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 67-year-old male with a history of hypertension and type 2
diabetes presents with a painful, erythematous, swollen left great toe.
Laboratory results reveal a serum uric acid level of 9.2 mg/dL. Joint aspiration
is performed, and polarized light microscopy of the synovial fluid is most
likely to reveal which of the following?
A. Needle-shaped, negatively birefringent crystals
B. Rhomboid-shaped, positively birefringent crystals
C. Thin, flexible, positively birefringent crystals
D. Round, amorphous, negatively birefringent aggregates
CORRECT ANSWER: A. Needle-shaped, negatively birefringent crystals
Rationale: This patient's presentation is classic for acute gouty arthritis. Gout is caused
by the deposition of monosodium urate (MSU) crystals. Under polarized light
microscopy, MSU crystals are needle-shaped and demonstrate strong negative
birefringence. In contrast, pseudogout (calcium pyrophosphate deposition disease) is
associated with rhomboid-shaped, positively birefringent crystals.
Question 2: A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. Her TSH is 12.5 mIU/L and free T4 is 0.6 ng/dL.
She is started on levothyroxine. What is the most appropriate initial dosing
strategy for this patient?
A. Start at a full replacement dose of 1.6 mcg/kg/day based on ideal body weight
B. Start at 25 mcg daily and titrate upward every 4-6 weeks
C. Start at 50 mcg daily for 2 weeks, then increase to 100 mcg daily
D. Start at 12.5 mcg daily and titrate by 12.5 mcg every week
CORRECT ANSWER: B. Start at 25 mcg daily and titrate upward every 4-6
weeks
Rationale: For a young, otherwise healthy patient with overt hypothyroidism, a starting
dose of 50-100 mcg daily (or 1.6 mcg/kg) is often appropriate. However, in older adults
or those with cardiac risk factors, a lower starting dose (e.g., 25 mcg) is recommended
to avoid precipitating angina or arrhythmias. This patient is 45 with no known cardiac
,history, making a lower starting dose a safe and conservative approach. The dose should
be titrated based on TSH levels measured every 4-6 weeks.
Question 3: A 72-year-old male with chronic kidney disease stage 3b presents
with a 2-day history of severe, sharp chest pain that is worse with inspiration
and when lying flat. He is afebrile. An EKG shows diffuse ST-segment
elevation. Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Aortic dissection
CORRECT ANSWER: B. Pericarditis
Rationale: The patient's symptoms of sharp, pleuritic chest pain that is worse with
inspiration and when lying flat, combined with diffuse ST-segment elevation on EKG, are
classic for acute pericarditis. While acute myocardial infarction can cause ST elevation, it
is typically localized to specific leads. Pulmonary embolism often presents with
tachycardia, tachypnea, and hypoxia. Aortic dissection presents with sudden, tearing
pain that radiates to the back.
Question 4: A 60-year-old woman with a history of osteoporosis presents for a
follow-up. She has been on alendronate for 5 years. A DEXA scan shows a T-
score of -1.5 at the lumbar spine. Which of the following is the most
appropriate management strategy?
A. Continue alendronate indefinitely
B. Discontinue alendronate and start a bisphosphonate holiday
C. Increase the dose of alendronate
D. Switch to raloxifene
CORRECT ANSWER: B. Discontinue alendronate and start a bisphosphonate
holiday
Rationale: The FDA and other major organizations recommend reevaluating the need
for continued bisphosphonate therapy after 3-5 years of treatment. In this patient with a
T-score now in the osteopenic range (-1.5), a drug holiday is appropriate to reduce the
risk of rare adverse effects like atypical femoral fractures and osteonecrosis of the jaw.
Question 5: A 28-year-old G2P1 woman at 36 weeks gestation presents with a
blood pressure of 155/95 mmHg and 3+ proteinuria on a urine dipstick. She
reports a severe headache and visual disturbances. Which of the following is
the most appropriate initial management?
A. Administer labetalol and plan for immediate delivery
B. Start oral methyldopa and discharge home with a fetal kick count diary
C. Administer magnesium sulfate and plan for delivery within 24-48 hours
D. Administer intravenous hydralazine and observe for 48 hours
,CORRECT ANSWER: C. Administer magnesium sulfate and plan for delivery
within 24-48 hours
Rationale: This patient meets the criteria for severe preeclampsia (BP ≥160/110 or
severe symptoms like headache/visual disturbances with proteinuria). The standard of
care is to administer magnesium sulfate for seizure prophylaxis and to plan for delivery,
typically within 24-48 hours, regardless of gestational age, to prevent maternal
morbidity.
