WGU D446 – Adult Health II Objective Assessment Practice
Exam
Exam Overview
Course: D446 – Adult Health II
Institution: Western Governors University (WGU)
Format: Multiple-choice, case-based, select-all-that-apply, and NGN-style questions
Key Domains: Cardiovascular, Respiratory, Neurological, Renal/GU, Endocrine, Gastrointestinal, Critical
Care, Immunology, Oncology, Fluid & Electrolytes
Section 1: Cardiovascular Disorders
Question 1
A nurse is assessing a client with acute decompensated heart failure (ADHF). Which finding is most
concerning?
A) +2 pitting edema in lower extremities
B) Jugular venous distension (JVD) at 45 degrees
C) Paroxysmal nocturnal dyspnea (PND)
D) Crackles audible to the mid-scapular region
Correct Answer: D
Rationale: Crackles that extend to the mid-scapular region indicate severe and widespread pulmonary
edema, signifying imminent respiratory compromise. While peripheral edema, JVD, and PND are
important signs of fluid overload, they are not as immediately life-threatening as extensive pulmonary
edema requiring urgent intervention .
Question 2
A client with infective endocarditis develops sudden left-sided weakness and slurred speech. What is
the priority action?
A) Administer aspirin 325 mg PO
B) Obtain a STAT CT scan of the head
C) Check blood glucose level
D) Reorient the client to person, place, time
Correct Answer: B
Rationale: The client is likely experiencing an embolic stroke from a vegetation fragment breaking off the
heart valve. A STAT CT scan is required to rule out hemorrhage before any thrombolytics or
anticoagulation can be considered. Aspirin could worsen a hemorrhagic stroke, making it contraindicated
until the type of stroke is determined .
, Question 3
A client on amiodarone for atrial fibrillation reports new bluish-gray discoloration on the face. Which
action is most appropriate?
A) Discontinue the medication immediately
B) Instruct the client to apply sunscreen daily
C) Document as a common side effect and continue monitoring
D) Prepare for thyroid function testing
Correct Answer: C
Rationale: Bluish-gray skin discoloration (amiodarone-induced pigment change) is a known side effect of
long-term amiodarone use due to iodine deposition in the skin. It is usually harmless, though cosmetically
concerning. It is not a reason to discontinue the drug unless other serious adverse effects develop .
Question 4
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 even using
fresh frozen plasma depending on the patient's clinical situation .
Question 5
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
Exam
Exam Overview
Course: D446 – Adult Health II
Institution: Western Governors University (WGU)
Format: Multiple-choice, case-based, select-all-that-apply, and NGN-style questions
Key Domains: Cardiovascular, Respiratory, Neurological, Renal/GU, Endocrine, Gastrointestinal, Critical
Care, Immunology, Oncology, Fluid & Electrolytes
Section 1: Cardiovascular Disorders
Question 1
A nurse is assessing a client with acute decompensated heart failure (ADHF). Which finding is most
concerning?
A) +2 pitting edema in lower extremities
B) Jugular venous distension (JVD) at 45 degrees
C) Paroxysmal nocturnal dyspnea (PND)
D) Crackles audible to the mid-scapular region
Correct Answer: D
Rationale: Crackles that extend to the mid-scapular region indicate severe and widespread pulmonary
edema, signifying imminent respiratory compromise. While peripheral edema, JVD, and PND are
important signs of fluid overload, they are not as immediately life-threatening as extensive pulmonary
edema requiring urgent intervention .
Question 2
A client with infective endocarditis develops sudden left-sided weakness and slurred speech. What is
the priority action?
A) Administer aspirin 325 mg PO
B) Obtain a STAT CT scan of the head
C) Check blood glucose level
D) Reorient the client to person, place, time
Correct Answer: B
Rationale: The client is likely experiencing an embolic stroke from a vegetation fragment breaking off the
heart valve. A STAT CT scan is required to rule out hemorrhage before any thrombolytics or
anticoagulation can be considered. Aspirin could worsen a hemorrhagic stroke, making it contraindicated
until the type of stroke is determined .
, Question 3
A client on amiodarone for atrial fibrillation reports new bluish-gray discoloration on the face. Which
action is most appropriate?
A) Discontinue the medication immediately
B) Instruct the client to apply sunscreen daily
C) Document as a common side effect and continue monitoring
D) Prepare for thyroid function testing
Correct Answer: C
Rationale: Bluish-gray skin discoloration (amiodarone-induced pigment change) is a known side effect of
long-term amiodarone use due to iodine deposition in the skin. It is usually harmless, though cosmetically
concerning. It is not a reason to discontinue the drug unless other serious adverse effects develop .
Question 4
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 even using
fresh frozen plasma depending on the patient's clinical situation .
Question 5
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
