WGU D446: Adult Health II
Objective Assessment (OA) Mastery Guide 2026
Comprehensive Actual-Style Questions | Detailed Rationales | Pass Guarantee
Neurological - Increased ICP
1. A patient with a head injury has a BP of 180/60, HR 45, and irregular respirations.
Which physiological phenomenon is the patient experiencing?
A. Autonomic Dysreflexia
B. Cushing's Triad
C. Hypovolemic Shock
D. Spinal Shock
Correct Answer: B
Rationale: Cushing's Triad (systolic hypertension with widened pulse pressure, bradycardia, and irregular
respirations) is a late sign of increased intracranial pressure and impending brain herniation.
Cardiac - Hemodynamics (Swan-Ganz)
2. A patient's pulmonary artery wedge pressure (PAWP) is 22 mmHg. Which clinical
condition does this finding most likely suggest?
A. Hypovolemic shock
B. Right-sided heart failure
C. Left-sided heart failure / Hypervolemia
D. Pulmonary embolism
Correct Answer: C
Rationale: Normal PAWP is 6-12 mmHg. An elevation (22 mmHg) indicates increased left ventricular end-
diastolic pressure, commonly seen in left-sided heart failure or fluid volume overload.
D446 OA Study Guide (2026) - Page 1
, Burns - Parkland Formula
3. An adult patient weighs 70 kg and has 40% TBSA burns. Using the Parkland
Formula (4mL/kg/%TBSA), how much fluid should be administered in the first 8
hours?
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 7,000 mL
Correct Answer: A
Rationale: Total 24h fluid = 4mL x 70kg x 40 = 11,200 mL. Half of the total (5,600 mL) must be given in the
first 8 hours from the time of injury.
Respiratory - PE management
4. A patient with a suspected pulmonary embolism (PE) is started on an
Unfractionated Heparin infusion. Which lab value is used to monitor the therapeutic
effect of this medication?
A. PT/INR
B. Platelet count
C. aPTT
D. D-dimer
Correct Answer: C
Rationale: The activated partial thromboplastin time (aPTT) is used to monitor heparin. PT/INR is used for
Warfarin. D-dimer is a diagnostic screening for the presence of a clot but doesn't monitor therapy.
D446 OA Study Guide (2026) - Page 2
, Acid-Base Balance - ABG Interpretation
5. ABG results: pH 7.30, PaCO2 55, HCO3 26. How should the nurse interpret these
findings?
A. Metabolic Acidosis
B. Respiratory Acidosis, uncompensated
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Correct Answer: B
Rationale: The pH is low (acidosis), the PaCO2 is high (respiratory cause), and the HCO3 is normal (no
compensation yet).
Neurological - Increased ICP
6. A patient with a head injury has a BP of 180/60, HR 45, and irregular respirations.
Which physiological phenomenon is the patient experiencing?
A. Autonomic Dysreflexia
B. Cushing's Triad
C. Hypovolemic Shock
D. Spinal Shock
Correct Answer: B
Rationale: Cushing's Triad (systolic hypertension with widened pulse pressure, bradycardia, and irregular
respirations) is a late sign of increased intracranial pressure and impending brain herniation.
D446 OA Study Guide (2026) - Page 3
, Cardiac - Hemodynamics (Swan-Ganz)
7. A patient's pulmonary artery wedge pressure (PAWP) is 22 mmHg. Which clinical
condition does this finding most likely suggest?
A. Hypovolemic shock
B. Right-sided heart failure
C. Left-sided heart failure / Hypervolemia
D. Pulmonary embolism
Correct Answer: C
Rationale: Normal PAWP is 6-12 mmHg. An elevation (22 mmHg) indicates increased left ventricular end-
diastolic pressure, commonly seen in left-sided heart failure or fluid volume overload.
Burns - Parkland Formula
8. An adult patient weighs 70 kg and has 40% TBSA burns. Using the Parkland
Formula (4mL/kg/%TBSA), how much fluid should be administered in the first 8
hours?
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 7,000 mL
Correct Answer: A
Rationale: Total 24h fluid = 4mL x 70kg x 40 = 11,200 mL. Half of the total (5,600 mL) must be given in the
first 8 hours from the time of injury.
