HESI: NUR 204 Leadership & Management
Exam Version 2 (New 2025/2026 Update) —
Practice Questions, Correct Answers &
Detailed Rationales – Fortis
Question 1
A 28-year-old charge nurse on a medical unit notes that two staff RNs are
arguing in the hallway about patient assignments. Which initial action by the
charge nurse demonstrates transformational leadership?
A. Re-assign both nurses to different patients and document the incident
B. Ignore the behavior unless it continues later in the shift
C. Walk over, acknowledge the conflict, and invite both nurses to a private
conference room to discuss
D. Immediately email the nurse manager and request formal disciplinary action
Correct Answer: C
Rationale: Transformational leaders actively manage conflict and role-model
respectful communication. Inviting staff to a private setting demonstrates
visibility, approachability, and commitment to collaborative problem-solving
(idealized influence & individual consideration). Re-assigning without discussion
(A) avoids the issue, ignoring (B) undermines unit culture, and rushing to
,discipline (D) bypasses informal resolution required by the chain of command
and may escalate tension.
Question 2
The unit’s patient satisfaction scores have declined for two consecutive quarters.
Which activity best reflects the “evaluation” phase of the quality-improvement
(QI) cycle?
A. Collecting baseline satisfaction data before launching a rounding script
project
B. Comparing post-intervention scores against benchmark data and staff
feedback
C. Selecting a new vendor for bedside meal ordering
D. Holding focus groups to identify possible causes of dissatisfaction
Correct Answer: B
Rationale: Evaluation compares post-intervention metrics with benchmarks to
determine if the change was effective. Collecting baseline data (A) is “measure”;
selecting vendors (C) is “plan”; focus groups (D) are “analyze.” Only option B
closes the loop by judging outcomes.
Question 3
Which task is most appropriate to delegate to an experienced UAP?
,A. Measuring vital signs on a stable post-op patient who is 12 hours
post-laparoscopic appendectomy
B. Assessing pain in a patient receiving PCA morphine for the first time
C. Monitoring chest-tube output in a fresh traumatic hemothorax case
D. Reinforcing discharge teaching for a patient with a new ileostomy
Correct Answer: A
Rationale: Vital signs on a stable, predictable patient fall within the UAP’s scope
and do not require independent clinical judgment. PCA assessment (B),
chest-tube evaluation (C), and discharge teaching (D) all require RN-level
assessment, analysis, or patient education that cannot be delegated.
Question 4
An RN receives a new admission with a serum potassium of 3.0 mEq/L and
new-onset confusion. Which statement best demonstrates the RN’s use of
clinical decision-making authority?
A. “I’ll wait for the physician to round before giving any potassium.”
B. “I’ll notify the provider and request an order for potassium chloride IV
piggyback.”
C. “I’ll obtain a 12-lead ECG, start cardiac monitoring, notify the provider, and
remain with the patient.”
D. “I’ll ask the charge nurse to assume care while I document the finding.”
, Correct Answer: C
Rationale: The RN independently performs appropriate assessments and safety
measures (ECG, monitoring, staying with patient) while simultaneously
communicating with the provider—demonstrating critical-thinking and timely
intervention. Waiting (A) or merely requesting an order (B) delays care; delegating
the patient (D) abdicates accountability.
Question 5
During a code blue, the respiratory therapist (RT) loudly refuses to compress the
bag-valve mask, stating, “That’s nurse work.” Which leadership response is most
effective in the moment?
A. Ignore the comment and delegate the task to another RN
B. State calmly but firmly: “Bagging the patient is within your scope and
essential—please begin while I assign roles.”
C. Report the RT to the supervisor after the code
D. Offer to bag while the RT documents
Correct Answer: B
Rationale: Crisis leadership requires assertive communication, role clarity, and
patient safety focus. Calmly reinforcing shared accountability (B) maintains team
function and respects scope—respiratory therapists are trained in airway
management. Ignoring (A) or swapping roles (D) compromises efficiency;
Exam Version 2 (New 2025/2026 Update) —
Practice Questions, Correct Answers &
Detailed Rationales – Fortis
Question 1
A 28-year-old charge nurse on a medical unit notes that two staff RNs are
arguing in the hallway about patient assignments. Which initial action by the
charge nurse demonstrates transformational leadership?
