WGU D447/D446 ADULT HEALTH OBJECTIVE
ASSESSMENTS – VERIFIED NURSING OA EXAMS
Comprehensive Practice Examination
Total Questions: 150
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-25)
1. A 68-year-old male presents with chest pain that occurs with exertion and is relieved by
rest. He describes the pain as a pressure sensation in the substernal area that radiates to his
left shoulder. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. Pericarditis
Answer: B. Stable angina
Rationale: Stable angina is characterized by chest pain that is predictable, occurring with
exertion or stress, and relieved by rest or nitroglycerin. The pain is typically substernal pressure
that may radiate to the left shoulder, arm, or jaw. Unstable angina occurs at rest or with
minimal exertion. MI presents with persistent pain not relieved by rest.
2. A patient is diagnosed with heart failure with reduced ejection fraction (HFrEF). Which
medication class has been shown to reduce mortality and is considered first-line therapy?
A. Beta-blockers
B. Calcium channel blockers
C. Digoxin
D. Diuretics
Answer: A. Beta-blockers
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) are first-line therapy for
HFrEF and have been shown to reduce mortality, hospitalizations, and improve symptoms.
Calcium channel blockers are not first-line. Digoxin is used for symptom control but does not
reduce mortality. Diuretics manage fluid overload but do not improve survival.
,3. A patient with atrial fibrillation is prescribed warfarin. The nurse should monitor which
laboratory value to assess the therapeutic effect?
A. aPTT
B. INR
C. Platelet count
D. Bleeding time
Answer: B. INR
Rationale: Warfarin therapy is monitored using the International Normalized Ratio (INR), with a
therapeutic range typically between 2.0-3.0 for atrial fibrillation. aPTT is used to monitor
heparin therapy. Platelet count and bleeding time are not specific indicators of warfarin
effectiveness.
4. A 72-year-old female presents with sudden onset of severe, tearing chest pain radiating to
the back. Her blood pressure is 180/100 in the right arm and 120/70 in the left arm. What is
the priority nursing action?
A. Administer aspirin
B. Administer nitroglycerin
C. Prepare for emergency surgery
D. Obtain a 12-lead ECG
Answer: C. Prepare for emergency surgery
Rationale: The presentation of tearing chest pain with a difference in blood pressure between
arms suggests aortic dissection, a life-threatening emergency requiring immediate surgical
intervention. Aspirin and nitroglycerin are used for MI but are contraindicated in aortic
dissection. An ECG is important but not the priority when dissection is suspected.
5. A patient is in cardiogenic shock. Which hemodynamic parameter would the nurse expect
to find?
A. Low cardiac output and high systemic vascular resistance
B. High cardiac output and low systemic vascular resistance
C. Low cardiac output and low systemic vascular resistance
D. High cardiac output and high systemic vascular resistance
Answer: A. Low cardiac output and high systemic vascular resistance
Rationale: Cardiogenic shock is characterized by low cardiac output and high systemic vascular
resistance. The heart is unable to pump effectively, leading to decreased CO and compensatory
vasoconstriction. This is in contrast to distributive shock (sepsis) where CO is high and SVR is
low.
,6. A patient is prescribed amiodarone for ventricular arrhythmias. Which adverse effect
requires ongoing monitoring?
A. Pulmonary fibrosis
B. Hypothyroidism
C. Corneal deposits
D. All of the above
Answer: D. All of the above
Rationale: Amiodarone can cause pulmonary fibrosis, thyroid dysfunction (both hyper and
hypothyroidism), corneal deposits, blue-gray skin discoloration, and hepatotoxicity. Regular
monitoring of pulmonary function, thyroid levels, liver function, and ophthalmologic
examination is required.
7. A 65-year-old male with a history of hypertension presents with a 1-hour history of
substernal chest pressure, diaphoresis, and nausea. ECG shows ST-segment elevation in the
anterior leads. What is the most appropriate initial treatment?
A. Thrombolytic therapy
B. Percutaneous coronary intervention (PCI)
C. Nitroglycerin
D. Morphine
Answer: B. Percutaneous coronary intervention (PCI)
Rationale: In a patient with STEMI, PCI is the preferred reperfusion strategy if it can be
performed within 90 minutes of arrival. Thrombolytic therapy is an alternative if PCI is not
available. Nitroglycerin and morphine are for symptom management, not reperfusion.
