Adult Health II (D446) New OA 2 Exam 4
V2 | Adult Health II (D446) New OA 2 Exam
Q&A | WGU
1. A client is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). Which
clinical finding should the nurse prioritize as the most concerning?
A. A respiratory rate of 28 breaths per minute
B. A PaO2 of 55 mmHg while on 100% oxygen
C. Scattered wheezing throughout the lung fields
D. Respiratory alkalosis shown on initial ABGs
Answer: B
Rationale: Refractory hypoxemia is a hallmark sign of ARDS where oxygen levels remain
low despite high concentrations of supplemental oxygen. A PaO2 of 55 mmHg on 100%
oxygen indicates severe shunting and impaired gas exchange. This requires immediate
intervention, often including mechanical ventilation with PEEP.
2. A nurse is caring for a patient in the ICU who has developed septic shock. Which of the
following hemodynamic parameters is most consistent with the early stage of septic shock?
A. Increased Systemic Vascular Resistance (SVR)
B. Decreased Cardiac Output (CO)
C. High Pulmonary Capillary Wedge Pressure (PCWP)
,D. Increased Cardiac Output (CO)
Answer: D
Rationale: Early or ‘hyperdynamic’ septic shock is characterized by a high cardiac output
and low systemic vascular resistance due to vasodilation. The body attempts to
compensate for the infective process by increasing heart rate and stroke volume. As the
shock progresses to the cold phase, the cardiac output will eventually drop.
3. A client arrives at the Emergency Department with full-thickness burns to the chest and
abdomen. Which assessment is the highest priority for the nurse to perform first?
A. Assess the airway and respiratory status
B. Calculate the Rule of Nines for fluid resuscitation
C. Insert a large-bore IV catheter
D. Administer IV morphine for pain control
Answer: A
Rationale: Airway management is always the priority in trauma and burn patients,
especially those with burns to the chest which can restrict chest expansion. Inhalation
injury is a high risk with burns to the upper torso and face. Establishing a patent airway
and ensuring adequate oxygenation takes precedence over fluid calculations and pain
management.
, 4. A patient with Atrial Fibrillation is being prepared for elective cardioversion. Which
medication does the nurse expect the provider to ensure the patient has been taking for
several weeks prior?
A. Epinephrine
B. Adenosine
C. Atropine
D. Warfarin
Answer: D
Rationale: Patients in Atrial Fibrillation for more than 48 hours are at high risk for
thrombus formation in the left atrium. Anticoagulation with drugs like Warfarin is typically
required for 3 to 4 weeks before elective cardioversion to prevent an embolic stroke. If the
procedure is urgent, a transesophageal echocardiogram (TEE) is performed to rule out
clots first.
5. The nurse is monitoring a patient on mechanical ventilation. The ‘High Pressure’ alarm
begins to sound. Which of the following could be the cause?
A. A leak in the ventilator circuit
B. Excessive secretions or a kink in the tubing
C. The patient has become disconnected from the vent
D. An accidental extubation has occurred
V2 | Adult Health II (D446) New OA 2 Exam
Q&A | WGU
1. A client is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). Which
clinical finding should the nurse prioritize as the most concerning?
A. A respiratory rate of 28 breaths per minute
B. A PaO2 of 55 mmHg while on 100% oxygen
C. Scattered wheezing throughout the lung fields
D. Respiratory alkalosis shown on initial ABGs
Answer: B
Rationale: Refractory hypoxemia is a hallmark sign of ARDS where oxygen levels remain
low despite high concentrations of supplemental oxygen. A PaO2 of 55 mmHg on 100%
oxygen indicates severe shunting and impaired gas exchange. This requires immediate
intervention, often including mechanical ventilation with PEEP.
2. A nurse is caring for a patient in the ICU who has developed septic shock. Which of the
following hemodynamic parameters is most consistent with the early stage of septic shock?
A. Increased Systemic Vascular Resistance (SVR)
B. Decreased Cardiac Output (CO)
C. High Pulmonary Capillary Wedge Pressure (PCWP)
,D. Increased Cardiac Output (CO)
Answer: D
Rationale: Early or ‘hyperdynamic’ septic shock is characterized by a high cardiac output
and low systemic vascular resistance due to vasodilation. The body attempts to
compensate for the infective process by increasing heart rate and stroke volume. As the
shock progresses to the cold phase, the cardiac output will eventually drop.
3. A client arrives at the Emergency Department with full-thickness burns to the chest and
abdomen. Which assessment is the highest priority for the nurse to perform first?
A. Assess the airway and respiratory status
B. Calculate the Rule of Nines for fluid resuscitation
C. Insert a large-bore IV catheter
D. Administer IV morphine for pain control
Answer: A
Rationale: Airway management is always the priority in trauma and burn patients,
especially those with burns to the chest which can restrict chest expansion. Inhalation
injury is a high risk with burns to the upper torso and face. Establishing a patent airway
and ensuring adequate oxygenation takes precedence over fluid calculations and pain
management.
, 4. A patient with Atrial Fibrillation is being prepared for elective cardioversion. Which
medication does the nurse expect the provider to ensure the patient has been taking for
several weeks prior?
A. Epinephrine
B. Adenosine
C. Atropine
D. Warfarin
Answer: D
Rationale: Patients in Atrial Fibrillation for more than 48 hours are at high risk for
thrombus formation in the left atrium. Anticoagulation with drugs like Warfarin is typically
required for 3 to 4 weeks before elective cardioversion to prevent an embolic stroke. If the
procedure is urgent, a transesophageal echocardiogram (TEE) is performed to rule out
clots first.
5. The nurse is monitoring a patient on mechanical ventilation. The ‘High Pressure’ alarm
begins to sound. Which of the following could be the cause?
A. A leak in the ventilator circuit
B. Excessive secretions or a kink in the tubing
C. The patient has become disconnected from the vent
D. An accidental extubation has occurred
