Question: 1 of 70 RN Leadership 2023
A charge nurse observes a staff nurse omit a step in a sterile dressing change procedure. Which
of the following actions should the charge nurse take first?
A. Report the nurse to the unit manager immediately.
✓ B. Stop the nurse and correct the technique at the bedside.
C. Document the error in the incident report.
D. Ask a colleague to observe the nurse's next dressing change.
✓ Correct Answer: B
The charge nurse's first priority is patient safety — stopping the procedure and correcting the technique
immediately prevents harm to the client. This is direct supervision. Reporting to the manager and completing an
incident report come after the immediate safety issue is addressed. Asking a colleague to observe the next
dressing change does not address the current unsafe situation.
,Question: 2 of 70 RN Leadership 2023
A nurse manager is preparing the unit budget. Which of the following expenses is considered a
variable cost?
A. Monthly equipment lease payments
B. Staff salaries for full-time employees
✓ C. Overtime pay for nurses during high census periods
D. Annual fire safety inspection fees
✓ Correct Answer: C
Variable costs change in direct proportion to patient volume or activity. Overtime pay increases when census is
high and decreases when census is low — this is a variable cost. Fixed costs remain constant regardless of
patient volume: equipment leases, full-time staff salaries, and annual inspection fees are fixed costs.
Understanding cost types helps nurse managers make staffing and resource allocation decisions.
,Question: 3 of 70 RN Leadership 2023
A nurse is caring for a client who refuses a blood transfusion based on religious beliefs. The
client is alert and oriented. Which of the following actions should the nurse take?
A. Administer the transfusion and document the client's objection.
B. Contact the hospital chaplain to persuade the client.
✓ C. Respect the client's decision and notify the provider.
D. Request a court order to override the client's decision.
✓ Correct Answer: C
An alert and oriented adult client has the legal and ethical right to refuse treatment — this is the principle of
autonomy and informed consent/refusal. The nurse must respect the decision, document the refusal, notify the
provider, and explore alternative treatments. Administering treatment against a competent client's wishes
constitutes battery. Involving a chaplain to persuade or seeking a court order to override a competent adult's
decision is inappropriate.
, Question: 4 of 70 RN Leadership 2023
A nurse is completing an incident report after a client fall. Which of the following information
should the nurse include in the report?
A. The nurse's personal opinion about why the fall occurred
✓ B. Objective description of the event, client condition, and actions taken
C. A statement that the fall was due to inadequate staffing
D. The names of all nurses who were on duty at the time
✓ Correct Answer: B
Incident reports (variance reports) should contain objective, factual information: what happened, when, where,
client status before and after, actions taken, and who was notified. Personal opinions, accusations, blame, and
conjecture should never be included. The incident report is NOT referenced in the medical record (avoid writing
'incident report filed' in the chart). Incident reports are quality improvement tools, not disciplinary documents.
A charge nurse observes a staff nurse omit a step in a sterile dressing change procedure. Which
of the following actions should the charge nurse take first?
A. Report the nurse to the unit manager immediately.
✓ B. Stop the nurse and correct the technique at the bedside.
C. Document the error in the incident report.
D. Ask a colleague to observe the nurse's next dressing change.
✓ Correct Answer: B
The charge nurse's first priority is patient safety — stopping the procedure and correcting the technique
immediately prevents harm to the client. This is direct supervision. Reporting to the manager and completing an
incident report come after the immediate safety issue is addressed. Asking a colleague to observe the next
dressing change does not address the current unsafe situation.
,Question: 2 of 70 RN Leadership 2023
A nurse manager is preparing the unit budget. Which of the following expenses is considered a
variable cost?
A. Monthly equipment lease payments
B. Staff salaries for full-time employees
✓ C. Overtime pay for nurses during high census periods
D. Annual fire safety inspection fees
✓ Correct Answer: C
Variable costs change in direct proportion to patient volume or activity. Overtime pay increases when census is
high and decreases when census is low — this is a variable cost. Fixed costs remain constant regardless of
patient volume: equipment leases, full-time staff salaries, and annual inspection fees are fixed costs.
Understanding cost types helps nurse managers make staffing and resource allocation decisions.
,Question: 3 of 70 RN Leadership 2023
A nurse is caring for a client who refuses a blood transfusion based on religious beliefs. The
client is alert and oriented. Which of the following actions should the nurse take?
A. Administer the transfusion and document the client's objection.
B. Contact the hospital chaplain to persuade the client.
✓ C. Respect the client's decision and notify the provider.
D. Request a court order to override the client's decision.
✓ Correct Answer: C
An alert and oriented adult client has the legal and ethical right to refuse treatment — this is the principle of
autonomy and informed consent/refusal. The nurse must respect the decision, document the refusal, notify the
provider, and explore alternative treatments. Administering treatment against a competent client's wishes
constitutes battery. Involving a chaplain to persuade or seeking a court order to override a competent adult's
decision is inappropriate.
, Question: 4 of 70 RN Leadership 2023
A nurse is completing an incident report after a client fall. Which of the following information
should the nurse include in the report?
A. The nurse's personal opinion about why the fall occurred
✓ B. Objective description of the event, client condition, and actions taken
C. A statement that the fall was due to inadequate staffing
D. The names of all nurses who were on duty at the time
✓ Correct Answer: B
Incident reports (variance reports) should contain objective, factual information: what happened, when, where,
client status before and after, actions taken, and who was notified. Personal opinions, accusations, blame, and
conjecture should never be included. The incident report is NOT referenced in the medical record (avoid writing
'incident report filed' in the chart). Incident reports are quality improvement tools, not disciplinary documents.