8. A patient with heart failure is prescribed spironolactone. Which laboratory value should
the nurse monitor closely?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Answer: A. Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia. Serum
potassium should be monitored closely, especially with concurrent use of ACE inhibitors, ARBs,
or potassium supplements. Hypokalemia is associated with loop and thiazide diuretics.
, 9. A patient with a history of DVT is being discharged on enoxaparin. The nurse should
instruct the patient to:
A. Massage the injection site after administration
B. Administer the medication subcutaneously in the abdomen
C. Administer the medication intramuscularly
D. Take the medication with food
Answer: B. Administer the medication subcutaneously in the abdomen
Rationale: Enoxaparin (Lovenox) is a low molecular weight heparin administered by
subcutaneous injection in the abdomen. The injection site should not be massaged to prevent
bruising. It is not given IM or orally. Food does not affect absorption.
10. A patient is in cardiac arrest. The cardiac monitor shows ventricular fibrillation. What is
the priority intervention?
A. Administer epinephrine
B. Defibrillate
C. Administer amiodarone
D. Continue CPR
Answer: B. Defibrillate
Rationale: Ventricular fibrillation is a shockable rhythm requiring immediate defibrillation. CPR
should be performed while preparing the defibrillator. Epinephrine and amiodarone are given
after defibrillation attempts or if the rhythm is refractory.
11. A patient with peripheral artery disease (PAD) is being discharged. Which instruction
should the nurse include in the teaching plan?
A. Apply heat to the affected extremity
B. Elevate the legs above heart level
C. Stop smoking
D. Wear tight-fitting clothing
Answer: C. Stop smoking
Rationale: Smoking cessation is the most important intervention for PAD as nicotine causes
vasoconstriction and impairs circulation. Heat application can cause burns due to decreased
sensation. Elevation worsens ischemia in PAD (unlike venous insufficiency where elevation is
helpful). Tight clothing constricts vessels.
12. A patient with deep vein thrombosis is prescribed heparin infusion. The nurse should
monitor for which complication?
ASSESSMENTS – VERIFIED NURSING OA EXAMS
Comprehensive Practice Examination
Total Questions: 150
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-25)
1. A 68-year-old male presents with chest pain that occurs with exertion and is relieved by
rest. He describes the pain as a pressure sensation in the substernal area that radiates to his
left shoulder. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute myocardial infarction
D. Pericarditis
Answer: B. Stable angina
Rationale: Stable angina is characterized by chest pain that is predictable, occurring with
exertion or stress, and relieved by rest or nitroglycerin. The pain is typically substernal pressure
that may radiate to the left shoulder, arm, or jaw. Unstable angina occurs at rest or with
minimal exertion. MI presents with persistent pain not relieved by rest.
2. A patient is diagnosed with heart failure with reduced ejection fraction (HFrEF). Which
medication class has been shown to reduce mortality and is considered first-line therapy?
A. Beta-blockers
B. Calcium channel blockers
C. Digoxin
D. Diuretics
Answer: A. Beta-blockers
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) are first-line therapy for
HFrEF and have been shown to reduce mortality, hospitalizations, and improve symptoms.
Calcium channel blockers are not first-line. Digoxin is used for symptom control but does not
reduce mortality. Diuretics manage fluid overload but do not improve survival.
,3. A patient with atrial fibrillation is prescribed warfarin. The nurse should monitor which
laboratory value to assess the therapeutic effect?
A. aPTT
B. INR
C. Platelet count
D. Bleeding time
Answer: B. INR
Rationale: Warfarin therapy is monitored using the International Normalized Ratio (INR), with a
therapeutic range typically between 2.0-3.0 for atrial fibrillation. aPTT is used to monitor
heparin therapy. Platelet count and bleeding time are not specific indicators of warfarin
effectiveness.
4. A 72-year-old female presents with sudden onset of severe, tearing chest pain radiating to
the back. Her blood pressure is 180/100 in the right arm and 120/70 in the left arm. What is
the priority nursing action?
