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, Patient & Family Education, Care
Coordination, Clinical Reasoning & Detailed
Rationales
Question 1: A 45-year-old male with a history of hypertension presents with a
sudden onset of severe, tearing chest pain radiating to his back. His blood
pressure is 180/100 mmHg in the right arm and 130/80 mmHg in the left arm.
Which of the following is the most appropriate initial diagnostic imaging study
to confirm the suspected diagnosis?
A. Computed tomography (CT) angiography of the chest
B. Transthoracic echocardiogram (TTE)
C. Standard chest X-ray
D. Magnetic resonance imaging (MRI) of the chest
CORRECT ANSWER: A. Computed tomography (CT) angiography of the chest
Rationale: The patient's presentation of acute, severe, tearing chest pain with a pulse
deficit and blood pressure differential between arms is classic for an acute aortic
dissection. CT angiography of the chest is the gold standard initial imaging modality due
to its high sensitivity and specificity, rapid acquisition time, and widespread availability.
A TTE can sometimes visualize the ascending aorta but is not the primary diagnostic
tool. A chest X-ray may show a widened mediastinum but is neither sensitive nor
specific. MRI is highly accurate but is time-consuming and not readily available in an
emergency setting.
Question 2: A 68-year-old female with a history of type 2 diabetes presents
with a painful, red, swollen left great toe. She reports no trauma. Joint
aspiration reveals needle-shaped, negatively birefringent crystals under
polarized light microscopy. Which of the following is the most appropriate
first-line pharmacologic treatment for an acute flare of this condition,
assuming no contraindications?
A. Allopurinol
B. Colchicine
,C. Probenecid
D. Febuxostat
CORRECT ANSWER: B. Colchicine
Rationale: The presence of needle-shaped, negatively birefringent crystals is diagnostic
of gout. For an acute gout flare, first-line treatment options include NSAIDs, colchicine,
or corticosteroids. Colchicine is highly effective if started within 24-48 hours of
symptom onset. Allopurinol and febuxostat are urate-lowering therapies used for chronic
management to prevent future flares, not to treat an acute attack. Probenecid is a
uricosuric agent also used for chronic management. Initiating urate-lowering therapy
during an acute flare can precipitate a paradoxical worsening of symptoms.
Question 3: A 72-year-old male with a history of coronary artery disease and
heart failure with reduced ejection fraction (HFrEF) presents with worsening
dyspnea on exertion and orthopnea. His medications include lisinopril,
carvedilol, and furosemide. His labs show a serum potassium of 5.8 mEq/L.
Which of the following medication adjustments is most appropriate?
A. Increase the lisinopril dose
B. Discontinue the furosemide
C. Decrease the carvedilol dose
D. Hold the lisinopril
CORRECT ANSWER: D. Hold the lisinopril
Rationale: This patient is on an ACE inhibitor (lisinopril) and a beta-blocker (carvedilol)
for HFrEF. Hyperkalemia (potassium >5.0 mEq/L) is a known adverse effect of ACE
inhibitors due to their inhibition of aldosterone secretion. The most appropriate initial
step is to hold the offending agent (lisinopril). Increasing the dose would worsen the
hyperkalemia. Furosemide helps excrete potassium and should not be discontinued; it
may actually need to be continued or increased to manage fluid overload. Carvedilol
does not typically cause hyperkalemia and does not need to be decreased.
Question 4: A 35-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. Physical exam reveals a bradycardia of 52 bpm
and a palpable, non-tender goiter. Laboratory studies show an elevated TSH
and a low free T4. Which of the following is the most likely diagnosis?
A. Graves' disease
B. Toxic multinodular goiter
C. Hashimoto's thyroiditis
D. Subacute granulomatous thyroiditis
CORRECT ANSWER: C. Hashimoto's thyroiditis
,Rationale: The patient's presentation of hypothyroidism (fatigue, weight gain, cold
intolerance, bradycardia) with a goiter is classic for Hashimoto's thyroiditis, the most
common cause of hypothyroidism in iodine-sufficient areas. The lab findings of elevated
TSH with low free T4 are consistent with primary hypothyroidism. Graves' disease and
toxic multinodular goiter cause hyperthyroidism, characterized by low TSH and high
free T4. Subacute granulomatous thyroiditis typically presents with a painful goiter
following a viral illness and can have a transient hyperthyroid phase.
