WGU D118 OBJECTIVE ASSESSMENT FINAL 2026| ADULT PRIMARY
CARE FOR THE ADVANCED PRACTICE NURSE |COMPLETE PRACTICE
EXAM 300 VERIFIED QUESTIONS WITH CORRECT ANSWERS &
DETAILED RATIONALES LATEST 2026 UPDATE |
100% GUARANTEED PASS
DOMAIN 1: HEALTH ASSESSMENT & DIAGNOSTIC REASONING (Questions 1-45)
Q1. A 58-year-old male with a 30-pack-year smoking history presents with a
chronic cough, hemoptysis, and weight loss. What is the most appropriate
initial diagnostic test?
A. Chest X-ray
B. CT scan of the chest
C. Sputum cytology
D. Bronchoscopy
Correct Answer: A
Rationale: Chest X-ray is the initial imaging study of choice for evaluating
suspected lung cancer in a patient with risk factors and concerning symptoms.
CT scan and bronchoscopy may follow if the X-ray is abnormal.
Q2. A 45-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. Which laboratory test is most appropriate for initial
screening?
A. TSH
B. Free T4
C. T3
D. Thyroid antibodies
Correct Answer: A
1
,Rationale: TSH is the most sensitive screening test for thyroid dysfunction.
An elevated TSH with low free T4 confirms hypothyroidism. T3 and antibodies
are not initial screening tests.
Q3. A 62-year-old male with a history of hypertension presents with a
blood pressure of 168/94 mmHg on two separate occasions. What is the
most appropriate next step?
A. Start antihypertensive medication
B. Order baseline labs and start lifestyle modifications
C. Refer to cardiology
D. Recheck in 1 month
Correct Answer: B
Rationale: For stage 2 hypertension (BP ≥160/100), the recommendation is to
start lifestyle modifications AND initiate antihypertensive therapy. Baseline
labs (CBC, CMP, lipid panel) should be obtained before starting medication.
Q4. A 55-year-old female presents with a 3-month history of epigastric pain,
bloating, and early satiety. She has a family history of gastric cancer.
What is the most appropriate initial test?
A. Upper endoscopy (EGD)
B. Abdominal ultrasound
C. H. pylori stool antigen test
D. CT scan of the abdomen
Correct Answer: C
Rationale: H. pylori testing is appropriate for patients with dyspepsia,
especially those with risk factors for gastric cancer. EGD would be
indicated if H. pylori is positive or if alarm symptoms are present
2
,(weight loss, anemia, GI bleeding).
Q5. A 68-year-old male presents with a new onset of confusion, fever, and
urinary frequency. Urinalysis shows leukocyte esterase and nitrites
positive. What is the most likely diagnosis?
A. Urinary tract infection with delirium
B. Alzheimer's disease
C. Cerebrovascular accident
D. Electrolyte imbalance
Correct Answer: A
Rationale: In elderly patients, UTI can present with delirium or confusion
without classic urinary symptoms. The positive urinalysis supports the
diagnosis of UTI as the cause of acute confusion.
Q6. A 52-year-old female presents with palpitations, heat intolerance,
tremors, and weight loss despite increased appetite. Which laboratory
finding would confirm the diagnosis?
A. Elevated TSH, low free T4
B. Low TSH, elevated free T4
C. Normal TSH, elevated free T4
D. Low TSH, normal free T4
Correct Answer: B
Rationale: Primary hyperthyroidism is characterized by low TSH (due to
negative feedback) and elevated free T4. Graves' disease is the most
common cause.
3
, Q7. A 65-year-old male presents with a 6-month history of progressive
dysphagia to solids, weight loss, and hoarseness. What is the most
appropriate diagnostic test?
A. Upper endoscopy (EGD)
B. Barium swallow
C. CT scan of the chest
D. Esophageal manometry
Correct Answer: A
Rationale: EGD with biopsy is the gold standard for evaluating dysphagia
with weight loss, which is concerning for esophageal cancer. Barium
swallow may be used if EGD is contraindicated.
Q8. A 48-year-old female presents with fatigue, joint pain, and a malar
rash that spares the nasolabial folds. Which laboratory test is most
specific for the suspected diagnosis?
A. ANA
B. Anti-dsDNA
C. Rheumatoid factor
D. ESR
Correct Answer: B
Rationale: Anti-dsDNA is highly specific for systemic lupus erythematosus.
ANA is sensitive but less specific. The malar rash sparing the nasolabial
folds is classic for SLE.
Q9. A 70-year-old male presents with a new onset of right-sided weakness,
facial droop, and aphasia. Symptoms began 2 hours ago. What is the most
appropriate immediate action?
