WGU D444: Adult Health 1 QUESTIONS AND ANSWER LATEST
UPDATE
Objective Assessment Competency Compendia (Comprehensive Exam Blueprint)
Question 1
A nurse is assessing a client who is 24 hours postoperative following an abdominal
hysterectomy. Which of the following assessment findings should the nurse identify as
the priority to report to the provider?
A. Absent bowel sounds in all four quadrants
B. Urinary output of 20 mL/hr for two consecutive hours
C. Serosanguineous drainage on the abdominal dressing
D. Client report of incisional pain rated as 6 on a scale of 0 to 10
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) and priority framework, an
output of less than 30 mL/hr indicates poor renal perfusion, potential hypovolemia, or
acute kidney injury, which requires immediate fluid resuscitation or medical intervention.
Absent bowel sounds are expected 24 hours post-abdominal surgery due to paralytic
ileus, serosanguineous drainage is normal, and pain can be addressed after ensuring
hemodynamic stability.
Question 2
A nurse is caring for a client admitted with an acute exacerbation of chronic obstructive
pulmonary disease (COPD). The client is receiving oxygen at 2 L/min via nasal cannula.
Which of the following findings indicates that the oxygen therapy is effective?
A. PaCO2 level of 52 mmHg
B. Oxygen saturation (SaO2) of 90%
C. Respiratory rate of 28/min
D. Bicarbonate level of 28 mEq/L
Correct Answer: B
Rationale: For clients with severe COPD, the therapeutic target for oxygen saturation is
typically between 88% and 92%. Raising the SaO2 higher can suppress their hypoxic
drive to breathe. A respiratory rate of 28/min indicates ongoing distress, and an
elevated PaCO2 is expected for a chronic retainer but does not measure oxygenation
efficiency.
Question 3
A nurse is reviewing the laboratory results of a client who is receiving a continuous
intravenous heparin infusion for a deep vein thrombosis (DVT). Which of the following
laboratory values indicates that the therapy is within the therapeutic range?
A. International Normalized Ratio (INR) of 2.5
B. Activated partial thromboplastin time (aPTT) of 65 seconds
C. Prothrombin time (PT) of 12 seconds
D. Platelet count of 98,000/mm³
Correct Answer: B
Rationale: Heparin therapy effectiveness is monitored using the aPTT value. The
normal baseline aPTT is 30 to 40 seconds, and the therapeutic target is 1.5 to 2.5 times
the baseline (roughly 60 to 80 seconds). INR is used to monitor warfarin, and a platelet
,count of 98,000 indicates heparin-induced thrombocytopenia (HIT), a critical adverse
event.
Question 4
A nurse is caring for a client who is in the compensatory stage of hypovolemic shock.
Which of the following clinical manifestations should the nurse expect to observe?
A. Metabolic acidosis with a base deficit
B. Cold, clammy skin and profound hypotension
C. Tachycardia and a narrowed pulse pressure
D. Decreased level of consciousness and lethargy
Correct Answer: C
Rationale: In the early compensatory stage of shock, the body uses the sympathetic
nervous system to maintain cardiac output and blood pressure. This causes a
compensatory increase in heart rate (tachycardia) and peripheral vasoconstriction,
leading to a narrowed pulse pressure. Lethargy, cold clammy skin, and profound
hypotension signify the progressive and irreversible stages.
Question 5
A nurse is completing an admission assessment for a client who has a history of type 1
diabetes mellitus and is scheduled for an elective cholecystectomy. The client states, "I
have not taken my long-acting insulin since yesterday morning because I've been
fasting." Which of the following complications is this client at the highest risk for
developing?
A. Hypoglycemic shock
B. Hyperosmolar hyperglycemic state (HHS)
C. Diabetic ketoacidosis (DKA)
D. Acute pancreatitis
Correct Answer: C
Rationale: Clients with type 1 diabetes mellitus lack endogenous insulin production.
