WGU D027 PRACTICE QUESTIONS WITH VERIFIED
ANSWERS
A patient has endured several dosage adjustments of his tricyclic antidepressant, so the
provider recommends genetic testing. Which statement correctly describes the rationale
for genetic testing?
a. The CYP2D6 gene influences metabolism of tricyclic antidepressants and certain
other drugs
b. The HER2 gene is a tumor marker that impacts metabolism of tricyclic
antidepressants
c. The BRCA2 gene influences metabolism of certain drugs and increases the risk for
breast cancer
d. The x-linked OPN1MW gene for male color blindness also slows metabolism of
certain drugs - Answers - a. The CYP2D6 gene influences metabolism of tricyclic
antidepressants and certain other drugs
Answer/Rationale: CYP2D6 - page 155 Box 4.3 of Chapter 4 Genes and Genetic
Diseases, McCance & Huether, Unit 2, Genes, Environmental Lifestyle, and Common
Diseases. HER2 is a gene often implicated with cancer, as is BRCA2. OPN1MW is the
gene that codes for color blindness in men. Metabolism of 25% of all prescribed drugs,
including tricyclic antidepressants, beta adrenergic receptor blockers, and neuroleptics,
is influenced by variants in a certain gene, requiring genetic testing to reduce trial-and-
error in estimating appropriate drug-dosage levels.
As an advanced practice nurse, you want to learn more about the CDC's initiatives
relative to asthma care and management in order to advocate for asthma sufferers at
the state legislative level. Your goal is to reduce medications costs to patients. Which
CDC recommendation supports your goal?
a. The CDC recommends that payers and employers promote healthy workspaces to
decrease environmental trigger exposures
b. The CDC recommends that providers prescribe the most cost-efficient long-acting
inhalers to lower patient co-pays
c. The CDC recommends that providers deviate from the stepwise approach to lessen
the financial impact to the patient
d. The CDC recommends that co-pays be removed for inhaled corticosteroids and other
prescribed medications - Answers - d. The CDC recommends that co-pays be removed
for inhaled corticosteroids and other prescribed medications
Answer/Rationale: D - The CDC recommends that co-pays be removed for inhaled
corticosteroids and other prescribed medications per the following link,
,https://healthpayerintelligence.com/news/top-10-most-expensive-chronic-diseases-for-
healthcare-payers; Genes, Environmental Lifestyle, and Common Diseases; Unit 2
A female patient has been recently diagnosed with invasive ductal carcinoma. As an
advanced practice nurse, you understand that she will be undergoing a multi-faceted
treatment approach that will include one or more medications. Which medication is
considered the "gold standard" endocrine treatment for breast cancer?
a. Fulvestrant (Faslodex), an antiestrogen indicated for metastatic estrogen receptor-
positive breast cancer in post-menopausal women
b. Tamoxifen (Nolvadex), a prodrug that must be converted to active metabolites in
order to block estrogen receptors in breast tissue
c. Trastuzumab (Herceptin), a monoclonal antibody approved for HER2-positive
metastatic breast cancer
d. Lapatinib (Tykerb), an oral inhibitor of HER2 tyrosine kinase and EGFR tyrosine
kinase, resulting in apoptosis and suppression of tumor cell growth - Answers - b.
Tamoxifen (Nolvadex), a prodrug that must be converted to active metabolites in order
to block estrogen receptors in breast tissue
Answer/Rationale: Tamoxifen, page 929, Chapter 82 of Lehne, Unit 2, Human
Structures for Self Defense
A patient reports a maternal family history of Lynch syndrome. Which laboratory finding
might indicate a need for further testing for the presence of Lynch syndrome in this
patient?
a. Elevated thyroid-stimulating hormone
b. Low cortisol level
c. Positive heme-occult test
d. Sputum positive for Pseudomonas Aeruginosa - Answers - c. Positive heme-occult
test
Answer/Rationale: Positive heme-occult because Lynch syndrome is a hereditary form
of colorectal cancer and colorectal bleeding can be a sign of cancer, per
https://www.healthypeople.gov/2020/topics-objectives/topic/genomics, Unit 2, Human
Structures for Self Defense
Your goal as the intensive care unit coordinator is to reduce falls. Upon review of
hospital data, you find that most of the falls are occurring in the patient population, ages
65 and older. As a result, you coordinate a fall reduction initiative after researching the
etiology of falls in the elderly. Which action should be included in the protocol?
a. Encourage slow position changes since orthostatic hypotension is a significant risk
factor for falls.
b. Allocate budgetary resources for assistive devices to be in every room at all times
since falls cannot be predicted.
