NEXT GENERATION (NGN) HESI LEADERSHIP AND
MANAGEMENT EXAM 200 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST 2026
The Next Generation (NGN) HESI Leadership and Management Exam is a
comprehensive nursing assessment designed to evaluate a candidate's ability
to manage patient care and lead healthcare teams effectively. This exam
incorporates NGN-style questions featuring new item types such as bow-ties,
trend reports, and extended multiple response, moving beyond traditional
multiple-choice formats. The exam assesses critical areas including delegation,
prioritization, conflict resolution, quality improvement, resource allocation,
legal and ethical issues, and disaster management. Candidates must
demonstrate clinical judgment and the ability to apply leadership principles in
complex, real-world scenarios. Success on this exam validates readiness for
professional nursing leadership roles and is essential for RN licensure and
advanced nursing practice.
1. A new graduate nurse is hired on a busy medical-surgical unit. The nurse notices
that the charge nurse focuses exclusively on task completion and staffing ratios,
while an experienced staff nurse inspires the team to pursue shared governance and
evidence-based practice. How does the new nurse best differentiate between the
roles observed?
A) The charge nurse is demonstrating leadership, while the staff nurse is
demonstrating management
B) The charge nurse is demonstrating management, while the staff nurse is
demonstrating leadership
C) Both nurses are demonstrating formal leadership roles assigned by the
organization
D) The charge nurse is an informal leader, and the staff nurse is a formal leader
Correct Answer: B
Rationale: Management focuses on maintaining stability, controlling resources,
staffing, and problem-solving (efficiency). Leadership involves setting a vision,
inspiring change, empowering others, and advocating for innovation
(effectiveness). The charge nurse is performing management; the staff nurse is
demonstrating leadership traits .
2. A nurse manager is implementing a shared governance model on the unit. Which
action best exemplifies the principles of this model?
,A) Posting the new fall prevention protocol on the bulletin board for staff to read
B) Forming a committee of staff nurses to revise the patient discharge process
C) Mandating that all staff attend a mandatory inservice on hand hygiene
D) Approving all vacation requests based on seniority only
Correct Answer: B
Rationale: Shared governance empowers clinical nurses to have control over their
practice and decisions that affect patient care. Forming a committee of staff nurses
to revise a process gives them autonomy and ownership over practice changes,
which is the core of this model .
3. A nurse is applying the "Five Rights of Delegation" to an LPN/LVN. Which
patient assignment is most appropriate for the LPN?
A) A new admission with pneumonia requiring an initial assessment
B) A stable patient with a gastrostomy tube requiring a scheduled feeding
C) A post-operative patient requiring discharge teaching on wound care
D) A patient with unstable blood pressure requiring IV push morphine
Correct Answer: B
Rationale: The Five Rights of Delegation include Right Task, Right Circumstance,
Right Person, Right Direction, and Right Supervision. LPNs/LVNs are licensed to
perform stable, predictable procedures like tube feedings. Initial assessments,
discharge teaching, and unstable patients/IV push meds are the responsibility of the
RN .
4. A charge nurse is making assignments for a shift that includes an RN who is
pregnant. Which assignment should the charge nurse avoid giving to this nurse?
A) A patient on contact precautions for MRSA
B) A patient receiving chemotherapy via IV push
C) A patient with a wound requiring a sterile dressing change
D) A patient with pneumonia requiring routine IV antibiotics
Correct Answer: B
Rationale: Pregnant nurses should avoid handling chemotherapy agents due to
potential teratogenic effects. This is a safety consideration for staff as well as
patients .
5. A patient refuses a blood transfusion due to religious beliefs. The family insists
the transfusion is necessary to save the patient's life. What should the nurse do
first?
A) Administer the transfusion to save the patient
B) Respect the patient's wishes and document refusal
C) Ask the family to sign a consent form
,D) Call the physician to override the refusal
Correct Answer: B
Rationale: The principle of autonomy dictates that a competent adult has the right
to refuse treatment, even life-saving treatment. The nurse acts as a patient
advocate, ensuring the patient's wishes are communicated to the physician and the
refusal is thoroughly documented .
6. A nurse on a medical-surgical unit is notified by the emergency department
(ED) that they are admitting a patient with bacterial meningitis. Which action by
the charge nurse is most appropriate regarding room placement?
A) Place the patient in a standard medical-surgical room with a roommate
B) Place the patient in a negative pressure room
C) Place the patient in a private room with droplet precautions signage
D) Place the patient in a room near the nurses' station for frequent observation
Correct Answer: C
Rationale: Neisseria meningitidis (bacterial meningitis) requires Droplet
Precautions for the first 24 hours of antibiotic therapy. A private room is preferred;
if not available, cohort with another meningitis patient. Negative pressure is for
Airborne precautions (TB, Measles, Chickenpox) .
7. A nurse observes a colleague preparing a medication that was not prescribed for
any assigned patient. When questioned, the colleague states, "I am taking this for
my headache because the pharmacy is closed." What is the most appropriate initial
action by the nurse?
