D238 Adult Health I Practice Questions and Answers Updated
2026 | Complete WGU Nursing Study Guide with Verified
Questions, Detailed Rationales, Medical-Surgical Nursing
Concepts, Cardiovascular, Respiratory, Renal, Endocrine
Disorders, Fluid & Electrolyte Balance, Infection Control, Pain
Management, Prioritization, Clinical Judgment & Objective
Assessment Exam Prep
Question 1: A nurse is assessing a client with heart failure. Which finding is most
indicative of left-sided heart failure?
A. Peripheral edema
B. Jugular vein distention
C. Crackles in the lung bases
D. Hepatomegaly
CORRECT ANSWER: C. Crackles in the lung bases
Rationale: Left-sided heart failure results in pulmonary congestion due to the heart's
inability to pump blood effectively from the lungs to the systemic circulation. Crackles
in the lung bases are a classic sign of pulmonary edema associated with left-sided
failure. Peripheral edema, jugular vein distention, and hepatomegaly are signs of right-
sided heart failure, which causes systemic venous congestion.
Question 2: A client with hypertension is prescribed lisinopril. Which assessment
finding requires immediate notification of the provider?
A. Dry cough
B. Serum potassium of 5.8 mEq/L
C. Orthostatic dizziness
D. Mild headache
CORRECT ANSWER: B. Serum potassium of 5.8 mEq/L
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia by reducing aldosterone
secretion. A serum potassium level of 5.8 mEq/L is above the normal range (3.5–5.0
mEq/L) and poses a risk for cardiac dysrhythmias, requiring immediate intervention.
While a dry cough is a common side effect of ACE inhibitors, it is not life-threatening.
Orthostatic dizziness and mild headache may occur but are less urgent than
hyperkalemia.
Question 3: During a cardiac assessment, a nurse hears a swishing sound over the
carotid artery. How should this finding be documented?
A. Thrill
B. Bruit
C. Murmur
D. Heave
,CORRECT ANSWER: B. Bruit
Rationale: A bruit is a swishing or blowing sound heard over an artery, indicating
turbulent blood flow often due to stenosis or atherosclerosis. A thrill is a palpable
vibration associated with murmurs. A murmur is an abnormal heart sound heard over
the precordium. A heave is a visible or palpable lifting of the chest wall during systole.
Question 4: A client with coronary artery disease experiences chest pain unrelieved
by nitroglycerin. What is the nurse's priority action?
A. Administer a second dose of nitroglycerin
B. Obtain a 12-lead electrocardiogram
C. Activate the emergency response system
D. Have the client perform deep breathing exercises
CORRECT ANSWER: C. Activate the emergency response system
Rationale: Chest pain unrelieved by nitroglycerin may indicate an acute myocardial
infarction, a life-threatening emergency. Activating the emergency response system
ensures rapid access to advanced cardiac care. While obtaining an ECG is important, it
should not delay emergency activation. Additional nitroglycerin may be given per
protocol, but only after emergency services are initiated if pain persists. Deep breathing
exercises are inappropriate for acute cardiac ischemia.
Question 5: Which intervention should the nurse include in the plan of care for a
client with peripheral artery disease?
A. Encourage prolonged sitting with legs dependent
B. Apply heating pads to the lower extremities
C. Teach the client to walk to the point of pain, rest, then resume
D. Recommend crossing legs at the knees to improve circulation
CORRECT ANSWER: C. Teach the client to walk to the point of pain, rest, then
resume
Rationale: Supervised exercise therapy, including walking to the point of claudication
pain, resting, and resuming, promotes collateral circulation and improves functional
capacity in peripheral artery disease. Prolonged sitting with legs dependent increases
edema and impairs arterial flow. Heating pads can cause burns due to decreased
sensation. Crossing legs compresses arteries and further reduces perfusion.
Question 6: A nurse is preparing to administer digoxin to a client with atrial
fibrillation. Which assessment finding should prompt the nurse to withhold the
dose?