4
CARE FOR THE ADVANCED PRACTICE NURSE |COMPLETE PRACTICE
EXAM 300 VERIFIED QUESTIONS WITH CORRECT ANSWERS &
DETAILED RATIONALES LATEST 2026 UPDATE |
100% GUARANTEED PASS
DOMAIN 1: HEALTH ASSESSMENT & DIAGNOSTIC REASONING (Questions 1-45)
Q1. A 58-year-old male with a 30-pack-year smoking history presents with a
chronic cough, hemoptysis, and weight loss. What is the most appropriate
initial diagnostic test?
A. Chest X-ray
B. CT scan of the chest
C. Sputum cytology
D. Bronchoscopy
Correct Answer: A
Rationale: Chest X-ray is the initial imaging study of choice for evaluating
suspected lung cancer in a patient with risk factors and concerning symptoms.
CT scan and bronchoscopy may follow if the X-ray is abnormal.
Q2. A 45-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. Which laboratory test is most appropriate for initial
screening?
A. TSH
B. Free T4
C. T3
D. Thyroid antibodies
Correct Answer: A
1
,Rationale: TSH is the most sensitive screening test for thyroid dysfunction.
An elevated TSH with low free T4 confirms hypothyroidism. T3 and antibodies
are not initial screening tests.
Q3. A 62-year-old male with a history of hypertension presents with a
blood pressure of 168/94 mmHg on two separate occasions. What is the
most appropriate next step?
A. Start antihypertensive medication
B. Order baseline labs and start lifestyle modifications
C. Refer to cardiology
D. Recheck in 1 month
Correct Answer: B
Rationale: For stage 2 hypertension (BP ≥160/100), the recommendation is to
start lifestyle modifications AND initiate antihypertensive therapy. Baseline
labs (CBC, CMP, lipid panel) should be obtained before starting medication.
Q4. A 55-year-old female presents with a 3-month history of epigastric pain,
bloating, and early satiety. She has a family history of gastric cancer.
What is the most appropriate initial test?
A. Upper endoscopy (EGD)
B. Abdominal ultrasound
C. H. pylori stool antigen test
D. CT scan of the abdomen
Correct Answer: C
Rationale: H. pylori testing is appropriate for patients with dyspepsia,
especially those with risk factors for gastric cancer. EGD would be
indicated if H. pylori is positive or if alarm symptoms are present
2
,(weight loss, anemia, GI bleeding).
Q5. A 68-year-old male presents with a new onset of confusion, fever, and
urinary frequency. Urinalysis shows leukocyte esterase and nitrites
positive. What is the most likely diagnosis?
A. Urinary tract infection with delirium
B. Alzheimer's disease
C. Cerebrovascular accident
D. Electrolyte imbalance
Correct Answer: A
Rationale: In elderly patients, UTI can present with delirium or confusion
without classic urinary symptoms. The positive urinalysis supports the
diagnosis of UTI as the cause of acute confusion.
Q6. A 52-year-old female presents with palpitations, heat intolerance,
tremors, and weight loss despite increased appetite. Which laboratory
finding would confirm the diagnosis?
A. Elevated TSH, low free T4
B. Low TSH, elevated free T4
C. Normal TSH, elevated free T4
D. Low TSH, normal free T4
Correct Answer: B
Rationale: Primary hyperthyroidism is characterized by low TSH (due to
negative feedback) and elevated free T4. Graves' disease is the most
common cause.
3
, Q7. A 65-year-old male presents with a 6-month history of progressive
dysphagia to solids, weight loss, and hoarseness. What is the most
appropriate diagnostic test?
A. Upper endoscopy (EGD)
B. Barium swallow
C. CT scan of the chest
D. Esophageal manometry
Correct Answer: A
Rationale: EGD with biopsy is the gold standard for evaluating dysphagia
with weight loss, which is concerning for esophageal cancer. Barium
swallow may be used if EGD is contraindicated.
Q8. A 48-year-old female presents with fatigue, joint pain, and a malar
rash that spares the nasolabial folds. Which laboratory test is most
specific for the suspected diagnosis?
A. ANA
B. Anti-dsDNA
C. Rheumatoid factor
D. ESR
Correct Answer: B
Rationale: Anti-dsDNA is highly specific for systemic lupus erythematosus.
ANA is sensitive but less specific. The malar rash sparing the nasolabial
folds is classic for SLE.
Q9. A 70-year-old male presents with a new onset of right-sided weakness,
facial droop, and aphasia. Symptoms began 2 hours ago. What is the most
appropriate immediate action?
4