D446 OA Study Guide (2026) - Page 4
Objective Assessment (OA) Mastery Guide 2026
Comprehensive Actual-Style Questions | Detailed Rationales | Pass Guarantee
Neurological - Increased ICP
1. A patient with a head injury has a BP of 180/60, HR 45, and irregular respirations.
Which physiological phenomenon is the patient experiencing?
A. Autonomic Dysreflexia
B. Cushing's Triad
C. Hypovolemic Shock
D. Spinal Shock
Correct Answer: B
Rationale: Cushing's Triad (systolic hypertension with widened pulse pressure, bradycardia, and irregular
respirations) is a late sign of increased intracranial pressure and impending brain herniation.
Cardiac - Hemodynamics (Swan-Ganz)
2. A patient's pulmonary artery wedge pressure (PAWP) is 22 mmHg. Which clinical
condition does this finding most likely suggest?
A. Hypovolemic shock
B. Right-sided heart failure
C. Left-sided heart failure / Hypervolemia
D. Pulmonary embolism
Correct Answer: C
Rationale: Normal PAWP is 6-12 mmHg. An elevation (22 mmHg) indicates increased left ventricular end-
diastolic pressure, commonly seen in left-sided heart failure or fluid volume overload.
D446 OA Study Guide (2026) - Page 1
, Burns - Parkland Formula
3. An adult patient weighs 70 kg and has 40% TBSA burns. Using the Parkland
Formula (4mL/kg/%TBSA), how much fluid should be administered in the first 8
hours?
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 7,000 mL
Correct Answer: A
Rationale: Total 24h fluid = 4mL x 70kg x 40 = 11,200 mL. Half of the total (5,600 mL) must be given in the
first 8 hours from the time of injury.
Respiratory - PE management
4. A patient with a suspected pulmonary embolism (PE) is started on an
Unfractionated Heparin infusion. Which lab value is used to monitor the therapeutic
effect of this medication?
A. PT/INR
B. Platelet count
C. aPTT
D. D-dimer
Correct Answer: C
Rationale: The activated partial thromboplastin time (aPTT) is used to monitor heparin. PT/INR is used for
Warfarin. D-dimer is a diagnostic screening for the presence of a clot but doesn't monitor therapy.
D446 OA Study Guide (2026) - Page 2
, Acid-Base Balance - ABG Interpretation
5. ABG results: pH 7.30, PaCO2 55, HCO3 26. How should the nurse interpret these
findings?
A. Metabolic Acidosis
B. Respiratory Acidosis, uncompensated
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Correct Answer: B
Rationale: The pH is low (acidosis), the PaCO2 is high (respiratory cause), and the HCO3 is normal (no
compensation yet).
Neurological - Increased ICP
6. A patient with a head injury has a BP of 180/60, HR 45, and irregular respirations.
Which physiological phenomenon is the patient experiencing?
A. Autonomic Dysreflexia
B. Cushing's Triad
C. Hypovolemic Shock
D. Spinal Shock
Correct Answer: B
Rationale: Cushing's Triad (systolic hypertension with widened pulse pressure, bradycardia, and irregular
respirations) is a late sign of increased intracranial pressure and impending brain herniation.
D446 OA Study Guide (2026) - Page 3
, Cardiac - Hemodynamics (Swan-Ganz)
7. A patient's pulmonary artery wedge pressure (PAWP) is 22 mmHg. Which clinical
condition does this finding most likely suggest?
A. Hypovolemic shock
B. Right-sided heart failure
C. Left-sided heart failure / Hypervolemia
D. Pulmonary embolism
Correct Answer: C
Rationale: Normal PAWP is 6-12 mmHg. An elevation (22 mmHg) indicates increased left ventricular end-
diastolic pressure, commonly seen in left-sided heart failure or fluid volume overload.
Burns - Parkland Formula
8. An adult patient weighs 70 kg and has 40% TBSA burns. Using the Parkland
Formula (4mL/kg/%TBSA), how much fluid should be administered in the first 8
hours?
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 7,000 mL
Correct Answer: A
Rationale: Total 24h fluid = 4mL x 70kg x 40 = 11,200 mL. Half of the total (5,600 mL) must be given in the
first 8 hours from the time of injury.
D446 OA Study Guide (2026) - Page 4
