WGU D116 Comprehensive Exam Well Explained Answers 2025

Which factors could be attributed to limited prescriptive authority for APRNs?Select all that apply. Inaccessibility of patient care Feedback: Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible patient care. It may also lead to poor collaboration among providers and higher health care costs. It would not directly impact patient’s health literacy. Higher health care costs Feedback: Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible patient care. It may also lead to poor collaboration among providers and higher health care costs. It would not directly impact patient’s health literacy. A patient reports that a medication prescribed for recurrent migraine headaches is not working. Which action should be taken first? Ask the patient about the number and frequency of tablets taken Feedback: using the drug as ordered. Asking the patient to tell the nurse how many tablets are taken and how often helps the nurse determine compliance. Assessing current pain does not yield information about how well the medication is working unless the patient is currently taking it. The nurse should gather as much information about compliance, symptoms, and drug effectiveness as possible before contacting the prescriber. Biofeedback may be an effective adjunct to treatment, but it should not be recommended without complete information about drug effectiveness A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated bythis patient inthe past. Which could be a probable cause of the test result? The patient is taking another medication that binds to serum albumin WGU D116 WGU D116 Feedback: Gentamicin binds to albumin, but only weakly, and in the presence of another drug that binds to albumin, it can rise to toxic levels in blood serum. A loading dose increases the initial amount ofa drug and is used to bring drug levels to the desired plateau more quickly. A drug that is not completely dissolved carries a risk of causing embolism. A drug given at a frequency longer than the drug half-life will likely be at subtherapeutic levels and not at toxic levels The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? Select all that apply Binding of one or both agents will be reduced Plasma levels of free drug will rise The increase in free drug will intensify effects Feedback: When two drugs bind to the same site on plasma albumin, coadministration of those drugs produces competition for binding. As a result, binding of one or both agents is reduced, causing plasma levels of free drug to rise. The increase in free drug can intensify the effect, but it usually undergoes rapid elimination. The increase in plasma levels of free drug is rarely sustained. Which patients are at increased risk for adverse drug events? Select all that apply A 2-month-old infant taking a medication for gastroesophageal reflux disease A 40-year-old male who is intubated in the intensive care unit and taking antibiotics and cardiac medications A 7-year-old female receiving insulin for diabetes An 80-year-old male taking medications for COPD Feedback: Patients at increased risk for adverse drug events include the very young, the very old, and those who have serious illnesses. Females, children, and young adults taking single medications do not have increased risk for adverse events. A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's: metabolism of drugs WGU D116 WGU D116 Feedback: The most common source of genetic variation in drug response is related to alterations in drug metabolism and is determined by genetic codes for various drug metabolizing isoenzymes. There are known genetic differences in codes for drug target sites, but these are not as numerous asthose for metabolic isoenzymes. Hypersensitivity potential is also genetically determined, but variations produce differences in adverse reactions to drugs and not in drug effectiveness. Psychosocial responses vary for many less measurable reasons, such as individual personalities and variations in cultures A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medication's effects? “I need to take it every day to reduce the frequency of migraines.” Feedback: When taken prophylactically, medications such as beta blockers can reduce the frequency of migraine attacks. They do not provide complete relief from migraines. They do not reduce the duration of migraines. They are not effective for treating a migraine once the migraine has begun A prescriber orders transdermal clonidine [Catapres TTS] for a patient with hypertension. What will the nurse teach this patient? To change the patch every week Feedback: Transdermal patches are to be changed every 7 days. Medication administered by patch has the same therapeutic effect and adverse effects asthat given by other routes, except that localized skin reactions may occur and are common with clonidine patches. The patch should be applied to intact, hairless skin on the upper arm or torso A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of: changes in the brain as a result of prolonged drug exposure Feedback: It is thought that beneficial responses to central nervous system (CNS) drugs are delayed because they result from adaptive changes as the CNS modifies itself in response to prolonged drug exposure, and that the responses are not the result of the WGU D116 WGU D116 direct effects of the drugs on synaptic functions. The blood-brain barrier prevents protein-bound and highly ionized drugs from crossing into the CNS, but it does not slow the effects of drugs that can cross the barrier. Tolerance is a decreased response to a drug after prolonged use A 25-year-old patient has been newly diagnosed with Parkinson disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about: any history of alcohol abuse or compulsive behaviors Feedback: Pramipexole has been associated with impulse control disorders, and this risk increases in patients with a history of alcohol abuse or compulsive behaviors. Pramipexole increases the risk of hypotension and sleep attacks, so a history of hypertension or insomnia would not be cautionary. Unlike with levodopa, the risk of psychoses is not increased. A nurse is preparing to administer memantine [Nemanda] to a patient and notes a slight elevation in the patient's creatinine clearance level. What will the nurse expect the provider to order for this patient? Continuing the memantine as ordered Feedback: Patients with severe renal impairment may require a dosage reduction. Adding sodium bicarbonate would alkalinize the urine and increase memantine levels, causing toxicity. It is not necessary to discontinue or decrease the dose of the memantine with mild or moderate renal impairment. A nurse is teaching a group of nursing students about the use of memantine [Namenda] for Alzheimer disease. Which statement by a student indicates understanding of the teaching? “Memantine modulates the effects of glutamate to alter calcium influx into neurons.” Feedback: Memantine modulates the effects of glutamate, which is involved in calcium influx into neuronal cells. Memantine is used for