WGU D118: ADULT PRIMARY CARE
FOR THE ADVANCED PRACTICE NURSE (OA) EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH
RATIONALES 100% GUARANTEED PASS!!
<LATEST VERSION>
1.
A 58-year-old patient returns for hypertension follow-up. The patient has been
taking lisinopril 20 mg daily consistently. Blood pressure readings from three
separate visits average 154/92 mm Hg. Serum potassium is 4.3 mEq/L, creatinine
is 0.9 mg/dL, and there is no evidence of secondary hypertension. Which
intervention is most appropriate?
A. Discontinue lisinopril and begin clonidine
B. Add a thiazide-type diuretic
C. Increase lisinopril to 80 mg daily
D. Add immediate-release nifedipine as needed for elevated readings
Answer: B
Rationale: This patient has persistent hypertension despite an adequate ACE
inhibitor regimen. Adding a first-line agent from another class, such as a thiazide-
type diuretic, is appropriate. Combining complementary antihypertensive classes
generally provides better blood-pressure control than simply escalating one
medication to an excessive dose. Clonidine is not preferred for routine initial
combination therapy, and immediate-release nifedipine is inappropriate for
outpatient episodic blood-pressure treatment.
,2.
A 67-year-old patient with HFrEF has an ejection fraction of 30%. Current
medications include carvedilol, sacubitril/valsartan, and spironolactone. The
patient remains symptomatic with exertion. Blood pressure is 118/70 mm Hg, heart
rate is 68/min, potassium is 4.5 mEq/L, and renal function is stable. Which
additional therapy should the APRN consider to reduce heart-failure
hospitalization and cardiovascular mortality?
A. Diltiazem
B. Digoxin as first-line mortality therapy
C. An SGLT2 inhibitor
D. Verapamil
Answer: C
Rationale: SGLT2 inhibitors such as dapagliflozin and empagliflozin are
guideline-directed therapy for HFrEF and provide cardiovascular and heart-failure
benefits even in patients without diabetes. Diltiazem and verapamil can worsen
systolic function and are generally avoided in HFrEF. Digoxin may reduce
hospitalizations in selected patients but does not provide the mortality benefit
associated with the major guideline-directed therapies.
3.
A 52-year-old patient with type 2 diabetes has an A1C of 8.9% despite maximally
tolerated metformin. The patient has obesity and established atherosclerotic
cardiovascular disease. Which medication class is particularly appropriate to add?
A. Sulfonylurea
B. GLP-1 receptor agonist
C. Meglitinide
D. Alpha-glucosidase inhibitor
Answer: B
,Rationale: A GLP-1 receptor agonist is an appropriate choice in a patient with
type 2 diabetes, obesity, and established ASCVD because several agents in this
class provide substantial glucose lowering, weight reduction, and cardiovascular
benefit. Treatment selection should consider comorbidities rather than focusing
solely on A1C reduction. Sulfonylureas can cause hypoglycemia and weight gain
and do not provide the same cardiovascular benefit.
4.
A 29-year-old patient reports episodic wheezing and chest tightness approximately
twice per month. Symptoms resolve promptly with an inhaled bronchodilator.
There are no nighttime awakenings and pulmonary function testing is normal
between episodes. Which finding would most strongly suggest that the patient's
asthma is not adequately controlled?
A. Symptoms occurring twice monthly
B. No activity limitation
C. Nighttime symptoms occurring several times per week
D. Normal spirometry between episodes
Answer: C
Rationale: Frequent nighttime symptoms indicate inadequate asthma control and
should prompt reassessment of treatment, adherence, triggers, and the need for
controller therapy. Normal spirometry between episodes does not exclude asthma
because airway obstruction can be variable. Activity limitation and symptom
frequency are important components of assessing control.
, 5.
A 71-year-old patient with COPD reports increased dyspnea, increased sputum
volume, and purulent sputum for 3 days. The patient has no chest pain, confusion,
or hemodynamic instability. Which management approach is most appropriate?
A. Antibiotic therapy should never be used in COPD exacerbations
B. Treat with a short-acting bronchodilator and consider antibiotics because of the
increased sputum purulence and volume
C. Begin chronic oral prednisone indefinitely
D. Begin inhaled corticosteroid monotherapy immediately
Answer: B
Rationale: Increased dyspnea, sputum volume, and sputum purulence are classic
features of a COPD exacerbation and support antibiotic therapy when bacterial
infection is suspected. Short-acting bronchodilator therapy is also an important
component of treatment. Systemic corticosteroids may be used for a limited course
during significant exacerbations but should not be continued indefinitely.
6.
A 45-year-old patient reports fatigue, constipation, dry skin, weight gain, and cold
intolerance. Laboratory testing shows an elevated TSH and a low free T4. Which
diagnosis is most likely?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Euthyroid sick syndrome
Answer: A
Rationale: Primary hypothyroidism results from thyroid gland dysfunction and
typically produces a high TSH with a low free T4 because the pituitary attempts to
stimulate an underactive thyroid. Secondary hypothyroidism is associated with
inadequate pituitary or hypothalamic stimulation and therefore does not produce
the expected elevated TSH response.
