WGU D455 EXIT HESI HCV2 COMPREHENSIVE EXAM
() ACTUAL QUESTIONS AND REVISED
ANSWERS WITH RATIONALES, (A+ GUARANTEE).
140 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Apply the nursing process to complex multi-system patient scenarios to formulate safe, evidence-based
care
2 Integrate pharmacological principles with patient assessment to anticipate, monitor, and manage
medication effects and interactions
3 Prioritize nursing actions using clinical judgment and Maslow's hierarchy, safety, and patient acuity
principles
4 Evaluate the effectiveness of interprofessional communication and delegation in dynamic healthcare
environments
5 Synthesize knowledge from nursing, pathophysiology, and nutrition to manage patients across the
lifespan and healthcare continuum
6 WGU D455 Exit HESI HCV2 Comprehensive Exam
7 2026
8 2027
9 Actual Questions and Revised Answers with Rationales
10 A+ Guarantee
11 Foundations of Nursing (Comprehensive Medical-Surgical, Pharmacology, Leadership, and Prioritization)
12 Applied Nursing (Comprehensive Medical-Surgical, Pharmacology, Leadership, and Prioritization)
13 Advanced Nursing (Comprehensive Medical-Surgical, Pharmacology, Leadership, and Prioritization)
14 Nursing (Comprehensive Medical-Surgical, Pharmacology, Leadership, and Prioritization) Review
Page 1
,Q1 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A patient with a history of chronic heart failure presents with a new prescription
for sacubitril/valsartan. Which finding in the patient's history would necessitate
withholding this medication and contacting the provider?
A. Current use of an ACE inhibitor within the past 36 hours CORRECT
B. Elevated serum creatinine of 1.5 mg/dL
C. Concurrent use of a beta-blocker
D. History of mild hepatic impairment
RATIONALE: Sacubitril/valsartan is contraindicated within 36 hours of ACE inhibitor use due to
the risk of angioedema. Elevated creatinine and hepatic impairment require monitoring but are
not absolute contraindications. Beta-blockers are commonly used concurrently in heart failure.
Q2 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A nurse is assessing a patient with suspected sepsis using the qSOFA criteria.
Which combination of findings would indicate a positive screen, prompting
immediate further evaluation?
A. Respiratory rate 24/min, systolic BP 90 mmHg, GCS 14 CORRECT
B. Heart rate 110/min, temperature 38.5°C, white blood cell count 14,000/mm³
C. Respiratory rate 20/min, systolic BP 110 mmHg, GCS 15
D. Oxygen saturation 91%, mean arterial pressure 65 mmHg, urine output 20 mL/hr
RATIONALE: qSOFA criteria include altered mentation (GCS <15), systolic BP 100 mmHg, and
respiratory rate 22/min. Option A meets all three criteria. The other options do not meet the
qSOFA threshold; they may indicate infection or organ dysfunction but are not the quick screen.
Page 2
,Q3 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A nurse on a medical-surgical unit is caring for four patients. Which patient should
the nurse assess first after receiving shift report?
A. A patient with a new tracheostomy who is receiving humidified oxygen and has stable vital
signs
B. A patient with diabetes who has a blood glucose level of 180 mg/dL and is scheduled for a
wound debridement
C. A patient with a chest tube that has continuous bubbling in the water seal chamber and
reports no shortness of breath CORRECT
D. A patient with a history of hypertension who has a blood pressure of 150/90 mmHg and
reports a mild headache
RATIONALE: Continuous bubbling in the water seal chamber indicates an air leak, which could
lead to a tension pneumothorax. This is a potentially life-threatening situation requiring immediate
assessment. The other patients have stable findings or are less acute.
Q4 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
Which instruction should the nurse include in the teaching plan for a patient who
is prescribed lithium carbonate for bipolar disorder?
