WGU D454 |1
WGU D454 — ADULT HEALTH III | STUDY GUIDE |
LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW
Table of Contents
1. Critical Care and Shock States
2. Cardiovascular Emergencies
3. Respiratory Failure and Mechanical Ventilation
4. Neurological Conditions and Stroke
5. Endocrine Emergencies
6. Renal and Genitourinary Disorders
7. Gastrointestinal and Hepatic Disorders
8. Infectious Diseases and Isolation Precautions
9. Pharmacology and Medication Safety
10. Postoperative and Bariatric Care
, WGU D454 |2
Question 1: A client with septic shock has a mean arterial pressure (MAP) of 58 mm Hg
despite adequate fluid resuscitation. According to the Surviving Sepsis Campaign guidelines,
which vasopressor is the first-line agent?
A) Epinephrine
B) Norepinephrine
C) Dopamine
D) Vasopressin
Correct Answer: B) Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-
adrenergic effects that increase systemic vascular resistance and blood pressure. The
Surviving Sepsis Campaign recommends initiating norepinephrine when MAP remains below
65 mm Hg despite fluid resuscitation.
Question 2: A client in cardiogenic shock is being monitored with a pulmonary artery
catheter. Which hemodynamic finding is most consistent with cardiogenic shock?
A) Low cardiac output and high systemic vascular resistance
B) High cardiac output and low systemic vascular resistance
C) Low cardiac output and low systemic vascular resistance
D) Normal cardiac output and low systemic vascular resistance
Correct Answer: A) Low cardiac output and high systemic vascular resistance
In cardiogenic shock, the heart's pumping ability is impaired, leading to decreased cardiac
output. Compensatory mechanisms increase systemic vascular resistance to maintain blood
pressure, resulting in low cardiac output with high SVR. This contrasts with septic shock,
which presents with high cardiac output and low SVR.
Question 3: A client is admitted to the ICU after a colon resection. Vital signs are temperature
100°F, heart rate 132 beats/minute, blood pressure 88/65 mm Hg, and urine output 10
mL/hour. Which intervention should the nurse implement first?
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
, WGU D454 |3
Correct Answer: A) Give a fluid challenge of 500 mL IV bolus
The client's vital signs indicate hypovolemic shock from fluid loss after colon resection
surgery (tachycardia, hypotension, and oliguria). The first-line treatment is rapid fluid
resuscitation to improve blood pressure and restore kidney perfusion. Low-grade fever and
oxygenation are secondary concerns until hemodynamics are stabilized.
Question 4: A nurse is caring for a client with acute respiratory distress syndrome (ARDS).
Which ventilator setting should the nurse anticipate?
A) High tidal volumes to improve oxygenation
B) Low tidal volumes to prevent lung injury
C) High positive end-expiratory pressure (PEEP) only
D) Pressure support ventilation alone
Correct Answer: B) Low tidal volumes to prevent lung injury
Lung-protective ventilation with low tidal volumes (4–8 mL/kg of predicted body weight) is
the standard of care for ARDS. High tidal volumes can cause ventilator-induced lung injury
and worsen outcomes. PEEP is also used to recruit collapsed alveoli, but low tidal volumes
are the foundation of lung-protective ventilation.
Question 5: A client with a traumatic brain injury has an intracranial pressure (ICP) reading
of 22 mm Hg. Which intervention should the nurse implement first?
A) Elevate the head of the bed to 30 degrees
B) Administer a bolus of hypotonic IV fluids
C) Perform endotracheal suctioning
D) Place the client in a flat, supine position
Correct Answer: A) Elevate the head of the bed to 30 degrees
Elevating the head of the bed to 30 degrees promotes venous drainage from the brain and
reduces ICP. Hypotonic fluids can worsen cerebral edema, and suctioning can transiently
increase ICP. A flat position does not promote venous drainage.
Question 6: A client with diabetic ketoacidosis (DKA) has a blood glucose of 480 mg/dL.
Which finding should the nurse anticipate?
, WGU D454 |4
A) Kussmaul respirations
B) Bradycardia
C) Hypertension
D) Hyperkalemia
Correct Answer: A) Kussmaul respirations
Kussmaul respirations are deep, rapid breaths that occur as a compensatory mechanism for
metabolic acidosis in DKA. The body attempts to blow off carbon dioxide to raise blood pH.
Bradycardia and hyperkalemia can occur but are not the classic respiratory finding.
Question 7: A client with chronic kidney disease (CKD) has a potassium level of 6.5 mEq/L.
Which intervention should the nurse anticipate?
A) Administer calcium gluconate
B) Restrict fluids
C) Administer a potassium supplement
D) Encourage a high-potassium diet
Correct Answer: A) Administer calcium gluconate
Calcium gluconate stabilizes cardiac membranes and protects against dysrhythmias in severe
hyperkalemia. It is administered as an emergency treatment while other measures (insulin
with glucose, sodium bicarbonate) shift potassium intracellularly. Potassium supplements
and a high-potassium diet would worsen the condition.
Question 8: A client with cirrhosis and ascites is prescribed spironolactone. Which laboratory
value should the nurse monitor most closely?
A) Serum potassium
B) Serum sodium
C) Serum calcium
D) Serum magnesium
Correct Answer: A) Serum potassium
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia. Monitoring
serum potassium is essential to prevent cardiac dysrhythmias. Hyponatremia can also occur
but is less directly related to spironolactone's mechanism.
