ES3J Study Guide Exam Questions With Guaranteed Pass
Solutions. - 190 Questions
This exam assesses advanced knowledge and application of management of care principles in complex healthcare
settings, including delegation, supervision, legal-ethical issues, resource allocation, and interprofessional
collaboration at a level consistent with top US university standards. It contains 190 multiple-choice questions,
each with four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is
organized into 8 focused sections: Management of Care, Safety and Infection Control, Health Promotion and
Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk
Potential, Physiological Adaptation. Targeted learning outcomes include: Analyze and apply legal and ethical
frameworks to resolve care management dilemmas.; Evaluate delegation and supervision strategies to ensure
safe, effective patient care.; Integrate principles of resource management and quality improvement in care
coordination.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 90%. Aligned with Designed to
meet AACN and CCNE standards for graduate-level nursing education. standards and reflects the question style
commonly seen on accredited program examinations. Students consistently achieving above the cut score on this
Section 1: Management of Care (Questions 1-25)
1 A charge nurse must assign four patients to a registered nurse (RN) and a licensed
practical nurse (LPN). Which patient assignment best demonstrates appropriate
delegation and scope of practice?
A) Assign the LPN to a patient with a new tracheostomy requiring frequent
suctioning and monitoring for bleeding.
B) Assign the RN to a patient receiving a blood transfusion and the LPN to a
patient with stable diabetes requiring insulin administration.
C) Assign the LPN to a patient with a chest tube to water seal and the RN to a
patient with a continuous IV heparin infusion.
D) Assign the RN to a patient requiring discharge teaching and the LPN to a
patient with a newly placed central line needing a dressing change.
Answer: B
Rationale: Option B respects scope: blood transfusion monitoring requires RN
assessment, while stable insulin administration is within LPN scope. Option A
involves unstable airway (RN only). Option C: chest tube management requires RN
assessment. Option D: central line dressing change requires RN.
2 A nurse manager is reviewing a sentinel event involving a wrong-site surgery.
Which root cause analysis finding would most likely indicate a systems-level
failure rather than individual error?
A) The surgeon was distracted by a personal phone call during the time-out.
,B) The preoperative checklist was not completed due to time pressure.
C) The facility had no policy requiring marking of the surgical site before the
patient entered the OR.
D) The circulating nurse failed to verify the consent form against the OR schedule.
Answer: C
Rationale: Absence of a site-marking policy is a systems failure (latent condition)
that predisposes to errors. Options A, B, and D are active failures by individuals, not
system-level root causes.
3 A nurse is caring for a patient who refuses a life-saving blood transfusion due to
religious beliefs. The patient is alert and oriented. Which action by the nurse
demonstrates ethical and legal management of care?
A) Obtain a court order to administer the transfusion against the patient's wishes.
B) Document the refusal and notify the healthcare provider to explore alternative
treatments.
C) Administer the transfusion silently while the patient sleeps to avoid conflict.
D) Convince the patient to accept the transfusion by explaining the risks of refusal.
Answer: B
Rationale: A competent adult has the right to refuse treatment even if life-saving.
Option B respects autonomy and legal requirements. Option A violates autonomy; C
is battery; D is coercive and unethical.
4 During a mass casualty incident, the nurse triages four victims. Which victim
should be tagged as 'expectant' (black tag) according to disaster triage principles?
A) A victim with an open femur fracture and palpable radial pulse.
B) A victim with agonal respirations and no palpable pulse after airway opening.
C) A victim with a sucking chest wound and altered mental status.
D) A victim with partial-thickness burns covering 30% of the body and able to
walk.
Answer: B
Rationale: Victim B has no pulse and agonal respirations despite airway intervention,
indicating unsurvivable injury. Expectant (black) means resources are not allocated.
Options A, C, and D have salvageable injuries with appropriate care.
5 A nurse is preparing to delegate vital sign measurement to an unlicensed assistive
personnel (UAP). Which instruction best ensures accurate and safe delegation?
A) 'Take vital signs on all patients in rooms 201-210 and report any abnormal
findings to me.'
,B) 'Measure blood pressure and pulse on Mr. Smith, and let me know if his
systolic is above 180 or below 90.'
C) 'Check vital signs on the post-op patients and record them in the chart.'
D) 'Take temperatures on all patients and call me if anyone has a fever.'
Answer: B
Rationale: Delegation must include specific parameters for reporting (e.g.,
thresholds). Option B provides clear criteria for when to report. Options A, C, and D
lack specific parameters, risking failure to report critical changes.
6 A nurse is leading a quality improvement project to reduce catheter-associated
urinary tract infections (CAUTI). Which intervention is most likely to achieve
sustained improvement?
A) Implement a nurse-driven protocol for daily catheter necessity review and
removal.
B) Provide a one-time educational session on catheter insertion technique.
C) Replace all indwelling catheters with condom catheters for male patients.
D) Increase the frequency of perineal care to every 2 hours.
Answer: A
Rationale: Nurse-driven protocols with daily assessment address the root cause
(unnecessary catheter days) and promote sustainability. Education alone (B) has
limited long-term effect. C is not always appropriate; D does not reduce catheter use.