A. Take the medication with a high-sodium meal to enhance absorption
B. Maintain consistent fluid and salt intake to prevent lithium toxicity CORRECT
C. Double the next dose if a dose is missed to maintain therapeutic levels
D. Discontinue the medication immediately if fine hand tremors occur
RATIONALE: Lithium levels are highly sensitive to sodium and hydration status; dehydration or
low sodium can increase lithium levels, leading to toxicity. Patients should maintain consistent
intake. High-sodium meals may decrease lithium levels. Missed doses should not be doubled,
and fine tremors are a common side effect that should be reported but not cause abrupt
discontinuation.
Page 3
, Q5 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A nurse is reviewing laboratory results for a patient receiving heparin via
continuous IV infusion. Which value requires immediate intervention?
A. aPTT of 60 seconds (control 30 seconds)
B. Platelet count of 120,000/mm³ CORRECT
C. Hemoglobin of 14 g/dL
D. Potassium of 4.0 mEq/L
RATIONALE: A platelet count of 120,000/mm³ is below normal and may indicate heparin-induced
thrombocytopenia (HIT), which requires immediate discontinuation of heparin and alternative
anticoagulation. An aPTT of 60 seconds is within the therapeutic range (1.5-2.5 times control).
The other values are normal.
Q6 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A nurse is preparing to administer a blood transfusion to a patient. Which action is
most important to prevent a transfusion-associated circulatory overload (TACO)?
A. Administer a diuretic before the transfusion
B. Transfuse the blood over a minimum of 4 hours
C. Assess the patient's fluid volume status and transfuse slowly CORRECT
D. Premedicate with an antihistamine and antipyretic
RATIONALE: TACO is caused by rapid infusion or excessive volume, especially in at-risk
patients. Assessing fluid status and transfusing slowly (e.g., 1-2 mL/kg/hr) reduces risk. Diuretics
may be used but are not routine. Premedication is for allergic reactions, and 4-hour infusion is
the maximum time, not a safeguard against TACO.
Page 4
() ACTUAL QUESTIONS AND REVISED
ANSWERS WITH RATIONALES, (A+ GUARANTEE).
140 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Apply the nursing process to complex multi-system patient scenarios to formulate safe, evidence-based
care
2 Integrate pharmacological principles with patient assessment to anticipate, monitor, and manage
medication effects and interactions
3 Prioritize nursing actions using clinical judgment and Maslow's hierarchy, safety, and patient acuity
principles
4 Evaluate the effectiveness of interprofessional communication and delegation in dynamic healthcare
environments
5 Synthesize knowledge from nursing, pathophysiology, and nutrition to manage patients across the
lifespan and healthcare continuum
6 WGU D455 Exit HESI HCV2 Comprehensive Exam
7 2026
8 2027
9 Actual Questions and Revised Answers with Rationales
10 A+ Guarantee
11 Foundations of Nursing (Comprehensive Medical-Surgical, Pharmacology, Leadership, and Prioritization)
12 Applied Nursing (Comprehensive Medical-Surgical, Pharmacology, Leadership, and Prioritization)
13 Advanced Nursing (Comprehensive Medical-Surgical, Pharmacology, Leadership, and Prioritization)
14 Nursing (Comprehensive Medical-Surgical, Pharmacology, Leadership, and Prioritization) Review
Page 1
,Q1 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A patient with a history of chronic heart failure presents with a new prescription
for sacubitril/valsartan. Which finding in the patient's history would necessitate
withholding this medication and contacting the provider?
A. Current use of an ACE inhibitor within the past 36 hours CORRECT
B. Elevated serum creatinine of 1.5 mg/dL
C. Concurrent use of a beta-blocker
D. History of mild hepatic impairment
RATIONALE: Sacubitril/valsartan is contraindicated within 36 hours of ACE inhibitor use due to
the risk of angioedema. Elevated creatinine and hepatic impairment require monitoring but are
not absolute contraindications. Beta-blockers are commonly used concurrently in heart failure.
