WGU D446 Adult Health II Objective Assessment (OA)
Exam | Complete Practice Questions, Correct Answers &
Detailed Rationales (2026/2027)
Question 1
A patient is admitted with acute decompensated heart failure
(ADHF) and pulmonary edema. Which medication order should the
nurse anticipate administering first to rapidly reduce preload?
• A. Digoxin 0.25 mg IV
• B. Furosemide 40 mg IV push
• C. Metoprolol 5 mg IV push
• D. Lisinopril 10 mg orally
Correct Answer: B. Furosemide 40 mg IV push
Detailed Rationale: Loop diuretics like furosemide act rapidly
intravenously to promote diuresis, reducing venous return (preload)
and relieving pulmonary congestion in acute heart failure.
Question 2
A patient with acute pericarditis reports sharp, severe chest pain.
Which clinical manifestation would lead the nurse to suspect the
development of cardiac tamponade?
• A. Bradycardia and bounding peripheral pulses
, • B. Hypotension, muffled heart sounds, and jugular venous
distention (Beck's triad)
• C. Hypertension and widening pulse pressure
• D. Persistent left arm numbness and diaphoresis
Correct Answer: B. Hypotension, muffled heart sounds, and
jugular venous distention (Beck's triad)
Detailed Rationale: Cardiac tamponade involves fluid
accumulation in the pericardial sac compressing the heart, resulting in
Beck's triad (hypotension, JVD, muffled heart sounds) and decreased
cardiac output.
Question 3
A nurse is assessing a client with infective endocarditis. Which
finding represents a peripheral vascular complication of
microembolization?
• A. Janeway lesions, Osler's nodes, and splinter hemorrhages in the
nail beds
• B. Generalized petechiae over the abdomen only
• C. Bilateral lower extremity pitting edema
• D. Asymmetric calf swelling and positive Homans' sign
Correct Answer: A. Janeway lesions, Osler's nodes, and splinter
hemorrhages in the nail beds
Detailed Rationale: Infective endocarditis causes vegetation on
heart valves that can break off into microemboli, manifesting as
,painless hemorrhagic macules (Janeway lesions), painful nodes (Osler's
nodes), and splinter hemorrhages.
Question 4
Which assessment finding is most characteristic of a patient
experiencing a left-sided acute myocardial infarction (MI) with
cardiogenic shock?
• A. Peripheral edema and jugular venous distention
• B. Crackles in lung bases, cool clammy skin, and diminished urine
output
• C. Weight gain and ascites
• D. Warm, flushed extremities and bounding pulses
Correct Answer: B. Crackles in lung bases, cool clammy skin, and
diminished urine output
Detailed Rationale: Left-sided pump failure causes pulmonary
congestion (crackles) and poor systemic tissue perfusion, leading to
cool, clammy skin and oliguria due to reduced renal blood flow.
Question 5
A patient is scheduled for a coronary artery bypass graft (CABG).
Which pre-operative teaching point is most critical for preventing post-
operative respiratory complications?
• A. Complete bed rest for 48 hours post-op
• B. Demonstrating how to use an incentive spirometer and perform
deep breathing and coughing exercises
• C. Restricting all fluid intake prior to surgery
, • D. Avoiding all movement of the lower extremities
Correct Answer: B. Demonstrating how to use an incentive
spirometer and perform deep breathing and coughing exercises
Detailed Rationale: Pre-op instruction on incentive spirometry
and pulmonary hygiene is vital to prevent atelectasis and pneumonia
following general anesthesia and sternotomy.
Question 6
A client presents to the emergency department with tearing chest
pain radiating to the back and a blood pressure differential between the
right and left arms. What condition is most likely?
• A. Myocardial infarction
• B. Acute aortic dissection
• C. Pulmonary embolism
• D. Stable angina
Correct Answer: B. Acute aortic dissection
Detailed Rationale: A tearing or ripping chest pain radiating to the
back, coupled with unequal blood pressure readings in the upper
extremities, is classic for an aortic dissection.
Question 7
Which intervention is the primary priority when managing a
patient experiencing symptomatic ventricular tachycardia with a pulse?
