WGU D221 WW | NGM2 TASK 1 | PRACTICE IMPROVEMENT PLAN PROPOSAL 2026/2027 UPDATE | WITH COMPLETE SOLUTION
WESTERN GOVERNORS UNIVERSITY | COURSE D221 | ORGANIZATIONAL SYSTEMS AND HEALTHCARE
TRANSFORMATION
WGU D221 WW - NGM2 TASK 1
Practice Improvement Plan Proposal
2026/2027 UPDATE | WITH COMPLETE SOLUTION
100 Practice Questions | 6 Curriculum-Aligned Sections | Cognitive Mix: 25% Recall / 55% Application / 20% Analysis
| Complete Answer Key with Comprehensive A+-Graded Rationales
Section 1: Systems-Level Safety Concerns and SBAR Framework (Questions
1-20)
Situation, Background, Assessment, Recommendation - Identifying System-Level Problems
Q1: Which of the following best defines a systems-level patient safety concern?
A. A one-time error committed by a careless nurse that affects a single patient
B. A recurring problem that affects multiple patients and results from failures in policy,
procedure, or process [CORRECT]
C. A complication that represents an unavoidable and known risk of a disease process
D. A complaint about staff attitude documented in a patient satisfaction survey
Correct Answer: B
Rationale: A systems-level safety concern is defined by three characteristics: it occurs repeatedly, it affects
multiple patients, and it originates from failures in organizational policy, procedure, or process rather than
from individual fault. Option A describes an isolated individual error, which reflects the blame-focused
mindset that D221 teaches nurses to move beyond because disciplining one person does not correct the
system that produced the error. Option C describes a non-preventable disease complication, not a process
failure, so it falls outside the practice improvement focus. Option D is patient experience feedback that may
inform improvement work, but it is not itself a safety concern rooted in system design.
Q2: On a medical-surgical unit, three different patients fell within one month. The falls
occurred on different shifts, in different rooms, and in each case the patient attempted to walk
to the bathroom unassisted after the call light went unanswered for more than 10 minutes.
Which finding most strongly supports classifying this as a systems-level concern?
A. Each patient was assigned to a different newly licensed nurse
B. All three falls occurred during the night shift
C. All three patients were over the age of 70
D. The falls recurred across different shifts and rooms, indicating a process failure such
as delayed call-light response rather than any single caregiver's
performance [CORRECT]
Correct Answer: D
WGU D221 - Organizational Systems and Healthcare Transformation 1
,WGU D221 WW | NGM2 TASK 1 | PRACTICE IMPROVEMENT PLAN PROPOSAL 2026/2027 UPDATE | WITH COMPLETE SOLUTION
Rationale: The defining evidence for a systems-level concern is repetition across multiple patients and
varying conditions, which points to a defect in the workflow itself, such as the call-light answering process,
purposeful rounding practices, or staffing adequacy. Option A subtly shifts attention toward individual
blame, yet the falls involved different shifts and cannot be attributed to one person. Options B and C identify
true patterns but are limited contextual factors that do not explain why the process failed repeatedly. The
cross-shift, cross-room recurrence is exactly the pattern the NGM2 Task 1 prompt expects students to trace
back to policy, procedure, or process failure.
Q3: In the context of a practice improvement plan proposal, what does the SBAR framework
stand for?
A. Situation, Background, Assessment, Recommendation [CORRECT]
B. Safety, Baseline, Analysis, Resolution
C. Situation, Barriers, Action, Results
D. Standard, Basis, Assessment, Review
Correct Answer: A
Rationale: SBAR is the standardized communication framework required for the NGM2 Task 1 proposal:
Situation states the concern concisely, Background supplies the supporting data and history, Assessment
analyzes the impact and contributing factors, and Recommendation presents the proposed evidence-based
change. The distractors deliberately mix plausible leadership words into the acronym, but none reproduces
the accepted framework. Recognizing the correct expansion is essential because each WGU proposal section
must map to the correct SBAR element. Confusing the components, for example placing data in the Situation
or the plan in the Assessment, is one of the most common Task 1 errors.
