WGU D118 — ADULT PRIMARY CARE
EXAM MASTERY STUDY GUIDE • 2026 EDITION
100 ORIGINAL PRACTICE QUESTIONS & ANSWERS
Clinical reasoning • Primary prevention • Adult chronic disease • Acute presentations • Pharmacology • Geriatrics • Screening
• Care coordination
Important note: This is an independently written study resource. It is not an official WGU document and does
not reproduce or claim to contain actual Objective Assessment questions. The question bank is designed to
reinforce the D118 subject areas identified in public course information and the publicly visible study-material
preview.
HOW TO USE THIS GUIDE
1. First pass: answer every question without looking at the answer.
2. Second pass: read the rationale and identify why the correct choice is best.
3. Third pass: revisit the “exam traps” and rapid-review tables.
4. Final pass: explain each concept aloud in your own words. If you cannot explain it, you do not yet own it.
COURSE FOCUS
WGU describes D118 as preparing graduate nursing students for adult primary care, including health promotion and disease
prevention, diagnosis and management of acute and chronic conditions, care coordination, and patient empowerment.
■cite■turn1search37■
EXAM-FOCUSED MINDSET
When two answers seem reasonable: choose the option that is safest, most evidence-based, most appropriate
to the patient's risk, and most directly addresses the question asked. Look for red flags before routine
management. Distinguish screening from diagnosis. Distinguish stable outpatient disease from emergencies.
D118 Adult Primary Care — Original Exam Mastery Study Guide Page 1
, RAPID REVIEW — HIGH-YIELD THRESHOLDS & DISTINCTIONS
Topic High-yield point Exam trap
Diabetes diagnosis A1C ≥6.5%; FPG ≥126 mg/dL; 2-h OGTT ≥200 mg/dL; random glucose ≥200
Without unequivocal
mg/dL with
hyperglycemia,
classic symptoms/crisis
confirmation is generally requi
Prediabetes A1C 5.7–6.4%; FPG 100–125 mg/dL Do not label prediabetes as established diabetes
A1C goal <7% for many nonpregnant adults, individualized One target does not fit every adult
Acute bronchitis Usually viral; antibiotics not routine Colored sputum alone does not prove bacterial infection
COPD GOLD framework Do not confuse COPD with asthma terminology
Stable angina Predictable exertional pain relieved by rest/nitroglycerin Rest pain or unstable pattern changes urgency
DVT/PE Use pretest probability to select D-dimer vs imaging D-dimer is not a rule-out test for every patient
Cauda equina Saddle anesthesia + bladder/bowel dysfunction or weakness Do not manage as routine low back pain
Delirium Acute/fluctuating attention and awareness disturbance Acute confusion is not normal aging
Screening Tests asymptomatic populations Positive screen usually requires diagnostic follow-up
2026 GUIDELINE NOTE
The 2026 ADA Standards state that diabetes can be diagnosed using A1C or plasma-glucose criteria, including A1C ≥6.5%,
fasting plasma glucose ≥126 mg/dL, 2-hour OGTT glucose ≥200 mg/dL, or random plasma glucose ≥200 mg/dL when classic
symptoms or hyperglycemic crisis are present. In the absence of unequivocal hyperglycemia, confirmatory testing is required.
■cite■turn1search0■
The 2026 ADA Standards also state that an A1C goal of <7% is appropriate for many nonpregnant adults, while goals should
be individualized when hypoglycemia risk, frailty, cognitive impairment, severe comorbidity, or treatment burden changes the
balance of benefits and harms. ■cite■turn1search1■
D118 Adult Primary Care — Original Exam Mastery Study Guide Page 2
, DOMAIN 1 — HEALTH PROMOTION, PREVENTION & ASSESSMENT
Q1. A 52-year-old adult presents for an annual visit with no acute complaint. What is the best overall approach to
preventive primary care?
ANSWER: Use a risk-based, age-appropriate preventive plan that combines history, examination, screening,
immunization review, behavioral counseling, and shared decision-making.
RATIONALE: Preventive care is not simply a checklist. The clinician should identify the patient's risk factors, social context,
family history, preventive-service eligibility, and preferences, then prioritize high-value interventions.
Q2. What is the difference between primary, secondary, and tertiary prevention?