• A. Immediate synchronized cardioversion
• B. Administration of oral beta-blockers
Exam | Complete Practice Questions, Correct Answers &
Detailed Rationales (2026/2027)
Question 1
A patient is admitted with acute decompensated heart failure
(ADHF) and pulmonary edema. Which medication order should the
nurse anticipate administering first to rapidly reduce preload?
• A. Digoxin 0.25 mg IV
• B. Furosemide 40 mg IV push
• C. Metoprolol 5 mg IV push
• D. Lisinopril 10 mg orally
Correct Answer: B. Furosemide 40 mg IV push
Detailed Rationale: Loop diuretics like furosemide act rapidly
intravenously to promote diuresis, reducing venous return (preload)
and relieving pulmonary congestion in acute heart failure.
Question 2
A patient with acute pericarditis reports sharp, severe chest pain.
Which clinical manifestation would lead the nurse to suspect the
development of cardiac tamponade?
• A. Bradycardia and bounding peripheral pulses
, • B. Hypotension, muffled heart sounds, and jugular venous
distention (Beck's triad)
• C. Hypertension and widening pulse pressure
• D. Persistent left arm numbness and diaphoresis
Correct Answer: B. Hypotension, muffled heart sounds, and
jugular venous distention (Beck's triad)
Detailed Rationale: Cardiac tamponade involves fluid
accumulation in the pericardial sac compressing the heart, resulting in
Beck's triad (hypotension, JVD, muffled heart sounds) and decreased
cardiac output.
Question 3
A nurse is assessing a client with infective endocarditis. Which
finding represents a peripheral vascular complication of
microembolization?
• A. Janeway lesions, Osler's nodes, and splinter hemorrhages in the
nail beds
• B. Generalized petechiae over the abdomen only
• C. Bilateral lower extremity pitting edema
• D. Asymmetric calf swelling and positive Homans' sign
Correct Answer: A. Janeway lesions, Osler's nodes, and splinter
hemorrhages in the nail beds
Detailed Rationale: Infective endocarditis causes vegetation on
heart valves that can break off into microemboli, manifesting as
,painless hemorrhagic macules (Janeway lesions), painful nodes (Osler's
nodes), and splinter hemorrhages.
Question 4
Which assessment finding is most characteristic of a patient
experiencing a left-sided acute myocardial infarction (MI) with
cardiogenic shock?
• A. Peripheral edema and jugular venous distention
• B. Crackles in lung bases, cool clammy skin, and diminished urine
output
• C. Weight gain and ascites
• D. Warm, flushed extremities and bounding pulses
Correct Answer: B. Crackles in lung bases, cool clammy skin, and
diminished urine output
Detailed Rationale: Left-sided pump failure causes pulmonary
congestion (crackles) and poor systemic tissue perfusion, leading to
cool, clammy skin and oliguria due to reduced renal blood flow.
Question 5
A patient is scheduled for a coronary artery bypass graft (CABG).
Which pre-operative teaching point is most critical for preventing post-
operative respiratory complications?
• A. Complete bed rest for 48 hours post-op
• B. Demonstrating how to use an incentive spirometer and perform
deep breathing and coughing exercises
• C. Restricting all fluid intake prior to surgery
, • D. Avoiding all movement of the lower extremities
Correct Answer: B. Demonstrating how to use an incentive
spirometer and perform deep breathing and coughing exercises
Detailed Rationale: Pre-op instruction on incentive spirometry
and pulmonary hygiene is vital to prevent atelectasis and pneumonia
following general anesthesia and sternotomy.
Question 6
A client presents to the emergency department with tearing chest
pain radiating to the back and a blood pressure differential between the
right and left arms. What condition is most likely?
• A. Myocardial infarction
• B. Acute aortic dissection
• C. Pulmonary embolism
• D. Stable angina
Correct Answer: B. Acute aortic dissection
Detailed Rationale: A tearing or ripping chest pain radiating to the
back, coupled with unequal blood pressure readings in the upper
extremities, is classic for an aortic dissection.
Question 7
Which intervention is the primary priority when managing a
patient experiencing symptomatic ventricular tachycardia with a pulse?
• A. Immediate synchronized cardioversion
• B. Administration of oral beta-blockers
