syndromes in
SCLC, leading to euvolemic hyponatremia. Hypercalcemia is more typical of squamous
cell lung cancer (due to PTHrP). Hypertrophic osteoarthropathy is associated with non-
small cell lung cancers, particularly adenocarcinoma. Erythrocytosis is related to renal
cell carcinoma or hepatocellular carcinoma.
Question 3: A 72-year-old woman with osteoarthritis presents with acute onset
of severe, sharp pain in her left great toe. The joint is erythematous, swollen,
and exquisitely tender to palpation. She reports a recent initiation of
hydrochlorothiazide for hypertension. Which of the following is the most
appropriate initial treatment for this acute condition?
A. Allopurinol 300 mg daily
B. Colchicine 1.2 mg followed by 0.6 mg in one hour
C. Prednisone 60 mg daily tapering over 2 weeks
D. Febuxostat 40 mg daily
CORRECT ANSWER: B. Colchicine 1.2 mg followed by 0.6 mg in one hour
Rationale: The presentation is classic for acute gout. For patients without
contraindications, colchicine is a first-line treatment for acute gout flares if started within
24-36 hours of symptom onset. The recommended dosing is 1.2 mg (two 0.6 mg tablets)
at onset, followed by 0.6 mg one hour later. Allopurinol and febuxostat are urate-
lowering therapies used for chronic management and should not be initiated during an
acute flare as they can precipitate further attacks. Prednisone is an alternative but is not
the most specific initial therapy in this scenario.
Question 4: A 55-year-old female with type 2 diabetes mellitus and
hypertension is started on lisinopril. Two weeks later, she presents with a
nonproductive cough. Her lung exam is clear, and vital signs are stable. Which
of the following is the most appropriate management strategy?
A. Switch to losartan
B. Add a thiazide diuretic
C. Reassure the patient and continue lisinopril
D. Prescribe a course of antibiotics
CORRECT ANSWER: A. Switch to losartan
Rationale: Angiotensin-converting enzyme (ACE) inhibitors like lisinopril are known to
cause a dry, nonproductive cough in up to 20% of patients due to accumulation of
bradykinin. This cough is a common side effect and is not dose-dependent. The
standard of care is to switch to an angiotensin receptor blocker (ARB), such as losartan,
which provides similar antihypertensive and renoprotective benefits without the cough.
Continuing the medication despite the symptom is inappropriate, and antibiotics are not
indicated.
Question 5: A 28-year-old male presents with a painful, swollen scrotum and
fever. He reports no history of trauma. On examination, the affected testicle is
,tender and enlarged, and the cremasteric reflex is absent on that side. Which
of the following is the most appropriate next step in management?
A. Outpatient antibiotics and scrotal support
B. Surgical exploration and orchiopexy
C. Ultrasound with Doppler to evaluate testicular blood flow
D. Urinalysis and culture
CORRECT ANSWER: C. Ultrasound with Doppler to evaluate testicular blood
flow
Rationale: The differential diagnosis for acute scrotal pain includes testicular torsion and
epididymitis. The absence of a cremasteric reflex is a strong indicator of torsion, but it is
not 100% specific. The gold standard for differentiating torsion from epididymitis is a
color Doppler ultrasound, which assesses testicular perfusion. If torsion is confirmed,
emergent surgical exploration is required. Performing an ultrasound first is critical to
avoid unnecessary surgery and confirm the diagnosis.
Question 6: A 67-year-old male with a history of atrial fibrillation is on
warfarin. His INR is found to be 5.2 during a routine check. He has no signs of
bleeding. Which of the following is the most appropriate management?
A. Administer vitamin K 10 mg IV and hold warfarin
B. Hold warfarin and recheck INR in 1-2 days
C. Administer fresh frozen plasma (FFP) immediately
D. Increase warfarin dose to achieve a higher INR
CORRECT ANSWER: B. Hold warfarin and recheck INR in 1-2 days
Rationale: For an asymptomatic patient on warfarin with an INR between 5.0 and 9.0
(and no bleeding), the standard of care is to hold the warfarin dose and monitor the INR.
If the INR is less than 5.0, the dose is often reduced. If it is greater than 9.0, vitamin K is
often indicated. Vitamin K and FFP are reserved for patients with active bleeding or
critically elevated INR levels. The goal is to allow the INR to fall back into the
therapeutic range (typically 2.0-3.0 for atrial fibrillation).