,c. Initiate depression screening on all new admissions since depressed affect has been
indicated in fall etiology.
d. Decrease the number of situations that require patient standing and walking, as
upright positions result in higher incidence of falls. - Answers - a. Encourage slow
position changes since orthostatic hypotension is a significant risk factor for falls.
Answer/Rationale: Encourage slow position changes since orthostatic hypotension is a
significant risk factor for falls. From page 1067, chapter 33, McCance & Huether,
Causes of Pathology in the Cardiovascular System, Unit 3
A patient who has lung cancer reports facial and neck swelling so severe that some
shirts no longer fit. What question by the healthcare professional would be most
appropriate to screen for superior vena cava syndrome, a possible complication of
cancer tumors?
a. "Have you gained weight recently?"
b. "Are your feet and ankles swollen?"
c. "Does your voice sound hoarse?"
d. "When was your last chemotherapy?" - Answers - c. "Does your voice sound
hoarse?"
ANS: C Patients with certain kinds of cancer (small cell and non-small cell cancers of
the lung, and lymphoma) can develop superior vena cava syndrome (SVCS) which is a
progressive occlusion of the superior vena cava. This leads to venous distention in the
upper extremities and head. Other symptoms include hoarse voice, dyspnea,
dysphagia, stridor, cough, and chest pain. The professional should ask about the other
symptoms. A large weight gain would occur slowly. Asking about edema elsewhere
would be a question if the patient denied any other symptoms of SVCS. The date of the
last chemotherapy is not relevant. Page 1061, ch 33, McCance & Huether, Unit 3
A patient is diagnosed with chronic obstructive pulmonary disease (COPD) and has
elevated pulmonary vascular resistance. Which symptom would indicate the need to
assess for the complication of cor pulmonale (right-sided heart failure)?
a. crackles bilaterally
b. generalized arthralgia
c. jugular venous distention
d. occasional constipation - Answers - c. jugular venous distention
ANS: C JVD - Symptoms of right-sided heart failure include the following:
hepatosplenomegaly, extremity edema, ascites, jugular venous distention, page 1102,
chapter 33, McCance & Huether, Unit 3
During the body's inflammatory process, what causes edema?
a. Vasodilation of blood vessels
, b. Emigration of neutrophils
c. Endothelial cell expansion
d. Increased capillary permeability - Answers - d. Increased capillary permeability
The increased flow and capillary permeability result in a leakage of plasma from the
vessels causing swelling (edema) in the surrounding tissue and is solely responsible for
inflammation induced edema
A 56-year-old diabetic patient has not taken his insulin in 4 days due to him" feeling well
without it". He is admitted to the ED with an elevated blood sugar. What electrolyte
should be assessed FIRST?
a. Calcium
b. Sodium
c. Potassium
d. Chloride - Answers - c. Potassium
ANS: C - Insulin facilitates the intracellular transport of potassium, phosphate, and
magnesium. Without insulin, potassium does not get transported to the intracellular
environment and the serum potassium will rise.
A 46-year-old women is considering having another child. The healthcare providers are
explaining to the woman that children born to women late in life have an increase rate in
having children with which condition.
a. Kawasaki's disease
b. Down syndrome
c. Klinefelter syndrome
d. Turner syndrome - Answers - b. Down syndrome
Down syndrome risk increases with Maternal age.
A patient with several risk factors is concerned about developing type 2 diabetes. The
healthcare professional advises the patient to lose weight, explaining that obesity is an
important risk factor for type 2 diabetes mellitus because it causes what?
a. Reduced insulin production by the pancreas
b. Increased resistance to insulin in the cells
c. Obstructed outflow of insulin from the pancreas
d. Stimulation of glucose production by the liver - Answers - b. Increased resistance to
insulin in the cells
People with type 2 diabetes mellitus suffer from insulin resistance. Obesity causes this
resistance so their cells have difficulty using insulin. Obesity does not lead to reduced
insulin production, obstructed insulin outflow, or stimulation of glucose production.
