WGU D454
Adult Health III
Objective Assessment
(2 Full Exams)
Actual Questions with Verified Answers
Take and pass the OA :)
What You Will Get:
➢120+ OA Exam Questions w/ Answers
➢Expert Rationales included.
➢OA Study Guide QS & Clinical Prioritization
➢AH III EXAM HINTS
, WGU D454 Adult Health III
Preview Pages Below
Get the Complete PDF After Purchase
"If you require further clarification or in need of any study resources,
feel free to Message me."
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,Table of Contents
D454 OA EXAM SET 1 ....................................................................... 2
D454 OA EXAM SET 2 ..................................................................... 43
D454 AH III EXAM HINTS ........................................................................ 87
D454 AH III Study Guide Qs w/ Ans .................................................... 105
D454 OA EXAM SET 1
1. A client is admitted to the intensive care unit (ICU) after a colon resection with
the formation of a loop colostomy. The nurse determines the client's abdominal
dressing is clean and dry. Vital signs are temperature 100°F, heart rate 132
beats/minute, blood pressure 88/65 mmHg, and urine output 10 mL/hour. Which
intervention should the nurse implement?
A. Give a fluid challenge of 500 mL IV bolus
B. Notify the provider of the fever
C. Assess the colostomy for patency
D. Increase the oxygen flow rate
Correct Answer: A
Rationale: The client's vital signs indicate hypovolemic shock (tachycardia HR 132,
hypotension BP 88/65, and oliguria urine output 10 mL/hr) likely due to fluid loss after
colon resection surgery. The first-line treatment for hypovolemic shock is rapid fluid
resuscitation to improve blood pressure and restore kidney perfusion. A 500 mL IV fluid
bolus is the priority intervention. While the low-grade fever (100°F) and oxygenation are
concerns, they are secondary to the immediate circulatory collapse. The colostomy
assessment can wait until hemodynamics are stabilized.
,2. (Priority Nursing Interventions — SATA) Which interventions are priority for a
client who collapsed while mowing the lawn with heat stroke, core temp 109.4°F,
now in ICU with HR 79, BP 118/75, RR 14, O₂ 94%, temp 102.2°F, opens eyes only
to painful stimuli, dark yellow urine 16 mL, pupils 4 mm reactive, central line
dressing soaked with blood, ecchymosis under BP cuff?
A. Continue rapid cooling (ice packs, cooling blanket)
B. Monitor and manage central line bleeding
C. Monitor urine output hourly and notify provider if <30 mL/hr
D. Frequent neurological checks
E. Administer acetaminophen for fever
Correct Answers: A, B, C, D
Rationale: This client has heat stroke with rhabdomyolysis and coagulopathy. All
selected interventions are priorities:
• A: Continued cooling is essential as temp remains elevated at 102.2°F (residual
hyperthermia)
• B: Central line bleeding indicates coagulopathy from heat-induced tissue injury
and requires immediate management
• C: Oliguria (16 mL dark yellow urine) signals acute kidney injury from
rhabdomyolysis; hourly monitoring is critical
• D: Altered mental status (opens eyes to pain only) requires frequent neuro
checks to monitor for brain injury progression
• E is incorrect: Acetaminophen is ineffective for heat stroke fever and may
worsen liver stress
3. (Highlight Assessment Findings — SATA) HISTORY AND PHYSICAL: A 28-year-
old male collapsed while mowing the lawn. Assessment findings: HR 79, BP
118/75, RR 14, O₂ sat 94%, temp 102.2°F. Client opens eyes to painful stimuli, does
not follow commands. Skin pink and warm. 16 mL dark yellow urine from condom
catheter. Pupils 4 mm reactive. Central line dressing soaked with blood.
Ecchymosis under BP cuff. Which findings require immediate attention?