Skipping long-acting insulin doses, combined with the physiological stress of surgery
and fasting, will result in rapid lipolysis and ketone production, directly precipitating
diabetic ketoacidosis (DKA). HHS is characteristic of type 2 diabetes mellitus.
Question 6
A nurse is teaching a client who has a new diagnosis of stable angina and a prescription
for sublingual nitroglycerin tablets. Which of the following instructions should the nurse
include in the teaching plan?
A. "Take one tablet every 15 minutes up to a maximum of 4 doses."
B. "Swallow the tablet immediately with a full glass of water."
C. "Sit down before taking the medication because it can cause dizziness."
D. "Discard the tablets if you experience a tingling sensation under your tongue."
Correct Answer: C
Rationale: Nitroglycerin is a potent systemic vasodilator that rapidly reduces preload
and afterload. This sudden change can cause severe orthostatic hypotension and
syncope; therefore, the client must sit or lie down before administration. Tablets should
be taken 5 minutes apart up to 3 doses, should not be swallowed, and a tingling
sensation indicates that the drug is fresh and chemically active.
Question 7
,A nurse is providing discharge instructions to a client who had a permanent demand
pacemaker inserted 48 hours ago. Which of the following client statements indicates an
accurate understanding of the instructions?
A. "I will avoid using my household microwave oven from now on."
B. "I need to take my pulse every morning and report a rate below the setting."
C. "I can safely return to my job operating heavy commercial arc-welding
equipment next week."
D. "I must keep my arm on the surgical side elevated above my shoulder for the
next month."
Correct Answer: B
Rationale: Clients must monitor their heart rate daily for a full minute to ensure the
demand pacemaker functions correctly and discharges when the intrinsic heart rate falls
below the designated threshold. Household microwaves are safe, heavy arc-welding
equipment produces strong electromagnetic interference that can disrupt the
pacemaker, and the affected arm should not be raised above the shoulder initially to
prevent lead displacement.
Question 8
A nurse is assessing a client who is being treated for a severe acute exacerbation of
ulcerative colitis. The client reports a sudden onset of severe abdominal pain, and the
nurse notes abdominal distension with rebound tenderness and rigid, board-like
abdominal muscles. Which of the following complications should the nurse suspect?
A. Intussusception
B. Toxic megacolon leading to perforation
C. Hepatic encephalopathy
D. Acute mechanical bowel obstruction
Correct Answer: B
Rationale: Toxic megacolon is an acute, life-threatening complication of inflammatory
bowel disease characterized by severe colonic dilation. If the colon ruptures or
perforates, it causes peritonitis, which manifests as a rigid, board-like abdomen, fever,
tachycardia, and rebound tenderness.
Question 9
A nurse is caring for a client who is 12 hours postoperative following a total
thyroidectomy. The client reports a tingling sensation in their fingers and around their
mouth. Which of the following nursing interventions is the priority?
A. Administer an oral potassium supplement as prescribed.
B. Assess the client for Trousseau's and Chvostek's signs.
C. Check the client's surgical dressing for posterior hemorrhage.
D. Encourage the client to perform deep-breathing exercises.
Correct Answer: B
Rationale: During a total thyroidectomy, the parathyroid glands can be accidentally
damaged or removed, resulting in acute hypocalcemia. Early manifestations of
hypocalcemia include circumoral paresthesia and numbness in the extremities.
Assessing for Chvostek's sign (facial twitching) and Trousseau's sign (carpal spasm)
validates this condition, which requires emergency calcium gluconate replacement to
prevent laryngospasm.
Question 10
, A nurse is preparing to administer blood pressure medications to a client who has
chronic kidney disease (CKD) Stage 4. Which of the following laboratory values should
the nurse evaluate before administering an Angiotensin-Converting Enzyme (ACE)
inhibitor?
