WGU D446 OBJECTIVE ASSESSMENT FINAL – 110
PRACTICE QUESTIONS Advanced Pathophysiology,
Pharmacotherapeutics, Critical Care, & Clinical
Judgment | 2025 Edition | Verified Answers with
Complete Rationales
Question 1: A nurse is caring for a client with septic shock who has a central
venous pressure (CVP) of 2 mm Hg, heart rate 118/min, blood pressure 84/50
mm Hg, and urine output 10 mL/hr. The healthcare provider orders a fluid
challenge with 0.9% sodium chloride over 30 minutes. Which finding
indicates the fluid challenge is achieving the desired therapeutic effect?
A) CVP increases to 8 mm Hg with an increase in blood pressure to 110/70
mm Hg
B) CVP remains at 2 mm Hg and heart rate increases to 130/min
C) Urine output decreases to 5 mL/hr and blood pressure drops to 80/42 mm
Hg
D) CVP increases to 12 mm Hg with crackles in the lung bases
Answer: A) CVP increases to 8 mm Hg with an increase in blood pressure
to 110/70 mm Hg
Rationale: In fluid-responsive septic shock, a fluid challenge should
demonstrate a rise in CVP (from 2 to 8 mm Hg, still within acceptable range)
and a corresponding improvement in cardiac output, reflected in increased
blood pressure. A CVP of 2 mm Hg indicates hypovolemia and the need for
fluid resuscitation. An unchanged or decreased blood pressure indicates the
patient is not responding appropriately, and a CVP rising to 12 mm Hg with
crackles suggests fluid overload and pulmonary edema. A drop in urine output
further indicates inadequate fluid replacement. The positive response is
improved hemodynamics without signs of volume overload.
Question 2: A client with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 6 mL/kg ideal body weight,
,PEEP 10 cm H₂O, and FiO₂ 0.60. Arterial blood gas shows pH 7.32, PaCO₂ 55
mm Hg, HCO₃⁻ 24 mEq/L. What intervention should the nurse anticipate?
A) Increase FiO₂ to 1.0 and decrease PEEP to 5 cm H₂O
B) Increase PEEP to 14 cm H₂O and consider permissive hypercapnia
C) Decrease tidal volume to 4 mL/kg ideal body weight
D) Administer sodium bicarbonate to correct the pH
Answer: B) Increase PEEP to 14 cm H₂O and consider permissive
hypercapnia
Rationale: The ABG shows respiratory acidosis (pH 7.32, PaCO₂ 55) with
normal HCO₃⁻, indicating acute respiratory acidosis. In ARDS, the lung-
protective strategy includes low tidal volume (6 mL/kg ideal body weight)
and permissive hypercapnia to minimize ventilator-induced lung injury. The
PEEP should be optimized to improve oxygenation and prevent alveolar
collapse. Increasing PEEP to 14 cm H₂O may improve oxygenation without
significantly compromising cardiac output. Permissive hypercapnia is
acceptable as long as pH remains above 7.20-7.25. Sodium bicarbonate is not
indicated for respiratory acidosis.
Question 3: A client with acute pancreatitis has a serum calcium level of 7.2
mg/dL (normal: 8.5-10.2 mg/dL). Which pathophysiological mechanism best
explains this finding?
A) Increased calcium excretion due to renal failure
B) Saponification of calcium with necrotic fat in the abdominal cavity
C) Decreased calcium absorption due to malabsorption
D) Increased calcitonin secretion from pancreatic inflammation
Answer: B) Saponification of calcium with necrotic fat in the abdominal
cavity
Rationale: Hypocalcemia in acute pancreatitis is caused by the saponification
(binding) of calcium with free fatty acids released from necrotic fat in the
abdominal cavity. This process consumes calcium, leading to decreased serum
calcium levels. This is a hallmark of severe acute pancreatitis and can be a
poor prognostic indicator. Renal failure, malabsorption, and calcitonin are not
the primary mechanisms.
,Question 4: A client with cirrhosis develops ascites and spontaneous
bacterial peritonitis (SBP). The nurse should monitor for which complication?
A) Hepatic encephalopathy
B) Hepatorenal syndrome
C) Esophageal varices
D) Portal vein thrombosis
Answer: B) Hepatorenal syndrome
Rationale: Spontaneous bacterial peritonitis (SBP) is a serious complication
of cirrhosis with ascites that can precipitate hepatorenal syndrome, a form of
functional renal failure caused by intense renal vasoconstriction. SBP leads to
systemic inflammation and worsening portal hypertension, which reduces
renal perfusion. Early recognition and treatment of SBP are essential to
prevent hepatorenal syndrome.
Question 5: A client with chronic kidney disease (CKD) stage 4 has a serum
potassium of 6.2 mEq/L, calcium of 7.8 mg/dL, and phosphorus of 6.5 mg/dL.
