WGU D446 Adult Health II Final Exam
Study Guide | D446 OA Review Pack |
Latest Update 2026 - 2027 (Pass Your Final
OA on First Attempt )
How does the RN know what to delegate?
Delegation - transferring a task/activity to unlicensed assertive personnel (UAP)
The nurse is accountable for the task and activity that is delegated
Rules can vary from state to state
5 Rights of Delegation TPCCS
1. Right task - is it in the UAPs job description, policies, or procedures according to the
nurse practice act
2. Right circumstances - patient needs to be stable
3. Right person - person you delegate to must have knowledge skills and abilities to do
tasks
4. Right communication - person you delegate to should be asking you clarifying
questions, they should understand the task at hand and not modify anything
5. Right supervision - delegation must be within your scope of practice, you must
monitor activity and follow-up to ensure the activity is completed. the person you
delegate to should communicate any significant patient information that occurred while
,giving that task, such as pain being reported. you must also ensure that you document
this appropriately
They should delegate things with predictable outcomes, and should consider patient
safety
Do delegate
Turning, positioning, vitals, intake, output, feeding, ambulation, oral suctioning, etc
Things that do not vary depending on patients needs - stuff that is pretty much the same
for everyone/follow a sequence of steps
Dont delegate
Tasks that involve ongoing assessment, interpretation, or decision making
-------LPNs can do ongoing assessments, UAPs cannot
Any admission assessments, irrigations of NG tubes, hanging blood transfusions, etc
Explain the cardiac blood flow and electrical system
Cardiac Blood Flow - Deoxygenated blood enters through the superior and inferior vena
cavas into the right atrium. Blood travels through the tricuspid valve into the Right
Ventricle. Blood is then pushed through the pulmonic valve into the pulmonary arteries
and into the lungs. Oxygenated blood is then returned to the heart through the
pulmonary veins and empty into the Left Atrium. Blood is then moved through the
,Mitral valve into the Left Ventricle. Then blood is pumped up and out of the heart
through the aortic valve into the aorta and into the body.
Electrical system- Electrical impulse travels from SA node (through L and R atria
causing them to contract)→ AV node→ Bundle of His → Bundle Branches (in between
the ventricles)→ Purkinje Fibers (outside the ventricles) → throughout the L and R
ventricles expelling their blood into the rest of the body via the aorta
Explain the difference between stable and unstable MI
Stable myocardial infarction (MI) refers to a heart attack that has occurred in the past
and has resulted in scar tissue formation in the heart. The symptoms may have resolved,
and the patient may not have any current symptoms, but there is a risk of developing
another heart attack.
stable angina--(more common) – attacks have a trigger (such as stress or exercise) and
stop within a few minutes of resting, it is usually predictable and can mimic previous
episodes of chest pain
Unstable MI refers to a heart attack that is currently occurring or is about to occur, and
the symptoms are severe and unstable
unstable angina-(more serious) – attacks are more unpredictable (they may not have a
trigger) and can continue despite resting, ST segment elevation or depression may occur
Stable angina can turn into unstable angina if the pattern of chest pain changes, or if it is
brought on by less activity than normal/becomes unpredictable
, Explain the EKG findings in a NSTEMI vs a STEMI
NSTEMI (aka non ST segment elevation MI)
- may or may not have s-t depression and T-wave inversion. May look normal on an
EKG.
- is a partial blockage of a major artery or a full blockage of a minor artery.
- Damage is reversible
-There may also be the presence of Q waves indicating past myocardial damage.
STEMI (aka ST segment elevation MI)
- Will have s-t elevation on an EKG, may have T inversion
- Full blockage of a major artery.
- Damage is NON-reversible
-indicates ongoing acute myocardial damage.
Image: Explain the EKG findings in a NSTEMI vs a STEMI
The indication for using some medications, such as, heparin in treating NSTEMI
Heparin is used in treating NSTEMI to prevent blood clot formation in the coronary
arteries, which can lead to a heart attack.