ANSWERS
A patient has endured several dosage adjustments of his tricyclic antidepressant, so the
provider recommends genetic testing. Which statement correctly describes the rationale
for genetic testing?
a. The CYP2D6 gene influences metabolism of tricyclic antidepressants and certain
other drugs
b. The HER2 gene is a tumor marker that impacts metabolism of tricyclic
antidepressants
c. The BRCA2 gene influences metabolism of certain drugs and increases the risk for
breast cancer
d. The x-linked OPN1MW gene for male color blindness also slows metabolism of
certain drugs - Answers - a. The CYP2D6 gene influences metabolism of tricyclic
antidepressants and certain other drugs
Answer/Rationale: CYP2D6 - page 155 Box 4.3 of Chapter 4 Genes and Genetic
Diseases, McCance & Huether, Unit 2, Genes, Environmental Lifestyle, and Common
Diseases. HER2 is a gene often implicated with cancer, as is BRCA2. OPN1MW is the
gene that codes for color blindness in men. Metabolism of 25% of all prescribed drugs,
including tricyclic antidepressants, beta adrenergic receptor blockers, and neuroleptics,
is influenced by variants in a certain gene, requiring genetic testing to reduce trial-and-
error in estimating appropriate drug-dosage levels.
As an advanced practice nurse, you want to learn more about the CDC's initiatives
relative to asthma care and management in order to advocate for asthma sufferers at
the state legislative level. Your goal is to reduce medications costs to patients. Which
CDC recommendation supports your goal?
a. The CDC recommends that payers and employers promote healthy workspaces to
decrease environmental trigger exposures
b. The CDC recommends that providers prescribe the most cost-efficient long-acting
inhalers to lower patient co-pays
c. The CDC recommends that providers deviate from the stepwise approach to lessen
the financial impact to the patient
d. The CDC recommends that co-pays be removed for inhaled corticosteroids and other
prescribed medications - Answers - d. The CDC recommends that co-pays be removed
for inhaled corticosteroids and other prescribed medications
Answer/Rationale: D - The CDC recommends that co-pays be removed for inhaled
corticosteroids and other prescribed medications per the following link,
,https://healthpayerintelligence.com/news/top-10-most-expensive-chronic-diseases-for-
healthcare-payers; Genes, Environmental Lifestyle, and Common Diseases; Unit 2
A female patient has been recently diagnosed with invasive ductal carcinoma. As an
advanced practice nurse, you understand that she will be undergoing a multi-faceted
treatment approach that will include one or more medications. Which medication is
considered the "gold standard" endocrine treatment for breast cancer?
a. Fulvestrant (Faslodex), an antiestrogen indicated for metastatic estrogen receptor-
positive breast cancer in post-menopausal women
b. Tamoxifen (Nolvadex), a prodrug that must be converted to active metabolites in
order to block estrogen receptors in breast tissue
c. Trastuzumab (Herceptin), a monoclonal antibody approved for HER2-positive
metastatic breast cancer
d. Lapatinib (Tykerb), an oral inhibitor of HER2 tyrosine kinase and EGFR tyrosine
kinase, resulting in apoptosis and suppression of tumor cell growth - Answers - b.
Tamoxifen (Nolvadex), a prodrug that must be converted to active metabolites in order
to block estrogen receptors in breast tissue
Answer/Rationale: Tamoxifen, page 929, Chapter 82 of Lehne, Unit 2, Human
Structures for Self Defense
A patient reports a maternal family history of Lynch syndrome. Which laboratory finding
might indicate a need for further testing for the presence of Lynch syndrome in this
patient?
a. Elevated thyroid-stimulating hormone
b. Low cortisol level
c. Positive heme-occult test
d. Sputum positive for Pseudomonas Aeruginosa - Answers - c. Positive heme-occult
test
Answer/Rationale: Positive heme-occult because Lynch syndrome is a hereditary form
of colorectal cancer and colorectal bleeding can be a sign of cancer, per
https://www.healthypeople.gov/2020/topics-objectives/topic/genomics, Unit 2, Human
Structures for Self Defense
Your goal as the intensive care unit coordinator is to reduce falls. Upon review of
hospital data, you find that most of the falls are occurring in the patient population, ages
65 and older. As a result, you coordinate a fall reduction initiative after researching the
etiology of falls in the elderly. Which action should be included in the protocol?
a. Encourage slow position changes since orthostatic hypotension is a significant risk
factor for falls.
b. Allocate budgetary resources for assistive devices to be in every room at all times
since falls cannot be predicted.
