WGU D439 Foundations of Nursing - Ultimate Study Bundle:
Complete OA Prep Guide + Actual NCLEX-Style Practice
Questions with Detailed Explanations & Verified Answers
(2026/2027 Edition) pdf — 200 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Nursing
Description Comprehensive examination covering advanced nursing concepts including
pharmacology, pathophysiology, evidence-based practice, patient safety, ethics,
and clinical decision-making. Designed to assess deep conceptual understanding
and application to complex clinical scenarios.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Integrate knowledge from nursing sciences to provide safe, effective patient
care.
2. Apply evidence-based practice to clinical decision-making.
3. Analyze ethical and legal principles in nursing practice.
4. Evaluate patient responses to pharmacological and non-pharmacological
interventions.
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) and
aligned with NCLEX-RN test plan standards.
Page 1
,1. A patient with a history of chronic heart failure is admitted with acute pulmonary
edema. The nurse notes that the patient's serum potassium level is 3.2 mEq/L. Which
of the following diuretics is most appropriate for this patient?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Mannitol
Answer: C. Spironolactone
Spironolactone is a potassium-sparing diuretic, making it the safest option for a patient
with hypokalemia. Furosemide and hydrochlorothiazide are potassium-wasting.
Mannitol is an osmotic diuretic not typically used for pulmonary edema.
2. A nurse is providing discharge instructions to a patient prescribed warfarin. The
patient asks about dietary restrictions. Which response by the nurse is most
accurate?
A. You should avoid all green leafy vegetables.
B. Maintain consistent intake of vitamin K-rich foods.
C. Increase consumption of foods high in vitamin K.
D. Avoid foods containing vitamin C.
Answer: B. Maintain consistent intake of vitamin K-rich foods.
Consistency in vitamin K intake is key to maintaining stable INR levels. Abrupt
changes can alter warfarin efficacy. Complete avoidance is unnecessary; moderation
and consistency are recommended.
3. A patient with type 2 diabetes is scheduled for a cardiac catheterization. The nurse
reviews the orders and notes that metformin is prescribed. What is the nurse's
priority action?
A. Administer metformin as ordered.
B. Hold metformin and notify the provider.
C. Give metformin with a small snack.
D. Check blood glucose before administering.
Answer: B. Hold metformin and notify the provider.
Metformin should be held before procedures using contrast dye due to risk of lactic
acidosis. The nurse must hold the medication and notify the provider for further orders.
Page 2
,4. A nurse is assessing a patient who has just returned from a bronchoscopy. Which
finding requires immediate intervention?
A. Coughing up small amounts of blood-tinged sputum
B. Oxygen saturation of 94% on room air
C. Complaint of sore throat
D. Respiratory rate of 28 breaths per minute with stridor
Answer: D. Respiratory rate of 28 breaths per minute with stridor
Stridor and tachypnea indicate possible laryngeal edema or airway obstruction,
requiring immediate intervention. Mild hemoptysis and sore throat are expected after
bronchoscopy. An SpO2 of 94% may be acceptable but needs monitoring.
5. A patient is receiving a blood transfusion. Fifteen minutes after the infusion
begins, the patient develops chills, fever, and lower back pain. What is the nurse's
priority action?
A. Slow the transfusion rate and administer antipyretics.
B. Stop the transfusion and maintain IV access with normal saline.
C. Increase the IV flow rate to dilute the blood product.
D. Notify the provider and continue the transfusion at a slower rate.
Answer: B. Stop the transfusion and maintain IV access with normal saline.
These symptoms indicate a hemolytic transfusion reaction. The nurse must stop the
transfusion immediately, maintain IV access with normal saline, and monitor vital
signs. Continuing or slowing the transfusion could worsen the reaction.
6. A patient with chronic kidney disease (CKD) is prescribed a low-protein diet.
Which statement by the patient indicates a need for further teaching?
A. I will eat more fruits and vegetables to get my energy.
B. I should limit my intake of meat and poultry.
C. I can have unlimited amounts of bread and pasta.
D. I will use oils and fats for additional calories.
Answer: C. I can have unlimited amounts of bread and pasta.
