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, 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. Synovial
fluid analysis reveals negatively birefringent needle-shaped crystals. Which of
the following is the most appropriate initial pharmacologic therapy for this
acute flare, assuming no contraindications?
A. Allopurinol
B. Febuxostat
C. Indomethacin
D. Probenecid
CORRECT ANSWER: C. Indomethacin
Rationale: The patient has acute gouty arthritis, confirmed by the presence of
monosodium urate crystals (negatively birefringent). The mainstay of treatment for an
acute flare is anti-inflammatory therapy. Indomethacin, a nonsteroidal anti-inflammatory
drug (NSAID), is a first-line agent for acute gout in patients without contraindications.
Allopurinol and Febuxostat are urate-lowering therapies used for chronic management
and are not indicated for acute flares; in fact, initiating them during an acute flare can
worsen symptoms. Probenecid is a uricosuric agent also used for chronic management
and is not appropriate for acute treatment.
Question 2: A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory tests reveal a markedly elevated
TSH and a low free T4. She reports no significant past medical history and is
not on any medications. Which of the following is the most likely underlying
cause of her condition?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Toxic multinodular goiter
D. Subacute thyroiditis
CORRECT ANSWER: B. Hashimoto's thyroiditis
,Rationale: The patient's presentation of hypothyroidism (fatigue, weight gain, cold
intolerance, constipation) with a low free T4 and elevated TSH is classic for primary
hypothyroidism. In a developed country, the most common cause of primary
hypothyroidism is Hashimoto's thyroiditis, an autoimmune destruction of the thyroid
gland. Graves' disease and Toxic multinodular goiter cause hyperthyroidism. Subacute
thyroiditis typically presents with a painful thyroid and a transient hyperthyroid phase
followed by hypothyroidism, but a painless goiter is not the classic presentation.
Question 3: A 55-year-old male with a 40-pack-year smoking history presents
with a chronic cough, hemoptysis, and weight loss. A chest CT reveals a 4-cm
mass in the right upper lobe with mediastinal lymphadenopathy. A biopsy of
the mass reveals small, oval cells with scant cytoplasm and a high nuclear-to-
cytoplasmic ratio. Which of the following paraneoplastic syndromes is this
patient at highest risk for developing?
A. Hypercalcemia
B. SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
C. Hypertrophic pulmonary osteoarthropathy
D. Gynecomastia
CORRECT ANSWER: B. SIADH (Syndrome of Inappropriate Antidiuretic
Hormone)
Rationale: The biopsy reveals small cell lung cancer (SCLC), characterized by small oval
cells with scant cytoplasm. SCLC is highly associated with paraneoplastic syndromes,
particularly SIADH, which leads to euvolemic hyponatremia. Hypercalcemia is more
commonly associated with squamous cell carcinoma of the lung. Hypertrophic
pulmonary osteoarthropathy is associated with non-small cell lung cancer, particularly
adenocarcinoma. Gynecomastia is associated with human chorionic gonadotropin (hCG)
secretion, which can occur with SCLC but is less classic than SIADH.
Question 4: A 28-year-old female G2P1 at 36 weeks gestation presents with a
sudden onset of severe, sharp abdominal pain and vaginal bleeding. Her vital
signs show tachycardia and hypotension. On examination, her uterus is firm
and tender to palpation. Which of the following is the most likely diagnosis?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Vasa previa
CORRECT ANSWER: B. Abruptio placentae
Rationale: The patient presents with a classic triad of painful vaginal bleeding, uterine
hypertonicity, and fetal distress (suggested by the severe pain and firm uterus). Abruptio
placentae is the premature separation of a normally implanted placenta and is a
common cause of bleeding in the third trimester. Placenta previa is characterized by
painless bleeding. Uterine rupture typically occurs in patients with a prior uterine scar
,and presents with acute abdominal pain and fetal bradycardia. Vasa previa is painless
bleeding from fetal vessels.
Question 5: A 72-year-old male with a history of atrial fibrillation on warfarin
presents with a sudden onset of severe headache, nausea, and vomiting.
Neurological exam reveals a left-sided hemiparesis and a right-sided dilated
pupil. A non-contrast head CT shows a large, hyperdense, lenticular-shaped
lesion in the right temporal lobe. Which of the following is the most
appropriate next step in management?
