WGU D446 ADULT HEALTH II OA
REVIEW & STUDY GUIDE (2026) |
REVIEW QUESTIONS |
LATEST MOCK PRACTICE SET
170 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
WGU D446 ADULT HEALTH II OA REVIEW & STUDY GUIDE (2026) | REVIEW QUESTIONS | GUARANTEE
PASS. It contains 170 carefully selected questions that reflect the most current exam content and testing
strategies. Each question is accompanied by a correct answer and a detailed rationale that explains the
underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 170 Questions
Foundations - Application - WGU D446 Adult Health II OA Review & Study Guide 2026 Review Guarantee
PASS Adult Health II Medical-surgical Nursing Undergraduate YEAR 3
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Acute 1-43 Finding, Kidney, Syndrome, Disease, Indicates
Finding 44-86 Acute, Intervention, Appropriate, Develops, Kidney
Develops 87-129 Acute, Finding, Appropriate, Pancreatitis, Intervention
Appropriate 130-170 Acute, Develops, Intervention, Kidney, Finding
TOTAL 170 All questions include answers and detailed rationales
,Section A - Acute
Q1.
A patient with chronic heart failure and a left ventricular ejection fraction of 25% presents
with worsening dyspnea, orthopnea, and 3+ pitting edema. Current medications include
lisinopril, carvedilol, and furosemide. Which addition to the medication regimen is most
likely to reduce mortality in this patient?
A. Digoxin B. Spironolactone
C. Hydralazine-isosorbide dinitrate D. Metoprolol succinate
Correct: B - Spironolactone
Rationale:Spironolactone, an aldosterone antagonist, has been shown to reduce mortality in
patients with NYHA class III-IV heart failure with reduced ejection fraction (RALES trial).
Digoxin improves symptoms but not mortality. Hydralazine-isosorbide dinitrate is beneficial in
African American patients but not first-line for all. Metoprolol succinate is already a
beta-blocker; carvedilol is already on board.
Q2.
A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled
ventilation with a tidal volume of 6 mL/kg ideal body weight. Plateau pressure is 32 cm
H2O and PaO2/FiO2 ratio is 120. Which intervention should the nurse anticipate to
improve oxygenation while minimizing ventilator-induced lung injury?
A. Increase tidal volume to 8 mL/kg B. Increase positive end-expiratory pressure
(PEEP)
C. Decrease FiO2 to maintain PaO2 60 D. Switch to pressure-controlled ventilation
mmHg
Correct: B - Increase positive end-expiratory pressure (PEEP)
Rationale:In ARDS, increasing PEEP can recruit collapsed alveoli, improve oxygenation, and
reduce atelectrauma, while maintaining low tidal volumes (lung-protective ventilation).
Increasing tidal volume would exacerbate lung injury. Decreasing FiO2 alone may not improve
oxygenation if shunt is significant. Pressure-controlled ventilation is not inherently
lung-protective; PEEP is the key.
Q3.
A patient with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L and ECG
changes showing peaked T waves. Which order should the nurse question?
A. IV calcium gluconate B. IV regular insulin with D50W
Page 3
, Section A - Acute
C. Oral sodium polystyrene sulfonate D. IV sodium bicarbonate
(Kayexalate)
Correct: C - Oral sodium polystyrene sulfonate (Kayexalate)
Rationale:In severe hyperkalemia with ECG changes, emergent treatment includes IV
calcium to stabilize myocardium, insulin/glucose to shift potassium intracellularly, and possibly
sodium bicarbonate for acidosis. Sodium polystyrene sulfonate works slowly (hours) and is
not appropriate for acute emergency; it can cause bowel necrosis, especially in postoperative
patients. Therefore, the nurse should question this order as the sole immediate intervention.
Q4.
A patient with cirrhosis and ascites develops confusion, asterixis, and a serum ammonia
level of 120 mcg/dL. Which intervention is most important to include in the plan of care?
A. Administer lactulose to achieve 2-3 loose B. Restrict protein intake to less than 40
stools per day g/day
C. Administer IV albumin to reduce ascites D. Prepare for paracentesis to remove
ascitic fluid
Correct: A - Administer lactulose to achieve 2-3 loose stools per day
Rationale:Hepatic encephalopathy is treated with lactulose to reduce ammonia absorption;
goal is 2-3 loose stools daily. Protein restriction is no longer routinely recommended; patients
need adequate protein. IV albumin and paracentesis address ascites, not encephalopathy.
Thus, lactulose is the priority.
Q5.
A patient with type 2 diabetes is started on metformin. Which laboratory result, if present,
should prompt the nurse to hold the medication and notify the provider?
A. eGFR 45 mL/min/1.73 m² B. ALT 60 U/L
C. Hemoglobin A1c 8.5% D. LDL 130 mg/dL
Correct: A - eGFR 45 mL/min/1.73 m²
Rationale:Metformin is contraindicated if eGFR is below 30 mL/min/1.73 m² and should be
held if eGFR falls below 45 due to risk of lactic acidosis. Mildly elevated ALT, elevated A1c,
and LDL are not contraindications. Thus, eGFR 45 is the threshold to reassess.
Q6.
A patient in the intensive care unit has a pulmonary artery catheter. The nurse notes a
cardiac output of 3.2 L/min, pulmonary artery wedge pressure of 18 mmHg, and systemic
vascular resistance of 1500 dynes/sec/cm. Which condition do these findings support?
