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WGU D344 Objective Assessment 2 Newest 2026
Actual Exam – 200 Complex Clinical Questions with
Verified Answers and Detailed Rationales –
Guaranteed Pass
Question 1. A patient with schizophrenia on clozapine presents with fever,
tachycardia, muscle rigidity, and altered mental status. Which complication
should the nurse suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Acute dystonia
D. Tardive dyskinesia
Answer: A
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening
reaction to antipsychotics characterized by fever, muscle rigidity, autonomic
instability, and altered mental status. Clozapine is an antipsychotic, though
NMS is more common with typical antipsychotics, it can occur with atypicals.
Serotonin syndrome presents with hyperreflexia, clonus, and diarrhea, and is
associated with serotonergic drugs. Acute dystonia involves muscle spasms,
and tardive dyskinesia involves involuntary movements.
Question 2. A patient with bipolar I disorder is started on lithium. Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum lithium level
C. Serum potassium
,2
D. Serum calcium
Answer: B
Rationale: Lithium has a narrow therapeutic index (0.6-1.2 mEq/L). Levels
above 1.5 mEq/L can cause toxicity. Monitoring lithium levels is essential.
Sodium and potassium are not directly affected by lithium in the same way,
though sodium depletion can increase lithium levels.
Question 3. A patient with major depressive disorder is prescribed phenelzine.
Which dietary instruction is essential?
A. Avoid foods high in vitamin K
B. Avoid tyramine-containing foods
C. Avoid dairy products
D. Avoid green leafy vegetables
Answer: B
Rationale: Phenelzine is an MAOI. Tyramine-rich foods (aged cheese, cured
meats, fermented products) can precipitate a hypertensive crisis. Vitamin K,
dairy, and green leafy vegetables are not restricted for MAOIs.
Question 4. A patient with obsessive-compulsive disorder is receiving
fluvoxamine. Which statement indicates understanding?
A. "I should take this medication only when I feel anxious."
B. "It may take several weeks before I notice improvement."
C. "I can stop the medication once my compulsions stop."
D. "This medication will cure my OCD immediately."
,3
Answer: B
Rationale: SSRIs like fluvoxamine take 4-6 weeks to show full effect. They
should be taken consistently, not PRN. They are not curative but manage
symptoms. Stopping abruptly can cause discontinuation syndrome.
Question 5. A patient with panic disorder is prescribed alprazolam. Which
instruction should the nurse include?
A. "Take this medication daily to prevent panic attacks."
B. "This medication is for long-term management."
C. "Avoid alcohol and other CNS depressants."
D. "You can stop the medication abruptly without issues."
Answer: C
Rationale: Alprazolam is a benzodiazepine used for short-term anxiety relief.
It can cause CNS depression, and alcohol increases this risk. It is not for long-
term management due to dependence risk. It should be tapered, not stopped
abruptly.
Question 6. A patient with schizophrenia reports hearing voices telling him to
hurt himself. Which response by the nurse is most therapeutic?
A. "The voices are not real. You should ignore them."
B. "What are the voices telling you to do?"
C. "I understand you are hearing voices. Let's talk about how you feel about
them."
D. "You need to take your medication to make the voices stop."
Answer: C
, 4
Rationale: The most therapeutic response acknowledges the patient's
experience without validating the hallucination and focuses on the patient's
feelings. Asking what the voices are saying (B) can reinforce the hallucination
and increase risk. Arguing (A) damages trust. Focusing solely on medication
(D) dismisses the patient's current distress.
Question 7. A patient with borderline personality disorder threatens to kill
herself if the nurse leaves at the end of the shift. Which action should the
nurse take first?
A. Ask the patient if she has a specific plan.
B. Reassure the patient that she will be safe.
C. Tell the patient that threatening suicide is manipulative.
D. Stay with the patient until the next shift arrives.
Answer: A
Rationale: The priority is to assess suicide risk. Asking about a plan is a direct,
therapeutic way to evaluate lethality. Reassurance (B) may be false. Accusing
the patient (C) damages rapport. Staying (D) may reinforce manipulative
behavior and is not a sustainable intervention; assessment comes first.
Question 8. A patient with anorexia nervosa is admitted with a BMI of 15.
Which finding is most concerning?
