WGU D444
Adult Health 1
Objective Assessment
Exam Questions with Verified Answers
Pass the Exam with Confidence
This comprehensive resource includes:
✓ full version of the Objective Assessment Exam
✓ Each with Actual Exam Questions with Verified Answers
✓ designed to help you ace the exam.
✓ Anyone who needs clear, concise guidance to pass
,Table of Contents
WGU D444 OA Exam......................................................................... 2
D444 New OA Study Guide ............................................................. 38
WGU D444 OA Exam
QUESTION 1 | Multiple Choice
Which instruction should the nurse include in the discharge teaching plan for an
adult client with hypernatremia?
A. Review food labels for sodium content
B. Increase fluid intake to 3 liters per day
C. Weigh daily and report weight gains
D. Avoid potassium-rich foods
✓ CORRECT ANSWER: A
EXPERT RATIONALE: Hypernatremia is defined as a serum sodium level greater than 145
mEq/L. The condition most commonly results from inadequate fluid intake, excessive
sodium intake, or impaired thirst mechanisms. Teaching the client to review food labels for
sodium content (A) is essential for identifying hidden sodium in processed foods and
maintaining sodium restriction. While increasing fluid intake (B) may be appropriate in some
cases of hypernatremia caused by dehydration, it is not universally recommended without
provider guidance, especially in clients with cardiac or renal compromise. Daily weights (C)
are more relevant for fluid overload states such as heart failure. Avoiding potassium-rich
foods (D) is unrelated to sodium management and is not appropriate teaching for
hypernatremia.
QUESTION 2 | Multiple Choice
A client who is experiencing respiratory distress is admitted with respiratory
acidosis. Which pathophysiological process supports the client's respiratory
acidosis?
A. Excessive bicarbonate (HCO₃⁻) has been lost through the kidneys
,B. High levels of carbon dioxide have accumulated in the blood
C. The kidneys are retaining too much hydrogen ion
D. Hyperventilation has caused excessive CO₂ excretion
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Respiratory acidosis is defined as a pH less than 7.35 with an
elevated PaCO₂ greater than 45 mm Hg. The primary defect is alveolar hypoventilation,
which results in the retention of carbon dioxide (CO₂). CO₂ combines with water (H₂O) to
form carbonic acid (H₂CO₃), which dissociates into hydrogen ions (H⁺) and bicarbonate
(HCO₃⁻), thereby lowering the pH. Option A describes metabolic acidosis caused by
bicarbonate loss. Option C describes renal compensation mechanisms, not the primary
cause of respiratory acidosis. Option D describes respiratory alkalosis, which is the opposite
condition caused by excessive CO₂ elimination.
QUESTION 3 | Multiple Choice (Prioritization)
A client with multiple sclerosis (MS) fell while walking to the bathroom. Upon transfer
to the intensive care unit, the client is confused and has had projectile vomiting
twice. Which intervention should the nurse implement first?
A. Complete head-to-toe neurological assessment
B. Insert a nasogastric tube for gastric decompression
C. Administer an antiemetic medication
D. Obtain a CT scan of the head immediately
✓ CORRECT ANSWER: A
EXPERT RATIONALE: The client with MS who fell and now presents with confusion and
projectile vomiting is exhibiting signs consistent with increased intracranial pressure (ICP),
possibly due to a traumatic brain injury from the fall. According to nursing process
prioritization, the nurse must first complete a comprehensive head-to-toe neurological
assessment (A) to establish baseline data, identify the extent of neurological compromise,
and determine the urgency of subsequent interventions. While a CT scan (D) will likely be
needed, assessment must precede diagnostic testing. Inserting an NG tube (B) and
administering antiemetics (C) are interventions that may follow the initial assessment but
are not the first action. The neurological assessment provides critical data that guides all
subsequent care decisions.
QUESTION 4 | Multiple Choice
A client has been administered lactulose for several days. Which therapeutic
response should the nurse expect for a client with hepatic encephalopathy?
