WGU D446 Adult Health II Objective Assessment
(OA): Advanced Clinical Judgment & Complex
Care Exam Study Guide | Complete Actual Exam
Questions with 100% Verified Correct Answers
and Detailed Rationales | Latest Updated Edition
2026/2027 - Already Graded A+
Question 1
A client with pheochromocytoma (adrenal gland tumor) reports the onset of a severe
headache. The nurse observes that the client is very diaphoretic (sweating heavily).
Which assessment data should the nurse obtain next?
A. Heart rate
B. Lung sounds
C. Temperature
D. Blood pressure
Answer: D
Rationale: Pheochromocytoma causes excessive catecholamine release, leading to
hypertension, headache, and diaphoresis. Blood pressure is the priority assessment to
evaluate for hypertensive crisis, which is the most life-threatening complication.
Question 2
An obese client with emphysema who smokes at least a pack of cigarettes daily is
admitted after experiencing a sudden increase in dyspnea and activity intolerance.
Oxygen therapy is initiated and it's determined that the client will be discharged with
oxygen. Which information is most important for the nurse to emphasize in the discharge
teaching plan?
A. Strict IV fluid replacement
B. Approaches to conserve energy
C. Guidelines for oxygen use
D. Methods for weight loss
pg. 1
,Answer: C
Rationale: Oxygen safety is the priority for a client being discharged with home oxygen.
Guidelines include keeping oxygen away from flames, avoiding petroleum-based
products, and ensuring proper storage. Safety issues are life-threatening and must be
emphasized.
Question 3
The nurse is preparing a client for surgery who was admitted to the emergency center
following a motor vehicle collision. The client has an open fracture of the femur and is
bleeding moderately from the bone protrusion site. During the preoperative assessment,
the nurse determines that the client currently receives heparin sodium 5,000 units
subcutaneously daily. What is the priority nursing action?
A. Observe the heparin injection sites for signs of bruising
B. Notify the healthcare provider of the client's medication history
C. Obtain a 12-lead electrocardiogram and begin continuous cardiac monitoring
D. Observe the heparin injection sites for signs of bruising
Answer: B
Rationale: Heparin is an anticoagulant that increases bleeding risk during surgery. The
provider must be notified immediately so the medication can be managed appropriately
before surgery, potentially reversing the anticoagulant effect.
Question 4
A female college student comes to the school's health clinic complaining of urinary
frequency and burning with right lower back pain. Which intervention should the nurse
implement first?
A. Encourage the client to drink 2 liters of water
B. Administer a broad-spectrum antibiotic immediately
C. Assess her abdominal sounds and bowel movements
D. Measure her temperature and pulse rate
Answer: D
Rationale: The client's symptoms suggest a urinary tract infection that could progress to
pyelonephritis. Measuring temperature and pulse rate assesses for systemic infection,
which is the priority before implementing other interventions.
pg. 2
,Question 5
A client receives a prescription for 1 liter of Ringer's intravenously to be infused over 6
hours. How many mL/hr should the nurse program the infusion pump to deliver? (Enter
numerical value only. If rounding is required, round to the nearest whole number.)
A. 187 mL
B. 167 mL
C. 333 mL
D. 1000 mL
Answer: B
Rationale: 1000 mL ÷ 6 hours = 166.6 ≈ 167 mL/hour.
Question 6
A nurse is performing a fingerstick blood glucose check. After milking the finger, the
fingertip becomes engorged. What should the nurse do next?
A. Prick the finger again in a different spot
B. Milk the finger more vigorously to increase blood flow
C. Continue to obtain the sample
D. Wipe the finger with alcohol and wait 30 seconds
Answer: A
Rationale: Milking the finger can cause tissue fluid to mix with blood, leading to
inaccurate glucose readings. The nurse should use a different finger or prick another site
to obtain an accurate sample.
Question 7
John, a 28-year-old male, is admitted to the emergency department with complaints of
worsening shortness of breath, chest tightness, and a dry cough for the past 24 hours. He
has a history of asthma but admits to inconsistent use of his prescribed inhalers,
particularly the corticosteroid inhaler. On examination, his respiratory rate is 24 breaths
per minute, heart rate is 104 beats per minute, and blood pressure is 130/80 mmHg. His
oxygen saturation is 93%, and he has bilateral expiratory wheezing on auscultation. A
peak flow measurement reveals 60% of his personal best. What is the primary purpose of
a peak flow meter for asthma management?
pg. 3
, A. Assess pulses with a vascular Doppler
B. Obtain a follow-up appointment to reassess his asthma control
C. Monitor for signs of infection
D. To assess the level of airway obstruction and monitor asthma control
Answer: D
Rationale: Peak flow meters measure the maximum speed of expiration, providing an
objective assessment of airway obstruction. They help monitor asthma control and guide
treatment decisions.
Question 8
A client receives a prescription for 1 liter of Ringer's intravenously to be infused over 6
hours. How many mL/hr should the nurse program the infusion pump to deliver? (Enter
numerical value only. If rounding is required, round to the nearest whole number.)
A. 187 mL
B. 1000 mL
C. 167 mL
D. 333 mL
Answer: C
Rationale: 1000 mL ÷ 6 hours = 166.6 ≈ 167 mL/hour.
Question 9
Which of the following is the most likely trigger for Emily's asthma exacerbation?
