WGU D567 Nursing Exam Western Governors
University Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
Clinical Judgment & Prioritization (NCLEX NGN Style)
(Questions 1–15)
Q1: A nurse is caring for four patients on a medical-surgical unit. Which patient requires immediate
assessment?
A. A patient 2 days post-op appendectomy requesting pain medication
B. A patient with heart failure whose oxygen saturation dropped from 94% to 88% [CORRECT]
C. A patient scheduled for discharge who needs discharge teaching
D. A patient with stable diabetes waiting for routine insulin
Correct Answer: B
Rationale: The best answer is B. When prioritizing, remember that unstable patients always take
priority over stable patients. A drop in oxygen saturation to 88% indicates respiratory compromise
and requires immediate intervention using the ABCs (airway, breathing, circulation). The other
patients are stable and can wait.
Q2: Using the NGN clinical judgment model, a nurse recognizes that a post-operative patient has
tachycardia, hypotension, and cool, clammy skin. What is the nurse's priority action?
A. Document the findings in the electronic health record
B. Call the provider to report the findings
C. Analyze that the patient is likely in hypovolemic shock and initiate fluid resuscitation per protocol
[CORRECT]
,D. Reassess vital signs in 30 minutes
Correct Answer: C
Rationale: The best answer is C. The nurse must analyze cues to form a hypothesis—tachycardia,
hypotension, and cool clammy skin are classic signs of hypovolemic shock. The priority is taking
action through fluid resuscitation while notifying the provider. Waiting or just documenting delays
critical care.
Q3: A charge nurse has four patients to assign. Which patient is most appropriate for the LPN?
A. A newly admitted patient requiring a comprehensive assessment
B. A stable patient with a Foley catheter needing routine catheter care and vital signs [CORRECT]
C. A patient with chest pain who needs continuous cardiac monitoring
D. A patient with new-onset confusion requiring neuro checks every 2 hours
Correct Answer: B
Rationale: The best answer is B. The RN cannot delegate assessment, evaluation, or nursing
judgment to an LPN. However, LPNs can care for stable patients with predictable outcomes, such
as routine catheter care and vital signs on stable patients. New admissions, unstable patients, and
those requiring frequent assessments must be cared for by the RN.
Q4: A nurse receives report on four patients. Which patient should be seen first?
A. Patient with a potassium level of 3.2 mEq/L who is asymptomatic
B. Patient with a blood pressure of 210/110 mmHg complaining of a severe headache [CORRECT]
C. Patient with a blood glucose of 180 mg/dL who is due for insulin
D. Patient requesting a sleeping medication at bedtime
Correct Answer: B
Rationale: The best answer is B. This patient shows signs of a hypertensive emergency—severe
hypertension with neurological symptoms (headache) indicates potential end-organ damage and
requires immediate intervention. While low potassium needs attention, the hypertensive emergency
takes priority based on Maslow's hierarchy and the potential for immediate harm.
,Q5: A 68-year-old patient with COPD presents with increased dyspnea, oxygen saturation of 84%
on 2L nasal cannula, and use of accessory muscles. What is the priority nursing intervention?
A. Increase oxygen to 6L nasal cannula to improve saturation
B. Position the patient upright and prepare for possible non-invasive ventilation [CORRECT]
C. Administer sedatives to decrease anxiety and respiratory rate
D. Draw arterial blood gases before making any changes
Correct Answer: B
Rationale: The best answer is B. In COPD exacerbation, positioning upright maximizes lung
expansion and reduces work of breathing. Non-invasive ventilation (BiPAP) is often indicated for
respiratory distress with accessory muscle use. High-flow oxygen can suppress the hypoxic drive in
COPD patients, and sedatives are contraindicated as they can worsen respiratory depression.
Q6: A nurse is reviewing morning labs. Which value requires immediate notification to the provider?
A. Sodium 148 mEq/L
B. Hemoglobin 9.2 g/dL in a stable patient
C. Potassium 6.8 mEq/L with peaked T waves on ECG [CORRECT]
D. Creatinine 1.4 mg/dL
Correct Answer: C
Rationale: The best answer is C. A potassium level of 6.8 mEq/L with ECG changes (peaked T
waves) indicates severe hyperkalemia that can progress to life-threatening dysrhythmias. This
requires immediate treatment with calcium gluconate to stabilize the myocardium, followed by
interventions to shift potassium intracellularly.
Q7: Which task can the RN safely delegate to the UAP (Unlicensed Assistive Personnel)?
