WGU D447/D446 Adult Health Objective Assessments
Comprehensive Adult Health Nursing Examination
QUESTION 1
A 68-year-old male with a history of chronic heart failure is admitted with worsening dyspnea, orthopnea,
and 3+ pitting edema in his lower extremities. His vital signs are: BP 145/90, HR 102, RR 28, SpO2 89% on
room air. Lung auscultation reveals crackles in both lung bases. What is the priority nursing intervention?
Answer: Administer supplemental oxygen and position the patient in high Fowler's position
Rationale: The patient is presenting with acute decompensated heart failure with pulmonary congestion and
hypoxia. The priority is to optimize oxygenation and respiratory status. High Fowler's position maximizes
lung expansion and reduces venous return (preload) to the heart, decreasing pulmonary congestion.
Supplemental oxygen should be administered to maintain SpO2 >92%. The nurse should also assess for
signs of respiratory distress, monitor vital signs, and prepare for diuretic therapy (furosemide) and other
interventions. The underlying cause of the exacerbation should be identified (e.g., medication non-
adherence, dietary indiscretion, infection).
QUESTION 2
A 72-year-old female is 2 days post-operative following a total hip replacement. She reports sudden onset
of chest pain and shortness of breath. Her vital signs are: HR 118, RR 26, BP 138/82, SpO2 87% on 2L
O2. What is the most likely complication?
Answer: Pulmonary embolism (PE)
Rationale: The patient is at high risk for venous thromboembolism (VTE) due to recent major orthopedic
surgery and immobility. Sudden onset of chest pain, dyspnea, tachycardia, and hypoxia are classic signs of
pulmonary embolism. The priority nursing intervention is to administer supplemental oxygen, notify the
healthcare provider immediately, and prepare for diagnostic studies (CT pulmonary angiography, V/Q
scan). The patient should be maintained on bed rest and monitored for hemodynamic instability.
Anticoagulation therapy (heparin or LMWH) should be initiated as ordered. VTE prophylaxis should have
been implemented pre-operatively.
QUESTION 3
,A 55-year-old male with a history of type 2 diabetes presents with a 2-day history of fever, chills, and
productive cough with purulent sputum. He has been non-compliant with his diabetes medications. Vital
signs: T 101.8°F, HR 112, RR 24, BP 148/90, SpO2 90% on room air. Lung auscultation reveals crackles
in the right lower lobe. What is the priority nursing diagnosis?
Answer: Ineffective airway clearance related to excessive mucus production
Rationale: The patient is presenting with community-acquired pneumonia with signs of infection and
hypoxia. The priority nursing diagnosis is ineffective airway clearance due to the productive cough and
sputum production. Nursing interventions include promoting effective coughing and deep breathing,
maintaining adequate hydration (IV or oral), administering bronchodilators and antibiotics as ordered, and
monitoring respiratory status. The patient's diabetes should also be managed, as hyperglycemia can impair
immune function and increase susceptibility to infection. The patient should be monitored for signs of
sepsis and respiratory failure.
QUESTION 4
A 60-year-old female with chronic kidney disease (CKD) stage 4 is admitted with hyperkalemia (K+ 6.8
mEq/L). Which ECG finding would the nurse expect to observe?
Answer: Peaked T waves
Rationale: Hyperkalemia (potassium >5.5 mEq/L) causes characteristic ECG changes, with peaked T
waves being the earliest and most common finding. As potassium levels rise further, PR interval
prolongation, QRS widening, and eventually sinusoidal waves and ventricular fibrillation may occur. The
patient is at high risk for cardiac arrhythmias. Immediate interventions for severe hyperkalemia include
calcium gluconate (to stabilize cardiac membranes), insulin with glucose (to shift potassium intracellularly),
albuterol nebulization, and sodium bicarbonate. Hemodialysis is the definitive treatment for CKD patients.
The nurse should place the patient on continuous telemetry and monitor for changes in cardiac rhythm.
QUESTION 5
A 45-year-old male presents with acute abdominal pain that started in the periumbilical region and migrated
to the right lower quadrant. He reports nausea, vomiting, and anorexia. Vital signs: T 100.6°F, HR 102, RR
20, BP 138/84. On exam, there is rebound tenderness and guarding in the right lower quadrant. What is the
most likely diagnosis?
Answer: Acute appendicitis
Rationale: The patient presents with classic signs of acute appendicitis: pain migrating from the
periumbilical to the right lower quadrant, nausea, vomiting, anorexia, fever, and rebound tenderness with
guarding. The most appropriate initial action is to maintain the patient NPO, initiate IV fluids, and prepare
for surgical consultation. A CT scan of the abdomen and pelvis with contrast can confirm the diagnosis.
Antibiotics are typically administered pre-operatively. Surgery (appendectomy) is the definitive treatment.
The nurse should monitor for signs of perforation (rigid abdomen, worsening pain, sepsis).
