WGU D446 Adult Health 2 OA | Objective Assessment
| Questions and Answers | 2026 Update | 100%
Correct.
1. A patient with a history of chronic heart failure (HFrEF) presents with acute dyspnea, jugular
venous distention, and a third heart sound (S3). After administering intravenous furosemide, the
nurse notes a decrease in urine output over the next hour. Which hemodynamic parameter most
likely explains this finding?
A. Increased systemic vascular resistance (SVR) due to compensatory vasoconstriction
B. Decreased renal perfusion pressure resulting from excessive diuresis
C. Reduced cardiac output from negative inotropic effect of furosemide
D. Elevated pulmonary capillary wedge pressure (PCWP) due to fluid shift
Answer: B
Rationale: Excessive diuresis can reduce preload and consequently decrease cardiac output, leading to
hypotension and reduced renal perfusion pressure. This triggers the kidneys to conserve water,
decreasing urine output. Increased SVR (A) is a compensatory mechanism but not the direct cause of
oliguria. Furosemide does not have a negative inotropic effect (C). PCWP (D) would decrease with
diuresis, not increase.
2. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled mechanical
ventilation with a tidal volume of 6 mL/kg ideal body weight and a positive end-expiratory
pressure (PEEP) of 12 cm H2O. The plateau pressure is 30 cm H2O, and the arterial blood gas
shows pH 7.25, PaCO2 55 mmHg, PaO2 60 mmHg. Which intervention should the nurse anticipate
to improve oxygenation while minimizing ventilator-induced lung injury?
A. Increase tidal volume to 8 mL/kg and increase PEEP to 15 cm H2O
B. Increase the fraction of inspired oxygen (FiO2) to 1.0 and perform recruitment maneuvers
C. Decrease PEEP to 5 cm H2O and increase respiratory rate to 25 breaths/min
D. Initiate prone positioning and consider neuromuscular blockade
Answer: D
Rationale: In ARDS, prone positioning improves ventilation-perfusion matching and oxygenation, while
neuromuscular blockade reduces oxygen consumption and patient-ventilator dyssynchrony. Increasing
tidal volume (A) risks volutrauma; FiO2 1.0 (B) may cause oxygen toxicity; decreasing PEEP (C) would
worsen oxygenation by allowing alveolar collapse.
3. A patient with diabetic ketoacidosis (DKA) has a serum potassium of 3.2 mEq/L on admission.
The nurse initiates intravenous insulin therapy. Which potassium management strategy is most
appropriate during the first 2 hours of treatment?
A. Hold potassium replacement until the serum potassium drops below 3.0 mEq/L
Page 1
,B. Administer 10 mEq of potassium chloride intravenously over 1 hour, then recheck
C. Give 40 mEq of potassium chloride intravenously immediately to prevent hypokalemia
D. Withhold potassium because insulin therapy will shift potassium intracellularly
Answer: B
Rationale: In DKA, total body potassium is depleted, but initial serum potassium may be normal or high
due to acidosis. With insulin therapy, potassium shifts intracellularly, causing hypokalemia. When serum
K+ is <3.3 mEq/L, insulin should be held and potassium replaced. Here, K+ is 3.2, so cautious
replacement (10 mEq over 1 hour) is indicated while monitoring. Option C is too aggressive; option D is
dangerous; option A delays necessary replacement.
4. A patient with a known cerebral aneurysm suddenly develops a severe headache, nausea, and
nuchal rigidity. A non-contrast CT scan shows subarachnoid hemorrhage. The patient is scheduled
for endovascular coiling. Which nursing assessment finding would be most concerning for the
development of cerebral vasospasm?
A. Heart rate of 56 beats per minute
B. Blood pressure 160/90 mmHg
C. Urine output 30 mL/hour
D. New onset of aphasia and hemiparesis
Answer: D
Rationale: Cerebral vasospasm is a major complication after subarachnoid hemorrhage, typically
occurring 3-14 days post-bleed. It leads to focal neurological deficits such as aphasia, hemiparesis, or
altered consciousness. Bradycardia (A) is not specific; hypertension (B) is common and may be
protective; oliguria (C) is not directly related.
5. A patient with a history of peptic ulcer disease is admitted with hematemesis and melena. An
upper endoscopy reveals a bleeding duodenal ulcer. The ulcer is injected with epinephrine and
clipped. Post-procedure, the patient is started on a proton pump inhibitor (PPI) continuous
infusion. Which pharmacologic rationale best supports the use of high-dose PPI therapy in this
setting?