A. Serum Calcium
B. Serum Potassium
C. Serum Sodium
D. Blood Urea Nitrogen (BUN) only
Correct Answer: B
Rationale: ACE inhibitors block the production of aldosterone, which reduces the
kidneys' ability to excrete potassium. Because clients with Stage 4 CKD already have
an impaired glomerular filtration rate and tend to retain potassium, giving an ACE
inhibitor places them at critical risk for life-threatening hyperkalemia.
Question 11
A nurse is caring for a client who has developed acute respiratory distress syndrome
(ARDS) following severe sepsis. The mechanical ventilator settings include High-
Positive End-Expiratory Pressure (PEEP). Which of the following systemic adverse
effects of high PEEP should the nurse monitor for?
A. Hypervolemia
B. Decreased cardiac output and hypotension
C. Respiratory alkalosis
D. Increased renal perfusion
Correct Answer: B
Rationale: High PEEP increases intrathoracic pressure, which compresses the vena
cava and decreases venous return to the right atrium. This drop in preload leads to
decreased cardiac output and systemic hypotension.
Question 12
A nurse is planning care for a client who has a permanent colostomy. To promote
optimal skin integrity around the stoma site, which of the following instructions should
the nurse provide?
A. Cleanse the peristomal skin using harsh alcohol swabs daily.
B. Cut the skin barrier opening to be exactly 1/8 inch larger than the stoma.
C. Change the entire pouching system every 12 to 24 hours.
D. Apply a thick layer of petroleum jelly directly under the adhesive backing.
Correct Answer: B
Rationale: The opening of the skin barrier should be cut approximately 1/8 inch larger
than the stoma to prevent the appliance from constricting the stoma while protecting the
surrounding peristomal skin from contact with corrosive fecal output. Changing the
system too frequently destroys the epidermis, and petroleum jelly prevents the pouch
from adhering.
Question 13
A nurse is assessing a client with left-sided heart failure. Which of the following clinical
findings should the nurse expect to observe?
A. Jugular venous distension (JVD)
B. Dependent bilateral pitting ankle edema
C. Pulmonary crackles and orthopnea
UPDATE
Objective Assessment Competency Compendia (Comprehensive Exam Blueprint)
Question 1
A nurse is assessing a client who is 24 hours postoperative following an abdominal
hysterectomy. Which of the following assessment findings should the nurse identify as
the priority to report to the provider?
A. Absent bowel sounds in all four quadrants
B. Urinary output of 20 mL/hr for two consecutive hours
C. Serosanguineous drainage on the abdominal dressing
D. Client report of incisional pain rated as 6 on a scale of 0 to 10
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) and priority framework, an
output of less than 30 mL/hr indicates poor renal perfusion, potential hypovolemia, or
acute kidney injury, which requires immediate fluid resuscitation or medical intervention.
Absent bowel sounds are expected 24 hours post-abdominal surgery due to paralytic
ileus, serosanguineous drainage is normal, and pain can be addressed after ensuring
hemodynamic stability.
Question 2
A nurse is caring for a client admitted with an acute exacerbation of chronic obstructive
pulmonary disease (COPD). The client is receiving oxygen at 2 L/min via nasal cannula.
Which of the following findings indicates that the oxygen therapy is effective?
A. PaCO2 level of 52 mmHg
B. Oxygen saturation (SaO2) of 90%
C. Respiratory rate of 28/min
D. Bicarbonate level of 28 mEq/L
Correct Answer: B
Rationale: For clients with severe COPD, the therapeutic target for oxygen saturation is
typically between 88% and 92%. Raising the SaO2 higher can suppress their hypoxic
drive to breathe. A respiratory rate of 28/min indicates ongoing distress, and an
elevated PaCO2 is expected for a chronic retainer but does not measure oxygenation
efficiency.
Question 3
A nurse is reviewing the laboratory results of a client who is receiving a continuous
intravenous heparin infusion for a deep vein thrombosis (DVT). Which of the following
laboratory values indicates that the therapy is within the therapeutic range?