A. Apical pulse of 58 beats per minute
B. Blood pressure of 138/86 mm Hg
C. Serum sodium of 139 mEq/L
D. Respiratory rate of 18 breaths per minute
,CORRECT ANSWER: A. Apical pulse of 58 beats per minute
Rationale: Digoxin slows the heart rate and should be withheld if the apical pulse is
below 60 beats per minute in adults due to the risk of severe bradycardia or heart block.
Blood pressure, serum sodium, and respiratory rate within normal limits do not
contraindicate digoxin administration.
Question 7: Which electrocardiogram (ECG) change is most characteristic of
myocardial ischemia?
A. ST-segment elevation
B. ST-segment depression
C. Pathological Q waves
D. Prolonged QT interval
CORRECT ANSWER: B. ST-segment depression
Rationale: ST-segment depression on an ECG is a classic indicator of myocardial
ischemia, reflecting subendocardial injury. ST-segment elevation suggests acute
myocardial infarction with transmural injury. Pathological Q waves indicate prior
myocardial infarction. A prolonged QT interval is associated with electrolyte imbalances
or medication effects, not acute ischemia.
Question 8: A client is admitted with acute decompensated heart failure. Which
medication should the nurse anticipate administering first?
A. Furosemide
B. Metoprolol
C. Lisinopril
D. Digoxin
CORRECT ANSWER: A. Furosemide
Rationale: Furosemide, a loop diuretic, is prioritized in acute decompensated heart
failure to rapidly reduce fluid overload, decrease pulmonary congestion, and improve
oxygenation. Beta-blockers like metoprolol and ACE inhibitors like lisinopril are used for
chronic management but may worsen acute symptoms. Digoxin has a limited role in
acute management and is not first-line.
Question 9: The nurse is teaching a client about warfarin therapy. Which statement
by the client indicates understanding?
A. "I will take my warfarin with a full glass of grapefruit juice."
B. "I will use an electric razor instead of a blade razor."
C. "I will increase my intake of leafy green vegetables."
D. "I can take ibuprofen for headaches while on warfarin."
CORRECT ANSWER: B. "I will use an electric razor instead of a blade razor."
, Rationale: Warfarin increases bleeding risk, so using an electric razor minimizes skin
trauma and bleeding. Grapefruit juice can interfere with warfarin metabolism. Leafy
green vegetables are high in vitamin K, which antagonizes warfarin and should be
consumed consistently, not increased. Ibuprofen increases bleeding risk and should be
avoided; acetaminophen is preferred.
Question 10: A client with deep vein thrombosis (DVT) is receiving heparin infusion.
Which laboratory value should the nurse monitor to evaluate therapeutic
effectiveness?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
CORRECT ANSWER: C. Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, with a therapeutic range typically
1.5–2.5 times the control value. PT and INR monitor warfarin therapy. Platelet count is
monitored to detect heparin-induced thrombocytopenia but does not assess
anticoagulation effectiveness.
Question 11: Which finding in a client with aortic stenosis should the nurse report
immediately?
A. Systolic murmur at the right sternal border
B. Syncope during exertion
C. Mild fatigue with activity
D. Occasional palpitations
CORRECT ANSWER: B. Syncope during exertion
Rationale: Syncope during exertion in aortic stenosis indicates severe obstruction and
reduced cardiac output, posing a high risk for sudden cardiac death. This requires
urgent evaluation. A systolic murmur is expected in aortic stenosis. Mild fatigue and
occasional palpitations are common but less urgent findings.
Question 12: A nurse is caring for a client post-cardiac catheterization via the
femoral artery. Which action is priority in the immediate post-procedure period?