A. PPIs neutralize gastric acid and promote platelet aggregation
B. PPIs inhibit the H+/K+ ATPase pump, raising intragastric pH above 6 to stabilize clot
C. PPIs reduce gastric motility, allowing the clot to adhere to the ulcer site
D. PPIs increase gastric mucus production, protecting the ulcer from further acid damage
Answer: B
Rationale: High-dose PPI therapy maintains intragastric pH >6, which is necessary for clot stability and
platelet aggregation. PPIs do not neutralize acid (they block secretion) (A), do not affect motility (C),
and do not directly increase mucus production (D).
6. A patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (6.8 mEq/L) and
ECG changes showing peaked T waves. The nurse administers intravenous calcium gluconate.
Which effect of calcium gluconate is most critical in this scenario?
A. It shifts potassium from extracellular to intracellular space
B. It antagonizes the cardiac effects of hyperkalemia without lowering serum potassium
Page 2
,C. It binds to potassium in the serum, forming an inactive complex
D. It stimulates renal excretion of potassium through diuresis
Answer: B
Rationale: Calcium gluconate stabilizes the cardiac cell membrane by antagonizing the effects of
hyperkalemia, protecting against life-threatening arrhythmias. It does not lower serum potassium (A and
C are incorrect). It does not promote renal excretion (D). Potassium-lowering measures (e.g., insulin,
albuterol) are needed subsequently.
7. A patient undergoing induction chemotherapy for acute myeloid leukemia develops tumor lysis
syndrome (TLS). Which combination of laboratory findings is most consistent with TLS?
A. Hypercalcemia, hypophosphatemia, hypouricemia, hyperkalemia
B. Hypocalcemia, hyperphosphatemia, hyperuricemia, hyperkalemia
C. Hypercalcemia, hyperphosphatemia, hypouricemia, hypokalemia
D. Hypocalcemia, hypophosphatemia, hypouricemia, hypokalemia
Answer: B
Rationale: TLS results from rapid cell lysis, releasing intracellular contents. Characteristic findings
include hyperuricemia, hyperphosphatemia, hypocalcemia (due to calcium phosphate precipitation), and
hyperkalemia. Options A, C, and D have incorrect combinations of these electrolytes.
8. A patient with a deep vein thrombosis (DVT) in the left lower extremity is started on a heparin
infusion. Six hours later, the activated partial thromboplastin time (aPTT) is 45 seconds
(therapeutic range 60-80 seconds). The nurse adjusts the infusion per protocol. Which additional
laboratory test should be monitored to assess for heparin-induced thrombocytopenia (HIT)?
A. Prothrombin time (PT)
B. Platelet count
C. Fibrinogen level
D. D-dimer
Answer: B
Rationale: HIT is a complication of heparin therapy characterized by a fall in platelet count (typically
>50% from baseline) occurring 5-10 days after initiation. Monitoring platelet count is essential. PT (A)
monitors warfarin therapy; fibrinogen (C) and D-dimer (D) are used in disseminated intravascular
coagulation (DIC) but not specific for HIT.
9. A patient with a traumatic femur fracture develops sudden chest pain, dyspnea, and hypoxia 48
hours after injury. A CT pulmonary angiogram confirms a pulmonary embolism (PE). The patient
is hemodynamically stable. Which intervention is the priority?
A. Initiate therapeutic anticoagulation with unfractionated heparin
B. Administer intravenous tissue plasminogen activator (tPA)
C. Prepare for emergency embolectomy
D. Place an inferior vena cava (IVC) filter
Answer: A
Rationale: For hemodynamically stable PE, anticoagulation with heparin is the first-line therapy to
prevent clot extension. tPA (B) is reserved for massive PE with hemodynamic instability. Embolectomy
Page 3
, (C) is for patients with contraindications to thrombolytics or failed thrombolysis. IVC filter (D) is
indicated when anticoagulation is contraindicated or fails.
10. A patient with advanced cirrhosis and ascites is admitted with acute confusion, asterixis, and a
serum ammonia level of 120 mcg/dL (normal 15-45). The nurse prepares to administer lactulose.
Which mechanism of action of lactulose is most important for reducing ammonia levels?
