HESI Leadership & Management Exam | Latest Version 2026
WITH FREQUENTLY TESTED QUESTIONS GUARANTEED
PASS - 249 Questions
This exam assesses advanced knowledge of Management of Care, including delegation, prioritization, resource
allocation, conflict resolution, and legal/ethical decision-making in complex healthcare environments. It contains
249 multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 8 focused sections: Management of Care, Safety and Infection
Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological
Therapies, Reduction of Risk Potential, Physiological Adaptation. Targeted learning outcomes include: Analyze
delegation principles to optimize team performance while ensuring patient safety.; Evaluate prioritization
frameworks (e.g., ABCs, Maslow, acute vs. chronic) in multi-patient scenarios.; Apply legal and ethical standards
to resolve care coordination conflicts.; Synthesize evidence-based leadership strategies to manage resources and
improve outcomes.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that
students can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 85%. Aligned with Meets AACN
Essentials and ANA Scope/Standards for US graduate-level nursing education. standards and reflects the question
style commonly seen on accredited program examinations. Students consistently achieving above the cut score on
Section 1: Management of Care (Questions 1-31)
1 A charge nurse on a medical-surgical unit is assigning four patients to a
registered nurse (RN) and a licensed practical nurse (LPN). Which patient
should be assigned to the LPN?
A) A patient with a new tracheostomy requiring frequent suctioning and
assessment
B) A patient with stable heart failure receiving IV furosemide and daily
weights
C) A patient with acute pancreatitis receiving PCA morphine and NPO status
D) A patient with a stage 3 sacral pressure ulcer requiring complex wound
care
Answer: B
Rationale: The LPN can care for stable patients with predictable outcomes. The
patient with stable heart failure on IV furosemide and daily weights is stable
and requires routine monitoring. Options A, C, and D involve unstable or
complex needs requiring RN assessment and judgment.
2 The nurse manager is evaluating staff satisfaction survey results showing low
scores for autonomy and decision-making. Which leadership strategy best
addresses these findings?
,A) Implementing a shared governance model with unit-based councils
B) Increasing the frequency of performance evaluations to monthly
C) Assigning a mentor to each new nurse for the first six months
D) Providing a one-time bonus for completing mandatory education
Answer: A
Rationale: Shared governance empowers nurses by involving them in decisions
about practice, quality, and work environment, directly addressing autonomy.
Options B and D do not increase decision-making involvement; option C
focuses on support but not autonomy.
3 A nurse is caring for four patients. Which patient should the nurse assess first
after receiving shift report?
A) A patient with a new order for an IV antibiotic to be administered within 1
hour
B) A patient with a serum potassium of 6.2 mEq/L and an irregular heart rate
C) A patient with a nasogastric tube on low intermittent suction with output
of 150 mL in 8 hours
D) A patient with a fractured femur awaiting discharge to a rehabilitation
facility
Answer: B
Rationale: Hyperkalemia (6.2 mEq/L) with an irregular heart rate is
life-threatening and requires immediate intervention. Option A is
time-sensitive but not as urgent. Options C and D are stable and can wait.
4 The nurse manager is reviewing the budget and notes a significant overspend
on overtime. Which action is most appropriate to reduce overtime while
maintaining safe staffing?
A) Implementing a policy requiring manager approval for all overtime
B) Reducing the number of staff on each shift by 10%
C) Hiring additional per-diem staff to fill gaps during peak times
D) Cancelling all elective surgeries for the next month
Answer: C
Rationale: Hiring per-diem staff provides flexibility to cover peak needs
without incurring overtime. Option A may reduce overtime but could delay
care. Option B may lead to unsafe staffing. Option D is extreme and affects
patient access.
,5 A nurse discovers that a colleague has documented administration of a
medication that was not actually given. What is the nurse's first action?
A) Report the colleague to the state board of nursing immediately
B) Confront the colleague in the presence of other staff
C) Discuss the concern privately with the colleague and encourage
self-reporting
D) Correct the documentation and notify the nurse manager
Answer: C
Rationale: The first step is to address the issue directly with the colleague
privately, as it may be an error or misunderstanding. Encouraging
self-reporting aligns with professional accountability. Option A is premature;
option B is unprofessional; option D falsifies the record further.
6 The nurse is leading a team in a code blue. Which action demonstrates
effective team leadership?
A) Assigning roles based on the team members' years of experience
B) Directing all communication through the charge nurse outside the room
C) Clearly stating each intervention and verifying closed-loop
communication
D) Allowing each team member to perform tasks without interruption
Answer: C
Rationale: Closed-loop communication ensures that instructions are heard and
understood, reducing errors during codes. Option A may not match skills;
option B creates delays; option D can lead to chaos without coordination.