A. Assessing a patient's pain level after medication administration
B. Feeding a stable patient who needs assistance with meals [CORRECT]
C. Teaching a patient about wound care before discharge
D. Evaluating the effectiveness of a patient's breathing treatments
Correct Answer: B
, Rationale: The best answer is B. UAPs can assist with activities of daily living like feeding stable
patients. Assessment, teaching, and evaluation require nursing judgment and cannot be delegated
to UAPs. Remember the five rights of delegation: right task, right circumstance, right person, right
direction/communication, and right supervision.
Q8: A patient with heart failure has the following assessment findings: crackles in bilateral lung
bases, JVD at 45 degrees, 3+ pitting edema in lower extremities, and reports waking up breathless
at night. Which intervention is the priority?
A. Administer IV furosemide as ordered [CORRECT]
B. Place the patient in Trendelenburg position
C. Administer a PRN sedative to help with sleep
D. Increase oral fluid intake to improve perfusion
Correct Answer: A
Rationale: The best answer is A. These findings indicate acute decompensated heart failure with
fluid overload. The priority is reducing preload through diuresis with furosemide. Trendelenburg
would worsen pulmonary edema, sedatives could mask respiratory distress, and increasing fluids
would exacerbate the fluid overload.
Q9: A nurse is caring for a patient post-stroke with left-sided weakness. The patient suddenly
becomes lethargic with a BP of 200/110, HR 52, and pupils unequal. What is the priority action?
A. Elevate the head of the bed to 30 degrees and notify the provider immediately [CORRECT]
B. Administer PRN acetaminophen for possible pain
C. Turn the patient to the left side to improve perfusion
D. Document the findings and continue monitoring
Correct Answer: A
Rationale: The best answer is A. These are signs of increased intracranial pressure (ICP) possibly
from cerebral edema or hemorrhagic conversion. Elevating the head of the bed promotes venous
drainage and reduces ICP. This is a neurological emergency requiring immediate provider
notification and likely imaging.
Q10: A patient with sepsis has the following vital signs: BP 88/52, HR 128, RR 28, Temp 101.8°F,
and lactate 4.2 mmol/L. According to the Surviving Sepsis Campaign, what is the priority
intervention?
University Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
Clinical Judgment & Prioritization (NCLEX NGN Style)
(Questions 1–15)
Q1: A nurse is caring for four patients on a medical-surgical unit. Which patient requires immediate
assessment?
A. A patient 2 days post-op appendectomy requesting pain medication
B. A patient with heart failure whose oxygen saturation dropped from 94% to 88% [CORRECT]
C. A patient scheduled for discharge who needs discharge teaching
D. A patient with stable diabetes waiting for routine insulin
Correct Answer: B
Rationale: The best answer is B. When prioritizing, remember that unstable patients always take
priority over stable patients. A drop in oxygen saturation to 88% indicates respiratory compromise
and requires immediate intervention using the ABCs (airway, breathing, circulation). The other
patients are stable and can wait.
Q2: Using the NGN clinical judgment model, a nurse recognizes that a post-operative patient has
tachycardia, hypotension, and cool, clammy skin. What is the nurse's priority action?
A. Document the findings in the electronic health record
B. Call the provider to report the findings
C. Analyze that the patient is likely in hypovolemic shock and initiate fluid resuscitation per protocol
[CORRECT]
,D. Reassess vital signs in 30 minutes
Correct Answer: C
Rationale: The best answer is C. The nurse must analyze cues to form a hypothesis—tachycardia,
hypotension, and cool clammy skin are classic signs of hypovolemic shock. The priority is taking
action through fluid resuscitation while notifying the provider. Waiting or just documenting delays
critical care.
Q3: A charge nurse has four patients to assign. Which patient is most appropriate for the LPN?
A. A newly admitted patient requiring a comprehensive assessment
B. A stable patient with a Foley catheter needing routine catheter care and vital signs [CORRECT]
C. A patient with chest pain who needs continuous cardiac monitoring
D. A patient with new-onset confusion requiring neuro checks every 2 hours
Correct Answer: B
Rationale: The best answer is B. The RN cannot delegate assessment, evaluation, or nursing
judgment to an LPN. However, LPNs can care for stable patients with predictable outcomes, such
as routine catheter care and vital signs on stable patients. New admissions, unstable patients, and
those requiring frequent assessments must be cared for by the RN.