A. Re-assign both nurses to different patients and document the incident
B. Ignore the behavior unless it continues later in the shift
C. Walk over, acknowledge the conflict, and invite both nurses to a private
conference room to discuss
D. Immediately email the nurse manager and request formal disciplinary action
Correct Answer: C
Rationale: Transformational leaders actively manage conflict and role-model
respectful communication. Inviting staff to a private setting demonstrates
visibility, approachability, and commitment to collaborative problem-solving
(idealized influence & individual consideration). Re-assigning without discussion
(A) avoids the issue, ignoring (B) undermines unit culture, and rushing to
,discipline (D) bypasses informal resolution required by the chain of command
and may escalate tension.
Question 2
The unit’s patient satisfaction scores have declined for two consecutive quarters.
Which activity best reflects the “evaluation” phase of the quality-improvement
(QI) cycle?
A. Collecting baseline satisfaction data before launching a rounding script
project
B. Comparing post-intervention scores against benchmark data and staff
feedback
C. Selecting a new vendor for bedside meal ordering
D. Holding focus groups to identify possible causes of dissatisfaction
Correct Answer: B
Rationale: Evaluation compares post-intervention metrics with benchmarks to
determine if the change was effective. Collecting baseline data (A) is “measure”;
selecting vendors (C) is “plan”; focus groups (D) are “analyze.” Only option B
closes the loop by judging outcomes.
Question 3
Which task is most appropriate to delegate to an experienced UAP?
,A. Measuring vital signs on a stable post-op patient who is 12 hours
post-laparoscopic appendectomy
B. Assessing pain in a patient receiving PCA morphine for the first time
C. Monitoring chest-tube output in a fresh traumatic hemothorax case
D. Reinforcing discharge teaching for a patient with a new ileostomy
Correct Answer: A
Rationale: Vital signs on a stable, predictable patient fall within the UAP’s scope
and do not require independent clinical judgment. PCA assessment (B),
chest-tube evaluation (C), and discharge teaching (D) all require RN-level
assessment, analysis, or patient education that cannot be delegated.
Question 4
An RN receives a new admission with a serum potassium of 3.0 mEq/L and
new-onset confusion. Which statement best demonstrates the RN’s use of
clinical decision-making authority?
A. “I’ll wait for the physician to round before giving any potassium.”
B. “I’ll notify the provider and request an order for potassium chloride IV
piggyback.”
C. “I’ll obtain a 12-lead ECG, start cardiac monitoring, notify the provider, and
remain with the patient.”
D. “I’ll ask the charge nurse to assume care while I document the finding.”
, Correct Answer: C
Rationale: The RN independently performs appropriate assessments and safety
measures (ECG, monitoring, staying with patient) while simultaneously
communicating with the provider—demonstrating critical-thinking and timely
intervention. Waiting (A) or merely requesting an order (B) delays care; delegating
the patient (D) abdicates accountability.
Question 5
During a code blue, the respiratory therapist (RT) loudly refuses to compress the
bag-valve mask, stating, “That’s nurse work.” Which leadership response is most
effective in the moment?
A. Ignore the comment and delegate the task to another RN
B. State calmly but firmly: “Bagging the patient is within your scope and
essential—please begin while I assign roles.”
C. Report the RT to the supervisor after the code
D. Offer to bag while the RT documents
Correct Answer: B
Rationale: Crisis leadership requires assertive communication, role clarity, and
patient safety focus. Calmly reinforcing shared accountability (B) maintains team
function and respects scope—respiratory therapists are trained in airway
management. Ignoring (A) or swapping roles (D) compromises efficiency;
