WGU D454 Adult Health III Objective Assessment (OA V1 and V2 ) | Full
Questions and Answers | 2026/27 Update | 100% Correct.
Question 1
A nurse is assessing a patient admitted with septic shock. The patient has received 30 mL/kg of
isotonic crystalloid fluid. Current findings include:
Blood pressure: 82/46 mm Hg
MAP: 58 mm Hg
Heart rate: 126/min
Urine output: 15 mL/hr
Lactate: 4.6 mmol/L
Which prescription should the nurse anticipate next?
A. IV furosemide
B. Norepinephrine infusion
C. Oral metoprolol
D. Fluid restriction
Correct answer: B. Norepinephrine infusion
Rationale: Persistent hypotension and a MAP below 65 mm Hg after adequate fluid
resuscitation indicate the need for a vasopressor. Norepinephrine is generally the first-line
vasopressor for septic shock because it produces vasoconstriction and improves systemic blood
pressure and organ perfusion.
A: Furosemide could worsen hypotension and tissue hypoperfusion.
C: Metoprolol would reduce heart rate and blood pressure and is inappropriate during
unstable shock.
D: Fluid restriction does not correct septic vasodilation and impaired perfusion.
Question 2
A patient with an acute myocardial infarction suddenly develops severe dyspnea, crackles
throughout both lungs, and pink frothy sputum. Which action should the nurse take first?
A. Place the patient in high-Fowler position and apply oxygen
B. Encourage oral fluid intake
C. Position the patient flat with the legs elevated
D. Obtain a routine daily weight
,Correct answer: A. Place the patient in high-Fowler position and apply oxygen
Rationale: These findings indicate acute pulmonary edema caused by left ventricular failure.
Using the ABC framework, the nurse must first improve oxygenation. High-Fowler positioning
decreases venous return and promotes lung expansion, while supplemental oxygen treats
hypoxemia.
B: Additional fluids may worsen pulmonary congestion.
C: A flat position increases venous return and can worsen pulmonary edema.
D: Daily weights are useful for monitoring fluid status but do not address the immediate
respiratory emergency.
Question 3
A nurse is caring for a patient with an arterial line. Which finding requires immediate
intervention?
A. The pressure bag is maintained at 300 mm Hg
B. The waveform becomes flattened, and the fingers are cool and pale
C. The transducer is leveled at the phlebostatic axis
D. The arterial-line site is covered with a transparent dressing
Correct answer: B. The waveform becomes flattened, and the fingers are cool and pale
Rationale: A flattened waveform accompanied by cool, pale fingers suggests impaired arterial
circulation, possibly caused by catheter obstruction, vasospasm, thrombosis, or compromised
distal perfusion. The nurse should immediately assess circulation and follow the facility protocol.
A: A pressure bag is commonly maintained at approximately 300 mm Hg.
C: The phlebostatic axis is the correct reference level for hemodynamic monitoring.
D: A transparent dressing permits visualization of the insertion site.
Question 4
A mechanically ventilated patient triggers a high-pressure alarm. Which assessment should the
nurse perform first?
A. Check for tubing disconnection
B. Assess for secretions, biting, or a kinked tube
C. Increase the ventilator’s tidal volume
D. Silence the alarm and reassess in 15 minutes
,Correct answer: B. Assess for secretions, biting, or a kinked tube
Rationale: A high-pressure alarm indicates increased resistance to airflow. Common causes
include accumulated secretions, bronchospasm, coughing, biting the tube, decreased lung
compliance, and kinked tubing. The patient must be assessed immediately.
A: A disconnection usually activates a low-pressure alarm.
C: Increasing tidal volume can worsen pressure and lung injury.
D: Alarms should never be silenced without determining their cause.
Question 5
A patient with diabetic ketoacidosis has the following laboratory findings:
Glucose: 620 mg/dL
Potassium: 5.8 mEq/L
Arterial pH: 7.19
Bicarbonate: 12 mEq/L
Which intervention should the nurse expect to implement first?
