N261 Exam 4 Actual Exam V1 | N261 Nursing (N261 Exam 4) |
University of California, Los Angeles
1. A nurse manager is implementing a new evidence-based practice protocol on the unit.
Which leadership style is most effective for ensuring long-term staff engagement and
commitment to the change?
A. Autocratic leadership
B. Transactional leadership
C. Laissez-faire leadership
D. Transformational leadership
Answer: D
Rationale: Transformational leadership focuses on inspiring and motivating staff through
a shared vision. This style encourages collaboration and empowers employees to take
ownership of the new protocol. Unlike transactional leadership, which relies on rewards
and punishments, transformational leadership builds a culture of continuous improvement.
2. The charge nurse is delegating tasks to a Licensed Vocational Nurse (LVN) and an
Unlicensed Assistive Personnel (UAP). Which task is most appropriate to delegate to the LVN?
A. Performing an initial admission assessment on a new patient.
B. Administering an intravenous bolus of a high-risk medication.
C. Developing a plan of care for a patient with complex needs.
D. Administering an intramuscular injection of an antibiotic.
Answer: D
Rationale: Administering intramuscular injections is within the scope of practice for an
LVN. Initial assessments and complex care planning require the advanced clinical judgment
of an RN. High-risk IV bolus medications are typically restricted to RN administration to
ensure patient safety and monitoring.
3. A nurse identifies a pattern of medication errors occurring during the night shift. What is
the first step the nurse manager should take to address this quality improvement issue?
A. Reprimand the nurses involved in the errors.
B. Implement a mandatory educational session for all night shift staff.
C. Conduct a root cause analysis to identify systemic factors.
D. Increase the frequency of random chart audits.
,Answer: C
Rationale: A root cause analysis is essential to identify why the errors are occurring rather
than just who is making them. This process focuses on systemic issues like staffing,
communication, or environmental distractions. Addressing the underlying cause is the
most effective way to prevent future errors and improve patient safety.
4. When using the SBAR communication tool, which information should the nurse include in
the ‘B’ (Background) section?
A. A summary of the patient’s medical history and admission reason.
B. The patient’s current vital signs and mental status.
C. A specific request for a medication change or diagnostic test.
D. The nurse’s assessment of the patient’s deteriorating condition.
Answer: A
Rationale: The Background section of SBAR provides the context necessary for the
receiver to understand the situation. It includes pertinent history, allergies, and the reason
for the current hospitalization. This information bridges the gap between the immediate
problem and the overall patient care plan.
5. A nurse is caring for a group of patients. Using the principle of prioritization, which patient
should the nurse assess first?
A. A patient who is two days post-operative and requesting pain medication.
B. A patient with a history of heart failure who has developed new-onset shortness of
breath.
C. A patient whose IV infusion pump is alarming due to an occlusion.
D. A patient scheduled for discharge who is waiting for their final prescriptions.
Answer: B
Rationale: The patient with new-onset shortness of breath represents a potential
compromise to the airway or breathing (ABCs). This situation is acute and life-threatening,
requiring immediate assessment and intervention. The other patients, while needing
attention, are not in immediate physiological distress.
6. A nurse is assigned to care for a patient with a complex medical history who is scheduled
for a procedure. The patient expresses confusion about the risks of the procedure. What is
the nurse’s primary responsibility?
A. Explain the risks and benefits of the procedure to the patient.
B. Ask the patient to sign the consent form since they already agreed verbally.
C. Provide the patient with a brochure detailing the procedure.
, D. Notify the physician that the patient does not fully understand the procedure.
Answer: D
Rationale: The nurse’s role in informed consent is to witness the signature and advocate
for the patient. If the patient is confused, the nurse must ensure the physician provides
further clarification. The primary responsibility for explaining risks and benefits lies with
the person performing the procedure.
7. A hospital is working toward achieving Magnet status. Which organizational characteristic
is most aligned with the Magnet Recognition Program?
A. Centralized decision-making by hospital administration.
B. Nursing staff involvement in shared governance models.
C. A primary focus on cost-cutting measures and efficiency.
D. Minimal emphasis on continuing education for nursing staff.
Answer: B
Rationale: Shared governance is a hallmark of Magnet organizations, as it empowers
clinical nurses to lead and make decisions about their practice. This model fosters
professional autonomy and improves patient outcomes through collaborative leadership.
Magnet status recognizes nursing excellence, which is driven by staff engagement and
evidence-based practice.
8. An RN is delegating tasks to a UAP. Which instruction provided by the RN represents the
‘Right Direction and Communication’?
A. ‘Please take the vital signs for all patients on the north wing this morning.’
B. ‘Check on the patient in room 402 when you have a free moment.’
C. ‘Let me know if any patient has a blood pressure higher than 140/90 mmHg.’
D. ‘Collect a urine sample from the patient in room 305 and put it in the lab.’
Answer: C
Rationale: Right direction and communication requires the RN to provide specific
instructions and clear parameters for reporting. By giving a specific blood pressure
threshold, the UAP knows exactly when to notify the RN. Vague instructions like ‘when you
have a free moment’ fail to communicate the urgency or specific expectations of the task.
9. A nurse manager is evaluating the unit’s HCAHPS scores. Which action is most likely to
improve the ‘Nurse Communication’ category?