A. Lanugo
B. Bradycardia
C. Amenorrhea
D. Cold intolerance
Answer: B
WGU D344 Objective Assessment 2 Newest 2026
Actual Exam – 200 Complex Clinical Questions with
Verified Answers and Detailed Rationales –
Guaranteed Pass
Question 1. A patient with schizophrenia on clozapine presents with fever,
tachycardia, muscle rigidity, and altered mental status. Which complication
should the nurse suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Acute dystonia
D. Tardive dyskinesia
Answer: A
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening
reaction to antipsychotics characterized by fever, muscle rigidity, autonomic
instability, and altered mental status. Clozapine is an antipsychotic, though
NMS is more common with typical antipsychotics, it can occur with atypicals.
Serotonin syndrome presents with hyperreflexia, clonus, and diarrhea, and is
associated with serotonergic drugs. Acute dystonia involves muscle spasms,
and tardive dyskinesia involves involuntary movements.
Question 2. A patient with bipolar I disorder is started on lithium. Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum lithium level
C. Serum potassium
,2
D. Serum calcium
Answer: B
Rationale: Lithium has a narrow therapeutic index (0.6-1.2 mEq/L). Levels
above 1.5 mEq/L can cause toxicity. Monitoring lithium levels is essential.
Sodium and potassium are not directly affected by lithium in the same way,
though sodium depletion can increase lithium levels.
Question 3. A patient with major depressive disorder is prescribed phenelzine.
Which dietary instruction is essential?
A. Avoid foods high in vitamin K
B. Avoid tyramine-containing foods
C. Avoid dairy products
D. Avoid green leafy vegetables
Answer: B
Rationale: Phenelzine is an MAOI. Tyramine-rich foods (aged cheese, cured
meats, fermented products) can precipitate a hypertensive crisis. Vitamin K,
dairy, and green leafy vegetables are not restricted for MAOIs.
Question 4. A patient with obsessive-compulsive disorder is receiving
fluvoxamine. Which statement indicates understanding?
A. "I should take this medication only when I feel anxious."
B. "It may take several weeks before I notice improvement."
C. "I can stop the medication once my compulsions stop."
D. "This medication will cure my OCD immediately."
,3
Answer: B
Rationale: SSRIs like fluvoxamine take 4-6 weeks to show full effect. They
should be taken consistently, not PRN. They are not curative but manage
symptoms. Stopping abruptly can cause discontinuation syndrome.
Question 5. A patient with panic disorder is prescribed alprazolam. Which
instruction should the nurse include?
A. "Take this medication daily to prevent panic attacks."
B. "This medication is for long-term management."
C. "Avoid alcohol and other CNS depressants."
D. "You can stop the medication abruptly without issues."
Answer: C
Rationale: Alprazolam is a benzodiazepine used for short-term anxiety relief.
It can cause CNS depression, and alcohol increases this risk. It is not for long-
term management due to dependence risk. It should be tapered, not stopped
abruptly.
Question 6. A patient with schizophrenia reports hearing voices telling him to
hurt himself. Which response by the nurse is most therapeutic?
A. "The voices are not real. You should ignore them."
B. "What are the voices telling you to do?"
C. "I understand you are hearing voices. Let's talk about how you feel about
them."
D. "You need to take your medication to make the voices stop."
Answer: C
, 4
Rationale: The most therapeutic response acknowledges the patient's
experience without validating the hallucination and focuses on the patient's
feelings. Asking what the voices are saying (B) can reinforce the hallucination
and increase risk. Arguing (A) damages trust. Focusing solely on medication
(D) dismisses the patient's current distress.
Question 7. A patient with borderline personality disorder threatens to kill
herself if the nurse leaves at the end of the shift. Which action should the
nurse take first?
A. Ask the patient if she has a specific plan.
B. Reassure the patient that she will be safe.
C. Tell the patient that threatening suicide is manipulative.
D. Stay with the patient until the next shift arrives.
Answer: A
Rationale: The priority is to assess suicide risk. Asking about a plan is a direct,
therapeutic way to evaluate lethality. Reassurance (B) may be false. Accusing
the patient (C) damages rapport. Staying (D) may reinforce manipulative
behavior and is not a sustainable intervention; assessment comes first.
Question 8. A patient with anorexia nervosa is admitted with a BMI of 15.
Which finding is most concerning?
A. Lanugo
B. Bradycardia
C. Amenorrhea
D. Cold intolerance
Answer: B
