WGU D454 ADULT HEALTH III ACTUAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH RATIONALES 100% GUARANTEED PASS!!
<LATEST VERSION>
1. A patient is admitted after a motor-vehicle collision with suspected internal
bleeding. The patient is restless, pale, and cool. Blood pressure is 78/46 mm Hg,
heart rate is 132/min, respiratory rate is 28/min, and urine output has been 10 mL
during the past hour. Which intervention should the nurse anticipate as the
priority?
A. Administer a vasopressor infusion immediately
B. Initiate rapid isotonic crystalloid administration
C. Place the patient in a high-Fowler position
D. Administer IV furosemide
Answer: B
Rationale: Hypovolemic shock results from inadequate circulating volume. Initial
treatment focuses on rapidly restoring intravascular volume with isotonic fluids
while the source of blood or fluid loss is addressed. Vasopressors may be
considered when hypotension persists despite appropriate volume resuscitation, but
they do not replace initial volume restoration.
,2. A patient develops profound hypotension after sustaining a cervical spinal cord
injury. The patient has a heart rate of 48/min and warm, dry skin. Which type of
shock should the nurse suspect?
A. Cardiogenic shock
B. Hypovolemic shock
C. Neurogenic shock
D. Septic shock
Answer: C
Rationale: Neurogenic shock results from loss of sympathetic vascular tone,
commonly after high spinal cord injury. The characteristic findings include
hypotension, bradycardia, and warm, dry skin. This pattern differs from most other
forms of shock, in which compensatory tachycardia and peripheral
vasoconstriction are common.
3. A patient with an acute myocardial infarction develops severe hypotension,
pulmonary crackles, jugular venous distention, cool extremities, and decreased
urine output. Which hemodynamic change is most consistent with the patient's
condition?
A. Decreased systemic vascular resistance with decreased filling pressures
B. Increased cardiac output with decreased pulmonary pressures
C. Decreased cardiac output with increased left ventricular filling pressure
D. Increased cardiac output with increased renal perfusion
Answer: C
Rationale: Cardiogenic shock occurs when the heart cannot generate sufficient
cardiac output. Left ventricular failure causes blood to back up into the pulmonary
circulation, producing elevated filling pressures, pulmonary congestion,
hypotension, and systemic hypoperfusion.
,4. A patient receiving treatment for septic shock has a serum lactate level of 5.1
mmol/L. Which finding most strongly indicates persistent tissue hypoperfusion?
A. Urine output of 15 mL/hr
B. Temperature of 37.4°C (99.3°F)
C. Heart rate of 88/min
D. Capillary refill of 2 seconds
Answer: A
Rationale: Oliguria in a patient with shock indicates decreased renal perfusion and
ongoing systemic hypoperfusion. Lactate elevation also supports impaired tissue
oxygen utilization or delivery. Urine output is a useful bedside indicator of organ
perfusion.
5. A patient with suspected sepsis has a temperature of 39.2°C (102.6°F), blood
pressure of 86/48 mm Hg, and altered mental status. Which action should the nurse
take first when obtaining cultures and initiating antimicrobial therapy?
A. Administer broad-spectrum antibiotics after obtaining ordered blood cultures
B. Wait for culture results before administering antibiotics
C. Administer a loop diuretic to improve renal perfusion
D. Restrict IV fluids to prevent pulmonary edema
Answer: A
Rationale: In suspected sepsis, cultures should be obtained promptly when this
can be accomplished without delaying antimicrobial treatment. Broad-spectrum
antibiotics should be administered rapidly, while fluid resuscitation and ongoing
hemodynamic assessment occur concurrently.
, 6. A patient with septic shock develops bleeding from IV sites and widespread
petechiae. Laboratory results include platelet count 48,000/mm³, prolonged PT and
aPTT, elevated D-dimer, and decreased fibrinogen. Which complication is most
likely?
A. Immune thrombocytopenia
B. Disseminated intravascular coagulation
C. Hemophilia A
D. Vitamin K toxicity
Answer: B
Rationale: DIC involves widespread activation of coagulation, resulting in
consumption of platelets and clotting factors. Patients may simultaneously develop
microvascular thrombosis and serious bleeding. Prolonged coagulation times,
thrombocytopenia, elevated D-dimer, and low fibrinogen support the diagnosis.
7. A patient with acute pancreatitis develops bluish-purple discoloration around the
umbilicus. Which interpretation should guide the nurse's response?
A. The finding indicates superficial venous insufficiency
B. The finding is characteristic of Cullen sign and may indicate intra-abdominal
bleeding
C. The finding indicates expected pancreatic inflammation
D. The finding indicates acute biliary obstruction without hemorrhage
Answer: B
Rationale: Cullen sign is periumbilical ecchymosis associated with intra-
abdominal or retroperitoneal bleeding. In severe pancreatitis, it can indicate
hemorrhagic complications and requires prompt evaluation.
QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH RATIONALES 100% GUARANTEED PASS!!
<LATEST VERSION>
1. A patient is admitted after a motor-vehicle collision with suspected internal
bleeding. The patient is restless, pale, and cool. Blood pressure is 78/46 mm Hg,
heart rate is 132/min, respiratory rate is 28/min, and urine output has been 10 mL
during the past hour. Which intervention should the nurse anticipate as the
priority?
A. Administer a vasopressor infusion immediately
B. Initiate rapid isotonic crystalloid administration
C. Place the patient in a high-Fowler position
D. Administer IV furosemide
Answer: B
Rationale: Hypovolemic shock results from inadequate circulating volume. Initial
treatment focuses on rapidly restoring intravascular volume with isotonic fluids
while the source of blood or fluid loss is addressed. Vasopressors may be
considered when hypotension persists despite appropriate volume resuscitation, but
they do not replace initial volume restoration.
,2. A patient develops profound hypotension after sustaining a cervical spinal cord
injury. The patient has a heart rate of 48/min and warm, dry skin. Which type of
shock should the nurse suspect?
A. Cardiogenic shock
B. Hypovolemic shock
C. Neurogenic shock
D. Septic shock
Answer: C
Rationale: Neurogenic shock results from loss of sympathetic vascular tone,
commonly after high spinal cord injury. The characteristic findings include
hypotension, bradycardia, and warm, dry skin. This pattern differs from most other
forms of shock, in which compensatory tachycardia and peripheral
vasoconstriction are common.
3. A patient with an acute myocardial infarction develops severe hypotension,
pulmonary crackles, jugular venous distention, cool extremities, and decreased
urine output. Which hemodynamic change is most consistent with the patient's
condition?
A. Decreased systemic vascular resistance with decreased filling pressures
B. Increased cardiac output with decreased pulmonary pressures
C. Decreased cardiac output with increased left ventricular filling pressure
D. Increased cardiac output with increased renal perfusion
Answer: C
Rationale: Cardiogenic shock occurs when the heart cannot generate sufficient
cardiac output. Left ventricular failure causes blood to back up into the pulmonary
circulation, producing elevated filling pressures, pulmonary congestion,
hypotension, and systemic hypoperfusion.
,4. A patient receiving treatment for septic shock has a serum lactate level of 5.1
mmol/L. Which finding most strongly indicates persistent tissue hypoperfusion?
A. Urine output of 15 mL/hr
B. Temperature of 37.4°C (99.3°F)
C. Heart rate of 88/min
D. Capillary refill of 2 seconds
Answer: A
Rationale: Oliguria in a patient with shock indicates decreased renal perfusion and
ongoing systemic hypoperfusion. Lactate elevation also supports impaired tissue
oxygen utilization or delivery. Urine output is a useful bedside indicator of organ
perfusion.
5. A patient with suspected sepsis has a temperature of 39.2°C (102.6°F), blood
pressure of 86/48 mm Hg, and altered mental status. Which action should the nurse
take first when obtaining cultures and initiating antimicrobial therapy?
A. Administer broad-spectrum antibiotics after obtaining ordered blood cultures
B. Wait for culture results before administering antibiotics
C. Administer a loop diuretic to improve renal perfusion
D. Restrict IV fluids to prevent pulmonary edema
Answer: A
Rationale: In suspected sepsis, cultures should be obtained promptly when this
can be accomplished without delaying antimicrobial treatment. Broad-spectrum
antibiotics should be administered rapidly, while fluid resuscitation and ongoing
hemodynamic assessment occur concurrently.
, 6. A patient with septic shock develops bleeding from IV sites and widespread
petechiae. Laboratory results include platelet count 48,000/mm³, prolonged PT and
aPTT, elevated D-dimer, and decreased fibrinogen. Which complication is most
likely?
A. Immune thrombocytopenia
B. Disseminated intravascular coagulation
C. Hemophilia A
D. Vitamin K toxicity
Answer: B
Rationale: DIC involves widespread activation of coagulation, resulting in
consumption of platelets and clotting factors. Patients may simultaneously develop
microvascular thrombosis and serious bleeding. Prolonged coagulation times,
thrombocytopenia, elevated D-dimer, and low fibrinogen support the diagnosis.
7. A patient with acute pancreatitis develops bluish-purple discoloration around the
umbilicus. Which interpretation should guide the nurse's response?
A. The finding indicates superficial venous insufficiency
B. The finding is characteristic of Cullen sign and may indicate intra-abdominal
bleeding
C. The finding indicates expected pancreatic inflammation
D. The finding indicates acute biliary obstruction without hemorrhage
Answer: B
Rationale: Cullen sign is periumbilical ecchymosis associated with intra-
abdominal or retroperitoneal bleeding. In severe pancreatitis, it can indicate
hemorrhagic complications and requires prompt evaluation.
