HESI: NUR 204 Leadership & Management
Exam Version 2 (New 2025/2026 Update) —
Actual Questions, Correct Answers & Detailed
Rationales – Fortis
1.
The charge nurse on a 32-bed medical unit learns that an unlicensed assistive personnel (UAP)
has been posting negative comments about coworkers on a public social-media site. Which
action should the charge nurse take FIRST?
A. Report the UAP to the state board of nursing
B. Schedule a private meeting with the UAP to discuss the posts
C. Immediately terminate the UAP’s employment
D. Ignore the posts because they occurred off-duty
Correct Answer: B
Rationale:
The FIRST responsibility of the charge nurse is to address the behavior privately, clarify agency
social-media policy, and educate the UAP about professionalism and potential HIPAA violations.
Meeting privately preserves dignity, models transformational leadership (open communication),
and allows fact-finding before escalation. Reporting to the board is premature without prior
coaching and documentation. Immediate termination bypasses progressive discipline and could
expose the facility to wrongful-termination claims. Ignoring the posts condones unprofessional
behavior and undermines team morale.
, 2.
A new RN is preparing to administer 0900 medications. The patient’s apical pulse is 52
beats/min. The prescriber has ordered digoxin 0.25 mg PO daily. Which leadership behavior
should the charge nurse demonstrate?
A. Tell the RN to hold the dose and notify the pharmacist
B. Instruct the RN to give the dose because the patient is asymptomatic
C. Ask the RN to articulate the decision-making process and then guide the next step
D. Take the medication administration record (MAR) and administer the dose personally
Correct Answer: C
Rationale:
A transformational leader uses the situation as a coaching moment, fostering critical thinking and
clinical judgment (QSEN safety). Guiding the RN to verbalize assessment findings, parameters,
and evidence promotes autonomy and competence. Simply telling the RN what to do (option A)
maintains dependence. Administering an inappropriate dose (B) jeopardizes safety. Taking over
(D) diminishes the RN’s confidence and learning opportunity.
3.
During a code blue, the nurse manager arrives and begins giving orders without identifying self
or assessing current team roles. Staff appear confused and duplicate tasks. Which leadership style
is the manager displaying?
A. Transformational
B. Democratic
C. Laissez-faire
,D. Autocratic
Correct Answer: D
Rationale:
Autocratic leadership is command-centered, with the leader making rapid decisions without
input. While appropriate in true emergencies if clear, the manager skipped situational assessment
and communication, creating chaos. Transformational leaders inspire and empower; democratic
leaders seek consensus; laissez-faire leaders offer minimal guidance—none fit this scenario.
4.
A unit’s fall rate has increased 15% over the last quarter. Which quality-improvement tool should
the nurse manager use FIRST to identify contributing factors?
A. Fishbone (Ishikawa) diagram
B. Pareto chart
C. Control chart
D. Flowchart
Correct Answer: A
Rationale:
A fishbone diagram organizes potential causes (equipment, personnel, environment, process) and
is used FIRST during root-cause analysis to brainstorm why falls occurred. A Pareto chart ranks
frequency of causes after data collection. A control chart tracks ongoing variation over time. A
flowchart maps process steps but does not identify causes.
5.
, An LPN informs the RN that she has never inserted a Foley catheter on a male patient and asks
the RN to demonstrate. The unit is short-staffed and the RN has two discharges pending. Which
action best demonstrates appropriate delegation?
A. Ask another UAP who is experienced to perform the skill
B. Tell the LPN to read the policy manual and proceed independently
C. Supervise the LPN while she performs the skill, then validate competency
D. Insert the catheter quickly to save time
Correct Answer: C
Rationale:
The RN cannot delegate tasks that require nursing judgment to UAPs (option A). Ignoring the
LPN’s request (B) compromises patient safety and staff development. Performing the task
oneself (D) prevents skill acquisition and overloads the RN. Supervising the LPN (C) upholds
the Five Rights of Delegation—right task, circumstance, person, direction/communication, and
supervision—while ensuring patient safety and legal scope of practice.
6.
A nurse manager overhears two RNs arguing loudly at the nurses’ station about patient
assignments. Which conflict-resolution strategy is MOST effective in maintaining team
cohesion?
A. Avoiding—walk away and let them cool off
B. Competing—tell each RN their viewpoint is wrong and assign new patients
C. Collaborating—facilitate a private discussion to identify mutual needs and solutions
D. Accommodating—give each RN the assignment they prefer
Exam Version 2 (New 2025/2026 Update) —
Actual Questions, Correct Answers & Detailed
Rationales – Fortis
1.
