WGU D446 ADULT HEALTH 2 OA EXAM –
COMPLETE
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-35)
Question 1
A nurse is assessing a client with left-sided heart failure. Which finding is most indicative?
A) Jugular venous distention
B) Peripheral edema
C) Crackles in the lung bases
D) Hepatomegaly
Correct answer: C
Rationale: Left-sided heart failure causes fluid backup into the pulmonary circulation, leading to
pulmonary congestion and crackles (rales) in the lung bases. JVD, peripheral edema, and
hepatomegaly are signs of right-sided heart failure.
Question 2
A client with chronic atrial fibrillation is prescribed warfarin. Which lab value requires immediate
intervention?
A) INR 2.5
B) aPTT 35 seconds
C) Platelets 150,000/mm³
D) INR 4.8
Correct answer: D
Rationale: An INR of 4.8 indicates a high risk of bleeding. The target INR for atrial fibrillation is
typically 2.0–3.0. An INR above 4.5 may require holding the next dose, administering vitamin K,
or using fresh frozen plasma depending on the clinical situation.
,Question 3
Post-cardiac catheterization, the nurse assesses the femoral insertion site. Which finding is
most concerning?
A) Small 2-cm bruise
B) Patient reports mild discomfort
C) Slight oozing with pressure
D) Expanding hematoma
Correct answer: D
Rationale: An expanding hematoma indicates possible retroperitoneal bleeding or
pseudoaneurysm formation. This is a vascular emergency requiring immediate provider
notification.
Question 4
A client with unstable angina is admitted. Which medication reduces mortality and should be
started within 24 hours?
A) Metoprolol
B) Furosemide
C) Digoxin
D) Alprazolam
Correct answer: A
Rationale: Beta-blockers (metoprolol) reduce myocardial oxygen demand, prevent remodeling,
and decrease mortality post-MI/unstable angina.
Question 5
A client presents with pallor, decreased MAP, tachycardia, decreased urinary output,
hypotension, and cold clammy skin. What is this patient most likely experiencing?
A) Myocardial infarction
,B) Hemorrhage
C) Hypertensive crisis
D) Heart failure exacerbation
Correct answer: B
Rationale: These are classic signs and symptoms of hemorrhage, indicating hypovolemic shock.
The body compensates with tachycardia and increased respiratory rate, while decreased
perfusion leads to pallor, cool skin, and decreased urine output.
Question 6
A client with right-sided heart failure is likely to exhibit which set of symptoms?
A) Dyspnea, orthopnea, crackles
B) Jugular vein distention, peripheral edema, ascites
C) Chest pain, diaphoresis, nausea
D) Palpitations, syncope, lightheadedness
Correct answer: B
Rationale: Right-sided heart failure results from fluid backing up into the venous system.
Symptoms include peripheral edema, jugular venous distention (JVD), ascites, hepatomegaly,
and weight gain.
Question 7
Which finding in a client with right-sided heart failure is caused by increased right ventricular
pressure?
A) Crackles
B) Jugular venous distension
C) Paroxysmal nocturnal dyspnea
D) Hepatomegaly
Correct answer: B
Rationale: Right-sided heart failure leads to systemic venous congestion. JVD is a direct result
of increased right atrial pressure and is a hallmark sign of right ventricular failure.
, Question 8
A patient with acute decompensated heart failure (ADHF) has crackles audible to the
mid-scapular region. Which action is priority?
A) Administer furosemide IV push
B) Place the patient in high Fowler's position
C) Prepare for intubation
D) Apply oxygen via non-rebreather mask
Correct answer: A
Rationale: Crackles extending to the mid-scapular region indicate severe, widespread
pulmonary edema. IV furosemide is the priority intervention to rapidly reduce preload and
relieve pulmonary congestion.
Question 9
A client is prescribed digoxin and furosemide. Which assessment finding requires immediate
action?
A) Heart rate of 58 bpm
B) Serum potassium of 3.2 mEq/L
C) Blood pressure 110/70 mm Hg
D) Urine output 40 mL/hour
Correct answer: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) increases the risk of digoxin toxicity. Furosemide is a
potassium-wasting diuretic that can cause hypokalemia, which potentiates digoxin's effects and
can lead to dangerous dysrhythmias.
Question 10
A patient with HFrEF is receiving carvedilol, lisinopril, furosemide, and spironolactone. Which
lab value must be monitored closely due to the spironolactone?
