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NGN HESI Leadership and Management Exam
2026/2027 Actual Exam | Latest Update
Questions and Answers | A+ Grade | Pass
Guaranteed - A+ Graded
Medical-Surgical Unit Management
Scenario Part 1 (Recognizing Cues)
A nurse manager on a 30-bed medical-surgical unit is reviewing the shift assignments. The unit
has the following staff: 2 RNs, 2 LPNs, and 3 CNAs. The census is 28 patients. The acuity level
is mixed: 8 high-acuity patients (requiring frequent monitoring, IV titration, or complex
assessments), 12 moderate-acuity patients (stable but requiring nursing care), and 8 low-acuity
patients (stable, approaching discharge).
Q1: Which of the following cues should the nurse manager consider when making assignments?
(Select all that apply)
A. [ ] Patient acuity levels [CORRECT]
B. [ ] Staff competency and experience [CORRECT]
C. [ ] Staff preferences for specific patients
D. [ ] Staff license and scope of practice [CORRECT]
E. [ ] Number of staff available [CORRECT]
Correct Answer: A, B, D, E
Rationale: Patient acuity, staff competency, license scope, and staffing numbers are essential for
safe assignments per the National Council of State Boards of Nursing (NCSBN) delegation
guidelines. Staff preferences (C) are a secondary consideration and should not compromise
patient safety or appropriate delegation.
Scenario Part 2 (Analyzing Cues)
The nurse manager notes that there are 8 high-acuity patients and only 2 RNs on duty. One RN
has 5 years of experience, and the other is a new graduate in orientation (3 weeks on the unit).
The LPNs have 2 and 4 years of experience respectively. The CNAs have varying experience
levels.
Q2: Which of the following is the MOST significant concern for the nurse manager?
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A. The new graduate RN is in orientation
B. There are 8 high-acuity patients with only 2 RNs [CORRECT]
C. The unit has 3 CNAs available
D. The LPNs are experienced
Correct Answer: B
Rationale: The ratio of 8 high-acuity patients to 2 RNs creates a 1:4 RN-to-high-acuity patient
ratio, which exceeds safe staffing guidelines. High-acuity patients require RN-level assessment
and intervention. While the new graduate's orientation status (A) is a concern, the overall acuity-
to-RN ratio (B) represents the most significant patient safety risk. The availability of CNAs (C)
and experienced LPNs (D) supports care but does not replace RN-level care for high-acuity
patients.
Scenario Part 3 (Prioritizing Hypotheses)
The nurse manager must make assignments to ensure patient safety. Several hypotheses emerge
about how to approach the situation.
Q3: Which of the following is the priority hypothesis for the nurse manager?
A. Staff satisfaction with assignments will improve retention
B. Patient safety and safe staffing ratios must be maintained [CORRECT]
C. Budgetary constraints on overtime must be prioritized
D. Staff training needs should determine assignments
Correct Answer: B
Rationale: Per the ANA Code of Ethics and nurse manager responsibilities, patient safety is
always the priority hypothesis. The nurse manager must first ensure safe staffing ratios and
appropriate acuity distribution before considering staff satisfaction (A), budget constraints (C), or
training opportunities (D). Safety is the foundation of all management decisions.
Scenario Part 4 (Generating Solutions)
The nurse manager decides to adjust the assignments to ensure safe care delivery. Several
solutions are considered.
Q4: Which of the following assignments is MOST appropriate?
A. Assign the new graduate RN to all 8 high-acuity patients with LPN assistance
B. Assign LPNs to high-acuity patients without RN supervision
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C. Assign the experienced RN to the 8 high-acuity patients and the new graduate to
moderate/low-acuity patients with experienced LPN support [CORRECT]
D. Have CNAs care for high-acuity patients independently with RN oversight from the nurses'
station
Correct Answer: C
Rationale: High-acuity patients require experienced RN care. The experienced RN should
manage the 8 high-acuity patients (4:1 ratio is challenging but manageable with support). The
new graduate should be assigned to lower-acuity patients (maximum 6-8 patients) with LPN
support for tasks within LPN scope. Option A places the new graduate in an unsafe situation.
Option B violates scope of practice (LPNs cannot independently manage high-acuity patients).
Option D violates scope of practice (CNAs cannot care for high-acuity patients independently).
Scenario Part 5 (Taking Action)
The charge nurse implements the assignments. During the shift, the new graduate RN reports
feeling overwhelmed with a patient who is deteriorating (increasing respiratory rate, decreasing
oxygen saturation, altered mental status).
Q5: Which of the following actions should the charge nurse take FIRST?
A. Tell the new graduate to handle it independently to build confidence
B. Assist the new graduate with the patient assessment and intervention [CORRECT]
C. Report the new graduate to the nurse manager for performance issues
D. Immediately assign the patient to an LPN and reassign the new graduate
Correct Answer: B
Rationale: The charge nurse's first action is to provide immediate support and supervision for the
deteriorating patient. This includes assisting with assessment, implementing interventions, and
ensuring patient safety. Option A delays necessary intervention and is unsafe. Option C is
punitive and inappropriate during an active patient care situation. Option D may be appropriate
later but immediate clinical support (B) takes priority. The charge nurse must balance staff
development with patient safety.