A. Administer IV regular insulin immediately before fluids
B. Begin rapid infusion of isotonic IV fluid
C. Administer oral potassium
D. Restrict sodium intake
Correct answer: B. Begin rapid infusion of isotonic IV fluid
Rationale: Patients with DKA have severe dehydration caused by osmotic diuresis. Restoring
circulating volume with isotonic saline is the initial priority. Insulin is then administered after
initial fluid resuscitation and confirmation that potassium is not dangerously low.
A: Insulin is essential, but circulating volume is usually restored first.
C: The initial potassium level is elevated, although total-body potassium is depleted.
D: Sodium restriction does not treat DKA.
Question 6
Four hours after an ischemic stroke, a patient becomes increasingly difficult to arouse and
develops projectile vomiting. Which complication should the nurse suspect?
, A. Increased intracranial pressure
B. Hypoglycemia
C. Deep vein thrombosis
D. Neurogenic bladder
Correct answer: A. Increased intracranial pressure
Rationale: Decreasing consciousness and projectile vomiting are signs of rising intracranial
pressure and possible cerebral edema or hemorrhagic transformation. This is an emergency
requiring immediate neurological evaluation.
B: Hypoglycemia can change mental status but does not typically cause projectile
vomiting.
C: DVT usually causes unilateral leg swelling, pain, and warmth.
D: Neurogenic bladder affects urinary function rather than consciousness.
Question 7
Which position is most appropriate for a patient with increased intracranial pressure?
A. Supine with the neck flexed
B. Head of bed at approximately 30 degrees with the head midline
C. Trendelenburg position
D. High-Fowler position with the hips sharply flexed
Correct answer: B. Head of bed at approximately 30 degrees with the head midline
Rationale: Elevating the head about 30 degrees and maintaining neutral head alignment
promotes cerebral venous drainage and may reduce intracranial pressure. Excessive hip or neck
flexion impairs venous return from the brain.
A: Neck flexion can obstruct cerebral venous drainage.
C: Trendelenburg positioning increases cerebral blood volume and ICP.
D: Excessive hip flexion can increase intra-abdominal and intrathoracic pressure,
impairing cerebral venous drainage.
Question 8
A patient with an inferior-wall myocardial infarction receives sublingual nitroglycerin. The
blood pressure decreases from 118/72 to 78/46 mm Hg. Which action should the nurse take first?
Questions and Answers | 2026/27 Update | 100% Correct.
Question 1
A nurse is assessing a patient admitted with septic shock. The patient has received 30 mL/kg of
isotonic crystalloid fluid. Current findings include:
Blood pressure: 82/46 mm Hg
MAP: 58 mm Hg
Heart rate: 126/min
Urine output: 15 mL/hr
Lactate: 4.6 mmol/L
Which prescription should the nurse anticipate next?
A. IV furosemide
B. Norepinephrine infusion
C. Oral metoprolol
D. Fluid restriction
Correct answer: B. Norepinephrine infusion
Rationale: Persistent hypotension and a MAP below 65 mm Hg after adequate fluid
resuscitation indicate the need for a vasopressor. Norepinephrine is generally the first-line
vasopressor for septic shock because it produces vasoconstriction and improves systemic blood
pressure and organ perfusion.
A: Furosemide could worsen hypotension and tissue hypoperfusion.
C: Metoprolol would reduce heart rate and blood pressure and is inappropriate during
unstable shock.
D: Fluid restriction does not correct septic vasodilation and impaired perfusion.
Question 2
A patient with an acute myocardial infarction suddenly develops severe dyspnea, crackles
throughout both lungs, and pink frothy sputum. Which action should the nurse take first?
A. Place the patient in high-Fowler position and apply oxygen
B. Encourage oral fluid intake
C. Position the patient flat with the legs elevated
D. Obtain a routine daily weight
,Correct answer: A. Place the patient in high-Fowler position and apply oxygen
Rationale: These findings indicate acute pulmonary edema caused by left ventricular failure.
Using the ABC framework, the nurse must first improve oxygenation. High-Fowler positioning
decreases venous return and promotes lung expansion, while supplemental oxygen treats
hypoxemia.
B: Additional fluids may worsen pulmonary congestion.
C: A flat position increases venous return and can worsen pulmonary edema.
D: Daily weights are useful for monitoring fluid status but do not address the immediate
respiratory emergency.
Question 3
A nurse is caring for a patient with an arterial line. Which finding requires immediate
intervention?