Which medication should the nurse anticipate administering?
A) Calcium carbonate
B) Sodium polystyrene sulfonate (Kayexalate)
C) Calcitriol
D) Ferrous sulfate
Answer: B) Sodium polystyrene sulfonate (Kayexalate)
Rationale: Hyperkalemia (K⁺ > 5.5 mEq/L) in CKD is a medical emergency
that requires immediate intervention. Sodium polystyrene sulfonate binds
potassium in the gastrointestinal tract and promotes its excretion. While
calcium carbonate is used to bind phosphorus and calcitriol is used to treat
secondary hyperparathyroidism, the immediate priority is lowering the
dangerously elevated potassium level to prevent cardiac arrhythmias.
, Question 6: A client with heart failure is receiving furosemide. The nurse
notes that the client's serum potassium is 3.1 mEq/L. Which of the following is
the most appropriate intervention?
A) Continue the furosemide as ordered
B) Hold the furosemide and notify the healthcare provider
C) Increase the furosemide dose
D) Administer a potassium-sparing diuretic
Answer: B) Hold the furosemide and notify the healthcare provider
Rationale: Serum potassium of 3.1 mEq/L indicates hypokalemia, which is a
side effect of loop diuretics like furosemide. Hypokalemia can predispose the
client to cardiac arrhythmias, especially if the client is also on digoxin. The
nurse should hold the furosemide, notify the healthcare provider, and
anticipate potassium replacement therapy.
Question 7: A client with type 1 diabetes mellitus is admitted with diabetic
ketoacidosis (DKA). The client's blood glucose is 520 mg/dL, serum
bicarbonate is 12 mEq/L, and pH is 7.15. Which of the following interventions
should the nurse anticipate first?
A) Administer 50% dextrose IV push
B) Initiate insulin therapy with regular insulin IV
C) Administer sodium bicarbonate IV
D) Initiate NPH insulin subcutaneously
Answer: B) Initiate insulin therapy with regular insulin IV
Rationale: The priority intervention in DKA is to initiate insulin therapy to
reverse ketosis and lower blood glucose. Regular insulin is given
intravenously to allow for rapid and titratable response. Insulin also corrects
acidosis by reducing ketone production and shifting potassium back into cells.
Sodium bicarbonate is rarely indicated unless pH is < 6.9. Dextrose is given
only when blood glucose falls below 250 mg/dL.
PRACTICE QUESTIONS Advanced Pathophysiology,
Pharmacotherapeutics, Critical Care, & Clinical
Judgment | 2025 Edition | Verified Answers with
Complete Rationales
Question 1: A nurse is caring for a client with septic shock who has a central
venous pressure (CVP) of 2 mm Hg, heart rate 118/min, blood pressure 84/50
mm Hg, and urine output 10 mL/hr. The healthcare provider orders a fluid
challenge with 0.9% sodium chloride over 30 minutes. Which finding
indicates the fluid challenge is achieving the desired therapeutic effect?
A) CVP increases to 8 mm Hg with an increase in blood pressure to 110/70
mm Hg
B) CVP remains at 2 mm Hg and heart rate increases to 130/min
C) Urine output decreases to 5 mL/hr and blood pressure drops to 80/42 mm
Hg
D) CVP increases to 12 mm Hg with crackles in the lung bases
Answer: A) CVP increases to 8 mm Hg with an increase in blood pressure
to 110/70 mm Hg
Rationale: In fluid-responsive septic shock, a fluid challenge should
demonstrate a rise in CVP (from 2 to 8 mm Hg, still within acceptable range)
and a corresponding improvement in cardiac output, reflected in increased
blood pressure. A CVP of 2 mm Hg indicates hypovolemia and the need for
fluid resuscitation. An unchanged or decreased blood pressure indicates the
patient is not responding appropriately, and a CVP rising to 12 mm Hg with
crackles suggests fluid overload and pulmonary edema. A drop in urine output
further indicates inadequate fluid replacement. The positive response is
improved hemodynamics without signs of volume overload.
Question 2: A client with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 6 mL/kg ideal body weight,
,PEEP 10 cm H₂O, and FiO₂ 0.60. Arterial blood gas shows pH 7.32, PaCO₂ 55
mm Hg, HCO₃⁻ 24 mEq/L. What intervention should the nurse anticipate?