Study Guide | D446 OA Review Pack |
Latest Update 2026 - 2027 (Pass Your Final
OA on First Attempt )
How does the RN know what to delegate?
Delegation - transferring a task/activity to unlicensed assertive personnel (UAP)
The nurse is accountable for the task and activity that is delegated
Rules can vary from state to state
5 Rights of Delegation TPCCS
1. Right task - is it in the UAPs job description, policies, or procedures according to the
nurse practice act
2. Right circumstances - patient needs to be stable
3. Right person - person you delegate to must have knowledge skills and abilities to do
tasks
4. Right communication - person you delegate to should be asking you clarifying
questions, they should understand the task at hand and not modify anything
5. Right supervision - delegation must be within your scope of practice, you must
monitor activity and follow-up to ensure the activity is completed. the person you
delegate to should communicate any significant patient information that occurred while
,giving that task, such as pain being reported. you must also ensure that you document
this appropriately
They should delegate things with predictable outcomes, and should consider patient
safety
Do delegate
Turning, positioning, vitals, intake, output, feeding, ambulation, oral suctioning, etc
Things that do not vary depending on patients needs - stuff that is pretty much the same
for everyone/follow a sequence of steps
Dont delegate
Tasks that involve ongoing assessment, interpretation, or decision making
-------LPNs can do ongoing assessments, UAPs cannot
Any admission assessments, irrigations of NG tubes, hanging blood transfusions, etc
Explain the cardiac blood flow and electrical system
Cardiac Blood Flow - Deoxygenated blood enters through the superior and inferior vena
cavas into the right atrium. Blood travels through the tricuspid valve into the Right
Ventricle. Blood is then pushed through the pulmonic valve into the pulmonary arteries
and into the lungs. Oxygenated blood is then returned to the heart through the
pulmonary veins and empty into the Left Atrium. Blood is then moved through the
,Mitral valve into the Left Ventricle. Then blood is pumped up and out of the heart
through the aortic valve into the aorta and into the body.
Electrical system- Electrical impulse travels from SA node (through L and R atria
causing them to contract)→ AV node→ Bundle of His → Bundle Branches (in between
the ventricles)→ Purkinje Fibers (outside the ventricles) → throughout the L and R
ventricles expelling their blood into the rest of the body via the aorta
Explain the difference between stable and unstable MI
Stable myocardial infarction (MI) refers to a heart attack that has occurred in the past
and has resulted in scar tissue formation in the heart. The symptoms may have resolved,
and the patient may not have any current symptoms, but there is a risk of developing
another heart attack.
stable angina--(more common) – attacks have a trigger (such as stress or exercise) and
stop within a few minutes of resting, it is usually predictable and can mimic previous
episodes of chest pain
Unstable MI refers to a heart attack that is currently occurring or is about to occur, and
the symptoms are severe and unstable
unstable angina-(more serious) – attacks are more unpredictable (they may not have a
trigger) and can continue despite resting, ST segment elevation or depression may occur
Stable angina can turn into unstable angina if the pattern of chest pain changes, or if it is
brought on by less activity than normal/becomes unpredictable
, Explain the EKG findings in a NSTEMI vs a STEMI
NSTEMI (aka non ST segment elevation MI)
- may or may not have s-t depression and T-wave inversion. May look normal on an
EKG.
- is a partial blockage of a major artery or a full blockage of a minor artery.
- Damage is reversible
-There may also be the presence of Q waves indicating past myocardial damage.
STEMI (aka ST segment elevation MI)
- Will have s-t elevation on an EKG, may have T inversion
- Full blockage of a major artery.
- Damage is NON-reversible
-indicates ongoing acute myocardial damage.
Image: Explain the EKG findings in a NSTEMI vs a STEMI
The indication for using some medications, such as, heparin in treating NSTEMI
Heparin is used in treating NSTEMI to prevent blood clot formation in the coronary
arteries, which can lead to a heart attack.