A. Lactulose increases stool pH, trapping ammonium (NH4+) in the colon and promoting excretion
B. Lactulose inhibits intestinal urease-producing bacteria, reducing ammonia production
C. Lactulose enhances renal excretion of ammonia by alkalinizing the urine
D. Lactulose directly binds to ammonia in the bloodstream, forming a nontoxic compound
Answer: A
Rationale: Lactulose is a non-absorbable disaccharide that is metabolized by colonic bacteria to lactic
and acetic acids, acidifying the colon. This converts ammonia (NH3) to ammonium (NH4+), which is
trapped and excreted in feces. It does not inhibit urease (B), does not affect renal excretion (C), and does
not bind ammonia in blood (D).
11. A patient with cirrhosis and ascites is being evaluated for spontaneous bacterial peritonitis
(SBP). Paracentesis reveals a neutrophil count of 350 cells/mm³. Given this finding, which of the
following is the most appropriate next step in management?
A. Start empiric antibiotics only if the patient is symptomatic
B. Administer intravenous albumin and start empiric antibiotics
C. Repeat paracentesis in 48 hours before initiating therapy
D. Start diuretic therapy to reduce ascites before antibiotics
Answer: B
Rationale: A neutrophil count >250 cells/mm³ in ascitic fluid is diagnostic of SBP. Empiric antibiotics
(e.g., cefotaxime) should be started immediately. Intravenous albumin reduces the risk of hepatorenal
syndrome and improves survival. Options A and C delay necessary treatment; diuretics are
contraindicated in SBP.
12. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L and
ECG changes showing peaked T waves. After administering intravenous calcium gluconate, which
of the following is the priority intervention to definitively lower serum potassium?
A. Administer sodium polystyrene sulfonate (SPS) orally
B. Initiate hemodialysis
C. Give intravenous regular insulin with dextrose
D. Administer albuterol via nebulizer
Answer: B
Rationale: In patients with CKD stage 4, severe hyperkalemia (K >6.0) with ECG changes requires
emergent dialysis as the most definitive treatment to remove potassium. Insulin and albuterol are
temporary measures; SPS is slow and less effective. Dialysis is the gold standard for rapid potassium
removal in ESRD.
Page 4
| Questions and Answers | 2026 Update | 100%
Correct.
1. A patient with a history of chronic heart failure (HFrEF) presents with acute dyspnea, jugular
venous distention, and a third heart sound (S3). After administering intravenous furosemide, the
nurse notes a decrease in urine output over the next hour. Which hemodynamic parameter most
likely explains this finding?
A. Increased systemic vascular resistance (SVR) due to compensatory vasoconstriction
B. Decreased renal perfusion pressure resulting from excessive diuresis
C. Reduced cardiac output from negative inotropic effect of furosemide
D. Elevated pulmonary capillary wedge pressure (PCWP) due to fluid shift
Answer: B
Rationale: Excessive diuresis can reduce preload and consequently decrease cardiac output, leading to
hypotension and reduced renal perfusion pressure. This triggers the kidneys to conserve water,
decreasing urine output. Increased SVR (A) is a compensatory mechanism but not the direct cause of
oliguria. Furosemide does not have a negative inotropic effect (C). PCWP (D) would decrease with
diuresis, not increase.
2. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled mechanical
ventilation with a tidal volume of 6 mL/kg ideal body weight and a positive end-expiratory
pressure (PEEP) of 12 cm H2O. The plateau pressure is 30 cm H2O, and the arterial blood gas
shows pH 7.25, PaCO2 55 mmHg, PaO2 60 mmHg. Which intervention should the nurse anticipate
to improve oxygenation while minimizing ventilator-induced lung injury?
A. Increase tidal volume to 8 mL/kg and increase PEEP to 15 cm H2O
B. Increase the fraction of inspired oxygen (FiO2) to 1.0 and perform recruitment maneuvers
C. Decrease PEEP to 5 cm H2O and increase respiratory rate to 25 breaths/min
D. Initiate prone positioning and consider neuromuscular blockade
Answer: D
Rationale: In ARDS, prone positioning improves ventilation-perfusion matching and oxygenation, while
neuromuscular blockade reduces oxygen consumption and patient-ventilator dyssynchrony. Increasing
tidal volume (A) risks volutrauma; FiO2 1.0 (B) may cause oxygen toxicity; decreasing PEEP (C) would
worsen oxygenation by allowing alveolar collapse.