Question 6: A 50-year-old male with a history of alcohol use disorder presents
with jaundice, ascites, and confusion. His AST is 250 U/L and ALT is 120 U/L.
Which of the following is the most likely diagnosis?
A. Alcoholic hepatitis
B. Viral hepatitis
C. Hepatic cirrhosis
D. Hepatocellular carcinoma
CORRECT ANSWER: A. Alcoholic hepatitis
Rationale: The patient's history of alcohol use, elevated transaminases with an AST/ALT
ratio >1.5 (typically 2:1 in alcoholic liver disease), jaundice, ascites, and hepatic
encephalopathy (confusion) are indicative of acute alcoholic hepatitis on a background
of chronic liver disease.
Question 7: A 34-year-old female presents with palpitations, weight loss, heat
intolerance, and a fine tremor. Her TSH is undetectable and free T4 is elevated.
A thyroid scan reveals diffusely increased uptake. Which of the following is the
most appropriate first-line treatment for a non-pregnant patient?
A. Radioactive iodine ablation
B. Methimazole
C. Propylthiouracil
D. Propranolol only
CORRECT ANSWER: B. Methimazole
Rationale: The patient has Graves' disease, an autoimmune hyperthyroid condition.
Methimazole is the preferred thioamide for first-line medical management in non-
pregnant patients due to its once-daily dosing and lower risk of severe hepatotoxicity
compared to propylthiouracil (PTU). PTU is preferred during the first trimester of
pregnancy. Radioactive iodine is also a treatment option but is not first-line for a young
patient due to the risk of hypothyroidism and radiation exposure.
Question 8: A 75-year-old man presents with a 3-month history of progressive
lower back pain. He also reports recent onset of constipation and urinary
hesitancy. A neurological exam reveals bilateral lower extremity weakness and
hyperreflexia. Which of the following is the most likely diagnosis?
, A. Lumbar spinal stenosis
B. Herniated lumbar disc
C. Cauda equina syndrome
D. Vertebral compression fracture
CORRECT ANSWER: C. Cauda equina syndrome
Rationale: Cauda equina syndrome is a surgical emergency. The classic triad includes
bilateral sciatica, saddle anesthesia (which may present as perineal sensory loss), and
bowel/bladder dysfunction (hesitancy/incontinence). The progressive nature and
bilateral neurologic findings are key indicators.
Question 9: A 42-year-old female presents with a painful, swollen, and tender
right knee. She reports no trauma. She has a history of psoriasis. Joint
aspiration reveals cloudy fluid with a white blood cell count of 25,000
cells/mm³. Which of the following is the most likely diagnosis?
A. Osteoarthritis
B. Gout
C. Septic arthritis
D. Psoriatic arthritis
CORRECT ANSWER: D. Psoriatic arthritis
Rationale: The patient has a history of psoriasis, which is a risk factor for psoriatic
arthritis. The presence of a monoarticular, inflammatory arthritis (elevated WBC count
in synovial fluid) without evidence of infection or crystals points towards a seronegative
spondyloarthropathy, such as psoriatic arthritis.
Question 10: A 55-year-old male with a 40-pack-year smoking history presents
with a cough and hemoptysis. A CT scan reveals a 3-cm mass in the right
upper lobe. Which of the following is the most appropriate next step in
management?
A. CT-guided biopsy
B. Surgical resection
C. Bronchoscopy with biopsy
D. PET scan
CORRECT ANSWER: C. Bronchoscopy with biopsy
Rationale: In a patient with a suspected lung mass, tissue diagnosis is required for
definitive diagnosis and staging. Bronchoscopy with biopsy is the preferred method for
central lesions (like the right upper lobe) and provides tissue for histopathological
examination.
Question 11: A 68-year-old female presents with a sudden onset of severe
headache and photophobia. A lumbar puncture is performed and reveals
elevated opening pressure. CSF analysis shows xanthochromia and 100,000
red blood cells/mm³. Which of the following is the most likely diagnosis?
