ACTUAL EXAM WITH COMPLETE QUESTIONS
AND CORRECT DETAILED ANSWERS (100%
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A nurse manager is implementing a new evidence-based practice guideline on a medical-
surgical unit. Which leadership approach will most effectively promote staff adoption of
the change?
A. Autocratic leadership with strict enforcement of rules
B. Transformational leadership focused on motivation and shared vision
C. Laissez-faire leadership with minimal involvement
D. Task-oriented leadership focusing only on assignments
Correct Answer: B
Expert Rationale
Transformational leadership is most effective in implementing evidence-based practice changes
because it inspires, motivates, and engages staff through shared vision and professional
empowerment. This leadership style encourages collaboration, supports professional growth, and
increases commitment to organizational goals. Staff are more likely to adopt practice changes
when they feel included in the process and understand the purpose behind the change. Autocratic
leadership may create resistance due to lack of staff input. Laissez-faire leadership often leads to
confusion and inconsistent implementation. Task-oriented leadership focuses on task completion
but does not address motivation or engagement needed for sustained practice change. Effective
leadership in nursing requires influencing behavior, supporting evidence-based practice, and
fostering a culture of continuous improvement.
DIF: Application
REF: Leadership Theories
OBJ: Apply leadership styles in practice change
TOP: Nursing Leadership / Change Management
A nurse manager notices increased staff turnover on the unit. Which intervention should
the leader implement first?
A. Increase mandatory overtime for remaining staff
B. Conduct exit interviews to identify causes of turnover
,C. Immediately replace all staff positions
D. Reduce patient safety reporting requirements
Correct Answer: B
Expert Rationale
Conducting exit interviews is the most appropriate first step because it allows the nurse leader to
identify root causes of staff turnover such as workload, burnout, leadership concerns, or
workplace culture issues. Evidence-based leadership emphasizes data collection before
implementing solutions. Increasing overtime may worsen burnout and further increase turnover.
Immediate replacement of staff does not address underlying problems. Reducing safety reporting
compromises patient safety and is not ethically appropriate. Effective leadership requires
systematic assessment, identification of contributing factors, and development of targeted
retention strategies based on evidence rather than assumptions.
DIF: Analysis
REF: Workforce Management
OBJ: Identify causes of staff turnover
TOP: Human Resources / Leadership
A nurse leader is evaluating staff performance. Which feedback approach is most effective
for improving clinical performance?
A. Public criticism during staff meetings
B. Constructive feedback with specific examples and solutions
C. Avoiding feedback to prevent conflict
D. Annual evaluation only without ongoing feedback
Correct Answer: B
Expert Rationale
Constructive feedback that is specific, timely, and solution-oriented is the most effective method
for improving staff performance and promoting professional development. This approach
supports learning, accountability, and behavior change. Public criticism can damage morale and
increase resistance. Avoiding feedback prevents performance improvement and allows unsafe
practices to continue. Annual evaluations alone are insufficient because they delay corrective
action and reduce opportunities for growth. Effective nursing leadership requires continuous
performance coaching and supportive communication to maintain high-quality patient care.
DIF: Application
REF: Performance Management
OBJ: Apply effective feedback strategies
TOP: Leadership Communication
A nurse manager is prioritizing patient assignments. Which patient should be assigned to
the most experienced nurse?
,A. Stable postoperative patient requiring discharge teaching
B. Patient with controlled hypertension
C. Patient with acute respiratory distress and oxygen saturation of 84%
D. Patient awaiting routine medication administration
Correct Answer: C
Expert Rationale
Patients with acute respiratory distress and low oxygen saturation represent unstable, high-risk
conditions requiring rapid clinical judgment and advanced assessment skills. Assigning such
patients to the most experienced nurse ensures prompt recognition of deterioration and
appropriate interventions. Stable postoperative patients and those with controlled chronic
conditions can be safely managed by less experienced staff. Routine medication administration
does not require advanced critical thinking. Effective leadership prioritization follows the
principle of matching patient acuity with nurse competency to ensure patient safety and optimal
outcomes.
DIF: Analysis
REF: Staffing and Assignment
OBJ: Prioritize patient assignments
TOP: Delegation and Prioritization
A nurse leader is implementing a fall prevention program. Which strategy best
demonstrates evidence-based leadership?
A. Relying on staff tradition and past practice
B. Implementing interventions based on current research findings
C. Allowing each nurse to decide independently
D. Using only physician preference for interventions
Correct Answer: B
Expert Rationale
Evidence-based leadership requires integrating current research findings, clinical expertise, and
patient safety data to guide decision-making. Implementing fall prevention strategies based on
current evidence improves patient outcomes and reduces injury rates. Relying on tradition or
individual preference leads to inconsistent care and increased risk. Independent decision-making
without standardized evidence-based protocols creates variability in outcomes. Physician
preference alone does not ensure best practice if not supported by research. Effective leadership
ensures standardization of care based on validated evidence and continuous quality
improvement.
DIF: Application
REF: Evidence-Based Leadership
OBJ: Apply evidence in leadership decisions
TOP: Quality Improvement
, A nurse manager is addressing workplace conflict between staff members. Which initial
action is most appropriate?
A. Ignore the conflict to avoid escalation
B. Remove both staff members from the unit permanently
C. Facilitate a structured discussion to identify issues
D. Immediately discipline both employees
Correct Answer: C
Expert Rationale
Effective leadership in conflict management involves early intervention through structured
communication to identify underlying issues, promote mutual understanding, and develop
resolution strategies. Facilitated discussions encourage collaboration and professional
accountability. Ignoring conflict allows issues to escalate and negatively impact patient care.
Immediate termination or discipline without investigation is inappropriate and may violate due
process. Removing staff permanently does not address root causes of conflict. Nurse leaders
must promote a healthy work environment through communication, mediation, and problem-
solving strategies.
DIF: Application
REF: Conflict Resolution
OBJ: Manage workplace conflict
TOP: Leadership and Communication
A nurse manager is evaluating delegation practices. Which task is appropriate to delegate
to a licensed practical nurse (LPN)? SATA
A. Administer oral medications to stable patients
B. Perform initial patient assessment
C. Reinforce patient teaching provided by the RN
D. Develop nursing care plans
E. Monitor stable postoperative patients
Correct Answers: A, C, E
Expert Rationale
Delegation decisions must follow scope of practice and patient stability. Licensed practical
nurses can safely administer oral medications to stable patients, reinforce education provided by
registered nurses, and monitor stable patients. Initial assessments and care plan development
require RN-level critical thinking and cannot be delegated. Effective delegation improves
workflow efficiency while maintaining patient safety. Nurse leaders must ensure tasks are
assigned based on competency, legal scope, and patient acuity.
DIF: Application
REF: Delegation Principles