,A. Decreased serum ammonia levels
B. Improved mental status
C. Resolution of jaundice
D. Increased urine output
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Lactulose is a non-absorbable synthetic disaccharide used to treat
hepatic encephalopathy. It works by acidifying the colonic contents, which converts
ammonia (NH₃) to ammonium (NH₄⁺), a non-absorbable form that is excreted in the stool.
While decreased serum ammonia (A) is the underlying physiological mechanism, the
primary therapeutic response that the nurse monitors and expects is improved mental
status (B), as this directly reflects clinical improvement in the client's condition. Hepatic
encephalopathy manifests as confusion, asterixis, altered level of consciousness, and
potential progression to coma; therefore, mental status is the key outcome measure.
Lactulose does not resolve jaundice (C), which is related to bilirubin metabolism and liver
dysfunction. It does not increase urine output (D).
QUESTION 5 | Multiple Choice
Which approach is best for the nurse to use when directing a client with Huntington's
disease to the hospital cafeteria?
A. Provide written directions with a map
B. Escort the client to the cafeteria
C. Ask a family member to accompany the client
D. Give verbal directions using landmarks
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Huntington's disease is an autosomal dominant, progressive
neurodegenerative disorder characterized by chorea (involuntary movements), cognitive
decline, and psychiatric disturbances. Clients with Huntington's disease experience
significant difficulties with spatial orientation, memory retention, and motor coordination. The
safest and most effective approach is for the nurse to personally escort the client (B) to
ensure safe arrival, as the client may become disoriented, forget directions, or be unable to
navigate due to motor impairments. Written directions (A) may be difficult to follow due to
cognitive impairment and visual disturbances. Verbal directions (D) may be forgotten or
misunderstood. While family involvement (C) is supportive, the nurse retains professional
responsibility for ensuring the client's safe navigation within the healthcare facility.
QUESTION 6 | Multiple Choice
,A client who is newly diagnosed with erosive esophagitis secondary to
gastroesophageal reflux disease (GERD) reports to the home health nurse that there
has been only a minimal reduction in symptoms after taking lansoprazole PO for one
full week. Which action should the nurse take?
A. Contact the healthcare provider to request an endoscopy
B. Advise the client that healing typically takes several weeks to occur
C. Recommend increasing the lansoprazole dose to twice daily
D. Suggest adding an H2 receptor antagonist for better control
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Lansoprazole is a proton pump inhibitor (PPI) that irreversibly
inhibits the hydrogen-potassium ATPase enzyme in gastric parietal cells, thereby reducing
gastric acid secretion. While symptom relief may begin within a few days of initiating
therapy, complete healing of erosive esophagitis typically requires 8 to 12 weeks of
continuous, compliant therapy. The nurse should reassure the client (B) that minimal
improvement after one week is expected and that continued adherence to the prescribed
regimen is necessary for full mucosal healing. Contacting the provider for endoscopy (A) is
premature at this stage of treatment. The nurse cannot independently recommend dose
increases (C) or additional medications (D); these require healthcare provider evaluation
and prescription orders.
QUESTION 7 | Multiple Choice
A client with psoriasis returns to the clinic reporting the persistence of several
silvery, scaly areas on the elbows and palms that frequently burn and sometimes
bleed. Which prescription should the nurse teach the client to use for the skin
condition?
A. Topical corticosteroids
B. Oral antifungal agents
C. Topical antibiotic ointment
D. Systemic corticosteroids
✓ CORRECT ANSWER: A
EXPERT RATIONALE: Psoriasis is a chronic, immune-mediated inflammatory condition
characterized by rapid keratinocyte proliferation, resulting in thick, erythematous plaques
with silvery scales. Topical corticosteroids (A) are the first-line treatment for mild to
moderate plaque psoriasis because they reduce inflammation, suppress immune-mediated
skin cell proliferation, and relieve pruritus and discomfort. Oral antifungal agents (B) treat
,fungal infections (e.g., tinea, candidiasis) and have no efficacy against autoimmune skin
conditions. Topical antibiotics (C) are indicated for bacterial skin infections, not psoriasis.
Systemic corticosteroids (D) are reserved for severe, widespread, or erythrodermic
psoriasis due to significant adverse effects, including rebound flares upon discontinuation;
they are not first-line for localized plaques on elbows and palms.
