WGU D446 ADULT HEALTH II OA V1 and
V2 150 DETAILED CORRECT ANSWERS
WITH RATIONALES GRADE A+ VERIFIED
| INSTANT DOWNLOAD | 100% PASS
GUARANTEE
1. A patient is admitted with a diagnosis of left-sided heart
failure. The nurse knows that the clinical manifestations
associated with this condition are primarily caused by: The
Correct Answer: is B. Pulmonary congestion and
fluid accumulation in the alveoli because left ventricular
failure results in decreased forward flow and increased
pressure in the left atrium and pulmonary veins, causing fluid
to leak into the pulmonary interstitium and alveoli, leading to
dyspnea, crackles, and orthopnea. A) Jugular venous
distention and peripheral edema B) Pulmonary congestion and
fluid accumulation in the alveoli C) Hepatomegaly and ascites
D) Weight gain and dependent edema
2. A patient with a history of angina pectoris experiences
substernal chest pain that radiates to the left arm. Which action
should the nurse take first? The Correct Answer: is A.
Assess the patient's airway, breathing, and circulation,
and administer supplemental oxygen if indicated
because while medication administration and ECG are critical,
the immediate priority is always to assess the ABCs to ensure
adequate oxygenation and perfusion before proceeding with
further diagnostic or therapeutic interventions. A) Assess the
patient's airway, breathing, and circulation, and administer
supplemental oxygen if indicated B) Administer sublingual
nitroglycerin immediately C) Obtain a 12-lead ECG D) Prepare
the patient for cardiac catheterization
,3. A patient with heart failure is prescribed digoxin and
furosemide. The nurse should hold the digoxin and notify the
provider if which assessment finding is present? The Correct
Answer: is C. Apical pulse of 52 beats per minute and
complaints of nausea and visual halos because digoxin
toxicity is characterized by bradycardia (heart rate <60 bpm),
gastrointestinal symptoms like nausea and vomiting, and
neurological/visual changes such as seeing yellow-green halos
around lights; administering another dose would worsen the
toxicity. A) Apical pulse of 78 beats per minute B) Serum
potassium of 4.2 mEq/L C) Apical pulse of 52 beats per minute
and complaints of nausea and visual halos D) Urine output of
50 mL/hr
4. A patient with chronic obstructive pulmonary disease
(COPD) is admitted with an acute exacerbation. The nurse
understands that oxygen therapy should be titrated to maintain
an oxygen saturation of: The Correct Answer: is B. 88%
to 92% because patients with severe COPD may rely on
hypoxemia to stimulate their respiratory drive; administering
excessive oxygen can suppress this drive, leading to CO2
retention and respiratory acidosis, so target saturation is kept
lower than in healthy adults. A) 95% to 100% B) 88% to 92%
C) 80% to 85% D) 98% to 100%
5. A patient has a chest tube connected to a water-seal drainage
system. The nurse observes continuous bubbling in the water-
seal chamber. The nurse's best action is to: The Correct
Answer: is D. Check the system for an air leak at the
insertion site or connections because intermittent
bubbling in the water-seal chamber is expected as air is
expelled from the pleural space during expiration, but
continuous bubbling indicates an air leak somewhere in the
system or at the chest tube insertion site, requiring immediate
assessment to prevent pneumothorax re-accumulation. A)
,Clamp the chest tube immediately B) Increase the suction
pressure C) Document the finding as normal D) Check the
system for an air leak at the insertion site or connections
6. A patient with community-acquired pneumonia is admitted
to the medical-surgical unit. Which assessment finding requires
the most immediate intervention? The Correct Answer: is
C. Oxygen saturation of 86% on room air with
increased work of breathing because hypoxemia and
respiratory distress indicate compromised gas exchange that
can rapidly progress to respiratory failure; this takes
precedence over fever, productive cough, or pleuritic pain,
which are expected symptoms of pneumonia. A) Temperature
of 101.5°F (38.6°C) B) Productive cough with rust-colored
sputum C) Oxygen saturation of 86% on room air with
increased work of breathing D) Pleuritic chest pain on
inspiration
7. A patient with type 1 diabetes is admitted with diabetic
ketoacidosis (DKA). The nurse understands that the priority
initial intervention is: The Correct Answer: is B.