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 67-year-old male with a history of hypertension and type 2
diabetes presents with a painful, erythematous, swollen left great toe.
Laboratory results reveal a serum uric acid level of 9.2 mg/dL. Joint aspiration
is performed, and polarized light microscopy of the synovial fluid is most
likely to reveal which of the following?
A. Needle-shaped, negatively birefringent crystals
B. Rhomboid-shaped, positively birefringent crystals
C. Thin, flexible, positively birefringent crystals
D. Round, amorphous, negatively birefringent aggregates
CORRECT ANSWER: A. Needle-shaped, negatively birefringent crystals
Rationale: This patient's presentation is classic for acute gouty arthritis. Gout is caused
by the deposition of monosodium urate (MSU) crystals. Under polarized light
microscopy, MSU crystals are needle-shaped and demonstrate strong negative
birefringence. In contrast, pseudogout (calcium pyrophosphate deposition disease) is
associated with rhomboid-shaped, positively birefringent crystals.
Question 2: A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. Her TSH is 12.5 mIU/L and free T4 is 0.6 ng/dL.
She is started on levothyroxine. What is the most appropriate initial dosing
strategy for this patient?
A. Start at a full replacement dose of 1.6 mcg/kg/day based on ideal body weight
B. Start at 25 mcg daily and titrate upward every 4-6 weeks
C. Start at 50 mcg daily for 2 weeks, then increase to 100 mcg daily
D. Start at 12.5 mcg daily and titrate by 12.5 mcg every week
CORRECT ANSWER: B. Start at 25 mcg daily and titrate upward every 4-6
weeks
Rationale: For a young, otherwise healthy patient with overt hypothyroidism, a starting
dose of 50-100 mcg daily (or 1.6 mcg/kg) is often appropriate. However, in older adults
or those with cardiac risk factors, a lower starting dose (e.g., 25 mcg) is recommended
to avoid precipitating angina or arrhythmias. This patient is 45 with no known cardiac
,history, making a lower starting dose a safe and conservative approach. The dose should
be titrated based on TSH levels measured every 4-6 weeks.
Question 3: A 72-year-old male with chronic kidney disease stage 3b presents
with a 2-day history of severe, sharp chest pain that is worse with inspiration
and when lying flat. He is afebrile. An EKG shows diffuse ST-segment
elevation. Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Aortic dissection
CORRECT ANSWER: B. Pericarditis
Rationale: The patient's symptoms of sharp, pleuritic chest pain that is worse with
inspiration and when lying flat, combined with diffuse ST-segment elevation on EKG, are
classic for acute pericarditis. While acute myocardial infarction can cause ST elevation, it
is typically localized to specific leads. Pulmonary embolism often presents with
tachycardia, tachypnea, and hypoxia. Aortic dissection presents with sudden, tearing
pain that radiates to the back.
Question 4: A 60-year-old woman with a history of osteoporosis presents for a
follow-up. She has been on alendronate for 5 years. A DEXA scan shows a T-
score of -1.5 at the lumbar spine. Which of the following is the most
appropriate management strategy?
A. Continue alendronate indefinitely
B. Discontinue alendronate and start a bisphosphonate holiday
C. Increase the dose of alendronate
D. Switch to raloxifene
CORRECT ANSWER: B. Discontinue alendronate and start a bisphosphonate
holiday
Rationale: The FDA and other major organizations recommend reevaluating the need
for continued bisphosphonate therapy after 3-5 years of treatment. In this patient with a
T-score now in the osteopenic range (-1.5), a drug holiday is appropriate to reduce the
risk of rare adverse effects like atypical femoral fractures and osteonecrosis of the jaw.
Question 5: A 28-year-old G2P1 woman at 36 weeks gestation presents with a
blood pressure of 155/95 mmHg and 3+ proteinuria on a urine dipstick. She
reports a severe headache and visual disturbances. Which of the following is
the most appropriate initial management?
A. Administer labetalol and plan for immediate delivery
B. Start oral methyldopa and discharge home with a fetal kick count diary
C. Administer magnesium sulfate and plan for delivery within 24-48 hours
D. Administer intravenous hydralazine and observe for 48 hours
,CORRECT ANSWER: C. Administer magnesium sulfate and plan for delivery
within 24-48 hours
Rationale: This patient meets the criteria for severe preeclampsia (BP ≥160/110 or
severe symptoms like headache/visual disturbances with proteinuria). The standard of
care is to administer magnesium sulfate for seizure prophylaxis and to plan for delivery,
typically within 24-48 hours, regardless of gestational age, to prevent maternal
morbidity.