QUESTION 8 | Multiple Choice
A client with open-angle glaucoma asks the nurse how long the prescribed eye drops
will need to be used. Which response made by the nurse is accurate?
A. Until intraocular pressure returns to normal, then they can be discontinued
B. For long-term control of normal eye pressure
C. Only during acute episodes of increased eye pressure
D. For 6 months, then the provider will reassess
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Open-angle glaucoma is a chronic, progressive optic neuropathy
characterized by elevated intraocular pressure (IOP) that causes irreversible damage to the
optic nerve and retinal ganglion cells. Glaucoma medications, including topical eye drops
(e.g., prostaglandin analogs, beta-blockers, alpha-agonists), are required for lifelong
management to maintain target IOP and prevent further vision loss. There is no cure for
glaucoma; treatment is aimed at preservation of remaining vision. Discontinuing medication
(A) would allow IOP to rise and cause progressive, irreversible optic nerve damage.
Glaucoma is not managed only during acute episodes (C); it requires continuous therapy.
While periodic reassessment (D) is appropriate, treatment is not time-limited to 6 months.
QUESTION 9 | Multiple Choice
A client with a history of asthma and bronchitis arrives at the clinic with shortness of
breath, productive cough with thickened, tenacious mucus, and the inability to walk
up a flight of stairs without experiencing breathlessness. Which action is most
important for the nurse to instruct the client about self-care?
A. Use a bronchodilator inhaler before any physical activity
B. Increase the daily intake of oral fluids to liquefy secretions
C. Perform pursed-lip breathing exercises every 2 hours
D. Sleep with the head of the bed elevated at 45 degrees
✓ CORRECT ANSWER: B
, EXPERT RATIONALE: The client presents with thickened, tenacious mucus and dyspnea
on exertion, indicating ineffective airway clearance due to viscous secretions that are
difficult to expectorate. Adequate hydration (B) is the cornerstone of self-management for
clients with chronic bronchitis and asthma, as sufficient fluid intake (typically 2-3 liters daily
unless contraindicated) thins mucus secretions, facilitating expectoration and improving
airway clearance. While bronchodilators (A) may help with bronchospasm, the primary issue
described is mucus viscosity, not bronchospasm. Pursed-lip breathing (C) improves gas
exchange and reduces dyspnea but does not address mucus viscosity. Elevating the head
of the bed (D) may facilitate breathing but does not liquefy secretions.
QUESTION 10 | Multiple Choice
A client is being cared for in the emergency department with acute abdominal pain
and a provisional diagnosis of pancreatitis. The nurse assesses the client and
obtains the results from laboratory studies. Which information is most valuable in
reporting the client's status to the healthcare provider?
A. Severity of nausea and vomiting and serum amylase results
B. Presence of jaundice and liver enzyme levels
C. Bowel sounds and white blood cell count
D. Urine output and blood urea nitrogen level
✓ CORRECT ANSWER: A
EXPERT RATIONALE: Acute pancreatitis is inflammation of the pancreas most commonly
caused by gallstones or alcohol use. The diagnosis is supported by elevated serum
amylase and lipase levels, typically three times the upper limit of normal. Serum amylase
rises within 6-12 hours of onset and is a key diagnostic indicator. Nausea and vomiting are
hallmark symptoms of pancreatitis that contribute to dehydration, electrolyte imbalances,
and hemodynamic instability; their severity indicates the extent of the inflammatory process
and guides fluid resuscitation needs. While liver enzymes (B) may be elevated in biliary
pancreatitis, they are not the primary diagnostic markers. Bowel sounds and WBC (C) are
supportive but less specific. Urine output and BUN (D) assess renal perfusion and hydration
status, which are important but secondary to establishing the pancreatic diagnosis.
QUESTION 11 | Multiple Choice (Prioritization)
The nurse is caring for a client with chronic obstructive pulmonary disease who
develops an onset of dyspnea and tachypnea with coughing. After positioning the
client upright, which action should the nurse take next?
