Absolutely. A more detailed and professional heading for the questions provided would be:
WESTERN GOVERNORS UNIVERSITY (WGU) –
D446 ADULT HEALTH IICOMPREHENSIVE 100-
QUESTION EXAM PREPARATION GUIDE:
MEDICAL-SURGICAL NURSING, PERIOPERATIVE
CARE, NEUROLOGICAL, CARDIOVASCULAR,
HEMATOLOGICAL, RENAL, ENDOCRINE, AND
MUSCULOSKELETAL DISORDERSQUESTIONS,
CORRECT ANSWERS, AND DETAILED RATIONALES
LATEST UPDATE
1. Which assessment finding immediately before surgery requires the nurse's priority
follow-up?
A) The patient reports having eaten a full breakfast two hours ago.
B) The patient states that the surgical site has been marked.
C) The patient reports mild anxiety about the procedure.
D) The patient has a temperature of 37.0°C (98.6°F).
Correct Answer: The patient reports having eaten a full breakfast two hours ago.
Rationale: Preoperative fasting reduces the risk of aspiration during anesthesia. Recent food
intake can significantly increase aspiration risk and should be communicated immediately to
the surgical and anesthesia teams. Surgical-site marking, mild anxiety, and a normal
temperature do not create the same immediate safety concern.
2. What is the primary purpose of the surgical time-out?
A) To determine whether postoperative analgesia is required
B) To verify the correct patient, procedure, and surgical site
C) To document the patient's medication history
D) To obtain the patient's postoperative vital signs
Correct Answer: To verify the correct patient, procedure, and surgical site
,Rationale: The surgical time-out is a critical safety process designed to prevent wrong-
patient, wrong-procedure, and wrong-site errors. Team members actively verify essential
procedural information before beginning. Medication history and postoperative assessment
are important but are not the primary purpose of the time-out.
3. A postoperative patient suddenly develops dyspnea, tachycardia, and oxygen saturation
of 86%. Which complication should the nurse suspect first?
A) Pulmonary embolism
B) Constipation
C) Urinary retention
D) Incisional infection
Correct Answer: Pulmonary embolism
Rationale: Sudden dyspnea, hypoxemia, and tachycardia after surgery are classic warning
signs of pulmonary embolism. Venous stasis, tissue injury, and hypercoagulability increase
postoperative thromboembolic risk. Constipation, urinary retention, and infection generally
do not produce this abrupt combination of respiratory findings.
4. Which intervention best reduces postoperative venous thromboembolism risk in a
stable patient?
A) Restricting oral fluids
B) Keeping the patient on strict bed rest
C) Encouraging early ambulation
D) Massaging painful calf muscles
Correct Answer: Encouraging early ambulation
Rationale: Early ambulation promotes venous return and reduces venous stasis, making it an
important postoperative prevention strategy. Prolonged bed rest increases thrombosis risk.
Calf massage is inappropriate when deep-vein thrombosis is suspected because
manipulation could potentially dislodge a thrombus.
5. Which finding is most concerning for postoperative hemorrhage?
A) Mild incisional discomfort
B) Heart rate of 124/min with decreasing blood pressure
C) Temperature of 37.4°C (99.3°F)
D) Mild nausea after anesthesia
,Correct Answer: Heart rate of 124/min with decreasing blood pressure
Rationale: Tachycardia accompanied by falling blood pressure can indicate significant blood
loss and developing hypovolemic shock. Early recognition is essential because compensatory
tachycardia may occur before severe hypotension. Mild pain, low-grade temperature
elevation, and postoperative nausea are common and are less immediately threatening.
6. Why is incentive spirometry commonly prescribed after surgery?
A) To increase urine output
B) To prevent constipation
C) To reduce venous thrombosis
D) To promote lung expansion and prevent atelectasis
Correct Answer: To promote lung expansion and prevent atelectasis
Rationale: Anesthesia, pain, and shallow postoperative breathing can reduce alveolar
expansion. Incentive spirometry encourages sustained deep inspiration, helping reopen and
maintain collapsed or poorly ventilated alveoli. It does not directly treat constipation, urinary
retention, or venous thrombosis.
7. Which postoperative finding most strongly suggests wound dehiscence?
A) A small amount of serosanguineous drainage
B) Mild tenderness around the incision
C) Sudden separation of wound edges
D) A temperature of 37.2°C (99.0°F)
Correct Answer: Sudden separation of wound edges
Rationale: Dehiscence refers to separation of previously approximated wound edges. It can
occur when tissue healing is impaired or excessive strain is placed on the incision. Sudden
separation requires prompt assessment and intervention because complete disruption can
progress to evisceration.
