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WGU D446 – Adult Health II Objective Assessment OA V1 and
V2 EXAM QUESTIONS AND CORRECT VERIFIED SOLUTIONS
LATEST UPDATE THIS YEAR – JUST RELEASED
WGU D446 – Adult Health II Objective Assessment | OA V1 and V2 Practice Exam
EXAM COVERAGE OVERVIEW (10 Key Points)
1. Exam Focus: The D446 Adult Health II Objective Assessment evaluates clinical judgment,
patient prioritization, and management of adult patients with complex medical-surgical
conditions across various body systems .
2. Question Format: The exam heavily features Next Generation NCLEX (NGN)-style
questions, including case-based scenarios, bowtie diagrams, and select-all-that-apply
(SATA) questions .
3. NGN-Style Case Studies: Each case study requires you to analyze a patient scenario
through the NCSBN Clinical Judgment Measurement Model, often involving multiple
sequential questions .
4. Cardiovascular System: Key topics include acute decompensated heart failure (ADHF),
myocardial infarction (MI), atrial fibrillation, valvular disorders, and cardiac
catheterization complications .
5. Heart Failure Management: Fluid overload assessment (JVD, crackles, edema), diuretic
therapy (furosemide monitoring), and patient education on fluid restrictions .
6. Infective Endocarditis & Embolic Stroke: Patients with endocarditis are at high risk for
embolic strokes from valvular vegetations. Priority action is a STAT CT scan of the head to
rule out hemorrhage .
7. Medication Safety: Warfarin requires INR monitoring (therapeutic range 2.0–3.0).
Digoxin toxicity presents with GI and visual disturbances. Amiodarone can cause bluish-
gray skin discoloration .
8. Peripheral Vascular Disease: Arterial ulcers (PAD) are pale, dry, and painful. Venous
insufficiency ulcers have brownish discoloration and edema .
9. MONA Protocol: The standard for acute MI management includes Morphine (for pain),
Oxygen (if hypoxic), Nitroglycerin, and Aspirin. Aspirin is the priority to prevent further
platelet aggregation .
10. Pharmacology: Beta-blockers and ACE inhibitors are foundational for heart failure with
reduced ejection fraction (HFrEF). Spironolactone requires close potassium monitoring
due to hyperkalemia risk .
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SECTION 1: CARDIOVASCULAR DISORDERS
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 midscapular region
Answer: D) Crackles audible to the midscapular region
Rationale: Crackles that extend to the midscapular region indicate severe, widespread
pulmonary edema, signifying imminent respiratory compromise. While edema, JVD, and PND
are important signs of fluid overload, they are not as immediately life-threatening as extensive
pulmonary edema .
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
Answer: B) Obtain a STAT CT scan of the head
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Rationale: 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 .
3. A client on amiodarone for atrial fibrillation reports new bluish-gray discoloration on the
face. Which action is most appropriate?
A) Discontinue the amiodarone immediately
B) Document the finding and continue to monitor
C) Notify the healthcare provider of this adverse effect
D) Apply a topical cream to the affected area
Answer: C) Notify the healthcare provider of this adverse effect
Rationale: Bluish-gray discoloration of the skin (slate-gray cyanosis) is a known adverse effect of
long-term amiodarone therapy due to iodine deposition. The healthcare provider should be
notified, though the discoloration is often irreversible and not dangerous .
4. Which laboratory finding is most consistent with a diagnosis of left-sided heart failure?
A) Elevated B-type natriuretic peptide (BNP)
B) Decreased troponin I
C) Elevated hemoglobin
D) Decreased serum potassium
Answer: A) Elevated B-type natriuretic peptide (BNP)
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Rationale: BNP is released by the ventricles in response to increased wall tension and volume
overload. Elevated BNP is a hallmark of heart failure. Troponin I is elevated in myocardial
infarction, not heart failure .
5. A client with heart failure has been prescribed furosemide (Lasix). Which assessment
finding indicates the medication is effective?
A) Decreased daily weight
B) Increased blood pressure
C) Increased peripheral edema
D) Decreased urine output
Answer: A) Decreased daily weight
Rationale: Furosemide is a loop diuretic used to reduce fluid overload. A decrease in daily
weight indicates effective diuresis and fluid removal .
6. A client with atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value
should the nurse monitor to evaluate therapeutic effectiveness?
