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WGU D446 – Adult Health II Objective Assessment
OA V1 and V2 QUESTIONS AND DETAILED
SOLUTIONS JUST RELEASED
WGU D446 – Adult Health II Objective Assessment | OA V1 and V2
10 POINT FORM EXAM COVERAGE AREAS (MOSTLY TESTED)
1. Cardiovascular Disorders (25%) - Heart failure (left vs. right-sided, ADHF), myocardial infarction
(acute management, MONA protocol), angina (stable vs. unstable), dysrhythmias (atrial
fibrillation, ventricular tachycardia), valve disorders (aortic stenosis), infective endocarditis,
coronary artery disease, hypertension, cardiac catheterization, and post-CABG care. Also
includes medication management (warfarin, digoxin, nitroglycerin, amiodarone, beta-blockers,
ACE inhibitors, furosemide) .
2. Respiratory Disorders (20%) - COPD, asthma, pneumonia, pulmonary embolism (acute onset
tachycardia, tachypnea, hypoxia), ARDS, chest tube management, pulmonary edema, and
tuberculosis. Focus on assessment, nursing interventions, and medication management .
3. Neurological Disorders (15%) - Stroke (acute management, tPA administration, CT scan priority),
seizures, meningitis (bacterial - fever, headache, stiff neck), Parkinson's disease (masked face),
myasthenia gravis, multiple sclerosis (diplopia, ptosis, muscle weakness), subdural hematoma,
and increased intracranial pressure management .
4. Renal and Genitourinary Disorders (15%) - Chronic kidney disease, acute kidney injury, renal
calculi, UTIs, TURP, dialysis (hemodialysis and peritoneal dialysis), fluid and electrolyte
imbalances, and nephrectomy recovery .
5. Endocrine Disorders (10%) - Diabetes mellitus (Type 1 and Type 2), thyroid disorders
(hyperthyroidism, hypothyroidism), adrenal insufficiency, and diabetic emergencies. Includes
medication management (insulin, metformin, levothyroxine) .
6. Gastrointestinal Disorders (10%) - Peptic ulcer disease (PUD - abdominal pain, bloody/black
stool), diverticulitis, bowel obstruction, liver disease, colorectal cancer (dark/tarry stool, family
history), GI bleed (tachycardia, hypotension, rapid hemoglobin drop), and pernicious anemia .
7. Hematologic and Immunologic Disorders - Leukemia (fatigue, pale skin, fever, frequent
infections), pernicious anemia (autoimmune, B12 deficiency), acute hemolytic transfusion
reaction (AHTR - chills, fever, hypotension, dark urine), and infective endocarditis .
8. Fluid & Electrolyte Imbalances - Dehydration, fluid overload, electrolyte disturbances
(potassium, sodium, calcium), acid-base imbalances, and related nursing interventions .
9. Perioperative and Critical Care - Preoperative assessment, intraoperative complications,
postoperative care (CABG, amputation, abdominal surgery), chest tube management, pain
management, and monitoring for complications (paralytic ileus, hemorrhage) .
10. Pharmacology and Medication Management - Mechanism of action, side effects, nursing
considerations for key medications including: warfarin (INR monitoring), digoxin (toxicity signs),
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furosemide (electrolyte monitoring), nitroglycerin (sublingual administration), beta-blockers,
ACE inhibitors, heparin (aPTT monitoring), amiodarone, and statins .
QUESTION 1
A nurse is assessing a client with acute decompensated heart failure (ADHF). Which finding is most
concerning and requires immediate intervention?
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 midscapular region
Answer: D - Crackles that extend to the midscapular region indicate that pulmonary edema is severe
and widespread, 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 .
QUESTION 2
A client with infective endocarditis develops sudden left-sided weakness and slurred speech. What is the
priority nursing action?
A) Administer aspirin 325 mg PO
B) Obtain a STAT CT scan of the head
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C) Check blood glucose level
D) Reorient the client to person, place, time
Answer: B - The client is likely experiencing an embolic stroke from a vegetation fragment. A STAT CT
scan is required to rule out hemorrhage before any thrombolytics or anticoagulation can be considered.
Aspirin could worsen a hemorrhagic stroke .
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
Answer: C - Bluish-gray skin discoloration (amiodarone-induced pigmentation) is a known side effect of
long-term amiodarone use and is usually harmless, though cosmetically concerning. It is not a reason to
discontinue the drug unless other serious adverse effects develop. However, thyroid function should be
monitored regularly .
QUESTION 4
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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
Answer: D - 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 5
Post-cardiac catheterization, the nurse assesses the femoral insertion site. Which finding is most
concerning and requires immediate notification of the provider?
A) Small 2-cm bruise
B) Patient reports mild discomfort
C) Slight oozing with pressure
D) Expanding hematoma
Answer: D - An expanding hematoma at the femoral site indicates active bleeding and possible
pseudoaneurysm formation. This requires immediate notification of the provider and may require
manual pressure or further intervention .