Q4: A nurse receives report on four patients. Which patient should be seen first?
A. Patient with a potassium level of 3.2 mEq/L who is asymptomatic
B. Patient with a blood pressure of 210/110 mmHg complaining of a severe headache [CORRECT]
C. Patient with a blood glucose of 180 mg/dL who is due for insulin
D. Patient requesting a sleeping medication at bedtime
Correct Answer: B
Rationale: The best answer is B. This patient shows signs of a hypertensive emergency—severe
hypertension with neurological symptoms (headache) indicates potential end-organ damage and
requires immediate intervention. While low potassium needs attention, the hypertensive emergency
takes priority based on Maslow's hierarchy and the potential for immediate harm.
,Q5: A 68-year-old patient with COPD presents with increased dyspnea, oxygen saturation of 84%
on 2L nasal cannula, and use of accessory muscles. What is the priority nursing intervention?
A. Increase oxygen to 6L nasal cannula to improve saturation
B. Position the patient upright and prepare for possible non-invasive ventilation [CORRECT]
C. Administer sedatives to decrease anxiety and respiratory rate
D. Draw arterial blood gases before making any changes
Correct Answer: B
Rationale: The best answer is B. In COPD exacerbation, positioning upright maximizes lung
expansion and reduces work of breathing. Non-invasive ventilation (BiPAP) is often indicated for
respiratory distress with accessory muscle use. High-flow oxygen can suppress the hypoxic drive in
COPD patients, and sedatives are contraindicated as they can worsen respiratory depression.
Q6: A nurse is reviewing morning labs. Which value requires immediate notification to the provider?
A. Sodium 148 mEq/L
B. Hemoglobin 9.2 g/dL in a stable patient
C. Potassium 6.8 mEq/L with peaked T waves on ECG [CORRECT]
D. Creatinine 1.4 mg/dL
Correct Answer: C
Rationale: The best answer is C. A potassium level of 6.8 mEq/L with ECG changes (peaked T
waves) indicates severe hyperkalemia that can progress to life-threatening dysrhythmias. This
requires immediate treatment with calcium gluconate to stabilize the myocardium, followed by
interventions to shift potassium intracellularly.
Q7: Which task can the RN safely delegate to the UAP (Unlicensed Assistive Personnel)?
A. Assessing a patient's pain level after medication administration
B. Feeding a stable patient who needs assistance with meals [CORRECT]
C. Teaching a patient about wound care before discharge
D. Evaluating the effectiveness of a patient's breathing treatments
Correct Answer: B
, Rationale: The best answer is B. UAPs can assist with activities of daily living like feeding stable
patients. Assessment, teaching, and evaluation require nursing judgment and cannot be delegated
to UAPs. Remember the five rights of delegation: right task, right circumstance, right person, right
direction/communication, and right supervision.
Q8: A patient with heart failure has the following assessment findings: crackles in bilateral lung
bases, JVD at 45 degrees, 3+ pitting edema in lower extremities, and reports waking up breathless
at night. Which intervention is the priority?
A. Administer IV furosemide as ordered [CORRECT]
B. Place the patient in Trendelenburg position
C. Administer a PRN sedative to help with sleep
D. Increase oral fluid intake to improve perfusion
Correct Answer: A
Rationale: The best answer is A. These findings indicate acute decompensated heart failure with
fluid overload. The priority is reducing preload through diuresis with furosemide. Trendelenburg
would worsen pulmonary edema, sedatives could mask respiratory distress, and increasing fluids
would exacerbate the fluid overload.
Q9: A nurse is caring for a patient post-stroke with left-sided weakness. The patient suddenly
becomes lethargic with a BP of 200/110, HR 52, and pupils unequal. What is the priority action?
A. Elevate the head of the bed to 30 degrees and notify the provider immediately [CORRECT]
B. Administer PRN acetaminophen for possible pain
C. Turn the patient to the left side to improve perfusion
D. Document the findings and continue monitoring
Correct Answer: A
Rationale: The best answer is A. These are signs of increased intracranial pressure (ICP) possibly
from cerebral edema or hemorrhagic conversion. Elevating the head of the bed promotes venous
drainage and reduces ICP. This is a neurological emergency requiring immediate provider
notification and likely imaging.
Q10: A patient with sepsis has the following vital signs: BP 88/52, HR 128, RR 28, Temp 101.8°F,
and lactate 4.2 mmol/L. According to the Surviving Sepsis Campaign, what is the priority
intervention?