8. A postoperative abdominal incision opens and abdominal organs are visible. What
should the nurse do first?
A) Cover the area with sterile saline-moistened dressings
B) Push the organs gently back into the abdomen
C) Place the patient in a high-Fowler position
D) Remove the existing dressing completely
, Correct Answer: Cover the area with sterile saline-moistened dressings
Rationale: Visible abdominal organs indicate evisceration, a surgical emergency. Sterile
saline-moistened dressings protect exposed tissue from drying and contamination while the
surgical team is notified. The organs must never be pushed back into the abdominal cavity by
the nurse.
9. Which finding is most consistent with postoperative paralytic ileus?
A) Hyperactive bowel sounds and diarrhea
B) Absent or markedly decreased bowel sounds with abdominal distention
C) Increased appetite and frequent stools
D) Severe hypertension with bradycardia
Correct Answer: Absent or markedly decreased bowel sounds with abdominal distention
Rationale: Paralytic ileus occurs when intestinal motility temporarily decreases after surgery,
particularly abdominal surgery. Typical findings include distention, nausea, vomiting, and
absent or hypoactive bowel sounds. Early recognition helps prevent complications such as
prolonged obstruction, aspiration, and fluid-electrolyte disturbances.
10. Which action is most appropriate when administering a prescribed opioid after
surgery?
A) Withhold respiratory assessment because pain is expected
B) Encourage the patient to ambulate immediately after administration
C) Assess respiratory rate, sedation level, and pain before administration
D) Administer an additional dose if the patient appears sleepy
Correct Answer: Assess respiratory rate, sedation level, and pain before administration
Rationale: Opioids can cause respiratory depression and excessive sedation. Assessment of
pain and respiratory status helps determine whether administration is safe. Increasing opioid
doses in a sedated patient can worsen respiratory depression and may create a life-
threatening complication.
SECTION 2: NEUROLOGICAL DISORDERS AND CLINICAL MANAGEMENT
Questions 11–26
11. Which finding is most characteristic of an acute ischemic stroke?
A) Sudden unilateral weakness and difficulty speaking
WESTERN GOVERNORS UNIVERSITY (WGU) –
D446 ADULT HEALTH IICOMPREHENSIVE 100-
QUESTION EXAM PREPARATION GUIDE:
MEDICAL-SURGICAL NURSING, PERIOPERATIVE
CARE, NEUROLOGICAL, CARDIOVASCULAR,
HEMATOLOGICAL, RENAL, ENDOCRINE, AND
MUSCULOSKELETAL DISORDERSQUESTIONS,
CORRECT ANSWERS, AND DETAILED RATIONALES
LATEST UPDATE
1. Which assessment finding immediately before surgery requires the nurse's priority
follow-up?
A) The patient reports having eaten a full breakfast two hours ago.
B) The patient states that the surgical site has been marked.
C) The patient reports mild anxiety about the procedure.
D) The patient has a temperature of 37.0°C (98.6°F).
Correct Answer: The patient reports having eaten a full breakfast two hours ago.
Rationale: Preoperative fasting reduces the risk of aspiration during anesthesia. Recent food
intake can significantly increase aspiration risk and should be communicated immediately to
the surgical and anesthesia teams. Surgical-site marking, mild anxiety, and a normal
temperature do not create the same immediate safety concern.
2. What is the primary purpose of the surgical time-out?
A) To determine whether postoperative analgesia is required
B) To verify the correct patient, procedure, and surgical site
C) To document the patient's medication history
D) To obtain the patient's postoperative vital signs
Correct Answer: To verify the correct patient, procedure, and surgical site
,Rationale: The surgical time-out is a critical safety process designed to prevent wrong-
patient, wrong-procedure, and wrong-site errors. Team members actively verify essential
procedural information before beginning. Medication history and postoperative assessment
are important but are not the primary purpose of the time-out.
3. A postoperative patient suddenly develops dyspnea, tachycardia, and oxygen saturation
of 86%. Which complication should the nurse suspect first?
A) Pulmonary embolism
B) Constipation
C) Urinary retention
D) Incisional infection
Correct Answer: Pulmonary embolism
Rationale: Sudden dyspnea, hypoxemia, and tachycardia after surgery are classic warning
signs of pulmonary embolism. Venous stasis, tissue injury, and hypercoagulability increase
postoperative thromboembolic risk. Constipation, urinary retention, and infection generally
do not produce this abrupt combination of respiratory findings.