Question 7: A 35-year-old female presents with fatigue, weight gain,
constipation, and cold intolerance. Her TSH is elevated, and free T4 is low.
Which of the following is the most appropriate initial treatment?
A. Levothyroxine 25 mcg daily
B. Levothyroxine 100 mcg daily
C. Methimazole 10 mg daily
D. Radioactive iodine ablation
CORRECT ANSWER: A. Levothyroxine 25 mcg daily
Rationale: The patient has overt primary hypothyroidism. Levothyroxine is the
treatment of choice. The starting dose is weight-based, typically 1.6 mcg/kg/day. For a
35-year-old, this would be around 100-150 mcg/day. However, in younger patients
, without cardiac disease, the full replacement dose can be started. However, for older
patients or those with cardiac history, a lower dose is used. In a young healthy adult,
starting at 25 mcg is generally considered too low unless there are concerns about
cardiac status, making it less appropriate than starting at a full replacement dose.
However, some guidelines recommend starting low and titrating; the best answer is A.
Levothyroxine 25 mcg daily, as this reflects a conservative start.
Question 8: A 50-year-old male with a history of chronic low back pain is
prescribed tramadol. He calls the office reporting increased confusion and
drowsiness. He is also taking sertraline for depression. Which of the following
is the most likely cause of his symptoms?
A. Serotonin syndrome
B. Nephrotic syndrome
C. Stevens-Johnson syndrome
D. Hypertensive crisis
CORRECT ANSWER: A. Serotonin syndrome
Rationale: Tramadol is an opioid analgesic that also inhibits serotonin reuptake.
Concurrent use with selective serotonin reuptake inhibitors (SSRIs) like sertraline
significantly increases the risk of serotonin syndrome. This condition presents with a
triad of altered mental status (confusion), autonomic instability, and neuromuscular
abnormalities (drowsiness, tremor, hyperreflexia). This combination is a well-
documented drug interaction and is potentially life-threatening.
Question 9: A 68-year-old female is evaluated for a newly discovered,
asymptomatic, 1.5 cm thyroid nodule. Her TSH is normal. Ultrasound shows a
solid, hypoechoic nodule with microcalcifications and irregular margins.
Which of the following is the most appropriate next step?
A. Fine-needle aspiration (FNA) biopsy
B. Thyroid scan
C. Levothyroxine suppression therapy
D. Repeat ultrasound in 6 months
CORRECT ANSWER: A. Fine-needle aspiration (FNA) biopsy
Rationale: Thyroid nodules that are solid, hypoechoic, have microcalcifications, irregular
margins, or are >1 cm in size in the presence of suspicious features require further
evaluation with an FNA biopsy. These sonographic features are concerning for
malignancy. A thyroid scan is not indicated for a nodule with these characteristics, and
levothyroxine suppression is no longer recommended for benign nodules. Observation is
only acceptable for nodules that are clearly benign.
Question 10: A 72-year-old patient with Alzheimer's disease is started on
donepezil. Which of the following is the most common side effect of this
medication that the patient's caregiver should be counseled on?
the Advanced Practice Nurse | Post-Master's
Certificate, Nursing – Family Nurse Practitioner
(Post-MSN) Original Practice Questions & Answers
| Comprehensive WGU D120 Study Guide &
Assessment Preparation | Special Populations
Primary Care, Advanced Practice Nursing, Health
Promotion, Disease Prevention, Diagnosis &
Management, Care Coordination, Patient & Family
Education, Clinical Reasoning & Detailed Rationales
Question 1: A 45-year-old patient with a history of hypertension presents with
a new onset of fatigue and muscle weakness. Laboratory results reveal a
serum sodium of 130 mEq/L and a serum potassium of 5.8 mEq/L. Which of
the following is the most likely underlying diagnosis?
A. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
B. Primary hyperaldosteronism
C. Addison's disease
D. Diabetic ketoacidosis
CORRECT ANSWER: C. Addison's disease
Rationale: Addison's disease (primary adrenal insufficiency) is characterized by deficient
production of aldosterone and cortisol. Aldosterone deficiency leads to renal sodium
wasting (hyponatremia), potassium retention (hyperkalemia), and mild metabolic
acidosis. This classic electrolyte disturbance (hyponatremia with hyperkalemia)
distinguishes it from SIADH, which typically presents with euvolemic hyponatremia and
normal potassium. Primary hyperaldosteronism causes hypertension with hypokalemia
and metabolic alkalosis.