Q2 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A nurse is assessing a patient with suspected sepsis using the qSOFA criteria.
Which combination of findings would indicate a positive screen, prompting
immediate further evaluation?
A. Respiratory rate 24/min, systolic BP 90 mmHg, GCS 14 CORRECT
B. Heart rate 110/min, temperature 38.5°C, white blood cell count 14,000/mm³
C. Respiratory rate 20/min, systolic BP 110 mmHg, GCS 15
D. Oxygen saturation 91%, mean arterial pressure 65 mmHg, urine output 20 mL/hr
RATIONALE: qSOFA criteria include altered mentation (GCS <15), systolic BP 100 mmHg, and
respiratory rate 22/min. Option A meets all three criteria. The other options do not meet the
qSOFA threshold; they may indicate infection or organ dysfunction but are not the quick screen.
Page 2
,Q3 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A nurse on a medical-surgical unit is caring for four patients. Which patient should
the nurse assess first after receiving shift report?
A. A patient with a new tracheostomy who is receiving humidified oxygen and has stable vital
signs
B. A patient with diabetes who has a blood glucose level of 180 mg/dL and is scheduled for a
wound debridement
C. A patient with a chest tube that has continuous bubbling in the water seal chamber and
reports no shortness of breath CORRECT
D. A patient with a history of hypertension who has a blood pressure of 150/90 mmHg and
reports a mild headache
RATIONALE: Continuous bubbling in the water seal chamber indicates an air leak, which could
lead to a tension pneumothorax. This is a potentially life-threatening situation requiring immediate
assessment. The other patients have stable findings or are less acute.
Q4 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
Which instruction should the nurse include in the teaching plan for a patient who
is prescribed lithium carbonate for bipolar disorder?
A. Take the medication with a high-sodium meal to enhance absorption
B. Maintain consistent fluid and salt intake to prevent lithium toxicity CORRECT
C. Double the next dose if a dose is missed to maintain therapeutic levels
D. Discontinue the medication immediately if fine hand tremors occur
RATIONALE: Lithium levels are highly sensitive to sodium and hydration status; dehydration or
low sodium can increase lithium levels, leading to toxicity. Patients should maintain consistent
intake. High-sodium meals may decrease lithium levels. Missed doses should not be doubled,
and fine tremors are a common side effect that should be reported but not cause abrupt
discontinuation.
Page 3
, Q5 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A nurse is reviewing laboratory results for a patient receiving heparin via
continuous IV infusion. Which value requires immediate intervention?
A. aPTT of 60 seconds (control 30 seconds)
B. Platelet count of 120,000/mm³ CORRECT
C. Hemoglobin of 14 g/dL
D. Potassium of 4.0 mEq/L
RATIONALE: A platelet count of 120,000/mm³ is below normal and may indicate heparin-induced
thrombocytopenia (HIT), which requires immediate discontinuation of heparin and alternative
anticoagulation. An aPTT of 60 seconds is within the therapeutic range (1.5-2.5 times control).
The other values are normal.
Q6 APPLY THE NURSING PROCESS TO COMPLEX MULTI-SYSTEM PATIENT SCENARIOS TO
FORMULATE SAFE, EVIDENCE-BASED CARE
A nurse is preparing to administer a blood transfusion to a patient. Which action is
most important to prevent a transfusion-associated circulatory overload (TACO)?
A. Administer a diuretic before the transfusion
B. Transfuse the blood over a minimum of 4 hours
C. Assess the patient's fluid volume status and transfuse slowly CORRECT
D. Premedicate with an antihistamine and antipyretic
RATIONALE: TACO is caused by rapid infusion or excessive volume, especially in at-risk
patients. Assessing fluid status and transfusing slowly (e.g., 1-2 mL/kg/hr) reduces risk. Diuretics
may be used but are not routine. Premedication is for allergic reactions, and 4-hour infusion is
the maximum time, not a safeguard against TACO.
Page 4
