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WGU D446 – Adult Health II Objective Assessment
OA V1 QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES
WGU D446 – Adult Health II Objective Assessment | OA V1
Question 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
Correct 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.
Question 2: A client with infective endocarditis develops sudden left-sided weakness and slurred
speech. What is the priority action?
A) Administer aspirin 325 mg PO
B) Obtain a STAT CT scan of the head
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C) Check blood glucose level
D) Reorient the client to person, place, time
Correct Answer: B
Rationale: The client is likely experiencing an embolic stroke from a vegetation fragment. A STAT CT
scan is required to rule out hemorrhage before any thrombolytics or anticoagulation can be considered.
Question 3: A client with chronic atrial fibrillation is prescribed warfarin. Which lab value requires
immediate intervention?
A) INR 2.5
B) aPTT 35 seconds
C) Platelets 150,000/mm³
D) INR 4.8
Correct Answer: D
Rationale: An INR of 4.8 indicates a high risk of bleeding. Target INR for atrial fibrillation is typically 2.0–
3.0. An INR above 4.5 may require holding the dose, administering vitamin K, or using fresh frozen
plasma depending on the clinical situation.
Question 4: 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
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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
Correct 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.
Question 5: A client presents with chest pain radiating to the left arm, diaphoresis, and nausea. Which
medication should the nurse anticipate administering first?
A) Morphine
B) Nitroglycerin
C) Aspirin
D) Oxygen
Correct Answer: C
Rationale: Aspirin should be administered immediately upon suspicion of myocardial infarction due to
its antiplatelet effects. The MONA protocol includes Morphine, Oxygen, Nitroglycerin, and Aspirin;
however, aspirin is the priority to prevent further clot formation. Oxygen is only indicated if the patient
is hypoxic.
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Question 6: 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
Correct 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.
Question 7: A client with aortic stenosis is scheduled for valve replacement. Which symptom is the
classic triad for this condition?
A) Syncope, angina, dyspnea on exertion
B) Palpitations, fever, weight loss
C) Hemoptysis, hoarseness, jugular distension
D) Peripheral edema, ascites, hepatomegaly
Correct Answer: A
Rationale: The classic triad of aortic stenosis is syncope (exertional), angina (chest pain due to LV
WGU D446 – Adult Health II Objective Assessment
OA V1 QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES
WGU D446 – Adult Health II Objective Assessment | OA V1
Question 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
Correct 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.
Question 2: A client with infective endocarditis develops sudden left-sided weakness and slurred
speech. What is the priority action?
A) Administer aspirin 325 mg PO
B) Obtain a STAT CT scan of the head
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C) Check blood glucose level
D) Reorient the client to person, place, time
Correct Answer: B
Rationale: The client is likely experiencing an embolic stroke from a vegetation fragment. A STAT CT
scan is required to rule out hemorrhage before any thrombolytics or anticoagulation can be considered.
Question 3: A client with chronic atrial fibrillation is prescribed warfarin. Which lab value requires
immediate intervention?
A) INR 2.5
B) aPTT 35 seconds
C) Platelets 150,000/mm³
D) INR 4.8
Correct Answer: D
Rationale: An INR of 4.8 indicates a high risk of bleeding. Target INR for atrial fibrillation is typically 2.0–
3.0. An INR above 4.5 may require holding the dose, administering vitamin K, or using fresh frozen
plasma depending on the clinical situation.
Question 4: 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
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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
Correct 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.
Question 5: A client presents with chest pain radiating to the left arm, diaphoresis, and nausea. Which
medication should the nurse anticipate administering first?
A) Morphine
B) Nitroglycerin
C) Aspirin
D) Oxygen
Correct Answer: C
Rationale: Aspirin should be administered immediately upon suspicion of myocardial infarction due to
its antiplatelet effects. The MONA protocol includes Morphine, Oxygen, Nitroglycerin, and Aspirin;
however, aspirin is the priority to prevent further clot formation. Oxygen is only indicated if the patient
is hypoxic.
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Question 6: 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
Correct 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.
Question 7: A client with aortic stenosis is scheduled for valve replacement. Which symptom is the
classic triad for this condition?
A) Syncope, angina, dyspnea on exertion
B) Palpitations, fever, weight loss
C) Hemoptysis, hoarseness, jugular distension
D) Peripheral edema, ascites, hepatomegaly
Correct Answer: A
Rationale: The classic triad of aortic stenosis is syncope (exertional), angina (chest pain due to LV