A. Obtain a pulse oximetry reading
B. Administer a prescribed bronchodilator immediately
Adult Health 1
Objective Assessment
Exam Questions with Verified Answers
Pass the Exam with Confidence
This comprehensive resource includes:
✓ full version of the Objective Assessment Exam
✓ Each with Actual Exam Questions with Verified Answers
✓ designed to help you ace the exam.
✓ Anyone who needs clear, concise guidance to pass
,Table of Contents
WGU D444 OA Exam......................................................................... 2
D444 New OA Study Guide ............................................................. 38
WGU D444 OA Exam
QUESTION 1 | Multiple Choice
Which instruction should the nurse include in the discharge teaching plan for an
adult client with hypernatremia?
A. Review food labels for sodium content
B. Increase fluid intake to 3 liters per day
C. Weigh daily and report weight gains
D. Avoid potassium-rich foods
✓ CORRECT ANSWER: A
EXPERT RATIONALE: Hypernatremia is defined as a serum sodium level greater than 145
mEq/L. The condition most commonly results from inadequate fluid intake, excessive
sodium intake, or impaired thirst mechanisms. Teaching the client to review food labels for
sodium content (A) is essential for identifying hidden sodium in processed foods and
maintaining sodium restriction. While increasing fluid intake (B) may be appropriate in some
cases of hypernatremia caused by dehydration, it is not universally recommended without
provider guidance, especially in clients with cardiac or renal compromise. Daily weights (C)
are more relevant for fluid overload states such as heart failure. Avoiding potassium-rich
foods (D) is unrelated to sodium management and is not appropriate teaching for
hypernatremia.
QUESTION 2 | Multiple Choice
A client who is experiencing respiratory distress is admitted with respiratory
acidosis. Which pathophysiological process supports the client's respiratory
acidosis?
A. Excessive bicarbonate (HCO₃⁻) has been lost through the kidneys
,B. High levels of carbon dioxide have accumulated in the blood
C. The kidneys are retaining too much hydrogen ion
D. Hyperventilation has caused excessive CO₂ excretion
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Respiratory acidosis is defined as a pH less than 7.35 with an
elevated PaCO₂ greater than 45 mm Hg. The primary defect is alveolar hypoventilation,
which results in the retention of carbon dioxide (CO₂). CO₂ combines with water (H₂O) to
form carbonic acid (H₂CO₃), which dissociates into hydrogen ions (H⁺) and bicarbonate
(HCO₃⁻), thereby lowering the pH. Option A describes metabolic acidosis caused by
bicarbonate loss. Option C describes renal compensation mechanisms, not the primary
cause of respiratory acidosis. Option D describes respiratory alkalosis, which is the opposite
condition caused by excessive CO₂ elimination.
QUESTION 3 | Multiple Choice (Prioritization)
A client with multiple sclerosis (MS) fell while walking to the bathroom. Upon transfer
to the intensive care unit, the client is confused and has had projectile vomiting
twice. Which intervention should the nurse implement first?
A. Complete head-to-toe neurological assessment
B. Insert a nasogastric tube for gastric decompression
C. Administer an antiemetic medication
D. Obtain a CT scan of the head immediately
✓ CORRECT ANSWER: A
EXPERT RATIONALE: The client with MS who fell and now presents with confusion and
projectile vomiting is exhibiting signs consistent with increased intracranial pressure (ICP),
possibly due to a traumatic brain injury from the fall. According to nursing process
prioritization, the nurse must first complete a comprehensive head-to-toe neurological
assessment (A) to establish baseline data, identify the extent of neurological compromise,
and determine the urgency of subsequent interventions. While a CT scan (D) will likely be
needed, assessment must precede diagnostic testing. Inserting an NG tube (B) and
administering antiemetics (C) are interventions that may follow the initial assessment but
are not the first action. The neurological assessment provides critical data that guides all
subsequent care decisions.
QUESTION 4 | Multiple Choice
A client has been administered lactulose for several days. Which therapeutic
response should the nurse expect for a client with hepatic encephalopathy?
,A. Decreased serum ammonia levels
B. Improved mental status
C. Resolution of jaundice
D. Increased urine output
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Lactulose is a non-absorbable synthetic disaccharide used to treat
hepatic encephalopathy. It works by acidifying the colonic contents, which converts
ammonia (NH₃) to ammonium (NH₄⁺), a non-absorbable form that is excreted in the stool.