A. Temperature 102.2°F
B. Opens eyes only to painful stimuli, does not follow commands
,Rationale: Securing prevents movement or accidental extubation. ETT
displacement risks:
• Unplanned extubation → respiratory arrest
• Mainstem intubation → lung collapse
• Esophageal migration → gastric insufflation, aspiration
• Use commercial tube holders or tape; mark tube depth at teeth/lips
• Do NOT deflate cuff (C) or reposition tube (D) routinely
• Suctioning (B) is PRN, not scheduled
58. The nurse assesses the telemetry monitor of a client 24 hours postoperative
from permanent pacemaker insertion. The nurse observes a pacemaker spike
before each QRS complex in lead II. Which intervention should the nurse
implement?
A. Document paced rhythm
B. Prepare for transcutaneous pacing
C. Notify the provider of pacemaker malfunction
D. Administer atropine 0.5 mg IV
Correct Answer: A
Rationale: Spike before every QRS = ventricularly paced rhythm = pacemaker
working normally.
• Pacemaker spike = electrical stimulus from generator
• Spike followed by QRS = successful ventricular capture
• This is the expected finding post-permanent pacemaker insertion
• Document the paced rhythm and monitor for capture loss (spike without QRS)
, • No intervention needed—this is normal function, not malfunction
59. The client is a 59-year-old female with hyperosmolar hyperglycemic syndrome
(HHS). She developed abdominal pain several days ago and nausea starting
yesterday. This morning she was extremely drowsy and confused at work. Her
coworker brought her to the hospital. Based on laboratory values at 1600, which
are appropriate nursing actions? (SATA)
LABS:
• Blood Glucose: 250 mg/dL (Normal: 74-106)
• Sodium (Na⁺): 152 mEq/L (Normal: 135-145)
• Potassium (K⁺): 3.2 mEq/L (Normal: 3.5-5.0)
• Bicarbonate (HCO₃⁻): 20 mEq/L (Normal: 22-26)
A. Decrease sodium concentration in IV fluids from 0.9% to 0.45%
B. Alert the provider of the current blood glucose level
C. Add 20 mEq of potassium chloride to the IV fluids
D. Increase the insulin infusion rate
E. Administer sodium bicarbonate IV
Correct Answers: A, B, C
Rationale:
Table
Lab Finding Action
Glucose Elevated but lower than Notify provider; may need adjusted
250 typical HHS (>600) insulin protocol
Na⁺ 152 Hypernatremia 0.45% NS (half-normal saline)
provides free water to correct
hypernatremia
K⁺ 3.2 Hypokalemia Add KCl; insulin will drive K⁺ into
cells, worsening hypokalemia
,(C) can worsen ascites and hyponatremia. Neomycin (D) is rarely used today due to
ototoxicity and nephrotoxicity; rifaximin is the preferred antibiotic adjunct if lactulose
alone is insufficient.
Question 56
The nurse is monitoring a client who received tissue plasminogen activator (tPA)
for an ischemic stroke 2 hours ago. The client's blood pressure has increased
from 148/92 mm Hg to 188/110 mm Hg. Which action should the nurse implement?
A. Administer labetalol 10 mg IV push
B. Recheck the blood pressure in 15 minutes
C. Notify the provider immediately and prepare for antihypertensive therapy
D. Elevate the head of the bed to 45 degrees
Correct Answer: C
Rationale: After tPA administration for acute ischemic stroke, strict blood pressure
control is essential to prevent hemorrhagic transformation of the infarct. The protocol
requires:
• Pre-tPA: BP <185/110 mm Hg
• Post-tPA: BP <180/105 mm Hg
A BP of 188/110 mm Hg exceeds the post-tPA threshold. The nurse must notify the
provider immediately and prepare for IV antihypertensive therapy (typically labetalol
or nicardipine). Waiting 15 minutes (B) is dangerous. While labetalol (A) is the likely
medication, the nurse should not administer it without an order or protocol. Elevating the
head of bed (D) is a supportive measure but insufficient for this degree of hypertension.
Question 57
A client with a history of alcohol use disorder is admitted to the ICU with delirium
tremens (DTs) 48 hours after the last drink. Vital signs are temperature 101.8°F
(38.8°C), heart rate 134 beats/minute, blood pressure 168/96 mm Hg, and
respiratory rate 28 breaths/minute. The client is hallucinating and agitated. Which
medication should the nurse anticipate administering?