4. Which intervention best reduces postoperative venous thromboembolism risk in a
stable patient?
A) Restricting oral fluids
B) Keeping the patient on strict bed rest
C) Encouraging early ambulation
D) Massaging painful calf muscles
Correct Answer: Encouraging early ambulation
Rationale: Early ambulation promotes venous return and reduces venous stasis, making it an
important postoperative prevention strategy. Prolonged bed rest increases thrombosis risk.
Calf massage is inappropriate when deep-vein thrombosis is suspected because
manipulation could potentially dislodge a thrombus.
5. Which finding is most concerning for postoperative hemorrhage?
A) Mild incisional discomfort
B) Heart rate of 124/min with decreasing blood pressure
C) Temperature of 37.4°C (99.3°F)
D) Mild nausea after anesthesia
,Correct Answer: Heart rate of 124/min with decreasing blood pressure
Rationale: Tachycardia accompanied by falling blood pressure can indicate significant blood
loss and developing hypovolemic shock. Early recognition is essential because compensatory
tachycardia may occur before severe hypotension. Mild pain, low-grade temperature
elevation, and postoperative nausea are common and are less immediately threatening.
6. Why is incentive spirometry commonly prescribed after surgery?
A) To increase urine output
B) To prevent constipation
C) To reduce venous thrombosis
D) To promote lung expansion and prevent atelectasis
Correct Answer: To promote lung expansion and prevent atelectasis
Rationale: Anesthesia, pain, and shallow postoperative breathing can reduce alveolar
expansion. Incentive spirometry encourages sustained deep inspiration, helping reopen and
maintain collapsed or poorly ventilated alveoli. It does not directly treat constipation, urinary
retention, or venous thrombosis.
7. Which postoperative finding most strongly suggests wound dehiscence?
A) A small amount of serosanguineous drainage
B) Mild tenderness around the incision
C) Sudden separation of wound edges
D) A temperature of 37.2°C (99.0°F)
Correct Answer: Sudden separation of wound edges
Rationale: Dehiscence refers to separation of previously approximated wound edges. It can
occur when tissue healing is impaired or excessive strain is placed on the incision. Sudden
separation requires prompt assessment and intervention because complete disruption can
progress to evisceration.
8. A postoperative abdominal incision opens and abdominal organs are visible. What
should the nurse do first?
A) Cover the area with sterile saline-moistened dressings
B) Push the organs gently back into the abdomen
C) Place the patient in a high-Fowler position
D) Remove the existing dressing completely
, Correct Answer: Cover the area with sterile saline-moistened dressings
Rationale: Visible abdominal organs indicate evisceration, a surgical emergency. Sterile
saline-moistened dressings protect exposed tissue from drying and contamination while the
surgical team is notified. The organs must never be pushed back into the abdominal cavity by
the nurse.
9. Which finding is most consistent with postoperative paralytic ileus?
A) Hyperactive bowel sounds and diarrhea
B) Absent or markedly decreased bowel sounds with abdominal distention
C) Increased appetite and frequent stools
D) Severe hypertension with bradycardia
Correct Answer: Absent or markedly decreased bowel sounds with abdominal distention
Rationale: Paralytic ileus occurs when intestinal motility temporarily decreases after surgery,
particularly abdominal surgery. Typical findings include distention, nausea, vomiting, and
absent or hypoactive bowel sounds. Early recognition helps prevent complications such as
prolonged obstruction, aspiration, and fluid-electrolyte disturbances.
10. Which action is most appropriate when administering a prescribed opioid after
surgery?
A) Withhold respiratory assessment because pain is expected
B) Encourage the patient to ambulate immediately after administration
C) Assess respiratory rate, sedation level, and pain before administration
D) Administer an additional dose if the patient appears sleepy
Correct Answer: Assess respiratory rate, sedation level, and pain before administration
Rationale: Opioids can cause respiratory depression and excessive sedation. Assessment of
pain and respiratory status helps determine whether administration is safe. Increasing opioid
doses in a sedated patient can worsen respiratory depression and may create a life-
threatening complication.
SECTION 2: NEUROLOGICAL DISORDERS AND CLINICAL MANAGEMENT
Questions 11–26
11. Which finding is most characteristic of an acute ischemic stroke?
A) Sudden unilateral weakness and difficulty speaking
