WGU D446 ADULT HEALTH 2 OA EXAM
PREP 200 NGN STYLE Q and A WITH
RATIONALES A+ VERIFIED STUDY
GUIDE 2026/2027
1. A 68-year-old male patient with a history of coronary artery disease,
hypertension, and type 2 diabetes mellitus is admitted to the medical-
surgical unit with complaints of increasing shortness of breath, bilateral
lower extremity edema, and a 5-pound weight gain over the past three
days; upon assessment, the nurse notes jugular venous distension,
crackles in the lower lung fields bilaterally, an S3 heart sound, and a
blood pressure of 168/94 mmHg; the patient's current medications
include lisinopril, metoprolol succinate, furosemide, and metformin.
Based on these clinical findings, which nursing intervention should be
prioritized FIRST to address the patient's most immediate physiological
need?
A) Administer the scheduled dose of metformin to maintain glycemic
control
B) Elevate the head of the bed to 45 degrees and apply supplemental
oxygen as ordered
C) Obtain a 12-lead electrocardiogram to evaluate for acute coronary
changes
D) Administer the prescribed intravenous furosemide to promote
diuresis and reduce pulmonary congestion
The patient is exhibiting classic signs of acute decompensated heart
failure with pulmonary congestion (crackles, JVD, S3, weight gain,
edema). While all interventions may be appropriate, reducing pulmonary
congestion through diuresis and improving oxygenation via positioning
and oxygen therapy addresses the most immediate threat to airway and
breathing. However, administering IV furosemide directly targets the
pathophysiology of fluid overload and will provide the most rapid
improvement in respiratory status, making it the priority intervention
after ensuring immediate airway support.
,2. A 54-year-old female patient who underwent a total hip arthroplasty
24 hours ago is receiving enoxaparin for deep vein thrombosis
prophylaxis and reports sudden onset of sharp chest pain, dyspnea, and
a sense of impending doom; the nurse assesses a heart rate of 118 bpm,
respiratory rate of 28 breaths/min, oxygen saturation of 89% on room
air, and blood pressure of 102/68 mmHg; the patient appears anxious
and diaphoretic. Which action should the nurse implement
IMMEDIATELY while awaiting provider notification?
A) Administer the scheduled dose of enoxaparin subcutaneously as
ordered
B) Place the patient in high-Fowler's position, apply supplemental
oxygen at 4 L/min via nasal cannula, and prepare for possible stat
imaging
C) Encourage the patient to perform deep breathing and coughing
exercises to improve oxygenation
D) Obtain a stat complete blood count to evaluate for postoperative
anemia
The patient's sudden onset of chest pain, dyspnea, tachycardia,
hypoxemia, and anxiety following orthopedic surgery strongly suggests a
pulmonary embolism, a life-threatening complication. Immediate
nursing priorities focus on optimizing oxygenation and ventilation while
preparing for diagnostic confirmation and treatment. Positioning the
patient upright and administering supplemental oxygen addresses
hypoxemia, while preparing for imaging (such as CT pulmonary
angiography) facilitates rapid diagnosis. Administering anticoagulants or
obtaining labs, while important, are secondary to stabilizing the patient's
respiratory status.
3. A 72-year-old male patient with chronic kidney disease stage 4 is
admitted with hyperkalemia (serum potassium 6.8 mEq/L) and reports
muscle weakness and palpitations; the electrocardiogram shows peaked
T waves and a widened QRS complex; the provider orders calcium
gluconate IV, regular insulin with dextrose, sodium polystyrene
sulfonate, and furosemide. Which medication should the nurse
administer FIRST to protect the patient from life-threatening cardiac
complications?
A) Regular insulin with 50% dextrose to shift potassium intracellularly
,B) Sodium polystyrene sulfonate to promote potassium excretion via the
GI tract
C) Calcium gluconate IV to stabilize the cardiac cell membrane
D) Furosemide to enhance renal potassium excretion
In severe hyperkalemia with ECG changes, calcium gluconate is
administered first because it stabilizes the cardiac cell membrane and
provides immediate protection against lethal arrhythmias, such as
ventricular fibrillation or asystole. While insulin/dextrose, sodium
polystyrene sulfonate, and diuretics are essential for lowering serum
potassium levels, their effects are delayed (minutes to hours). Calcium
gluconate works within minutes to counteract the cardiotoxic effects of
hyperkalemia, making it the priority intervention when ECG
abnormalities are present.
4. A 45-year-old female patient with a history of Graves' disease presents
to the emergency department with fever of 103.2°F (39.6°C), heart rate
of 142 bpm, blood pressure of 90/58 mmHg, agitation, and diarrhea; the
patient reports recently stopping her methimazole due to financial
constraints. The nurse recognizes these findings as indicative of thyroid
storm and anticipates which collaborative intervention will be initiated
FIRST to address the underlying pathophysiology?