A) Ignore the incident to avoid confrontation with a coworker
B) Report the colleague to the Board of Nursing immediately
C) Confront the colleague firmly and report the diversion to the nurse manager
D) Offer to get the colleague an over-the-counter medication from the gift shop
Correct Answer: C
Rationale: This describes drug diversion (theft), which is a legal and safety issue.
The nurse has a duty to report unsafe practice. Confrontation and reporting to the
immediate manager is the correct chain of command. Reporting to the BON
usually happens after internal investigation .
8. A unit is experiencing high rates of nurse burnout and turnover. The nurse
manager wants to improve the work environment. Which strategy is most likely to
address moral distress and improve retention?
A) Implementing a mandatory "no overtime" policy regardless of acuity
B) Establishing a nurse-led ethics committee to debrief after difficult patient cases
C) Increasing the patient-to-nurse ratio to save money for bonuses
, D) Requiring nurses to sign a contract agreeing to mandatory shifts
Correct Answer: B
Rationale: Moral distress occurs when nurses know the right thing to do but feel
powerless to do it due to institutional constraints. Providing a forum for debriefing
and ethical reflection helps nurses process complex situations and feel supported .
9. A nurse manager is creating the budget for the next fiscal year. The manager
allocates funds for new infusion pumps to replace the current 10-year-old models.
This type of budgeting is known as:
A) Operational budget
B) Capital budget
C) Personnel budget
D) Revenue budget
Correct Answer: B
Rationale: A capital budget covers major equipment purchases that have a long
useful life (typically >1 year), such as infusion pumps, ventilators, and beds.
Operational budgets cover day-to-day expenses (supplies, salaries) .
10. A charge nurse is evaluating the documentation of staff. Which documentation
entry is most accurate and legally defensible?
A) "Patient agitated and combative"
B) "Patient refused morning medications"
C) "Patient appears to be in pain"
D) "Patient seems depressed today"
Correct Answer: B
Rationale: Documentation should be objective, factual, and describe what was
observed or said. "Patient refused morning medications" is factual and observable.
"Agitated," "appears," and "seems" are subjective and open to interpretation .
11. A nurse is caring for a client who is experiencing pain. The nurse delegates the
task of administering medication to the nursing assistant (NA). Which of the
following is an appropriate action for the nurse to take in this situation?
A) Let the NA administer the medication without further instruction
B) Teach the NA how to assess for pain before administering the medication
C) Delegate the responsibility of evaluating the effectiveness of the medication to
the NA
D) Verify that the medication is administered correctly by the NA
Correct Answer: D
Rationale: The nurse remains accountable for the outcomes of the delegated task,
even if the task is delegated to a nursing assistant. Verifying the correct
MANAGEMENT EXAM 200 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST 2026
The Next Generation (NGN) HESI Leadership and Management Exam is a
comprehensive nursing assessment designed to evaluate a candidate's ability
to manage patient care and lead healthcare teams effectively. This exam
incorporates NGN-style questions featuring new item types such as bow-ties,
trend reports, and extended multiple response, moving beyond traditional
multiple-choice formats. The exam assesses critical areas including delegation,
prioritization, conflict resolution, quality improvement, resource allocation,
legal and ethical issues, and disaster management. Candidates must
demonstrate clinical judgment and the ability to apply leadership principles in
complex, real-world scenarios. Success on this exam validates readiness for
professional nursing leadership roles and is essential for RN licensure and
advanced nursing practice.
1. A new graduate nurse is hired on a busy medical-surgical unit. The nurse notices
that the charge nurse focuses exclusively on task completion and staffing ratios,
while an experienced staff nurse inspires the team to pursue shared governance and
evidence-based practice. How does the new nurse best differentiate between the
roles observed?
A) The charge nurse is demonstrating leadership, while the staff nurse is
demonstrating management
B) The charge nurse is demonstrating management, while the staff nurse is
demonstrating leadership
C) Both nurses are demonstrating formal leadership roles assigned by the
organization
D) The charge nurse is an informal leader, and the staff nurse is a formal leader
Correct Answer: B
Rationale: Management focuses on maintaining stability, controlling resources,
staffing, and problem-solving (efficiency). Leadership involves setting a vision,
inspiring change, empowering others, and advocating for innovation
(effectiveness). The charge nurse is performing management; the staff nurse is
demonstrating leadership traits .
2. A nurse manager is implementing a shared governance model on the unit. Which
action best exemplifies the principles of this model?
,A) Posting the new fall prevention protocol on the bulletin board for staff to read
B) Forming a committee of staff nurses to revise the patient discharge process
C) Mandating that all staff attend a mandatory inservice on hand hygiene
D) Approving all vacation requests based on seniority only
Correct Answer: B
Rationale: Shared governance empowers clinical nurses to have control over their
practice and decisions that affect patient care. Forming a committee of staff nurses
to revise a process gives them autonomy and ownership over practice changes,
which is the core of this model .
3. A nurse is applying the "Five Rights of Delegation" to an LPN/LVN. Which
patient assignment is most appropriate for the LPN?
