WGU D446 Adult Health 2 OA Exam
Study Guide (updated 2025) Questions &
Answers | Latest Already Graded A+
UPDATE 2025|2026
1. A nurse is assessing a client with acute decompensated
heart failure (ADHF). Which finding is most concerning?
A) +2 pitting edema in lower extremities
B) Jugular venous distension (JVD) at 45 degrees
C) Paroxysmal nocturnal dyspnea (PND)
D) Crackles audible to the mid-scapular region
Correct Answer: D
Rationale: Crackles that extend to the mid-scapular region
indicate that pulmonary edema is severe and widespread,
signifying imminent respiratory compromise. While
peripheral edema, JVD, and PND are important signs of fluid
overload, they are not as immediately life-threatening as
extensive pulmonary edema.
2. A client with infective endocarditis develops sudden
left-sided weakness and slurred speech. What is the priority
action?
A) Administer aspirin 325 mg PO
B) Obtain a STAT CT scan of the head
C) Check blood glucose level
D) Reorient the client to person, place, time
Correct Answer: B
, Rationale: The client is likely experiencing an embolic stroke
from a vegetation fragment. A STAT CT scan is required to
rule out hemorrhage before any thrombolytics or
anticoagulation can be considered. Aspirin could worsen a
hemorrhagic stroke.
3. A client on amiodarone for atrial fibrillation reports a new
bluish-gray discoloration on the face. Which action is most
appropriate?
A) Discontinue the medication immediately
B) Instruct the client to apply sunscreen daily
C) Document as a common side effect and continue monitoring
D) Prepare for thyroid function testing
Correct Answer: C
Rationale: Bluish-gray skin discoloration
(amiodarone-induced pigment change) is a known side effect
of long-term amiodarone use and is usually harmless, though
cosmetically concerning. It is not a reason to discontinue the
drug unless other serious adverse effects develop.
4. A client with chronic atrial fibrillation is prescribed
warfarin. Which lab value requires immediate intervention?
A) INR 2.5
B) aPTT 35 seconds
C) Platelets 150,000/mm³
D) INR 4.8
Correct Answer: D
Rationale: An INR of 4.8 indicates a high risk of bleeding.
The target INR for atrial fibrillation is typically 2.0–3.0. An INR
above 4.5 may require holding the next dose, administering
, vitamin K, or even using fresh frozen plasma depending on
the patient’s clinical situation.
5. Post-cardiac catheterization, the nurse assesses the femoral
insertion site. Which finding is most concerning?
A) Small 2-cm bruise
B) Patient reports mild discomfort
C) Slight oozing with pressure
D) Expanding hematoma
Correct Answer: D
Rationale: An expanding hematoma suggests active
bleeding into the tissues, potentially indicating
retroperitoneal bleeding or pseudoaneurysm, which requires
immediate intervention. A small bruise, mild discomfort, and
slight oozing are expected or common post-procedure.
6. A client post-MI has a new murmur heard at the apex.
What complication should the nurse suspect?
A) Pericarditis
B) Ventricular septal rupture
C) Papillary muscle rupture
D) Left ventricular aneurysm
Correct Answer: C
Rationale: A new systolic murmur at the apex following an
MI suggests acute mitral regurgitation from papillary muscle
rupture. It is a mechanical complication that can cause
sudden hemodynamic deterioration.
7. A client is admitted with unstable angina. Which
medication reduces mortality and should be started within 24
, hours?
A) Metoprolol
B) Furosemide
C) Digoxin
D) Alprazolam
Correct Answer: A
Rationale: Beta-blockers reduce myocardial O2 demand,
prevent ventricular remodeling, and decrease mortality
post-MI and in unstable angina.
8. A client with a mechanical mitral valve is on warfarin. The
target INR is generally:
A) 1.5–2.0
B) 2.0–2.5
C) 2.5–3.5
D) 3.5–4.0
Correct Answer: C
Rationale: Mechanical valves in the mitral position are more
thrombogenic than aortic valves, so a higher INR target (2.5–
3.5) is required.
9. Which of the following is an absolute contraindication to
tissue plasminogen activator (tPA) administration in a patient
with acute ischemic stroke?