A. Administer tPA (tissue plasminogen activator)
B. Urgent neurosurgical consultation for evacuation
C. Start heparin drip
D. Administer aspirin
CORRECT ANSWER: B. Urgent neurosurgical consultation for evacuation
Rationale: The patient is on warfarin and presents with symptoms of a massive
intracranial hemorrhage. The CT finding of a hyperdense, lenticular-shaped (biconvex)
lesion is classic for an epidural or subdural hematoma. However, the acute presentation
and mass effect on a patient on anticoagulation suggests a large, life-threatening
hemorrhage that requires surgical evacuation. tPA is contraindicated in hemorrhagic
stroke. Heparin and aspirin would worsen the bleeding.
Question 6: A 4-year-old boy is brought to the clinic by his mother for a routine
well-child visit. His growth chart shows his weight is below the 3rd percentile,
but his height is at the 50th percentile. He has a protuberant abdomen and thin
extremities. His mother reports he has a voracious appetite but is not gaining
weight. Which of the following is the most likely diagnosis?
A. Celiac disease
B. Cystic fibrosis
C. Marasmus
D. Kwashiorkor
CORRECT ANSWER: D. Kwashiorkor
Rationale: The patient's presentation of growth failure with weight far below height
(wasting) is characteristic of kwashiorkor. Kwashiorkor is a form of severe acute
malnutrition caused by protein deficiency in the presence of adequate caloric intake,
leading to a protuberant abdomen from ascites and fatty liver, along with edema.
Marasmus is characterized by overall caloric deficiency leading to severe wasting of
both weight and height.
Question 7: A 65-year-old male presents with a several-month history of
progressive difficulty with fine motor skills, such as buttoning his shirt, and a
resting tremor in his right hand. He also reports a shuffling gait and a reduced
arm swing on the right side. Which of the following is the most specific
diagnostic test for this condition?
, A. MRI of the brain
B. Levodopa challenge test
C. Clinical diagnosis based on history and physical exam
D. DaTscan (Ioflupane I-123 injection)
CORRECT ANSWER: C. Clinical diagnosis based on history and physical exam
Rationale: Parkinson's disease is primarily a clinical diagnosis based on the presence of
bradykinesia plus either resting tremor or rigidity. There is no definitive diagnostic test
for Parkinson's disease, and the diagnosis is based on a thorough history and
neurological examination. MRI may be used to rule out other causes. A levodopa
challenge test can be supportive but is not specific. DaTscan can help differentiate
Parkinson's disease from essential tremor or drug-induced parkinsonism but is not a
standard diagnostic test for all patients.
Question 8: A 32-year-old female presents with a chief complaint of episodes
of palpitations, sweating, and anxiety that occur suddenly and resolve within
15 minutes. These episodes are not associated with any specific triggers. She
has no other significant past medical history. An ECG during one of these
episodes shows sinus tachycardia. Which of the following is the most
appropriate next step in the diagnostic evaluation?
A. 24-hour Holter monitor
B. Electrolyte panel
C. Thyroid function tests
D. Cardiac stress test
CORRECT ANSWER: C. Thyroid function tests
Rationale: The patient's symptoms of palpitations, sweating, and anxiety are consistent
with hyperthyroidism. Although the episodes are paroxysmal, the presence of sinus
tachycardia and these symptoms warrant ruling out hyperthyroidism before proceeding
with more specific cardiac testing. Thyroid function tests are a simple and effective first
step to evaluate for an endocrine cause. A 24-hour Holter monitor would be appropriate
if the episodes were more frequent or if the diagnosis of a specific arrhythmia was
suspected. Electrolyte panel and stress tests are less likely to reveal the underlying cause
in this case.
Question 9: A 55-year-old female with a history of hypertension and
hyperlipidemia presents with a sudden onset of severe, tearing chest pain that
radiates to her back. Her blood pressure is 180/100 mmHg in the right arm and
140/80 mmHg in the left arm. Which of the following is the most appropriate
initial imaging modality to confirm the diagnosis?
A. Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography of the chest
D. Magnetic resonance angiography
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, 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. Synovial
fluid analysis reveals negatively birefringent needle-shaped crystals. Which of
the following is the most appropriate initial pharmacologic therapy for this
acute flare, assuming no contraindications?
A. Allopurinol
B. Febuxostat
C. Indomethacin
D. Probenecid
CORRECT ANSWER: C. Indomethacin
Rationale: The patient has acute gouty arthritis, confirmed by the presence of
monosodium urate crystals (negatively birefringent). The mainstay of treatment for an
acute flare is anti-inflammatory therapy. Indomethacin, a nonsteroidal anti-inflammatory
drug (NSAID), is a first-line agent for acute gout in patients without contraindications.
Allopurinol and Febuxostat are urate-lowering therapies used for chronic management
and are not indicated for acute flares; in fact, initiating them during an acute flare can
worsen symptoms. Probenecid is a uricosuric agent also used for chronic management
and is not appropriate for acute treatment.
Question 2: A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory tests reveal a markedly elevated
TSH and a low free T4. She reports no significant past medical history and is
not on any medications. Which of the following is the most likely underlying
cause of her condition?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Toxic multinodular goiter
D. Subacute thyroiditis
CORRECT ANSWER: B. Hashimoto's thyroiditis
,Rationale: The patient's presentation of hypothyroidism (fatigue, weight gain, cold
intolerance, constipation) with a low free T4 and elevated TSH is classic for primary
hypothyroidism. In a developed country, the most common cause of primary
hypothyroidism is Hashimoto's thyroiditis, an autoimmune destruction of the thyroid
gland. Graves' disease and Toxic multinodular goiter cause hyperthyroidism. Subacute
thyroiditis typically presents with a painful thyroid and a transient hyperthyroid phase
followed by hypothyroidism, but a painless goiter is not the classic presentation.
Question 3: A 55-year-old male with a 40-pack-year smoking history presents
with a chronic cough, hemoptysis, and weight loss. A chest CT reveals a 4-cm
mass in the right upper lobe with mediastinal lymphadenopathy. A biopsy of
the mass reveals small, oval cells with scant cytoplasm and a high nuclear-to-
cytoplasmic ratio. Which of the following paraneoplastic syndromes is this
patient at highest risk for developing?
A. Hypercalcemia
B. SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
C. Hypertrophic pulmonary osteoarthropathy
D. Gynecomastia
CORRECT ANSWER: B. SIADH (Syndrome of Inappropriate Antidiuretic
Hormone)
Rationale: The biopsy reveals small cell lung cancer (SCLC), characterized by small oval
cells with scant cytoplasm. SCLC is highly associated with paraneoplastic syndromes,
particularly SIADH, which leads to euvolemic hyponatremia. Hypercalcemia is more
commonly associated with squamous cell carcinoma of the lung. Hypertrophic
pulmonary osteoarthropathy is associated with non-small cell lung cancer, particularly
adenocarcinoma. Gynecomastia is associated with human chorionic gonadotropin (hCG)
secretion, which can occur with SCLC but is less classic than SIADH.
Question 4: A 28-year-old female G2P1 at 36 weeks gestation presents with a
sudden onset of severe, sharp abdominal pain and vaginal bleeding. Her vital
signs show tachycardia and hypotension. On examination, her uterus is firm
and tender to palpation. Which of the following is the most likely diagnosis?
A. Placenta previa
B. Abruptio placentae
C. Uterine rupture
D. Vasa previa
CORRECT ANSWER: B. Abruptio placentae
Rationale: The patient presents with a classic triad of painful vaginal bleeding, uterine
hypertonicity, and fetal distress (suggested by the severe pain and firm uterus). Abruptio
placentae is the premature separation of a normally implanted placenta and is a
common cause of bleeding in the third trimester. Placenta previa is characterized by
painless bleeding. Uterine rupture typically occurs in patients with a prior uterine scar
,and presents with acute abdominal pain and fetal bradycardia. Vasa previa is painless
bleeding from fetal vessels.
Question 5: A 72-year-old male with a history of atrial fibrillation on warfarin
presents with a sudden onset of severe headache, nausea, and vomiting.