ANSWER: Primary prevention prevents disease before it occurs; secondary prevention detects disease early;
tertiary prevention reduces complications and disability after disease is established.
RATIONALE: Vaccination and smoking cessation are primary prevention. Screening for colorectal cancer or hypertension
is secondary prevention. Rehabilitation after a stroke is tertiary prevention.
Q3. Which component of the history is especially important when assessing cardiovascular risk?
ANSWER: Assess tobacco exposure, blood pressure, diabetes status, lipid history, diet, physical activity, obesity,
family history of premature ASCVD, and other risk-enhancing conditions.
RATIONALE: Risk assessment should integrate modifiable and nonmodifiable factors rather than relying on a single
laboratory value.
Q4. A patient says, 'I know I should exercise, but I am not ready to change.' Which counseling response is most
appropriate?
ANSWER: Use motivational interviewing: explore ambivalence, ask permission to discuss change, use
open-ended questions, and support patient autonomy.
RATIONALE: Arguing or lecturing commonly increases resistance. Motivational interviewing emphasizes collaboration
rather than confrontation.
Q5. What is health literacy?
ANSWER: The ability to access, understand, evaluate, and use health information and services to make
appropriate health decisions.
RATIONALE: Low health literacy is common and should not be interpreted as lack of intelligence. Use plain language,
teach-back, and clear written instructions.
Q6. What is the teach-back method?
ANSWER: Ask the patient to explain in their own words what they will do after the visit.
RATIONALE: Teach-back checks whether the clinician communicated effectively. It is not a test of the patient's intelligence
or memory.
Q7. Why is medication reconciliation important at primary-care visits?
ANSWER: It identifies discrepancies among prescribed, over-the-counter, complementary, and discontinued
medications and reduces preventable medication errors.
RATIONALE: A patient may take a medication differently from the prescription, duplicate therapies, or continue an old
drug. Reconciliation should include dose, route, frequency, indication, and actual use.
Q8. What is a social determinant of health?
ANSWER: A condition in the environments where people are born, live, learn, work, play, worship, and age that
influences health and quality of life.
D118 Adult Primary Care — Original Exam Mastery Study Guide Page 3
EXAM MASTERY STUDY GUIDE • 2026 EDITION
100 ORIGINAL PRACTICE QUESTIONS & ANSWERS
Clinical reasoning • Primary prevention • Adult chronic disease • Acute presentations • Pharmacology • Geriatrics • Screening
• Care coordination
Important note: This is an independently written study resource. It is not an official WGU document and does
not reproduce or claim to contain actual Objective Assessment questions. The question bank is designed to
reinforce the D118 subject areas identified in public course information and the publicly visible study-material
preview.
HOW TO USE THIS GUIDE
1. First pass: answer every question without looking at the answer.
2. Second pass: read the rationale and identify why the correct choice is best.
3. Third pass: revisit the “exam traps” and rapid-review tables.
4. Final pass: explain each concept aloud in your own words. If you cannot explain it, you do not yet own it.
COURSE FOCUS
WGU describes D118 as preparing graduate nursing students for adult primary care, including health promotion and disease
prevention, diagnosis and management of acute and chronic conditions, care coordination, and patient empowerment.
■cite■turn1search37■
EXAM-FOCUSED MINDSET
When two answers seem reasonable: choose the option that is safest, most evidence-based, most appropriate
to the patient's risk, and most directly addresses the question asked. Look for red flags before routine
management. Distinguish screening from diagnosis. Distinguish stable outpatient disease from emergencies.