Question 5: A 55-year-old male with a 30-pack-year smoking history presents
with a chronic cough, hemoptysis, and weight loss. A chest CT reveals a right
hilar mass and mediastinal lymphadenopathy. A biopsy is performed, and the
pathology report describes small, round, blue cells with scant cytoplasm.
Which of the following paraneoplastic syndromes is most commonly
associated with this histological type of lung cancer?
A. Hypertrophic pulmonary osteoarthropathy
B. Hypercalcemia
C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
D. Gynecomastia
CORRECT ANSWER: C. Syndrome of inappropriate antidiuretic hormone
secretion (SIADH)
Rationale: The patient's history and CT findings are suspicious for lung cancer, and the
description of "small, round, blue cells with scant cytoplasm" is the classic histological
appearance of small cell lung cancer (SCLC). SCLC is highly associated with several
paraneoplastic syndromes, most notably SIADH, which causes euvolemic hyponatremia.
Hypertrophic pulmonary osteoarthropathy is more commonly associated with non-small
cell lung cancer (NSCLC), particularly adenocarcinoma. Hypercalcemia is associated
with squamous cell carcinoma of the lung. Gynecomastia can be seen with hCG-
secreting tumors, which are rare.
Question 6: A 28-year-old female presents with palpitations, heat intolerance,
and a 10-pound weight loss over the past two months despite an increased
appetite. On exam, she has a fine tremor and a diffuse, painless goiter with a
bruit. Her TSH is undetectable and free T4 is elevated. Which of the following
is the most appropriate initial treatment for this patient, assuming she is not
pregnant?
A. Methimazole
B. Propylthiouracil (PTU)
C. Radioactive iodine ablation
D. Thyroidectomy
CORRECT ANSWER: A. Methimazole
, Rationale: The patient's presentation is classic for Graves' disease, the most common
cause of hyperthyroidism. Methimazole is the first-line thioamide drug for the treatment
of hyperthyroidism in non-pregnant patients due to its once-daily dosing and favorable
side effect profile compared to PTU. PTU is the preferred agent during the first trimester
of pregnancy. Radioactive iodine ablation and thyroidectomy are definitive therapies but
are generally reserved for patients who fail medical therapy, have significant side effects,
or have large goiters causing compressive symptoms.
Question 7: A 50-year-old male with a history of alcohol use disorder presents
with confusion, ataxia, and ophthalmoplegia. Which of the following is the
most likely diagnosis, and what is the immediate treatment?
A. Korsakoff syndrome; Thiamine 100 mg IV
B. Wernicke encephalopathy; Thiamine 100 mg IV
C. Hepatic encephalopathy; Lactulose
D. Alcohol withdrawal delirium; Lorazepam
CORRECT ANSWER: B. Wernicke encephalopathy; Thiamine 100 mg IV
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia (which can
include nystagmus and cranial nerve palsies) is characteristic of Wernicke
encephalopathy, a neurological emergency caused by thiamine (vitamin B1) deficiency,
often seen in patients with alcohol use disorder. The immediate treatment is high-dose
IV thiamine to prevent progression to Korsakoff syndrome, which is characterized by
irreversible memory impairment. Lactulose is used for hepatic encephalopathy.
Lorazepam is used for alcohol withdrawal.
Question 8: A 62-year-old female presents with a dry cough, fatigue, and
progressive shortness of breath. A chest X-ray shows bilateral hilar
lymphadenopathy. Which of the following is the most likely diagnosis?
A. Sarcoidosis
B. Tuberculosis
C. Lymphoma
D. Silicosis
CORRECT ANSWER: A. Sarcoidosis
Rationale: Bilateral hilar lymphadenopathy is a hallmark radiographic finding of
sarcoidosis, a multisystem granulomatous disease of unknown etiology. While
tuberculosis and lymphoma can also cause hilar lymphadenopathy, they are more
typically unilateral or asymmetric. Silicosis presents with a history of occupational
exposure and radiographic findings of upper lobe nodular opacities, not typically
prominent hilar adenopathy.