Patients with CKD on a low-protein diet often need to limit carbohydrates to avoid
hyperglycemia and fluid retention. Unlimited bread and pasta can lead to excessive
calorie and carbohydrate intake, which may be detrimental.
Page 3
, 7. A nurse is caring for a patient who is receiving a continuous infusion of heparin.
The aPTT result is 90 seconds. The patient has no signs of bleeding. What should the
nurse do?
A. Increase the heparin infusion rate.
B. Decrease the heparin infusion rate.
C. Administer protamine sulfate.
D. Continue the current infusion rate.
Answer: B. Decrease the heparin infusion rate.
The therapeutic aPTT range for heparin is typically 1.5 to 2.5 times the control (usually
60-80 seconds). An aPTT of 90 seconds is supratherapeutic, increasing bleeding risk.
The nurse should decrease the infusion rate per protocol.
8. A patient with severe preeclampsia is receiving magnesium sulfate. The nurse
notes that the patient's respiratory rate is 10 breaths per minute and deep tendon
reflexes are absent. What is the priority nursing action?
A. Administer calcium gluconate.
B. Increase the magnesium sulfate infusion.
C. Place the patient in Trendelenburg position.
D. Prepare for emergency cesarean section.
Answer: A. Administer calcium gluconate.
These signs indicate magnesium toxicity, which can lead to respiratory arrest. Calcium
gluconate is the antidote. The infusion should be stopped, not increased. Trendelenburg
position is not indicated; airway support is critical.
9. A patient is admitted with diabetic ketoacidosis (DKA). Which assessment finding
is most consistent with this condition?
A. Slow, deep respirations with a fruity odor
B. Hypotension and bradycardia
C. Warm, dry skin and flat neck veins
D. Hyperactive bowel sounds and abdominal cramping
Answer: A. Slow, deep respirations with a fruity odor
Kussmaul respirations (deep, rapid) with a fruity odor due to acetone are classic for
DKA. Hypotension and tachycardia are more common. Warm dry skin suggests
hyperglycemia but not specifically DKA. Bowel sounds may be hypoactive.
Page 4
Complete OA Prep Guide + Actual NCLEX-Style Practice
Questions with Detailed Explanations & Verified Answers
(2026/2027 Edition) pdf — 200 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Nursing
Description Comprehensive examination covering advanced nursing concepts including
pharmacology, pathophysiology, evidence-based practice, patient safety, ethics,
and clinical decision-making. Designed to assess deep conceptual understanding
and application to complex clinical scenarios.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Integrate knowledge from nursing sciences to provide safe, effective patient
care.
2. Apply evidence-based practice to clinical decision-making.
3. Analyze ethical and legal principles in nursing practice.
4. Evaluate patient responses to pharmacological and non-pharmacological
interventions.
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) and
aligned with NCLEX-RN test plan standards.
Page 1
,1. A patient with a history of chronic heart failure is admitted with acute pulmonary
edema. The nurse notes that the patient's serum potassium level is 3.2 mEq/L. Which
of the following diuretics is most appropriate for this patient?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Mannitol
Answer: C. Spironolactone
Spironolactone is a potassium-sparing diuretic, making it the safest option for a patient
with hypokalemia. Furosemide and hydrochlorothiazide are potassium-wasting.
Mannitol is an osmotic diuretic not typically used for pulmonary edema.
2. A nurse is providing discharge instructions to a patient prescribed warfarin. The
patient asks about dietary restrictions. Which response by the nurse is most
accurate?
A. You should avoid all green leafy vegetables.
B. Maintain consistent intake of vitamin K-rich foods.
C. Increase consumption of foods high in vitamin K.
D. Avoid foods containing vitamin C.
Answer: B. Maintain consistent intake of vitamin K-rich foods.
Consistency in vitamin K intake is key to maintaining stable INR levels. Abrupt
changes can alter warfarin efficacy. Complete avoidance is unnecessary; moderation
and consistency are recommended.
3. A patient with type 2 diabetes is scheduled for a cardiac catheterization. The nurse
reviews the orders and notes that metformin is prescribed. What is the nurse's
priority action?