A. The pressure bag is maintained at 300 mm Hg
B. The waveform becomes flattened, and the fingers are cool and pale
C. The transducer is leveled at the phlebostatic axis
D. The arterial-line site is covered with a transparent dressing
Correct answer: B. The waveform becomes flattened, and the fingers are cool and pale
Rationale: A flattened waveform accompanied by cool, pale fingers suggests impaired arterial
circulation, possibly caused by catheter obstruction, vasospasm, thrombosis, or compromised
distal perfusion. The nurse should immediately assess circulation and follow the facility protocol.
A: A pressure bag is commonly maintained at approximately 300 mm Hg.
C: The phlebostatic axis is the correct reference level for hemodynamic monitoring.
D: A transparent dressing permits visualization of the insertion site.
Question 4
A mechanically ventilated patient triggers a high-pressure alarm. Which assessment should the
nurse perform first?
A. Check for tubing disconnection
B. Assess for secretions, biting, or a kinked tube
C. Increase the ventilator’s tidal volume
D. Silence the alarm and reassess in 15 minutes
,Correct answer: B. Assess for secretions, biting, or a kinked tube
Rationale: A high-pressure alarm indicates increased resistance to airflow. Common causes
include accumulated secretions, bronchospasm, coughing, biting the tube, decreased lung
compliance, and kinked tubing. The patient must be assessed immediately.
A: A disconnection usually activates a low-pressure alarm.
C: Increasing tidal volume can worsen pressure and lung injury.
D: Alarms should never be silenced without determining their cause.
Question 5
A patient with diabetic ketoacidosis has the following laboratory findings:
Glucose: 620 mg/dL
Potassium: 5.8 mEq/L
Arterial pH: 7.19
Bicarbonate: 12 mEq/L
Which intervention should the nurse expect to implement first?
A. Administer IV regular insulin immediately before fluids
B. Begin rapid infusion of isotonic IV fluid
C. Administer oral potassium
D. Restrict sodium intake
Correct answer: B. Begin rapid infusion of isotonic IV fluid
Rationale: Patients with DKA have severe dehydration caused by osmotic diuresis. Restoring
circulating volume with isotonic saline is the initial priority. Insulin is then administered after
initial fluid resuscitation and confirmation that potassium is not dangerously low.
A: Insulin is essential, but circulating volume is usually restored first.
C: The initial potassium level is elevated, although total-body potassium is depleted.
D: Sodium restriction does not treat DKA.
Question 6
Four hours after an ischemic stroke, a patient becomes increasingly difficult to arouse and
develops projectile vomiting. Which complication should the nurse suspect?
, A. Increased intracranial pressure
B. Hypoglycemia
C. Deep vein thrombosis
D. Neurogenic bladder
Correct answer: A. Increased intracranial pressure
Rationale: Decreasing consciousness and projectile vomiting are signs of rising intracranial
pressure and possible cerebral edema or hemorrhagic transformation. This is an emergency
requiring immediate neurological evaluation.
B: Hypoglycemia can change mental status but does not typically cause projectile
vomiting.
C: DVT usually causes unilateral leg swelling, pain, and warmth.
D: Neurogenic bladder affects urinary function rather than consciousness.
Question 7
Which position is most appropriate for a patient with increased intracranial pressure?
A. Supine with the neck flexed
B. Head of bed at approximately 30 degrees with the head midline
C. Trendelenburg position
D. High-Fowler position with the hips sharply flexed
Correct answer: B. Head of bed at approximately 30 degrees with the head midline
Rationale: Elevating the head about 30 degrees and maintaining neutral head alignment
promotes cerebral venous drainage and may reduce intracranial pressure. Excessive hip or neck
flexion impairs venous return from the brain.
A: Neck flexion can obstruct cerebral venous drainage.
C: Trendelenburg positioning increases cerebral blood volume and ICP.
D: Excessive hip flexion can increase intra-abdominal and intrathoracic pressure,
impairing cerebral venous drainage.
Question 8
A patient with an inferior-wall myocardial infarction receives sublingual nitroglycerin. The
blood pressure decreases from 118/72 to 78/46 mm Hg. Which action should the nurse take first?