A. Haloperidol 5 mg IV push
B. Lorazepam 4 mg IV push, repeated every 5–15 minutes
C. Phenobarbital 130 mg IV push
D. Propofol 25 mcg/kg/min infusion
,Correct Answer: B
Rationale: Delirium tremens is a life-threatening alcohol withdrawal syndrome
characterized by autonomic hyperactivity, hallucinations, and agitation.
Benzodiazepines (lorazepam, diazepam) are the first-line treatment as they:
• Cross-tolerate with alcohol at GABA receptors
• Prevent seizures
• Reduce autonomic instability
Lorazepam is preferred in ICU settings due to its predictable metabolism (not affected
by liver dysfunction). The Clinical Institute Withdrawal Assessment for Alcohol
(CIWA-Ar) score guides dosing; high scores require frequent, escalating doses.
Haloperidol (A) lowers seizure threshold and is contraindicated in DTs. Phenobarbital
(C) is a second-line adjunct for refractory cases. Propofol (D) is reserved for intubated,
refractory patients.
| Alcohol Withdrawal Timeline | |---|---| | 6–12 hours | Tremors, anxiety, insomnia,
nausea | | 12–24 hours | Hallucinations (visual, tactile, auditory) | | 24–48 hours |
Withdrawal seizures | | 48–72 hours | Delirium tremens (peak mortality risk) |
Question 58
The nurse is caring for a client who had an abdominal aortic aneurysm (AAA)
repair 6 hours ago. The nasogastric tube (NGT) has drained 1,200 mL of bright red
blood in the past 2 hours. Vital signs are heart rate 118 beats/minute, blood
pressure 92/58 mm Hg, and respiratory rate 24 breaths/minute. Which
intervention should the nurse implement first?
A. Irrigate the nasogastric tube with 30 mL normal saline
B. Notify the healthcare provider and prepare for emergency surgery
C. Administer a proton pump inhibitor IV
D. Check the client's hemoglobin and hematocrit
Correct Answer: B
Rationale: 1,200 mL of bright red blood from an NGT in 2 hours post-AAA repair
indicates acute upper GI hemorrhage — likely a aortoenteric fistula (communication
between the aortic graft and duodenum) or stress ulceration. Combined with
hypotension (92/58) and tachycardia (118), this represents hemorrhagic shock. The
first action is to notify the provider and prepare for emergency surgical
intervention to control bleeding. NGT irrigation (A) is inappropriate with active
,Rapid infusion of volume-expanding fluids
78. In cardiogenic shock, the infusion of ___ may result in pulmonary
edema:
Volume-expanding fluids
79. Fluids to improve preload:
Blood, colloids, electrolyte solutions
80. Where the pulse ox should be placed in shock:
Patient's earlobe or forehead
81. Where pain radiates in MI:
Neck, jaw, back
82. When to activate an emergency for chest pain:
If it's unrelieved after 5 mins of taking nitro; if it's present with nausea or
sweating
83. Water is a ___ fluid:
Hypotonic
84. Anorexia, nausea, and vomiting are present in which electrolyte
imbalances?
Hyponatremia, hypokalemia
, 85. Rules with potassium admin:
1) Unpleasant tasting & irritating to GI tract - do not give on empty stomach;
2) Dilute it; 3) Never give IV bolus; 4) Assess renal status before admin
86. Foods high in potassium:
Bananas, oranges, cantaloupe, avocado, spinach, potatoes
87. How to treat hyperkalemia:
1) Give 50% glucose with regular insulin; 2) Give kayexalate
88. Foods high in calcium:
Dairy products, leafy greens
89. Foods high in magnesium:
Meat, nuts, legumes, fish, veggies
90. Disease that is the primary cause of respiratory acidosis:
COPD
91. Excessive vomiting will cause which acid-base imbalance?
Metabolic alkalosis
92. Common side effect of nitro:
Hypotension
Adult Health III
Objective Assessment
(2 Full Exams)
Actual Questions with Verified Answers
Take and pass the OA :)
What You Will Get:
➢120+ OA Exam Questions w/ Answers
➢Expert Rationales included.