The charge nurse on a 32-bed medical unit learns that an unlicensed assistive personnel (UAP)
has been posting negative comments about coworkers on a public social-media site. Which
action should the charge nurse take FIRST?
A. Report the UAP to the state board of nursing
B. Schedule a private meeting with the UAP to discuss the posts
C. Immediately terminate the UAP’s employment
D. Ignore the posts because they occurred off-duty
Correct Answer: B
Rationale:
The FIRST responsibility of the charge nurse is to address the behavior privately, clarify agency
social-media policy, and educate the UAP about professionalism and potential HIPAA violations.
Meeting privately preserves dignity, models transformational leadership (open communication),
and allows fact-finding before escalation. Reporting to the board is premature without prior
coaching and documentation. Immediate termination bypasses progressive discipline and could
expose the facility to wrongful-termination claims. Ignoring the posts condones unprofessional
behavior and undermines team morale.
, 2.
A new RN is preparing to administer 0900 medications. The patient’s apical pulse is 52
beats/min. The prescriber has ordered digoxin 0.25 mg PO daily. Which leadership behavior
should the charge nurse demonstrate?
A. Tell the RN to hold the dose and notify the pharmacist
B. Instruct the RN to give the dose because the patient is asymptomatic
C. Ask the RN to articulate the decision-making process and then guide the next step
D. Take the medication administration record (MAR) and administer the dose personally
Correct Answer: C
Rationale:
A transformational leader uses the situation as a coaching moment, fostering critical thinking and
clinical judgment (QSEN safety). Guiding the RN to verbalize assessment findings, parameters,
and evidence promotes autonomy and competence. Simply telling the RN what to do (option A)
maintains dependence. Administering an inappropriate dose (B) jeopardizes safety. Taking over
(D) diminishes the RN’s confidence and learning opportunity.
3.
During a code blue, the nurse manager arrives and begins giving orders without identifying self
or assessing current team roles. Staff appear confused and duplicate tasks. Which leadership style
is the manager displaying?
A. Transformational
B. Democratic
C. Laissez-faire
,D. Autocratic
Correct Answer: D
Rationale:
Autocratic leadership is command-centered, with the leader making rapid decisions without
input. While appropriate in true emergencies if clear, the manager skipped situational assessment
and communication, creating chaos. Transformational leaders inspire and empower; democratic
leaders seek consensus; laissez-faire leaders offer minimal guidance—none fit this scenario.
4.
A unit’s fall rate has increased 15% over the last quarter. Which quality-improvement tool should
the nurse manager use FIRST to identify contributing factors?
A. Fishbone (Ishikawa) diagram
B. Pareto chart
C. Control chart
D. Flowchart
Correct Answer: A
Rationale:
A fishbone diagram organizes potential causes (equipment, personnel, environment, process) and
is used FIRST during root-cause analysis to brainstorm why falls occurred. A Pareto chart ranks
frequency of causes after data collection. A control chart tracks ongoing variation over time. A
flowchart maps process steps but does not identify causes.
5.
, An LPN informs the RN that she has never inserted a Foley catheter on a male patient and asks
the RN to demonstrate. The unit is short-staffed and the RN has two discharges pending. Which
action best demonstrates appropriate delegation?
A. Ask another UAP who is experienced to perform the skill
B. Tell the LPN to read the policy manual and proceed independently
C. Supervise the LPN while she performs the skill, then validate competency
D. Insert the catheter quickly to save time
Correct Answer: C
Rationale:
The RN cannot delegate tasks that require nursing judgment to UAPs (option A). Ignoring the
LPN’s request (B) compromises patient safety and staff development. Performing the task
oneself (D) prevents skill acquisition and overloads the RN. Supervising the LPN (C) upholds
the Five Rights of Delegation—right task, circumstance, person, direction/communication, and
supervision—while ensuring patient safety and legal scope of practice.
6.
A nurse manager overhears two RNs arguing loudly at the nurses’ station about patient
assignments. Which conflict-resolution strategy is MOST effective in maintaining team
cohesion?
A. Avoiding—walk away and let them cool off
B. Competing—tell each RN their viewpoint is wrong and assign new patients
C. Collaborating—facilitate a private discussion to identify mutual needs and solutions
D. Accommodating—give each RN the assignment they prefer
