WGU D446 Adult Health 2 Final OA Practice Exam 2026 | Complete Objective
Assessment Study Guide with Verified Questions & Answers | Comprehensive Adult
Health Nursing Review for WGU Students | Med-Surg Concepts, Clinical Judgment,
Pharmacology & Patient Care Prep | 2026
Question 1: A patient is admitted with community-acquired pneumonia (CAP). What
underlying pathophysiological process is primarily responsible for the patient's
hypoxemia?
A. Bronchospasm and air trapping
B. Inflammation and fluid leakage into the alveoli
C. Destruction of the alveolar walls
D. Mucus plugging of the upper airways
Correct Answer: B
Rationale: In CAP, the inflammatory response increases vascular permeability,
causing fluid, protein, and cells to leak from capillaries into the alveoli. This fluid-
filled alveoli cannot participate in gas exchange, leading to V/Q mismatch and
hypoxemia. (A) is typical of asthma; (C) is seen in emphysema; (D) is not the
primary cause of hypoxemia in CAP .
Question 2: A nurse is assessing a patient during an acute asthma exacerbation. Which
finding requires immediate intervention?
A. Expiratory wheezing in all lung fields
B. A silent chest on auscultation
C. A productive cough with clear sputum
D. A respiratory rate of 24 breaths/minute
,Correct Answer: B
Rationale: A "silent chest" indicates severe bronchospasm and such limited
airflow that wheezing is no longer audible. This is a sign of impending respiratory
failure and requires immediate intervention, such as high-dose bronchodilators
and potentially intubation. (A) indicates airflow obstruction but is not as critical
as a silent chest; (C) is expected; (D) indicates respiratory distress but is not the
most critical finding .
Question 3: A patient with severe COPD has an SpO2 of 86% on room air. You initiate
supplemental oxygen. What is the target SpO2 range for this patient to balance
oxygenation and ventilation?
A. 90% to 92%
B. 94% to 96%
C. 88% to 92%
D. 100%
Correct Answer: C
Rationale: For patients with chronic hypercapnic respiratory failure (common in
severe COPD), the goal is to maintain adequate tissue oxygenation (SpO2 >88%)
while avoiding knocking out their hypoxic drive, which can lead to worsened
hypercapnia and acidosis. (A & B) are standard targets but may be too high for a
CO2 retainer; (D) is unnecessary and dangerous .
Question 4: A patient with COPD asks what kind of diet they should follow. Which
response by the nurse is most appropriate?
A. "You should eat three large meals per day to maintain energy."
B. "A low-fat, low-calorie diet is best for weight management."
,C. "High-protein, high-calorie small meals help maintain energy without causing
shortness of breath."
D. "Clear liquids only during exacerbations."
Correct Answer: C
Rationale: COPD patients have increased metabolic demand. Small, frequent
high-protein, high-calorie meals prevent early satiety and reduce the work of
breathing associated with large meals. (A) can cause early satiety and increase
dyspnea; (B) is not appropriate as they need more calories; (D) is not sufficient
for nutrition .
Question 5: The nurse is assessing a patient with suspected tuberculosis. Which classic
signs and symptoms should the nurse expect to find? (Select all that apply)
A. Night sweats
B. Weight gain
C. Blood-tinged sputum
D. Persistent productive cough
Correct Answer: A, C, D
Rationale: Classic TB symptoms include night sweats, hemoptysis (blood-tinged
sputum), persistent cough, unintentional weight loss (not gain), and low-grade
fever. (B) is incorrect as weight loss, not gain, is a classic sign .
Question 6: A patient with a history of COPD is receiving oxygen via nasal cannula at 2
L/min. The nurse notes the patient is becoming confused and lethargic. What is the
nurse's priority action?
A. Increase oxygen to 4 L/min
B. Assess the patient's SpO2 and ABGs
, C. Suction the patient's airway
D. Prepare for intubation immediately
Correct Answer: B
Rationale: COPD patients may retain CO2. Excessive oxygen can suppress their
hypoxic drive, leading to hypercapnia and altered mental status. Assessment of
SpO2 and ABGs guides appropriate adjustments. (A) would likely worsen the
problem; (C & D) may be needed but are not the priority without further
assessment .
Question 7: A patient with pneumonia has an oxygen saturation of 89% on room air. The
nurse applies oxygen at 2 L/min via nasal cannula. What is the primary goal of this
intervention?
A. Maintain SpO2 >95%
B. Maintain SpO2 88-92% for COPD patients
C. Maintain SpO2 >90% for most patients
D. Achieve PaO2 >100 mm Hg
Correct Answer: C
Rationale: For most patients with pneumonia, the goal is SpO2 >90% to ensure
adequate tissue oxygenation. Over-oxygenation is generally not harmful in non-
COPD patients but is unnecessary. (A) is a reasonable goal but ">90%" is the
minimum standard; (B) is for COPD; (D) is excessive .
Question 8: A patient with asthma is receiving albuterol via nebulizer. How does the
nurse evaluate therapeutic response?