7 A nurse is delegating tasks to an unlicensed assistive personnel (UAP).
Which task is appropriate to delegate?
A) Assessing the lung sounds of a patient with pneumonia
B) Emptying the urinary drainage bag and recording output for a stable
patient
C) Administering a tube feeding via a gastrostomy tube
D) Teaching a patient how to self-administer insulin injections
Answer: B
Rationale: Emptying a urinary drainage bag and recording output is a routine,
non-invasive task that UAPs are trained to perform. Option A requires
assessment (RN only). Option C involves invasive procedure (LPN/RN).
, Option D requires teaching (RN).
8 A patient with a do-not-resuscitate (DNR) order develops respiratory
distress. The family insists on intubation. What is the nurse's best response?
A) Honor the family's request to maintain a positive relationship
B) Explain that the DNR order is a legal document and must be followed
C) Notify the healthcare provider to discuss the situation with the family
D) Initiate resuscitation while the ethics committee reviews the case
Answer: C
Rationale: The nurse should facilitate a discussion between the provider and
family to clarify goals of care and possibly revise the DNR if appropriate.
Option A violates the patient's wishes; option B may be perceived as
dismissive; option D is against the DNR order.
9 The nurse is managing care for a patient with sepsis who is deteriorating.
Which intervention should the nurse implement first?
A) Administer the prescribed broad-spectrum antibiotic
B) Obtain blood cultures before antibiotic administration
C) Start intravenous fluids as per the sepsis protocol
D) Insert a urinary catheter to monitor urine output
Answer: B
Rationale: According to sepsis guidelines, blood cultures should be obtained
before antibiotics to maximize yield. While fluids and antibiotics are critical,
culture timing is essential for targeted therapy. Catheterization is lower
priority.
10 The nurse manager is implementing a quality improvement initiative to
reduce catheter-associated urinary tract infections (CAUTI). Which
intervention is most likely to be effective?
A) Requiring daily chlorhexidine baths for all catheterized patients
B) Implementing a nurse-driven protocol for early catheter removal
C) Changing catheter bags every 48 hours
D) Using silver-alloy catheters for all patients
Answer: B
Rationale: Nurse-driven protocols that allow nurses to remove unnecessary
catheters reduce duration of catheterization, a key CAUTI risk factor. Options
WITH FREQUENTLY TESTED QUESTIONS GUARANTEED
PASS - 249 Questions
This exam assesses advanced knowledge of Management of Care, including delegation, prioritization, resource
allocation, conflict resolution, and legal/ethical decision-making in complex healthcare environments. It contains
249 multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 8 focused sections: Management of Care, Safety and Infection
Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological
Therapies, Reduction of Risk Potential, Physiological Adaptation. Targeted learning outcomes include: Analyze
delegation principles to optimize team performance while ensuring patient safety.; Evaluate prioritization
frameworks (e.g., ABCs, Maslow, acute vs. chronic) in multi-patient scenarios.; Apply legal and ethical standards
to resolve care coordination conflicts.; Synthesize evidence-based leadership strategies to manage resources and
improve outcomes.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that
students can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 85%. Aligned with Meets AACN
Essentials and ANA Scope/Standards for US graduate-level nursing education. standards and reflects the question
style commonly seen on accredited program examinations. Students consistently achieving above the cut score on
Section 1: Management of Care (Questions 1-31)
1 A charge nurse on a medical-surgical unit is assigning four patients to a
registered nurse (RN) and a licensed practical nurse (LPN). Which patient
should be assigned to the LPN?
A) A patient with a new tracheostomy requiring frequent suctioning and
assessment
B) A patient with stable heart failure receiving IV furosemide and daily
weights
C) A patient with acute pancreatitis receiving PCA morphine and NPO status
D) A patient with a stage 3 sacral pressure ulcer requiring complex wound
care
Answer: B
Rationale: The LPN can care for stable patients with predictable outcomes. The
patient with stable heart failure on IV furosemide and daily weights is stable
and requires routine monitoring. Options A, C, and D involve unstable or
complex needs requiring RN assessment and judgment.
2 The nurse manager is evaluating staff satisfaction survey results showing low
scores for autonomy and decision-making. Which leadership strategy best
addresses these findings?
,A) Implementing a shared governance model with unit-based councils
B) Increasing the frequency of performance evaluations to monthly
C) Assigning a mentor to each new nurse for the first six months
D) Providing a one-time bonus for completing mandatory education
Answer: A
Rationale: Shared governance empowers nurses by involving them in decisions
about practice, quality, and work environment, directly addressing autonomy.
