HESI: NUR 204 Leadership & Management
Exam Version 2 (New 2025/2026 Update) —
Questions, Correct Answers & Detailed
Rationales – Fortis
1
The charge nurse on a 32-bed medical unit learns that a newly licensed RN consistently
documents assessments 2–3 hours before they are actually performed. Which action
should the charge nurse take FIRST?
A. Confront the RN in the presence of preceptor to emphasize the severity of the issue
B. Complete an incident report and submit it to the nurse manager without discussing it
with the RN
C. Meet privately with the RN to review the documentation discrepancy and explore
contributing factors
D. Reassign the RN to a lower-acuity patient load until competency is verified
Correct Answer: C
Rationale: The first responsibility of a charge nurse is to address practice issues directly
and respectfully, maintaining professional dignity while gathering facts. Meeting
privately (C) allows the charge nurse to determine whether the behavior is intentional,
due to time-management deficits, or a misunderstanding of policy. Option A undermines
psychological safety and violates principles of respectful communication. Option B
bypasses immediate coaching and may escalate fear rather than correct behavior. Option
D is punitive and does not address the root cause or promote professional growth.
2
A unit manager is implementing a new evidence-based fall-reduction protocol. Which
leadership style will MOST effectively promote staff ownership and sustained adoption?
A. Transactional leadership offering a gift-card reward for zero falls each month
B. Laissez-faire leadership allowing teams to decide whether to use the protocol
C. Transformational leadership that articulates a clear vision and engages staff in protocol
design
D. Autocratic leadership mandating compliance with disciplinary action for
non-adherence
Correct Answer: C
Rationale: Transformational leaders inspire change by creating shared vision and
fostering intrinsic motivation, both proven to increase adherence to evidence-based
,practices. Staff who co-design protocols are more committed to outcomes. Transactional
rewards (A) produce short-term compliance but do not sustain cultural change.
Laissez-faire (B) creates inconsistent practice and potential safety gaps. Autocratic
mandates (D) generate resistance and conceal non-compliance rather than engage staff in
meaningful improvement.
3
During morning rounds, an RN delegates vital signs on a stable post-op patient to a UAP.
Fifteen minutes later the UAP reports the patient now has chest pain and shortness of
breath. What is the RN’s BEST first action?
A. Ask the UAP to obtain a full set of vitals while the RN finishes medication
administration on another patient
B. Immediately assess the patient and initiate appropriate interventions
C. Instruct the UAP to notify the respiratory therapist first
D. Document the change in condition and then proceed to assess
Correct Answer: B
Rationale: Once assessment data indicate a change in condition, the RN must personally
re-assess and apply clinical judgment; these actions cannot be delegated. Delaying
assessment (A, C, D) could compromise patient safety and violates the RN’s scope.
Although the UAP can gather data, the RN retains accountability for interpretation and
decision-making.
4
A nurse manager overhears two staff nurses arguing loudly at the medication cart about
who should receive the next admission. Which conflict-resolution strategy will MOST
likely produce a long-term solution?
A. Avoidance—tell them to “cool off” and resume work
B. Competition—assign the admission to the nurse with lighter load without discussion
C. Compromise—split the admission tasks so each nurse performs half
D. Collaboration—facilitate a discussion to identify underlying concerns and develop a
fair admission policy
Correct Answer: D
Rationale: Collaboration seeks a win-win outcome and addresses systemic issues, thereby
preventing future conflicts. Avoidance (A) leaves tension unresolved. Competition (B)
may breed resentment. Compromise (C) can be superficial if workflow problems are not
examined. A facilitated conversation (D) models professional communication and often
yields sustainable policy changes such as rotating admission responsibilities based on
acuity and workload.
5
, A staff nurse reports a physician who repeatedly yells and uses profanity when
questioned about orders. Which action BEST demonstrates the manager’s commitment to
a culture of safety?