,c. Initiate depression screening on all new admissions since depressed affect has been
indicated in fall etiology.
d. Decrease the number of situations that require patient standing and walking, as
upright positions result in higher incidence of falls. - Answers - a. Encourage slow
position changes since orthostatic hypotension is a significant risk factor for falls.
Answer/Rationale: Encourage slow position changes since orthostatic hypotension is a
significant risk factor for falls. From page 1067, chapter 33, McCance & Huether,
Causes of Pathology in the Cardiovascular System, Unit 3
A patient who has lung cancer reports facial and neck swelling so severe that some
shirts no longer fit. What question by the healthcare professional would be most
appropriate to screen for superior vena cava syndrome, a possible complication of
cancer tumors?
a. "Have you gained weight recently?"
b. "Are your feet and ankles swollen?"
c. "Does your voice sound hoarse?"
d. "When was your last chemotherapy?" - Answers - c. "Does your voice sound
hoarse?"
ANS: C Patients with certain kinds of cancer (small cell and non-small cell cancers of
the lung, and lymphoma) can develop superior vena cava syndrome (SVCS) which is a
progressive occlusion of the superior vena cava. This leads to venous distention in the
upper extremities and head. Other symptoms include hoarse voice, dyspnea,
dysphagia, stridor, cough, and chest pain. The professional should ask about the other
symptoms. A large weight gain would occur slowly. Asking about edema elsewhere
would be a question if the patient denied any other symptoms of SVCS. The date of the
last chemotherapy is not relevant. Page 1061, ch 33, McCance & Huether, Unit 3
A patient is diagnosed with chronic obstructive pulmonary disease (COPD) and has
elevated pulmonary vascular resistance. Which symptom would indicate the need to
assess for the complication of cor pulmonale (right-sided heart failure)?
a. crackles bilaterally
b. generalized arthralgia
c. jugular venous distention
d. occasional constipation - Answers - c. jugular venous distention
ANS: C JVD - Symptoms of right-sided heart failure include the following:
hepatosplenomegaly, extremity edema, ascites, jugular venous distention, page 1102,
chapter 33, McCance & Huether, Unit 3
During the body's inflammatory process, what causes edema?
a. Vasodilation of blood vessels
, b. Emigration of neutrophils
c. Endothelial cell expansion
d. Increased capillary permeability - Answers - d. Increased capillary permeability
The increased flow and capillary permeability result in a leakage of plasma from the
vessels causing swelling (edema) in the surrounding tissue and is solely responsible for
inflammation induced edema
A 56-year-old diabetic patient has not taken his insulin in 4 days due to him" feeling well
without it". He is admitted to the ED with an elevated blood sugar. What electrolyte
should be assessed FIRST?
a. Calcium
b. Sodium
c. Potassium
d. Chloride - Answers - c. Potassium
ANS: C - Insulin facilitates the intracellular transport of potassium, phosphate, and
magnesium. Without insulin, potassium does not get transported to the intracellular
environment and the serum potassium will rise.
A 46-year-old women is considering having another child. The healthcare providers are
explaining to the woman that children born to women late in life have an increase rate in
having children with which condition.
a. Kawasaki's disease
b. Down syndrome
c. Klinefelter syndrome
d. Turner syndrome - Answers - b. Down syndrome
Down syndrome risk increases with Maternal age.
A patient with several risk factors is concerned about developing type 2 diabetes. The
healthcare professional advises the patient to lose weight, explaining that obesity is an
important risk factor for type 2 diabetes mellitus because it causes what?
a. Reduced insulin production by the pancreas
b. Increased resistance to insulin in the cells
c. Obstructed outflow of insulin from the pancreas
d. Stimulation of glucose production by the liver - Answers - b. Increased resistance to
insulin in the cells
People with type 2 diabetes mellitus suffer from insulin resistance. Obesity causes this
resistance so their cells have difficulty using insulin. Obesity does not lead to reduced
insulin production, obstructed insulin outflow, or stimulation of glucose production.