A) Administer acetaminophen for fever reduction and comfort
B) Administer propylthiouracil (PTU) or methimazole to inhibit thyroid
hormone synthesis
C) Initiate IV fluid resuscitation with normal saline to treat hypotension
D) Apply cooling measures such as a cooling blanket to reduce
hyperthermia
Thyroid storm is a life-threatening exacerbation of hyperthyroidism
requiring immediate intervention to halt excessive thyroid hormone
production. While fever management, hemodynamic support, and
cooling measures are critical supportive interventions, administering an
antithyroid medication (PTU or methimazole) addresses the root cause
by inhibiting new thyroid hormone synthesis. PTU is often preferred in
thyroid storm because it also blocks peripheral conversion of T4 to the
more active T3. Supportive care should occur concurrently, but blocking
hormone production is the foundational pharmacologic intervention.
, 5. A 60-year-old male patient with COPD is admitted with an acute
exacerbation characterized by increased dyspnea, productive cough with
yellow-green sputum, and oxygen saturation of 86% on 2 L/min nasal
cannula; arterial blood gases reveal pH 7.32, PaCO2 58 mmHg, PaO2 52
mmHg, and HCO3- 28 mEq/L; the provider orders bronchodilators,
systemic corticosteroids, antibiotics, and titration of oxygen therapy.
Which nursing action is MOST appropriate when administering oxygen
to this patient?
A) Increase oxygen to 6 L/min via nasal cannula to rapidly correct
hypoxemia
B) Titrate oxygen to maintain SpO2 between 88-92% while monitoring
for CO2 retention
C) Switch to a non-rebreather mask at 15 L/min to maximize oxygen
delivery
D) Discontinue oxygen therapy to stimulate the patient's hypoxic
respiratory drive
Patients with severe COPD and chronic hypercapnia may rely on hypoxic
drive for ventilation; however, current evidence supports titrating
oxygen to achieve target saturations of 88-92% to correct hypoxemia
without causing significant CO2 retention. While the hypoxic drive
theory has been debated, the priority is to treat life-threatening
hypoxemia while avoiding excessive oxygen that could worsen
hypercapnia. Close monitoring of ABGs and clinical status guides
ongoing oxygen therapy adjustments.
6. A 58-year-old female patient with a history of atrial fibrillation on
warfarin therapy presents with sudden onset of severe headache, left-
sided facial droop, slurred speech, and right-sided hemiparesis; the
nurse notes the patient's last INR was 3.2 within therapeutic range; a
stat non-contrast CT head is ordered. Which nursing intervention should
be prioritized WHILE awaiting imaging results?
A) Administer the scheduled dose of warfarin to maintain
anticoagulation
B) Maintain NPO status, elevate the head of bed to 30 degrees, and
perform frequent neurological assessments
C) Apply a cold compress to the patient's forehead to alleviate headache
pain
PREP 200 NGN STYLE Q and A WITH
RATIONALES A+ VERIFIED STUDY
GUIDE 2026/2027
1. A 68-year-old male patient with a history of coronary artery disease,
hypertension, and type 2 diabetes mellitus is admitted to the medical-
surgical unit with complaints of increasing shortness of breath, bilateral
lower extremity edema, and a 5-pound weight gain over the past three
days; upon assessment, the nurse notes jugular venous distension,
crackles in the lower lung fields bilaterally, an S3 heart sound, and a
blood pressure of 168/94 mmHg; the patient's current medications
include lisinopril, metoprolol succinate, furosemide, and metformin.
Based on these clinical findings, which nursing intervention should be
prioritized FIRST to address the patient's most immediate physiological
need?
A) Administer the scheduled dose of metformin to maintain glycemic
control
B) Elevate the head of the bed to 45 degrees and apply supplemental
oxygen as ordered
C) Obtain a 12-lead electrocardiogram to evaluate for acute coronary
changes
D) Administer the prescribed intravenous furosemide to promote
diuresis and reduce pulmonary congestion
The patient is exhibiting classic signs of acute decompensated heart
failure with pulmonary congestion (crackles, JVD, S3, weight gain,
edema). While all interventions may be appropriate, reducing pulmonary
congestion through diuresis and improving oxygenation via positioning
and oxygen therapy addresses the most immediate threat to airway and
breathing. However, administering IV furosemide directly targets the
pathophysiology of fluid overload and will provide the most rapid
improvement in respiratory status, making it the priority intervention
after ensuring immediate airway support.
,2. A 54-year-old female patient who underwent a total hip arthroplasty
24 hours ago is receiving enoxaparin for deep vein thrombosis
prophylaxis and reports sudden onset of sharp chest pain, dyspnea, and
a sense of impending doom; the nurse assesses a heart rate of 118 bpm,
respiratory rate of 28 breaths/min, oxygen saturation of 89% on room
air, and blood pressure of 102/68 mmHg; the patient appears anxious
and diaphoretic. Which action should the nurse implement
IMMEDIATELY while awaiting provider notification?