Scenario Part 6 (Evaluating Outcomes)
After the shift, the nurse manager reviews the assignments and outcomes to determine
effectiveness.
Q6: Which of the following outcomes indicates effective management of the unit?
A. No adverse patient events occurred during the shift [CORRECT]
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B. Staff worked 2 hours of overtime to complete documentation
C. Patients complained about wait times for pain medication
D. The new graduate requested transfer to a different unit
Correct Answer: A
Rationale: The primary indicator of effective management is patient safety—no adverse events,
no falls, no medication errors, and appropriate response to changes in condition. While overtime
(B) may indicate staffing inefficiency, patient complaints (C) indicate care gaps, and staff
transfer requests (D) indicate management or unit culture issues, the absence of adverse events
(A) is the critical safety outcome. The nurse manager should also evaluate staff development, but
safety is paramount.
UNFOLDING CASE STUDY 2: Delegation and Supervision
Scenario Part 1 (Recognizing Cues)
A charge nurse on a busy medical-surgical unit has the following team: 1 RN (self), 1 LPN with
3 years of experience, and 2 CNAs. The patient assignment includes:
Patient A: Post-operative day 1 after abdominal surgery, PCA morphine, continuous monitoring
Patient B: Stable, admitted for cellulitis, IV antibiotics due at 1400
Patient C: New admission from ED with chest pain, awaiting cardiac workup
Patient D: Stable, discharge planning, needs teaching on wound care
Patient E: Elderly, requires assistance with ADLs, fall risk
Patient F: Diabetic, blood glucose monitoring before meals, insulin administration
Q7: Which of the following cues indicate tasks that require RN-level intervention? (Select all
that apply)
A. [ ] PCA morphine management for Patient A [CORRECT]
B. [ ] IV antibiotics administration for Patient B
C. [ ] Initial assessment of Patient C with chest pain [CORRECT]
D. [ ] Discharge teaching for Patient D [CORRECT]
E. [ ] Blood glucose monitoring for Patient F
Correct Answer: A, C, D
Rationale: PCA management (A) requires RN assessment and monitoring for
sedation/respiratory depression. Initial assessment of chest pain (C) requires RN-level clinical
NGN HESI Leadership and Management Exam
2026/2027 Actual Exam | Latest Update
Questions and Answers | A+ Grade | Pass
Guaranteed - A+ Graded
Medical-Surgical Unit Management
Scenario Part 1 (Recognizing Cues)
A nurse manager on a 30-bed medical-surgical unit is reviewing the shift assignments. The unit
has the following staff: 2 RNs, 2 LPNs, and 3 CNAs. The census is 28 patients. The acuity level
is mixed: 8 high-acuity patients (requiring frequent monitoring, IV titration, or complex
assessments), 12 moderate-acuity patients (stable but requiring nursing care), and 8 low-acuity
patients (stable, approaching discharge).
Q1: Which of the following cues should the nurse manager consider when making assignments?
(Select all that apply)
A. [ ] Patient acuity levels [CORRECT]
B. [ ] Staff competency and experience [CORRECT]
C. [ ] Staff preferences for specific patients
D. [ ] Staff license and scope of practice [CORRECT]
E. [ ] Number of staff available [CORRECT]
Correct Answer: A, B, D, E
Rationale: Patient acuity, staff competency, license scope, and staffing numbers are essential for
safe assignments per the National Council of State Boards of Nursing (NCSBN) delegation
guidelines. Staff preferences (C) are a secondary consideration and should not compromise
patient safety or appropriate delegation.
Scenario Part 2 (Analyzing Cues)
The nurse manager notes that there are 8 high-acuity patients and only 2 RNs on duty. One RN
has 5 years of experience, and the other is a new graduate in orientation (3 weeks on the unit).
The LPNs have 2 and 4 years of experience respectively. The CNAs have varying experience
levels.
Q2: Which of the following is the MOST significant concern for the nurse manager?
,2
A. The new graduate RN is in orientation
B. There are 8 high-acuity patients with only 2 RNs [CORRECT]
C. The unit has 3 CNAs available
D. The LPNs are experienced
Correct Answer: B
Rationale: The ratio of 8 high-acuity patients to 2 RNs creates a 1:4 RN-to-high-acuity patient
ratio, which exceeds safe staffing guidelines. High-acuity patients require RN-level assessment
and intervention. While the new graduate's orientation status (A) is a concern, the overall acuity-
to-RN ratio (B) represents the most significant patient safety risk. The availability of CNAs (C)
and experienced LPNs (D) supports care but does not replace RN-level care for high-acuity
patients.