WGU D446 – Adult Health II Objective Assessment
OA V1 and V2 QUESTIONS AND DETAILED
SOLUTIONS JUST RELEASED
WGU D446 – Adult Health II Objective Assessment | OA V1 and V2
10 POINT FORM EXAM COVERAGE AREAS (MOSTLY TESTED)
1. Cardiovascular Disorders (25%) - Heart failure (left vs. right-sided, ADHF), myocardial infarction
(acute management, MONA protocol), angina (stable vs. unstable), dysrhythmias (atrial
fibrillation, ventricular tachycardia), valve disorders (aortic stenosis), infective endocarditis,
coronary artery disease, hypertension, cardiac catheterization, and post-CABG care. Also
includes medication management (warfarin, digoxin, nitroglycerin, amiodarone, beta-blockers,
ACE inhibitors, furosemide) .
2. Respiratory Disorders (20%) - COPD, asthma, pneumonia, pulmonary embolism (acute onset
tachycardia, tachypnea, hypoxia), ARDS, chest tube management, pulmonary edema, and
tuberculosis. Focus on assessment, nursing interventions, and medication management .
3. Neurological Disorders (15%) - Stroke (acute management, tPA administration, CT scan priority),
seizures, meningitis (bacterial - fever, headache, stiff neck), Parkinson's disease (masked face),
myasthenia gravis, multiple sclerosis (diplopia, ptosis, muscle weakness), subdural hematoma,
and increased intracranial pressure management .
4. Renal and Genitourinary Disorders (15%) - Chronic kidney disease, acute kidney injury, renal
calculi, UTIs, TURP, dialysis (hemodialysis and peritoneal dialysis), fluid and electrolyte
imbalances, and nephrectomy recovery .
5. Endocrine Disorders (10%) - Diabetes mellitus (Type 1 and Type 2), thyroid disorders
(hyperthyroidism, hypothyroidism), adrenal insufficiency, and diabetic emergencies. Includes
medication management (insulin, metformin, levothyroxine) .
6. Gastrointestinal Disorders (10%) - Peptic ulcer disease (PUD - abdominal pain, bloody/black
stool), diverticulitis, bowel obstruction, liver disease, colorectal cancer (dark/tarry stool, family
history), GI bleed (tachycardia, hypotension, rapid hemoglobin drop), and pernicious anemia .
7. Hematologic and Immunologic Disorders - Leukemia (fatigue, pale skin, fever, frequent
infections), pernicious anemia (autoimmune, B12 deficiency), acute hemolytic transfusion
reaction (AHTR - chills, fever, hypotension, dark urine), and infective endocarditis .
8. Fluid & Electrolyte Imbalances - Dehydration, fluid overload, electrolyte disturbances
(potassium, sodium, calcium), acid-base imbalances, and related nursing interventions .
9. Perioperative and Critical Care - Preoperative assessment, intraoperative complications,
postoperative care (CABG, amputation, abdominal surgery), chest tube management, pain
management, and monitoring for complications (paralytic ileus, hemorrhage) .
10. Pharmacology and Medication Management - Mechanism of action, side effects, nursing
considerations for key medications including: warfarin (INR monitoring), digoxin (toxicity signs),
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furosemide (electrolyte monitoring), nitroglycerin (sublingual administration), beta-blockers,
ACE inhibitors, heparin (aPTT monitoring), amiodarone, and statins .
QUESTION 1
A nurse is assessing a client with acute decompensated heart failure (ADHF). Which finding is most
concerning and requires immediate intervention?
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 midscapular region
Answer: D - Crackles that extend to the midscapular region indicate that pulmonary edema is severe
and widespread, 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 .
QUESTION 2
A client with infective endocarditis develops sudden left-sided weakness and slurred speech. What is the
priority nursing action?
A) Administer aspirin 325 mg PO
B) Obtain a STAT CT scan of the head
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C) Check blood glucose level
D) Reorient the client to person, place, time
Answer: B - The client is likely experiencing an embolic stroke from a vegetation fragment. A STAT CT
scan is required to rule out hemorrhage before any thrombolytics or anticoagulation can be considered.
Aspirin could worsen a hemorrhagic stroke .
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
Answer: C - Bluish-gray skin discoloration (amiodarone-induced pigmentation) is a known side effect of
long-term amiodarone use and is usually harmless, though cosmetically concerning. It is not a reason to
discontinue the drug unless other serious adverse effects develop. However, thyroid function should be
monitored regularly .
QUESTION 4
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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
Answer: D - 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 5
Post-cardiac catheterization, the nurse assesses the femoral insertion site. Which finding is most
concerning and requires immediate notification of the provider?
A) Small 2-cm bruise
B) Patient reports mild discomfort
C) Slight oozing with pressure
D) Expanding hematoma
Answer: D - An expanding hematoma at the femoral site indicates active bleeding and possible
pseudoaneurysm formation. This requires immediate notification of the provider and may require
manual pressure or further intervention .