3. A patient with diabetic ketoacidosis (DKA) has a serum potassium of 3.2 mEq/L on admission.
The nurse initiates intravenous insulin therapy. Which potassium management strategy is most
appropriate during the first 2 hours of treatment?
A. Hold potassium replacement until the serum potassium drops below 3.0 mEq/L
Page 1
,B. Administer 10 mEq of potassium chloride intravenously over 1 hour, then recheck
C. Give 40 mEq of potassium chloride intravenously immediately to prevent hypokalemia
D. Withhold potassium because insulin therapy will shift potassium intracellularly
Answer: B
Rationale: In DKA, total body potassium is depleted, but initial serum potassium may be normal or high
due to acidosis. With insulin therapy, potassium shifts intracellularly, causing hypokalemia. When serum
K+ is <3.3 mEq/L, insulin should be held and potassium replaced. Here, K+ is 3.2, so cautious
replacement (10 mEq over 1 hour) is indicated while monitoring. Option C is too aggressive; option D is
dangerous; option A delays necessary replacement.
4. A patient with a known cerebral aneurysm suddenly develops a severe headache, nausea, and
nuchal rigidity. A non-contrast CT scan shows subarachnoid hemorrhage. The patient is scheduled
for endovascular coiling. Which nursing assessment finding would be most concerning for the
development of cerebral vasospasm?
A. Heart rate of 56 beats per minute
B. Blood pressure 160/90 mmHg
C. Urine output 30 mL/hour
D. New onset of aphasia and hemiparesis
Answer: D
Rationale: Cerebral vasospasm is a major complication after subarachnoid hemorrhage, typically
occurring 3-14 days post-bleed. It leads to focal neurological deficits such as aphasia, hemiparesis, or
altered consciousness. Bradycardia (A) is not specific; hypertension (B) is common and may be
protective; oliguria (C) is not directly related.
5. A patient with a history of peptic ulcer disease is admitted with hematemesis and melena. An
upper endoscopy reveals a bleeding duodenal ulcer. The ulcer is injected with epinephrine and
clipped. Post-procedure, the patient is started on a proton pump inhibitor (PPI) continuous
infusion. Which pharmacologic rationale best supports the use of high-dose PPI therapy in this
setting?
A. PPIs neutralize gastric acid and promote platelet aggregation
B. PPIs inhibit the H+/K+ ATPase pump, raising intragastric pH above 6 to stabilize clot
C. PPIs reduce gastric motility, allowing the clot to adhere to the ulcer site
D. PPIs increase gastric mucus production, protecting the ulcer from further acid damage
Answer: B
Rationale: High-dose PPI therapy maintains intragastric pH >6, which is necessary for clot stability and
platelet aggregation. PPIs do not neutralize acid (they block secretion) (A), do not affect motility (C),
and do not directly increase mucus production (D).
6. A patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (6.8 mEq/L) and
ECG changes showing peaked T waves. The nurse administers intravenous calcium gluconate.
Which effect of calcium gluconate is most critical in this scenario?
A. It shifts potassium from extracellular to intracellular space
B. It antagonizes the cardiac effects of hyperkalemia without lowering serum potassium
Page 2
,C. It binds to potassium in the serum, forming an inactive complex
D. It stimulates renal excretion of potassium through diuresis
Answer: B
Rationale: Calcium gluconate stabilizes the cardiac cell membrane by antagonizing the effects of
hyperkalemia, protecting against life-threatening arrhythmias. It does not lower serum potassium (A and
C are incorrect). It does not promote renal excretion (D). Potassium-lowering measures (e.g., insulin,
albuterol) are needed subsequently.
7. A patient undergoing induction chemotherapy for acute myeloid leukemia develops tumor lysis
syndrome (TLS). Which combination of laboratory findings is most consistent with TLS?
A. Hypercalcemia, hypophosphatemia, hypouricemia, hyperkalemia
B. Hypocalcemia, hyperphosphatemia, hyperuricemia, hyperkalemia
C. Hypercalcemia, hyperphosphatemia, hypouricemia, hypokalemia
D. Hypocalcemia, hypophosphatemia, hypouricemia, hypokalemia
Answer: B
Rationale: TLS results from rapid cell lysis, releasing intracellular contents. Characteristic findings
include hyperuricemia, hyperphosphatemia, hypocalcemia (due to calcium phosphate precipitation), and
hyperkalemia. Options A, C, and D have incorrect combinations of these electrolytes.
