WGU D118: Adult Primary Care Exam 2025–2026 – 200
Multiple-Choice Questions with Answers and Explanations
1. A 58‑year‑old patient with hypertension and diabetes has BP readings averaging 152/92 mmHg. What
is the best initial medication?
a) Beta‑blocker
b) Thiazide diuretic
c) ACE inhibitor
d) Calcium channel blocker
Answer: c) ACE inhibitor
Explanation: In patients with diabetes and hypertension, ACE inhibitors are preferred because they slow
the progression of diabetic nephropathy and reduce cardiovascular events.
2. Which finding indicates target‑organ damage from uncontrolled hypertension?
a) Proteinuria
b) Left ventricular hypertrophy
c) Retinal arteriolar narrowing
d) All of the above
Answer: d) All of the above
Explanation: Proteinuria reflects nephropathy, LVH reflects chronic pressure overload, and retinal
changes indicate hypertensive retinopathy – all are signs of end‑organ damage.
3. Exertional chest pain that is relieved by rest suggests what diagnosis?
a) Unstable angina
b) Stable angina
c) Prinzmetal’s angina
d) Pericarditis
Answer: b) Stable angina
Explanation: Stable angina is reproducible ischemic chest pain that resolves with rest or nitroglycerin.
,4. First‑line treatment for stable angina?
a) Aspirin daily
b) Nitroglycerin (sublingual PRN)
c) Beta‑blocker
d) Statin therapy
Answer: b) Nitroglycerin (sublingual PRN)
Explanation: For immediate relief of an angina episode, sublingual nitroglycerin is the fastest and most
effective.
5. Which lipid abnormality most increases ASCVD risk?
a) Elevated HDL
b) Elevated LDL
c) Elevated triglycerides
d) Elevated VLDL
Answer: b) Elevated LDL
Explanation: LDL cholesterol is the primary atherogenic lipoprotein; lowering LDL is the main target of
lipid‑lowering therapy.
6. Chronic cough, weight loss, and night sweats are most concerning for what diagnosis?
a) Lung cancer
b) Tuberculosis
c) Sarcoidosis
d) Asthma
Answer: b) Tuberculosis
Explanation: The classic triad of constitutional symptoms – cough, weight loss, night sweats – strongly
suggests active TB.
7. GOLD criteria classify which disease?
a) Asthma
,b) COPD
c) Bronchiectasis
d) Interstitial lung disease
Answer: b) COPD
Explanation: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides staging and
management recommendations for COPD.
8. Best initial test for suspected pulmonary embolism in a low‑risk patient?
a) CT pulmonary angiography
b) V/Q scan
c) D‑dimer
d) Chest X‑ray
Answer: c) D‑dimer
Explanation: In low‑clinical‑probability patients, a normal D‑dimer effectively rules out PE, avoiding
unnecessary radiation.
9. Which inhaler is considered a rescue medication?
a) Fluticasone (Flovent)
b) Albuterol
c) Tiotropium (Spiriva)
d) Salmeterol (Serevent)
Answer: b) Albuterol
Explanation: Albuterol is a short‑acting beta‑2 agonist that rapidly bronchodilates during acute
symptoms.
10. When are antibiotics indicated for acute bronchitis?
a) Only if symptoms last >10 days
b) Routinely for all patients
c) Never routinely
d) Only if sputum is discolored
, Answer: c) Never routinely
Explanation: Acute bronchitis is almost always viral; antibiotic overuse promotes resistance without
benefit.
11. A 58‑year‑old patient with hypertension is started on lisinopril. What is the most important lab to
monitor?
a) Sodium
b) Potassium
c) Calcium
d) Hemoglobin
Answer: b) Potassium
Explanation: ACE inhibitors reduce aldosterone secretion, which can lead to hyperkalemia. Routine
potassium monitoring is essential.
12. A patient presents with chest pain radiating to the left arm and diaphoresis. What is the priority
action?
a) Give antacid
b) Obtain ECG immediately
c) Schedule outpatient stress test
d) Administer ibuprofen
Answer: b) Obtain ECG immediately
Explanation: Suspected acute coronary syndrome requires immediate ECG to assess for ischemia or
infarction; door‑to‑ECG time should be ≤10 min.