Scenario Part 3 (Prioritizing Hypotheses)
The nurse manager must make assignments to ensure patient safety. Several hypotheses emerge
about how to approach the situation.
Q3: Which of the following is the priority hypothesis for the nurse manager?
A. Staff satisfaction with assignments will improve retention
B. Patient safety and safe staffing ratios must be maintained [CORRECT]
C. Budgetary constraints on overtime must be prioritized
D. Staff training needs should determine assignments
Correct Answer: B
Rationale: Per the ANA Code of Ethics and nurse manager responsibilities, patient safety is
always the priority hypothesis. The nurse manager must first ensure safe staffing ratios and
appropriate acuity distribution before considering staff satisfaction (A), budget constraints (C), or
training opportunities (D). Safety is the foundation of all management decisions.
Scenario Part 4 (Generating Solutions)
The nurse manager decides to adjust the assignments to ensure safe care delivery. Several
solutions are considered.
Q4: Which of the following assignments is MOST appropriate?
A. Assign the new graduate RN to all 8 high-acuity patients with LPN assistance
B. Assign LPNs to high-acuity patients without RN supervision
,3
C. Assign the experienced RN to the 8 high-acuity patients and the new graduate to
moderate/low-acuity patients with experienced LPN support [CORRECT]
D. Have CNAs care for high-acuity patients independently with RN oversight from the nurses'
station
Correct Answer: C
Rationale: High-acuity patients require experienced RN care. The experienced RN should
manage the 8 high-acuity patients (4:1 ratio is challenging but manageable with support). The
new graduate should be assigned to lower-acuity patients (maximum 6-8 patients) with LPN
support for tasks within LPN scope. Option A places the new graduate in an unsafe situation.
Option B violates scope of practice (LPNs cannot independently manage high-acuity patients).
Option D violates scope of practice (CNAs cannot care for high-acuity patients independently).
Scenario Part 5 (Taking Action)
The charge nurse implements the assignments. During the shift, the new graduate RN reports
feeling overwhelmed with a patient who is deteriorating (increasing respiratory rate, decreasing
oxygen saturation, altered mental status).
Q5: Which of the following actions should the charge nurse take FIRST?
A. Tell the new graduate to handle it independently to build confidence
B. Assist the new graduate with the patient assessment and intervention [CORRECT]
C. Report the new graduate to the nurse manager for performance issues
D. Immediately assign the patient to an LPN and reassign the new graduate
Correct Answer: B
Rationale: The charge nurse's first action is to provide immediate support and supervision for the
deteriorating patient. This includes assisting with assessment, implementing interventions, and
ensuring patient safety. Option A delays necessary intervention and is unsafe. Option C is
punitive and inappropriate during an active patient care situation. Option D may be appropriate
later but immediate clinical support (B) takes priority. The charge nurse must balance staff
development with patient safety.
Scenario Part 6 (Evaluating Outcomes)
After the shift, the nurse manager reviews the assignments and outcomes to determine
effectiveness.
Q6: Which of the following outcomes indicates effective management of the unit?
A. No adverse patient events occurred during the shift [CORRECT]
, 4
B. Staff worked 2 hours of overtime to complete documentation
C. Patients complained about wait times for pain medication
D. The new graduate requested transfer to a different unit
Correct Answer: A
Rationale: The primary indicator of effective management is patient safety—no adverse events,
no falls, no medication errors, and appropriate response to changes in condition. While overtime
(B) may indicate staffing inefficiency, patient complaints (C) indicate care gaps, and staff
transfer requests (D) indicate management or unit culture issues, the absence of adverse events
(A) is the critical safety outcome. The nurse manager should also evaluate staff development, but
safety is paramount.
UNFOLDING CASE STUDY 2: Delegation and Supervision
Scenario Part 1 (Recognizing Cues)
A charge nurse on a busy medical-surgical unit has the following team: 1 RN (self), 1 LPN with
3 years of experience, and 2 CNAs. The patient assignment includes:
Patient A: Post-operative day 1 after abdominal surgery, PCA morphine, continuous monitoring
Patient B: Stable, admitted for cellulitis, IV antibiotics due at 1400
Patient C: New admission from ED with chest pain, awaiting cardiac workup
Patient D: Stable, discharge planning, needs teaching on wound care
Patient E: Elderly, requires assistance with ADLs, fall risk
Patient F: Diabetic, blood glucose monitoring before meals, insulin administration
Q7: Which of the following cues indicate tasks that require RN-level intervention? (Select all
that apply)
A. [ ] PCA morphine management for Patient A [CORRECT]
B. [ ] IV antibiotics administration for Patient B
C. [ ] Initial assessment of Patient C with chest pain [CORRECT]
D. [ ] Discharge teaching for Patient D [CORRECT]
E. [ ] Blood glucose monitoring for Patient F
Correct Answer: A, C, D
Rationale: PCA management (A) requires RN assessment and monitoring for
sedation/respiratory depression. Initial assessment of chest pain (C) requires RN-level clinical