A. Encourage oral fluids to promote dye excretion
B. Assess the puncture site for bleeding or hematoma
C. Administer scheduled analgesics for groin discomfort
D. Ambulate the client to the bathroom
CORRECT ANSWER: B. Assess the puncture site for bleeding or hematoma
Rationale: After femoral artery catheterization, the priority is monitoring the puncture
site for bleeding, hematoma, or compromised distal circulation, as these are life-
threatening complications. Encouraging fluids is important but secondary. Analgesics
2026 | Complete WGU Nursing Study Guide with Verified
Questions, Detailed Rationales, Medical-Surgical Nursing
Concepts, Cardiovascular, Respiratory, Renal, Endocrine
Disorders, Fluid & Electrolyte Balance, Infection Control, Pain
Management, Prioritization, Clinical Judgment & Objective
Assessment Exam Prep
Question 1: A nurse is assessing a client with heart failure. Which finding is most
indicative of left-sided heart failure?
A. Peripheral edema
B. Jugular vein distention
C. Crackles in the lung bases
D. Hepatomegaly
CORRECT ANSWER: C. Crackles in the lung bases
Rationale: Left-sided heart failure results in pulmonary congestion due to the heart's
inability to pump blood effectively from the lungs to the systemic circulation. Crackles
in the lung bases are a classic sign of pulmonary edema associated with left-sided
failure. Peripheral edema, jugular vein distention, and hepatomegaly are signs of right-
sided heart failure, which causes systemic venous congestion.
Question 2: A client with hypertension is prescribed lisinopril. Which assessment
finding requires immediate notification of the provider?
A. Dry cough
B. Serum potassium of 5.8 mEq/L
C. Orthostatic dizziness
D. Mild headache
CORRECT ANSWER: B. Serum potassium of 5.8 mEq/L
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia by reducing aldosterone
secretion. A serum potassium level of 5.8 mEq/L is above the normal range (3.5–5.0
mEq/L) and poses a risk for cardiac dysrhythmias, requiring immediate intervention.
While a dry cough is a common side effect of ACE inhibitors, it is not life-threatening.
Orthostatic dizziness and mild headache may occur but are less urgent than
hyperkalemia.
Question 3: During a cardiac assessment, a nurse hears a swishing sound over the
carotid artery. How should this finding be documented?
A. Thrill
B. Bruit
C. Murmur
D. Heave
,CORRECT ANSWER: B. Bruit
Rationale: A bruit is a swishing or blowing sound heard over an artery, indicating
turbulent blood flow often due to stenosis or atherosclerosis. A thrill is a palpable
vibration associated with murmurs. A murmur is an abnormal heart sound heard over
the precordium. A heave is a visible or palpable lifting of the chest wall during systole.
Question 4: A client with coronary artery disease experiences chest pain unrelieved
by nitroglycerin. What is the nurse's priority action?
A. Administer a second dose of nitroglycerin
B. Obtain a 12-lead electrocardiogram
C. Activate the emergency response system
D. Have the client perform deep breathing exercises
CORRECT ANSWER: C. Activate the emergency response system
Rationale: Chest pain unrelieved by nitroglycerin may indicate an acute myocardial
infarction, a life-threatening emergency. Activating the emergency response system
ensures rapid access to advanced cardiac care. While obtaining an ECG is important, it
should not delay emergency activation. Additional nitroglycerin may be given per
protocol, but only after emergency services are initiated if pain persists. Deep breathing
exercises are inappropriate for acute cardiac ischemia.
Question 5: Which intervention should the nurse include in the plan of care for a
client with peripheral artery disease?
A. Encourage prolonged sitting with legs dependent
B. Apply heating pads to the lower extremities
C. Teach the client to walk to the point of pain, rest, then resume
D. Recommend crossing legs at the knees to improve circulation
CORRECT ANSWER: C. Teach the client to walk to the point of pain, rest, then
resume
Rationale: Supervised exercise therapy, including walking to the point of claudication
pain, resting, and resuming, promotes collateral circulation and improves functional
capacity in peripheral artery disease. Prolonged sitting with legs dependent increases
edema and impairs arterial flow. Heating pads can cause burns due to decreased
sensation. Crossing legs compresses arteries and further reduces perfusion.
Question 6: A nurse is preparing to administer digoxin to a client with atrial
fibrillation. Which assessment finding should prompt the nurse to withhold the
dose?