➢OA Study Guide QS & Clinical Prioritization
➢AH III EXAM HINTS
, WGU D454 Adult Health III
Preview Pages Below
Get the Complete PDF After Purchase
"If you require further clarification or in need of any study resources,
feel free to Message me."
Digital Preview Sample
,Table of Contents
D454 OA EXAM SET 1 ....................................................................... 2
D454 OA EXAM SET 2 ..................................................................... 43
D454 AH III EXAM HINTS ........................................................................ 87
D454 AH III Study Guide Qs w/ Ans .................................................... 105
D454 OA EXAM SET 1
1. A client is admitted to the intensive care unit (ICU) after a colon resection with
the formation of a loop colostomy. The nurse determines the client's abdominal
dressing is clean and dry. Vital signs are temperature 100°F, heart rate 132
beats/minute, blood pressure 88/65 mmHg, and urine output 10 mL/hour. Which
intervention should the nurse implement?
A. Give a fluid challenge of 500 mL IV bolus
B. Notify the provider of the fever
C. Assess the colostomy for patency
D. Increase the oxygen flow rate
Correct Answer: A
Rationale: The client's vital signs indicate hypovolemic shock (tachycardia HR 132,
hypotension BP 88/65, and oliguria urine output 10 mL/hr) likely due to fluid loss after
colon resection surgery. The first-line treatment for hypovolemic shock is rapid fluid
resuscitation to improve blood pressure and restore kidney perfusion. A 500 mL IV fluid
bolus is the priority intervention. While the low-grade fever (100°F) and oxygenation are
concerns, they are secondary to the immediate circulatory collapse. The colostomy
assessment can wait until hemodynamics are stabilized.
,2. (Priority Nursing Interventions — SATA) Which interventions are priority for a
client who collapsed while mowing the lawn with heat stroke, core temp 109.4°F,
now in ICU with HR 79, BP 118/75, RR 14, O₂ 94%, temp 102.2°F, opens eyes only
to painful stimuli, dark yellow urine 16 mL, pupils 4 mm reactive, central line
dressing soaked with blood, ecchymosis under BP cuff?
A. Continue rapid cooling (ice packs, cooling blanket)
B. Monitor and manage central line bleeding
C. Monitor urine output hourly and notify provider if <30 mL/hr
D. Frequent neurological checks
E. Administer acetaminophen for fever
Correct Answers: A, B, C, D
Rationale: This client has heat stroke with rhabdomyolysis and coagulopathy. All
selected interventions are priorities:
• A: Continued cooling is essential as temp remains elevated at 102.2°F (residual
hyperthermia)
• B: Central line bleeding indicates coagulopathy from heat-induced tissue injury
and requires immediate management
• C: Oliguria (16 mL dark yellow urine) signals acute kidney injury from
rhabdomyolysis; hourly monitoring is critical
• D: Altered mental status (opens eyes to pain only) requires frequent neuro
checks to monitor for brain injury progression
• E is incorrect: Acetaminophen is ineffective for heat stroke fever and may
worsen liver stress
3. (Highlight Assessment Findings — SATA) HISTORY AND PHYSICAL: A 28-year-
old male collapsed while mowing the lawn. Assessment findings: HR 79, BP
118/75, RR 14, O₂ sat 94%, temp 102.2°F. Client opens eyes to painful stimuli, does
not follow commands. Skin pink and warm. 16 mL dark yellow urine from condom
catheter. Pupils 4 mm reactive. Central line dressing soaked with blood.
Ecchymosis under BP cuff. Which findings require immediate attention?