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, Patient & Family Education, Care
Coordination, Clinical Reasoning & Detailed
Rationales
Question 1: A 45-year-old male with a history of hypertension presents with a
sudden onset of severe, tearing chest pain radiating to his back. His blood
pressure is 180/100 mmHg in the right arm and 130/80 mmHg in the left arm.
Which of the following is the most appropriate initial diagnostic imaging study
to confirm the suspected diagnosis?
A. Computed tomography (CT) angiography of the chest
B. Transthoracic echocardiogram (TTE)
C. Standard chest X-ray
D. Magnetic resonance imaging (MRI) of the chest
CORRECT ANSWER: A. Computed tomography (CT) angiography of the chest
Rationale: The patient's presentation of acute, severe, tearing chest pain with a pulse
deficit and blood pressure differential between arms is classic for an acute aortic
dissection. CT angiography of the chest is the gold standard initial imaging modality due
to its high sensitivity and specificity, rapid acquisition time, and widespread availability.
A TTE can sometimes visualize the ascending aorta but is not the primary diagnostic
tool. A chest X-ray may show a widened mediastinum but is neither sensitive nor
specific. MRI is highly accurate but is time-consuming and not readily available in an
emergency setting.
Question 2: A 68-year-old female with a history of type 2 diabetes presents
with a painful, red, swollen left great toe. She reports no trauma. Joint
aspiration reveals needle-shaped, negatively birefringent crystals under
polarized light microscopy. Which of the following is the most appropriate
first-line pharmacologic treatment for an acute flare of this condition,
assuming no contraindications?
A. Allopurinol
B. Colchicine
,C. Probenecid
D. Febuxostat
CORRECT ANSWER: B. Colchicine
Rationale: The presence of needle-shaped, negatively birefringent crystals is diagnostic
of gout. For an acute gout flare, first-line treatment options include NSAIDs, colchicine,
or corticosteroids. Colchicine is highly effective if started within 24-48 hours of
symptom onset. Allopurinol and febuxostat are urate-lowering therapies used for chronic
management to prevent future flares, not to treat an acute attack. Probenecid is a
uricosuric agent also used for chronic management. Initiating urate-lowering therapy
during an acute flare can precipitate a paradoxical worsening of symptoms.
Question 3: A 72-year-old male with a history of coronary artery disease and
heart failure with reduced ejection fraction (HFrEF) presents with worsening
dyspnea on exertion and orthopnea. His medications include lisinopril,
carvedilol, and furosemide. His labs show a serum potassium of 5.8 mEq/L.
Which of the following medication adjustments is most appropriate?
A. Increase the lisinopril dose
B. Discontinue the furosemide
C. Decrease the carvedilol dose
D. Hold the lisinopril
CORRECT ANSWER: D. Hold the lisinopril
Rationale: This patient is on an ACE inhibitor (lisinopril) and a beta-blocker (carvedilol)
for HFrEF. Hyperkalemia (potassium >5.0 mEq/L) is a known adverse effect of ACE
inhibitors due to their inhibition of aldosterone secretion. The most appropriate initial
step is to hold the offending agent (lisinopril). Increasing the dose would worsen the
hyperkalemia. Furosemide helps excrete potassium and should not be discontinued; it
may actually need to be continued or increased to manage fluid overload. Carvedilol
does not typically cause hyperkalemia and does not need to be decreased.
Question 4: A 35-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. Physical exam reveals a bradycardia of 52 bpm
and a palpable, non-tender goiter. Laboratory studies show an elevated TSH
and a low free T4. Which of the following is the most likely diagnosis?
A. Graves' disease
B. Toxic multinodular goiter
C. Hashimoto's thyroiditis
D. Subacute granulomatous thyroiditis
CORRECT ANSWER: C. Hashimoto's thyroiditis
,Rationale: The patient's presentation of hypothyroidism (fatigue, weight gain, cold
intolerance, bradycardia) with a goiter is classic for Hashimoto's thyroiditis, the most
common cause of hypothyroidism in iodine-sufficient areas. The lab findings of elevated
TSH with low free T4 are consistent with primary hypothyroidism. Graves' disease and
toxic multinodular goiter cause hyperthyroidism, characterized by low TSH and high
free T4. Subacute granulomatous thyroiditis typically presents with a painful goiter
following a viral illness and can have a transient hyperthyroid phase.