A. International Normalized Ratio (INR) of 2.5
B. Activated partial thromboplastin time (aPTT) of 65 seconds
C. Prothrombin time (PT) of 12 seconds
D. Platelet count of 98,000/mm³
Correct Answer: B
Rationale: Heparin therapy effectiveness is monitored using the aPTT value. The
normal baseline aPTT is 30 to 40 seconds, and the therapeutic target is 1.5 to 2.5 times
the baseline (roughly 60 to 80 seconds). INR is used to monitor warfarin, and a platelet
,count of 98,000 indicates heparin-induced thrombocytopenia (HIT), a critical adverse
event.
Question 4
A nurse is caring for a client who is in the compensatory stage of hypovolemic shock.
Which of the following clinical manifestations should the nurse expect to observe?
A. Metabolic acidosis with a base deficit
B. Cold, clammy skin and profound hypotension
C. Tachycardia and a narrowed pulse pressure
D. Decreased level of consciousness and lethargy
Correct Answer: C
Rationale: In the early compensatory stage of shock, the body uses the sympathetic
nervous system to maintain cardiac output and blood pressure. This causes a
compensatory increase in heart rate (tachycardia) and peripheral vasoconstriction,
leading to a narrowed pulse pressure. Lethargy, cold clammy skin, and profound
hypotension signify the progressive and irreversible stages.
Question 5
A nurse is completing an admission assessment for a client who has a history of type 1
diabetes mellitus and is scheduled for an elective cholecystectomy. The client states, "I
have not taken my long-acting insulin since yesterday morning because I've been
fasting." Which of the following complications is this client at the highest risk for
developing?
A. Hypoglycemic shock
B. Hyperosmolar hyperglycemic state (HHS)
C. Diabetic ketoacidosis (DKA)
D. Acute pancreatitis
Correct Answer: C
Rationale: Clients with type 1 diabetes mellitus lack endogenous insulin production.
Skipping long-acting insulin doses, combined with the physiological stress of surgery
and fasting, will result in rapid lipolysis and ketone production, directly precipitating
diabetic ketoacidosis (DKA). HHS is characteristic of type 2 diabetes mellitus.
Question 6
A nurse is teaching a client who has a new diagnosis of stable angina and a prescription
for sublingual nitroglycerin tablets. Which of the following instructions should the nurse
include in the teaching plan?
A. "Take one tablet every 15 minutes up to a maximum of 4 doses."
B. "Swallow the tablet immediately with a full glass of water."
C. "Sit down before taking the medication because it can cause dizziness."
D. "Discard the tablets if you experience a tingling sensation under your tongue."
Correct Answer: C
Rationale: Nitroglycerin is a potent systemic vasodilator that rapidly reduces preload
and afterload. This sudden change can cause severe orthostatic hypotension and
syncope; therefore, the client must sit or lie down before administration. Tablets should
be taken 5 minutes apart up to 3 doses, should not be swallowed, and a tingling
sensation indicates that the drug is fresh and chemically active.
Question 7
,A nurse is providing discharge instructions to a client who had a permanent demand
pacemaker inserted 48 hours ago. Which of the following client statements indicates an
accurate understanding of the instructions?
A. "I will avoid using my household microwave oven from now on."
B. "I need to take my pulse every morning and report a rate below the setting."
C. "I can safely return to my job operating heavy commercial arc-welding
equipment next week."
D. "I must keep my arm on the surgical side elevated above my shoulder for the
next month."
Correct Answer: B
Rationale: Clients must monitor their heart rate daily for a full minute to ensure the
demand pacemaker functions correctly and discharges when the intrinsic heart rate falls
below the designated threshold. Household microwaves are safe, heavy arc-welding
equipment produces strong electromagnetic interference that can disrupt the
pacemaker, and the affected arm should not be raised above the shoulder initially to
prevent lead displacement.
