**The Leadership & Delegation Decisive:
Management of Care, Ethics, and Priority
Setting**
1. A charge nurse is making assignments for a medical-surgical unit. Which patient should be assigned to
an experienced LPN/LVN rather than an RN?
A) A patient with a chest tube output of 400 mL in 4 hours
B) A patient receiving a continuous IV heparin infusion
C) A stable patient with a new colostomy needing routine care
D) A new admission with altered mental status and fever
💫RATIONALE✔️✔️: LPNs can provide stable, routine care (ostomy care, wound care, stable vital signs).
Unstable patients, titratable infusions (heparin), and new admissions require RN assessment.
💫ANSWER✔️✔️: C) A stable patient with a new colostomy needing routine care
---
2. A nurse witnesses a colleague administering a medication that the colleague then charts as given at a
time different from the actual administration. What is the nurse's priority action?
A) Report the colleague to the nursing supervisor immediately
B) Confront the colleague privately about the discrepancy
C) Document the discrepancy in the patient's medical record
D) Ignore the incident as a one-time documentation error
💫RATIONALE✔️✔️: Falsifying medical records is unethical and illegal. The witnessing nurse has a duty to
report the colleague to the nurse manager or supervisor. Patient safety is paramount.
💫ANSWER✔️✔️: A) Report the colleague to the nursing supervisor immediately
---
,3. A nurse manager is implementing a new fall prevention protocol. Which step represents the "Plan"
phase of the PDSA (Plan-Do-Study-Act) cycle?
A) Reviewing fall rates after the protocol is implemented
B) Training staff on the new fall prevention measures
C) Identifying that fall rates are above the national benchmark
D) Adjusting the protocol based on staff feedback
💫RATIONALE✔️✔️: The Plan phase involves identifying the problem and planning the change (identifying
high fall rates and designing an intervention). Do = implement; Study = analyze data; Act = adjust.
💫ANSWER✔️✔️: C) Identifying that fall rates are above the national benchmark
---
4. A nurse is caring for a patient who refuses a blood transfusion due to religious beliefs (Jehovah's
Witness). The patient is hemodynamically stable but anemic. What is the nurse's best response?
A) "I will notify the provider to obtain a court order for transfusion."
B) "I respect your decision. Let me review alternative treatments with your provider."
C) "Your life is at risk; you must accept the transfusion."
D) "I will have the chaplain speak with you about this decision."
💫RATIONALE✔️✔️: Competent adults have the right to refuse treatment, including blood transfusions,
based on religious beliefs. The nurse must respect autonomy and advocate for alternative management
(iron, erythropoietin).
💫ANSWER✔️✔️: B) "I respect your decision. Let me review alternative treatments with your provider."
---
5. A charge nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is appropriate
to delegate?
A) Obtaining a blood pressure on a patient with a new onset of chest pain
B) Feeding a patient with dysphagia who requires thickened liquids
C) Ambulating a stable post-operative patient who is 2 days post-op
D) Assessing a patient's pain level using a numeric rating scale
,💫RATIONALE✔️✔️: Stable ambulation (walking a stable patient) is within UAP scope. Feeding a dysphagic
patient requires assessment; obtaining BP on a chest pain patient is assessment; pain assessment is an
RN responsibility.
💫ANSWER✔️✔️: C) Ambulating a stable post-operative patient who is 2 days post-op
---
6. A nurse is preparing to administer a medication to a patient. The patient states, "I've never taken that
pill before. Are you sure it's for me?" What is the priority action?
A) Reassure the patient that the medication is correct
B) Check the medication administration record (MAR) again
C) Stop the administration and verify the order
D) Explain the medication's purpose to the patient
💫RATIONALE✔️✔️: The patient's statement raises a possible error. The nurse must stop, verify the order
(check MAR, pharmacy, provider), and confirm the patient's identity using two identifiers.
💫ANSWER✔️✔️: C) Stop the administration and verify the order
---
7. A nurse manager is reviewing sentinel events. Which event requires reporting to The Joint
Commission?
A) A patient falls out of bed but is uninjured
B) A wrong-site surgery (wrong knee)
C) A medication error that was caught before administration
D) A patient elopement that was resolved within 10 minutes
💫RATIONALE✔️✔️: Sentinel events are unexpected occurrences involving death or serious
physical/psychological injury. Wrong-site surgery is a sentinel event requiring root cause analysis and
reporting.
