N261 Exam 4 Actual Exam V2 | N261 Nursing (N261 Exam 4) |
University of California, Los Angeles
1. A charge nurse is delegating tasks to a Licensed Practical Nurse (LPN) and an Unlicensed
Assistive Personnel (UAP). Which task is most appropriate for the LPN?
A. Administering an initial dose of IV push medication.
B. Performing a sterile dressing change on a stable post-operative patient.
C. Developing the initial plan of care for a newly admitted patient.
D. Assisting a patient with oral hygiene and ambulation.
Answer: B
Rationale: LPNs are qualified to perform sterile procedures on stable patients as part of
their scope of practice. Initial assessments and IV push medications are generally reserved
for the Registered Nurse to ensure patient safety and proper evaluation. Assisting with
ADLs is a task that should be delegated to the UAP to optimize unit efficiency.
2. A nurse manager is using Lewin’s Change Theory to implement a new bedside reporting
protocol. During which stage does the manager reinforce the new behavior to ensure it
becomes permanent?
A. Unfreezing
B. Moving
C. Refreezing
D. Assessing
Answer: C
Rationale: Refreezing is the final stage of Lewin’s theory where the new change is
integrated into the organizational culture to prevent reversion to old habits. Unfreezing
involves creating readiness for change, while the moving stage involves the actual
implementation of the new process. Successful refreezing requires positive reinforcement
and monitoring of compliance by leadership.
3. Which patient should the nurse prioritize seeing first after receiving the morning shift
report?
A. A patient with a history of heart failure reporting 2+ pitting edema in lower extremities.
B. A patient with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 90%.
C. A patient who is 2 hours post-thyroidectomy reporting tingling in the fingers and toes.
,D. A patient requesting PRN pain medication for a chronic back injury.
Answer: C
Rationale: Tingling in the fingers and toes post-thyroidectomy is a sign of hypocalcemia,
which can lead to life-threatening laryngospasm and seizures. This represents a potential
airway and neurological emergency that requires immediate intervention. The other
patients exhibit stable chronic symptoms or expected post-operative findings that do not
take priority over acute electrolyte imbalances.
4. A nurse is preparing to delegate tasks to a UAP. Which of the ‘Five Rights of Delegation’
requires the nurse to evaluate the UAP’s ability to perform the specific task safely?
A. Right Task
B. Right Direction/Communication
C. Right Person
D. Right Circumstance
Answer: C
Rationale: The ‘Right Person’ involves ensuring that the individual being delegated to has
the necessary knowledge, skills, and competency to perform the task. The nurse must
verify that the UAP’s job description and demonstrated abilities align with the patient’s
needs. Failure to assess the competence of the staff member can lead to adverse patient
outcomes and legal liability for the nurse.
5. A healthcare team is conducting a Root Cause Analysis (RCA) after a medication error
occurred. What is the primary purpose of an RCA?
A. To identify which individual staff member is at fault.
B. To fulfill legal requirements for the facility’s insurance provider.
C. To identify system-level vulnerabilities that contributed to the error.
D. To discipline the nurse involved in the error to prevent recurrence.
Answer: C
Rationale: Root Cause Analysis is a reactive quality improvement process designed to look
past human error and identify flaws in the system or process. By focusing on ‘why’ the
system failed rather than ‘who’ failed, the organization can implement safeguards to
prevent similar events. This approach promotes a ‘Just Culture’ where reporting is
encouraged to improve overall patient safety.
6. A nurse leader is described as inspiring the staff to achieve a shared vision and fostering an
environment of innovation. Which leadership style does this represent?
A. Transactional Leadership
, B. Transformational Leadership
C. Autocratic Leadership
D. Laissez-faire Leadership
Answer: B
Rationale: Transformational leaders focus on building relationships and motivating staff
through a shared vision and intellectual stimulation. This style is associated with higher
staff satisfaction and better patient outcomes because it empowers employees. In contrast,
transactional leadership relies on rewards and punishments to achieve compliance with
organizational goals.
7. An RN is caring for a patient with a complex wound. Which action represents the
‘Coordination of Care’ competency?
A. Collaborating with the dietician and wound care specialist to optimize healing.
B. Cleaning the wound with normal saline and applying a dry dressing.
C. Documenting the wound’s dimensions in the electronic health record.
D. Explaining the purpose of the antibiotics to the patient’s family.
Answer: A
Rationale: Coordination of care involves organizing patient care activities and sharing
information among all members of the healthcare team. By involving the dietician and
specialist, the nurse ensures that all factors affecting wound healing, such as nutrition and
specialized treatment, are addressed. This interdisciplinary approach is essential for
managing complex patient needs effectively.
8. A hospital is implementing a new bar-code medication administration (BCMA) system. How
does this technology primarily improve patient safety?
A. By ensuring the five rights of medication administration are verified.
B. By decreasing the time the nurse spends at the bedside.
C. By allowing the nurse to bypass the pharmacy review for urgent meds.
D. By reducing the cost of medications for the hospital.
Answer: A
Rationale: BCMA technology requires scanning the patient’s ID band and the medication,
providing an electronic check for the right patient, drug, dose, route, and time. This system
acts as a safeguard against human error by alerting the nurse if there is a mismatch. While
it may alter workflow, its main purpose is to reduce medication errors and enhance clinical
safety.