8. A patient with a deep vein thrombosis (DVT) in the left lower extremity is started on a heparin
infusion. Six hours later, the activated partial thromboplastin time (aPTT) is 45 seconds
(therapeutic range 60-80 seconds). The nurse adjusts the infusion per protocol. Which additional
laboratory test should be monitored to assess for heparin-induced thrombocytopenia (HIT)?
A. Prothrombin time (PT)
B. Platelet count
C. Fibrinogen level
D. D-dimer
Answer: B
Rationale: HIT is a complication of heparin therapy characterized by a fall in platelet count (typically
>50% from baseline) occurring 5-10 days after initiation. Monitoring platelet count is essential. PT (A)
monitors warfarin therapy; fibrinogen (C) and D-dimer (D) are used in disseminated intravascular
coagulation (DIC) but not specific for HIT.
9. A patient with a traumatic femur fracture develops sudden chest pain, dyspnea, and hypoxia 48
hours after injury. A CT pulmonary angiogram confirms a pulmonary embolism (PE). The patient
is hemodynamically stable. Which intervention is the priority?
A. Initiate therapeutic anticoagulation with unfractionated heparin
B. Administer intravenous tissue plasminogen activator (tPA)
C. Prepare for emergency embolectomy
D. Place an inferior vena cava (IVC) filter
Answer: A
Rationale: For hemodynamically stable PE, anticoagulation with heparin is the first-line therapy to
prevent clot extension. tPA (B) is reserved for massive PE with hemodynamic instability. Embolectomy
Page 3
, (C) is for patients with contraindications to thrombolytics or failed thrombolysis. IVC filter (D) is
indicated when anticoagulation is contraindicated or fails.
10. A patient with advanced cirrhosis and ascites is admitted with acute confusion, asterixis, and a
serum ammonia level of 120 mcg/dL (normal 15-45). The nurse prepares to administer lactulose.
Which mechanism of action of lactulose is most important for reducing ammonia levels?
A. Lactulose increases stool pH, trapping ammonium (NH4+) in the colon and promoting excretion
B. Lactulose inhibits intestinal urease-producing bacteria, reducing ammonia production
C. Lactulose enhances renal excretion of ammonia by alkalinizing the urine
D. Lactulose directly binds to ammonia in the bloodstream, forming a nontoxic compound
Answer: A
Rationale: Lactulose is a non-absorbable disaccharide that is metabolized by colonic bacteria to lactic
and acetic acids, acidifying the colon. This converts ammonia (NH3) to ammonium (NH4+), which is
trapped and excreted in feces. It does not inhibit urease (B), does not affect renal excretion (C), and does
not bind ammonia in blood (D).
11. A patient with cirrhosis and ascites is being evaluated for spontaneous bacterial peritonitis
(SBP). Paracentesis reveals a neutrophil count of 350 cells/mm³. Given this finding, which of the
following is the most appropriate next step in management?
A. Start empiric antibiotics only if the patient is symptomatic
B. Administer intravenous albumin and start empiric antibiotics
C. Repeat paracentesis in 48 hours before initiating therapy
D. Start diuretic therapy to reduce ascites before antibiotics
Answer: B
Rationale: A neutrophil count >250 cells/mm³ in ascitic fluid is diagnostic of SBP. Empiric antibiotics
(e.g., cefotaxime) should be started immediately. Intravenous albumin reduces the risk of hepatorenal
syndrome and improves survival. Options A and C delay necessary treatment; diuretics are
contraindicated in SBP.
12. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L and
ECG changes showing peaked T waves. After administering intravenous calcium gluconate, which
of the following is the priority intervention to definitively lower serum potassium?
A. Administer sodium polystyrene sulfonate (SPS) orally
B. Initiate hemodialysis
C. Give intravenous regular insulin with dextrose
D. Administer albuterol via nebulizer
Answer: B
Rationale: In patients with CKD stage 4, severe hyperkalemia (K >6.0) with ECG changes requires
emergent dialysis as the most definitive treatment to remove potassium. Insulin and albuterol are
temporary measures; SPS is slow and less effective. Dialysis is the gold standard for rapid potassium
removal in ESRD.
Page 4
