A PACKAGE DEAL FOR WGU D116 ADVANCED
PHARMACOLOGY EXAM 2024 ACTUAL EXAM COMPLETE
QUESTIONS WITH DETAILED VERIFIED ANSWERS /ALREADY
GRADED A+
A patient is believed to be experiencing the effects of Virchow's triad. Which
assessment data support this assumption? Select all that apply.
- Recovering from carpal tunnel surgery on left wrist
- History of a previous venous thrombosis
- Lower leg varicosities note bilaterally
- Oral contraceptive use
- Body mass index (BMI) of 17 - ANSWER: History of a previous venous thrombosis
Lower leg varicosities note bilaterally
Oral contraceptive use
Rationale: A venous thromboembolism (VTE) is a thromboembolic event occurring in
the venous system, and it is manifested as either deep vein thrombosis (DVT) or
pulmonary embolism (PE). Venous thrombus formation occurs in the setting of
venous stasis (sluggish blood flow), vascular endothelial wall injury, and
hypercoagulability (propensity for increased blood clotting); these three features are
classically referred to as Virchow's triad. Oral contraceptive use can contribute to
hypercoagulability while a history of venous thrombosis is a risk factor for vascular
endothelial wall injury. Conditions that increase venous pressure include varicose
veins. Although obesity may contribute to the risk of VTE, the patient's BMI is within
normal range. Vascular intimal injury is often related to recent surgery, especially
abdominal and orthopedic surgery but carpal tunnel surgery is not a none risk factor.
Page Number and Header: 981-982 Venous Thromboembolism
What diagnosis places the patient at highest risk for experiencing a life-threatening
emergency?
-Distal deep vein thrombosis (DVT)
-Thrombophilia
-Proximal deep vein thrombosis (DVT)
-Varicosities - ANSWER: Proximal deep vein thrombosis (DVT)
Rationale: The major complication of proximal DVT is thrombus dislodgment and
extension into the pulmonary circulation. Pulmonary embolism (PE) is a life-
threatening emergency, with an associated mortality rate of 25%. Patients with
thrombophilia or varicosities have an increased tendency to develop a thrombosis
but not necessarily a proximal DVT.
Page Number and Header: 981-982 Venous Thromboembolism
A patient with a heart valve replacement currently on Warfarin is being treated for
an ischemic stroke. Which diagnostic result(s) must be evaluated prior to initiating
fibrinolytic therapy? Select all that apply.
,-12-lead electrocardiogram (ECG)
-International normalized ration (INR)
-Electrolytes
-Activated partial thromboplastin time (aPTT)
-Blood glucose - ANSWER: International normalized ration (INR)
Blood glucose
Rationale: All patients presenting with suspected ischemic stroke require several
diagnostic tests, including blood glucose, electrolytes, complete blood count (CBC)
with platelets, 12-lead ECG, troponin, prothrombin time (PT), INR, aPTT, and oxygen
saturation. In patients receiving warfarin, only blood glucose and assessment of INR
should precede the administration of alteplase in candidates eligible for fibrinolysis.
Warfarin is the current standard for oral anticoagulation therapy in patients with
mechanical heart valves.
Page Number and Header: 988, Diagnostic Criteria/Ischemic Stroke
A patient with a history of hypertension has been newly diagnosed with anemia.
What diagnostic test should the healthcare provider ordered for this specific patient
to rule out a common cause of anemia?
-Glycated hemoglobin (A1C)
-Urinalysis
-Adrenocorticotropic hormone (ACTH) stimulation test
-24-hour urine test - ANSWER: 24-hour urine test
Rationale: Anemia is a common complication of chronic renal disease (CKD) and is
primarily due to reduced erythropoietin production by the kidney. Hypertension is a
risk factor for CKD. Measurement of albuminuria is a good test for early detection of
renal disease; a 24-hour urine collection is the "gold standard." The remaining
options are diagnostic tests to confirm disease processes that are factors in
increasing the risk for CKD; A1C (diabetes), ACTH stimulation test (Addison disease
and autoimmune disease), and urinalysis (proteinuria). Because the patient presents
with a known factor for CKD (hypertension) there is no need to confirm the presence
of another known factor. The aim is to determine the existence of CKD.