Page 4
REVIEW & STUDY GUIDE (2026) |
REVIEW QUESTIONS |
LATEST MOCK PRACTICE SET
170 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
WGU D446 ADULT HEALTH II OA REVIEW & STUDY GUIDE (2026) | REVIEW QUESTIONS | GUARANTEE
PASS. It contains 170 carefully selected questions that reflect the most current exam content and testing
strategies. Each question is accompanied by a correct answer and a detailed rationale that explains the
underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 170 Questions
Foundations - Application - WGU D446 Adult Health II OA Review & Study Guide 2026 Review Guarantee
PASS Adult Health II Medical-surgical Nursing Undergraduate YEAR 3
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Acute 1-43 Finding, Kidney, Syndrome, Disease, Indicates
Finding 44-86 Acute, Intervention, Appropriate, Develops, Kidney
Develops 87-129 Acute, Finding, Appropriate, Pancreatitis, Intervention
Appropriate 130-170 Acute, Develops, Intervention, Kidney, Finding
TOTAL 170 All questions include answers and detailed rationales
,Section A - Acute
Q1.
A patient with chronic heart failure and a left ventricular ejection fraction of 25% presents
with worsening dyspnea, orthopnea, and 3+ pitting edema. Current medications include
lisinopril, carvedilol, and furosemide. Which addition to the medication regimen is most
likely to reduce mortality in this patient?
A. Digoxin B. Spironolactone
C. Hydralazine-isosorbide dinitrate D. Metoprolol succinate
Correct: B - Spironolactone
Rationale:Spironolactone, an aldosterone antagonist, has been shown to reduce mortality in
patients with NYHA class III-IV heart failure with reduced ejection fraction (RALES trial).
Digoxin improves symptoms but not mortality. Hydralazine-isosorbide dinitrate is beneficial in
African American patients but not first-line for all. Metoprolol succinate is already a
beta-blocker; carvedilol is already on board.
Q2.
A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled
ventilation with a tidal volume of 6 mL/kg ideal body weight. Plateau pressure is 32 cm
H2O and PaO2/FiO2 ratio is 120. Which intervention should the nurse anticipate to
improve oxygenation while minimizing ventilator-induced lung injury?
A. Increase tidal volume to 8 mL/kg B. Increase positive end-expiratory pressure
(PEEP)
C. Decrease FiO2 to maintain PaO2 60 D. Switch to pressure-controlled ventilation
mmHg
Correct: B - Increase positive end-expiratory pressure (PEEP)
Rationale:In ARDS, increasing PEEP can recruit collapsed alveoli, improve oxygenation, and
reduce atelectrauma, while maintaining low tidal volumes (lung-protective ventilation).
Increasing tidal volume would exacerbate lung injury. Decreasing FiO2 alone may not improve
oxygenation if shunt is significant. Pressure-controlled ventilation is not inherently
lung-protective; PEEP is the key.
Q3.
A patient with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L and ECG
changes showing peaked T waves. Which order should the nurse question?
A. IV calcium gluconate B. IV regular insulin with D50W
Page 3
, Section A - Acute
C. Oral sodium polystyrene sulfonate D. IV sodium bicarbonate
(Kayexalate)
Correct: C - Oral sodium polystyrene sulfonate (Kayexalate)
Rationale:In severe hyperkalemia with ECG changes, emergent treatment includes IV
calcium to stabilize myocardium, insulin/glucose to shift potassium intracellularly, and possibly
sodium bicarbonate for acidosis. Sodium polystyrene sulfonate works slowly (hours) and is
not appropriate for acute emergency; it can cause bowel necrosis, especially in postoperative
patients. Therefore, the nurse should question this order as the sole immediate intervention.
Q4.
A patient with cirrhosis and ascites develops confusion, asterixis, and a serum ammonia
level of 120 mcg/dL. Which intervention is most important to include in the plan of care?
A. Administer lactulose to achieve 2-3 loose B. Restrict protein intake to less than 40
stools per day g/day
C. Administer IV albumin to reduce ascites D. Prepare for paracentesis to remove
ascitic fluid
Correct: A - Administer lactulose to achieve 2-3 loose stools per day
Rationale:Hepatic encephalopathy is treated with lactulose to reduce ammonia absorption;
goal is 2-3 loose stools daily. Protein restriction is no longer routinely recommended; patients
need adequate protein. IV albumin and paracentesis address ascites, not encephalopathy.
Thus, lactulose is the priority.
Q5.
A patient with type 2 diabetes is started on metformin. Which laboratory result, if present,
should prompt the nurse to hold the medication and notify the provider?
A. eGFR 45 mL/min/1.73 m² B. ALT 60 U/L
C. Hemoglobin A1c 8.5% D. LDL 130 mg/dL
Correct: A - eGFR 45 mL/min/1.73 m²
Rationale:Metformin is contraindicated if eGFR is below 30 mL/min/1.73 m² and should be
held if eGFR falls below 45 due to risk of lactic acidosis. Mildly elevated ALT, elevated A1c,
and LDL are not contraindications. Thus, eGFR 45 is the threshold to reassess.
Q6.
A patient in the intensive care unit has a pulmonary artery catheter. The nurse notes a
cardiac output of 3.2 L/min, pulmonary artery wedge pressure of 18 mmHg, and systemic
vascular resistance of 1500 dynes/sec/cm. Which condition do these findings support?
Page 4