💫ANSWER✔️✔️: B) A wrong-site surgery (wrong knee)
---
8. A nurse is caring for a patient with a do-not-resuscitate (DNR) order. The patient's family member
demands that CPR be performed if the patient's heart stops. What is the nurse's best action?
, A) Call a code blue and perform CPR as the family requests
B) Respect the DNR order and do not initiate CPR
C) Contact the ethics committee for a consultation
D) Ask the provider to revoke the DNR order
💫RATIONALE✔️✔️: A valid DNR order is legally binding. The nurse must follow the order. If the family
disagrees, the provider should discuss with them, but the nurse does not initiate CPR against the order.
💫ANSWER✔️✔️: B) Respect the DNR order and do not initiate CPR
---
9. A nurse is triaging patients after a mass casualty incident (MCI). Which patient should receive a red
(immediate) tag?
A) A patient with an open femur fracture and palpable distal pulse
B) A patient with burns on 30% of TBSA who is alert and talking
C) A patient with a penetrating head wound and no respirations
D) A patient with a sucking chest wound and respiratory distress
💫RATIONALE✔️✔️: Red tag (immediate) for patients with life-threatening injuries but survivable with
intervention. Sucking chest wound with respiratory distress requires immediate treatment. No
respirations = black (expectant).
💫ANSWER✔️✔️: D) A patient with a sucking chest wound and respiratory distress
---
10. A charge nurse is making shift assignments. Which patient should be assigned to a new graduate RN
(orientation week 2) with a preceptor?
A) A patient with a new tracheostomy requiring frequent suctioning
B) A stable patient with diabetes requiring insulin before meals
C) A patient with a chest tube for a pneumothorax
D) A patient with a new diagnosis of heart failure requiring complex discharge teaching
💫RATIONALE✔️✔️: The new graduate should care for stable patients with routine care (insulin
administration, stable vital signs). Complex or unstable patients (tracheostomy, chest tubes, complex
teaching) require more experienced RNs.
💫ANSWER✔️✔️: B) A stable patient with diabetes requiring insulin before meals
Management of Care, Ethics, and Priority
Setting**
1. A charge nurse is making assignments for a medical-surgical unit. Which patient should be assigned to
an experienced LPN/LVN rather than an RN?
A) A patient with a chest tube output of 400 mL in 4 hours
B) A patient receiving a continuous IV heparin infusion
C) A stable patient with a new colostomy needing routine care
D) A new admission with altered mental status and fever
💫RATIONALE✔️✔️: LPNs can provide stable, routine care (ostomy care, wound care, stable vital signs).
Unstable patients, titratable infusions (heparin), and new admissions require RN assessment.
💫ANSWER✔️✔️: C) A stable patient with a new colostomy needing routine care
---
2. A nurse witnesses a colleague administering a medication that the colleague then charts as given at a
time different from the actual administration. What is the nurse's priority action?
A) Report the colleague to the nursing supervisor immediately
B) Confront the colleague privately about the discrepancy
C) Document the discrepancy in the patient's medical record
D) Ignore the incident as a one-time documentation error
💫RATIONALE✔️✔️: Falsifying medical records is unethical and illegal. The witnessing nurse has a duty to
report the colleague to the nurse manager or supervisor. Patient safety is paramount.
💫ANSWER✔️✔️: A) Report the colleague to the nursing supervisor immediately
---
,3. A nurse manager is implementing a new fall prevention protocol. Which step represents the "Plan"
phase of the PDSA (Plan-Do-Study-Act) cycle?
A) Reviewing fall rates after the protocol is implemented
B) Training staff on the new fall prevention measures
C) Identifying that fall rates are above the national benchmark
D) Adjusting the protocol based on staff feedback
💫RATIONALE✔️✔️: The Plan phase involves identifying the problem and planning the change (identifying
high fall rates and designing an intervention). Do = implement; Study = analyze data; Act = adjust.
💫ANSWER✔️✔️: C) Identifying that fall rates are above the national benchmark
---
4. A nurse is caring for a patient who refuses a blood transfusion due to religious beliefs (Jehovah's
Witness). The patient is hemodynamically stable but anemic. What is the nurse's best response?
