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
, Preview Pages Below
Get the Complete PDF After Purchase
STUDENT PREVIEW
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or in need of any study resources,
feel free to Message me.
Preview the selected pages below before purchase.
,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
,C. 16 mL dark yellow urine from condom catheter
D. Central line dressing soaked with blood
E. Ecchymosis under the blood pressure cuff
F. Oxygen saturation 94%
Correct Answers: A, B, C, D, E
Rationale:
Table
Finding Clinical Significance
Temp 102.2°F Residual hyperthermia from heat stroke; ongoing
brain/CNS injury risk
Opens eyes to pain Indicates severe brain injury from heat (GCS motor
only impairment)
16 mL dark yellow Oliguria + myoglobinuria = rhabdomyolysis causing acute
urine kidney injury
Central line Coagulopathy from heat-induced liver/disseminated
bleeding intravascular coagulation
Ecchymosis under Fragile vessels from coagulopathy; abnormal bleeding
cuff tendency
O₂ sat 94% Lower priority; mild hypoxemia not immediately life-
threatening compared to above
4. H&P: A 28-year-old male collapsed while mowing the lawn. The nurse reviews
laboratory values. Based on the laboratory findings, the client likely has ______.
A. Heat exhaustion
B. Internal bleeding
C. Dehydration
D. Hyponatremia
,Correct Answer: B
Rationale: The client likely has internal bleeding related to coagulopathy from heat
stroke and tissue injury. Heat stroke causes direct thermal damage to vascular
endothelium, liver dysfunction (impaired clotting factor synthesis), and disseminated
intravascular coagulation (DIC). Laboratory findings supporting this include prolonged
PT/PTT, elevated CK from rhabdomyolysis, and elevated BUN/Cr indicating acute
kidney injury. The physical findings of central line bleeding and ecchymosis under the
BP cuff further confirm coagulopathy and internal bleeding risk.
5. The client is a 28-year-old male who collapsed while mowing the lawn. Nurses'
Notes: 1300—Client does not respond to painful stimuli, pupils 5 mm and
reactive, breath sounds clear. 1330—Central line placed. The nurse reviews
laboratory findings. Based on the laboratory findings, the client likely has ______
related to ______.
A. Sepsis; metabolic acidosis
B. Heat stroke; hyperkalemia
C. Hypovolemic shock; respiratory alkalosis
D. Cerebral edema; hyponatremia
Correct Answer: A
Rationale: The client likely has sepsis related to metabolic acidosis. Sepsis is
suggested by altered mental status (does not respond to painful stimuli), hypotension
risk, abnormal bleeding (coagulopathy), and ecchymosis. Metabolic acidosis develops
due to tissue hypoperfusion, rhabdomyolysis (elevated CK from muscle breakdown),
and organ stress from heat stroke. The combination of shock physiology, tissue
ischemia, and lactic acid accumulation drives the metabolic acidosis.
6. H&P: A 28-year-old male collapsed while mowing the lawn. Match the symptom
with its direct cause.
Table
Symptom Direct Cause
A. Opens eyes only to pain 1. Brain overheated / CNS hyperthermia
, D454 OA EXAM SET 2
Question 1
A client is being prepared for discharge. The client's discharge plan includes
resuming the lower dose of lithium and continuing to take desmopressin in oral
form. The nurse teaches the client about safety related to management of
diabetes insipidus and care. Which client statements indicate teaching was
effective? (Select all that apply)
A. "I will monitor my urine output and pay attention to the volume and color."
B. "I will always wear my medical alert bracelet."
C. "I will use the same scale and wear a similar amount of clothing when I take my
weekly weight."
Correct Answers: A, B, C
Rationale: Diabetes insipidus (DI) is characterized by the inability to concentrate urine
due to deficiency of antidiuretic hormone (ADH) or lack of renal response to ADH.
Desmopressin is a synthetic analog of ADH used to treat central DI. All three statements
demonstrate effective teaching:
• A — Monitoring urine output and color is essential because polyuria and dilute
urine are hallmark signs of inadequate ADH replacement or worsening DI.
• B — A medical alert bracelet is critical because DI is a lifelong condition; in
emergencies, healthcare providers must know the client cannot concentrate urine
and requires desmopressin.