, QUESTION 6
A 75-year-old male with a history of benign prostatic hyperplasia (BPH) presents with acute urinary
retention. He is unable to void and is experiencing severe suprapubic pain. What is the priority nursing
intervention?
Answer: Insert a Foley catheter to relieve the obstruction
Rationale: Acute urinary retention is a urological emergency. The immediate priority is to relieve the
obstruction by inserting a Foley catheter to drain the bladder. This will relieve pain, prevent bladder
distension, and prevent acute kidney injury. The nurse should use sterile technique and assess the amount
and character of urine output. After the bladder is drained, the patient should be evaluated for the cause of
the obstruction (usually BPH in elderly males). The patient may be started on an alpha-blocker (e.g.,
tamsulosin) to relax the prostate. A voiding trial may be attempted after the catheter is removed.
QUESTION 7
A 62-year-old female with a history of hypertension presents with a 30-minute episode of right-sided
weakness and slurred speech that resolved completely. She reports a similar episode 3 days ago. What is
the most likely diagnosis?
Answer: Transient ischemic attack (TIA)
Rationale: A transient ischemic attack (TIA) is a temporary episode of neurological deficit that resolves
within 24 hours. It is a warning sign for a future stroke. The patient's symptoms (right-sided weakness,
slurred speech) suggest involvement of the left hemisphere. The most appropriate nursing actions include a
thorough neurological assessment, evaluation of risk factors (hypertension, hyperlipidemia, smoking), and
initiation of antiplatelet therapy (aspirin) as ordered. The patient should be educated on stroke warning
signs and the importance of seeking immediate medical attention. Diagnostic studies (carotid ultrasound,
echocardiogram, brain imaging) may be ordered to identify the cause.
QUESTION 8
A 58-year-old male with a 30-pack-year smoking history presents with a 3-month history of progressive
hoarseness and a sensation of a lump in his throat. He has a history of gastroesophageal reflux disease
(GERD). What is the priority nursing action?
Answer: Refer the patient for otolaryngology evaluation and possible laryngoscopy
Rationale: Persistent hoarseness (>3 weeks) in a patient with risk factors for laryngeal cancer (smoking,
GERD) requires prompt evaluation. The priority is to refer the patient to an otolaryngologist for a
laryngoscopy to visualize the vocal cords and assess for lesions. Hoarseness can also be caused by
GERD, vocal cord nodules, or infection, but malignancy must be ruled out. Nursing care includes providing
emotional support, educating the patient on smoking cessation, and preparing for possible biopsy. Early
Comprehensive Adult Health Nursing Examination
QUESTION 1
A 68-year-old male with a history of chronic heart failure is admitted with worsening dyspnea, orthopnea,
and 3+ pitting edema in his lower extremities. His vital signs are: BP 145/90, HR 102, RR 28, SpO2 89% on
room air. Lung auscultation reveals crackles in both lung bases. What is the priority nursing intervention?
Answer: Administer supplemental oxygen and position the patient in high Fowler's position
Rationale: The patient is presenting with acute decompensated heart failure with pulmonary congestion and
hypoxia. The priority is to optimize oxygenation and respiratory status. High Fowler's position maximizes
lung expansion and reduces venous return (preload) to the heart, decreasing pulmonary congestion.
Supplemental oxygen should be administered to maintain SpO2 >92%. The nurse should also assess for
signs of respiratory distress, monitor vital signs, and prepare for diuretic therapy (furosemide) and other
interventions. The underlying cause of the exacerbation should be identified (e.g., medication non-
adherence, dietary indiscretion, infection).
QUESTION 2
A 72-year-old female is 2 days post-operative following a total hip replacement. She reports sudden onset
of chest pain and shortness of breath. Her vital signs are: HR 118, RR 26, BP 138/82, SpO2 87% on 2L
O2. What is the most likely complication?
Answer: Pulmonary embolism (PE)
Rationale: The patient is at high risk for venous thromboembolism (VTE) due to recent major orthopedic
surgery and immobility. Sudden onset of chest pain, dyspnea, tachycardia, and hypoxia are classic signs of
pulmonary embolism. The priority nursing intervention is to administer supplemental oxygen, notify the
healthcare provider immediately, and prepare for diagnostic studies (CT pulmonary angiography, V/Q
scan). The patient should be maintained on bed rest and monitored for hemodynamic instability.
Anticoagulation therapy (heparin or LMWH) should be initiated as ordered. VTE prophylaxis should have
been implemented pre-operatively.
QUESTION 3
,A 55-year-old male with a history of type 2 diabetes presents with a 2-day history of fever, chills, and
productive cough with purulent sputum. He has been non-compliant with his diabetes medications. Vital
signs: T 101.8°F, HR 112, RR 24, BP 148/90, SpO2 90% on room air. Lung auscultation reveals crackles
in the right lower lobe. What is the priority nursing diagnosis?