A) A new admission with pneumonia requiring an initial assessment
B) A stable patient with a gastrostomy tube requiring a scheduled feeding
C) A post-operative patient requiring discharge teaching on wound care
D) A patient with unstable blood pressure requiring IV push morphine
Correct Answer: B
Rationale: The Five Rights of Delegation include Right Task, Right Circumstance,
Right Person, Right Direction, and Right Supervision. LPNs/LVNs are licensed to
perform stable, predictable procedures like tube feedings. Initial assessments,
discharge teaching, and unstable patients/IV push meds are the responsibility of the
RN .
4. A charge nurse is making assignments for a shift that includes an RN who is
pregnant. Which assignment should the charge nurse avoid giving to this nurse?
A) A patient on contact precautions for MRSA
B) A patient receiving chemotherapy via IV push
C) A patient with a wound requiring a sterile dressing change
D) A patient with pneumonia requiring routine IV antibiotics
Correct Answer: B
Rationale: Pregnant nurses should avoid handling chemotherapy agents due to
potential teratogenic effects. This is a safety consideration for staff as well as
patients .
5. A patient refuses a blood transfusion due to religious beliefs. The family insists
the transfusion is necessary to save the patient's life. What should the nurse do
first?
A) Administer the transfusion to save the patient
B) Respect the patient's wishes and document refusal
C) Ask the family to sign a consent form
,D) Call the physician to override the refusal
Correct Answer: B
Rationale: The principle of autonomy dictates that a competent adult has the right
to refuse treatment, even life-saving treatment. The nurse acts as a patient
advocate, ensuring the patient's wishes are communicated to the physician and the
refusal is thoroughly documented .
6. A nurse on a medical-surgical unit is notified by the emergency department
(ED) that they are admitting a patient with bacterial meningitis. Which action by
the charge nurse is most appropriate regarding room placement?
A) Place the patient in a standard medical-surgical room with a roommate
B) Place the patient in a negative pressure room
C) Place the patient in a private room with droplet precautions signage
D) Place the patient in a room near the nurses' station for frequent observation
Correct Answer: C
Rationale: Neisseria meningitidis (bacterial meningitis) requires Droplet
Precautions for the first 24 hours of antibiotic therapy. A private room is preferred;
if not available, cohort with another meningitis patient. Negative pressure is for
Airborne precautions (TB, Measles, Chickenpox) .
7. A nurse observes a colleague preparing a medication that was not prescribed for
any assigned patient. When questioned, the colleague states, "I am taking this for
my headache because the pharmacy is closed." What is the most appropriate initial
action by the nurse?
A) Ignore the incident to avoid confrontation with a coworker
B) Report the colleague to the Board of Nursing immediately
C) Confront the colleague firmly and report the diversion to the nurse manager
D) Offer to get the colleague an over-the-counter medication from the gift shop
Correct Answer: C
Rationale: This describes drug diversion (theft), which is a legal and safety issue.
The nurse has a duty to report unsafe practice. Confrontation and reporting to the
immediate manager is the correct chain of command. Reporting to the BON
usually happens after internal investigation .
8. A unit is experiencing high rates of nurse burnout and turnover. The nurse
manager wants to improve the work environment. Which strategy is most likely to
address moral distress and improve retention?
A) Implementing a mandatory "no overtime" policy regardless of acuity
B) Establishing a nurse-led ethics committee to debrief after difficult patient cases
C) Increasing the patient-to-nurse ratio to save money for bonuses
, D) Requiring nurses to sign a contract agreeing to mandatory shifts
Correct Answer: B
Rationale: Moral distress occurs when nurses know the right thing to do but feel
powerless to do it due to institutional constraints. Providing a forum for debriefing
and ethical reflection helps nurses process complex situations and feel supported .
9. A nurse manager is creating the budget for the next fiscal year. The manager
allocates funds for new infusion pumps to replace the current 10-year-old models.
This type of budgeting is known as:
A) Operational budget
B) Capital budget
C) Personnel budget
D) Revenue budget
Correct Answer: B
Rationale: A capital budget covers major equipment purchases that have a long
useful life (typically >1 year), such as infusion pumps, ventilators, and beds.
Operational budgets cover day-to-day expenses (supplies, salaries) .
10. A charge nurse is evaluating the documentation of staff. Which documentation
entry is most accurate and legally defensible?
A) "Patient agitated and combative"
B) "Patient refused morning medications"
C) "Patient appears to be in pain"
D) "Patient seems depressed today"
Correct Answer: B
Rationale: Documentation should be objective, factual, and describe what was
observed or said. "Patient refused morning medications" is factual and observable.
"Agitated," "appears," and "seems" are subjective and open to interpretation .
11. A nurse is caring for a client who is experiencing pain. The nurse delegates the
task of administering medication to the nursing assistant (NA). Which of the
following is an appropriate action for the nurse to take in this situation?
A) Let the NA administer the medication without further instruction
B) Teach the NA how to assess for pain before administering the medication
C) Delegate the responsibility of evaluating the effectiveness of the medication to
the NA
D) Verify that the medication is administered correctly by the NA
Correct Answer: D
Rationale: The nurse remains accountable for the outcomes of the delegated task,
even if the task is delegated to a nursing assistant. Verifying the correct