• C — Using the same scale and similar clothing for weekly weights helps detect
fluid volume changes early; rapid weight loss indicates fluid deficit from
uncontrolled polyuria.
| Key Teaching Points for DI | |---|---| | Monitor daily weights with same scale/clothing |
| Track urine output, color, and specific gravity | | Wear medical alert identification | |
Take desmopressin exactly as prescribed | | Report signs of fluid deficit immediately |
Question 2
,A client diagnosed with pancreatitis reports severe epigastric pain. After
administering a narcotic analgesic, the client insists on sitting up and leaning
forward. Which action should the nurse implement?
A. Encourage the client to lie flat to promote rest
B. Provide a bedside table for the client to lean on
C. Apply a warm compress to the abdomen
D. Administer an additional dose of analgesic
Correct Answer: B
Rationale: In acute pancreatitis, the pancreas becomes inflamed and enzymes
autodigest pancreatic tissue. A classic finding is that pain is relieved by sitting up and
leaning forward (the fetal or tripod position). This position reduces tension on the
inflamed pancreas and decreases pressure on the diaphragm. The nurse should
facilitate this position of comfort by providing a bedside table or pillows for support.
Lying flat (Option A) typically worsens the pain. Warm compresses (Option C) are
contraindicated as heat increases blood flow and may worsen inflammation. Additional
analgesic (Option D) is not indicated without reassessment.
Question 3
After an endotracheal tube (ETT) is initially placed for a client requiring
mechanical ventilation, which intervention should the nurse implement first?
A. Auscultate for breath sounds bilaterally in all lung fields
B. Secure the ETT with tape or a commercial holder
C. Obtain a chest x-ray to confirm placement
D. Attach the client to the ventilator
Correct Answer: A
Rationale: After ETT placement, the highest priority is to verify that the tube is in the
trachea and not the esophagus or a mainstem bronchus. Auscultation of bilateral
breath sounds is the quickest bedside method to confirm tracheal placement and
detect mainstem intubation (which would produce unilateral breath sounds). While
securing the tube (B), obtaining a chest x-ray (C), and attaching to the ventilator (D) are
all important, they must follow confirmation of correct placement. If the tube is in the
esophagus, the client will have no breath sounds and requires immediate repositioning.
Question 4
,The nurse assesses the telemetry monitor of a client who is 24 hours
postoperative from having a permanent pacemaker insertion. The nurse observes
that a pacemaker spike is present before each QRS complex in lead II of the
electrocardiogram (ECG). Which intervention should the nurse implement?
A. Prepare the client for cardioversion
B. Document that the client is experiencing a paced rhythm
C. Notify the healthcare provider immediately
D. Apply transcutaneous pacing pads
Correct Answer: B
Rationale: A pacemaker spike immediately preceding each QRS complex indicates
that the pacemaker is successfully capturing and pacing the ventricles. This is the
expected and desired outcome of permanent pacemaker insertion. The nurse should
simply document this finding. No intervention is needed because:
• Capture is occurring (spike → QRS)
• The rhythm is regular and appropriate
• This is not a malfunction requiring cardioversion (A), provider notification (C), or
emergency pacing (D)
| Pacemaker Spike Interpretation | |---|---| | Spike before P wave | Atrial pacing | |
Spike before QRS | Ventricular pacing | | Spike with no following complex | Failure to
capture (problem!) | | No spike when expected | Failure to fire (problem!) |
Question 5
After intubating a client, correct placement of the endotracheal tube (ETT) is
confirmed with a chest x-ray. Which intervention should the nurse implement to
ensure that the ETT placement is maintained?
A. Suction the client every 2 hours
B. Firmly secure the ETT in place
C. Administer a sedative to prevent self-extubation
D. Deflate the cuff to check for leaks
Correct Answer: B
Rationale: Once correct ETT placement is confirmed radiographically (tip typically 3–5
cm above the carina), the most important intervention to maintain placement is to
secure the tube firmly using tape, twill tape, or a commercial ETT holder. Tube
displacement (either extubation or mainstem intubation) is a serious complication. While
, D454 AH III EXAM HINTS
1. An unexpected, catastrophic pulmonary complication with no
previous pulmonary moriar or oplems:
ARDS
2. Interventions for ventilated patients with ARDS:
Elevate HOB to at least 30 degrees; sedation vacations; strict oral hygiene;
implement mobilization program
3. Increased risk and mortality rate from ARDS in individuals who
have a history of:
Alcohol abuse
4. Suction only when:
Secretions are present
5. Before drawing a sample for ABGs from the radial artery, perform
the ___ to assess collateral circulation:
Allen test
6. Three most common symptoms of respiratory failure:
Dyspnea/tachypnea, intercostal and sternal retractions, cyanosis
7. Early signs of shock:
Agitation and restlessness
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
, Preview Pages Below
Get the Complete PDF After Purchase
STUDENT PREVIEW
If you require further clarification
or in need of any study resources,
feel free to Message me.