Q4: A nurse is drafting an SBAR-format practice improvement plan proposal to reduce
medication administration errors. In which SBAR component should the nurse present the
specific proposed evidence-based change, such as integrating barcode medication
administration (BCMA) scanning?
A. Situation, because the technology is the starting point of the proposal
B. Background, because evidence belongs with the historical data
C. Recommendation, because this component presents the proposed change and
implementation plan [CORRECT]
D. Assessment, because the technology solves the analyzed problem
Correct Answer: C
Rationale: The Recommendation component is where the nurse proposes what should be done, including
the evidence-based intervention such as BCMA, the implementation strategies, and the plan for evaluating
outcomes. The Situation only concisely names the safety concern, so option A misplaces the solution. Option
B is incorrect because Background carries the quantitative data, current process description, and history
rather than the proposed fix. Option D is incorrect because the Assessment analyzes causes, impact, and
consequences of leaving the problem unaddressed, not the intervention itself. Placing the intervention in the
Recommendation demonstrates the component mastery WGU rubric evaluators look for.
WGU D221 - Organizational Systems and Healthcare Transformation 2
,WGU D221 WW | NGM2 TASK 1 | PRACTICE IMPROVEMENT PLAN PROPOSAL 2026/2027 UPDATE | WITH COMPLETE SOLUTION
Q5: A nurse is writing an SBAR proposal to reduce catheter-associated urinary tract infections
(CAUTIs). Which statement would correctly appear in the Situation component?
A. CAUTIs added an estimated 48,000 dollars in costs last quarter, and the current
catheter removal protocol is inconsistently followed on the unit.
B. Urinary catheter-associated infections on the medical-surgical unit have increased over
the past three months and require prompt attention. [CORRECT]
C. Inconsistent catheter necessity reviews are causing preventable infections, which will
continue to rise without corrective action.
D. The unit should implement a nurse-driven catheter removal protocol within 60 days.
Correct Answer: B
Rationale: The Situation is a brief, concise statement of what is happening right now, and option B captures
exactly that without data, analysis, or proposed action. Option A belongs in the Background because it
contains quantitative cost data and the description of the current process. Option C belongs in the
Assessment because it interprets causes and predicts consequences of inaction. Option D belongs in the
Recommendation because it states the proposed change with a time frame. NGM2 Task 1 evaluators
specifically look for clean separation of these four components, and blending data or solutions into the
Situation is a frequent rubric deduction.
Q6: A nurse has gathered twelve months of unit data showing the fall rate rising from 3.1 to
4.8 falls per 1,000 patient days, cost figures for injured falls, and a description of the current
fall-prevention protocol. In which SBAR component should this information be placed in the
practice improvement plan proposal?
A. Situation, to show the problem is measurable
B. Assessment, to justify the interpretation of the problem
C. Background, because it supplies the supporting data and current process
description [CORRECT]
D. Recommendation, to anchor the proposed intervention in evidence
Correct Answer: C
Rationale: The Background component is the evidence repository of an SBAR proposal: it presents the
quantitative data, such as rates per 1,000 patient days and cost figures, along with the history and description
of the current process. Option A is incorrect because the Situation must remain a brief statement of the
concern, not a data summary. Option B is incorrect because the Assessment interprets what the data mean,
while the raw data themselves sit in the Background. Option D is incorrect because the Recommendation
proposes the change and cites supporting evidence, but it does not catalog the baseline data. Task 1 rubrics
explicitly reward placement of specific numbers in the Background.
WGU D221 - Organizational Systems and Healthcare Transformation 3
, WGU D221 WW | NGM2 TASK 1 | PRACTICE IMPROVEMENT PLAN PROPOSAL 2026/2027 UPDATE | WITH COMPLETE SOLUTION
Q7: A nurse administered the wrong medication dose because two look-alike, sound-alike vials
were stored side by side in the automated dispensing cabinet and barcode scanning was not
being used on the unit. The unit manager's response is to send the nurse to a medication safety
refresher course. Using systems-level thinking, why is this response insufficient?
