WGU D446) NURS 3119 Adult
Health II - OA Readiness Exam
Guide - 2026.
Section 1: Cardiovascular Disorders
Question 1: A nurse is assessing a client with left-sided heart failure. Which
finding is most indicative of this condition?
• A) Jugular venous distention
• B) Peripheral edema
• C) Crackles in the lung bases
• D) Hepatomegaly
Correct Answer: C
Rationale:
• A) JVD is incorrect because jugular venous distention is caused by
increased right ventricular pressure, which is characteristic of right-sided
heart failure .
• B) Peripheral edema is incorrect as this results from fluid backup in the
systemic circulation, also a sign of right-sided failure .
• C) Crackles in the lung bases is correct. Left-sided heart failure causes the
left ventricle to fail at pumping blood forward, leading to pulmonary
congestion. Fluid backs up into the lungs, producing crackles/rales on
auscultation .
• D) Hepatomegaly is incorrect because liver enlargement occurs from
systemic venous congestion, another right-sided failure finding .
,Question 2: A client with chronic atrial fibrillation is prescribed warfarin. Which
laboratory value requires immediate intervention?
• A) INR of 2.5
• B) aPTT of 35 seconds
• C) Platelets 150,000/mm³
• D) INR of 4.8
Correct Answer: D
Rationale:
• A) INR of 2.5 is incorrect and actually therapeutic. The target INR range
for atrial fibrillation on warfarin is typically 2.0–3.0, so 2.5 requires no
intervention .
• B) aPTT of 35 seconds is incorrect. This is a normal aPTT value (normal
range is approximately 30-40 seconds). Warfarin does not affect aPTT; this
value monitors heparin therapy .
• C) Platelets 150,000/mm³ is incorrect. This is a normal platelet count
(normal range 150,000-400,000). Warfarin affects clotting factors, not
platelets .
• D) INR of 4.8 is correct. This value is significantly above the therapeutic
range, indicating a high risk of bleeding. The nurse should hold the next
warfarin dose, notify the provider, and prepare for potential vitamin K
administration .
Question 3: Post-cardiac catheterization, the nurse assesses the femoral insertion
site. Which finding is most concerning and requires immediate action?
• A) Small 2 cm bruise at the site
• B) Patient reports mild discomfort
• C) Expanding hematoma at the insertion site
• D) Slight oozing with direct pressure applied
Correct Answer: C
Rationale:
, • A) Small bruise is incorrect as this is an expected finding after arterial
puncture and typically resolves without intervention .
• B) Mild discomfort is incorrect because some discomfort is expected post-
procedure and can be managed with analgesics .
• C) Expanding hematoma is correct. This finding indicates potential
retroperitoneal bleeding or pseudoaneurysm formation. An expanding
hematoma suggests active bleeding and requires immediate notification of
the provider and possible intervention .
• D) Slight oozing with pressure is incorrect as this is common and
managed with continued manual pressure .
Question 4: A client with unstable angina is admitted. Which medication reduces
mortality and should be started within 24 hours?
• A) Metoprolol
• B) Furosemide
• C) Digoxin
• D) Alprazolam
Correct Answer: A
Rationale:
• A) Metoprolol is correct. Beta-blockers reduce myocardial oxygen
demand, prevent ventricular remodeling, and decrease mortality when given
to patients post-MI or with unstable angina. Early administration (within 24
hours) is recommended .
• B) Furosemide is incorrect. This loop diuretic is used for fluid overload
(e.g., heart failure) but provides no mortality benefit in angina or MI .
• C) Digoxin is incorrect. Digoxin is used for heart failure with atrial
fibrillation, not for unstable angina. It does not reduce mortality in this
scenario .
• D) Alprazolam is incorrect. This benzodiazepine treats anxiety but has no
mortality benefit in acute coronary syndromes .
, Question 5: A client with a mechanical mitral valve is on warfarin. What is the
target INR range for this client?
• A) 1.5–2.0
• B) 2.0–2.5
• C) 2.5–3.5
• D) 3.5–4.0
Correct Answer: C
Rationale:
• A) 1.5–2.0 is incorrect as this is not sufficient to prevent thrombus
formation on a mechanical valve .
• B) 2.0–2.5 is incorrect —this is the target range for atrial fibrillation alone
but is insufficient for mechanical valves .
• C) 2.5–3.5 is correct. Mechanical valves in the mitral position are more
thrombogenic than those in the aortic position, requiring a higher INR target.
Aortic valves typically require INR 2.0–3.0 .
• D) 3.5–4.0 is incorrect and would place the patient at excessive bleeding
risk without additional benefit .
Question 6: Which ECG finding is characteristic of an acute myocardial infarction
(MI)?
• A) Peaked T waves
• B) ST-segment elevation
• C) U waves
• D) Prolonged PR interval
Correct Answer: B
Rationale:
• A) Peaked T waves are incorrect —this finding is characteristic of
hyperkalemia, not MI .
• B) ST-segment elevation is correct. ST elevation on ECG indicates STEMI
(ST-elevation myocardial infarction), representing full-thickness infarction
of the myocardium requiring emergent reperfusion .
