NSG 444A Exam 4 V2 | NSG 444A Transition to
Practice | Actual Q&A with Rationale (NSG444A
Exam 4) | Grand Canyon University
1. A new graduate nurse is experiencing the ‘shock’ phase of reality shock. Which behaviors
are consistent with this phase? Select all that apply.
A. Feelings of rejection and lack of accomplishment
B. Excessive fatigue and physical illness
C. Developing a sense of humor about the situation
D. Frequent use of sick leave
E. Identifying with the values of the nursing school
F. Beginning to see the ‘big picture’ of patient care
Correct Answer: A, B, D, E
Explanation: The shock phase of reality shock is characterized by frustration, anger, and
physical exhaustion as the new nurse encounters the discrepancies between school and the
work world. Nurses in this phase often cling to their educational values while feeling
unsuccessful in the clinical environment. This period is often marked by increased
absenteeism and physical symptoms related to stress.
,2. According to Patricia Benner’s stages of clinical competence, a nurse who has been on the
same unit for 2 to 3 years and can coordinate multiple complex care requirements is at which
level?
A. Advanced Beginner
B. Expert
C. Proficient
D. Competent
Correct Answer: D
Explanation: The Competent nurse has typically been in the same job for two to three
years and develops the ability to plan and organize care. They are able to see their actions
in terms of long-range goals and are efficient in their delivery of care. This stage is marked
by conscious, deliberate planning rather than the reactive nature of the advanced beginner.
3. Which leadership style is most effective in a crisis situation, such as a cardiac arrest, where
immediate decisions and actions are required?
A. Democratic
B. Laissez-faire
C. Autocratic
D. Transformational
Correct Answer: C
, Explanation: Autocratic leadership is characterized by individual control over all decisions
and little input from group members. This style is highly effective in emergencies where
decisions must be made quickly and without consultation to ensure patient safety. While
not ideal for long-term staff morale, it provides necessary structure during high-stress
clinical events.
4. A nurse manager is utilizing the PDSA cycle for a quality improvement project. What does
the ‘S’ in PDSA represent?
A. Standardize
B. Search
C. Solve
D. Study
Correct Answer: D
Explanation: The PDSA cycle stands for Plan-Do-Study-Act, which is a logic model for
quality improvement. In the Study phase, the team analyzes the data collected during the
Do phase to determine if the change resulted in improvement. This evaluation is critical to
decide whether to adopt, adapt, or abandon the intervention.
5. The nurse is delegating tasks to an Unlicensed Assistive Personnel (UAP). Which tasks are
appropriate to delegate? Select all that apply.
A. Obtaining vital signs on a stable patient
B. Performing an initial admission assessment
Practice | Actual Q&A with Rationale (NSG444A
Exam 4) | Grand Canyon University
1. A new graduate nurse is experiencing the ‘shock’ phase of reality shock. Which behaviors
are consistent with this phase? Select all that apply.
A. Feelings of rejection and lack of accomplishment
B. Excessive fatigue and physical illness
C. Developing a sense of humor about the situation
D. Frequent use of sick leave
E. Identifying with the values of the nursing school
F. Beginning to see the ‘big picture’ of patient care
Correct Answer: A, B, D, E
Explanation: The shock phase of reality shock is characterized by frustration, anger, and
physical exhaustion as the new nurse encounters the discrepancies between school and the
work world. Nurses in this phase often cling to their educational values while feeling
unsuccessful in the clinical environment. This period is often marked by increased
absenteeism and physical symptoms related to stress.
,2. According to Patricia Benner’s stages of clinical competence, a nurse who has been on the
same unit for 2 to 3 years and can coordinate multiple complex care requirements is at which
level?
A. Advanced Beginner
B. Expert
C. Proficient
D. Competent
Correct Answer: D
Explanation: The Competent nurse has typically been in the same job for two to three
years and develops the ability to plan and organize care. They are able to see their actions
in terms of long-range goals and are efficient in their delivery of care. This stage is marked
by conscious, deliberate planning rather than the reactive nature of the advanced beginner.
3. Which leadership style is most effective in a crisis situation, such as a cardiac arrest, where
immediate decisions and actions are required?
A. Democratic
B. Laissez-faire
C. Autocratic
D. Transformational
Correct Answer: C
, Explanation: Autocratic leadership is characterized by individual control over all decisions
and little input from group members. This style is highly effective in emergencies where
decisions must be made quickly and without consultation to ensure patient safety. While
not ideal for long-term staff morale, it provides necessary structure during high-stress
clinical events.
4. A nurse manager is utilizing the PDSA cycle for a quality improvement project. What does
the ‘S’ in PDSA represent?
A. Standardize
B. Search
C. Solve
D. Study
Correct Answer: D
Explanation: The PDSA cycle stands for Plan-Do-Study-Act, which is a logic model for
quality improvement. In the Study phase, the team analyzes the data collected during the
Do phase to determine if the change resulted in improvement. This evaluation is critical to
decide whether to adopt, adapt, or abandon the intervention.
5. The nurse is delegating tasks to an Unlicensed Assistive Personnel (UAP). Which tasks are
appropriate to delegate? Select all that apply.
A. Obtaining vital signs on a stable patient
B. Performing an initial admission assessment