A. Increased heart rate and blood pressure
B. Decreased wheezing and improved peak flow
Assessment Study Guide with Verified Questions & Answers | Comprehensive Adult
Health Nursing Review for WGU Students | Med-Surg Concepts, Clinical Judgment,
Pharmacology & Patient Care Prep | 2026
Question 1: A patient is admitted with community-acquired pneumonia (CAP). What
underlying pathophysiological process is primarily responsible for the patient's
hypoxemia?
A. Bronchospasm and air trapping
B. Inflammation and fluid leakage into the alveoli
C. Destruction of the alveolar walls
D. Mucus plugging of the upper airways
Correct Answer: B
Rationale: In CAP, the inflammatory response increases vascular permeability,
causing fluid, protein, and cells to leak from capillaries into the alveoli. This fluid-
filled alveoli cannot participate in gas exchange, leading to V/Q mismatch and
hypoxemia. (A) is typical of asthma; (C) is seen in emphysema; (D) is not the
primary cause of hypoxemia in CAP .
Question 2: A nurse is assessing a patient during an acute asthma exacerbation. Which
finding requires immediate intervention?
A. Expiratory wheezing in all lung fields
B. A silent chest on auscultation
C. A productive cough with clear sputum
D. A respiratory rate of 24 breaths/minute
,Correct Answer: B
Rationale: A "silent chest" indicates severe bronchospasm and such limited
airflow that wheezing is no longer audible. This is a sign of impending respiratory
failure and requires immediate intervention, such as high-dose bronchodilators
and potentially intubation. (A) indicates airflow obstruction but is not as critical
as a silent chest; (C) is expected; (D) indicates respiratory distress but is not the
most critical finding .
Question 3: A patient with severe COPD has an SpO2 of 86% on room air. You initiate
supplemental oxygen. What is the target SpO2 range for this patient to balance
oxygenation and ventilation?
A. 90% to 92%
B. 94% to 96%
C. 88% to 92%
D. 100%
Correct Answer: C
Rationale: For patients with chronic hypercapnic respiratory failure (common in
severe COPD), the goal is to maintain adequate tissue oxygenation (SpO2 >88%)
while avoiding knocking out their hypoxic drive, which can lead to worsened
hypercapnia and acidosis. (A & B) are standard targets but may be too high for a
CO2 retainer; (D) is unnecessary and dangerous .
Question 4: A patient with COPD asks what kind of diet they should follow. Which
response by the nurse is most appropriate?
A. "You should eat three large meals per day to maintain energy."
B. "A low-fat, low-calorie diet is best for weight management."
,C. "High-protein, high-calorie small meals help maintain energy without causing
shortness of breath."
D. "Clear liquids only during exacerbations."
Correct Answer: C
Rationale: COPD patients have increased metabolic demand. Small, frequent
high-protein, high-calorie meals prevent early satiety and reduce the work of
breathing associated with large meals. (A) can cause early satiety and increase
dyspnea; (B) is not appropriate as they need more calories; (D) is not sufficient
for nutrition .
Question 5: The nurse is assessing a patient with suspected tuberculosis. Which classic
signs and symptoms should the nurse expect to find? (Select all that apply)
A. Night sweats
B. Weight gain
C. Blood-tinged sputum
D. Persistent productive cough
Correct Answer: A, C, D
Rationale: Classic TB symptoms include night sweats, hemoptysis (blood-tinged
sputum), persistent cough, unintentional weight loss (not gain), and low-grade
fever. (B) is incorrect as weight loss, not gain, is a classic sign .
Question 6: A patient with a history of COPD is receiving oxygen via nasal cannula at 2
L/min. The nurse notes the patient is becoming confused and lethargic. What is the
nurse's priority action?
A. Increase oxygen to 4 L/min
B. Assess the patient's SpO2 and ABGs
, C. Suction the patient's airway
D. Prepare for intubation immediately
Correct Answer: B
Rationale: COPD patients may retain CO2. Excessive oxygen can suppress their
hypoxic drive, leading to hypercapnia and altered mental status. Assessment of
SpO2 and ABGs guides appropriate adjustments. (A) would likely worsen the
problem; (C & D) may be needed but are not the priority without further
assessment .
Question 7: A patient with pneumonia has an oxygen saturation of 89% on room air. The
nurse applies oxygen at 2 L/min via nasal cannula. What is the primary goal of this
intervention?
A. Maintain SpO2 >95%
B. Maintain SpO2 88-92% for COPD patients
C. Maintain SpO2 >90% for most patients
D. Achieve PaO2 >100 mm Hg
Correct Answer: C
Rationale: For most patients with pneumonia, the goal is SpO2 >90% to ensure
adequate tissue oxygenation. Over-oxygenation is generally not harmful in non-
COPD patients but is unnecessary. (A) is a reasonable goal but ">90%" is the
minimum standard; (B) is for COPD; (D) is excessive .
Question 8: A patient with asthma is receiving albuterol via nebulizer. How does the
nurse evaluate therapeutic response?
A. Increased heart rate and blood pressure
B. Decreased wheezing and improved peak flow