Answer: Ineffective airway clearance related to excessive mucus production
Rationale: The patient is presenting with community-acquired pneumonia with signs of infection and
hypoxia. The priority nursing diagnosis is ineffective airway clearance due to the productive cough and
sputum production. Nursing interventions include promoting effective coughing and deep breathing,
maintaining adequate hydration (IV or oral), administering bronchodilators and antibiotics as ordered, and
monitoring respiratory status. The patient's diabetes should also be managed, as hyperglycemia can impair
immune function and increase susceptibility to infection. The patient should be monitored for signs of
sepsis and respiratory failure.
QUESTION 4
A 60-year-old female with chronic kidney disease (CKD) stage 4 is admitted with hyperkalemia (K+ 6.8
mEq/L). Which ECG finding would the nurse expect to observe?
Answer: Peaked T waves
Rationale: Hyperkalemia (potassium >5.5 mEq/L) causes characteristic ECG changes, with peaked T
waves being the earliest and most common finding. As potassium levels rise further, PR interval
prolongation, QRS widening, and eventually sinusoidal waves and ventricular fibrillation may occur. The
patient is at high risk for cardiac arrhythmias. Immediate interventions for severe hyperkalemia include
calcium gluconate (to stabilize cardiac membranes), insulin with glucose (to shift potassium intracellularly),
albuterol nebulization, and sodium bicarbonate. Hemodialysis is the definitive treatment for CKD patients.
The nurse should place the patient on continuous telemetry and monitor for changes in cardiac rhythm.
QUESTION 5
A 45-year-old male presents with acute abdominal pain that started in the periumbilical region and migrated
to the right lower quadrant. He reports nausea, vomiting, and anorexia. Vital signs: T 100.6°F, HR 102, RR
20, BP 138/84. On exam, there is rebound tenderness and guarding in the right lower quadrant. What is the
most likely diagnosis?
Answer: Acute appendicitis
Rationale: The patient presents with classic signs of acute appendicitis: pain migrating from the
periumbilical to the right lower quadrant, nausea, vomiting, anorexia, fever, and rebound tenderness with
guarding. The most appropriate initial action is to maintain the patient NPO, initiate IV fluids, and prepare
for surgical consultation. A CT scan of the abdomen and pelvis with contrast can confirm the diagnosis.
Antibiotics are typically administered pre-operatively. Surgery (appendectomy) is the definitive treatment.
The nurse should monitor for signs of perforation (rigid abdomen, worsening pain, sepsis).
, QUESTION 6
A 75-year-old male with a history of benign prostatic hyperplasia (BPH) presents with acute urinary
retention. He is unable to void and is experiencing severe suprapubic pain. What is the priority nursing
intervention?
Answer: Insert a Foley catheter to relieve the obstruction
Rationale: Acute urinary retention is a urological emergency. The immediate priority is to relieve the
obstruction by inserting a Foley catheter to drain the bladder. This will relieve pain, prevent bladder
distension, and prevent acute kidney injury. The nurse should use sterile technique and assess the amount
and character of urine output. After the bladder is drained, the patient should be evaluated for the cause of
the obstruction (usually BPH in elderly males). The patient may be started on an alpha-blocker (e.g.,
tamsulosin) to relax the prostate. A voiding trial may be attempted after the catheter is removed.
QUESTION 7
A 62-year-old female with a history of hypertension presents with a 30-minute episode of right-sided
weakness and slurred speech that resolved completely. She reports a similar episode 3 days ago. What is
the most likely diagnosis?
Answer: Transient ischemic attack (TIA)
Rationale: A transient ischemic attack (TIA) is a temporary episode of neurological deficit that resolves
within 24 hours. It is a warning sign for a future stroke. The patient's symptoms (right-sided weakness,
slurred speech) suggest involvement of the left hemisphere. The most appropriate nursing actions include a
thorough neurological assessment, evaluation of risk factors (hypertension, hyperlipidemia, smoking), and
initiation of antiplatelet therapy (aspirin) as ordered. The patient should be educated on stroke warning
signs and the importance of seeking immediate medical attention. Diagnostic studies (carotid ultrasound,
echocardiogram, brain imaging) may be ordered to identify the cause.
QUESTION 8
A 58-year-old male with a 30-pack-year smoking history presents with a 3-month history of progressive
hoarseness and a sensation of a lump in his throat. He has a history of gastroesophageal reflux disease
(GERD). What is the priority nursing action?
Answer: Refer the patient for otolaryngology evaluation and possible laryngoscopy
Rationale: Persistent hoarseness (>3 weeks) in a patient with risk factors for laryngeal cancer (smoking,
GERD) requires prompt evaluation. The priority is to refer the patient to an otolaryngologist for a
laryngoscopy to visualize the vocal cords and assess for lesions. Hoarseness can also be caused by
GERD, vocal cord nodules, or infection, but malignancy must be ruled out. Nursing care includes providing
emotional support, educating the patient on smoking cessation, and preparing for possible biopsy. Early
