BSN 465 Exam 4 V1 | BSN 465 Decision-
making in Nursing | Q&A with Rationale
(BSN465 Exam 4) | Nightingale College
1. A nurse manager is evaluating the unit’s performance using core quality indicators. Which
of the following should the manager identify as a structure indicator?
A. The percentage of patients who developed a pressure injury during their stay.
B. The ratio of registered nurses to assistive personnel on a shift.
C. The incidence of medication administration errors over a quarter.
D. The average length of stay for patients following a hip replacement.
Correct Answer: B
Rationale: Structure indicators reflect the setting in which care is provided and the
resources available, including staffing ratios and skill mix. Outcomes and processes like
pressure injuries or medication errors reflect the quality of care provided rather than the
structure.
2. A nurse is preparing to delegate tasks to an Assistive Personnel (AP). Which of the
following tasks is appropriate for the nurse to delegate?
A. Assisting a stable patient with ambulation to the bathroom.
B. Providing initial tracheostomy care for a patient who is 24 hours post-op.
C. Evaluating the effectiveness of a PRN pain medication.
,D. Creating a teaching plan for a patient newly diagnosed with diabetes.
Correct Answer: A
Rationale: Nurses can delegate stable tasks with predictable outcomes to APs. Assessment,
evaluation, and teaching are professional nursing responsibilities that cannot be delegated.
3. A nurse is caring for a group of patients and needs to prioritize care. Which patient should
the nurse see first?
A. A patient with a history of heart failure who has 2+ pitting edema in the lower
extremities.
B. A patient with asthma who is experiencing increased wheezing and a respiratory rate of
28/min.
C. A patient who is 1 day postoperative and reports a pain level of 6 on a scale of 0 to 10.
D. A patient scheduled for discharge who requires instructions on wound care.
Correct Answer: B
Rationale: Using the ABC (Airway-Breathing-Circulation) framework, the patient with
asthma and respiratory distress (increased wheezing and tachypnea) is the highest priority
as their breathing is compromised.
4. A nurse manager is utilizing Lewin’s Change Theory to implement a new electronic health
record system. Which action represents the ‘unfreezing’ stage?
A. Identifying that the current paper-based charting is causing significant delays.
, B. Updating the policy and procedure manual to reflect the new system.
C. Providing hands-on training sessions for all staff members.
D. Offering incentives to ‘super users’ who help their colleagues.
Correct Answer: A
Rationale: The unfreezing stage involves creating awareness of the need for change and
identifying the problem. Training and incentives are part of the ‘moving’ stage, while
updating policies is part of ‘refreezing’.
5. A nurse is unsure about the legality of a specific task. Which document should the nurse
consult to determine the legal scope of practice in their state?
A. The American Nurses Association (ANA) Code of Ethics.
B. The State Nurse Practice Act.
C. The hospital’s policy and procedure manual.
D. The Patient’s Bill of Rights.
Correct Answer: B
Rationale: The Nurse Practice Act is a state law that defines the scope and boundaries of
nursing practice within that specific state.
6. Which of the following leadership styles is characterized by a leader who makes decisions
independently without seeking input from the team?
A. Democratic
making in Nursing | Q&A with Rationale
(BSN465 Exam 4) | Nightingale College
1. A nurse manager is evaluating the unit’s performance using core quality indicators. Which
of the following should the manager identify as a structure indicator?
A. The percentage of patients who developed a pressure injury during their stay.
B. The ratio of registered nurses to assistive personnel on a shift.
C. The incidence of medication administration errors over a quarter.
D. The average length of stay for patients following a hip replacement.
Correct Answer: B
Rationale: Structure indicators reflect the setting in which care is provided and the
resources available, including staffing ratios and skill mix. Outcomes and processes like
pressure injuries or medication errors reflect the quality of care provided rather than the
structure.
2. A nurse is preparing to delegate tasks to an Assistive Personnel (AP). Which of the
following tasks is appropriate for the nurse to delegate?
A. Assisting a stable patient with ambulation to the bathroom.
B. Providing initial tracheostomy care for a patient who is 24 hours post-op.
C. Evaluating the effectiveness of a PRN pain medication.
,D. Creating a teaching plan for a patient newly diagnosed with diabetes.
Correct Answer: A
Rationale: Nurses can delegate stable tasks with predictable outcomes to APs. Assessment,
evaluation, and teaching are professional nursing responsibilities that cannot be delegated.
3. A nurse is caring for a group of patients and needs to prioritize care. Which patient should
the nurse see first?
A. A patient with a history of heart failure who has 2+ pitting edema in the lower
extremities.
B. A patient with asthma who is experiencing increased wheezing and a respiratory rate of
28/min.
C. A patient who is 1 day postoperative and reports a pain level of 6 on a scale of 0 to 10.
D. A patient scheduled for discharge who requires instructions on wound care.
Correct Answer: B
Rationale: Using the ABC (Airway-Breathing-Circulation) framework, the patient with
asthma and respiratory distress (increased wheezing and tachypnea) is the highest priority
as their breathing is compromised.
4. A nurse manager is utilizing Lewin’s Change Theory to implement a new electronic health
record system. Which action represents the ‘unfreezing’ stage?
A. Identifying that the current paper-based charting is causing significant delays.
, B. Updating the policy and procedure manual to reflect the new system.
C. Providing hands-on training sessions for all staff members.
D. Offering incentives to ‘super users’ who help their colleagues.
Correct Answer: A
Rationale: The unfreezing stage involves creating awareness of the need for change and
identifying the problem. Training and incentives are part of the ‘moving’ stage, while
updating policies is part of ‘refreezing’.
5. A nurse is unsure about the legality of a specific task. Which document should the nurse
consult to determine the legal scope of practice in their state?
A. The American Nurses Association (ANA) Code of Ethics.
B. The State Nurse Practice Act.
C. The hospital’s policy and procedure manual.
D. The Patient’s Bill of Rights.
Correct Answer: B
Rationale: The Nurse Practice Act is a state law that defines the scope and boundaries of
nursing practice within that specific state.
6. Which of the following leadership styles is characterized by a leader who makes decisions
independently without seeking input from the team?
A. Democratic