University of California, Los Angeles
1. A charge nurse is delegating tasks to a Licensed Practical Nurse (LPN) and an Unlicensed
Assistive Personnel (UAP). Which task is most appropriate for the LPN?
A. Administering an initial dose of IV push medication.
B. Performing a sterile dressing change on a stable post-operative patient.
C. Developing the initial plan of care for a newly admitted patient.
D. Assisting a patient with oral hygiene and ambulation.
Answer: B
Rationale: LPNs are qualified to perform sterile procedures on stable patients as part of
their scope of practice. Initial assessments and IV push medications are generally reserved
for the Registered Nurse to ensure patient safety and proper evaluation. Assisting with
ADLs is a task that should be delegated to the UAP to optimize unit efficiency.
2. A nurse manager is using Lewin’s Change Theory to implement a new bedside reporting
protocol. During which stage does the manager reinforce the new behavior to ensure it
becomes permanent?
A. Unfreezing
B. Moving
C. Refreezing
D. Assessing
Answer: C
Rationale: Refreezing is the final stage of Lewin’s theory where the new change is
integrated into the organizational culture to prevent reversion to old habits. Unfreezing
involves creating readiness for change, while the moving stage involves the actual
implementation of the new process. Successful refreezing requires positive reinforcement
and monitoring of compliance by leadership.
3. Which patient should the nurse prioritize seeing first after receiving the morning shift
report?
A. A patient with a history of heart failure reporting 2+ pitting edema in lower extremities.
B. A patient with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 90%.
C. A patient who is 2 hours post-thyroidectomy reporting tingling in the fingers and toes.
,D. A patient requesting PRN pain medication for a chronic back injury.
Answer: C
Rationale: Tingling in the fingers and toes post-thyroidectomy is a sign of hypocalcemia,
which can lead to life-threatening laryngospasm and seizures. This represents a potential
airway and neurological emergency that requires immediate intervention. The other
patients exhibit stable chronic symptoms or expected post-operative findings that do not
take priority over acute electrolyte imbalances.
4. A nurse is preparing to delegate tasks to a UAP. Which of the ‘Five Rights of Delegation’
requires the nurse to evaluate the UAP’s ability to perform the specific task safely?
A. Right Task
B. Right Direction/Communication
C. Right Person
D. Right Circumstance
Answer: C
Rationale: The ‘Right Person’ involves ensuring that the individual being delegated to has
the necessary knowledge, skills, and competency to perform the task. The nurse must
verify that the UAP’s job description and demonstrated abilities align with the patient’s
needs. Failure to assess the competence of the staff member can lead to adverse patient
outcomes and legal liability for the nurse.
5. A healthcare team is conducting a Root Cause Analysis (RCA) after a medication error
occurred. What is the primary purpose of an RCA?
A. To identify which individual staff member is at fault.
B. To fulfill legal requirements for the facility’s insurance provider.
C. To identify system-level vulnerabilities that contributed to the error.
D. To discipline the nurse involved in the error to prevent recurrence.
Answer: C
Rationale: Root Cause Analysis is a reactive quality improvement process designed to look
past human error and identify flaws in the system or process. By focusing on ‘why’ the
system failed rather than ‘who’ failed, the organization can implement safeguards to
prevent similar events. This approach promotes a ‘Just Culture’ where reporting is
encouraged to improve overall patient safety.
6. A nurse leader is described as inspiring the staff to achieve a shared vision and fostering an
environment of innovation. Which leadership style does this represent?
A. Transactional Leadership
, B. Transformational Leadership
C. Autocratic Leadership
D. Laissez-faire Leadership
Answer: B
Rationale: Transformational leaders focus on building relationships and motivating staff
through a shared vision and intellectual stimulation. This style is associated with higher
staff satisfaction and better patient outcomes because it empowers employees. In contrast,
transactional leadership relies on rewards and punishments to achieve compliance with
organizational goals.
7. An RN is caring for a patient with a complex wound. Which action represents the
‘Coordination of Care’ competency?
A. Collaborating with the dietician and wound care specialist to optimize healing.
B. Cleaning the wound with normal saline and applying a dry dressing.
C. Documenting the wound’s dimensions in the electronic health record.
D. Explaining the purpose of the antibiotics to the patient’s family.
Answer: A
Rationale: Coordination of care involves organizing patient care activities and sharing
information among all members of the healthcare team. By involving the dietician and
specialist, the nurse ensures that all factors affecting wound healing, such as nutrition and
specialized treatment, are addressed. This interdisciplinary approach is essential for
managing complex patient needs effectively.
8. A hospital is implementing a new bar-code medication administration (BCMA) system. How
does this technology primarily improve patient safety?
A. By ensuring the five rights of medication administration are verified.
B. By decreasing the time the nurse spends at the bedside.
C. By allowing the nurse to bypass the pharmacy review for urgent meds.
D. By reducing the cost of medications for the hospital.
Answer: A
Rationale: BCMA technology requires scanning the patient’s ID band and the medication,
providing an electronic check for the right patient, drug, dose, route, and time. This system
acts as a safeguard against human error by alerting the nurse if there is a mismatch. While
it may alter workflow, its main purpose is to reduce medication errors and enhance clinical
safety.
