WGU D446 - Adult Health II Objective Assessment | OA V1 and
V2 | Questions and Answers - 2026 Update | 100% Correct
EXAM with Questions and Answers/Plus a Rationale Updated
2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Cardiovascular Disorders and Hemodynamic Management
2. Complex Respiratory Failure and Mechanical Ventilation Protocols
3. Acute Neurological Alterations and Intracranial Pressure Regulation
4. Endocrine Emergencies and Metabolic Regulation
5. Renal Replacement Therapy and Multisystem Fluid Balance
6. Gastrointestinal Bleeding, Hepatic Failure, and Pancreatitis Management
1. A telemetry nurse is evaluating a 64-year-old patient admitted with acute decompensated heart
failure. The patient's central venous pressure (CVP) is elevated at $14\text{ mmHg}$, cardiac
index is $1.9\text{ L/min/m}^2$, and systemic vascular resistance (SVR) is markedly increased.
Which pharmacologic combination is most appropriate to optimize hemodynamics?
A. Continuous infusion of normal saline and a high-dose beta-blocker.
B. Intravenous loop diuretic combined with a vasodilator such as nitroprusside or
nitroglycerin.
C. Titration of a pure alpha-1 adrenergic agonist to increase systemic vascular tone.
D. Administration of oral calcium channel blockers and high-sodium dietary support.
CORRECT ANSWER : B
Rationale: An elevated CVP and low cardiac index with high SVR reflect high preload and
afterload in decompensated heart failure. Combining a loop diuretic to reduce preload with a
, vasodilator reduces SVR, easing ventricular ejection. Normal saline or vasopressors would
dangerously exacerbate fluid overload and afterload.
2. A patient in the coronary care unit who suffered an anterior wall myocardial infarction three days
ago develops sudden, severe shortness of breath, a new harsh holosystolic murmur loudest at the
apex with a radiation to the axilla, and acute pulmonary edema. What mechanical complication
should the nurse suspect?
A. Ventricular septal rupture
B. Mitral valve papillary muscle rupture
C. Free wall cardiac rupture
D. Acute aortic dissection
CORRECT ANSWER : B
Rationale: Ischemia or infarction of the papillary muscle supporting the mitral valve commonly
occurs 2 to 7 days post-myocardial infarction, resulting in acute mitral regurgitation, severe
pulmonary congestion, and a new systolic murmur. Ventricular septal rupture presents with a
loud murmur at the left sternal border rather than the apex. Aortic dissection typically presents
with tearing chest pain and widened mediastinum.
3. A patient with a permanent pacemaker is seen in the outpatient clinic for routine interrogation.
The report indicates that pacemaker spikes are visible on the ECG, but they fail to capture,
meaning they are not followed by myocardial depolarization (P waves or QRS complexes).
Which troubleshooting action should the nurse anticipate?
A. Repositioning the patient onto their left side and applying magnet mode.
B. Increasing the programmed milliamperage (output energy) or evaluating lead
displacement.
C. Decreasing the sensitivity threshold to allow intrinsic signals to override the device.
D. Replacing the internal pulse generator battery immediately via emergency thoracotomy.
CORRECT ANSWER : B
Rationale: Failure to capture occurs when pacemaker output energy is insufficient to depolarize
the myocardium or when the lead has displaced. Increasing output energy or
repositioning/revising the lead resolves this. Decreasing sensitivity would worsen sensing
anomalies, and repositioning on the left side does not fix internal electrical coupling.
,4. A patient in the ICU is being monitored via a pulmonary artery catheter. The hemodynamic
report shows a pulmonary artery wedge pressure (PAWP) of $18\text{ mmHg}$, a cardiac index
of $1.7\text{ L/min/m}^2$, and a mean arterial pressure of $70\text{ mmHg}$. Which clinical
classification best fits this hemodynamic profile?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
CORRECT ANSWER : B
Rationale: A PAWP above $12\text{ mmHg}$ indicates elevated left ventricular filling pressures
(preload), while a cardiac index below $2.2\text{ L/min/m}^2$ reflects depressed cardiac output
characteristic of cardiogenic shock. Hypovolemic and septic shocks typically feature low or
normal PAWP due to volume depletion or systemic vasodilation.
5. A patient is admitted with a hypertensive emergency characterized by a blood pressure of
$220/130\text{ mmHg}$ and acute encephalopathy. The physician orders a continuous infusion
of sodium nitroprusside. Which critical monitoring parameter must the nurse prioritize during
this infusion?
A. Continuous monitoring of core body temperature via foley catheter.
B. Arterial blood pressure titration with an arterial line and screening for signs of cyanide
toxicity.
