WGU D116 Advanced Pharmacology:
Comprehensive 100-Question Practice OA High-
Yield, Evidence-Based Questions with Detailed
Rationales
Appendix: Question Distribution by Part
Part Question Range Primary Focus
Part I 1–25 Cardiovascular, Anticoagulation, Diabetes, Asthma
Part II 26–50 Infectious Disease, Psychiatry, Neurology
Part III 51–75 Heart Failure, TB, Psych, Endocrine, Pain
Part IV 76–100 Hypertension, DVT, Stroke, Antidepressants, Antipsychotics, Opioids, Special Populations
PART I (Questions 1-25)
Question 1
A patient with heart failure is started on digoxin. Which laboratory finding would
place the patient at highest risk for digoxin toxicity?
A) Serum potassium 3.2 mEq/L
B) Serum calcium 10.5 mg/dL
C) Serum magnesium 2.1 mEq/L
D) Serum sodium 138 mEq/L
Correct Answer: A
Rationale: Hypokalemia (K+ <3.5 mEq/L) increases the risk of digoxin toxicity
because digoxin binds to the same site on the Na+/K+-ATPase pump as potassium.
Low potassium enhances digoxin's binding and effects. The other values are
within normal limits (calcium 8.5-10.2, magnesium 1.5-2.5, sodium 135-145).
1|Page
,Question 2
A nurse is teaching a patient about warfarin therapy. Which statement by the
patient indicates a need for further teaching?
A) "I will have my blood drawn regularly to check my INR."
B) "I can eat as many green leafy vegetables as I want."
C) "I should report any nosebleeds or bruising to my doctor."
D) "I will avoid starting any new medications without consulting my provider."
Correct Answer: B
Rationale: Green leafy vegetables are high in vitamin K, which antagonizes
warfarin's effects. Patients should maintain consistent vitamin K intake, not
consume "as many as they want." Sudden increases in vitamin K will lower INR
and reduce anticoagulation.
Question 3
A patient with type 2 diabetes has a glycated hemoglobin (HbA1c) of 9.2% while
on metformin monotherapy. Which medication is most appropriate to add next?
A) Insulin glargine
B) Sitagliptin
C) Empagliflozin
D) Glipizide
Correct Answer: C (or D depending on guidelines - let me explain)
Rationale: Current ADA guidelines recommend adding an SGLT2 inhibitor
(empagliflozin) or GLP-1 agonist for patients with established cardiovascular
disease or high risk. Empagliflozin also provides cardiovascular and renal benefits.
Glipizide (sulfonylurea) is effective but carries hypoglycemia risk and weight
gain. Note: Both C and D are clinically appropriate; on the actual OA, read the
patient context carefully.
2|Page
,Question 4
A patient is prescribed albuterol via metered-dose inhaler for asthma. Which
adverse effect is most commonly associated with this medication?
A) Bradycardia
B) Hyperkalemia
C) Tremor
D) Cough
Correct Answer: C
Rationale: Albuterol is a beta-2 adrenergic agonist. Common adverse effects
include tremor, nervousness, palpitations, and tachycardia due to beta-2 receptor
stimulation in skeletal muscle and beta-1 effects at higher doses.
Question 5
A patient receiving IV vancomycin reports flushing, rash, and hypotension 10
minutes after the infusion starts. What is the nurse's priority action?
A) Stop the infusion immediately
B) Slow the infusion rate
C) Administer diphenhydramine
D) Document as a non-allergic reaction
Correct Answer: A
Rationale: These symptoms describe "Red Man Syndrome," a histamine-release
reaction to rapid vancomycin infusion. However, the priority is to STOP the
infusion first, then slow the rate after symptoms resolve. Anaphylaxis cannot be
immediately ruled out, so stopping the infusion is safest.
Question 6
Which medication is considered first-line treatment for neuropathic pain
associated with diabetic peripheral neuropathy?
A) Ibuprofen
B) Oxycodone
3|Page
, C) Duloxetine
D) Cyclobenzaprine
Correct Answer: C
Rationale: Duloxetine (SNRI) and gabapentin/pregabalin are first-line agents for
diabetic neuropathic pain. NSAIDs and opioids are not first-line. Cyclobenzaprine
is a muscle relaxant.
Question 7
A patient on lithium therapy has a serum level of 1.8 mEq/L. Which symptom
would the nurse expect to assess?
A) Polyuria and polydipsia
B) Coarse tremor and confusion
C) Metallic taste and mild nausea
D) Hair thinning and acne
Correct Answer: B
Rationale: Lithium therapeutic range: 0.6-1.2 mEq/L. 1.8 mEq/L indicates toxicity.
Early toxicity (1.5-2.0) includes coarse tremor, confusion, ataxia, nausea/vomiting.
Polyuria/polydipsia (A) is an expected adverse effect, not toxicity. Metallic taste
(C) is common at therapeutic levels.
Question 8
A patient is prescribed metformin. Which instruction should the nurse include in
discharge teaching?
A) "Take this medication 30 minutes before meals."
B) "Report any muscle pain or weakness to your provider."
C) "Monitor your blood glucose before each meal and at bedtime."
D) "This medication may cause weight gain."
Correct Answer: B
Rationale: Metformin carries a rare but serious risk of lactic acidosis. Patients
should report unexplained muscle pain, weakness, malaise, or breathing difficulty.