Administration of intravenous normal saline (0.9%
NaCl) because the primary life-threatening issue in DKA is
profound dehydration and hypovolemia caused by osmotic
diuresis; aggressive fluid resuscitation restores intravascular
volume and renal perfusion before insulin therapy can be
safely initiated to avoid cardiovascular collapse. A)
Administration of subcutaneous insulin B) Administration of
intravenous normal saline (0.9% NaCl) C) Administration of
intravenous potassium chloride D) Administration of sodium
bicarbonate
8. A patient with diabetes experiences shakiness, diaphoresis,
and confusion. A fingerstick glucose reading is 52 mg/dL. The
patient is conscious and able to swallow. The nurse's immediate
action should be to: The Correct Answer: is A.
, Administer 15 to 20 grams of fast-acting carbohydrate
orally because for a conscious patient with hypoglycemia,
oral fast-acting carbohydrates (like juice or glucose tablets)
are the safest and fastest way to raise blood glucose; IV
dextrose or glucagon is reserved for unconscious patients or
those unable to swallow safely. A) Administer 15 to 20 grams
of fast-acting carbohydrate orally B) Administer 50 mL of 50%
dextrose intravenously C) Administer 1 mg of glucagon
intramuscularly D) Recheck the blood glucose in 30 minutes
before intervening
9. A patient with advanced cirrhosis develops confusion,
lethargy, and a flapping tremor of the hands (asterixis). The
nurse anticipates an order for lactulose, which works by: The
Correct Answer: is C. Binding ammonia in the colon
and promoting its excretion through osmotic diarrhea
because hepatic encephalopathy is caused by the accumulation
of ammonia due to the liver's inability to convert it to urea;
lactulose is a non-absorbable sugar that acidifies the colonic
contents, converting ammonia (NH3NH3) to ammonium
(NH4+NH4+) which cannot be absorbed, and promotes its
excretion via stool. A) Reducing portal hypertension by
decreasing blood volume B) Providing essential amino acids for
liver regeneration C) Binding ammonia in the colon and
promoting its excretion through osmotic diarrhea D)
Preventing spontaneous bacterial peritonitis
10. A patient is admitted with acute pancreatitis. The nurse
understands that the most important initial intervention is to:
The Correct Answer: is B. Maintain NPO status and
administer intravenous fluids for aggressive hydration
because pancreatic enzyme secretion is stimulated by food
entering the GI tract, so keeping the patient NPO rests the
pancreas; concurrent aggressive IV hydration is critical
because third-spacing and fluid loss can lead to hypovolemic
shock and pancreatic necrosis. A) Administer a clear liquid diet
V2 150 DETAILED CORRECT ANSWERS
WITH RATIONALES GRADE A+ VERIFIED
| INSTANT DOWNLOAD | 100% PASS
GUARANTEE
1. A patient is admitted with a diagnosis of left-sided heart
failure. The nurse knows that the clinical manifestations
associated with this condition are primarily caused by: The
Correct Answer: is B. Pulmonary congestion and
fluid accumulation in the alveoli because left ventricular
failure results in decreased forward flow and increased
pressure in the left atrium and pulmonary veins, causing fluid
to leak into the pulmonary interstitium and alveoli, leading to
dyspnea, crackles, and orthopnea. A) Jugular venous
distention and peripheral edema B) Pulmonary congestion and
fluid accumulation in the alveoli C) Hepatomegaly and ascites
D) Weight gain and dependent edema
2. A patient with a history of angina pectoris experiences
substernal chest pain that radiates to the left arm. Which action
should the nurse take first? The Correct Answer: is A.