Preview the selected pages below before purchase.
,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
,C. 16 mL dark yellow urine from condom catheter
D. Central line dressing soaked with blood
E. Ecchymosis under the blood pressure cuff
F. Oxygen saturation 94%
Correct Answers: A, B, C, D, E
Rationale:
Table
Finding Clinical Significance
Temp 102.2°F Residual hyperthermia from heat stroke; ongoing
brain/CNS injury risk
Opens eyes to pain Indicates severe brain injury from heat (GCS motor
only impairment)
16 mL dark yellow Oliguria + myoglobinuria = rhabdomyolysis causing acute
urine kidney injury
Central line Coagulopathy from heat-induced liver/disseminated
bleeding intravascular coagulation
Ecchymosis under Fragile vessels from coagulopathy; abnormal bleeding
cuff tendency
O₂ sat 94% Lower priority; mild hypoxemia not immediately life-
threatening compared to above
4. H&P: A 28-year-old male collapsed while mowing the lawn. The nurse reviews
laboratory values. Based on the laboratory findings, the client likely has ______.
A. Heat exhaustion
B. Internal bleeding
C. Dehydration
D. Hyponatremia
,Correct Answer: B
Rationale: The client likely has internal bleeding related to coagulopathy from heat
stroke and tissue injury. Heat stroke causes direct thermal damage to vascular
endothelium, liver dysfunction (impaired clotting factor synthesis), and disseminated
intravascular coagulation (DIC). Laboratory findings supporting this include prolonged
PT/PTT, elevated CK from rhabdomyolysis, and elevated BUN/Cr indicating acute
kidney injury. The physical findings of central line bleeding and ecchymosis under the
BP cuff further confirm coagulopathy and internal bleeding risk.
5. The client is a 28-year-old male who collapsed while mowing the lawn. Nurses'
Notes: 1300—Client does not respond to painful stimuli, pupils 5 mm and
reactive, breath sounds clear. 1330—Central line placed. The nurse reviews
laboratory findings. Based on the laboratory findings, the client likely has ______
related to ______.
A. Sepsis; metabolic acidosis
B. Heat stroke; hyperkalemia
C. Hypovolemic shock; respiratory alkalosis
D. Cerebral edema; hyponatremia
Correct Answer: A
Rationale: The client likely has sepsis related to metabolic acidosis. Sepsis is
suggested by altered mental status (does not respond to painful stimuli), hypotension
risk, abnormal bleeding (coagulopathy), and ecchymosis. Metabolic acidosis develops
due to tissue hypoperfusion, rhabdomyolysis (elevated CK from muscle breakdown),
and organ stress from heat stroke. The combination of shock physiology, tissue
ischemia, and lactic acid accumulation drives the metabolic acidosis.
6. H&P: A 28-year-old male collapsed while mowing the lawn. Match the symptom
with its direct cause.
Table
Symptom Direct Cause
A. Opens eyes only to pain 1. Brain overheated / CNS hyperthermia
, D454 OA EXAM SET 2
Question 1
A client is being prepared for discharge. The client's discharge plan includes
resuming the lower dose of lithium and continuing to take desmopressin in oral
form. The nurse teaches the client about safety related to management of
diabetes insipidus and care. Which client statements indicate teaching was
effective? (Select all that apply)
A. "I will monitor my urine output and pay attention to the volume and color."
B. "I will always wear my medical alert bracelet."
C. "I will use the same scale and wear a similar amount of clothing when I take my
weekly weight."
Correct Answers: A, B, C
Rationale: Diabetes insipidus (DI) is characterized by the inability to concentrate urine
due to deficiency of antidiuretic hormone (ADH) or lack of renal response to ADH.
Desmopressin is a synthetic analog of ADH used to treat central DI. All three statements
demonstrate effective teaching:
• A — Monitoring urine output and color is essential because polyuria and dilute
urine are hallmark signs of inadequate ADH replacement or worsening DI.
• B — A medical alert bracelet is critical because DI is a lifelong condition; in
emergencies, healthcare providers must know the client cannot concentrate urine
and requires desmopressin.