Options B and D do not increase decision-making involvement; option C
focuses on support but not autonomy.
3 A nurse is caring for four patients. Which patient should the nurse assess first
after receiving shift report?
A) A patient with a new order for an IV antibiotic to be administered within 1
hour
B) A patient with a serum potassium of 6.2 mEq/L and an irregular heart rate
C) A patient with a nasogastric tube on low intermittent suction with output
of 150 mL in 8 hours
D) A patient with a fractured femur awaiting discharge to a rehabilitation
facility
Answer: B
Rationale: Hyperkalemia (6.2 mEq/L) with an irregular heart rate is
life-threatening and requires immediate intervention. Option A is
time-sensitive but not as urgent. Options C and D are stable and can wait.
4 The nurse manager is reviewing the budget and notes a significant overspend
on overtime. Which action is most appropriate to reduce overtime while
maintaining safe staffing?
A) Implementing a policy requiring manager approval for all overtime
B) Reducing the number of staff on each shift by 10%
C) Hiring additional per-diem staff to fill gaps during peak times
D) Cancelling all elective surgeries for the next month
Answer: C
Rationale: Hiring per-diem staff provides flexibility to cover peak needs
without incurring overtime. Option A may reduce overtime but could delay
care. Option B may lead to unsafe staffing. Option D is extreme and affects
patient access.
,5 A nurse discovers that a colleague has documented administration of a
medication that was not actually given. What is the nurse's first action?
A) Report the colleague to the state board of nursing immediately
B) Confront the colleague in the presence of other staff
C) Discuss the concern privately with the colleague and encourage
self-reporting
D) Correct the documentation and notify the nurse manager
Answer: C
Rationale: The first step is to address the issue directly with the colleague
privately, as it may be an error or misunderstanding. Encouraging
self-reporting aligns with professional accountability. Option A is premature;
option B is unprofessional; option D falsifies the record further.
6 The nurse is leading a team in a code blue. Which action demonstrates
effective team leadership?
A) Assigning roles based on the team members' years of experience
B) Directing all communication through the charge nurse outside the room
C) Clearly stating each intervention and verifying closed-loop
communication
D) Allowing each team member to perform tasks without interruption
Answer: C
Rationale: Closed-loop communication ensures that instructions are heard and
understood, reducing errors during codes. Option A may not match skills;
option B creates delays; option D can lead to chaos without coordination.
7 A nurse is delegating tasks to an unlicensed assistive personnel (UAP).
Which task is appropriate to delegate?
A) Assessing the lung sounds of a patient with pneumonia
B) Emptying the urinary drainage bag and recording output for a stable
patient
C) Administering a tube feeding via a gastrostomy tube
D) Teaching a patient how to self-administer insulin injections
Answer: B
Rationale: Emptying a urinary drainage bag and recording output is a routine,
non-invasive task that UAPs are trained to perform. Option A requires
assessment (RN only). Option C involves invasive procedure (LPN/RN).
, Option D requires teaching (RN).
8 A patient with a do-not-resuscitate (DNR) order develops respiratory
distress. The family insists on intubation. What is the nurse's best response?
A) Honor the family's request to maintain a positive relationship
B) Explain that the DNR order is a legal document and must be followed
C) Notify the healthcare provider to discuss the situation with the family
D) Initiate resuscitation while the ethics committee reviews the case
Answer: C
Rationale: The nurse should facilitate a discussion between the provider and
family to clarify goals of care and possibly revise the DNR if appropriate.
Option A violates the patient's wishes; option B may be perceived as
dismissive; option D is against the DNR order.
9 The nurse is managing care for a patient with sepsis who is deteriorating.
Which intervention should the nurse implement first?
A) Administer the prescribed broad-spectrum antibiotic
B) Obtain blood cultures before antibiotic administration
C) Start intravenous fluids as per the sepsis protocol
D) Insert a urinary catheter to monitor urine output
Answer: B
Rationale: According to sepsis guidelines, blood cultures should be obtained
before antibiotics to maximize yield. While fluids and antibiotics are critical,
culture timing is essential for targeted therapy. Catheterization is lower
priority.
10 The nurse manager is implementing a quality improvement initiative to
reduce catheter-associated urinary tract infections (CAUTI). Which
intervention is most likely to be effective?
A) Requiring daily chlorhexidine baths for all catheterized patients
B) Implementing a nurse-driven protocol for early catheter removal
C) Changing catheter bags every 48 hours
D) Using silver-alloy catheters for all patients
Answer: B
Rationale: Nurse-driven protocols that allow nurses to remove unnecessary
catheters reduce duration of catheterization, a key CAUTI risk factor. Options