A. Administer aspirin
B. Administer nitroglycerin
C. Prepare for emergency surgery
D. Obtain a 12-lead ECG
Answer: C. Prepare for emergency surgery
Rationale: The presentation of tearing chest pain with a difference in blood pressure between
arms suggests aortic dissection, a life-threatening emergency requiring immediate surgical
intervention. Aspirin and nitroglycerin are used for MI but are contraindicated in aortic
dissection. An ECG is important but not the priority when dissection is suspected.
5. A patient is in cardiogenic shock. Which hemodynamic parameter would the nurse expect
to find?
A. Low cardiac output and high systemic vascular resistance
B. High cardiac output and low systemic vascular resistance
C. Low cardiac output and low systemic vascular resistance
D. High cardiac output and high systemic vascular resistance
Answer: A. Low cardiac output and high systemic vascular resistance
Rationale: Cardiogenic shock is characterized by low cardiac output and high systemic vascular
resistance. The heart is unable to pump effectively, leading to decreased CO and compensatory
vasoconstriction. This is in contrast to distributive shock (sepsis) where CO is high and SVR is
low.
,6. A patient is prescribed amiodarone for ventricular arrhythmias. Which adverse effect
requires ongoing monitoring?
A. Pulmonary fibrosis
B. Hypothyroidism
C. Corneal deposits
D. All of the above
Answer: D. All of the above
Rationale: Amiodarone can cause pulmonary fibrosis, thyroid dysfunction (both hyper and
hypothyroidism), corneal deposits, blue-gray skin discoloration, and hepatotoxicity. Regular
monitoring of pulmonary function, thyroid levels, liver function, and ophthalmologic
examination is required.
7. A 65-year-old male with a history of hypertension presents with a 1-hour history of
substernal chest pressure, diaphoresis, and nausea. ECG shows ST-segment elevation in the
anterior leads. What is the most appropriate initial treatment?
A. Thrombolytic therapy
B. Percutaneous coronary intervention (PCI)
C. Nitroglycerin
D. Morphine
Answer: B. Percutaneous coronary intervention (PCI)
Rationale: In a patient with STEMI, PCI is the preferred reperfusion strategy if it can be
performed within 90 minutes of arrival. Thrombolytic therapy is an alternative if PCI is not
available. Nitroglycerin and morphine are for symptom management, not reperfusion.
8. A patient with heart failure is prescribed spironolactone. Which laboratory value should
the nurse monitor closely?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Answer: A. Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia. Serum
potassium should be monitored closely, especially with concurrent use of ACE inhibitors, ARBs,
or potassium supplements. Hypokalemia is associated with loop and thiazide diuretics.
, 9. A patient with a history of DVT is being discharged on enoxaparin. The nurse should
instruct the patient to:
A. Massage the injection site after administration
B. Administer the medication subcutaneously in the abdomen
C. Administer the medication intramuscularly
D. Take the medication with food
Answer: B. Administer the medication subcutaneously in the abdomen
Rationale: Enoxaparin (Lovenox) is a low molecular weight heparin administered by
subcutaneous injection in the abdomen. The injection site should not be massaged to prevent
bruising. It is not given IM or orally. Food does not affect absorption.
10. A patient is in cardiac arrest. The cardiac monitor shows ventricular fibrillation. What is
the priority intervention?
A. Administer epinephrine
B. Defibrillate
C. Administer amiodarone
D. Continue CPR
Answer: B. Defibrillate
Rationale: Ventricular fibrillation is a shockable rhythm requiring immediate defibrillation. CPR
should be performed while preparing the defibrillator. Epinephrine and amiodarone are given
after defibrillation attempts or if the rhythm is refractory.
11. A patient with peripheral artery disease (PAD) is being discharged. Which instruction
should the nurse include in the teaching plan?
A. Apply heat to the affected extremity
B. Elevate the legs above heart level
C. Stop smoking
D. Wear tight-fitting clothing
Answer: C. Stop smoking
Rationale: Smoking cessation is the most important intervention for PAD as nicotine causes
vasoconstriction and impairs circulation. Heat application can cause burns due to decreased
sensation. Elevation worsens ischemia in PAD (unlike venous insufficiency where elevation is
helpful). Tight clothing constricts vessels.
12. A patient with deep vein thrombosis is prescribed heparin infusion. The nurse should
monitor for which complication?