Page Number and Header: 1020-1021, Anemia of Chronic Renal Failure
What is the best measurement of an effective response to treatment in a compliant
patient who has been treated for anemia for two full weeks?
-No indication of exercise induced dyspnea
-Stabilization of epoetin dosage at 900 units/kg/wk
-Resolution of fatigue and weakness
-Demonstrated increase of 0.8 g/dL (8 g/L) in serum hemoglobin - ANSWER:
Demonstrated increase of 0.8 g/dL (8 g/L) in serum hemoglobin
Rationale: An effective response is likely if, after two weeks of therapy, the
hemoglobin increases more than 0.5 g/dL (5 g/L). If no response has been observed
at 900 units/kg/wk, further escalation is unlikely to be effective. A resolution of
symptoms is impacted by hemoglobin levels as well as other factors.
,Page Number and Header: 1021-1022, Anemia of Chronic Disease/Goals of Drug
Therapy
A patient presents to the emergency department after accidentally taking too much
prescribed warfarin. The patient's heart rate is 78 beats/minute and the blood
pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have
any obvious hematoma or petechiae and does not report any pain. What will the
provider order initially to address the patient's current condition?
-Vitamin K
-Protamine sulfate
-A prothrombin time (PT) and an international normalized ratio (INR)
-An activated partial thromboplastin time (aPTT) - ANSWER: A prothrombin time (PT)
and an international normalized ratio (INR)
Rationale: This patient does not exhibit any signs of bleeding from a warfarin
overdose. The vital signs are stable, there are no hematomas or petechiae, and the
patient does not have pain. A PT and INR should be drawn to evaluate the
anticoagulant effects. Vitamin K may be given if laboratory values indicate overdose.
Protamine sulfate is given for heparin overdose. PTT evaluation is used to monitor
heparin therapy.
A patient who has taken warfarin for a year has now been prescribed
carbamazepine. What additional action will the provider take to assure the patient's
safety?
-Order more frequent aPTT monitoring
-Order extra dietary vitamin K
-Increase the dose of warfarin.
-Decrease the usual dose of carbamazepine. - ANSWER: Increase the dose of
warfarin.
Rationale: Carbamazepine is a powerful inducer of hepatic drug-metabolizing
enzymes and can accelerate warfarin degradation. The warfarin dose should be
increased if the patient begins taking carbamazepine. Decreasing the dose of
carbamazepine is not indicated. It is not necessary to perform more frequent aPTT
monitoring or to add extra vitamin K.
A patient has been receiving subcutaneous Lovenox for 2 days after hip replacement
surgery. The provider is alerted to the following assessment data: Patient's stools
appear black. Patient is pale and reports feeling tired. Patient's heart rate is 98
beats/minute, respirations are 20 breaths/minute, and the blood pressure is 100/50
mm Hg. What order will the provider take initially to best assure appropriate care for
this patient?
-Packed red blood cells
-Hemoglobin and hematocrit levels
-A stool guaiac
-Hypertonic fluid bolus - ANSWER: Hemoglobin and hematocrit levels
, Rationale: This patient is showing signs of anemia, as manifested by tachycardia and
pallor. Because this patient's blood pressure is low, the anemia probably has
occurred secondary to blood loss, a common occurrence with hip replacement
surgery. The first response should be to obtain an H&H to compare baseline and
posttreatment levels. This should be done before an intervention is ordered. A stool
guaiac is not indicated first before identifying the patient's hemoglobin and
hematocrit levels. If the patient has blood loss that is causing hypotension, an
isotonic fluid bolus and packed red blood cells (PRBCs) are indicated to treat this.