A) Age >80 years
B) History of prior ischemic stroke
C) Intracranial hemorrhage on CT scan
D) Blood pressure 185/110 mm Hg
Correct Answer: C
Study Guide (updated 2025) Questions &
Answers | Latest Already Graded A+
UPDATE 2025|2026
1. A nurse is assessing a client with acute decompensated
heart failure (ADHF). Which finding is most concerning?
A) +2 pitting edema in lower extremities
B) Jugular venous distension (JVD) at 45 degrees
C) Paroxysmal nocturnal dyspnea (PND)
D) Crackles audible to the mid-scapular region
Correct Answer: D
Rationale: Crackles that extend to the mid-scapular region
indicate that pulmonary edema is severe and widespread,
signifying imminent respiratory compromise. While
peripheral edema, JVD, and PND are important signs of fluid
overload, they are not as immediately life-threatening as
extensive pulmonary edema.
2. A client with infective endocarditis develops sudden
left-sided weakness and slurred speech. What is the priority
action?
A) Administer aspirin 325 mg PO
B) Obtain a STAT CT scan of the head
C) Check blood glucose level
D) Reorient the client to person, place, time
Correct Answer: B
, Rationale: The client is likely experiencing an embolic stroke
from a vegetation fragment. A STAT CT scan is required to
rule out hemorrhage before any thrombolytics or
anticoagulation can be considered. Aspirin could worsen a
hemorrhagic stroke.
3. A client on amiodarone for atrial fibrillation reports a new
bluish-gray discoloration on the face. Which action is most
appropriate?
A) Discontinue the medication immediately
B) Instruct the client to apply sunscreen daily
C) Document as a common side effect and continue monitoring
D) Prepare for thyroid function testing
Correct Answer: C
Rationale: Bluish-gray skin discoloration
(amiodarone-induced pigment change) is a known side effect
of long-term amiodarone use and is usually harmless, though
cosmetically concerning. It is not a reason to discontinue the
drug unless other serious adverse effects develop.
4. A client with chronic atrial fibrillation is prescribed
warfarin. Which lab value requires immediate intervention?
A) INR 2.5
B) aPTT 35 seconds
C) Platelets 150,000/mm³
D) INR 4.8
Correct Answer: D
Rationale: An INR of 4.8 indicates a high risk of bleeding.
The target INR for atrial fibrillation is typically 2.0–3.0. An INR
above 4.5 may require holding the next dose, administering
, vitamin K, or even using fresh frozen plasma depending on
the patient’s clinical situation.
5. Post-cardiac catheterization, the nurse assesses the femoral
insertion site. Which finding is most concerning?
A) Small 2-cm bruise
B) Patient reports mild discomfort
C) Slight oozing with pressure
D) Expanding hematoma
Correct Answer: D
Rationale: An expanding hematoma suggests active
bleeding into the tissues, potentially indicating
retroperitoneal bleeding or pseudoaneurysm, which requires
immediate intervention. A small bruise, mild discomfort, and
slight oozing are expected or common post-procedure.
6. A client post-MI has a new murmur heard at the apex.
What complication should the nurse suspect?
A) Pericarditis
B) Ventricular septal rupture
C) Papillary muscle rupture
D) Left ventricular aneurysm
Correct Answer: C
Rationale: A new systolic murmur at the apex following an
MI suggests acute mitral regurgitation from papillary muscle
rupture. It is a mechanical complication that can cause
sudden hemodynamic deterioration.
7. A client is admitted with unstable angina. Which
medication reduces mortality and should be started within 24
, hours?
A) Metoprolol
B) Furosemide
C) Digoxin
D) Alprazolam
Correct Answer: A
Rationale: Beta-blockers reduce myocardial O2 demand,
prevent ventricular remodeling, and decrease mortality
post-MI and in unstable angina.
8. A client with a mechanical mitral valve is on warfarin. The
target INR is generally:
A) 1.5–2.0
B) 2.0–2.5
C) 2.5–3.5
D) 3.5–4.0
Correct Answer: C
Rationale: Mechanical valves in the mitral position are more
thrombogenic than aortic valves, so a higher INR target (2.5–
3.5) is required.
9. Which of the following is an absolute contraindication to
tissue plasminogen activator (tPA) administration in a patient
with acute ischemic stroke?
A) Age >80 years
B) History of prior ischemic stroke
C) Intracranial hemorrhage on CT scan
D) Blood pressure 185/110 mm Hg
Correct Answer: C