A) "I will notify the provider to obtain a court order for transfusion."
B) "I respect your decision. Let me review alternative treatments with your provider."
C) "Your life is at risk; you must accept the transfusion."
D) "I will have the chaplain speak with you about this decision."
💫RATIONALE✔️✔️: Competent adults have the right to refuse treatment, including blood transfusions,
based on religious beliefs. The nurse must respect autonomy and advocate for alternative management
(iron, erythropoietin).
💫ANSWER✔️✔️: B) "I respect your decision. Let me review alternative treatments with your provider."
---
5. A charge nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is appropriate
to delegate?
A) Obtaining a blood pressure on a patient with a new onset of chest pain
B) Feeding a patient with dysphagia who requires thickened liquids
C) Ambulating a stable post-operative patient who is 2 days post-op
D) Assessing a patient's pain level using a numeric rating scale
,💫RATIONALE✔️✔️: Stable ambulation (walking a stable patient) is within UAP scope. Feeding a dysphagic
patient requires assessment; obtaining BP on a chest pain patient is assessment; pain assessment is an
RN responsibility.
💫ANSWER✔️✔️: C) Ambulating a stable post-operative patient who is 2 days post-op
---
6. A nurse is preparing to administer a medication to a patient. The patient states, "I've never taken that
pill before. Are you sure it's for me?" What is the priority action?
A) Reassure the patient that the medication is correct
B) Check the medication administration record (MAR) again
C) Stop the administration and verify the order
D) Explain the medication's purpose to the patient
💫RATIONALE✔️✔️: The patient's statement raises a possible error. The nurse must stop, verify the order
(check MAR, pharmacy, provider), and confirm the patient's identity using two identifiers.
💫ANSWER✔️✔️: C) Stop the administration and verify the order
---
7. A nurse manager is reviewing sentinel events. Which event requires reporting to The Joint
Commission?
A) A patient falls out of bed but is uninjured
B) A wrong-site surgery (wrong knee)
C) A medication error that was caught before administration
D) A patient elopement that was resolved within 10 minutes
💫RATIONALE✔️✔️: Sentinel events are unexpected occurrences involving death or serious
physical/psychological injury. Wrong-site surgery is a sentinel event requiring root cause analysis and
reporting.
💫ANSWER✔️✔️: B) A wrong-site surgery (wrong knee)
---
8. A nurse is caring for a patient with a do-not-resuscitate (DNR) order. The patient's family member
demands that CPR be performed if the patient's heart stops. What is the nurse's best action?
, A) Call a code blue and perform CPR as the family requests
B) Respect the DNR order and do not initiate CPR
C) Contact the ethics committee for a consultation
D) Ask the provider to revoke the DNR order
💫RATIONALE✔️✔️: A valid DNR order is legally binding. The nurse must follow the order. If the family
disagrees, the provider should discuss with them, but the nurse does not initiate CPR against the order.
💫ANSWER✔️✔️: B) Respect the DNR order and do not initiate CPR
---
9. A nurse is triaging patients after a mass casualty incident (MCI). Which patient should receive a red
(immediate) tag?
A) A patient with an open femur fracture and palpable distal pulse
B) A patient with burns on 30% of TBSA who is alert and talking
C) A patient with a penetrating head wound and no respirations
D) A patient with a sucking chest wound and respiratory distress
💫RATIONALE✔️✔️: Red tag (immediate) for patients with life-threatening injuries but survivable with
intervention. Sucking chest wound with respiratory distress requires immediate treatment. No
respirations = black (expectant).
💫ANSWER✔️✔️: D) A patient with a sucking chest wound and respiratory distress
---
10. A charge nurse is making shift assignments. Which patient should be assigned to a new graduate RN
(orientation week 2) with a preceptor?
A) A patient with a new tracheostomy requiring frequent suctioning
B) A stable patient with diabetes requiring insulin before meals
C) A patient with a chest tube for a pneumothorax
D) A patient with a new diagnosis of heart failure requiring complex discharge teaching
💫RATIONALE✔️✔️: The new graduate should care for stable patients with routine care (insulin
administration, stable vital signs). Complex or unstable patients (tracheostomy, chest tubes, complex
teaching) require more experienced RNs.
💫ANSWER✔️✔️: B) A stable patient with diabetes requiring insulin before meals