13. Which finding is most consistent with heart failure?
a) Bradycardia
b) Crackles in lungs
c) Hyperactive bowel sounds
d) Dry skin
Answer: b) Crackles in lungs
Multiple-Choice Questions with Answers and Explanations
1. A 58‑year‑old patient with hypertension and diabetes has BP readings averaging 152/92 mmHg. What
is the best initial medication?
a) Beta‑blocker
b) Thiazide diuretic
c) ACE inhibitor
d) Calcium channel blocker
Answer: c) ACE inhibitor
Explanation: In patients with diabetes and hypertension, ACE inhibitors are preferred because they slow
the progression of diabetic nephropathy and reduce cardiovascular events.
2. Which finding indicates target‑organ damage from uncontrolled hypertension?
a) Proteinuria
b) Left ventricular hypertrophy
c) Retinal arteriolar narrowing
d) All of the above
Answer: d) All of the above
Explanation: Proteinuria reflects nephropathy, LVH reflects chronic pressure overload, and retinal
changes indicate hypertensive retinopathy – all are signs of end‑organ damage.
3. Exertional chest pain that is relieved by rest suggests what diagnosis?
a) Unstable angina
b) Stable angina
c) Prinzmetal’s angina
d) Pericarditis
Answer: b) Stable angina
Explanation: Stable angina is reproducible ischemic chest pain that resolves with rest or nitroglycerin.
,4. First‑line treatment for stable angina?
a) Aspirin daily
b) Nitroglycerin (sublingual PRN)
c) Beta‑blocker
d) Statin therapy
Answer: b) Nitroglycerin (sublingual PRN)
Explanation: For immediate relief of an angina episode, sublingual nitroglycerin is the fastest and most
effective.
5. Which lipid abnormality most increases ASCVD risk?
a) Elevated HDL
b) Elevated LDL
c) Elevated triglycerides
d) Elevated VLDL
Answer: b) Elevated LDL
Explanation: LDL cholesterol is the primary atherogenic lipoprotein; lowering LDL is the main target of
lipid‑lowering therapy.
6. Chronic cough, weight loss, and night sweats are most concerning for what diagnosis?
a) Lung cancer
b) Tuberculosis
c) Sarcoidosis
d) Asthma
Answer: b) Tuberculosis
Explanation: The classic triad of constitutional symptoms – cough, weight loss, night sweats – strongly
suggests active TB.
7. GOLD criteria classify which disease?
a) Asthma
,b) COPD
c) Bronchiectasis
d) Interstitial lung disease
Answer: b) COPD
Explanation: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides staging and
management recommendations for COPD.
8. Best initial test for suspected pulmonary embolism in a low‑risk patient?
a) CT pulmonary angiography
b) V/Q scan
c) D‑dimer
d) Chest X‑ray
Answer: c) D‑dimer
Explanation: In low‑clinical‑probability patients, a normal D‑dimer effectively rules out PE, avoiding
unnecessary radiation.
9. Which inhaler is considered a rescue medication?
a) Fluticasone (Flovent)
b) Albuterol
c) Tiotropium (Spiriva)
d) Salmeterol (Serevent)
Answer: b) Albuterol
Explanation: Albuterol is a short‑acting beta‑2 agonist that rapidly bronchodilates during acute
symptoms.
10. When are antibiotics indicated for acute bronchitis?
a) Only if symptoms last >10 days
b) Routinely for all patients
c) Never routinely
d) Only if sputum is discolored
, Answer: c) Never routinely
Explanation: Acute bronchitis is almost always viral; antibiotic overuse promotes resistance without
benefit.
11. A 58‑year‑old patient with hypertension is started on lisinopril. What is the most important lab to
monitor?
a) Sodium
b) Potassium
c) Calcium
d) Hemoglobin
Answer: b) Potassium
Explanation: ACE inhibitors reduce aldosterone secretion, which can lead to hyperkalemia. Routine
potassium monitoring is essential.
12. A patient presents with chest pain radiating to the left arm and diaphoresis. What is the priority
action?
a) Give antacid
b) Obtain ECG immediately
c) Schedule outpatient stress test
d) Administer ibuprofen
Answer: b) Obtain ECG immediately
Explanation: Suspected acute coronary syndrome requires immediate ECG to assess for ischemia or
infarction; door‑to‑ECG time should be ≤10 min.
13. Which finding is most consistent with heart failure?
a) Bradycardia
b) Crackles in lungs
c) Hyperactive bowel sounds
d) Dry skin
Answer: b) Crackles in lungs