Health II - OA Readiness Exam
Guide - 2026.
Section 1: Cardiovascular Disorders
Question 1: A nurse is assessing a client with left-sided heart failure. Which
finding is most indicative of this condition?
• A) Jugular venous distention
• B) Peripheral edema
• C) Crackles in the lung bases
• D) Hepatomegaly
Correct Answer: C
Rationale:
• A) JVD is incorrect because jugular venous distention is caused by
increased right ventricular pressure, which is characteristic of right-sided
heart failure .
• B) Peripheral edema is incorrect as this results from fluid backup in the
systemic circulation, also a sign of right-sided failure .
• C) Crackles in the lung bases is correct. Left-sided heart failure causes the
left ventricle to fail at pumping blood forward, leading to pulmonary
congestion. Fluid backs up into the lungs, producing crackles/rales on
auscultation .
• D) Hepatomegaly is incorrect because liver enlargement occurs from
systemic venous congestion, another right-sided failure finding .
,Question 2: A client with chronic atrial fibrillation is prescribed warfarin. Which
laboratory value requires immediate intervention?
• A) INR of 2.5
• B) aPTT of 35 seconds
• C) Platelets 150,000/mm³
• D) INR of 4.8
Correct Answer: D
Rationale:
• A) INR of 2.5 is incorrect and actually therapeutic. The target INR range
for atrial fibrillation on warfarin is typically 2.0–3.0, so 2.5 requires no
intervention .
• B) aPTT of 35 seconds is incorrect. This is a normal aPTT value (normal
range is approximately 30-40 seconds). Warfarin does not affect aPTT; this
value monitors heparin therapy .
• C) Platelets 150,000/mm³ is incorrect. This is a normal platelet count
(normal range 150,000-400,000). Warfarin affects clotting factors, not
platelets .
• D) INR of 4.8 is correct. This value is significantly above the therapeutic
range, indicating a high risk of bleeding. The nurse should hold the next
warfarin dose, notify the provider, and prepare for potential vitamin K
administration .
Question 3: Post-cardiac catheterization, the nurse assesses the femoral insertion
site. Which finding is most concerning and requires immediate action?
• A) Small 2 cm bruise at the site
• B) Patient reports mild discomfort
• C) Expanding hematoma at the insertion site
• D) Slight oozing with direct pressure applied
Correct Answer: C
Rationale:
, • A) Small bruise is incorrect as this is an expected finding after arterial
puncture and typically resolves without intervention .
• B) Mild discomfort is incorrect because some discomfort is expected post-
procedure and can be managed with analgesics .
• C) Expanding hematoma is correct. This finding indicates potential
retroperitoneal bleeding or pseudoaneurysm formation. An expanding
hematoma suggests active bleeding and requires immediate notification of
the provider and possible intervention .
• D) Slight oozing with pressure is incorrect as this is common and
managed with continued manual pressure .
Question 4: A client with unstable angina is admitted. Which medication reduces
mortality and should be started within 24 hours?
• A) Metoprolol
• B) Furosemide
• C) Digoxin
• D) Alprazolam
Correct Answer: A
Rationale:
• A) Metoprolol is correct. Beta-blockers reduce myocardial oxygen
demand, prevent ventricular remodeling, and decrease mortality when given
to patients post-MI or with unstable angina. Early administration (within 24
hours) is recommended .
• B) Furosemide is incorrect. This loop diuretic is used for fluid overload
(e.g., heart failure) but provides no mortality benefit in angina or MI .
• C) Digoxin is incorrect. Digoxin is used for heart failure with atrial
fibrillation, not for unstable angina. It does not reduce mortality in this
scenario .
• D) Alprazolam is incorrect. This benzodiazepine treats anxiety but has no
mortality benefit in acute coronary syndromes .
, Question 5: A client with a mechanical mitral valve is on warfarin. What is the
target INR range for this client?
• A) 1.5–2.0
• B) 2.0–2.5
• C) 2.5–3.5
• D) 3.5–4.0
Correct Answer: C
Rationale:
• A) 1.5–2.0 is incorrect as this is not sufficient to prevent thrombus
formation on a mechanical valve .
• B) 2.0–2.5 is incorrect —this is the target range for atrial fibrillation alone
but is insufficient for mechanical valves .
• C) 2.5–3.5 is correct. Mechanical valves in the mitral position are more
thrombogenic than those in the aortic position, requiring a higher INR target.
Aortic valves typically require INR 2.0–3.0 .
• D) 3.5–4.0 is incorrect and would place the patient at excessive bleeding
risk without additional benefit .
Question 6: Which ECG finding is characteristic of an acute myocardial infarction
(MI)?
• A) Peaked T waves
• B) ST-segment elevation
• C) U waves
• D) Prolonged PR interval
Correct Answer: B
Rationale:
• A) Peaked T waves are incorrect —this finding is characteristic of
hyperkalemia, not MI .
• B) ST-segment elevation is correct. ST elevation on ECG indicates STEMI
(ST-elevation myocardial infarction), representing full-thickness infarction
of the myocardium requiring emergent reperfusion .
