, Question 1
A nurse manager wants to implement a shared governance council. Which
leadership approach best aligns with empowering staff decision-making while
maintaining accountability for unit outcomes?
A. Transactional leadership with contingent reward systems
B. Transformational leadership emphasizing idealized influence and
intellectual stimulation
C. Laissez-faire leadership allowing staff full autonomy
D. Autocratic leadership with centralized decision authority
Correct Answer: B - Transformational leadership emphasizing
idealized influence and intellectual stimulation
RATIONALE
Transformational leadership fosters empowerment, shared vision, and
intellectual stimulation, which are core to shared governance while the
manager retains accountability. Transactional leadership relies on
rewards/punishments and does not empower. Laissez-faire abdicates
accountability, and autocratic leadership centralizes power,
contradicting shared governance.
Question 2
A hospital is adopting a new electronic health record. According to Kotter's
eight-step change model, which action should occur immediately after creating
a sense of urgency?
A. Consolidating gains and producing more change
B. Forming a powerful guiding coalition
C. Empowering broad-based action
D. Anchoring new approaches in culture
Correct Answer: B - Forming a powerful guiding coalition
Page 2
, RATIONALE
Kotter's model sequence places 'forming a powerful guiding coalition'
directly after establishing urgency. Consolidating gains, empowering
action, and anchoring culture occur later in the model. Sequencing is
critical for successful change implementation.
Question 3
A charge nurse notices a colleague diverting controlled substances. Which
action best reflects the nurse's ethical and legal obligation under state nurse
practice acts and professional standards?
A. Confront the colleague privately and offer to help them self-report
B. Document the observation and report to the nurse manager and
appropriate authority immediately
C. Ignore the behavior to avoid conflict and protect unit morale
D. Report only if patient harm is directly observed
Correct Answer: B - Document the observation and report to the
nurse manager and appropriate authority immediately
RATIONALE
Nurses have a legal and ethical duty to report suspected impairment or
diversion to protect patients and comply with mandatory reporting
laws. Private confrontation may jeopardize safety and evidence.
Ignoring or waiting for harm violates duty to report and patient safety
standards.
Question 4
Which organizational structure best facilitates rapid interdisciplinary
decision-making in a high-acuity unit while maintaining clear accountability?
A. Traditional bureaucratic hierarchy with rigid chain of command
B. Matrix structure with dual reporting lines
C. Flat decentralized structure with shared decision-making councils
D. Line-and-staff structure with centralized authority
Page 3
, Correct Answer: C - Flat decentralized structure with shared
decision-making councils
RATIONALE
Flat decentralized structures with shared governance allow rapid
interdisciplinary collaboration and maintain accountability through
defined roles. Bureaucratic and line-and-staff structures slow
decision-making. Matrix structures can create role confusion and slow
responses due to dual reporting.
Question 5
A nurse manager is delegating tasks during a staffing crisis. Which task is most
appropriate to delegate to a licensed practical nurse (LPN) under most state
nurse practice acts?
A. Administering IV push medications via central line
B. Performing an initial admission assessment on a complex patient
C. Reinforcing teaching about a newly prescribed medication
D. Developing the nursing care plan for a critically ill patient
Correct Answer: C - Reinforcing teaching about a newly
prescribed medication
RATIONALE
LPNs can reinforce teaching after the RN has completed the initial
assessment and teaching plan. IV push meds via central line, initial
assessments, and care plan development for complex patients are RN
responsibilities. Delegation must align with scope of practice and
patient stability.
Question 6
A nurse leader is evaluating a quality improvement initiative that reduced
central line-associated bloodstream infections (CLABSIs). Which metric best
demonstrates sustained improvement?
Page 4
A nurse manager wants to implement a shared governance council. Which
leadership approach best aligns with empowering staff decision-making while
maintaining accountability for unit outcomes?
A. Transactional leadership with contingent reward systems
B. Transformational leadership emphasizing idealized influence and
intellectual stimulation
C. Laissez-faire leadership allowing staff full autonomy
D. Autocratic leadership with centralized decision authority
Correct Answer: B - Transformational leadership emphasizing
idealized influence and intellectual stimulation
RATIONALE
Transformational leadership fosters empowerment, shared vision, and
intellectual stimulation, which are core to shared governance while the
manager retains accountability. Transactional leadership relies on
rewards/punishments and does not empower. Laissez-faire abdicates
accountability, and autocratic leadership centralizes power,
contradicting shared governance.
Question 2
A hospital is adopting a new electronic health record. According to Kotter's
eight-step change model, which action should occur immediately after creating
a sense of urgency?
A. Consolidating gains and producing more change
B. Forming a powerful guiding coalition
C. Empowering broad-based action
D. Anchoring new approaches in culture
Correct Answer: B - Forming a powerful guiding coalition
Page 2
, RATIONALE
Kotter's model sequence places 'forming a powerful guiding coalition'
directly after establishing urgency. Consolidating gains, empowering
action, and anchoring culture occur later in the model. Sequencing is
critical for successful change implementation.
Question 3
A charge nurse notices a colleague diverting controlled substances. Which
action best reflects the nurse's ethical and legal obligation under state nurse
practice acts and professional standards?
A. Confront the colleague privately and offer to help them self-report
B. Document the observation and report to the nurse manager and
appropriate authority immediately
C. Ignore the behavior to avoid conflict and protect unit morale
D. Report only if patient harm is directly observed
Correct Answer: B - Document the observation and report to the
nurse manager and appropriate authority immediately
RATIONALE
Nurses have a legal and ethical duty to report suspected impairment or
diversion to protect patients and comply with mandatory reporting
laws. Private confrontation may jeopardize safety and evidence.
Ignoring or waiting for harm violates duty to report and patient safety
standards.
Question 4
Which organizational structure best facilitates rapid interdisciplinary
decision-making in a high-acuity unit while maintaining clear accountability?
A. Traditional bureaucratic hierarchy with rigid chain of command
B. Matrix structure with dual reporting lines
C. Flat decentralized structure with shared decision-making councils
D. Line-and-staff structure with centralized authority
Page 3
, Correct Answer: C - Flat decentralized structure with shared
decision-making councils
RATIONALE
Flat decentralized structures with shared governance allow rapid
interdisciplinary collaboration and maintain accountability through
defined roles. Bureaucratic and line-and-staff structures slow
decision-making. Matrix structures can create role confusion and slow
responses due to dual reporting.
Question 5
A nurse manager is delegating tasks during a staffing crisis. Which task is most
appropriate to delegate to a licensed practical nurse (LPN) under most state
nurse practice acts?
A. Administering IV push medications via central line
B. Performing an initial admission assessment on a complex patient
C. Reinforcing teaching about a newly prescribed medication
D. Developing the nursing care plan for a critically ill patient
Correct Answer: C - Reinforcing teaching about a newly
prescribed medication
RATIONALE
LPNs can reinforce teaching after the RN has completed the initial
assessment and teaching plan. IV push meds via central line, initial
assessments, and care plan development for complex patients are RN
responsibilities. Delegation must align with scope of practice and
patient stability.
Question 6
A nurse leader is evaluating a quality improvement initiative that reduced
central line-associated bloodstream infections (CLABSIs). Which metric best
demonstrates sustained improvement?
Page 4