A 56-year-old patient presents to the clinic for a sick visit. The patient describes the
gradual onset of bothersome nasal congestion, sore throat, mild body aches, and
fatigue beginning 3 days ago. The patient has been taking over-the-counter
diphenhydramine as needed, which has provided no symptomatic relief. The
patient's temperature today is 98.4°F (36.9°C). On examination, nasal congestion is
noted with mild pharyngeal erythema. There is no adenopathy and the lungs are
clear to auscultation. The patient's medical history includes obesity, hyperlipidemia,
hypertension, and obstructive sleep apnea. What is the most likely diagnosis?
-Chronic rhinosinusitis
-Acute infectious rhinitis
-Acute rhinosinusitis
-Community-acquired pneumonia - ANSWER: Acute infectious rhinitis
Rationale: Based on the patient's short duration of illness, symptomatic
presentation, and absence of fever, the patient most likely has acute infectious
rhinitis, or the common cold. Community-acquired pneumonia commonly presents
with cough with sputum production, fever, chest pain, and dyspnea. It is unlikely that
the patient has acute rhinosinusitis because the patient does not have at least two of
its hallmark symptoms: nasal congestion, nasal discharge, facial pain or headache,
and anosmia. A diagnosis of chronic rhinosinusitis would necessitate symptoms
persisting for greater than 12 weeks.
A 36-year-old patient with no significant past medical history is evaluated for a
report of nasal congestion for the past 6 weeks. The patient has been taking
loratadine for the past month with limited improvement. The patient uses
oxymetazoline nasal spray 5 to 6 days per week, which the patient started following
the first week of symptoms. The patient has not been given any steroids or
antibiotics. What should the health care provider recommend the patient do first?
-Discontinue oxymetazoline
-Initiate loratadine and discontinue cetirizine.
-Initiate azithromycin
-Initiate phenylephrine nasal spray - ANSWER: Discontinue oxymetazoline
Rationale: The patient is experiencing rhinitis medicamentosa, or rebound
congestion, caused by topical decongestants with prolonged use greater than 3 days.
PHARMACOLOGY EXAM 2024 ACTUAL EXAM COMPLETE
QUESTIONS WITH DETAILED VERIFIED ANSWERS /ALREADY
GRADED A+
A patient is believed to be experiencing the effects of Virchow's triad. Which
assessment data support this assumption? Select all that apply.
- Recovering from carpal tunnel surgery on left wrist
- History of a previous venous thrombosis
- Lower leg varicosities note bilaterally
- Oral contraceptive use
- Body mass index (BMI) of 17 - ANSWER: History of a previous venous thrombosis
Lower leg varicosities note bilaterally
Oral contraceptive use
Rationale: A venous thromboembolism (VTE) is a thromboembolic event occurring in
the venous system, and it is manifested as either deep vein thrombosis (DVT) or
pulmonary embolism (PE). Venous thrombus formation occurs in the setting of
venous stasis (sluggish blood flow), vascular endothelial wall injury, and
hypercoagulability (propensity for increased blood clotting); these three features are
classically referred to as Virchow's triad. Oral contraceptive use can contribute to
hypercoagulability while a history of venous thrombosis is a risk factor for vascular
endothelial wall injury. Conditions that increase venous pressure include varicose
veins. Although obesity may contribute to the risk of VTE, the patient's BMI is within
normal range. Vascular intimal injury is often related to recent surgery, especially
abdominal and orthopedic surgery but carpal tunnel surgery is not a none risk factor.
Page Number and Header: 981-982 Venous Thromboembolism
What diagnosis places the patient at highest risk for experiencing a life-threatening
emergency?
-Distal deep vein thrombosis (DVT)
-Thrombophilia
-Proximal deep vein thrombosis (DVT)
-Varicosities - ANSWER: Proximal deep vein thrombosis (DVT)
Rationale: The major complication of proximal DVT is thrombus dislodgment and
extension into the pulmonary circulation. Pulmonary embolism (PE) is a life-
threatening emergency, with an associated mortality rate of 25%. Patients with
thrombophilia or varicosities have an increased tendency to develop a thrombosis
but not necessarily a proximal DVT.