WGU D454 — ADULT HEALTH III | STUDY GUIDE |
LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW
Table of Contents
1. Critical Care and Shock States
2. Cardiovascular Emergencies
3. Respiratory Failure and Mechanical Ventilation
4. Neurological Conditions and Stroke
5. Endocrine Emergencies
6. Renal and Genitourinary Disorders
7. Gastrointestinal and Hepatic Disorders
8. Infectious Diseases and Isolation Precautions
9. Pharmacology and Medication Safety
10. Postoperative and Bariatric Care
, WGU D454 |2
Question 1: A client with septic shock has a mean arterial pressure (MAP) of 58 mm Hg
despite adequate fluid resuscitation. According to the Surviving Sepsis Campaign guidelines,
which vasopressor is the first-line agent?
A) Epinephrine
B) Norepinephrine
C) Dopamine
D) Vasopressin
Correct Answer: B) Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-
adrenergic effects that increase systemic vascular resistance and blood pressure. The
Surviving Sepsis Campaign recommends initiating norepinephrine when MAP remains below
65 mm Hg despite fluid resuscitation.
Question 2: A client in cardiogenic shock is being monitored with a pulmonary artery
catheter. Which hemodynamic finding is most consistent with cardiogenic shock?
A) Low cardiac output and high systemic vascular resistance
B) High cardiac output and low systemic vascular resistance
C) Low cardiac output and low systemic vascular resistance
D) Normal cardiac output and low systemic vascular resistance
Correct Answer: A) Low cardiac output and high systemic vascular resistance
In cardiogenic shock, the heart's pumping ability is impaired, leading to decreased cardiac
output. Compensatory mechanisms increase systemic vascular resistance to maintain blood
pressure, resulting in low cardiac output with high SVR. This contrasts with septic shock,
which presents with high cardiac output and low SVR.
Question 3: A client is admitted to the ICU after a colon resection. Vital signs are temperature
100°F, heart rate 132 beats/minute, blood pressure 88/65 mm Hg, and urine output 10
mL/hour. Which intervention should the nurse implement first?
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
, WGU D454 |3
Correct Answer: A) Give a fluid challenge of 500 mL IV bolus
The client's vital signs indicate hypovolemic shock from fluid loss after colon resection
surgery (tachycardia, hypotension, and oliguria). The first-line treatment is rapid fluid
resuscitation to improve blood pressure and restore kidney perfusion. Low-grade fever and
oxygenation are secondary concerns until hemodynamics are stabilized.
Question 4: A nurse is caring for a client with acute respiratory distress syndrome (ARDS).
Which ventilator setting should the nurse anticipate?
A) High tidal volumes to improve oxygenation
B) Low tidal volumes to prevent lung injury
C) High positive end-expiratory pressure (PEEP) only
D) Pressure support ventilation alone
Correct Answer: B) Low tidal volumes to prevent lung injury
Lung-protective ventilation with low tidal volumes (4–8 mL/kg of predicted body weight) is
the standard of care for ARDS. High tidal volumes can cause ventilator-induced lung injury
and worsen outcomes. PEEP is also used to recruit collapsed alveoli, but low tidal volumes
are the foundation of lung-protective ventilation.
Question 5: A client with a traumatic brain injury has an intracranial pressure (ICP) reading
of 22 mm Hg. Which intervention should the nurse implement first?
A) Elevate the head of the bed to 30 degrees
B) Administer a bolus of hypotonic IV fluids
C) Perform endotracheal suctioning
D) Place the client in a flat, supine position
Correct Answer: A) Elevate the head of the bed to 30 degrees
Elevating the head of the bed to 30 degrees promotes venous drainage from the brain and
reduces ICP. Hypotonic fluids can worsen cerebral edema, and suctioning can transiently
increase ICP. A flat position does not promote venous drainage.
Question 6: A client with diabetic ketoacidosis (DKA) has a blood glucose of 480 mg/dL.
Which finding should the nurse anticipate?
, WGU D454 |4
A) Kussmaul respirations
B) Bradycardia
C) Hypertension
D) Hyperkalemia
Correct Answer: A) Kussmaul respirations
Kussmaul respirations are deep, rapid breaths that occur as a compensatory mechanism for
metabolic acidosis in DKA. The body attempts to blow off carbon dioxide to raise blood pH.
Bradycardia and hyperkalemia can occur but are not the classic respiratory finding.
Question 7: A client with chronic kidney disease (CKD) has a potassium level of 6.5 mEq/L.
Which intervention should the nurse anticipate?
A) Administer calcium gluconate
B) Restrict fluids
C) Administer a potassium supplement
D) Encourage a high-potassium diet
Correct Answer: A) Administer calcium gluconate
Calcium gluconate stabilizes cardiac membranes and protects against dysrhythmias in severe
hyperkalemia. It is administered as an emergency treatment while other measures (insulin
with glucose, sodium bicarbonate) shift potassium intracellularly. Potassium supplements
and a high-potassium diet would worsen the condition.
Question 8: A client with cirrhosis and ascites is prescribed spironolactone. Which laboratory
value should the nurse monitor most closely?
A) Serum potassium
B) Serum sodium
C) Serum calcium
D) Serum magnesium
Correct Answer: A) Serum potassium
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia. Monitoring
serum potassium is essential to prevent cardiac dysrhythmias. Hyponatremia can also occur
but is less directly related to spironolactone's mechanism.