While decreased serum ammonia (A) is the underlying physiological mechanism, the
primary therapeutic response that the nurse monitors and expects is improved mental
status (B), as this directly reflects clinical improvement in the client's condition. Hepatic
encephalopathy manifests as confusion, asterixis, altered level of consciousness, and
potential progression to coma; therefore, mental status is the key outcome measure.
Lactulose does not resolve jaundice (C), which is related to bilirubin metabolism and liver
dysfunction. It does not increase urine output (D).
QUESTION 5 | Multiple Choice
Which approach is best for the nurse to use when directing a client with Huntington's
disease to the hospital cafeteria?
A. Provide written directions with a map
B. Escort the client to the cafeteria
C. Ask a family member to accompany the client
D. Give verbal directions using landmarks
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Huntington's disease is an autosomal dominant, progressive
neurodegenerative disorder characterized by chorea (involuntary movements), cognitive
decline, and psychiatric disturbances. Clients with Huntington's disease experience
significant difficulties with spatial orientation, memory retention, and motor coordination. The
safest and most effective approach is for the nurse to personally escort the client (B) to
ensure safe arrival, as the client may become disoriented, forget directions, or be unable to
navigate due to motor impairments. Written directions (A) may be difficult to follow due to
cognitive impairment and visual disturbances. Verbal directions (D) may be forgotten or
misunderstood. While family involvement (C) is supportive, the nurse retains professional
responsibility for ensuring the client's safe navigation within the healthcare facility.
QUESTION 6 | Multiple Choice
,A client who is newly diagnosed with erosive esophagitis secondary to
gastroesophageal reflux disease (GERD) reports to the home health nurse that there
has been only a minimal reduction in symptoms after taking lansoprazole PO for one
full week. Which action should the nurse take?
A. Contact the healthcare provider to request an endoscopy
B. Advise the client that healing typically takes several weeks to occur
C. Recommend increasing the lansoprazole dose to twice daily
D. Suggest adding an H2 receptor antagonist for better control
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Lansoprazole is a proton pump inhibitor (PPI) that irreversibly
inhibits the hydrogen-potassium ATPase enzyme in gastric parietal cells, thereby reducing
gastric acid secretion. While symptom relief may begin within a few days of initiating
therapy, complete healing of erosive esophagitis typically requires 8 to 12 weeks of
continuous, compliant therapy. The nurse should reassure the client (B) that minimal
improvement after one week is expected and that continued adherence to the prescribed
regimen is necessary for full mucosal healing. Contacting the provider for endoscopy (A) is
premature at this stage of treatment. The nurse cannot independently recommend dose
increases (C) or additional medications (D); these require healthcare provider evaluation
and prescription orders.
QUESTION 7 | Multiple Choice
A client with psoriasis returns to the clinic reporting the persistence of several
silvery, scaly areas on the elbows and palms that frequently burn and sometimes
bleed. Which prescription should the nurse teach the client to use for the skin
condition?
A. Topical corticosteroids
B. Oral antifungal agents
C. Topical antibiotic ointment
D. Systemic corticosteroids
✓ CORRECT ANSWER: A
EXPERT RATIONALE: Psoriasis is a chronic, immune-mediated inflammatory condition
characterized by rapid keratinocyte proliferation, resulting in thick, erythematous plaques
with silvery scales. Topical corticosteroids (A) are the first-line treatment for mild to
moderate plaque psoriasis because they reduce inflammation, suppress immune-mediated
skin cell proliferation, and relieve pruritus and discomfort. Oral antifungal agents (B) treat
,fungal infections (e.g., tinea, candidiasis) and have no efficacy against autoimmune skin
conditions. Topical antibiotics (C) are indicated for bacterial skin infections, not psoriasis.
Systemic corticosteroids (D) are reserved for severe, widespread, or erythrodermic
psoriasis due to significant adverse effects, including rebound flares upon discontinuation;
they are not first-line for localized plaques on elbows and palms.