Neurological exam reveals a left-sided hemiparesis and a right-sided dilated
pupil. A non-contrast head CT shows a large, hyperdense, lenticular-shaped
lesion in the right temporal lobe. Which of the following is the most
appropriate next step in management?
A. Administer tPA (tissue plasminogen activator)
B. Urgent neurosurgical consultation for evacuation
C. Start heparin drip
D. Administer aspirin
CORRECT ANSWER: B. Urgent neurosurgical consultation for evacuation
Rationale: The patient is on warfarin and presents with symptoms of a massive
intracranial hemorrhage. The CT finding of a hyperdense, lenticular-shaped (biconvex)
lesion is classic for an epidural or subdural hematoma. However, the acute presentation
and mass effect on a patient on anticoagulation suggests a large, life-threatening
hemorrhage that requires surgical evacuation. tPA is contraindicated in hemorrhagic
stroke. Heparin and aspirin would worsen the bleeding.
Question 6: A 4-year-old boy is brought to the clinic by his mother for a routine
well-child visit. His growth chart shows his weight is below the 3rd percentile,
but his height is at the 50th percentile. He has a protuberant abdomen and thin
extremities. His mother reports he has a voracious appetite but is not gaining
weight. Which of the following is the most likely diagnosis?
A. Celiac disease
B. Cystic fibrosis
C. Marasmus
D. Kwashiorkor
CORRECT ANSWER: D. Kwashiorkor
Rationale: The patient's presentation of growth failure with weight far below height
(wasting) is characteristic of kwashiorkor. Kwashiorkor is a form of severe acute
malnutrition caused by protein deficiency in the presence of adequate caloric intake,
leading to a protuberant abdomen from ascites and fatty liver, along with edema.
Marasmus is characterized by overall caloric deficiency leading to severe wasting of
both weight and height.
Question 7: A 65-year-old male presents with a several-month history of
progressive difficulty with fine motor skills, such as buttoning his shirt, and a
resting tremor in his right hand. He also reports a shuffling gait and a reduced
arm swing on the right side. Which of the following is the most specific
diagnostic test for this condition?
, A. MRI of the brain
B. Levodopa challenge test
C. Clinical diagnosis based on history and physical exam
D. DaTscan (Ioflupane I-123 injection)
CORRECT ANSWER: C. Clinical diagnosis based on history and physical exam
Rationale: Parkinson's disease is primarily a clinical diagnosis based on the presence of
bradykinesia plus either resting tremor or rigidity. There is no definitive diagnostic test
for Parkinson's disease, and the diagnosis is based on a thorough history and
neurological examination. MRI may be used to rule out other causes. A levodopa
challenge test can be supportive but is not specific. DaTscan can help differentiate
Parkinson's disease from essential tremor or drug-induced parkinsonism but is not a
standard diagnostic test for all patients.
Question 8: A 32-year-old female presents with a chief complaint of episodes
of palpitations, sweating, and anxiety that occur suddenly and resolve within
15 minutes. These episodes are not associated with any specific triggers. She
has no other significant past medical history. An ECG during one of these
episodes shows sinus tachycardia. Which of the following is the most
appropriate next step in the diagnostic evaluation?
A. 24-hour Holter monitor
B. Electrolyte panel
C. Thyroid function tests
D. Cardiac stress test
CORRECT ANSWER: C. Thyroid function tests
Rationale: The patient's symptoms of palpitations, sweating, and anxiety are consistent
with hyperthyroidism. Although the episodes are paroxysmal, the presence of sinus
tachycardia and these symptoms warrant ruling out hyperthyroidism before proceeding
with more specific cardiac testing. Thyroid function tests are a simple and effective first
step to evaluate for an endocrine cause. A 24-hour Holter monitor would be appropriate
if the episodes were more frequent or if the diagnosis of a specific arrhythmia was
suspected. Electrolyte panel and stress tests are less likely to reveal the underlying cause
in this case.
Question 9: A 55-year-old female with a history of hypertension and
hyperlipidemia presents with a sudden onset of severe, tearing chest pain that
radiates to her back. Her blood pressure is 180/100 mmHg in the right arm and
140/80 mmHg in the left arm. Which of the following is the most appropriate
initial imaging modality to confirm the diagnosis?
A. Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography of the chest
D. Magnetic resonance angiography