A. Temperature 102.2°F
B. Opens eyes only to painful stimuli, does not follow commands
,Rationale: Securing prevents movement or accidental extubation. ETT
displacement risks:
• Unplanned extubation → respiratory arrest
• Mainstem intubation → lung collapse
• Esophageal migration → gastric insufflation, aspiration
• Use commercial tube holders or tape; mark tube depth at teeth/lips
• Do NOT deflate cuff (C) or reposition tube (D) routinely
• Suctioning (B) is PRN, not scheduled
58. The nurse assesses the telemetry monitor of a client 24 hours postoperative
from permanent pacemaker insertion. The nurse observes a pacemaker spike
before each QRS complex in lead II. Which intervention should the nurse
implement?
A. Document paced rhythm
B. Prepare for transcutaneous pacing
C. Notify the provider of pacemaker malfunction
D. Administer atropine 0.5 mg IV
Correct Answer: A
Rationale: Spike before every QRS = ventricularly paced rhythm = pacemaker
working normally.
• Pacemaker spike = electrical stimulus from generator
• Spike followed by QRS = successful ventricular capture
• This is the expected finding post-permanent pacemaker insertion
• Document the paced rhythm and monitor for capture loss (spike without QRS)
, • No intervention needed—this is normal function, not malfunction
59. The client is a 59-year-old female with hyperosmolar hyperglycemic syndrome
(HHS). She developed abdominal pain several days ago and nausea starting
yesterday. This morning she was extremely drowsy and confused at work. Her
coworker brought her to the hospital. Based on laboratory values at 1600, which
are appropriate nursing actions? (SATA)
LABS:
• Blood Glucose: 250 mg/dL (Normal: 74-106)
• Sodium (Na⁺): 152 mEq/L (Normal: 135-145)
• Potassium (K⁺): 3.2 mEq/L (Normal: 3.5-5.0)
• Bicarbonate (HCO₃⁻): 20 mEq/L (Normal: 22-26)
A. Decrease sodium concentration in IV fluids from 0.9% to 0.45%
B. Alert the provider of the current blood glucose level
C. Add 20 mEq of potassium chloride to the IV fluids
D. Increase the insulin infusion rate
E. Administer sodium bicarbonate IV
Correct Answers: A, B, C
Rationale:
Table
Lab Finding Action
Glucose Elevated but lower than Notify provider; may need adjusted
250 typical HHS (>600) insulin protocol
Na⁺ 152 Hypernatremia 0.45% NS (half-normal saline)
provides free water to correct
hypernatremia
K⁺ 3.2 Hypokalemia Add KCl; insulin will drive K⁺ into
cells, worsening hypokalemia
,(C) can worsen ascites and hyponatremia. Neomycin (D) is rarely used today due to
ototoxicity and nephrotoxicity; rifaximin is the preferred antibiotic adjunct if lactulose
alone is insufficient.
Question 56
The nurse is monitoring a client who received tissue plasminogen activator (tPA)
for an ischemic stroke 2 hours ago. The client's blood pressure has increased
from 148/92 mm Hg to 188/110 mm Hg. Which action should the nurse implement?
A. Administer labetalol 10 mg IV push
B. Recheck the blood pressure in 15 minutes
C. Notify the provider immediately and prepare for antihypertensive therapy
D. Elevate the head of the bed to 45 degrees
Correct Answer: C
Rationale: After tPA administration for acute ischemic stroke, strict blood pressure
control is essential to prevent hemorrhagic transformation of the infarct. The protocol
requires:
• Pre-tPA: BP <185/110 mm Hg
• Post-tPA: BP <180/105 mm Hg
A BP of 188/110 mm Hg exceeds the post-tPA threshold. The nurse must notify the
provider immediately and prepare for IV antihypertensive therapy (typically labetalol
or nicardipine). Waiting 15 minutes (B) is dangerous. While labetalol (A) is the likely
medication, the nurse should not administer it without an order or protocol. Elevating the
head of bed (D) is a supportive measure but insufficient for this degree of hypertension.
Question 57
A client with a history of alcohol use disorder is admitted to the ICU with delirium
tremens (DTs) 48 hours after the last drink. Vital signs are temperature 101.8°F
(38.8°C), heart rate 134 beats/minute, blood pressure 168/96 mm Hg, and
respiratory rate 28 breaths/minute. The client is hallucinating and agitated. Which
medication should the nurse anticipate administering?
