WGU D453 ADVANCED NURSING SKILLS OA EXAM
ACTUAL EXAM QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
1. A patient with a chest tube following a traumatic hemothorax has a drainage
system connected to wall suction. During assessment, the nurse notices continuous
bubbling in the water-seal chamber. The patient's respiratory rate is unchanged,
oxygen saturation is 95%, and the insertion site is dry and intact. What should the
nurse do first?
A. Clamp the chest tube immediately
B. Assess the tubing and connections for an air leak
C. Increase the wall suction pressure
D. Remove the chest tube dressing and inspect the insertion site
Answer: B
Rationale: Continuous bubbling in the water-seal chamber may indicate an air
leak. The nurse should first inspect the system from the patient toward the drainage
unit, including tubing connections and the insertion site, to locate the source.
Routine clamping can cause tension pneumothorax and should not be performed
simply because bubbling is present.
2. A mechanically ventilated patient suddenly triggers a high-pressure alarm. The
oxygen saturation has decreased from 96% to 88%, and coarse crackles are now
audible bilaterally. The ventilator tubing contains visible thick secretions. Which
action should the nurse take first?
A. Increase the set tidal volume
B. Silence the alarm and continue to monitor
C. Assess the airway and suction the patient as indicated
D. Decrease the positive end-expiratory pressure
Answer: C
,Rationale: Thick secretions can obstruct airflow and increase airway resistance,
producing a high-pressure alarm. Because oxygen saturation is declining, the nurse
should immediately assess the airway and suction when indicated. Changing
ventilator settings before determining the cause may worsen the patient's condition.
3. A patient receiving invasive mechanical ventilation has the following arterial
blood gas results:
pH: 7.29
PaCO₂: 58 mm Hg
HCO₃⁻: 27 mEq/L
PaO₂: 74 mm Hg
Which interpretation is most accurate?
A. Fully compensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Metabolic acidosis with complete compensation
D. Metabolic alkalosis with partial compensation
Answer: B
Rationale: The pH is below 7.35, indicating acidemia. The PaCO₂ is elevated,
identifying the primary problem as respiratory acidosis. The bicarbonate is slightly
elevated, showing renal compensation has begun, but the pH remains abnormal.
Therefore, the disorder is partially compensated respiratory acidosis.
,4. A patient monitored by telemetry suddenly reports severe chest pressure and
becomes pale and diaphoretic. The monitor displays a wide-complex rhythm at
approximately 190 beats/minute. The patient is unresponsive and has no palpable
pulse. Which intervention should the nurse anticipate immediately?
A. Administration of oral metoprolol
B. Synchronized cardioversion
C. Defibrillation and initiation of CPR
D. Intravenous adenosine followed by observation
Answer: C
Rationale: A pulseless wide-complex tachycardia is treated as ventricular
fibrillation or pulseless ventricular tachycardia until determined otherwise.
Immediate high-quality CPR and unsynchronized defibrillation are required.
Synchronized cardioversion is used for certain unstable tachyarrhythmias when a
pulse is present.
5. A patient with a tracheostomy becomes restless and anxious. Oxygen saturation
falls from 97% to 84%. The nurse notes diminished airflow through the
tracheostomy and hears a harsh sound during inspiration. Which action should
occur first?
A. Remove the tracheostomy tube and leave the stoma open
B. Assess the tracheostomy tube for obstruction and attempt suctioning
C. Increase the intravenous fluid rate
D. Place the patient flat and reassess in 15 minutes
Answer: B
Rationale: Acute hypoxemia with diminished airflow through a tracheostomy
suggests airway obstruction, commonly from secretions or tube occlusion. The
nurse should rapidly assess patency and suction as indicated. Emergency
replacement equipment and a backup airway should also be available.
, 6. During a central venous catheter dressing change, the nurse discovers that the
sterile transparent dressing has become damp underneath and the insertion site is
no longer fully covered. The patient is afebrile and has no signs of infection. What
is the appropriate action?
A. Reinforce the existing dressing with tape
B. Leave the dressing in place until the next scheduled change
C. Replace the compromised dressing using aseptic technique
D. Apply topical antibiotic ointment and cover the area
Answer: C
Rationale: A damp, loose, or otherwise compromised central-line dressing should
be replaced promptly using appropriate aseptic technique. Moisture can promote
microbial growth and compromise the protective barrier around the catheter.
7. A patient receiving continuous parenteral nutrition has an infusion pump
malfunction. The replacement pump will not be available for approximately 30
minutes. The nurse is concerned about abruptly stopping the infusion. Which
intervention is most appropriate?
A. Stop the infusion and leave the catheter saline locked
B. Substitute a balanced crystalloid solution
C. Follow the prescribed protocol for temporary dextrose administration
D. Increase the next hour's parenteral nutrition rate to compensate
Answer: C
Rationale: Abrupt interruption of a continuous high-dextrose parenteral nutrition
infusion can cause hypoglycemia. When PN must be temporarily interrupted, the
nurse follows the facility protocol, commonly using an appropriate dextrose-
containing solution until the PN can safely resume.