7 A nurse is coordinating care for a patient with complex needs requiring multiple
specialists. Which model of care delivery is most effective for ensuring continuity
and reducing fragmentation?
A) Total patient care by an RN.
B) Functional nursing with task assignment.
C) Interprofessional collaborative practice with a primary nurse coordinator.
D) Team nursing with a charge nurse assigning tasks daily.
Answer: C
Rationale: Interprofessional collaboration with a primary nurse coordinator ensures
communication and continuity across disciplines. Total patient care (A) is inefficient
for complex needs. Functional (B) and team nursing (D) can fragment care.
8 A nurse discovers that a colleague has been diverting opioid medications. What is
the nurse's legal and ethical obligation?
A) Confront the colleague privately and advise them to seek help.
B) Report the suspicion to the nursing supervisor or appropriate authority.
, C) Ignore the behavior because the colleague is a close friend.
D) Document the incident in the colleague's personnel file.
Answer: B
Rationale: Nurses have a duty to report suspected diversion to protect patients and
uphold licensure. Confidential reporting is required. Confrontation (A) is not
appropriate; ignoring (C) violates ethics; documentation (D) is not the proper
channel.
9 A nurse is managing a patient with a do-not-resuscitate (DNR) order who
develops respiratory distress. The patient is alert and says, 'I want to be kept
comfortable.' Which action is most appropriate?
A) Initiate bag-mask ventilation and call a code.
B) Administer oxygen and morphine as needed for dyspnea.
C) Intubate the patient to prevent respiratory arrest.
D) Begin chest compressions immediately.
Answer: B
Rationale: A DNR order means no resuscitation; comfort measures are appropriate.
Option B provides symptom management. Options A, C, and D are resuscitation
actions that violate the DNR order and patient's wishes.
10 A nurse is evaluating the effectiveness of a new protocol to reduce central
line-associated bloodstream infections (CLABSI). Which outcome measure is
most indicative of protocol success?
A) Decreased length of stay for patients with central lines.
B) Reduction in the number of central lines inserted per month.
C) Decrease in the CLABSI rate per 1,000 central line days.
D) Increased documentation of line insertion dates.
Answer: C
Rationale: CLABSI rate per 1,000 central line days is the standard metric for
infection control, accounting for exposure time. Length of stay (A) is affected by
many factors; line count (B) does not reflect infections; documentation (D) is
process, not outcome.
11 A nurse manager is implementing a shared governance model in a
medical-surgical unit. Which outcome is most directly associated with this
model?
A) Increased physician satisfaction
B) Reduced length of patient stay
Solutions. - 190 Questions
This exam assesses advanced knowledge and application of management of care principles in complex healthcare
settings, including delegation, supervision, legal-ethical issues, resource allocation, and interprofessional
collaboration at a level consistent with top US university standards. It contains 190 multiple-choice questions,
each with four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is
organized into 8 focused sections: Management of Care, Safety and Infection Control, Health Promotion and
Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk
Potential, Physiological Adaptation. Targeted learning outcomes include: Analyze and apply legal and ethical
frameworks to resolve care management dilemmas.; Evaluate delegation and supervision strategies to ensure
safe, effective patient care.; Integrate principles of resource management and quality improvement in care
coordination.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 90%. Aligned with Designed to
meet AACN and CCNE standards for graduate-level nursing education. standards and reflects the question style
commonly seen on accredited program examinations. Students consistently achieving above the cut score on this
Section 1: Management of Care (Questions 1-25)
1 A charge nurse must assign four patients to a registered nurse (RN) and a licensed
practical nurse (LPN). Which patient assignment best demonstrates appropriate
delegation and scope of practice?
A) Assign the LPN to a patient with a new tracheostomy requiring frequent
suctioning and monitoring for bleeding.
B) Assign the RN to a patient receiving a blood transfusion and the LPN to a
patient with stable diabetes requiring insulin administration.
C) Assign the LPN to a patient with a chest tube to water seal and the RN to a
patient with a continuous IV heparin infusion.
D) Assign the RN to a patient requiring discharge teaching and the LPN to a
patient with a newly placed central line needing a dressing change.
Answer: B
Rationale: Option B respects scope: blood transfusion monitoring requires RN
assessment, while stable insulin administration is within LPN scope. Option A
involves unstable airway (RN only). Option C: chest tube management requires RN
assessment. Option D: central line dressing change requires RN.
2 A nurse manager is reviewing a sentinel event involving a wrong-site surgery.
Which root cause analysis finding would most likely indicate a systems-level
failure rather than individual error?
A) The surgeon was distracted by a personal phone call during the time-out.
,B) The preoperative checklist was not completed due to time pressure.
C) The facility had no policy requiring marking of the surgical site before the
patient entered the OR.
D) The circulating nurse failed to verify the consent form against the OR schedule.
Answer: C
Rationale: Absence of a site-marking policy is a systems failure (latent condition)
that predisposes to errors. Options A, B, and D are active failures by individuals, not
system-level root causes.