Page Number and Header: 981-982 Venous Thromboembolism
A patient with a heart valve replacement currently on Warfarin is being treated for
an ischemic stroke. Which diagnostic result(s) must be evaluated prior to initiating
fibrinolytic therapy? Select all that apply.
,-12-lead electrocardiogram (ECG)
-International normalized ration (INR)
-Electrolytes
-Activated partial thromboplastin time (aPTT)
-Blood glucose - ANSWER: International normalized ration (INR)
Blood glucose
Rationale: All patients presenting with suspected ischemic stroke require several
diagnostic tests, including blood glucose, electrolytes, complete blood count (CBC)
with platelets, 12-lead ECG, troponin, prothrombin time (PT), INR, aPTT, and oxygen
saturation. In patients receiving warfarin, only blood glucose and assessment of INR
should precede the administration of alteplase in candidates eligible for fibrinolysis.
Warfarin is the current standard for oral anticoagulation therapy in patients with
mechanical heart valves.
Page Number and Header: 988, Diagnostic Criteria/Ischemic Stroke
A patient with a history of hypertension has been newly diagnosed with anemia.
What diagnostic test should the healthcare provider ordered for this specific patient
to rule out a common cause of anemia?
-Glycated hemoglobin (A1C)
-Urinalysis
-Adrenocorticotropic hormone (ACTH) stimulation test
-24-hour urine test - ANSWER: 24-hour urine test
Rationale: Anemia is a common complication of chronic renal disease (CKD) and is
primarily due to reduced erythropoietin production by the kidney. Hypertension is a
risk factor for CKD. Measurement of albuminuria is a good test for early detection of
renal disease; a 24-hour urine collection is the "gold standard." The remaining
options are diagnostic tests to confirm disease processes that are factors in
increasing the risk for CKD; A1C (diabetes), ACTH stimulation test (Addison disease
and autoimmune disease), and urinalysis (proteinuria). Because the patient presents
with a known factor for CKD (hypertension) there is no need to confirm the presence
of another known factor. The aim is to determine the existence of CKD.
Page Number and Header: 1020-1021, Anemia of Chronic Renal Failure
What is the best measurement of an effective response to treatment in a compliant
patient who has been treated for anemia for two full weeks?
-No indication of exercise induced dyspnea
-Stabilization of epoetin dosage at 900 units/kg/wk
-Resolution of fatigue and weakness
-Demonstrated increase of 0.8 g/dL (8 g/L) in serum hemoglobin - ANSWER:
Demonstrated increase of 0.8 g/dL (8 g/L) in serum hemoglobin
Rationale: An effective response is likely if, after two weeks of therapy, the
hemoglobin increases more than 0.5 g/dL (5 g/L). If no response has been observed
at 900 units/kg/wk, further escalation is unlikely to be effective. A resolution of
symptoms is impacted by hemoglobin levels as well as other factors.
,Page Number and Header: 1021-1022, Anemia of Chronic Disease/Goals of Drug
Therapy
A patient presents to the emergency department after accidentally taking too much
prescribed warfarin. The patient's heart rate is 78 beats/minute and the blood
pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have
any obvious hematoma or petechiae and does not report any pain. What will the
provider order initially to address the patient's current condition?
-Vitamin K
-Protamine sulfate
-A prothrombin time (PT) and an international normalized ratio (INR)
-An activated partial thromboplastin time (aPTT) - ANSWER: A prothrombin time (PT)
and an international normalized ratio (INR)
Rationale: This patient does not exhibit any signs of bleeding from a warfarin
overdose. The vital signs are stable, there are no hematomas or petechiae, and the
patient does not have pain. A PT and INR should be drawn to evaluate the
anticoagulant effects. Vitamin K may be given if laboratory values indicate overdose.