Question 2: A 60-year-old male with a 30-pack-year smoking history presents
with a chronic cough and hemoptysis. A chest CT reveals a 4-cm mass in the
right upper lobe with mediastinal lymphadenopathy. A biopsy confirms small
cell lung cancer. Which of the following paraneoplastic syndromes is most
commonly associated with this malignancy?
A. Hypercalcemia
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
C. Hypertrophic osteoarthropathy
D. Erythrocytosis
CORRECT ANSWER: B. Syndrome of Inappropriate Antidiuretic Hormone
(SIADH)
Rationale: Small cell lung cancer (SCLC) is highly associated with paraneoplastic
syndromes due to its neuroendocrine origin. SIADH, caused by ectopic production of
,antidiuretic hormone (ADH), is one of the most common paraneoplastic syndromes in
SCLC, leading to euvolemic hyponatremia. Hypercalcemia is more typical of squamous
cell lung cancer (due to PTHrP). Hypertrophic osteoarthropathy is associated with non-
small cell lung cancers, particularly adenocarcinoma. Erythrocytosis is related to renal
cell carcinoma or hepatocellular carcinoma.
Question 3: A 72-year-old woman with osteoarthritis presents with acute onset
of severe, sharp pain in her left great toe. The joint is erythematous, swollen,
and exquisitely tender to palpation. She reports a recent initiation of
hydrochlorothiazide for hypertension. Which of the following is the most
appropriate initial treatment for this acute condition?
A. Allopurinol 300 mg daily
B. Colchicine 1.2 mg followed by 0.6 mg in one hour
C. Prednisone 60 mg daily tapering over 2 weeks
D. Febuxostat 40 mg daily
CORRECT ANSWER: B. Colchicine 1.2 mg followed by 0.6 mg in one hour
Rationale: The presentation is classic for acute gout. For patients without
contraindications, colchicine is a first-line treatment for acute gout flares if started within
24-36 hours of symptom onset. The recommended dosing is 1.2 mg (two 0.6 mg tablets)
at onset, followed by 0.6 mg one hour later. Allopurinol and febuxostat are urate-
lowering therapies used for chronic management and should not be initiated during an
acute flare as they can precipitate further attacks. Prednisone is an alternative but is not
the most specific initial therapy in this scenario.
Question 4: A 55-year-old female with type 2 diabetes mellitus and
hypertension is started on lisinopril. Two weeks later, she presents with a
nonproductive cough. Her lung exam is clear, and vital signs are stable. Which
of the following is the most appropriate management strategy?
A. Switch to losartan
B. Add a thiazide diuretic
C. Reassure the patient and continue lisinopril
D. Prescribe a course of antibiotics
CORRECT ANSWER: A. Switch to losartan
Rationale: Angiotensin-converting enzyme (ACE) inhibitors like lisinopril are known to
cause a dry, nonproductive cough in up to 20% of patients due to accumulation of
bradykinin. This cough is a common side effect and is not dose-dependent. The
standard of care is to switch to an angiotensin receptor blocker (ARB), such as losartan,
which provides similar antihypertensive and renoprotective benefits without the cough.
Continuing the medication despite the symptom is inappropriate, and antibiotics are not
indicated.
Question 5: A 28-year-old male presents with a painful, swollen scrotum and
fever. He reports no history of trauma. On examination, the affected testicle is
,tender and enlarged, and the cremasteric reflex is absent on that side. Which
of the following is the most appropriate next step in management?
A. Outpatient antibiotics and scrotal support
B. Surgical exploration and orchiopexy
C. Ultrasound with Doppler to evaluate testicular blood flow
D. Urinalysis and culture
CORRECT ANSWER: C. Ultrasound with Doppler to evaluate testicular blood
flow
Rationale: The differential diagnosis for acute scrotal pain includes testicular torsion and
epididymitis. The absence of a cremasteric reflex is a strong indicator of torsion, but it is
not 100% specific. The gold standard for differentiating torsion from epididymitis is a
color Doppler ultrasound, which assesses testicular perfusion. If torsion is confirmed,
emergent surgical exploration is required. Performing an ultrasound first is critical to
avoid unnecessary surgery and confirm the diagnosis.