C. Hourly blood glucose checks and serial lipase evaluations.
D. Daily coagulation profile including INR and fibrinogen degradation products.
CORRECT ANSWER : B
Rationale: Sodium nitroprusside metabolizes into cyanide and thiocyanate, posing a risk of
toxicity during prolonged or high-dose infusions, particularly in renal impairment. Continuous
arterial line blood pressure monitoring is vital to prevent precipitous drops in cerebral
perfusion.
6. A patient is undergoing treatment for an unruptured cerebral aneurysm when they suddenly
experience a severe "thunderclap" headache, nuchal rigidity, and photophobia. A subarachnoid
hemorrhage (SAH) is diagnosed. Which oral calcium channel blocker is specifically prescribed
to prevent cerebral vasospasm?
, A. Amlodipine
B. Nimodipine
C. Diltiazem
D. Verapamil
CORRECT ANSWER : B
Rationale: Nimodipine is a lipophilic dihydropyridine calcium channel blocker specifically
indicated to reduce morbidity and mortality from delayed cerebral ischemia caused by
vasospasm following SAH. Other calcium channel blockers lack this targeted cerebral protective
profile.
7. A patient with a severe traumatic brain injury has an intracranial pressure (ICP) of $26\text{
mmHg}$ and a mean arterial pressure (MAP) of $80\text{ mmHg}$. What is the calculated
cerebral perfusion pressure (CPP), and is it within the recommended therapeutic range?
A. CPP is $54\text{ mmHg}$, which is above the target range.
B. CPP is $54\text{ mmHg}$, which is below the target threshold of $60\text{ to }70\text{
mmHg}$.
C. CPP is $106\text{ mmHg}$, which is within normal limits.
D. CPP is $26\text{ mmHg}$, which represents normal autoregulation.
CORRECT ANSWER : B
Rationale: Cerebral perfusion pressure is calculated as $\text{CPP} = \text{MAP} - \text{ICP}$.
Here, $80 - 26 = 54\text{ mmHg}$. The recommended target range for CPP in adult TBI is
$60\text{ to }70\text{ mmHg}$, making $54\text{ mmHg}$ inadequate and placing the brain at
risk for ischemia.
8. A patient is admitted to the neurological ICU with status epilepticus. After receiving two doses
of intravenous lorazepam, the seizure activity persists. Which second-line intravenous
antiepileptic drug should the nurse prepare to administer immediately?
A. Oral carbamazepine suspension
B. Levetiracetam or fosphenytoin
C. Subcutaneous sumatriptan
D. Intravenous magnesium sulfate push
V2 | Questions and Answers - 2026 Update | 100% Correct
EXAM with Questions and Answers/Plus a Rationale Updated
2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Cardiovascular Disorders and Hemodynamic Management
2. Complex Respiratory Failure and Mechanical Ventilation Protocols
3. Acute Neurological Alterations and Intracranial Pressure Regulation
4. Endocrine Emergencies and Metabolic Regulation
5. Renal Replacement Therapy and Multisystem Fluid Balance
6. Gastrointestinal Bleeding, Hepatic Failure, and Pancreatitis Management
1. A telemetry nurse is evaluating a 64-year-old patient admitted with acute decompensated heart
failure. The patient's central venous pressure (CVP) is elevated at $14\text{ mmHg}$, cardiac
index is $1.9\text{ L/min/m}^2$, and systemic vascular resistance (SVR) is markedly increased.
Which pharmacologic combination is most appropriate to optimize hemodynamics?
A. Continuous infusion of normal saline and a high-dose beta-blocker.
B. Intravenous loop diuretic combined with a vasodilator such as nitroprusside or
nitroglycerin.
C. Titration of a pure alpha-1 adrenergic agonist to increase systemic vascular tone.
D. Administration of oral calcium channel blockers and high-sodium dietary support.
CORRECT ANSWER : B
Rationale: An elevated CVP and low cardiac index with high SVR reflect high preload and
afterload in decompensated heart failure. Combining a loop diuretic to reduce preload with a
, vasodilator reduces SVR, easing ventricular ejection. Normal saline or vasopressors would
dangerously exacerbate fluid overload and afterload.
2. A patient in the coronary care unit who suffered an anterior wall myocardial infarction three days
ago develops sudden, severe shortness of breath, a new harsh holosystolic murmur loudest at the
apex with a radiation to the axilla, and acute pulmonary edema. What mechanical complication
should the nurse suspect?
A. Ventricular septal rupture
B. Mitral valve papillary muscle rupture
C. Free wall cardiac rupture
D. Acute aortic dissection
CORRECT ANSWER : B
Rationale: Ischemia or infarction of the papillary muscle supporting the mitral valve commonly
occurs 2 to 7 days post-myocardial infarction, resulting in acute mitral regurgitation, severe
pulmonary congestion, and a new systolic murmur. Ventricular septal rupture presents with a
loud murmur at the left sternal border rather than the apex. Aortic dissection typically presents
with tearing chest pain and widened mediastinum.
