1
WGU D116 Advanced Pharmacology
OA & Pre-Assessment Exam Bank
Actual Exam 2026/2027 | Questions
with Verified Answers | 100%
Correct | Pass Guaranteed +
PRE-ASSESSMENT SECTION (Questions 1-60)
Use this section to gauge your baseline knowledge.
Q1 (Domain 1): The "first-pass effect" primarily influences which
pharmacokinetic parameter of an orally administered drug?
A. Protein binding
B. Bioavailability
C. Volume of distribution
D. Half-life
Correct Answer: B
Verified Solution & Rationale: This is correct because the first-pass effect refers
to pre-systemic metabolism in the liver, which directly reduces the fraction of
drug that reaches systemic circulation (bioavailability).
Q2 (Domain 1): A patient taking warfarin begins a course of trimethoprim-
sulfamethoxazole for a UTI. Which laboratory parameter requires MOST
frequent monitoring during concurrent therapy?
A. International Normalized Ratio (INR)
B. Serum creatinine
C. Liver function tests
D. Serum potassium
Correct Answer: A
,2
Verified Solution & Rationale: This is correct because TMP-SMX potently
inhibits CYP2C9, significantly increasing warfarin levels and bleeding risk,
necessitating intensive INR monitoring per anticoagulation guidelines.
Q3 (Domain 1): A 55-kg patient requires a loading dose of digoxin 15 mcg/kg.
How many milligrams should be administered?
A. 0.55 mg
B. 0.825 mg
C. 1.25 mg
D. 0.75 mg
Correct Answer: B
Verified Solution & Rationale: This is correct because 55 kg × 15 mcg/kg = 825
mcg, which converts to 0.825 mg (essential calculation for safe cardiac
glycoside initiation).
Q4 (Domain 1): Which factor is the MOST critical consideration when
prescribing renally cleared medications to an elderly patient?
A. Increased gastric pH
B. Decreased hepatic blood flow
C. Reduced glomerular filtration rate
D. Altered plasma protein binding
Correct Answer: C
Verified Solution & Rationale: This is correct because age-related GFR decline
directly impairs drug elimination, requiring mandatory dose adjustments for
renally cleared medications to prevent toxicity.
Q5 (Domain 1): Phenytoin exhibits zero-order kinetics at therapeutic doses,
which means that:
A. A constant fraction of drug is eliminated per unit time.
B. Elimination is directly proportional to drug concentration.
C. A constant amount of drug is eliminated per unit time regardless of
concentration.
D. The drug is completely metabolized before excretion.
Correct Answer: C
Verified Solution & Rationale: This is correct because zero-order kinetics
indicates saturable metabolic pathways, where a fixed amount (not fraction) of
drug is eliminated hourly, explaining nonlinear dose-response relationships.
,3
Q6 (Domain 2): A patient with generalized anxiety disorder is prescribed
buspirone. Which instruction is MOST important for the nurse practitioner to
provide?
A. "Take this medication with food to enhance absorption."
B. "You may experience immediate relief within 30 minutes."
C. "Therapeutic effects typically require 2-4 weeks of consistent use."
D. "Avoid caffeine while taking this medication."
Correct Answer: C
Verified Solution & Rationale: This is correct because buspirone, as a partial 5 -
HT1A agonist, exhibits delayed onset of anxiolysis requiring several weeks,
unlike benzodiazepines.
Q7 (Domain 2): The first-line pharmacologic treatment for uncomplicated
hypertension in a diabetic patient is typically:
A. A beta-blocker
B. An ACE inhibitor
C. A calcium channel blocker
D. A thiazide diuretic
Correct Answer: B
Verified Solution & Rationale: This is correct because ACE inhibitors provide
renoprotective benefits and reduce cardiovascular events in diabetic patients per
ADA and ACC/AHA guidelines.
Q8 (Domain 2): A patient on long-term haloperidol therapy develops
involuntary lip smacking and tongue protrusions. This is most consistent with:
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Parkinsonism
Correct Answer: C
Verified Solution & Rationale: This is correct because tardive dyskinesia
manifests as late-onset, persistent orofacial choreiform movements after
prolonged dopamine receptor blockade.
Q9 (Domain 2): Which medication class is CONTRAINDICATED in a patient
with bipolar I disorder experiencing acute mania?
A. Lithium
, 4
B. Valproic acid
C. Selective serotonin reuptake inhibitor
D. Second-generation antipsychotic
Correct Answer: C
Verified Solution & Rationale: This is correct because SSRIs can precipitate or
worsen manic episodes and are contraindicated as monotherapy in acute mania
per bipolar treatment guidelines.
Q10 (Domain 2): A patient with chronic neuropathic pain has inadequate relief
from gabapentin. Which medication is the MOST appropriate next -line agent?
A. Ibuprofen
B. Tramadol
C. Duloxetine
D. Acetaminophen
Correct Answer: C
Verified Solution & Rationale: This is correct because duloxetine, an SNRI, is
recommended as first-line for neuropathic pain refractory to gabapentinoids per
neuropathic pain management guidelines.
Q11 (Domain 3): A patient with hypertension and benign prostatic hyperplasia
would benefit most from which antihypertensive class?
A. Beta-blocker
B. Alpha-1 antagonist
C. ACE inhibitor
D. Thiazide diuretic
Correct Answer: B
Verified Solution & Rationale: This is correct because alpha-1 antagonists (e.g.,
doxazosin) lower blood pressure while relieving BPH urinary symptoms
through prostate smooth muscle relaxation.
Q12 (Domain 3): Which laboratory value is MOST important to monitor in a
patient started on spironolactone for heart failure?
