WGU D453 – Advanced Nursing Skills
Exam Questions and Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf.
1. A registered nurse is preparing to administer packed red blood
cells (PRBCs) to a patient with symptomatic anemia. Which action
should the nurse perform first?
A. Prime the tubing with dextrose 5% in water
B. Obtain baseline vital signs and verify the blood with another licensed
clinician
C. Administer acetaminophen before the transfusion
D. Infuse the blood over 30 minutes
Correct Answer: B. Obtain baseline vital signs and verify the blood
with another licensed clinician
Rationale: Blood transfusion safety begins with positive patient
identification, verification of the blood product by two qualified
individuals according to facility policy, and obtaining baseline vital signs.
These steps reduce the risk of administering incompatible blood and
establish a baseline for recognizing transfusion reactions. Dextrose
solutions should never be used with blood products because they can
damage red blood cells.
, 2. A patient develops fever, chills, and low back pain 15 minutes after
a blood transfusion begins. What is the nurse's priority action?
A. Slow the transfusion rate
B. Administer diphenhydramine
C. Stop the transfusion immediately and maintain IV access with
normal saline
D. Continue the transfusion and reassess in 30 minutes
Correct Answer: C. Stop the transfusion immediately and maintain IV
access with normal saline
Rationale: These findings suggest an acute hemolytic transfusion
reaction, which is life-threatening. The nurse should immediately stop
the transfusion, maintain IV access with normal saline using new tubing,
notify the healthcare provider and blood bank, monitor the patient, and
prepare to treat complications.
3. A nurse is caring for a patient receiving continuous cardiac
monitoring. Which ECG finding is most consistent with atrial
fibrillation?
A. Regular rhythm with upright P waves
B. Wide QRS complexes at a rate of 40 bpm
C. Irregularly irregular rhythm with absent distinct P waves
D. Sawtooth flutter waves with regular conduction
Correct Answer: C. Irregularly irregular rhythm with absent distinct P
waves
,Rationale: Atrial fibrillation is characterized by chaotic atrial activity,
resulting in absent identifiable P waves and an irregularly irregular
ventricular rhythm. Patients are at increased risk for thromboembolic
events, making anticoagulation and rate or rhythm control important
considerations.
4. Which assessment finding requires immediate intervention in a
patient receiving intravenous potassium chloride?
A. Mild discomfort at the IV site
B. Serum potassium of 4.2 mEq/L
C. Burning at the IV site accompanied by redness and swelling
D. Heart rate of 78 beats/min
Correct Answer: C. Burning at the IV site accompanied by redness and
swelling
Rationale: Potassium chloride is highly irritating to veins. Burning,
redness, and swelling indicate infiltration or phlebitis and require
immediate discontinuation of the infusion at that site. Untreated
infiltration can result in tissue injury.
5. A patient has a central venous catheter. Which nursing action best
reduces the risk of central line-associated bloodstream infection
(CLABSI)?
A. Replace the dressing every day regardless of condition
B. Flush the catheter with sterile water
C. Perform meticulous hand hygiene and use sterile technique during
, dressing changes
D. Apply antibiotic ointment with every dressing change
Correct Answer: C. Perform meticulous hand hygiene and use sterile
technique during dressing changes
Rationale: Proper hand hygiene, maximal sterile precautions,
chlorhexidine skin antisepsis, and sterile dressing techniques are among
the most effective evidence-based interventions for preventing CLABSI.
Routine daily dressing changes are unnecessary unless indicated.
6. Which patient is at greatest risk for developing a pulmonary
embolism?
A. Patient with seasonal allergies
B. Patient recovering from cataract surgery
C. Patient who underwent total hip replacement and has prolonged
immobility
D. Patient with controlled hypertension
Correct Answer: C. Patient who underwent total hip replacement and
has prolonged immobility
Rationale: Major orthopedic surgery and prolonged immobility
significantly increase venous thromboembolism risk. Nurses should
promote early ambulation, administer anticoagulants as prescribed, and
use mechanical prophylaxis when indicated.
7. A nurse is assessing a postoperative patient. Which finding is most
concerning for compartment syndrome?