A) Administer the scheduled dose of enoxaparin subcutaneously as
ordered
B) Place the patient in high-Fowler's position, apply supplemental
oxygen at 4 L/min via nasal cannula, and prepare for possible stat
imaging
C) Encourage the patient to perform deep breathing and coughing
exercises to improve oxygenation
D) Obtain a stat complete blood count to evaluate for postoperative
anemia
The patient's sudden onset of chest pain, dyspnea, tachycardia,
hypoxemia, and anxiety following orthopedic surgery strongly suggests a
pulmonary embolism, a life-threatening complication. Immediate
nursing priorities focus on optimizing oxygenation and ventilation while
preparing for diagnostic confirmation and treatment. Positioning the
patient upright and administering supplemental oxygen addresses
hypoxemia, while preparing for imaging (such as CT pulmonary
angiography) facilitates rapid diagnosis. Administering anticoagulants or
obtaining labs, while important, are secondary to stabilizing the patient's
respiratory status.
3. A 72-year-old male patient with chronic kidney disease stage 4 is
admitted with hyperkalemia (serum potassium 6.8 mEq/L) and reports
muscle weakness and palpitations; the electrocardiogram shows peaked
T waves and a widened QRS complex; the provider orders calcium
gluconate IV, regular insulin with dextrose, sodium polystyrene
sulfonate, and furosemide. Which medication should the nurse
administer FIRST to protect the patient from life-threatening cardiac
complications?
A) Regular insulin with 50% dextrose to shift potassium intracellularly
,B) Sodium polystyrene sulfonate to promote potassium excretion via the
GI tract
C) Calcium gluconate IV to stabilize the cardiac cell membrane
D) Furosemide to enhance renal potassium excretion
In severe hyperkalemia with ECG changes, calcium gluconate is
administered first because it stabilizes the cardiac cell membrane and
provides immediate protection against lethal arrhythmias, such as
ventricular fibrillation or asystole. While insulin/dextrose, sodium
polystyrene sulfonate, and diuretics are essential for lowering serum
potassium levels, their effects are delayed (minutes to hours). Calcium
gluconate works within minutes to counteract the cardiotoxic effects of
hyperkalemia, making it the priority intervention when ECG
abnormalities are present.
4. A 45-year-old female patient with a history of Graves' disease presents
to the emergency department with fever of 103.2°F (39.6°C), heart rate
of 142 bpm, blood pressure of 90/58 mmHg, agitation, and diarrhea; the
patient reports recently stopping her methimazole due to financial
constraints. The nurse recognizes these findings as indicative of thyroid
storm and anticipates which collaborative intervention will be initiated
FIRST to address the underlying pathophysiology?
A) Administer acetaminophen for fever reduction and comfort
B) Administer propylthiouracil (PTU) or methimazole to inhibit thyroid
hormone synthesis
C) Initiate IV fluid resuscitation with normal saline to treat hypotension
D) Apply cooling measures such as a cooling blanket to reduce
hyperthermia
Thyroid storm is a life-threatening exacerbation of hyperthyroidism
requiring immediate intervention to halt excessive thyroid hormone
production. While fever management, hemodynamic support, and
cooling measures are critical supportive interventions, administering an
antithyroid medication (PTU or methimazole) addresses the root cause
by inhibiting new thyroid hormone synthesis. PTU is often preferred in
thyroid storm because it also blocks peripheral conversion of T4 to the
more active T3. Supportive care should occur concurrently, but blocking
hormone production is the foundational pharmacologic intervention.
, 5. A 60-year-old male patient with COPD is admitted with an acute
exacerbation characterized by increased dyspnea, productive cough with
yellow-green sputum, and oxygen saturation of 86% on 2 L/min nasal
cannula; arterial blood gases reveal pH 7.32, PaCO2 58 mmHg, PaO2 52
mmHg, and HCO3- 28 mEq/L; the provider orders bronchodilators,
systemic corticosteroids, antibiotics, and titration of oxygen therapy.
Which nursing action is MOST appropriate when administering oxygen
to this patient?
A) Increase oxygen to 6 L/min via nasal cannula to rapidly correct
hypoxemia
B) Titrate oxygen to maintain SpO2 between 88-92% while monitoring
for CO2 retention
C) Switch to a non-rebreather mask at 15 L/min to maximize oxygen
delivery
D) Discontinue oxygen therapy to stimulate the patient's hypoxic
respiratory drive
Patients with severe COPD and chronic hypercapnia may rely on hypoxic
drive for ventilation; however, current evidence supports titrating
oxygen to achieve target saturations of 88-92% to correct hypoxemia
without causing significant CO2 retention. While the hypoxic drive
theory has been debated, the priority is to treat life-threatening
hypoxemia while avoiding excessive oxygen that could worsen
hypercapnia. Close monitoring of ABGs and clinical status guides
ongoing oxygen therapy adjustments.
6. A 58-year-old female patient with a history of atrial fibrillation on
warfarin therapy presents with sudden onset of severe headache, left-
sided facial droop, slurred speech, and right-sided hemiparesis; the
nurse notes the patient's last INR was 3.2 within therapeutic range; a
stat non-contrast CT head is ordered. Which nursing intervention should
be prioritized WHILE awaiting imaging results?
A) Administer the scheduled dose of warfarin to maintain
anticoagulation
B) Maintain NPO status, elevate the head of bed to 30 degrees, and
perform frequent neurological assessments
C) Apply a cold compress to the patient's forehead to alleviate headache
pain
