N261 Exam 4 Actual Exam V3 | N261 Nursing (N261 Exam 4) |
University of California, Los Angeles
1. A charge nurse is managing a unit with several high-acuity patients. Which task is most
appropriate to delegate to an experienced Unlicensed Assistive Personnel (UAP)?
A. Feeding a client who was just admitted with a potential stroke.
B. Providing discharge instructions to a patient going home on anticoagulants.
C. Assessing the skin integrity of a patient with a stage III pressure injury.
D. Collecting a mid-stream urine specimen from a stable preoperative patient.
Answer: D
Rationale: Delegation to UAPs should focus on routine tasks for stable patients that do not
require clinical judgment or assessment. Collecting a urine specimen is a technical, non-
complex skill within the UAP’s scope of practice. Assessing, teaching, and managing
unstable patients are strictly RN responsibilities that cannot be delegated.
2. A nurse manager is applying Lewin’s Change Theory to implement a new electronic health
record system. During the ‘Unfreezing’ stage, which action should the manager take?
A. Providing technical training sessions for all staff members.
B. Developing new policies to sustain the use of the electronic system.
C. Communicating the reasons why the old paper system is no longer efficient.
D. Evaluating the success of the implementation after one month of use.
Answer: C
Rationale: The Unfreezing stage involves creating readiness for change by helping others
realize that the current status quo is no longer acceptable. By communicating the
inefficiencies of the old system, the manager builds a sense of urgency among the staff. This
stage is critical for overcoming resistance before the actual transition takes place.
3. Which action by the nurse best demonstrates the role of a patient advocate in a clinical
setting?
A. Administering scheduled medications on time to ensure therapeutic levels.
B. Reviewing the patient’s chart to ensure all laboratory results are present.
C. Completing an incident report after a patient falls in the bathroom.
D. Assisting a patient to clarify their goals of care before a family meeting with the
physician.
,Answer: D
Rationale: Patient advocacy involves supporting the patient’s rights and ensuring their
voice is heard in the medical decision-making process. Helping a patient clarify their own
values and goals empowers them to participate actively in their treatment plan. This role
requires the nurse to act as a bridge between the patient and the healthcare team to protect
patient autonomy.
4. A nurse is caring for four patients on a medical-surgical unit. Which patient should the
nurse assess first?
A. A patient with deep vein thrombosis who suddenly reports shortness of breath and chest
pain.
B. A patient who is two hours postoperative following an abdominal surgery and reports
pain as 8/10.
C. A patient with chronic obstructive pulmonary disease (COPD) with a pulse oximetry of
90%.
D. A patient who is ready for discharge and waiting for a final assessment of their surgical
wound.
Answer: A
Rationale: Prioritization should follow the ABC (Airway, Breathing, Circulation)
framework, giving precedence to acute, life-threatening changes. A patient with a DVT
reporting sudden chest pain and shortness of breath is exhibiting signs of a pulmonary
embolism, which is a medical emergency. The other patients are either stable or
experiencing expected postoperative or chronic symptoms.
5. In the context of Quality Improvement, what is the primary purpose of a Root Cause
Analysis (RCA) after a sentinel event occurs?
A. To determine the underlying system failures that contributed to the event.
B. To identify which specific staff member is responsible for the error.
C. To provide a basis for disciplinary action against the nursing staff.
D. To calculate the financial loss incurred by the hospital due to the mistake.
Answer: A
Rationale: Root Cause Analysis is a retrospective tool used to investigate why an error
occurred by looking at process and system vulnerabilities rather than individual blame.
The goal is to implement changes that prevent the recurrence of similar events in the
future. This approach fosters a ‘Just Culture’ where safety is prioritized through systemic
improvement.
, 6. A nurse is working in a hospital that utilizes a ‘flat’ organizational structure. Which
characteristic is typical of this leadership model?
A. A tall hierarchy with many layers of middle management.
B. Decentralized decision-making that empowers staff nurses.
C. Centralized decision-making at the top levels of administration.
D. Strict adherence to a chain of command for even minor clinical issues.
Answer: B
Rationale: A flat organizational structure is characterized by few layers of management
and decentralized decision-making. This allows staff nurses to have more autonomy and
direct input into unit operations and patient care policies. Such structures often improve
communication speed and enhance staff satisfaction by valuing professional expertise.
7. Which leadership style is most effective when a nurse manager needs to lead a team
through a rapid, life-threatening emergency, such as a code blue?
A. Democratic
B. Laissez-faire
C. Autocratic
D. Transformational
Answer: C
Rationale: Autocratic leadership is most appropriate in emergency situations where quick,
decisive action is required and there is no time for group consensus. The leader takes full
control and gives specific directions to ensure tasks are completed immediately to save a
patient’s life. While less ideal for day-to-day operations, it is essential for safety in high-
stress, time-sensitive crises.
8. A nurse discovers a medication error where the patient received double the dose of an
antihypertensive. What should be the nurse’s first action?
A. Assess the patient’s blood pressure and heart rate immediately.
B. Call the physician to report the error and request new orders.
C. Complete an incident report and notify the risk manager.
D. Inform the charge nurse so they can speak with the patient’s family.
Answer: A
Rationale: When an error occurs, the nurse’s immediate priority is always patient safety
and clinical assessment. Assessing the patient allows the nurse to determine if the error has
University of California, Los Angeles
1. A charge nurse is managing a unit with several high-acuity patients. Which task is most
appropriate to delegate to an experienced Unlicensed Assistive Personnel (UAP)?