patients with moderate to severe AD. Memantine does not prevent calcium from leaving cells; it only affects the influx of calcium. In studies, although the effects of memantine and donepezil appear to be synergistic or may confer independent benefits, they only demonstrate improvement in cognitive function and not a stop in disease progression WGU D116 WGU D116 A patient will begin taking a cholinesterase inhibitor for early Alzheimer disease. The nurse is teaching the patient's spouse about the medication. Which statement by the spouse indicates a need for further teaching? “This drug significantly slows the progression of the disease.” Feedback: Cholinesterase inhibitors produce modest improvements in cognition, behavior, and function and may slightly delay disease progression; they do not have a major impact on delaying progression of the disease. Gastrointestinal symptoms are common side effects. Drugs that block cholinergic receptors, including antihistamines, can reduce therapeutic effects and should be avoided. Cholinesterase inhibitors do not affect neurons already damaged, but they do improve function in those not yet affected A nurse is caring for an older adult patient who has Alzheimer disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse? lowed heart rate and lightheadedness Feedback: Cardiovascular effects of cholinesterase inhibitor drugs are uncommon but cause the most concern. Bradycardia and fainting can occur when cholinergic receptors in the heart are activated. Confusion and memory impairment are signs of the disease and are not side effects of the drug. Dizziness, headache, nausea, vomiting, and diarrhea are all expected adverse effects, and although uncomfortable, they do not present an increased risk to the patient. A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action? Giving an anticholinergic medication Feedback: The patient is showing signs of parkinsonism, an extrapyramidal effect associated with antipsychotic medications. Anticholinergic medications are indicated. A direct dopamine antagonist would counter the effects of the antipsychotic and remove any beneficial effect it has. Increasing the dose of the antipsychotic medication would only worsen the extrapyramidal symptoms. A second-generation antipsychotic medication may be used if parkinsonism is severe, since the risk of parkinsonism is WGU D116 WGU D116 lower than with the FGA. This patient is exhibiting mild symptoms, so this is not necessary at this point. A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effects of ACE inhibitors will not occur with an ARB medication (select all that apply)? Cough Feedback: ARBs do not produce clinically significant hyperkalemia. Angioedema may occur with ARBs, but the incidence is lower than with ACE inhibitors. They do not promote the accumulation of bradykinin in the lungs and produce a lower incidence of cough. An increased risk of cancer may be a concern with ARBs but is not a concern with ACE inhibitors. As with ACE inhibitors, renal failure can occur in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney Hyperkalemia Feedback: ARBs do not produce clinically significant hyperkalemia. Angioedema may occur with ARBs, but the incidence is lower than with ACE inhibitors. They do not promote the accumulation of bradykinin in the lungs and produce a lower incidence of cough. An increased risk of cancer may be a concern with ARBs but is not a concern with ACE inhibitors. As with ACE inhibitors, renal failure can occur in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do? Instruct the patient not to get up without assistance. Feedback: Severe hypotension can result with the first dose of an ACE inhibitor. The patient should be discouraged from getting up without assistance. Potassium supplements are contraindicated. A dry cough is an expected side effect that eventually may cause a patient to discontinue the drug; however, it is not a contraindication to treatment. Diuretics can exacerbate hypotension and should be discontinued temporarily when a patient starts an ACE inhibitor. A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient? The patient should stop taking the medication and contact her provider immediately WGU D116 WGU D116 Feedback: ACE inhibitors are known to cause serious fetal injury during the second and third trimesters of pregnancy. Whether injury occurs earlier in pregnancy is unknown, and the incidence probably is low. However, women should be counseled to stop taking the drug if they become pregnant, and they should not take it if they are contemplating becoming pregnant. Women who take ACE inhibitors in the first trimester should be counseled that the risk to the fetus is probably low. Women should stop taking the drug when pregnant. ARBs carry the same risk as ACE inhibitors. Apatient has begun taking anHMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse during patient education would be inappropriate? “You should come into the clinic for liver enzymes in 1 month.” Feedback: Baseline liver enzyme tests should be done before a patient starts taking an HMG-COA reductase inhibitor. They should be measured again in 6 to 12 months unless the patient has poor liver function, in which case the tests are indicated every 3 months. A recent study demonstrated protection against influenza morbidity in patients because of a decrease in proinflammatory cytokine release. Statins do reduce the risk of stroke and coronary events in people with normal LDL levels. Maintaining a healthy lifestyle is important, as is avoiding high-fat foods An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient'sfamily? A patient has had blood pressures of 150/95 mmHg and 148/90 mmHg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order: a thiazide diuretic. Feedback: This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first line WGU D116 WGU D116 drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy but should also begin drug therapy because hypertension already exists A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient? ACE inhibitors Feedback: ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia. A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment bythe nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment? Check the patient for other symptoms of digitalis toxicity. Feedback: Yellow halos around lights indicate digoxin toxicity. The use of furosemide increases the risk of hypokalemia, which in turn potentiates digoxin toxicity. The patient should also be assessed for headache, nausea, and vomiting, and blood should be drawn for measurement of the serum digoxin level. The nurse should not withhold the dose of furosemide until further assessment is done, including measurement of a serum digoxin level. No evidence indicates that the patient is in worsening heart failure. Documentation of findings is secondary to further assessment and prevention of digoxin toxicity. A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend? 400 to 800 mg of folic acid per day Feedback: The current recommendation is that all women of childbearing ag