3 A nurse is caring for a patient who refuses a life-saving blood transfusion due to
religious beliefs. The patient is alert and oriented. Which action by the nurse
demonstrates ethical and legal management of care?
A) Obtain a court order to administer the transfusion against the patient's wishes.
B) Document the refusal and notify the healthcare provider to explore alternative
treatments.
C) Administer the transfusion silently while the patient sleeps to avoid conflict.
D) Convince the patient to accept the transfusion by explaining the risks of refusal.
Answer: B
Rationale: A competent adult has the right to refuse treatment even if life-saving.
Option B respects autonomy and legal requirements. Option A violates autonomy; C
is battery; D is coercive and unethical.
4 During a mass casualty incident, the nurse triages four victims. Which victim
should be tagged as 'expectant' (black tag) according to disaster triage principles?
A) A victim with an open femur fracture and palpable radial pulse.
B) A victim with agonal respirations and no palpable pulse after airway opening.
C) A victim with a sucking chest wound and altered mental status.
D) A victim with partial-thickness burns covering 30% of the body and able to
walk.
Answer: B
Rationale: Victim B has no pulse and agonal respirations despite airway intervention,
indicating unsurvivable injury. Expectant (black) means resources are not allocated.
Options A, C, and D have salvageable injuries with appropriate care.
5 A nurse is preparing to delegate vital sign measurement to an unlicensed assistive
personnel (UAP). Which instruction best ensures accurate and safe delegation?
A) 'Take vital signs on all patients in rooms 201-210 and report any abnormal
findings to me.'
,B) 'Measure blood pressure and pulse on Mr. Smith, and let me know if his
systolic is above 180 or below 90.'
C) 'Check vital signs on the post-op patients and record them in the chart.'
D) 'Take temperatures on all patients and call me if anyone has a fever.'
Answer: B
Rationale: Delegation must include specific parameters for reporting (e.g.,
thresholds). Option B provides clear criteria for when to report. Options A, C, and D
lack specific parameters, risking failure to report critical changes.
6 A nurse is leading a quality improvement project to reduce catheter-associated
urinary tract infections (CAUTI). Which intervention is most likely to achieve
sustained improvement?
A) Implement a nurse-driven protocol for daily catheter necessity review and
removal.
B) Provide a one-time educational session on catheter insertion technique.
C) Replace all indwelling catheters with condom catheters for male patients.
D) Increase the frequency of perineal care to every 2 hours.
Answer: A
Rationale: Nurse-driven protocols with daily assessment address the root cause
(unnecessary catheter days) and promote sustainability. Education alone (B) has
limited long-term effect. C is not always appropriate; D does not reduce catheter use.
7 A nurse is coordinating care for a patient with complex needs requiring multiple
specialists. Which model of care delivery is most effective for ensuring continuity
and reducing fragmentation?
A) Total patient care by an RN.
B) Functional nursing with task assignment.
C) Interprofessional collaborative practice with a primary nurse coordinator.
D) Team nursing with a charge nurse assigning tasks daily.
Answer: C
Rationale: Interprofessional collaboration with a primary nurse coordinator ensures
communication and continuity across disciplines. Total patient care (A) is inefficient
for complex needs. Functional (B) and team nursing (D) can fragment care.
8 A nurse discovers that a colleague has been diverting opioid medications. What is
the nurse's legal and ethical obligation?
A) Confront the colleague privately and advise them to seek help.
B) Report the suspicion to the nursing supervisor or appropriate authority.
, C) Ignore the behavior because the colleague is a close friend.
D) Document the incident in the colleague's personnel file.
Answer: B
Rationale: Nurses have a duty to report suspected diversion to protect patients and
uphold licensure. Confidential reporting is required. Confrontation (A) is not
appropriate; ignoring (C) violates ethics; documentation (D) is not the proper
channel.
9 A nurse is managing a patient with a do-not-resuscitate (DNR) order who
develops respiratory distress. The patient is alert and says, 'I want to be kept
comfortable.' Which action is most appropriate?
A) Initiate bag-mask ventilation and call a code.
B) Administer oxygen and morphine as needed for dyspnea.
C) Intubate the patient to prevent respiratory arrest.
D) Begin chest compressions immediately.
Answer: B
Rationale: A DNR order means no resuscitation; comfort measures are appropriate.
Option B provides symptom management. Options A, C, and D are resuscitation
actions that violate the DNR order and patient's wishes.
10 A nurse is evaluating the effectiveness of a new protocol to reduce central
line-associated bloodstream infections (CLABSI). Which outcome measure is
most indicative of protocol success?
A) Decreased length of stay for patients with central lines.
B) Reduction in the number of central lines inserted per month.
C) Decrease in the CLABSI rate per 1,000 central line days.
D) Increased documentation of line insertion dates.
Answer: C
Rationale: CLABSI rate per 1,000 central line days is the standard metric for
infection control, accounting for exposure time. Length of stay (A) is affected by
many factors; line count (B) does not reflect infections; documentation (D) is
process, not outcome.
11 A nurse manager is implementing a shared governance model in a
medical-surgical unit. Which outcome is most directly associated with this
model?
A) Increased physician satisfaction
B) Reduced length of patient stay