FOR THE ADVANCED PRACTICE NURSE (OA) EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH
RATIONALES 100% GUARANTEED PASS!!
<LATEST VERSION>
1.
A 58-year-old patient returns for hypertension follow-up. The patient has been
taking lisinopril 20 mg daily consistently. Blood pressure readings from three
separate visits average 154/92 mm Hg. Serum potassium is 4.3 mEq/L, creatinine
is 0.9 mg/dL, and there is no evidence of secondary hypertension. Which
intervention is most appropriate?
A. Discontinue lisinopril and begin clonidine
B. Add a thiazide-type diuretic
C. Increase lisinopril to 80 mg daily
D. Add immediate-release nifedipine as needed for elevated readings
Answer: B
Rationale: This patient has persistent hypertension despite an adequate ACE
inhibitor regimen. Adding a first-line agent from another class, such as a thiazide-
type diuretic, is appropriate. Combining complementary antihypertensive classes
generally provides better blood-pressure control than simply escalating one
medication to an excessive dose. Clonidine is not preferred for routine initial
combination therapy, and immediate-release nifedipine is inappropriate for
outpatient episodic blood-pressure treatment.
,2.
A 67-year-old patient with HFrEF has an ejection fraction of 30%. Current
medications include carvedilol, sacubitril/valsartan, and spironolactone. The
patient remains symptomatic with exertion. Blood pressure is 118/70 mm Hg, heart
rate is 68/min, potassium is 4.5 mEq/L, and renal function is stable. Which
additional therapy should the APRN consider to reduce heart-failure
hospitalization and cardiovascular mortality?
A. Diltiazem
B. Digoxin as first-line mortality therapy
C. An SGLT2 inhibitor
D. Verapamil
Answer: C
Rationale: SGLT2 inhibitors such as dapagliflozin and empagliflozin are
guideline-directed therapy for HFrEF and provide cardiovascular and heart-failure
benefits even in patients without diabetes. Diltiazem and verapamil can worsen
systolic function and are generally avoided in HFrEF. Digoxin may reduce
hospitalizations in selected patients but does not provide the mortality benefit
associated with the major guideline-directed therapies.
3.
A 52-year-old patient with type 2 diabetes has an A1C of 8.9% despite maximally
tolerated metformin. The patient has obesity and established atherosclerotic
cardiovascular disease. Which medication class is particularly appropriate to add?
A. Sulfonylurea
B. GLP-1 receptor agonist
C. Meglitinide
D. Alpha-glucosidase inhibitor
Answer: B
,Rationale: A GLP-1 receptor agonist is an appropriate choice in a patient with
type 2 diabetes, obesity, and established ASCVD because several agents in this
class provide substantial glucose lowering, weight reduction, and cardiovascular
benefit. Treatment selection should consider comorbidities rather than focusing
solely on A1C reduction. Sulfonylureas can cause hypoglycemia and weight gain
and do not provide the same cardiovascular benefit.
4.
A 29-year-old patient reports episodic wheezing and chest tightness approximately
twice per month. Symptoms resolve promptly with an inhaled bronchodilator.
There are no nighttime awakenings and pulmonary function testing is normal
between episodes. Which finding would most strongly suggest that the patient's
asthma is not adequately controlled?
A. Symptoms occurring twice monthly
B. No activity limitation
C. Nighttime symptoms occurring several times per week
D. Normal spirometry between episodes
Answer: C
Rationale: Frequent nighttime symptoms indicate inadequate asthma control and
should prompt reassessment of treatment, adherence, triggers, and the need for
controller therapy. Normal spirometry between episodes does not exclude asthma
because airway obstruction can be variable. Activity limitation and symptom
frequency are important components of assessing control.
, 5.
A 71-year-old patient with COPD reports increased dyspnea, increased sputum
volume, and purulent sputum for 3 days. The patient has no chest pain, confusion,
or hemodynamic instability. Which management approach is most appropriate?
A. Antibiotic therapy should never be used in COPD exacerbations
B. Treat with a short-acting bronchodilator and consider antibiotics because of the
increased sputum purulence and volume
C. Begin chronic oral prednisone indefinitely
D. Begin inhaled corticosteroid monotherapy immediately
Answer: B
Rationale: Increased dyspnea, sputum volume, and sputum purulence are classic
features of a COPD exacerbation and support antibiotic therapy when bacterial
infection is suspected. Short-acting bronchodilator therapy is also an important
component of treatment. Systemic corticosteroids may be used for a limited course
during significant exacerbations but should not be continued indefinitely.
6.
A 45-year-old patient reports fatigue, constipation, dry skin, weight gain, and cold
intolerance. Laboratory testing shows an elevated TSH and a low free T4. Which
diagnosis is most likely?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Euthyroid sick syndrome
Answer: A
Rationale: Primary hypothyroidism results from thyroid gland dysfunction and
typically produces a high TSH with a low free T4 because the pituitary attempts to
stimulate an underactive thyroid. Secondary hypothyroidism is associated with
inadequate pituitary or hypothalamic stimulation and therefore does not produce
the expected elevated TSH response.