Question 8
A nurse is assessing a client who is being treated for a severe acute exacerbation of
ulcerative colitis. The client reports a sudden onset of severe abdominal pain, and the
nurse notes abdominal distension with rebound tenderness and rigid, board-like
abdominal muscles. Which of the following complications should the nurse suspect?
A. Intussusception
B. Toxic megacolon leading to perforation
C. Hepatic encephalopathy
D. Acute mechanical bowel obstruction
Correct Answer: B
Rationale: Toxic megacolon is an acute, life-threatening complication of inflammatory
bowel disease characterized by severe colonic dilation. If the colon ruptures or
perforates, it causes peritonitis, which manifests as a rigid, board-like abdomen, fever,
tachycardia, and rebound tenderness.
Question 9
A nurse is caring for a client who is 12 hours postoperative following a total
thyroidectomy. The client reports a tingling sensation in their fingers and around their
mouth. Which of the following nursing interventions is the priority?
A. Administer an oral potassium supplement as prescribed.
B. Assess the client for Trousseau's and Chvostek's signs.
C. Check the client's surgical dressing for posterior hemorrhage.
D. Encourage the client to perform deep-breathing exercises.
Correct Answer: B
Rationale: During a total thyroidectomy, the parathyroid glands can be accidentally
damaged or removed, resulting in acute hypocalcemia. Early manifestations of
hypocalcemia include circumoral paresthesia and numbness in the extremities.
Assessing for Chvostek's sign (facial twitching) and Trousseau's sign (carpal spasm)
validates this condition, which requires emergency calcium gluconate replacement to
prevent laryngospasm.
Question 10
, A nurse is preparing to administer blood pressure medications to a client who has
chronic kidney disease (CKD) Stage 4. Which of the following laboratory values should
the nurse evaluate before administering an Angiotensin-Converting Enzyme (ACE)
inhibitor?
A. Serum Calcium
B. Serum Potassium
C. Serum Sodium
D. Blood Urea Nitrogen (BUN) only
Correct Answer: B
Rationale: ACE inhibitors block the production of aldosterone, which reduces the
kidneys' ability to excrete potassium. Because clients with Stage 4 CKD already have
an impaired glomerular filtration rate and tend to retain potassium, giving an ACE
inhibitor places them at critical risk for life-threatening hyperkalemia.
Question 11
A nurse is caring for a client who has developed acute respiratory distress syndrome
(ARDS) following severe sepsis. The mechanical ventilator settings include High-
Positive End-Expiratory Pressure (PEEP). Which of the following systemic adverse
effects of high PEEP should the nurse monitor for?
A. Hypervolemia
B. Decreased cardiac output and hypotension
C. Respiratory alkalosis
D. Increased renal perfusion
Correct Answer: B
Rationale: High PEEP increases intrathoracic pressure, which compresses the vena
cava and decreases venous return to the right atrium. This drop in preload leads to
decreased cardiac output and systemic hypotension.
Question 12
A nurse is planning care for a client who has a permanent colostomy. To promote
optimal skin integrity around the stoma site, which of the following instructions should
the nurse provide?
A. Cleanse the peristomal skin using harsh alcohol swabs daily.
B. Cut the skin barrier opening to be exactly 1/8 inch larger than the stoma.
C. Change the entire pouching system every 12 to 24 hours.
D. Apply a thick layer of petroleum jelly directly under the adhesive backing.
Correct Answer: B
Rationale: The opening of the skin barrier should be cut approximately 1/8 inch larger
than the stoma to prevent the appliance from constricting the stoma while protecting the
surrounding peristomal skin from contact with corrosive fecal output. Changing the
system too frequently destroys the epidermis, and petroleum jelly prevents the pouch
from adhering.
Question 13
A nurse is assessing a client with left-sided heart failure. Which of the following clinical
findings should the nurse expect to observe?
A. Jugular venous distension (JVD)
B. Dependent bilateral pitting ankle edema
C. Pulmonary crackles and orthopnea