A) Platelet count
B) Activated partial thromboplastin time (aPTT)
C) International normalized ratio (INR)
D) Serum potassium
Answer: C) International normalized ratio (INR)
WGU D446 – Adult Health II Objective Assessment OA V1 and
V2 EXAM QUESTIONS AND CORRECT VERIFIED SOLUTIONS
LATEST UPDATE THIS YEAR – JUST RELEASED
WGU D446 – Adult Health II Objective Assessment | OA V1 and V2 Practice Exam
EXAM COVERAGE OVERVIEW (10 Key Points)
1. Exam Focus: The D446 Adult Health II Objective Assessment evaluates clinical judgment,
patient prioritization, and management of adult patients with complex medical-surgical
conditions across various body systems .
2. Question Format: The exam heavily features Next Generation NCLEX (NGN)-style
questions, including case-based scenarios, bowtie diagrams, and select-all-that-apply
(SATA) questions .
3. NGN-Style Case Studies: Each case study requires you to analyze a patient scenario
through the NCSBN Clinical Judgment Measurement Model, often involving multiple
sequential questions .
4. Cardiovascular System: Key topics include acute decompensated heart failure (ADHF),
myocardial infarction (MI), atrial fibrillation, valvular disorders, and cardiac
catheterization complications .
5. Heart Failure Management: Fluid overload assessment (JVD, crackles, edema), diuretic
therapy (furosemide monitoring), and patient education on fluid restrictions .
6. Infective Endocarditis & Embolic Stroke: Patients with endocarditis are at high risk for
embolic strokes from valvular vegetations. Priority action is a STAT CT scan of the head to
rule out hemorrhage .
7. Medication Safety: Warfarin requires INR monitoring (therapeutic range 2.0–3.0).
Digoxin toxicity presents with GI and visual disturbances. Amiodarone can cause bluish-
gray skin discoloration .
8. Peripheral Vascular Disease: Arterial ulcers (PAD) are pale, dry, and painful. Venous
insufficiency ulcers have brownish discoloration and edema .
9. MONA Protocol: The standard for acute MI management includes Morphine (for pain),
Oxygen (if hypoxic), Nitroglycerin, and Aspirin. Aspirin is the priority to prevent further
platelet aggregation .
10. Pharmacology: Beta-blockers and ACE inhibitors are foundational for heart failure with
reduced ejection fraction (HFrEF). Spironolactone requires close potassium monitoring
due to hyperkalemia risk .
, Page 2 of 127
SECTION 1: CARDIOVASCULAR DISORDERS
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 midscapular region
Answer: D) Crackles audible to the midscapular region
Rationale: Crackles that extend to the midscapular region indicate severe, widespread
pulmonary edema, signifying imminent respiratory compromise. While edema, JVD, and PND
are important signs of fluid overload, they are not as immediately life-threatening as extensive
pulmonary edema .
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
Answer: B) Obtain a STAT CT scan of the head
, Page 3 of 127
Rationale: 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 .
3. A client on amiodarone for atrial fibrillation reports new bluish-gray discoloration on the
face. Which action is most appropriate?
A) Discontinue the amiodarone immediately
B) Document the finding and continue to monitor
C) Notify the healthcare provider of this adverse effect
D) Apply a topical cream to the affected area
Answer: C) Notify the healthcare provider of this adverse effect
Rationale: Bluish-gray discoloration of the skin (slate-gray cyanosis) is a known adverse effect of
long-term amiodarone therapy due to iodine deposition. The healthcare provider should be
notified, though the discoloration is often irreversible and not dangerous .
4. Which laboratory finding is most consistent with a diagnosis of left-sided heart failure?
A) Elevated B-type natriuretic peptide (BNP)
B) Decreased troponin I
C) Elevated hemoglobin
D) Decreased serum potassium
Answer: A) Elevated B-type natriuretic peptide (BNP)
, Page 4 of 127
Rationale: BNP is released by the ventricles in response to increased wall tension and volume
overload. Elevated BNP is a hallmark of heart failure. Troponin I is elevated in myocardial
infarction, not heart failure .
5. A client with heart failure has been prescribed furosemide (Lasix). Which assessment
finding indicates the medication is effective?
A) Decreased daily weight
B) Increased blood pressure
C) Increased peripheral edema
D) Decreased urine output
Answer: A) Decreased daily weight
Rationale: Furosemide is a loop diuretic used to reduce fluid overload. A decrease in daily
weight indicates effective diuresis and fluid removal .
6. A client with atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value
should the nurse monitor to evaluate therapeutic effectiveness?
A) Platelet count
B) Activated partial thromboplastin time (aPTT)
C) International normalized ratio (INR)
D) Serum potassium
Answer: C) International normalized ratio (INR)