D118 Adult Primary Care — Original Exam Mastery Study Guide Page 1
, RAPID REVIEW — HIGH-YIELD THRESHOLDS & DISTINCTIONS
Topic High-yield point Exam trap
Diabetes diagnosis A1C ≥6.5%; FPG ≥126 mg/dL; 2-h OGTT ≥200 mg/dL; random glucose ≥200
Without unequivocal
mg/dL with
hyperglycemia,
classic symptoms/crisis
confirmation is generally requi
Prediabetes A1C 5.7–6.4%; FPG 100–125 mg/dL Do not label prediabetes as established diabetes
A1C goal <7% for many nonpregnant adults, individualized One target does not fit every adult
Acute bronchitis Usually viral; antibiotics not routine Colored sputum alone does not prove bacterial infection
COPD GOLD framework Do not confuse COPD with asthma terminology
Stable angina Predictable exertional pain relieved by rest/nitroglycerin Rest pain or unstable pattern changes urgency
DVT/PE Use pretest probability to select D-dimer vs imaging D-dimer is not a rule-out test for every patient
Cauda equina Saddle anesthesia + bladder/bowel dysfunction or weakness Do not manage as routine low back pain
Delirium Acute/fluctuating attention and awareness disturbance Acute confusion is not normal aging
Screening Tests asymptomatic populations Positive screen usually requires diagnostic follow-up
2026 GUIDELINE NOTE
The 2026 ADA Standards state that diabetes can be diagnosed using A1C or plasma-glucose criteria, including A1C ≥6.5%,
fasting plasma glucose ≥126 mg/dL, 2-hour OGTT glucose ≥200 mg/dL, or random plasma glucose ≥200 mg/dL when classic
symptoms or hyperglycemic crisis are present. In the absence of unequivocal hyperglycemia, confirmatory testing is required.
■cite■turn1search0■
The 2026 ADA Standards also state that an A1C goal of <7% is appropriate for many nonpregnant adults, while goals should
be individualized when hypoglycemia risk, frailty, cognitive impairment, severe comorbidity, or treatment burden changes the
balance of benefits and harms. ■cite■turn1search1■
D118 Adult Primary Care — Original Exam Mastery Study Guide Page 2
, DOMAIN 1 — HEALTH PROMOTION, PREVENTION & ASSESSMENT
Q1. A 52-year-old adult presents for an annual visit with no acute complaint. What is the best overall approach to
preventive primary care?
ANSWER: Use a risk-based, age-appropriate preventive plan that combines history, examination, screening,
immunization review, behavioral counseling, and shared decision-making.
RATIONALE: Preventive care is not simply a checklist. The clinician should identify the patient's risk factors, social context,
family history, preventive-service eligibility, and preferences, then prioritize high-value interventions.
Q2. What is the difference between primary, secondary, and tertiary prevention?
ANSWER: Primary prevention prevents disease before it occurs; secondary prevention detects disease early;
tertiary prevention reduces complications and disability after disease is established.
RATIONALE: Vaccination and smoking cessation are primary prevention. Screening for colorectal cancer or hypertension
is secondary prevention. Rehabilitation after a stroke is tertiary prevention.
Q3. Which component of the history is especially important when assessing cardiovascular risk?
ANSWER: Assess tobacco exposure, blood pressure, diabetes status, lipid history, diet, physical activity, obesity,
family history of premature ASCVD, and other risk-enhancing conditions.
RATIONALE: Risk assessment should integrate modifiable and nonmodifiable factors rather than relying on a single
laboratory value.
Q4. A patient says, 'I know I should exercise, but I am not ready to change.' Which counseling response is most
appropriate?
ANSWER: Use motivational interviewing: explore ambivalence, ask permission to discuss change, use
open-ended questions, and support patient autonomy.
RATIONALE: Arguing or lecturing commonly increases resistance. Motivational interviewing emphasizes collaboration
rather than confrontation.
Q5. What is health literacy?
ANSWER: The ability to access, understand, evaluate, and use health information and services to make
appropriate health decisions.
RATIONALE: Low health literacy is common and should not be interpreted as lack of intelligence. Use plain language,
teach-back, and clear written instructions.
Q6. What is the teach-back method?
ANSWER: Ask the patient to explain in their own words what they will do after the visit.
RATIONALE: Teach-back checks whether the clinician communicated effectively. It is not a test of the patient's intelligence
or memory.
Q7. Why is medication reconciliation important at primary-care visits?
ANSWER: It identifies discrepancies among prescribed, over-the-counter, complementary, and discontinued
medications and reduces preventable medication errors.
RATIONALE: A patient may take a medication differently from the prescription, duplicate therapies, or continue an old
drug. Reconciliation should include dose, route, frequency, indication, and actual use.
Q8. What is a social determinant of health?
ANSWER: A condition in the environments where people are born, live, learn, work, play, worship, and age that
influences health and quality of life.
D118 Adult Primary Care — Original Exam Mastery Study Guide Page 3