A. Retraining is insufficient because the nurse should also complete a supervised
medication pass before returning to independent practice.
B. Retraining is insufficient because the manager should have also notified the state
board of nursing.
C. Retraining is sufficient, provided the refresher course includes high-fidelity
simulation.
D. Retraining is insufficient because the error resulted from system factors, including
hazardous storage and missing scanning safeguards, which remain in place after the
course. [CORRECT]
Correct Answer: D
Rationale: The error chain described, look-alike storage plus absent barcode verification, is a classic system
failure, so educating one nurse leaves every subsequent nurse exposed to the same hazardous process. Option
D applies the core D221 principle that fixes must target policy, procedure, and process, such as separating
look-alike stock and enforcing BCMA scanning. Option A adds more individual-level remediation but still
never touches the system defect. Option B escalates punishment without improving safety and reflects the
punitive culture that suppresses incident reporting. Option C is wrong because it accepts retraining as
adequate, directly contradicting the systems-level analysis the scenario demands.
Q8: Which of the following is the clearest example of a systems-level patient safety concern
appropriate for a practice improvement plan proposal?
A. CAUTI rates rising unit-wide because the catheter necessity review is inconsistently
performed [CORRECT]
B. One nurse forgetting to document a single head-to-toe assessment
C. A patient declining one scheduled medication dose for personal reasons
D. A visitor slipping in the hospital lobby on a rainy day
Correct Answer: A
Rationale: Option A describes a preventable outcome, CAUTI, that recurs across the unit because a
required process step, the daily catheter necessity review, is applied inconsistently, which is precisely the
policy and procedure failure that defines a systems-level concern. Option B is a single documentation lapse
by one nurse, an individual error unless it repeats across the staff. Option C reflects patient autonomy over a
personal health decision and does not represent a care process defect. Option D is an environmental incident
unrelated to a recurring clinical process on the unit. Task 1 requires selecting concerns that are repeated,
multi-patient, and process-driven, and only option A meets all three tests.
WGU D221 - Organizational Systems and Healthcare Transformation 4
WESTERN GOVERNORS UNIVERSITY | COURSE D221 | ORGANIZATIONAL SYSTEMS AND HEALTHCARE
TRANSFORMATION
WGU D221 WW - NGM2 TASK 1
Practice Improvement Plan Proposal
2026/2027 UPDATE | WITH COMPLETE SOLUTION
100 Practice Questions | 6 Curriculum-Aligned Sections | Cognitive Mix: 25% Recall / 55% Application / 20% Analysis
| Complete Answer Key with Comprehensive A+-Graded Rationales
Section 1: Systems-Level Safety Concerns and SBAR Framework (Questions
1-20)
Situation, Background, Assessment, Recommendation - Identifying System-Level Problems
Q1: Which of the following best defines a systems-level patient safety concern?
A. A one-time error committed by a careless nurse that affects a single patient
B. A recurring problem that affects multiple patients and results from failures in policy,
procedure, or process [CORRECT]
C. A complication that represents an unavoidable and known risk of a disease process
D. A complaint about staff attitude documented in a patient satisfaction survey
Correct Answer: B
Rationale: A systems-level safety concern is defined by three characteristics: it occurs repeatedly, it affects
multiple patients, and it originates from failures in organizational policy, procedure, or process rather than
from individual fault. Option A describes an isolated individual error, which reflects the blame-focused
mindset that D221 teaches nurses to move beyond because disciplining one person does not correct the
system that produced the error. Option C describes a non-preventable disease complication, not a process
failure, so it falls outside the practice improvement focus. Option D is patient experience feedback that may
inform improvement work, but it is not itself a safety concern rooted in system design.
Q2: On a medical-surgical unit, three different patients fell within one month. The falls
occurred on different shifts, in different rooms, and in each case the patient attempted to walk
to the bathroom unassisted after the call light went unanswered for more than 10 minutes.
Which finding most strongly supports classifying this as a systems-level concern?