QUESTION 8 | Multiple Choice
A client with open-angle glaucoma asks the nurse how long the prescribed eye drops
will need to be used. Which response made by the nurse is accurate?
A. Until intraocular pressure returns to normal, then they can be discontinued
B. For long-term control of normal eye pressure
C. Only during acute episodes of increased eye pressure
D. For 6 months, then the provider will reassess
✓ CORRECT ANSWER: B
EXPERT RATIONALE: Open-angle glaucoma is a chronic, progressive optic neuropathy
characterized by elevated intraocular pressure (IOP) that causes irreversible damage to the
optic nerve and retinal ganglion cells. Glaucoma medications, including topical eye drops
(e.g., prostaglandin analogs, beta-blockers, alpha-agonists), are required for lifelong
management to maintain target IOP and prevent further vision loss. There is no cure for
glaucoma; treatment is aimed at preservation of remaining vision. Discontinuing medication
(A) would allow IOP to rise and cause progressive, irreversible optic nerve damage.
Glaucoma is not managed only during acute episodes (C); it requires continuous therapy.
While periodic reassessment (D) is appropriate, treatment is not time-limited to 6 months.
QUESTION 9 | Multiple Choice
A client with a history of asthma and bronchitis arrives at the clinic with shortness of
breath, productive cough with thickened, tenacious mucus, and the inability to walk
up a flight of stairs without experiencing breathlessness. Which action is most
important for the nurse to instruct the client about self-care?
A. Use a bronchodilator inhaler before any physical activity
B. Increase the daily intake of oral fluids to liquefy secretions
C. Perform pursed-lip breathing exercises every 2 hours
D. Sleep with the head of the bed elevated at 45 degrees
✓ CORRECT ANSWER: B
, EXPERT RATIONALE: The client presents with thickened, tenacious mucus and dyspnea
on exertion, indicating ineffective airway clearance due to viscous secretions that are
difficult to expectorate. Adequate hydration (B) is the cornerstone of self-management for
clients with chronic bronchitis and asthma, as sufficient fluid intake (typically 2-3 liters daily
unless contraindicated) thins mucus secretions, facilitating expectoration and improving
airway clearance. While bronchodilators (A) may help with bronchospasm, the primary issue
described is mucus viscosity, not bronchospasm. Pursed-lip breathing (C) improves gas
exchange and reduces dyspnea but does not address mucus viscosity. Elevating the head
of the bed (D) may facilitate breathing but does not liquefy secretions.
QUESTION 10 | Multiple Choice
A client is being cared for in the emergency department with acute abdominal pain
and a provisional diagnosis of pancreatitis. The nurse assesses the client and
obtains the results from laboratory studies. Which information is most valuable in
reporting the client's status to the healthcare provider?
A. Severity of nausea and vomiting and serum amylase results
B. Presence of jaundice and liver enzyme levels
C. Bowel sounds and white blood cell count
D. Urine output and blood urea nitrogen level
✓ CORRECT ANSWER: A
EXPERT RATIONALE: Acute pancreatitis is inflammation of the pancreas most commonly
caused by gallstones or alcohol use. The diagnosis is supported by elevated serum
amylase and lipase levels, typically three times the upper limit of normal. Serum amylase
rises within 6-12 hours of onset and is a key diagnostic indicator. Nausea and vomiting are
hallmark symptoms of pancreatitis that contribute to dehydration, electrolyte imbalances,
and hemodynamic instability; their severity indicates the extent of the inflammatory process
and guides fluid resuscitation needs. While liver enzymes (B) may be elevated in biliary
pancreatitis, they are not the primary diagnostic markers. Bowel sounds and WBC (C) are
supportive but less specific. Urine output and BUN (D) assess renal perfusion and hydration
status, which are important but secondary to establishing the pancreatic diagnosis.
QUESTION 11 | Multiple Choice (Prioritization)
The nurse is caring for a client with chronic obstructive pulmonary disease who
develops an onset of dyspnea and tachypnea with coughing. After positioning the
client upright, which action should the nurse take next?
A. Obtain a pulse oximetry reading
B. Administer a prescribed bronchodilator immediately