A. Decreasing the nurse-to-patient ratio to allow more time for tasks.
B. Requiring nurses to document their interactions every hour.
University of California, Los Angeles
1. A nurse manager is implementing a new evidence-based practice protocol on the unit.
Which leadership style is most effective for ensuring long-term staff engagement and
commitment to the change?
A. Autocratic leadership
B. Transactional leadership
C. Laissez-faire leadership
D. Transformational leadership
Answer: D
Rationale: Transformational leadership focuses on inspiring and motivating staff through
a shared vision. This style encourages collaboration and empowers employees to take
ownership of the new protocol. Unlike transactional leadership, which relies on rewards
and punishments, transformational leadership builds a culture of continuous improvement.
2. The charge nurse is delegating tasks to a Licensed Vocational Nurse (LVN) and an
Unlicensed Assistive Personnel (UAP). Which task is most appropriate to delegate to the LVN?
A. Performing an initial admission assessment on a new patient.
B. Administering an intravenous bolus of a high-risk medication.
C. Developing a plan of care for a patient with complex needs.
D. Administering an intramuscular injection of an antibiotic.
Answer: D
Rationale: Administering intramuscular injections is within the scope of practice for an
LVN. Initial assessments and complex care planning require the advanced clinical judgment
of an RN. High-risk IV bolus medications are typically restricted to RN administration to
ensure patient safety and monitoring.
3. A nurse identifies a pattern of medication errors occurring during the night shift. What is
the first step the nurse manager should take to address this quality improvement issue?
A. Reprimand the nurses involved in the errors.
B. Implement a mandatory educational session for all night shift staff.
C. Conduct a root cause analysis to identify systemic factors.
D. Increase the frequency of random chart audits.
,Answer: C
Rationale: A root cause analysis is essential to identify why the errors are occurring rather
than just who is making them. This process focuses on systemic issues like staffing,
communication, or environmental distractions. Addressing the underlying cause is the
most effective way to prevent future errors and improve patient safety.
4. When using the SBAR communication tool, which information should the nurse include in
the ‘B’ (Background) section?
A. A summary of the patient’s medical history and admission reason.
B. The patient’s current vital signs and mental status.
C. A specific request for a medication change or diagnostic test.
D. The nurse’s assessment of the patient’s deteriorating condition.
Answer: A
Rationale: The Background section of SBAR provides the context necessary for the
receiver to understand the situation. It includes pertinent history, allergies, and the reason
for the current hospitalization. This information bridges the gap between the immediate
problem and the overall patient care plan.
5. A nurse is caring for a group of patients. Using the principle of prioritization, which patient
should the nurse assess first?
A. A patient who is two days post-operative and requesting pain medication.
B. A patient with a history of heart failure who has developed new-onset shortness of
breath.
C. A patient whose IV infusion pump is alarming due to an occlusion.
D. A patient scheduled for discharge who is waiting for their final prescriptions.
Answer: B
Rationale: The patient with new-onset shortness of breath represents a potential
compromise to the airway or breathing (ABCs). This situation is acute and life-threatening,
requiring immediate assessment and intervention. The other patients, while needing
attention, are not in immediate physiological distress.
6. A nurse is assigned to care for a patient with a complex medical history who is scheduled
for a procedure. The patient expresses confusion about the risks of the procedure. What is
the nurse’s primary responsibility?
A. Explain the risks and benefits of the procedure to the patient.
B. Ask the patient to sign the consent form since they already agreed verbally.
C. Provide the patient with a brochure detailing the procedure.
, D. Notify the physician that the patient does not fully understand the procedure.
Answer: D
Rationale: The nurse’s role in informed consent is to witness the signature and advocate
for the patient. If the patient is confused, the nurse must ensure the physician provides
further clarification. The primary responsibility for explaining risks and benefits lies with
the person performing the procedure.
7. A hospital is working toward achieving Magnet status. Which organizational characteristic
is most aligned with the Magnet Recognition Program?
A. Centralized decision-making by hospital administration.
B. Nursing staff involvement in shared governance models.
C. A primary focus on cost-cutting measures and efficiency.
D. Minimal emphasis on continuing education for nursing staff.
Answer: B
Rationale: Shared governance is a hallmark of Magnet organizations, as it empowers
clinical nurses to lead and make decisions about their practice. This model fosters
professional autonomy and improves patient outcomes through collaborative leadership.
Magnet status recognizes nursing excellence, which is driven by staff engagement and
evidence-based practice.
8. An RN is delegating tasks to a UAP. Which instruction provided by the RN represents the
‘Right Direction and Communication’?
A. ‘Please take the vital signs for all patients on the north wing this morning.’
B. ‘Check on the patient in room 402 when you have a free moment.’
C. ‘Let me know if any patient has a blood pressure higher than 140/90 mmHg.’
D. ‘Collect a urine sample from the patient in room 305 and put it in the lab.’
Answer: C
Rationale: Right direction and communication requires the RN to provide specific
instructions and clear parameters for reporting. By giving a specific blood pressure
threshold, the UAP knows exactly when to notify the RN. Vague instructions like ‘when you
have a free moment’ fail to communicate the urgency or specific expectations of the task.
9. A nurse manager is evaluating the unit’s HCAHPS scores. Which action is most likely to
improve the ‘Nurse Communication’ category?
A. Decreasing the nurse-to-patient ratio to allow more time for tasks.
B. Requiring nurses to document their interactions every hour.