ACTUAL EXAM QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
1. A patient with a chest tube following a traumatic hemothorax has a drainage
system connected to wall suction. During assessment, the nurse notices continuous
bubbling in the water-seal chamber. The patient's respiratory rate is unchanged,
oxygen saturation is 95%, and the insertion site is dry and intact. What should the
nurse do first?
A. Clamp the chest tube immediately
B. Assess the tubing and connections for an air leak
C. Increase the wall suction pressure
D. Remove the chest tube dressing and inspect the insertion site
Answer: B
Rationale: Continuous bubbling in the water-seal chamber may indicate an air
leak. The nurse should first inspect the system from the patient toward the drainage
unit, including tubing connections and the insertion site, to locate the source.
Routine clamping can cause tension pneumothorax and should not be performed
simply because bubbling is present.
2. A mechanically ventilated patient suddenly triggers a high-pressure alarm. The
oxygen saturation has decreased from 96% to 88%, and coarse crackles are now
audible bilaterally. The ventilator tubing contains visible thick secretions. Which
action should the nurse take first?
A. Increase the set tidal volume
B. Silence the alarm and continue to monitor
C. Assess the airway and suction the patient as indicated
D. Decrease the positive end-expiratory pressure
Answer: C
,Rationale: Thick secretions can obstruct airflow and increase airway resistance,
producing a high-pressure alarm. Because oxygen saturation is declining, the nurse
should immediately assess the airway and suction when indicated. Changing
ventilator settings before determining the cause may worsen the patient's condition.
3. A patient receiving invasive mechanical ventilation has the following arterial
blood gas results:
pH: 7.29
PaCO₂: 58 mm Hg
HCO₃⁻: 27 mEq/L
PaO₂: 74 mm Hg
Which interpretation is most accurate?
A. Fully compensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Metabolic acidosis with complete compensation
D. Metabolic alkalosis with partial compensation
Answer: B
Rationale: The pH is below 7.35, indicating acidemia. The PaCO₂ is elevated,
identifying the primary problem as respiratory acidosis. The bicarbonate is slightly
elevated, showing renal compensation has begun, but the pH remains abnormal.
Therefore, the disorder is partially compensated respiratory acidosis.
,4. A patient monitored by telemetry suddenly reports severe chest pressure and
becomes pale and diaphoretic. The monitor displays a wide-complex rhythm at
approximately 190 beats/minute. The patient is unresponsive and has no palpable
pulse. Which intervention should the nurse anticipate immediately?
A. Administration of oral metoprolol
B. Synchronized cardioversion
C. Defibrillation and initiation of CPR
D. Intravenous adenosine followed by observation
Answer: C
Rationale: A pulseless wide-complex tachycardia is treated as ventricular
fibrillation or pulseless ventricular tachycardia until determined otherwise.
Immediate high-quality CPR and unsynchronized defibrillation are required.
Synchronized cardioversion is used for certain unstable tachyarrhythmias when a
pulse is present.
5. A patient with a tracheostomy becomes restless and anxious. Oxygen saturation
falls from 97% to 84%. The nurse notes diminished airflow through the
tracheostomy and hears a harsh sound during inspiration. Which action should
occur first?
A. Remove the tracheostomy tube and leave the stoma open
B. Assess the tracheostomy tube for obstruction and attempt suctioning
C. Increase the intravenous fluid rate
D. Place the patient flat and reassess in 15 minutes
Answer: B
Rationale: Acute hypoxemia with diminished airflow through a tracheostomy
suggests airway obstruction, commonly from secretions or tube occlusion. The
nurse should rapidly assess patency and suction as indicated. Emergency
replacement equipment and a backup airway should also be available.
, 6. During a central venous catheter dressing change, the nurse discovers that the
sterile transparent dressing has become damp underneath and the insertion site is
no longer fully covered. The patient is afebrile and has no signs of infection. What
is the appropriate action?
A. Reinforce the existing dressing with tape
B. Leave the dressing in place until the next scheduled change
C. Replace the compromised dressing using aseptic technique
D. Apply topical antibiotic ointment and cover the area
Answer: C
Rationale: A damp, loose, or otherwise compromised central-line dressing should
be replaced promptly using appropriate aseptic technique. Moisture can promote
microbial growth and compromise the protective barrier around the catheter.
7. A patient receiving continuous parenteral nutrition has an infusion pump
malfunction. The replacement pump will not be available for approximately 30
minutes. The nurse is concerned about abruptly stopping the infusion. Which
intervention is most appropriate?
A. Stop the infusion and leave the catheter saline locked
B. Substitute a balanced crystalloid solution
C. Follow the prescribed protocol for temporary dextrose administration
D. Increase the next hour's parenteral nutrition rate to compensate
Answer: C
Rationale: Abrupt interruption of a continuous high-dextrose parenteral nutrition
infusion can cause hypoglycemia. When PN must be temporarily interrupted, the
nurse follows the facility protocol, commonly using an appropriate dextrose-
containing solution until the PN can safely resume.