A. Each patient was assigned to a different newly licensed nurse
B. All three falls occurred during the night shift
C. All three patients were over the age of 70
D. The falls recurred across different shifts and rooms, indicating a process failure such
as delayed call-light response rather than any single caregiver's
performance [CORRECT]
Correct Answer: D
WGU D221 - Organizational Systems and Healthcare Transformation 1
,WGU D221 WW | NGM2 TASK 1 | PRACTICE IMPROVEMENT PLAN PROPOSAL 2026/2027 UPDATE | WITH COMPLETE SOLUTION
Rationale: The defining evidence for a systems-level concern is repetition across multiple patients and
varying conditions, which points to a defect in the workflow itself, such as the call-light answering process,
purposeful rounding practices, or staffing adequacy. Option A subtly shifts attention toward individual
blame, yet the falls involved different shifts and cannot be attributed to one person. Options B and C identify
true patterns but are limited contextual factors that do not explain why the process failed repeatedly. The
cross-shift, cross-room recurrence is exactly the pattern the NGM2 Task 1 prompt expects students to trace
back to policy, procedure, or process failure.
Q3: In the context of a practice improvement plan proposal, what does the SBAR framework
stand for?
A. Situation, Background, Assessment, Recommendation [CORRECT]
B. Safety, Baseline, Analysis, Resolution
C. Situation, Barriers, Action, Results
D. Standard, Basis, Assessment, Review
Correct Answer: A
Rationale: SBAR is the standardized communication framework required for the NGM2 Task 1 proposal:
Situation states the concern concisely, Background supplies the supporting data and history, Assessment
analyzes the impact and contributing factors, and Recommendation presents the proposed evidence-based
change. The distractors deliberately mix plausible leadership words into the acronym, but none reproduces
the accepted framework. Recognizing the correct expansion is essential because each WGU proposal section
must map to the correct SBAR element. Confusing the components, for example placing data in the Situation
or the plan in the Assessment, is one of the most common Task 1 errors.
Q4: A nurse is drafting an SBAR-format practice improvement plan proposal to reduce
medication administration errors. In which SBAR component should the nurse present the
specific proposed evidence-based change, such as integrating barcode medication
administration (BCMA) scanning?
A. Situation, because the technology is the starting point of the proposal
B. Background, because evidence belongs with the historical data
C. Recommendation, because this component presents the proposed change and
implementation plan [CORRECT]
D. Assessment, because the technology solves the analyzed problem
Correct Answer: C
Rationale: The Recommendation component is where the nurse proposes what should be done, including
the evidence-based intervention such as BCMA, the implementation strategies, and the plan for evaluating
outcomes. The Situation only concisely names the safety concern, so option A misplaces the solution. Option
B is incorrect because Background carries the quantitative data, current process description, and history
rather than the proposed fix. Option D is incorrect because the Assessment analyzes causes, impact, and
consequences of leaving the problem unaddressed, not the intervention itself. Placing the intervention in the
Recommendation demonstrates the component mastery WGU rubric evaluators look for.
WGU D221 - Organizational Systems and Healthcare Transformation 2
,WGU D221 WW | NGM2 TASK 1 | PRACTICE IMPROVEMENT PLAN PROPOSAL 2026/2027 UPDATE | WITH COMPLETE SOLUTION
Q5: A nurse is writing an SBAR proposal to reduce catheter-associated urinary tract infections
(CAUTIs). Which statement would correctly appear in the Situation component?
A. CAUTIs added an estimated 48,000 dollars in costs last quarter, and the current
catheter removal protocol is inconsistently followed on the unit.
B. Urinary catheter-associated infections on the medical-surgical unit have increased over
the past three months and require prompt attention. [CORRECT]
C. Inconsistent catheter necessity reviews are causing preventable infections, which will
continue to rise without corrective action.