Question 5: A 55-year-old male with a 30-pack-year smoking history presents
with a chronic cough, hemoptysis, and weight loss. A chest CT reveals a right
hilar mass and mediastinal lymphadenopathy. A biopsy is performed, and the
pathology report describes small, round, blue cells with scant cytoplasm.
Which of the following paraneoplastic syndromes is most commonly
associated with this histological type of lung cancer?
A. Hypertrophic pulmonary osteoarthropathy
B. Hypercalcemia
C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
D. Gynecomastia
CORRECT ANSWER: C. Syndrome of inappropriate antidiuretic hormone
secretion (SIADH)
Rationale: The patient's history and CT findings are suspicious for lung cancer, and the
description of "small, round, blue cells with scant cytoplasm" is the classic histological
appearance of small cell lung cancer (SCLC). SCLC is highly associated with several
paraneoplastic syndromes, most notably SIADH, which causes euvolemic hyponatremia.
Hypertrophic pulmonary osteoarthropathy is more commonly associated with non-small
cell lung cancer (NSCLC), particularly adenocarcinoma. Hypercalcemia is associated
with squamous cell carcinoma of the lung. Gynecomastia can be seen with hCG-
secreting tumors, which are rare.
Question 6: A 28-year-old female presents with palpitations, heat intolerance,
and a 10-pound weight loss over the past two months despite an increased
appetite. On exam, she has a fine tremor and a diffuse, painless goiter with a
bruit. Her TSH is undetectable and free T4 is elevated. Which of the following
is the most appropriate initial treatment for this patient, assuming she is not
pregnant?
A. Methimazole
B. Propylthiouracil (PTU)
C. Radioactive iodine ablation
D. Thyroidectomy
CORRECT ANSWER: A. Methimazole
, Rationale: The patient's presentation is classic for Graves' disease, the most common
cause of hyperthyroidism. Methimazole is the first-line thioamide drug for the treatment
of hyperthyroidism in non-pregnant patients due to its once-daily dosing and favorable
side effect profile compared to PTU. PTU is the preferred agent during the first trimester
of pregnancy. Radioactive iodine ablation and thyroidectomy are definitive therapies but
are generally reserved for patients who fail medical therapy, have significant side effects,
or have large goiters causing compressive symptoms.
Question 7: A 50-year-old male with a history of alcohol use disorder presents
with confusion, ataxia, and ophthalmoplegia. Which of the following is the
most likely diagnosis, and what is the immediate treatment?
A. Korsakoff syndrome; Thiamine 100 mg IV
B. Wernicke encephalopathy; Thiamine 100 mg IV
C. Hepatic encephalopathy; Lactulose
D. Alcohol withdrawal delirium; Lorazepam
CORRECT ANSWER: B. Wernicke encephalopathy; Thiamine 100 mg IV
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia (which can
include nystagmus and cranial nerve palsies) is characteristic of Wernicke
encephalopathy, a neurological emergency caused by thiamine (vitamin B1) deficiency,
often seen in patients with alcohol use disorder. The immediate treatment is high-dose
IV thiamine to prevent progression to Korsakoff syndrome, which is characterized by
irreversible memory impairment. Lactulose is used for hepatic encephalopathy.
Lorazepam is used for alcohol withdrawal.
Question 8: A 62-year-old female presents with a dry cough, fatigue, and
progressive shortness of breath. A chest X-ray shows bilateral hilar
lymphadenopathy. Which of the following is the most likely diagnosis?
A. Sarcoidosis
B. Tuberculosis
C. Lymphoma
D. Silicosis
CORRECT ANSWER: A. Sarcoidosis
Rationale: Bilateral hilar lymphadenopathy is a hallmark radiographic finding of
sarcoidosis, a multisystem granulomatous disease of unknown etiology. While
tuberculosis and lymphoma can also cause hilar lymphadenopathy, they are more
typically unilateral or asymmetric. Silicosis presents with a history of occupational
exposure and radiographic findings of upper lobe nodular opacities, not typically
prominent hilar adenopathy.
