Nr 446 Exam – Comprehensive Questions And
Answers | Verified And Well-Detailed Answers |
Detailed Explanations And Rationales | Complete
Exam Preparation Study Guide | Practice
Questions | Latest Exam Update
Question 1
Q: A Registered Nurse (RN) is managing a busy med-surg unit with an Unlicensed
Assistive Personnel (UAP) and a Licensed Practical Nurse (LPN). Which of the
following tasks is most appropriate for the RN to delegate to the LPN?
• A) Administering the initial IV piggyback antibiotic to a newly admitted septic
patient.
• B) Performing a comprehensive physical assessment on a patient returning from
a cardiac catheterization.
• C) Administering routine subcutaneous insulin to a stable diabetic patient who
has been on the unit for three days.
• D) Formulating the initial plan of care for a patient post-operative day 1 following
a total knee arthroplasty.
Correct Answer: C) Administering routine subcutaneous insulin to a stable
diabetic patient who has been on the unit for three days.
Detailed Rationale:
• Delegation Rules (Five Rights of Delegation): The RN must retain tasks
requiring the Nursing Process (Assessment, Diagnosis, Planning,
Implementation requiring complex judgment, and Evaluation — "E-A-T" rule: Do
not delegate Evaluation, Assessment, or Teaching).
• Option C is correct: LPNs are licensed to administer routine medications
(including subcutaneous injections) to stable, predictable patients.
• Option A is incorrect: Initial doses of critical medications or IV push
medications generally require RN assessment for potential acute adverse
reactions or anaphylaxis.
• Option B is incorrect: Initial post-procedure or admission physical assessments
must be performed by the RN.
• Option D is incorrect: Nursing care plan formulation is an RN responsibility that
cannot be delegated.
Question 2
,Q: An RN receives the morning shift report for four patients. Using Maslow’s Hierarchy
of Needs and the ABC (Airway, Breathing, Circulation) framework, which patient should
the nurse assess FIRST?
• A) A 54-year-old post-operative patient complaining of incision pain rated 8/10.
• B) A 68-year-old patient with COPD exhibiting a respiratory rate of 28
breaths/min and an SpO2 of 88% on 2 L/min oxygen via nasal cannula.
• C) A 42-year-old patient 2 hours post-thyroidectomy reporting tingling around the
mouth and minor hoarseness.
• D) a 75-year-old patient with heart failure requesting assistance to use the
bedside commode.
Correct Answer: C) A 42-year-old patient 2 hours post-thyroidectomy reporting
tingling around the mouth and minor hoarseness.
Detailed Rationale:
• Prioritization Analysis:
o Tingling around the mouth (perioral paresthesia) following a thyroidectomy
is a classic sign of severe hypocalcemia caused by accidental removal or
trauma to the parathyroid glands (Trousseau/Chvostek signs).
o Hypocalcemia can rapidly progress to laryngeal stridor, laryngospasm,
and complete airway obstruction (Airway issue).
• Option B: COPD baseline saturation is often low (88–92%); while elevated, this
is a chronic baseline state and second priority to an impending acute airway
crisis.
• Option A: Pain is a priority (comfort/physiologic), but secondary to airway
stability.
• Option D: Safety/elimination is secondary to an acute airway threat.
Module 2: Leadership Theories, Quality Improvement,
& Management Systems
Question Block 2.1: Organizational Change and Quality Metrics
Question 3
Q: A nurse manager notices that hospital-acquired pressure injuries (HAPIs) have
increased by 15% over the last quarter on an orthopedic unit. Using Lewin’s Change
Model, which action represents the "Unfreezing" stage?
• A) Drafting a new standardized turn-q2h protocol and uploading it to the unit
intranet.
• B) Sharing the unit's HAPI data with the staff at a meeting to highlight the
discrepancy between current practice and clinical benchmarks.
, • C) Conducting daily audits to reward staff members who document skin
assessments accurately.
• D) Embedding a mandatory skin risk assessment prompt in the Electronic Health
Record (EHR).
Correct Answer: B) Sharing the unit's HAPI data with the staff at a meeting to
highlight the discrepancy between current practice and clinical benchmarks.
Detailed Rationale:
• Kurt Lewin’s Change Theory consists of three distinct phases:
1. Unfreezing: Creating the motivation for change by raising awareness of
the problem, challenging current habits, and establishing a sense of
urgency.
2. Moving (Change): Implementing the actual change, piloting new
workflows, and training personnel.
3. Refreezing: Standardizing the new behavior into institutional policy,
sustaining the changes, and embedding them into routine culture.
• Option B directly demonstrates Unfreezing by showing the staff the need for
change using benchmark data.
• Option A & D represent the Moving/Changing phase.