A. Apical pulse of 58 beats per minute
B. Blood pressure of 138/86 mm Hg
C. Serum sodium of 139 mEq/L
D. Respiratory rate of 18 breaths per minute
,CORRECT ANSWER: A. Apical pulse of 58 beats per minute
Rationale: Digoxin slows the heart rate and should be withheld if the apical pulse is
below 60 beats per minute in adults due to the risk of severe bradycardia or heart block.
Blood pressure, serum sodium, and respiratory rate within normal limits do not
contraindicate digoxin administration.
Question 7: Which electrocardiogram (ECG) change is most characteristic of
myocardial ischemia?
A. ST-segment elevation
B. ST-segment depression
C. Pathological Q waves
D. Prolonged QT interval
CORRECT ANSWER: B. ST-segment depression
Rationale: ST-segment depression on an ECG is a classic indicator of myocardial
ischemia, reflecting subendocardial injury. ST-segment elevation suggests acute
myocardial infarction with transmural injury. Pathological Q waves indicate prior
myocardial infarction. A prolonged QT interval is associated with electrolyte imbalances
or medication effects, not acute ischemia.
Question 8: A client is admitted with acute decompensated heart failure. Which
medication should the nurse anticipate administering first?
A. Furosemide
B. Metoprolol
C. Lisinopril
D. Digoxin
CORRECT ANSWER: A. Furosemide
Rationale: Furosemide, a loop diuretic, is prioritized in acute decompensated heart
failure to rapidly reduce fluid overload, decrease pulmonary congestion, and improve
oxygenation. Beta-blockers like metoprolol and ACE inhibitors like lisinopril are used for
chronic management but may worsen acute symptoms. Digoxin has a limited role in
acute management and is not first-line.
Question 9: The nurse is teaching a client about warfarin therapy. Which statement
by the client indicates understanding?
A. "I will take my warfarin with a full glass of grapefruit juice."
B. "I will use an electric razor instead of a blade razor."
C. "I will increase my intake of leafy green vegetables."
D. "I can take ibuprofen for headaches while on warfarin."
CORRECT ANSWER: B. "I will use an electric razor instead of a blade razor."
, Rationale: Warfarin increases bleeding risk, so using an electric razor minimizes skin
trauma and bleeding. Grapefruit juice can interfere with warfarin metabolism. Leafy
green vegetables are high in vitamin K, which antagonizes warfarin and should be
consumed consistently, not increased. Ibuprofen increases bleeding risk and should be
avoided; acetaminophen is preferred.
Question 10: A client with deep vein thrombosis (DVT) is receiving heparin infusion.
Which laboratory value should the nurse monitor to evaluate therapeutic
effectiveness?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
CORRECT ANSWER: C. Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, with a therapeutic range typically
1.5–2.5 times the control value. PT and INR monitor warfarin therapy. Platelet count is
monitored to detect heparin-induced thrombocytopenia but does not assess
anticoagulation effectiveness.
Question 11: Which finding in a client with aortic stenosis should the nurse report
immediately?
A. Systolic murmur at the right sternal border
B. Syncope during exertion
C. Mild fatigue with activity
D. Occasional palpitations
CORRECT ANSWER: B. Syncope during exertion
Rationale: Syncope during exertion in aortic stenosis indicates severe obstruction and
reduced cardiac output, posing a high risk for sudden cardiac death. This requires
urgent evaluation. A systolic murmur is expected in aortic stenosis. Mild fatigue and
occasional palpitations are common but less urgent findings.
Question 12: A nurse is caring for a client post-cardiac catheterization via the
femoral artery. Which action is priority in the immediate post-procedure period?
A. Encourage oral fluids to promote dye excretion
B. Assess the puncture site for bleeding or hematoma
C. Administer scheduled analgesics for groin discomfort
D. Ambulate the client to the bathroom
CORRECT ANSWER: B. Assess the puncture site for bleeding or hematoma
Rationale: After femoral artery catheterization, the priority is monitoring the puncture
site for bleeding, hematoma, or compromised distal circulation, as these are life-
threatening complications. Encouraging fluids is important but secondary. Analgesics