A. Feeding a client who was just admitted with a potential stroke.
B. Providing discharge instructions to a patient going home on anticoagulants.
C. Assessing the skin integrity of a patient with a stage III pressure injury.
D. Collecting a mid-stream urine specimen from a stable preoperative patient.
Answer: D
Rationale: Delegation to UAPs should focus on routine tasks for stable patients that do not
require clinical judgment or assessment. Collecting a urine specimen is a technical, non-
complex skill within the UAP’s scope of practice. Assessing, teaching, and managing
unstable patients are strictly RN responsibilities that cannot be delegated.
2. A nurse manager is applying Lewin’s Change Theory to implement a new electronic health
record system. During the ‘Unfreezing’ stage, which action should the manager take?
A. Providing technical training sessions for all staff members.
B. Developing new policies to sustain the use of the electronic system.
C. Communicating the reasons why the old paper system is no longer efficient.
D. Evaluating the success of the implementation after one month of use.
Answer: C
Rationale: The Unfreezing stage involves creating readiness for change by helping others
realize that the current status quo is no longer acceptable. By communicating the
inefficiencies of the old system, the manager builds a sense of urgency among the staff. This
stage is critical for overcoming resistance before the actual transition takes place.
3. Which action by the nurse best demonstrates the role of a patient advocate in a clinical
setting?
A. Administering scheduled medications on time to ensure therapeutic levels.
B. Reviewing the patient’s chart to ensure all laboratory results are present.
C. Completing an incident report after a patient falls in the bathroom.
D. Assisting a patient to clarify their goals of care before a family meeting with the
physician.
,Answer: D
Rationale: Patient advocacy involves supporting the patient’s rights and ensuring their
voice is heard in the medical decision-making process. Helping a patient clarify their own
values and goals empowers them to participate actively in their treatment plan. This role
requires the nurse to act as a bridge between the patient and the healthcare team to protect
patient autonomy.
4. A nurse is caring for four patients on a medical-surgical unit. Which patient should the
nurse assess first?
A. A patient with deep vein thrombosis who suddenly reports shortness of breath and chest
pain.
B. A patient who is two hours postoperative following an abdominal surgery and reports
pain as 8/10.
C. A patient with chronic obstructive pulmonary disease (COPD) with a pulse oximetry of
90%.
D. A patient who is ready for discharge and waiting for a final assessment of their surgical
wound.
Answer: A
Rationale: Prioritization should follow the ABC (Airway, Breathing, Circulation)
framework, giving precedence to acute, life-threatening changes. A patient with a DVT
reporting sudden chest pain and shortness of breath is exhibiting signs of a pulmonary
embolism, which is a medical emergency. The other patients are either stable or
experiencing expected postoperative or chronic symptoms.
5. In the context of Quality Improvement, what is the primary purpose of a Root Cause
Analysis (RCA) after a sentinel event occurs?
A. To determine the underlying system failures that contributed to the event.
B. To identify which specific staff member is responsible for the error.
C. To provide a basis for disciplinary action against the nursing staff.
D. To calculate the financial loss incurred by the hospital due to the mistake.
Answer: A
Rationale: Root Cause Analysis is a retrospective tool used to investigate why an error
occurred by looking at process and system vulnerabilities rather than individual blame.
The goal is to implement changes that prevent the recurrence of similar events in the
future. This approach fosters a ‘Just Culture’ where safety is prioritized through systemic
improvement.
, 6. A nurse is working in a hospital that utilizes a ‘flat’ organizational structure. Which
characteristic is typical of this leadership model?
A. A tall hierarchy with many layers of middle management.
B. Decentralized decision-making that empowers staff nurses.
C. Centralized decision-making at the top levels of administration.
D. Strict adherence to a chain of command for even minor clinical issues.
Answer: B
Rationale: A flat organizational structure is characterized by few layers of management
and decentralized decision-making. This allows staff nurses to have more autonomy and
direct input into unit operations and patient care policies. Such structures often improve
communication speed and enhance staff satisfaction by valuing professional expertise.
7. Which leadership style is most effective when a nurse manager needs to lead a team
through a rapid, life-threatening emergency, such as a code blue?
A. Democratic
B. Laissez-faire
C. Autocratic
D. Transformational
Answer: C
Rationale: Autocratic leadership is most appropriate in emergency situations where quick,
decisive action is required and there is no time for group consensus. The leader takes full
control and gives specific directions to ensure tasks are completed immediately to save a
patient’s life. While less ideal for day-to-day operations, it is essential for safety in high-
stress, time-sensitive crises.
8. A nurse discovers a medication error where the patient received double the dose of an
antihypertensive. What should be the nurse’s first action?
A. Assess the patient’s blood pressure and heart rate immediately.
B. Call the physician to report the error and request new orders.
C. Complete an incident report and notify the risk manager.
D. Inform the charge nurse so they can speak with the patient’s family.
Answer: A
Rationale: When an error occurs, the nurse’s immediate priority is always patient safety
and clinical assessment. Assessing the patient allows the nurse to determine if the error has