A. Haloperidol 5 mg IV push
B. Lorazepam 4 mg IV push, repeated every 5–15 minutes
C. Phenobarbital 130 mg IV push
D. Propofol 25 mcg/kg/min infusion
,Correct Answer: B
Rationale: Delirium tremens is a life-threatening alcohol withdrawal syndrome
characterized by autonomic hyperactivity, hallucinations, and agitation.
Benzodiazepines (lorazepam, diazepam) are the first-line treatment as they:
• Cross-tolerate with alcohol at GABA receptors
• Prevent seizures
• Reduce autonomic instability
Lorazepam is preferred in ICU settings due to its predictable metabolism (not affected
by liver dysfunction). The Clinical Institute Withdrawal Assessment for Alcohol
(CIWA-Ar) score guides dosing; high scores require frequent, escalating doses.
Haloperidol (A) lowers seizure threshold and is contraindicated in DTs. Phenobarbital
(C) is a second-line adjunct for refractory cases. Propofol (D) is reserved for intubated,
refractory patients.
| Alcohol Withdrawal Timeline | |---|---| | 6–12 hours | Tremors, anxiety, insomnia,
nausea | | 12–24 hours | Hallucinations (visual, tactile, auditory) | | 24–48 hours |
Withdrawal seizures | | 48–72 hours | Delirium tremens (peak mortality risk) |
Question 58
The nurse is caring for a client who had an abdominal aortic aneurysm (AAA)
repair 6 hours ago. The nasogastric tube (NGT) has drained 1,200 mL of bright red
blood in the past 2 hours. Vital signs are heart rate 118 beats/minute, blood
pressure 92/58 mm Hg, and respiratory rate 24 breaths/minute. Which
intervention should the nurse implement first?
A. Irrigate the nasogastric tube with 30 mL normal saline
B. Notify the healthcare provider and prepare for emergency surgery
C. Administer a proton pump inhibitor IV
D. Check the client's hemoglobin and hematocrit
Correct Answer: B
Rationale: 1,200 mL of bright red blood from an NGT in 2 hours post-AAA repair
indicates acute upper GI hemorrhage — likely a aortoenteric fistula (communication
between the aortic graft and duodenum) or stress ulceration. Combined with
hypotension (92/58) and tachycardia (118), this represents hemorrhagic shock. The
first action is to notify the provider and prepare for emergency surgical
intervention to control bleeding. NGT irrigation (A) is inappropriate with active
,Rapid infusion of volume-expanding fluids
78. In cardiogenic shock, the infusion of ___ may result in pulmonary
edema:
Volume-expanding fluids
79. Fluids to improve preload:
Blood, colloids, electrolyte solutions
80. Where the pulse ox should be placed in shock:
Patient's earlobe or forehead
81. Where pain radiates in MI:
Neck, jaw, back
82. When to activate an emergency for chest pain:
If it's unrelieved after 5 mins of taking nitro; if it's present with nausea or
sweating
83. Water is a ___ fluid:
Hypotonic
84. Anorexia, nausea, and vomiting are present in which electrolyte
imbalances?
Hyponatremia, hypokalemia
, 85. Rules with potassium admin:
1) Unpleasant tasting & irritating to GI tract - do not give on empty stomach;
2) Dilute it; 3) Never give IV bolus; 4) Assess renal status before admin
86. Foods high in potassium:
Bananas, oranges, cantaloupe, avocado, spinach, potatoes
87. How to treat hyperkalemia:
1) Give 50% glucose with regular insulin; 2) Give kayexalate
88. Foods high in calcium:
Dairy products, leafy greens
89. Foods high in magnesium:
Meat, nuts, legumes, fish, veggies
90. Disease that is the primary cause of respiratory acidosis:
COPD
91. Excessive vomiting will cause which acid-base imbalance?
Metabolic alkalosis
92. Common side effect of nitro:
Hypotension