• C — Using the same scale and similar clothing for weekly weights helps detect
fluid volume changes early; rapid weight loss indicates fluid deficit from
uncontrolled polyuria.
| Key Teaching Points for DI | |---|---| | Monitor daily weights with same scale/clothing |
| Track urine output, color, and specific gravity | | Wear medical alert identification | |
Take desmopressin exactly as prescribed | | Report signs of fluid deficit immediately |
Question 2
,A client diagnosed with pancreatitis reports severe epigastric pain. After
administering a narcotic analgesic, the client insists on sitting up and leaning
forward. Which action should the nurse implement?
A. Encourage the client to lie flat to promote rest
B. Provide a bedside table for the client to lean on
C. Apply a warm compress to the abdomen
D. Administer an additional dose of analgesic
Correct Answer: B
Rationale: In acute pancreatitis, the pancreas becomes inflamed and enzymes
autodigest pancreatic tissue. A classic finding is that pain is relieved by sitting up and
leaning forward (the fetal or tripod position). This position reduces tension on the
inflamed pancreas and decreases pressure on the diaphragm. The nurse should
facilitate this position of comfort by providing a bedside table or pillows for support.
Lying flat (Option A) typically worsens the pain. Warm compresses (Option C) are
contraindicated as heat increases blood flow and may worsen inflammation. Additional
analgesic (Option D) is not indicated without reassessment.
Question 3
After an endotracheal tube (ETT) is initially placed for a client requiring
mechanical ventilation, which intervention should the nurse implement first?
A. Auscultate for breath sounds bilaterally in all lung fields
B. Secure the ETT with tape or a commercial holder
C. Obtain a chest x-ray to confirm placement
D. Attach the client to the ventilator
Correct Answer: A
Rationale: After ETT placement, the highest priority is to verify that the tube is in the
trachea and not the esophagus or a mainstem bronchus. Auscultation of bilateral
breath sounds is the quickest bedside method to confirm tracheal placement and
detect mainstem intubation (which would produce unilateral breath sounds). While
securing the tube (B), obtaining a chest x-ray (C), and attaching to the ventilator (D) are
all important, they must follow confirmation of correct placement. If the tube is in the
esophagus, the client will have no breath sounds and requires immediate repositioning.
Question 4
,The nurse assesses the telemetry monitor of a client who is 24 hours
postoperative from having a permanent pacemaker insertion. The nurse observes
that a pacemaker spike is present before each QRS complex in lead II of the
electrocardiogram (ECG). Which intervention should the nurse implement?
A. Prepare the client for cardioversion
B. Document that the client is experiencing a paced rhythm
C. Notify the healthcare provider immediately
D. Apply transcutaneous pacing pads
Correct Answer: B
Rationale: A pacemaker spike immediately preceding each QRS complex indicates
that the pacemaker is successfully capturing and pacing the ventricles. This is the
expected and desired outcome of permanent pacemaker insertion. The nurse should
simply document this finding. No intervention is needed because:
• Capture is occurring (spike → QRS)
• The rhythm is regular and appropriate
• This is not a malfunction requiring cardioversion (A), provider notification (C), or
emergency pacing (D)
| Pacemaker Spike Interpretation | |---|---| | Spike before P wave | Atrial pacing | |
Spike before QRS | Ventricular pacing | | Spike with no following complex | Failure to
capture (problem!) | | No spike when expected | Failure to fire (problem!) |
Question 5
After intubating a client, correct placement of the endotracheal tube (ETT) is
confirmed with a chest x-ray. Which intervention should the nurse implement to
ensure that the ETT placement is maintained?
A. Suction the client every 2 hours
B. Firmly secure the ETT in place
C. Administer a sedative to prevent self-extubation
D. Deflate the cuff to check for leaks
Correct Answer: B
Rationale: Once correct ETT placement is confirmed radiographically (tip typically 3–5
cm above the carina), the most important intervention to maintain placement is to
secure the tube firmly using tape, twill tape, or a commercial ETT holder. Tube
displacement (either extubation or mainstem intubation) is a serious complication. While
, D454 AH III EXAM HINTS
1. An unexpected, catastrophic pulmonary complication with no
previous pulmonary moriar or oplems:
ARDS
2. Interventions for ventilated patients with ARDS:
Elevate HOB to at least 30 degrees; sedation vacations; strict oral hygiene;
implement mobilization program
3. Increased risk and mortality rate from ARDS in individuals who
have a history of:
Alcohol abuse
4. Suction only when:
Secretions are present
5. Before drawing a sample for ABGs from the radial artery, perform
the ___ to assess collateral circulation:
Allen test
6. Three most common symptoms of respiratory failure:
Dyspnea/tachypnea, intercostal and sternal retractions, cyanosis
7. Early signs of shock:
Agitation and restlessness