• Option C represents the Refreezing phase (reinforcing and rewarding sustained
practice).
Question 4
Q: Which of the following leadership styles is characterized by inspiring and motivating
team members through a shared vision, encouraging professional development, and
empowering staff to achieve organizational excellence?
• A) Transactional Leadership
• B) Autocratic Leadership
• C) Transformational Leadership
• D) Laissez-faire Leadership
Correct Answer: C) Transformational Leadership
Detailed Rationale:
• Transformational Leadership focuses on vision, intellectual stimulation,
individualized consideration, and charismatic inspiration to transform
organizational culture.
• Transactional Leadership relies on a hierarchy where compliance is managed
through rewards and punishments (a transaction).
• Autocratic Leadership involves centralized decision-making with little to no
input from staff.
, • Laissez-faire Leadership is a passive, hands-off approach that provides little
direction or feedback.
Module 3: Interprofessional Collaboration, Conflict
Resolution, & Nursing Ethics
Question Block 3.1: Professional Ethics and Workplace Conflict
Question 5
Q: An RN discovers that a colleague has been documenting administration of IV
narcotics that were never actually delivered to patients. The RN suspects substance
use disorder and diversion. According to the ANA Code of Ethics and legal mandates,
what is the RN's PRIMARY responsibility?
• A) Confront the colleague immediately in front of the patient care team.
• B) Cover the colleague's assignment for the rest of the shift to protect patient
safety.
• C) Report the observations immediately to the nurse manager or nursing
supervisor.
• D) Wait until the end of the week to gather more evidence before notifying
leadership.
Correct Answer: C) Report the observations immediately to the nurse manager or
nursing supervisor.
Detailed Rationale:
• Ethical/Legal Imperative: The nurse's primary duty is patient safety and
advocating for vulnerable patients. Reporting suspected impaired practice or
diversion to the immediate supervisor ensures patient protection and initiates
support resources for the impaired professional.
• Direct confrontation (Option A) can lead to escalation or destruction of evidence.
• Covering for a peer (Option B) enables impaired practice and puts patients at
ongoing risk.
• Delaying action (Option D) leaves patients exposed to unmanaged pain and
potential safety hazards.
Question 6
Q: Two staff nurses are in a disagreement regarding the weekend shift coverage
schedule. One nurse agrees to work all requested night shifts if the other nurse agrees
to cover all upcoming holiday shifts next month. Which conflict resolution strategy is
being utilized?
Answers | Verified And Well-Detailed Answers |
Detailed Explanations And Rationales | Complete
Exam Preparation Study Guide | Practice
Questions | Latest Exam Update
Question 1
Q: A Registered Nurse (RN) is managing a busy med-surg unit with an Unlicensed
Assistive Personnel (UAP) and a Licensed Practical Nurse (LPN). Which of the
following tasks is most appropriate for the RN to delegate to the LPN?
• A) Administering the initial IV piggyback antibiotic to a newly admitted septic
patient.
• B) Performing a comprehensive physical assessment on a patient returning from
a cardiac catheterization.
• C) Administering routine subcutaneous insulin to a stable diabetic patient who
has been on the unit for three days.
• D) Formulating the initial plan of care for a patient post-operative day 1 following
a total knee arthroplasty.
Correct Answer: C) Administering routine subcutaneous insulin to a stable
diabetic patient who has been on the unit for three days.
Detailed Rationale:
• Delegation Rules (Five Rights of Delegation): The RN must retain tasks
requiring the Nursing Process (Assessment, Diagnosis, Planning,
Implementation requiring complex judgment, and Evaluation — "E-A-T" rule: Do
not delegate Evaluation, Assessment, or Teaching).
• Option C is correct: LPNs are licensed to administer routine medications
(including subcutaneous injections) to stable, predictable patients.
• Option A is incorrect: Initial doses of critical medications or IV push
medications generally require RN assessment for potential acute adverse
reactions or anaphylaxis.
• Option B is incorrect: Initial post-procedure or admission physical assessments
must be performed by the RN.
• Option D is incorrect: Nursing care plan formulation is an RN responsibility that
cannot be delegated.
Question 2
,Q: An RN receives the morning shift report for four patients. Using Maslow’s Hierarchy
of Needs and the ABC (Airway, Breathing, Circulation) framework, which patient should
the nurse assess FIRST?
• A) A 54-year-old post-operative patient complaining of incision pain rated 8/10.
• B) A 68-year-old patient with COPD exhibiting a respiratory rate of 28
breaths/min and an SpO2 of 88% on 2 L/min oxygen via nasal cannula.
• C) A 42-year-old patient 2 hours post-thyroidectomy reporting tingling around the
mouth and minor hoarseness.
• D) a 75-year-old patient with heart failure requesting assistance to use the
bedside commode.