Exam Questions and Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf.
1. A registered nurse is preparing to administer packed red blood
cells (PRBCs) to a patient with symptomatic anemia. Which action
should the nurse perform first?
A. Prime the tubing with dextrose 5% in water
B. Obtain baseline vital signs and verify the blood with another licensed
clinician
C. Administer acetaminophen before the transfusion
D. Infuse the blood over 30 minutes
Correct Answer: B. Obtain baseline vital signs and verify the blood
with another licensed clinician
Rationale: Blood transfusion safety begins with positive patient
identification, verification of the blood product by two qualified
individuals according to facility policy, and obtaining baseline vital signs.
These steps reduce the risk of administering incompatible blood and
establish a baseline for recognizing transfusion reactions. Dextrose
solutions should never be used with blood products because they can
damage red blood cells.
, 2. A patient develops fever, chills, and low back pain 15 minutes after
a blood transfusion begins. What is the nurse's priority action?
A. Slow the transfusion rate
B. Administer diphenhydramine
C. Stop the transfusion immediately and maintain IV access with
normal saline
D. Continue the transfusion and reassess in 30 minutes
Correct Answer: C. Stop the transfusion immediately and maintain IV
access with normal saline
Rationale: These findings suggest an acute hemolytic transfusion
reaction, which is life-threatening. The nurse should immediately stop
the transfusion, maintain IV access with normal saline using new tubing,
notify the healthcare provider and blood bank, monitor the patient, and
prepare to treat complications.
3. A nurse is caring for a patient receiving continuous cardiac
monitoring. Which ECG finding is most consistent with atrial
fibrillation?
A. Regular rhythm with upright P waves
B. Wide QRS complexes at a rate of 40 bpm
C. Irregularly irregular rhythm with absent distinct P waves
D. Sawtooth flutter waves with regular conduction
Correct Answer: C. Irregularly irregular rhythm with absent distinct P
waves
,Rationale: Atrial fibrillation is characterized by chaotic atrial activity,
resulting in absent identifiable P waves and an irregularly irregular
ventricular rhythm. Patients are at increased risk for thromboembolic
events, making anticoagulation and rate or rhythm control important
considerations.
4. Which assessment finding requires immediate intervention in a
patient receiving intravenous potassium chloride?
A. Mild discomfort at the IV site
B. Serum potassium of 4.2 mEq/L
C. Burning at the IV site accompanied by redness and swelling
D. Heart rate of 78 beats/min
Correct Answer: C. Burning at the IV site accompanied by redness and
swelling
Rationale: Potassium chloride is highly irritating to veins. Burning,
redness, and swelling indicate infiltration or phlebitis and require
immediate discontinuation of the infusion at that site. Untreated
infiltration can result in tissue injury.
5. A patient has a central venous catheter. Which nursing action best
reduces the risk of central line-associated bloodstream infection
(CLABSI)?
A. Replace the dressing every day regardless of condition
B. Flush the catheter with sterile water
C. Perform meticulous hand hygiene and use sterile technique during
, dressing changes
D. Apply antibiotic ointment with every dressing change
Correct Answer: C. Perform meticulous hand hygiene and use sterile
technique during dressing changes
Rationale: Proper hand hygiene, maximal sterile precautions,
chlorhexidine skin antisepsis, and sterile dressing techniques are among
the most effective evidence-based interventions for preventing CLABSI.
Routine daily dressing changes are unnecessary unless indicated.
6. Which patient is at greatest risk for developing a pulmonary
embolism?
A. Patient with seasonal allergies
B. Patient recovering from cataract surgery
C. Patient who underwent total hip replacement and has prolonged
immobility
D. Patient with controlled hypertension
Correct Answer: C. Patient who underwent total hip replacement and
has prolonged immobility
Rationale: Major orthopedic surgery and prolonged immobility
significantly increase venous thromboembolism risk. Nurses should
promote early ambulation, administer anticoagulants as prescribed, and
use mechanical prophylaxis when indicated.
7. A nurse is assessing a postoperative patient. Which finding is most
concerning for compartment syndrome?