4|Page
Comprehensive 100-Question Practice OA High-
Yield, Evidence-Based Questions with Detailed
Rationales
Appendix: Question Distribution by Part
Part Question Range Primary Focus
Part I 1–25 Cardiovascular, Anticoagulation, Diabetes, Asthma
Part II 26–50 Infectious Disease, Psychiatry, Neurology
Part III 51–75 Heart Failure, TB, Psych, Endocrine, Pain
Part IV 76–100 Hypertension, DVT, Stroke, Antidepressants, Antipsychotics, Opioids, Special Populations
PART I (Questions 1-25)
Question 1
A patient with heart failure is started on digoxin. Which laboratory finding would
place the patient at highest risk for digoxin toxicity?
A) Serum potassium 3.2 mEq/L
B) Serum calcium 10.5 mg/dL
C) Serum magnesium 2.1 mEq/L
D) Serum sodium 138 mEq/L
Correct Answer: A
Rationale: Hypokalemia (K+ <3.5 mEq/L) increases the risk of digoxin toxicity
because digoxin binds to the same site on the Na+/K+-ATPase pump as potassium.
Low potassium enhances digoxin's binding and effects. The other values are
within normal limits (calcium 8.5-10.2, magnesium 1.5-2.5, sodium 135-145).
1|Page
,Question 2
A nurse is teaching a patient about warfarin therapy. Which statement by the
patient indicates a need for further teaching?
A) "I will have my blood drawn regularly to check my INR."
B) "I can eat as many green leafy vegetables as I want."
C) "I should report any nosebleeds or bruising to my doctor."
D) "I will avoid starting any new medications without consulting my provider."
Correct Answer: B
Rationale: Green leafy vegetables are high in vitamin K, which antagonizes
warfarin's effects. Patients should maintain consistent vitamin K intake, not
consume "as many as they want." Sudden increases in vitamin K will lower INR
and reduce anticoagulation.
Question 3
A patient with type 2 diabetes has a glycated hemoglobin (HbA1c) of 9.2% while
on metformin monotherapy. Which medication is most appropriate to add next?
A) Insulin glargine
B) Sitagliptin
C) Empagliflozin
D) Glipizide
Correct Answer: C (or D depending on guidelines - let me explain)
Rationale: Current ADA guidelines recommend adding an SGLT2 inhibitor
(empagliflozin) or GLP-1 agonist for patients with established cardiovascular
disease or high risk. Empagliflozin also provides cardiovascular and renal benefits.
Glipizide (sulfonylurea) is effective but carries hypoglycemia risk and weight
gain. Note: Both C and D are clinically appropriate; on the actual OA, read the
patient context carefully.
2|Page
,Question 4
A patient is prescribed albuterol via metered-dose inhaler for asthma. Which
adverse effect is most commonly associated with this medication?
A) Bradycardia
B) Hyperkalemia
C) Tremor
D) Cough
Correct Answer: C
Rationale: Albuterol is a beta-2 adrenergic agonist. Common adverse effects
include tremor, nervousness, palpitations, and tachycardia due to beta-2 receptor
stimulation in skeletal muscle and beta-1 effects at higher doses.
Question 5
A patient receiving IV vancomycin reports flushing, rash, and hypotension 10
minutes after the infusion starts. What is the nurse's priority action?
A) Stop the infusion immediately
B) Slow the infusion rate
C) Administer diphenhydramine
D) Document as a non-allergic reaction
Correct Answer: A
Rationale: These symptoms describe "Red Man Syndrome," a histamine-release
reaction to rapid vancomycin infusion. However, the priority is to STOP the
infusion first, then slow the rate after symptoms resolve. Anaphylaxis cannot be
immediately ruled out, so stopping the infusion is safest.
Question 6
Which medication is considered first-line treatment for neuropathic pain
associated with diabetic peripheral neuropathy?
A) Ibuprofen
B) Oxycodone
3|Page
, C) Duloxetine
D) Cyclobenzaprine
Correct Answer: C
Rationale: Duloxetine (SNRI) and gabapentin/pregabalin are first-line agents for
diabetic neuropathic pain. NSAIDs and opioids are not first-line. Cyclobenzaprine
is a muscle relaxant.
Question 7
A patient on lithium therapy has a serum level of 1.8 mEq/L. Which symptom
would the nurse expect to assess?
A) Polyuria and polydipsia
B) Coarse tremor and confusion
C) Metallic taste and mild nausea
D) Hair thinning and acne
Correct Answer: B
Rationale: Lithium therapeutic range: 0.6-1.2 mEq/L. 1.8 mEq/L indicates toxicity.
Early toxicity (1.5-2.0) includes coarse tremor, confusion, ataxia, nausea/vomiting.
Polyuria/polydipsia (A) is an expected adverse effect, not toxicity. Metallic taste
(C) is common at therapeutic levels.
Question 8
A patient is prescribed metformin. Which instruction should the nurse include in
discharge teaching?
A) "Take this medication 30 minutes before meals."
B) "Report any muscle pain or weakness to your provider."
C) "Monitor your blood glucose before each meal and at bedtime."
D) "This medication may cause weight gain."
Correct Answer: B
Rationale: Metformin carries a rare but serious risk of lactic acidosis. Patients
should report unexplained muscle pain, weakness, malaise, or breathing difficulty.
4|Page