A. Uremia due to lupus nephritis
B. Stress and cooler weather
C. Oral thrush
D. Increased pain that is unrelieved by analgesics
Answer: B
Rationale: Asthma exacerbations are commonly triggered by stress and environmental
factors such as cooler weather. The patient's history of recent stress and weather changes
indicates these are likely triggers.
pg. 4
(OA): Advanced Clinical Judgment & Complex
Care Exam Study Guide | Complete Actual Exam
Questions with 100% Verified Correct Answers
and Detailed Rationales | Latest Updated Edition
2026/2027 - Already Graded A+
Question 1
A client with pheochromocytoma (adrenal gland tumor) reports the onset of a severe
headache. The nurse observes that the client is very diaphoretic (sweating heavily).
Which assessment data should the nurse obtain next?
A. Heart rate
B. Lung sounds
C. Temperature
D. Blood pressure
Answer: D
Rationale: Pheochromocytoma causes excessive catecholamine release, leading to
hypertension, headache, and diaphoresis. Blood pressure is the priority assessment to
evaluate for hypertensive crisis, which is the most life-threatening complication.
Question 2
An obese client with emphysema who smokes at least a pack of cigarettes daily is
admitted after experiencing a sudden increase in dyspnea and activity intolerance.
Oxygen therapy is initiated and it's determined that the client will be discharged with
oxygen. Which information is most important for the nurse to emphasize in the discharge
teaching plan?
A. Strict IV fluid replacement
B. Approaches to conserve energy
C. Guidelines for oxygen use
D. Methods for weight loss
pg. 1
,Answer: C
Rationale: Oxygen safety is the priority for a client being discharged with home oxygen.
Guidelines include keeping oxygen away from flames, avoiding petroleum-based
products, and ensuring proper storage. Safety issues are life-threatening and must be
emphasized.
Question 3
The nurse is preparing a client for surgery who was admitted to the emergency center
following a motor vehicle collision. The client has an open fracture of the femur and is
bleeding moderately from the bone protrusion site. During the preoperative assessment,
the nurse determines that the client currently receives heparin sodium 5,000 units
subcutaneously daily. What is the priority nursing action?
A. Observe the heparin injection sites for signs of bruising
B. Notify the healthcare provider of the client's medication history
C. Obtain a 12-lead electrocardiogram and begin continuous cardiac monitoring
D. Observe the heparin injection sites for signs of bruising
Answer: B
Rationale: Heparin is an anticoagulant that increases bleeding risk during surgery. The
provider must be notified immediately so the medication can be managed appropriately
before surgery, potentially reversing the anticoagulant effect.
Question 4
A female college student comes to the school's health clinic complaining of urinary
frequency and burning with right lower back pain. Which intervention should the nurse
implement first?
A. Encourage the client to drink 2 liters of water
B. Administer a broad-spectrum antibiotic immediately
C. Assess her abdominal sounds and bowel movements
D. Measure her temperature and pulse rate
Answer: D
Rationale: The client's symptoms suggest a urinary tract infection that could progress to
pyelonephritis. Measuring temperature and pulse rate assesses for systemic infection,
which is the priority before implementing other interventions.
pg. 2
,Question 5
A client receives a prescription for 1 liter of Ringer's intravenously to be infused over 6
hours. How many mL/hr should the nurse program the infusion pump to deliver? (Enter
numerical value only. If rounding is required, round to the nearest whole number.)
A. 187 mL
B. 167 mL
C. 333 mL
D. 1000 mL
Answer: B
Rationale: 1000 mL ÷ 6 hours = 166.6 ≈ 167 mL/hour.
Question 6
A nurse is performing a fingerstick blood glucose check. After milking the finger, the
fingertip becomes engorged. What should the nurse do next?
A. Prick the finger again in a different spot
B. Milk the finger more vigorously to increase blood flow
C. Continue to obtain the sample
D. Wipe the finger with alcohol and wait 30 seconds
Answer: A
Rationale: Milking the finger can cause tissue fluid to mix with blood, leading to
inaccurate glucose readings. The nurse should use a different finger or prick another site
to obtain an accurate sample.
Question 7
John, a 28-year-old male, is admitted to the emergency department with complaints of
worsening shortness of breath, chest tightness, and a dry cough for the past 24 hours. He
has a history of asthma but admits to inconsistent use of his prescribed inhalers,
particularly the corticosteroid inhaler. On examination, his respiratory rate is 24 breaths
per minute, heart rate is 104 beats per minute, and blood pressure is 130/80 mmHg. His
oxygen saturation is 93%, and he has bilateral expiratory wheezing on auscultation. A
peak flow measurement reveals 60% of his personal best. What is the primary purpose of
a peak flow meter for asthma management?
pg. 3
, A. Assess pulses with a vascular Doppler
B. Obtain a follow-up appointment to reassess his asthma control
C. Monitor for signs of infection
D. To assess the level of airway obstruction and monitor asthma control
Answer: D
Rationale: Peak flow meters measure the maximum speed of expiration, providing an
objective assessment of airway obstruction. They help monitor asthma control and guide
treatment decisions.
Question 8
A client receives a prescription for 1 liter of Ringer's intravenously to be infused over 6
hours. How many mL/hr should the nurse program the infusion pump to deliver? (Enter
numerical value only. If rounding is required, round to the nearest whole number.)
A. 187 mL
B. 1000 mL
C. 167 mL
D. 333 mL
Answer: C
Rationale: 1000 mL ÷ 6 hours = 166.6 ≈ 167 mL/hour.
Question 9
Which of the following is the most likely trigger for Emily's asthma exacerbation?
A. Uremia due to lupus nephritis
B. Stress and cooler weather
C. Oral thrush
D. Increased pain that is unrelieved by analgesics
Answer: B
Rationale: Asthma exacerbations are commonly triggered by stress and environmental
factors such as cooler weather. The patient's history of recent stress and weather changes
indicates these are likely triggers.
pg. 4
