Wgu D447 HESI

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Sample questions from Wgu D447 HESI

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client is in the emergency department with crushing chest pressure, diaphoresis, and nausea. Blood pressure is 86/54 mm Hg, heart rate is 118/min, and oxygen saturation is 93% on room air. The electrocardiogram shows ST elevation in leads II, III, and aVF. Which action should the nurse take first?

   • A.Administer sublingual nitroglycerin for chest pain
   • B.Establish intravenous access and prepare for prescribed fluid resuscitation
   • C.Obtain a detailed history of the client's cardiac risk factors
   • D.Administer oral aspirin with a full glass of water

   Rationale: The client has an acute inferior myocardial infarction with hypotension, so establishing access and supporting perfusion are immediate priorities; right ventricular involvement may make preload-dependent hypotension worse. Nitroglycerin can further lower blood pressure, and a detailed history can wait until stabilization. Aspirin is important in acute coronary syndrome but is not the first action for this unstable client. The exam takeaway is to address hemodynamic instability before routine history or symptom-relief measures.

2. 2.A 74-year-old client is admitted to a medical unit with pneumonia and new confusion. The client has a temperature of 39.2 C (102.6 F), blood pressure of 82/48 mm Hg, heart rate of 126/min, respiratory rate of 30/min, and oxygen saturation of 89% on room air. Which nursing action has priority?

   • A.Obtain a urine specimen for culture
   • B.Administer the prescribed broad-spectrum antibiotic
   • C.Apply supplemental oxygen and activate the sepsis response
   • D.Provide a cool bath to reduce the temperature

   Rationale: Hypotension, tachycardia, altered mentation, and hypoxemia suggest sepsis with impaired perfusion, requiring immediate oxygen support and escalation. Cultures should be obtained promptly when feasible, but they must not delay stabilization or timely sepsis treatment. Antibiotics are essential, but the unstable airway-breathing-circulation problem takes priority. A cool bath does not correct the underlying shock and may cause discomfort or shivering.

3. 3.A 56-year-old client with type 1 diabetes is admitted to the emergency department with vomiting and abdominal pain. The client is drowsy, has deep rapid respirations, glucose of 620 mg/dL, potassium of 5.4 mEq/L, and arterial pH of 7.12. Which prescribed intervention should the nurse implement first?

   • A.Begin an isotonic intravenous fluid bolus
   • B.Administer intravenous regular insulin
   • C.Give oral potassium replacement
   • D.Administer sodium bicarbonate

   Rationale: The presentation is diabetic ketoacidosis with likely severe volume depletion, so isotonic fluid replacement is the initial priority. Insulin is needed after initial fluid assessment and must be managed with ongoing potassium monitoring. Potassium is elevated and oral replacement is inappropriate, while bicarbonate is not routinely given for this pH without specific indications. The exam takeaway is to restore circulating volume first in DKA while monitoring electrolytes closely.

4. 4.A 23-year-old client with asthma arrives at urgent care with audible wheezing and difficulty speaking in full sentences. Respiratory rate is 32/min, heart rate is 124/min, and oxygen saturation is 90% on room air. Which action is most appropriate?

   • A.Teach the client to use a peak-flow meter
   • B.Administer the prescribed inhaled short-acting bronchodilator
   • C.Encourage the client to lie flat and rest
   • D.Obtain a sputum specimen before treatment

   Answer and rationale are in the full material.

5. 5.A 79-year-old client is postoperative day 1 after hip repair. The client suddenly reports shortness of breath and chest pain; heart rate is 132/min, respiratory rate is 34/min, oxygen saturation is 84% on room air, and blood pressure is 104/68 mm Hg. What should the nurse do first?

   • A.Assist the client to ambulate to improve circulation
   • B.Apply oxygen and activate the rapid response system
   • C.Administer the prescribed oral analgesic
   • D.Document the findings and reassess in 15 minutes

   Answer and rationale are in the full material.