D. The unit should implement a nurse-driven catheter removal protocol within 60 days.
Correct Answer: B
Rationale: The Situation is a brief, concise statement of what is happening right now, and option B captures
exactly that without data, analysis, or proposed action. Option A belongs in the Background because it
contains quantitative cost data and the description of the current process. Option C belongs in the
Assessment because it interprets causes and predicts consequences of inaction. Option D belongs in the
Recommendation because it states the proposed change with a time frame. NGM2 Task 1 evaluators
specifically look for clean separation of these four components, and blending data or solutions into the
Situation is a frequent rubric deduction.
Q6: A nurse has gathered twelve months of unit data showing the fall rate rising from 3.1 to
4.8 falls per 1,000 patient days, cost figures for injured falls, and a description of the current
fall-prevention protocol. In which SBAR component should this information be placed in the
practice improvement plan proposal?
A. Situation, to show the problem is measurable
B. Assessment, to justify the interpretation of the problem
C. Background, because it supplies the supporting data and current process
description [CORRECT]
D. Recommendation, to anchor the proposed intervention in evidence
Correct Answer: C
Rationale: The Background component is the evidence repository of an SBAR proposal: it presents the
quantitative data, such as rates per 1,000 patient days and cost figures, along with the history and description
of the current process. Option A is incorrect because the Situation must remain a brief statement of the
concern, not a data summary. Option B is incorrect because the Assessment interprets what the data mean,
while the raw data themselves sit in the Background. Option D is incorrect because the Recommendation
proposes the change and cites supporting evidence, but it does not catalog the baseline data. Task 1 rubrics
explicitly reward placement of specific numbers in the Background.
WGU D221 - Organizational Systems and Healthcare Transformation 3
, WGU D221 WW | NGM2 TASK 1 | PRACTICE IMPROVEMENT PLAN PROPOSAL 2026/2027 UPDATE | WITH COMPLETE SOLUTION
Q7: A nurse administered the wrong medication dose because two look-alike, sound-alike vials
were stored side by side in the automated dispensing cabinet and barcode scanning was not
being used on the unit. The unit manager's response is to send the nurse to a medication safety
refresher course. Using systems-level thinking, why is this response insufficient?
A. Retraining is insufficient because the nurse should also complete a supervised
medication pass before returning to independent practice.
B. Retraining is insufficient because the manager should have also notified the state
board of nursing.
C. Retraining is sufficient, provided the refresher course includes high-fidelity
simulation.
D. Retraining is insufficient because the error resulted from system factors, including
hazardous storage and missing scanning safeguards, which remain in place after the
course. [CORRECT]
Correct Answer: D
Rationale: The error chain described, look-alike storage plus absent barcode verification, is a classic system
failure, so educating one nurse leaves every subsequent nurse exposed to the same hazardous process. Option
D applies the core D221 principle that fixes must target policy, procedure, and process, such as separating
look-alike stock and enforcing BCMA scanning. Option A adds more individual-level remediation but still
never touches the system defect. Option B escalates punishment without improving safety and reflects the
punitive culture that suppresses incident reporting. Option C is wrong because it accepts retraining as
adequate, directly contradicting the systems-level analysis the scenario demands.
Q8: Which of the following is the clearest example of a systems-level patient safety concern
appropriate for a practice improvement plan proposal?
A. CAUTI rates rising unit-wide because the catheter necessity review is inconsistently
performed [CORRECT]
B. One nurse forgetting to document a single head-to-toe assessment
C. A patient declining one scheduled medication dose for personal reasons
D. A visitor slipping in the hospital lobby on a rainy day
Correct Answer: A
Rationale: Option A describes a preventable outcome, CAUTI, that recurs across the unit because a
required process step, the daily catheter necessity review, is applied inconsistently, which is precisely the
policy and procedure failure that defines a systems-level concern. Option B is a single documentation lapse
by one nurse, an individual error unless it repeats across the staff. Option C reflects patient autonomy over a
personal health decision and does not represent a care process defect. Option D is an environmental incident
unrelated to a recurring clinical process on the unit. Task 1 requires selecting concerns that are repeated,
multi-patient, and process-driven, and only option A meets all three tests.
WGU D221 - Organizational Systems and Healthcare Transformation 4