Assess the patient's airway, breathing, and circulation,
and administer supplemental oxygen if indicated
because while medication administration and ECG are critical,
the immediate priority is always to assess the ABCs to ensure
adequate oxygenation and perfusion before proceeding with
further diagnostic or therapeutic interventions. A) Assess the
patient's airway, breathing, and circulation, and administer
supplemental oxygen if indicated B) Administer sublingual
nitroglycerin immediately C) Obtain a 12-lead ECG D) Prepare
the patient for cardiac catheterization
,3. A patient with heart failure is prescribed digoxin and
furosemide. The nurse should hold the digoxin and notify the
provider if which assessment finding is present? The Correct
Answer: is C. Apical pulse of 52 beats per minute and
complaints of nausea and visual halos because digoxin
toxicity is characterized by bradycardia (heart rate <60 bpm),
gastrointestinal symptoms like nausea and vomiting, and
neurological/visual changes such as seeing yellow-green halos
around lights; administering another dose would worsen the
toxicity. A) Apical pulse of 78 beats per minute B) Serum
potassium of 4.2 mEq/L C) Apical pulse of 52 beats per minute
and complaints of nausea and visual halos D) Urine output of
50 mL/hr
4. A patient with chronic obstructive pulmonary disease
(COPD) is admitted with an acute exacerbation. The nurse
understands that oxygen therapy should be titrated to maintain
an oxygen saturation of: The Correct Answer: is B. 88%
to 92% because patients with severe COPD may rely on
hypoxemia to stimulate their respiratory drive; administering
excessive oxygen can suppress this drive, leading to CO2
retention and respiratory acidosis, so target saturation is kept
lower than in healthy adults. A) 95% to 100% B) 88% to 92%
C) 80% to 85% D) 98% to 100%
5. A patient has a chest tube connected to a water-seal drainage
system. The nurse observes continuous bubbling in the water-
seal chamber. The nurse's best action is to: The Correct
Answer: is D. Check the system for an air leak at the
insertion site or connections because intermittent
bubbling in the water-seal chamber is expected as air is
expelled from the pleural space during expiration, but
continuous bubbling indicates an air leak somewhere in the
system or at the chest tube insertion site, requiring immediate
assessment to prevent pneumothorax re-accumulation. A)
,Clamp the chest tube immediately B) Increase the suction
pressure C) Document the finding as normal D) Check the
system for an air leak at the insertion site or connections
6. A patient with community-acquired pneumonia is admitted
to the medical-surgical unit. Which assessment finding requires
the most immediate intervention? The Correct Answer: is
C. Oxygen saturation of 86% on room air with
increased work of breathing because hypoxemia and
respiratory distress indicate compromised gas exchange that
can rapidly progress to respiratory failure; this takes
precedence over fever, productive cough, or pleuritic pain,
which are expected symptoms of pneumonia. A) Temperature
of 101.5°F (38.6°C) B) Productive cough with rust-colored
sputum C) Oxygen saturation of 86% on room air with
increased work of breathing D) Pleuritic chest pain on
inspiration
7. A patient with type 1 diabetes is admitted with diabetic
ketoacidosis (DKA). The nurse understands that the priority
initial intervention is: The Correct Answer: is B.
Administration of intravenous normal saline (0.9%
NaCl) because the primary life-threatening issue in DKA is
profound dehydration and hypovolemia caused by osmotic
diuresis; aggressive fluid resuscitation restores intravascular
volume and renal perfusion before insulin therapy can be
safely initiated to avoid cardiovascular collapse. A)
Administration of subcutaneous insulin B) Administration of
intravenous normal saline (0.9% NaCl) C) Administration of
intravenous potassium chloride D) Administration of sodium
bicarbonate
8. A patient with diabetes experiences shakiness, diaphoresis,
and confusion. A fingerstick glucose reading is 52 mg/dL. The
patient is conscious and able to swallow. The nurse's immediate
action should be to: The Correct Answer: is A.
, Administer 15 to 20 grams of fast-acting carbohydrate
orally because for a conscious patient with hypoglycemia,
oral fast-acting carbohydrates (like juice or glucose tablets)
are the safest and fastest way to raise blood glucose; IV
dextrose or glucagon is reserved for unconscious patients or
those unable to swallow safely. A) Administer 15 to 20 grams
of fast-acting carbohydrate orally B) Administer 50 mL of 50%
dextrose intravenously C) Administer 1 mg of glucagon
intramuscularly D) Recheck the blood glucose in 30 minutes
before intervening
9. A patient with advanced cirrhosis develops confusion,
lethargy, and a flapping tremor of the hands (asterixis). The
nurse anticipates an order for lactulose, which works by: The
Correct Answer: is C. Binding ammonia in the colon
and promoting its excretion through osmotic diarrhea
because hepatic encephalopathy is caused by the accumulation
of ammonia due to the liver's inability to convert it to urea;
lactulose is a non-absorbable sugar that acidifies the colonic
contents, converting ammonia (NH3NH3) to ammonium
(NH4+NH4+) which cannot be absorbed, and promotes its
excretion via stool. A) Reducing portal hypertension by
decreasing blood volume B) Providing essential amino acids for
liver regeneration C) Binding ammonia in the colon and
promoting its excretion through osmotic diarrhea D)
Preventing spontaneous bacterial peritonitis
10. A patient is admitted with acute pancreatitis. The nurse
understands that the most important initial intervention is to:
The Correct Answer: is B. Maintain NPO status and
administer intravenous fluids for aggressive hydration
because pancreatic enzyme secretion is stimulated by food
entering the GI tract, so keeping the patient NPO rests the
pancreas; concurrent aggressive IV hydration is critical
because third-spacing and fluid loss can lead to hypovolemic
shock and pancreatic necrosis. A) Administer a clear liquid diet