A. Sodium
B. Potassium
C. Chloride
D. Calcium
Correct Answer: B
WGU D116 Advanced Pharmacology
OA & Pre-Assessment Exam Bank
Actual Exam 2026/2027 | Questions
with Verified Answers | 100%
Correct | Pass Guaranteed +
PRE-ASSESSMENT SECTION (Questions 1-60)
Use this section to gauge your baseline knowledge.
Q1 (Domain 1): The "first-pass effect" primarily influences which
pharmacokinetic parameter of an orally administered drug?
A. Protein binding
B. Bioavailability
C. Volume of distribution
D. Half-life
Correct Answer: B
Verified Solution & Rationale: This is correct because the first-pass effect refers
to pre-systemic metabolism in the liver, which directly reduces the fraction of
drug that reaches systemic circulation (bioavailability).
Q2 (Domain 1): A patient taking warfarin begins a course of trimethoprim-
sulfamethoxazole for a UTI. Which laboratory parameter requires MOST
frequent monitoring during concurrent therapy?
A. International Normalized Ratio (INR)
B. Serum creatinine
C. Liver function tests
D. Serum potassium
Correct Answer: A
,2
Verified Solution & Rationale: This is correct because TMP-SMX potently
inhibits CYP2C9, significantly increasing warfarin levels and bleeding risk,
necessitating intensive INR monitoring per anticoagulation guidelines.
Q3 (Domain 1): A 55-kg patient requires a loading dose of digoxin 15 mcg/kg.
How many milligrams should be administered?
A. 0.55 mg
B. 0.825 mg
C. 1.25 mg
D. 0.75 mg
Correct Answer: B
Verified Solution & Rationale: This is correct because 55 kg × 15 mcg/kg = 825
mcg, which converts to 0.825 mg (essential calculation for safe cardiac
glycoside initiation).
Q4 (Domain 1): Which factor is the MOST critical consideration when
prescribing renally cleared medications to an elderly patient?
A. Increased gastric pH
B. Decreased hepatic blood flow
C. Reduced glomerular filtration rate
D. Altered plasma protein binding
Correct Answer: C
Verified Solution & Rationale: This is correct because age-related GFR decline
directly impairs drug elimination, requiring mandatory dose adjustments for
renally cleared medications to prevent toxicity.
Q5 (Domain 1): Phenytoin exhibits zero-order kinetics at therapeutic doses,
which means that:
A. A constant fraction of drug is eliminated per unit time.
B. Elimination is directly proportional to drug concentration.
C. A constant amount of drug is eliminated per unit time regardless of
concentration.
D. The drug is completely metabolized before excretion.
Correct Answer: C
Verified Solution & Rationale: This is correct because zero-order kinetics
indicates saturable metabolic pathways, where a fixed amount (not fraction) of
drug is eliminated hourly, explaining nonlinear dose-response relationships.
,3
Q6 (Domain 2): A patient with generalized anxiety disorder is prescribed
buspirone. Which instruction is MOST important for the nurse practitioner to
provide?
A. "Take this medication with food to enhance absorption."
B. "You may experience immediate relief within 30 minutes."
C. "Therapeutic effects typically require 2-4 weeks of consistent use."
D. "Avoid caffeine while taking this medication."
Correct Answer: C
Verified Solution & Rationale: This is correct because buspirone, as a partial 5 -
HT1A agonist, exhibits delayed onset of anxiolysis requiring several weeks,
unlike benzodiazepines.
Q7 (Domain 2): The first-line pharmacologic treatment for uncomplicated
hypertension in a diabetic patient is typically:
A. A beta-blocker
B. An ACE inhibitor
C. A calcium channel blocker
D. A thiazide diuretic
Correct Answer: B
Verified Solution & Rationale: This is correct because ACE inhibitors provide
renoprotective benefits and reduce cardiovascular events in diabetic patients per
ADA and ACC/AHA guidelines.
Q8 (Domain 2): A patient on long-term haloperidol therapy develops
involuntary lip smacking and tongue protrusions. This is most consistent with:
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Parkinsonism
Correct Answer: C
Verified Solution & Rationale: This is correct because tardive dyskinesia
manifests as late-onset, persistent orofacial choreiform movements after
prolonged dopamine receptor blockade.
Q9 (Domain 2): Which medication class is CONTRAINDICATED in a patient
with bipolar I disorder experiencing acute mania?
A. Lithium
, 4
B. Valproic acid
C. Selective serotonin reuptake inhibitor
D. Second-generation antipsychotic
Correct Answer: C
Verified Solution & Rationale: This is correct because SSRIs can precipitate or
worsen manic episodes and are contraindicated as monotherapy in acute mania
per bipolar treatment guidelines.
Q10 (Domain 2): A patient with chronic neuropathic pain has inadequate relief
from gabapentin. Which medication is the MOST appropriate next -line agent?
A. Ibuprofen
B. Tramadol
C. Duloxetine
D. Acetaminophen
Correct Answer: C
Verified Solution & Rationale: This is correct because duloxetine, an SNRI, is
recommended as first-line for neuropathic pain refractory to gabapentinoids per
neuropathic pain management guidelines.
Q11 (Domain 3): A patient with hypertension and benign prostatic hyperplasia
would benefit most from which antihypertensive class?
A. Beta-blocker
B. Alpha-1 antagonist
C. ACE inhibitor
D. Thiazide diuretic
Correct Answer: B
Verified Solution & Rationale: This is correct because alpha-1 antagonists (e.g.,
doxazosin) lower blood pressure while relieving BPH urinary symptoms
through prostate smooth muscle relaxation.
Q12 (Domain 3): Which laboratory value is MOST important to monitor in a
patient started on spironolactone for heart failure?
A. Sodium
B. Potassium
C. Chloride
D. Calcium
Correct Answer: B
