WGU D446 Adult Health 2 — Comprehensive
Study Guide & NGN-Style Prac ce Ques ons
2026
1. A client with acute pulmonary edema is severely dyspneic and has an oxygen saturation of
82%. Which intervention should the nurse implement first?
A. Administer prescribed IV furosemide
B. Place the client in high-Fowler's position
C. Obtain a complete medication history
D. Restrict the client's oral fluid intake
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning promotes maximum lung expansion and can immediately
improve ventilation and reduce the work of breathing. Medication administration and fluid
restriction may be necessary but are not the immediate priority for severe respiratory distress.
2. A client with heart failure is receiving digoxin. Which finding requires the nurse's immediate
attention?
A. Apical pulse of 54/min
B. Blood pressure of 138/82 mmHg
C. Respiratory rate of 18/min
D. Potassium level of 4.2 mEq/L
Answer: A. Apical pulse of 54/min
Rationale: Digoxin can cause bradycardia, and an apical pulse below the commonly accepted
administration threshold of 60/min requires withholding the medication and notifying the
provider according to the prescription/protocol. The other findings are not immediately
concerning.
3. A client experiencing an acute myocardial infarction reports crushing substernal chest pain.
Which assessment finding is most concerning?
,A. Pain radiating to the left arm
B. Diaphoresis
C. New-onset ventricular dysrhythmia
D. Mild anxiety
Answer: C. New-onset ventricular dysrhythmia
Rationale: Ventricular dysrhythmias can rapidly compromise cardiac output and progress to
cardiac arrest. Chest pain, diaphoresis, and anxiety are common manifestations of acute
myocardial infarction but are less immediately life-threatening than a new unstable ventricular
rhythm.
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen. Which
nursing action is most appropriate?
A. Maintain oxygen at the highest possible flow rate
B. Titrate oxygen according to the prescribed target saturation
C. Discontinue oxygen when the client becomes sleepy
D. Encourage prolonged breath-holding exercises
Answer: B. Titrate oxygen according to the prescribed target saturation
Rationale: Oxygen therapy in COPD should be carefully titrated to the prescribed target
because excessive oxygen can worsen hypercapnia in susceptible patients. Oxygen should not be
withheld when clinically indicated.
5. A client with an acute ischemic stroke suddenly develops difficulty speaking and right-sided
weakness. Which action has the highest priority?
A. Give the client oral fluids
B. Determine the time the symptoms began
C. Place the client in Trendelenburg position
D. Encourage the client to ambulate
Answer: B. Determine the time the symptoms began
Rationale: The exact time of symptom onset or the last-known-well time is critical when
determining eligibility for time-sensitive stroke therapies. Oral intake and ambulation should be
avoided until swallowing and neurological safety are assessed.
,6. A client with increased intracranial pressure is being monitored in the intensive care unit.
Which finding requires immediate intervention?
A. Headache
B. Restlessness
C. Unequal pupils
D. Mild nausea
Answer: C. Unequal pupils
Rationale: New unequal pupils can indicate worsening neurological compromise and possible
brain herniation. This is an emergency requiring immediate assessment and intervention.
7. A client with acute kidney injury has a potassium level of 6.4 mEq/L. Which assessment
finding should the nurse anticipate?
A. Peaked T waves
B. Flattened T waves
C. Increased bowel sounds only
D. Severe hypoglycemia
Answer: A. Peaked T waves
Rationale: Hyperkalemia can cause characteristic ECG changes, including peaked T waves, and
can progress to life-threatening cardiac dysrhythmias. A potassium level of 6.4 mEq/L requires
urgent evaluation and treatment.
8. A client with diabetic ketoacidosis (DKA) arrives in the emergency department. Which
intervention is generally the initial priority?
A. Begin isotonic IV fluid replacement
B. Administer long-acting insulin
C. Restrict fluids
D. Give oral glucose
Answer: A. Begin isotonic IV fluid replacement
Rationale: Significant dehydration and volume depletion are characteristic of DKA. Initial
management generally includes isotonic IV fluid replacement, followed by insulin and careful
electrolyte management.
, 9. A client with syndrome of inappropriate antidiuretic hormone secretion (SIADH) has a serum
sodium level of 118 mEq/L. Which finding is most concerning?
A. Increased thirst
B. Confusion and seizure activity
C. Dry skin
D. Increased urine output
Answer: B. Confusion and seizure activity
Rationale: Severe hyponatremia can cause cerebral edema and neurological deterioration,
including seizures and decreased level of consciousness. These findings require immediate
intervention.
10. A client with a gastrointestinal bleed has a blood pressure of 86/52 mmHg, heart rate of
128/min, cool clammy skin, and altered mental status. Which nursing action has the highest
priority?
A. Obtain a dietary history
B. Establish or maintain large-bore IV access
C. Administer an oral antacid
D. Encourage the client to sit upright and eat
Answer: B. Establish or maintain large-bore IV access
Rationale: The findings indicate possible hypovolemic shock from acute blood loss. Rapid
vascular access is essential for fluid and blood-product resuscitation and administration of
emergency medications.
11. A client with heart failure reports a 3-kg weight gain over 3 days. Which action is most
appropriate?
A. Encourage increased fluid intake
B. Notify the healthcare provider
C. Encourage a high-sodium diet
D. Reassure the client that the change is expected
Answer: B. Notify the healthcare provider
Rationale: A rapid weight gain suggests fluid retention and worsening heart failure. Prompt
evaluation is needed so treatment can be adjusted.