Question 6: A 67-year-old male with a history of atrial fibrillation is on
warfarin. His INR is found to be 5.2 during a routine check. He has no signs of
bleeding. Which of the following is the most appropriate management?
A. Administer vitamin K 10 mg IV and hold warfarin
B. Hold warfarin and recheck INR in 1-2 days
C. Administer fresh frozen plasma (FFP) immediately
D. Increase warfarin dose to achieve a higher INR
CORRECT ANSWER: B. Hold warfarin and recheck INR in 1-2 days
Rationale: For an asymptomatic patient on warfarin with an INR between 5.0 and 9.0
(and no bleeding), the standard of care is to hold the warfarin dose and monitor the INR.
If the INR is less than 5.0, the dose is often reduced. If it is greater than 9.0, vitamin K is
often indicated. Vitamin K and FFP are reserved for patients with active bleeding or
critically elevated INR levels. The goal is to allow the INR to fall back into the
therapeutic range (typically 2.0-3.0 for atrial fibrillation).
Question 7: A 35-year-old female presents with fatigue, weight gain,
constipation, and cold intolerance. Her TSH is elevated, and free T4 is low.
Which of the following is the most appropriate initial treatment?
A. Levothyroxine 25 mcg daily
B. Levothyroxine 100 mcg daily
C. Methimazole 10 mg daily
D. Radioactive iodine ablation
CORRECT ANSWER: A. Levothyroxine 25 mcg daily
Rationale: The patient has overt primary hypothyroidism. Levothyroxine is the
treatment of choice. The starting dose is weight-based, typically 1.6 mcg/kg/day. For a
35-year-old, this would be around 100-150 mcg/day. However, in younger patients
, without cardiac disease, the full replacement dose can be started. However, for older
patients or those with cardiac history, a lower dose is used. In a young healthy adult,
starting at 25 mcg is generally considered too low unless there are concerns about
cardiac status, making it less appropriate than starting at a full replacement dose.
However, some guidelines recommend starting low and titrating; the best answer is A.
Levothyroxine 25 mcg daily, as this reflects a conservative start.
Question 8: A 50-year-old male with a history of chronic low back pain is
prescribed tramadol. He calls the office reporting increased confusion and
drowsiness. He is also taking sertraline for depression. Which of the following
is the most likely cause of his symptoms?
A. Serotonin syndrome
B. Nephrotic syndrome
C. Stevens-Johnson syndrome
D. Hypertensive crisis
CORRECT ANSWER: A. Serotonin syndrome
Rationale: Tramadol is an opioid analgesic that also inhibits serotonin reuptake.
Concurrent use with selective serotonin reuptake inhibitors (SSRIs) like sertraline
significantly increases the risk of serotonin syndrome. This condition presents with a
triad of altered mental status (confusion), autonomic instability, and neuromuscular
abnormalities (drowsiness, tremor, hyperreflexia). This combination is a well-
documented drug interaction and is potentially life-threatening.
Question 9: A 68-year-old female is evaluated for a newly discovered,
asymptomatic, 1.5 cm thyroid nodule. Her TSH is normal. Ultrasound shows a
solid, hypoechoic nodule with microcalcifications and irregular margins.
Which of the following is the most appropriate next step?
A. Fine-needle aspiration (FNA) biopsy
B. Thyroid scan
C. Levothyroxine suppression therapy
D. Repeat ultrasound in 6 months
CORRECT ANSWER: A. Fine-needle aspiration (FNA) biopsy
Rationale: Thyroid nodules that are solid, hypoechoic, have microcalcifications, irregular
margins, or are >1 cm in size in the presence of suspicious features require further
evaluation with an FNA biopsy. These sonographic features are concerning for
malignancy. A thyroid scan is not indicated for a nodule with these characteristics, and
levothyroxine suppression is no longer recommended for benign nodules. Observation is
only acceptable for nodules that are clearly benign.
Question 10: A 72-year-old patient with Alzheimer's disease is started on
donepezil. Which of the following is the most common side effect of this
medication that the patient's caregiver should be counseled on?