A) Sodium
COMPLETE
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-35)
Question 1
A nurse is assessing a client with left-sided heart failure. Which finding is most indicative?
A) Jugular venous distention
B) Peripheral edema
C) Crackles in the lung bases
D) Hepatomegaly
Correct answer: C
Rationale: Left-sided heart failure causes fluid backup into the pulmonary circulation, leading to
pulmonary congestion and crackles (rales) in the lung bases. JVD, peripheral edema, and
hepatomegaly are signs of right-sided heart failure.
Question 2
A client with chronic atrial fibrillation is prescribed warfarin. Which lab value requires immediate
intervention?
A) INR 2.5
B) aPTT 35 seconds
C) Platelets 150,000/mm³
D) INR 4.8
Correct answer: D
Rationale: An INR of 4.8 indicates a high risk of bleeding. The target INR for atrial fibrillation is
typically 2.0–3.0. An INR above 4.5 may require holding the next dose, administering vitamin K,
or using fresh frozen plasma depending on the clinical situation.
,Question 3
Post-cardiac catheterization, the nurse assesses the femoral insertion site. Which finding is
most concerning?
A) Small 2-cm bruise
B) Patient reports mild discomfort
C) Slight oozing with pressure
D) Expanding hematoma
Correct answer: D
Rationale: An expanding hematoma indicates possible retroperitoneal bleeding or
pseudoaneurysm formation. This is a vascular emergency requiring immediate provider
notification.
Question 4
A client with unstable angina is admitted. Which medication reduces mortality and should be
started within 24 hours?
A) Metoprolol
B) Furosemide
C) Digoxin
D) Alprazolam
Correct answer: A
Rationale: Beta-blockers (metoprolol) reduce myocardial oxygen demand, prevent remodeling,
and decrease mortality post-MI/unstable angina.
Question 5
A client presents with pallor, decreased MAP, tachycardia, decreased urinary output,
hypotension, and cold clammy skin. What is this patient most likely experiencing?
A) Myocardial infarction
,B) Hemorrhage
C) Hypertensive crisis
D) Heart failure exacerbation
Correct answer: B
Rationale: These are classic signs and symptoms of hemorrhage, indicating hypovolemic shock.
The body compensates with tachycardia and increased respiratory rate, while decreased
perfusion leads to pallor, cool skin, and decreased urine output.
Question 6
A client with right-sided heart failure is likely to exhibit which set of symptoms?
A) Dyspnea, orthopnea, crackles
B) Jugular vein distention, peripheral edema, ascites
C) Chest pain, diaphoresis, nausea
D) Palpitations, syncope, lightheadedness
Correct answer: B
Rationale: Right-sided heart failure results from fluid backing up into the venous system.
Symptoms include peripheral edema, jugular venous distention (JVD), ascites, hepatomegaly,
and weight gain.
Question 7
Which finding in a client with right-sided heart failure is caused by increased right ventricular
pressure?
A) Crackles
B) Jugular venous distension
C) Paroxysmal nocturnal dyspnea
D) Hepatomegaly
Correct answer: B
Rationale: Right-sided heart failure leads to systemic venous congestion. JVD is a direct result
of increased right atrial pressure and is a hallmark sign of right ventricular failure.
, Question 8
A patient with acute decompensated heart failure (ADHF) has crackles audible to the
mid-scapular region. Which action is priority?
A) Administer furosemide IV push
B) Place the patient in high Fowler's position
C) Prepare for intubation
D) Apply oxygen via non-rebreather mask
Correct answer: A
Rationale: Crackles extending to the mid-scapular region indicate severe, widespread
pulmonary edema. IV furosemide is the priority intervention to rapidly reduce preload and
relieve pulmonary congestion.
Question 9
A client is prescribed digoxin and furosemide. Which assessment finding requires immediate
action?
A) Heart rate of 58 bpm
B) Serum potassium of 3.2 mEq/L
C) Blood pressure 110/70 mm Hg
D) Urine output 40 mL/hour
Correct answer: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) increases the risk of digoxin toxicity. Furosemide is a
potassium-wasting diuretic that can cause hypokalemia, which potentiates digoxin's effects and
can lead to dangerous dysrhythmias.
Question 10
A patient with HFrEF is receiving carvedilol, lisinopril, furosemide, and spironolactone. Which
lab value must be monitored closely due to the spironolactone?
A) Sodium