Study Guide & NGN-Style Prac ce Ques ons
2026
1. A client with acute pulmonary edema is severely dyspneic and has an oxygen saturation of
82%. Which intervention should the nurse implement first?
A. Administer prescribed IV furosemide
B. Place the client in high-Fowler's position
C. Obtain a complete medication history
D. Restrict the client's oral fluid intake
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning promotes maximum lung expansion and can immediately
improve ventilation and reduce the work of breathing. Medication administration and fluid
restriction may be necessary but are not the immediate priority for severe respiratory distress.
2. A client with heart failure is receiving digoxin. Which finding requires the nurse's immediate
attention?
A. Apical pulse of 54/min
B. Blood pressure of 138/82 mmHg
C. Respiratory rate of 18/min
D. Potassium level of 4.2 mEq/L
Answer: A. Apical pulse of 54/min
Rationale: Digoxin can cause bradycardia, and an apical pulse below the commonly accepted
administration threshold of 60/min requires withholding the medication and notifying the
provider according to the prescription/protocol. The other findings are not immediately
concerning.
3. A client experiencing an acute myocardial infarction reports crushing substernal chest pain.
Which assessment finding is most concerning?
,A. Pain radiating to the left arm
B. Diaphoresis
C. New-onset ventricular dysrhythmia
D. Mild anxiety
Answer: C. New-onset ventricular dysrhythmia
Rationale: Ventricular dysrhythmias can rapidly compromise cardiac output and progress to
cardiac arrest. Chest pain, diaphoresis, and anxiety are common manifestations of acute
myocardial infarction but are less immediately life-threatening than a new unstable ventricular
rhythm.
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen. Which
nursing action is most appropriate?
A. Maintain oxygen at the highest possible flow rate
B. Titrate oxygen according to the prescribed target saturation
C. Discontinue oxygen when the client becomes sleepy
D. Encourage prolonged breath-holding exercises
Answer: B. Titrate oxygen according to the prescribed target saturation
Rationale: Oxygen therapy in COPD should be carefully titrated to the prescribed target
because excessive oxygen can worsen hypercapnia in susceptible patients. Oxygen should not be
withheld when clinically indicated.
5. A client with an acute ischemic stroke suddenly develops difficulty speaking and right-sided
weakness. Which action has the highest priority?
A. Give the client oral fluids
B. Determine the time the symptoms began
C. Place the client in Trendelenburg position
D. Encourage the client to ambulate
Answer: B. Determine the time the symptoms began
Rationale: The exact time of symptom onset or the last-known-well time is critical when
determining eligibility for time-sensitive stroke therapies. Oral intake and ambulation should be
avoided until swallowing and neurological safety are assessed.
,6. A client with increased intracranial pressure is being monitored in the intensive care unit.
Which finding requires immediate intervention?
A. Headache
B. Restlessness
C. Unequal pupils
D. Mild nausea
Answer: C. Unequal pupils
Rationale: New unequal pupils can indicate worsening neurological compromise and possible
brain herniation. This is an emergency requiring immediate assessment and intervention.
7. A client with acute kidney injury has a potassium level of 6.4 mEq/L. Which assessment
finding should the nurse anticipate?
A. Peaked T waves
B. Flattened T waves
C. Increased bowel sounds only
D. Severe hypoglycemia
Answer: A. Peaked T waves
Rationale: Hyperkalemia can cause characteristic ECG changes, including peaked T waves, and
can progress to life-threatening cardiac dysrhythmias. A potassium level of 6.4 mEq/L requires
urgent evaluation and treatment.
8. A client with diabetic ketoacidosis (DKA) arrives in the emergency department. Which
intervention is generally the initial priority?
A. Begin isotonic IV fluid replacement
B. Administer long-acting insulin
C. Restrict fluids
D. Give oral glucose
Answer: A. Begin isotonic IV fluid replacement
Rationale: Significant dehydration and volume depletion are characteristic of DKA. Initial
management generally includes isotonic IV fluid replacement, followed by insulin and careful
electrolyte management.
, 9. A client with syndrome of inappropriate antidiuretic hormone secretion (SIADH) has a serum
sodium level of 118 mEq/L. Which finding is most concerning?
A. Increased thirst
B. Confusion and seizure activity
C. Dry skin
D. Increased urine output
Answer: B. Confusion and seizure activity
Rationale: Severe hyponatremia can cause cerebral edema and neurological deterioration,
including seizures and decreased level of consciousness. These findings require immediate
intervention.
10. A client with a gastrointestinal bleed has a blood pressure of 86/52 mmHg, heart rate of
128/min, cool clammy skin, and altered mental status. Which nursing action has the highest
priority?
A. Obtain a dietary history
B. Establish or maintain large-bore IV access
C. Administer an oral antacid
D. Encourage the client to sit upright and eat
Answer: B. Establish or maintain large-bore IV access
Rationale: The findings indicate possible hypovolemic shock from acute blood loss. Rapid
vascular access is essential for fluid and blood-product resuscitation and administration of
emergency medications.
11. A client with heart failure reports a 3-kg weight gain over 3 days. Which action is most
appropriate?
A. Encourage increased fluid intake
B. Notify the healthcare provider
C. Encourage a high-sodium diet
D. Reassure the client that the change is expected
Answer: B. Notify the healthcare provider
Rationale: A rapid weight gain suggests fluid retention and worsening heart failure. Prompt
evaluation is needed so treatment can be adjusted.