A. Administer metformin as ordered.
B. Hold metformin and notify the provider.
C. Give metformin with a small snack.
D. Check blood glucose before administering.
Answer: B. Hold metformin and notify the provider.
Metformin should be held before procedures using contrast dye due to risk of lactic
acidosis. The nurse must hold the medication and notify the provider for further orders.
Page 2
,4. A nurse is assessing a patient who has just returned from a bronchoscopy. Which
finding requires immediate intervention?
A. Coughing up small amounts of blood-tinged sputum
B. Oxygen saturation of 94% on room air
C. Complaint of sore throat
D. Respiratory rate of 28 breaths per minute with stridor
Answer: D. Respiratory rate of 28 breaths per minute with stridor
Stridor and tachypnea indicate possible laryngeal edema or airway obstruction,
requiring immediate intervention. Mild hemoptysis and sore throat are expected after
bronchoscopy. An SpO2 of 94% may be acceptable but needs monitoring.
5. A patient is receiving a blood transfusion. Fifteen minutes after the infusion
begins, the patient develops chills, fever, and lower back pain. What is the nurse's
priority action?
A. Slow the transfusion rate and administer antipyretics.
B. Stop the transfusion and maintain IV access with normal saline.
C. Increase the IV flow rate to dilute the blood product.
D. Notify the provider and continue the transfusion at a slower rate.
Answer: B. Stop the transfusion and maintain IV access with normal saline.
These symptoms indicate a hemolytic transfusion reaction. The nurse must stop the
transfusion immediately, maintain IV access with normal saline, and monitor vital
signs. Continuing or slowing the transfusion could worsen the reaction.
6. A patient with chronic kidney disease (CKD) is prescribed a low-protein diet.
Which statement by the patient indicates a need for further teaching?
A. I will eat more fruits and vegetables to get my energy.
B. I should limit my intake of meat and poultry.
C. I can have unlimited amounts of bread and pasta.
D. I will use oils and fats for additional calories.
Answer: C. I can have unlimited amounts of bread and pasta.
Patients with CKD on a low-protein diet often need to limit carbohydrates to avoid
hyperglycemia and fluid retention. Unlimited bread and pasta can lead to excessive
calorie and carbohydrate intake, which may be detrimental.
Page 3
, 7. A nurse is caring for a patient who is receiving a continuous infusion of heparin.
The aPTT result is 90 seconds. The patient has no signs of bleeding. What should the
nurse do?
A. Increase the heparin infusion rate.
B. Decrease the heparin infusion rate.
C. Administer protamine sulfate.
D. Continue the current infusion rate.
Answer: B. Decrease the heparin infusion rate.
The therapeutic aPTT range for heparin is typically 1.5 to 2.5 times the control (usually
60-80 seconds). An aPTT of 90 seconds is supratherapeutic, increasing bleeding risk.
The nurse should decrease the infusion rate per protocol.
8. A patient with severe preeclampsia is receiving magnesium sulfate. The nurse
notes that the patient's respiratory rate is 10 breaths per minute and deep tendon
reflexes are absent. What is the priority nursing action?
A. Administer calcium gluconate.
B. Increase the magnesium sulfate infusion.
C. Place the patient in Trendelenburg position.
D. Prepare for emergency cesarean section.
Answer: A. Administer calcium gluconate.
These signs indicate magnesium toxicity, which can lead to respiratory arrest. Calcium
gluconate is the antidote. The infusion should be stopped, not increased. Trendelenburg
position is not indicated; airway support is critical.
9. A patient is admitted with diabetic ketoacidosis (DKA). Which assessment finding
is most consistent with this condition?
A. Slow, deep respirations with a fruity odor
B. Hypotension and bradycardia
C. Warm, dry skin and flat neck veins
D. Hyperactive bowel sounds and abdominal cramping
Answer: A. Slow, deep respirations with a fruity odor
Kussmaul respirations (deep, rapid) with a fruity odor due to acetone are classic for
DKA. Hypotension and tachycardia are more common. Warm dry skin suggests
hyperglycemia but not specifically DKA. Bowel sounds may be hypoactive.
Page 4
