WGU D446 – Adult Health II Objective
Assessment | OA V1 and V2 | Questions and
Answers – 2026/2027 Update | 100% Correct
250 Practice Questions with Detailed
Rationales
EXAM OVERVIEW
The WGU D446 Adult Health II Objective Assessment (OA) evaluates your ability to
assess, prioritize, and manage adult patients in complex clinical situations. The exam is
heavily focused on Next Generation NCLEX (NGN)-style questions, including bowtie
diagrams, select-all-that-apply, and case-based scenarios. Key topics include
cardiovascular, respiratory, neurological, renal/GU, endocrine, gastrointestinal, critical
care, perioperative, immunology, oncology, and fluid & electrolyte disorders.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-65)
Heart Failure
1. A nurse is assessing a client with acute decompensated heart failure (ADHF).
Which finding is most concerning?
A. +2 pitting edema in lower extremities
B. Jugular venous distension (JVD) at 45 degrees
C. Paroxysmal nocturnal dyspnea (PND)
D. Crackles audible to the midscapular region
Answer: D
Rationale: Crackles extending to the midscapular region indicate severe, widespread
pulmonary edema, signifying imminent respiratory compromise. While peripheral
,edema, JVD, and PND are important signs of fluid overload, they are not as immediately
life-threatening as extensive pulmonary edema.
2. Which of the following is a classic symptom of left-sided heart failure?
A. Peripheral edema and JVD
B. Dyspnea, orthopnea, and crackles
C. Ascites and hepatomegaly
D. Weight gain and nocturia
Answer: B
Rationale: Left-sided heart failure results in fluid backing up into the pulmonary
circulation, causing dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and crackles.
Right-sided heart failure presents with peripheral symptoms such as edema, ascites, and
JVD.
3. Which of the following is a classic symptom of right-sided heart failure?
A. Dyspnea and crackles
B. Orthopnea
C. Paroxysmal nocturnal dyspnea
D. Peripheral edema and JVD
Answer: D
Rationale: Right-sided heart failure results in systemic venous congestion with
symptoms including peripheral edema, jugular venous distension (JVD), ascites, and
weight gain. Left-sided failure causes pulmonary congestion.
4. Which laboratory finding is most consistent with a diagnosis of left-sided heart
failure?
A. Elevated B-type natriuretic peptide (BNP)
,B. Decreased troponin I
C. Elevated hemoglobin
D. Decreased serum potassium
Answer: A
Rationale: BNP is released by the ventricles in response to increased pressure and
volume overload. Elevated BNP levels indicate heart failure. Normal BNP is <100 pg/mL.
Troponin I indicates myocardial injury.
5. A client with heart failure has been prescribed furosemide (Lasix). Which
assessment finding indicates the medication is effective?
A. Decreased daily weight
B. Increased blood pressure
C. Increased peripheral edema
D. Decreased urine output
Answer: A
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart failure. A
decrease in daily weight indicates effective diuresis and fluid removal.
6. The nurse administers IV furosemide to a client with acute pulmonary edema.
Which assessment best indicates therapeutic effect?
A. Blood pressure increases from 90/60 to 110/70
B. Urine output of 300 mL in the first hour
C. Respiratory rate decreases from 32 to 18
D. Serum potassium level of 3.8 mEq/L
Answer: C
Rationale: Decreased respiratory rate and improved work of breathing indicate reduced
pulmonary congestion, demonstrating the effectiveness of furosemide. While increased
, urine output is expected, the most clinically significant assessment is improvement in
respiratory status.
7. A client with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding indicates the medication is effective?
A. Increased JVD
B. Increased peripheral edema
C. Decreased dyspnea and crackles
D. Increased weight
Answer: C
Rationale: A decrease in dyspnea and crackles indicates that pulmonary congestion is
resolving, demonstrating the effectiveness of furosemide. Effective diuresis should also
result in decreased JVD, decreased edema, and weight loss.
8. A client with heart failure is on a fluid restriction. Which finding indicates the
client is adhering to the restriction?
A. Weight gain of 2 kg in 24 hours
B. Weight loss of 1 kg in 24 hours
C. Increased JVD
D. Increased peripheral edema
Answer: B
Rationale: Weight loss of 1 kg (2.2 lb) in 24 hours indicates fluid loss (diuresis) and
adherence to fluid restriction. Weight gain would indicate fluid retention and worsening
heart failure.
9. A client is prescribed a beta-blocker for heart failure. What is the primary
therapeutic effect of this medication?