3. A patient with a permanent pacemaker is seen in the outpatient clinic for routine interrogation.
The report indicates that pacemaker spikes are visible on the ECG, but they fail to capture,
meaning they are not followed by myocardial depolarization (P waves or QRS complexes).
Which troubleshooting action should the nurse anticipate?
A. Repositioning the patient onto their left side and applying magnet mode.
B. Increasing the programmed milliamperage (output energy) or evaluating lead
displacement.
C. Decreasing the sensitivity threshold to allow intrinsic signals to override the device.
D. Replacing the internal pulse generator battery immediately via emergency thoracotomy.
CORRECT ANSWER : B
Rationale: Failure to capture occurs when pacemaker output energy is insufficient to depolarize
the myocardium or when the lead has displaced. Increasing output energy or
repositioning/revising the lead resolves this. Decreasing sensitivity would worsen sensing
anomalies, and repositioning on the left side does not fix internal electrical coupling.
,4. A patient in the ICU is being monitored via a pulmonary artery catheter. The hemodynamic
report shows a pulmonary artery wedge pressure (PAWP) of $18\text{ mmHg}$, a cardiac index
of $1.7\text{ L/min/m}^2$, and a mean arterial pressure of $70\text{ mmHg}$. Which clinical
classification best fits this hemodynamic profile?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
CORRECT ANSWER : B
Rationale: A PAWP above $12\text{ mmHg}$ indicates elevated left ventricular filling pressures
(preload), while a cardiac index below $2.2\text{ L/min/m}^2$ reflects depressed cardiac output
characteristic of cardiogenic shock. Hypovolemic and septic shocks typically feature low or
normal PAWP due to volume depletion or systemic vasodilation.
5. A patient is admitted with a hypertensive emergency characterized by a blood pressure of
$220/130\text{ mmHg}$ and acute encephalopathy. The physician orders a continuous infusion
of sodium nitroprusside. Which critical monitoring parameter must the nurse prioritize during
this infusion?
A. Continuous monitoring of core body temperature via foley catheter.
B. Arterial blood pressure titration with an arterial line and screening for signs of cyanide
toxicity.
C. Hourly blood glucose checks and serial lipase evaluations.
D. Daily coagulation profile including INR and fibrinogen degradation products.
CORRECT ANSWER : B
Rationale: Sodium nitroprusside metabolizes into cyanide and thiocyanate, posing a risk of
toxicity during prolonged or high-dose infusions, particularly in renal impairment. Continuous
arterial line blood pressure monitoring is vital to prevent precipitous drops in cerebral
perfusion.
6. A patient is undergoing treatment for an unruptured cerebral aneurysm when they suddenly
experience a severe "thunderclap" headache, nuchal rigidity, and photophobia. A subarachnoid
hemorrhage (SAH) is diagnosed. Which oral calcium channel blocker is specifically prescribed
to prevent cerebral vasospasm?
, A. Amlodipine
B. Nimodipine
C. Diltiazem
D. Verapamil
CORRECT ANSWER : B
Rationale: Nimodipine is a lipophilic dihydropyridine calcium channel blocker specifically
indicated to reduce morbidity and mortality from delayed cerebral ischemia caused by
vasospasm following SAH. Other calcium channel blockers lack this targeted cerebral protective
profile.
7. A patient with a severe traumatic brain injury has an intracranial pressure (ICP) of $26\text{
mmHg}$ and a mean arterial pressure (MAP) of $80\text{ mmHg}$. What is the calculated
cerebral perfusion pressure (CPP), and is it within the recommended therapeutic range?
A. CPP is $54\text{ mmHg}$, which is above the target range.
B. CPP is $54\text{ mmHg}$, which is below the target threshold of $60\text{ to }70\text{
mmHg}$.
C. CPP is $106\text{ mmHg}$, which is within normal limits.
D. CPP is $26\text{ mmHg}$, which represents normal autoregulation.
CORRECT ANSWER : B
Rationale: Cerebral perfusion pressure is calculated as $\text{CPP} = \text{MAP} - \text{ICP}$.
Here, $80 - 26 = 54\text{ mmHg}$. The recommended target range for CPP in adult TBI is
$60\text{ to }70\text{ mmHg}$, making $54\text{ mmHg}$ inadequate and placing the brain at
risk for ischemia.
8. A patient is admitted to the neurological ICU with status epilepticus. After receiving two doses
of intravenous lorazepam, the seizure activity persists. Which second-line intravenous
antiepileptic drug should the nurse prepare to administer immediately?
A. Oral carbamazepine suspension
B. Levetiracetam or fosphenytoin
C. Subcutaneous sumatriptan
D. Intravenous magnesium sulfate push