Question 6: A 50-year-old male with a history of alcohol use disorder presents
with jaundice, ascites, and confusion. His AST is 250 U/L and ALT is 120 U/L.
Which of the following is the most likely diagnosis?
A. Alcoholic hepatitis
B. Viral hepatitis
C. Hepatic cirrhosis
D. Hepatocellular carcinoma
CORRECT ANSWER: A. Alcoholic hepatitis
Rationale: The patient's history of alcohol use, elevated transaminases with an AST/ALT
ratio >1.5 (typically 2:1 in alcoholic liver disease), jaundice, ascites, and hepatic
encephalopathy (confusion) are indicative of acute alcoholic hepatitis on a background
of chronic liver disease.
Question 7: A 34-year-old female presents with palpitations, weight loss, heat
intolerance, and a fine tremor. Her TSH is undetectable and free T4 is elevated.
A thyroid scan reveals diffusely increased uptake. Which of the following is the
most appropriate first-line treatment for a non-pregnant patient?
A. Radioactive iodine ablation
B. Methimazole
C. Propylthiouracil
D. Propranolol only
CORRECT ANSWER: B. Methimazole
Rationale: The patient has Graves' disease, an autoimmune hyperthyroid condition.
Methimazole is the preferred thioamide for first-line medical management in non-
pregnant patients due to its once-daily dosing and lower risk of severe hepatotoxicity
compared to propylthiouracil (PTU). PTU is preferred during the first trimester of
pregnancy. Radioactive iodine is also a treatment option but is not first-line for a young
patient due to the risk of hypothyroidism and radiation exposure.
Question 8: A 75-year-old man presents with a 3-month history of progressive
lower back pain. He also reports recent onset of constipation and urinary
hesitancy. A neurological exam reveals bilateral lower extremity weakness and
hyperreflexia. Which of the following is the most likely diagnosis?
, A. Lumbar spinal stenosis
B. Herniated lumbar disc
C. Cauda equina syndrome
D. Vertebral compression fracture
CORRECT ANSWER: C. Cauda equina syndrome
Rationale: Cauda equina syndrome is a surgical emergency. The classic triad includes
bilateral sciatica, saddle anesthesia (which may present as perineal sensory loss), and
bowel/bladder dysfunction (hesitancy/incontinence). The progressive nature and
bilateral neurologic findings are key indicators.
Question 9: A 42-year-old female presents with a painful, swollen, and tender
right knee. She reports no trauma. She has a history of psoriasis. Joint
aspiration reveals cloudy fluid with a white blood cell count of 25,000
cells/mm³. Which of the following is the most likely diagnosis?
A. Osteoarthritis
B. Gout
C. Septic arthritis
D. Psoriatic arthritis
CORRECT ANSWER: D. Psoriatic arthritis
Rationale: The patient has a history of psoriasis, which is a risk factor for psoriatic
arthritis. The presence of a monoarticular, inflammatory arthritis (elevated WBC count
in synovial fluid) without evidence of infection or crystals points towards a seronegative
spondyloarthropathy, such as psoriatic arthritis.
Question 10: A 55-year-old male with a 40-pack-year smoking history presents
with a cough and hemoptysis. A CT scan reveals a 3-cm mass in the right
upper lobe. Which of the following is the most appropriate next step in
management?
A. CT-guided biopsy
B. Surgical resection
C. Bronchoscopy with biopsy
D. PET scan
CORRECT ANSWER: C. Bronchoscopy with biopsy
Rationale: In a patient with a suspected lung mass, tissue diagnosis is required for
definitive diagnosis and staging. Bronchoscopy with biopsy is the preferred method for
central lesions (like the right upper lobe) and provides tissue for histopathological
examination.
Question 11: A 68-year-old female presents with a sudden onset of severe
headache and photophobia. A lumbar puncture is performed and reveals
elevated opening pressure. CSF analysis shows xanthochromia and 100,000
red blood cells/mm³. Which of the following is the most likely diagnosis?