Protamine sulfate is given for heparin overdose. PTT evaluation is used to monitor
heparin therapy.
A patient who has taken warfarin for a year has now been prescribed
carbamazepine. What additional action will the provider take to assure the patient's
safety?
-Order more frequent aPTT monitoring
-Order extra dietary vitamin K
-Increase the dose of warfarin.
-Decrease the usual dose of carbamazepine. - ANSWER: Increase the dose of
warfarin.
Rationale: Carbamazepine is a powerful inducer of hepatic drug-metabolizing
enzymes and can accelerate warfarin degradation. The warfarin dose should be
increased if the patient begins taking carbamazepine. Decreasing the dose of
carbamazepine is not indicated. It is not necessary to perform more frequent aPTT
monitoring or to add extra vitamin K.
A patient has been receiving subcutaneous Lovenox for 2 days after hip replacement
surgery. The provider is alerted to the following assessment data: Patient's stools
appear black. Patient is pale and reports feeling tired. Patient's heart rate is 98
beats/minute, respirations are 20 breaths/minute, and the blood pressure is 100/50
mm Hg. What order will the provider take initially to best assure appropriate care for
this patient?
-Packed red blood cells
-Hemoglobin and hematocrit levels
-A stool guaiac
-Hypertonic fluid bolus - ANSWER: Hemoglobin and hematocrit levels
, Rationale: This patient is showing signs of anemia, as manifested by tachycardia and
pallor. Because this patient's blood pressure is low, the anemia probably has
occurred secondary to blood loss, a common occurrence with hip replacement
surgery. The first response should be to obtain an H&H to compare baseline and
posttreatment levels. This should be done before an intervention is ordered. A stool
guaiac is not indicated first before identifying the patient's hemoglobin and
hematocrit levels. If the patient has blood loss that is causing hypotension, an
isotonic fluid bolus and packed red blood cells (PRBCs) are indicated to treat this.
A 56-year-old patient presents to the clinic for a sick visit. The patient describes the
gradual onset of bothersome nasal congestion, sore throat, mild body aches, and
fatigue beginning 3 days ago. The patient has been taking over-the-counter
diphenhydramine as needed, which has provided no symptomatic relief. The
patient's temperature today is 98.4°F (36.9°C). On examination, nasal congestion is
noted with mild pharyngeal erythema. There is no adenopathy and the lungs are
clear to auscultation. The patient's medical history includes obesity, hyperlipidemia,
hypertension, and obstructive sleep apnea. What is the most likely diagnosis?
-Chronic rhinosinusitis
-Acute infectious rhinitis
-Acute rhinosinusitis
-Community-acquired pneumonia - ANSWER: Acute infectious rhinitis
Rationale: Based on the patient's short duration of illness, symptomatic
presentation, and absence of fever, the patient most likely has acute infectious
rhinitis, or the common cold. Community-acquired pneumonia commonly presents
with cough with sputum production, fever, chest pain, and dyspnea. It is unlikely that
the patient has acute rhinosinusitis because the patient does not have at least two of
its hallmark symptoms: nasal congestion, nasal discharge, facial pain or headache,
and anosmia. A diagnosis of chronic rhinosinusitis would necessitate symptoms
persisting for greater than 12 weeks.
A 36-year-old patient with no significant past medical history is evaluated for a
report of nasal congestion for the past 6 weeks. The patient has been taking
loratadine for the past month with limited improvement. The patient uses
oxymetazoline nasal spray 5 to 6 days per week, which the patient started following
the first week of symptoms. The patient has not been given any steroids or
antibiotics. What should the health care provider recommend the patient do first?
-Discontinue oxymetazoline
-Initiate loratadine and discontinue cetirizine.
-Initiate azithromycin
-Initiate phenylephrine nasal spray - ANSWER: Discontinue oxymetazoline
Rationale: The patient is experiencing rhinitis medicamentosa, or rebound
congestion, caused by topical decongestants with prolonged use greater than 3 days.