Assessment | OA V1 and V2 | Questions and
Answers – 2026/2027 Update | 100% Correct
250 Practice Questions with Detailed
Rationales
EXAM OVERVIEW
The WGU D446 Adult Health II Objective Assessment (OA) evaluates your ability to
assess, prioritize, and manage adult patients in complex clinical situations. The exam is
heavily focused on Next Generation NCLEX (NGN)-style questions, including bowtie
diagrams, select-all-that-apply, and case-based scenarios. Key topics include
cardiovascular, respiratory, neurological, renal/GU, endocrine, gastrointestinal, critical
care, perioperative, immunology, oncology, and fluid & electrolyte disorders.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-65)
Heart Failure
1. A nurse is assessing a client with acute decompensated heart failure (ADHF).
Which finding is most concerning?
A. +2 pitting edema in lower extremities
B. Jugular venous distension (JVD) at 45 degrees
C. Paroxysmal nocturnal dyspnea (PND)
D. Crackles audible to the midscapular region
Answer: D
Rationale: Crackles extending to the midscapular region indicate severe, widespread
pulmonary edema, signifying imminent respiratory compromise. While peripheral
,edema, JVD, and PND are important signs of fluid overload, they are not as immediately
life-threatening as extensive pulmonary edema.
2. Which of the following is a classic symptom of left-sided heart failure?
A. Peripheral edema and JVD
B. Dyspnea, orthopnea, and crackles
C. Ascites and hepatomegaly
D. Weight gain and nocturia
Answer: B
Rationale: Left-sided heart failure results in fluid backing up into the pulmonary
circulation, causing dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and crackles.
Right-sided heart failure presents with peripheral symptoms such as edema, ascites, and
JVD.
3. Which of the following is a classic symptom of right-sided heart failure?
A. Dyspnea and crackles
B. Orthopnea
C. Paroxysmal nocturnal dyspnea
D. Peripheral edema and JVD
Answer: D
Rationale: Right-sided heart failure results in systemic venous congestion with
symptoms including peripheral edema, jugular venous distension (JVD), ascites, and
weight gain. Left-sided failure causes pulmonary congestion.
4. Which laboratory finding is most consistent with a diagnosis of left-sided heart
failure?
A. Elevated B-type natriuretic peptide (BNP)
,B. Decreased troponin I
C. Elevated hemoglobin
D. Decreased serum potassium
Answer: A
Rationale: BNP is released by the ventricles in response to increased pressure and
volume overload. Elevated BNP levels indicate heart failure. Normal BNP is <100 pg/mL.
Troponin I indicates myocardial injury.
5. A client with heart failure has been prescribed furosemide (Lasix). Which
assessment finding indicates the medication is effective?
A. Decreased daily weight
B. Increased blood pressure
C. Increased peripheral edema
D. Decreased urine output
Answer: A
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart failure. A
decrease in daily weight indicates effective diuresis and fluid removal.
6. The nurse administers IV furosemide to a client with acute pulmonary edema.
Which assessment best indicates therapeutic effect?
A. Blood pressure increases from 90/60 to 110/70
B. Urine output of 300 mL in the first hour
C. Respiratory rate decreases from 32 to 18
D. Serum potassium level of 3.8 mEq/L
Answer: C
Rationale: Decreased respiratory rate and improved work of breathing indicate reduced
pulmonary congestion, demonstrating the effectiveness of furosemide. While increased
, urine output is expected, the most clinically significant assessment is improvement in
respiratory status.
7. A client with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding indicates the medication is effective?
A. Increased JVD
B. Increased peripheral edema
C. Decreased dyspnea and crackles
D. Increased weight
Answer: C
Rationale: A decrease in dyspnea and crackles indicates that pulmonary congestion is
resolving, demonstrating the effectiveness of furosemide. Effective diuresis should also
result in decreased JVD, decreased edema, and weight loss.
8. A client with heart failure is on a fluid restriction. Which finding indicates the
client is adhering to the restriction?
A. Weight gain of 2 kg in 24 hours
B. Weight loss of 1 kg in 24 hours
C. Increased JVD
D. Increased peripheral edema
Answer: B
Rationale: Weight loss of 1 kg (2.2 lb) in 24 hours indicates fluid loss (diuresis) and
adherence to fluid restriction. Weight gain would indicate fluid retention and worsening
heart failure.
9. A client is prescribed a beta-blocker for heart failure. What is the primary
therapeutic effect of this medication?