A) Increase FiO₂ to 1.0 and decrease PEEP to 5 cm H₂O
B) Increase PEEP to 14 cm H₂O and consider permissive hypercapnia
C) Decrease tidal volume to 4 mL/kg ideal body weight
D) Administer sodium bicarbonate to correct the pH
Answer: B) Increase PEEP to 14 cm H₂O and consider permissive
hypercapnia
Rationale: The ABG shows respiratory acidosis (pH 7.32, PaCO₂ 55) with
normal HCO₃⁻, indicating acute respiratory acidosis. In ARDS, the lung-
protective strategy includes low tidal volume (6 mL/kg ideal body weight)
and permissive hypercapnia to minimize ventilator-induced lung injury. The
PEEP should be optimized to improve oxygenation and prevent alveolar
collapse. Increasing PEEP to 14 cm H₂O may improve oxygenation without
significantly compromising cardiac output. Permissive hypercapnia is
acceptable as long as pH remains above 7.20-7.25. Sodium bicarbonate is not
indicated for respiratory acidosis.
Question 3: A client with acute pancreatitis has a serum calcium level of 7.2
mg/dL (normal: 8.5-10.2 mg/dL). Which pathophysiological mechanism best
explains this finding?
A) Increased calcium excretion due to renal failure
B) Saponification of calcium with necrotic fat in the abdominal cavity
C) Decreased calcium absorption due to malabsorption
D) Increased calcitonin secretion from pancreatic inflammation
Answer: B) Saponification of calcium with necrotic fat in the abdominal
cavity
Rationale: Hypocalcemia in acute pancreatitis is caused by the saponification
(binding) of calcium with free fatty acids released from necrotic fat in the
abdominal cavity. This process consumes calcium, leading to decreased serum
calcium levels. This is a hallmark of severe acute pancreatitis and can be a
poor prognostic indicator. Renal failure, malabsorption, and calcitonin are not
the primary mechanisms.
,Question 4: A client with cirrhosis develops ascites and spontaneous
bacterial peritonitis (SBP). The nurse should monitor for which complication?
A) Hepatic encephalopathy
B) Hepatorenal syndrome
C) Esophageal varices
D) Portal vein thrombosis
Answer: B) Hepatorenal syndrome
Rationale: Spontaneous bacterial peritonitis (SBP) is a serious complication
of cirrhosis with ascites that can precipitate hepatorenal syndrome, a form of
functional renal failure caused by intense renal vasoconstriction. SBP leads to
systemic inflammation and worsening portal hypertension, which reduces
renal perfusion. Early recognition and treatment of SBP are essential to
prevent hepatorenal syndrome.
Question 5: A client with chronic kidney disease (CKD) stage 4 has a serum
potassium of 6.2 mEq/L, calcium of 7.8 mg/dL, and phosphorus of 6.5 mg/dL.
Which medication should the nurse anticipate administering?
A) Calcium carbonate
B) Sodium polystyrene sulfonate (Kayexalate)
C) Calcitriol
D) Ferrous sulfate
Answer: B) Sodium polystyrene sulfonate (Kayexalate)
Rationale: Hyperkalemia (K⁺ > 5.5 mEq/L) in CKD is a medical emergency
that requires immediate intervention. Sodium polystyrene sulfonate binds
potassium in the gastrointestinal tract and promotes its excretion. While
calcium carbonate is used to bind phosphorus and calcitriol is used to treat
secondary hyperparathyroidism, the immediate priority is lowering the
dangerously elevated potassium level to prevent cardiac arrhythmias.
, Question 6: A client with heart failure is receiving furosemide. The nurse
notes that the client's serum potassium is 3.1 mEq/L. Which of the following is
the most appropriate intervention?
A) Continue the furosemide as ordered
B) Hold the furosemide and notify the healthcare provider
C) Increase the furosemide dose
D) Administer a potassium-sparing diuretic
Answer: B) Hold the furosemide and notify the healthcare provider
Rationale: Serum potassium of 3.1 mEq/L indicates hypokalemia, which is a
side effect of loop diuretics like furosemide. Hypokalemia can predispose the
client to cardiac arrhythmias, especially if the client is also on digoxin. The
nurse should hold the furosemide, notify the healthcare provider, and
anticipate potassium replacement therapy.
Question 7: A client with type 1 diabetes mellitus is admitted with diabetic
ketoacidosis (DKA). The client's blood glucose is 520 mg/dL, serum
bicarbonate is 12 mEq/L, and pH is 7.15. Which of the following interventions
should the nurse anticipate first?
A) Administer 50% dextrose IV push
B) Initiate insulin therapy with regular insulin IV
C) Administer sodium bicarbonate IV
D) Initiate NPH insulin subcutaneously
Answer: B) Initiate insulin therapy with regular insulin IV
Rationale: The priority intervention in DKA is to initiate insulin therapy to
reverse ketosis and lower blood glucose. Regular insulin is given
intravenously to allow for rapid and titratable response. Insulin also corrects
acidosis by reducing ketone production and shifting potassium back into cells.
Sodium bicarbonate is rarely indicated unless pH is < 6.9. Dextrose is given
only when blood glucose falls below 250 mg/dL.