Correct Answer: C) A 42-year-old patient 2 hours post-thyroidectomy reporting
tingling around the mouth and minor hoarseness.
Detailed Rationale:
• Prioritization Analysis:
o Tingling around the mouth (perioral paresthesia) following a thyroidectomy
is a classic sign of severe hypocalcemia caused by accidental removal or
trauma to the parathyroid glands (Trousseau/Chvostek signs).
o Hypocalcemia can rapidly progress to laryngeal stridor, laryngospasm,
and complete airway obstruction (Airway issue).
• Option B: COPD baseline saturation is often low (88–92%); while elevated, this
is a chronic baseline state and second priority to an impending acute airway
crisis.
• Option A: Pain is a priority (comfort/physiologic), but secondary to airway
stability.
• Option D: Safety/elimination is secondary to an acute airway threat.
Module 2: Leadership Theories, Quality Improvement,
& Management Systems
Question Block 2.1: Organizational Change and Quality Metrics
Question 3
Q: A nurse manager notices that hospital-acquired pressure injuries (HAPIs) have
increased by 15% over the last quarter on an orthopedic unit. Using Lewin’s Change
Model, which action represents the "Unfreezing" stage?
• A) Drafting a new standardized turn-q2h protocol and uploading it to the unit
intranet.
• B) Sharing the unit's HAPI data with the staff at a meeting to highlight the
discrepancy between current practice and clinical benchmarks.
, • C) Conducting daily audits to reward staff members who document skin
assessments accurately.
• D) Embedding a mandatory skin risk assessment prompt in the Electronic Health
Record (EHR).
Correct Answer: B) Sharing the unit's HAPI data with the staff at a meeting to
highlight the discrepancy between current practice and clinical benchmarks.
Detailed Rationale:
• Kurt Lewin’s Change Theory consists of three distinct phases:
1. Unfreezing: Creating the motivation for change by raising awareness of
the problem, challenging current habits, and establishing a sense of
urgency.
2. Moving (Change): Implementing the actual change, piloting new
workflows, and training personnel.
3. Refreezing: Standardizing the new behavior into institutional policy,
sustaining the changes, and embedding them into routine culture.
• Option B directly demonstrates Unfreezing by showing the staff the need for
change using benchmark data.
• Option A & D represent the Moving/Changing phase.
• Option C represents the Refreezing phase (reinforcing and rewarding sustained
practice).
Question 4
Q: Which of the following leadership styles is characterized by inspiring and motivating
team members through a shared vision, encouraging professional development, and
empowering staff to achieve organizational excellence?
• A) Transactional Leadership
• B) Autocratic Leadership
• C) Transformational Leadership
• D) Laissez-faire Leadership
Correct Answer: C) Transformational Leadership
Detailed Rationale:
• Transformational Leadership focuses on vision, intellectual stimulation,
individualized consideration, and charismatic inspiration to transform
organizational culture.
• Transactional Leadership relies on a hierarchy where compliance is managed
through rewards and punishments (a transaction).
• Autocratic Leadership involves centralized decision-making with little to no
input from staff.
, • Laissez-faire Leadership is a passive, hands-off approach that provides little
direction or feedback.
Module 3: Interprofessional Collaboration, Conflict
Resolution, & Nursing Ethics
Question Block 3.1: Professional Ethics and Workplace Conflict
Question 5
Q: An RN discovers that a colleague has been documenting administration of IV
narcotics that were never actually delivered to patients. The RN suspects substance
use disorder and diversion. According to the ANA Code of Ethics and legal mandates,
what is the RN's PRIMARY responsibility?
• A) Confront the colleague immediately in front of the patient care team.
• B) Cover the colleague's assignment for the rest of the shift to protect patient
safety.
• C) Report the observations immediately to the nurse manager or nursing
supervisor.
• D) Wait until the end of the week to gather more evidence before notifying
leadership.
Correct Answer: C) Report the observations immediately to the nurse manager or
nursing supervisor.
Detailed Rationale:
• Ethical/Legal Imperative: The nurse's primary duty is patient safety and
advocating for vulnerable patients. Reporting suspected impaired practice or
diversion to the immediate supervisor ensures patient protection and initiates
support resources for the impaired professional.
• Direct confrontation (Option A) can lead to escalation or destruction of evidence.
• Covering for a peer (Option B) enables impaired practice and puts patients at
ongoing risk.
• Delaying action (Option D) leaves patients exposed to unmanaged pain and
potential safety hazards.
Question 6
Q: Two staff nurses are in a disagreement regarding the weekend shift coverage
schedule. One nurse agrees to work all requested night shifts if the other nurse agrees
to cover all upcoming holiday shifts next month. Which conflict resolution strategy is
being utilized?