A. Suggest the nurse “develop a thicker skin” when working with this physician
B. Schedule a private meeting with the physician to review the code of conduct and
outline consequences
C. Document the complaint but wait until a second nurse corroborates the behavior
before intervening
D. Reassign the nurse to a different team to avoid future interactions
Correct Answer: B
Rationale: Disruptive behavior undermines safety by silencing staff and increasing error
risk. The manager must address unprofessional conduct immediately and privately (B),
following the organization’s code of conduct and progressive-discipline policy. Option A
normalizes intimidation. Option C delays action and implies tolerance. Option D
penalizes the reporter and fails to address the perpetrator, thereby perpetuating an unsafe
climate.
6
An RN is floated to a cardiac step-down unit where the patient ratio is 1:4, all on
telemetry. The RN has not worked cardiac in five years. Which action is MOST
appropriate?
A. Accept the assignment but plan to ask coworkers for help as needed
B. Refuse the assignment and leave the facility immediately
C. Request a modified assignment with patients who have the lowest acuity and receive
an orientation to unit-specific equipment
D. Take the assignment and quickly review cardiac rhythms on a smartphone app at the
desk
Correct Answer: C
Rationale: Nurses must practice within their competency; however, they also have a duty
to accept reasonable accommodations that ensure patient safety. Requesting a low-acuity
load and brief orientation (C) balances legal obligations with safety. Refusing without
negotiation (B) constitutes abandonment. Relying solely on coworkers (A) or a quick app
review (D) does not provide sufficient competence for telemetry monitoring.
7
A quality-improvement team is analyzing a near-miss medication error in which insulin
was nearly administered intravenously instead of subcutaneously. Which QI tool will
BEST identify all contributing factors?
A. Pareto chart
Exam Version 2 (New 2025/2026 Update) —
Questions, Correct Answers & Detailed
Rationales – Fortis
1
The charge nurse on a 32-bed medical unit learns that a newly licensed RN consistently
documents assessments 2–3 hours before they are actually performed. Which action
should the charge nurse take FIRST?
A. Confront the RN in the presence of preceptor to emphasize the severity of the issue
B. Complete an incident report and submit it to the nurse manager without discussing it
with the RN
C. Meet privately with the RN to review the documentation discrepancy and explore
contributing factors
D. Reassign the RN to a lower-acuity patient load until competency is verified
Correct Answer: C
Rationale: The first responsibility of a charge nurse is to address practice issues directly
and respectfully, maintaining professional dignity while gathering facts. Meeting
privately (C) allows the charge nurse to determine whether the behavior is intentional,
due to time-management deficits, or a misunderstanding of policy. Option A undermines
psychological safety and violates principles of respectful communication. Option B
bypasses immediate coaching and may escalate fear rather than correct behavior. Option
D is punitive and does not address the root cause or promote professional growth.
2
A unit manager is implementing a new evidence-based fall-reduction protocol. Which
leadership style will MOST effectively promote staff ownership and sustained adoption?
A. Transactional leadership offering a gift-card reward for zero falls each month
B. Laissez-faire leadership allowing teams to decide whether to use the protocol
C. Transformational leadership that articulates a clear vision and engages staff in protocol
design
D. Autocratic leadership mandating compliance with disciplinary action for
non-adherence
Correct Answer: C
Rationale: Transformational leaders inspire change by creating shared vision and
fostering intrinsic motivation, both proven to increase adherence to evidence-based
,practices. Staff who co-design protocols are more committed to outcomes. Transactional
rewards (A) produce short-term compliance but do not sustain cultural change.
Laissez-faire (B) creates inconsistent practice and potential safety gaps. Autocratic
mandates (D) generate resistance and conceal non-compliance rather than engage staff in
meaningful improvement.
3
During morning rounds, an RN delegates vital signs on a stable post-op patient to a UAP.
Fifteen minutes later the UAP reports the patient now has chest pain and shortness of
breath. What is the RN’s BEST first action?
A. Ask the UAP to obtain a full set of vitals while the RN finishes medication
administration on another patient
B. Immediately assess the patient and initiate appropriate interventions
C. Instruct the UAP to notify the respiratory therapist first
D. Document the change in condition and then proceed to assess
Correct Answer: B
Rationale: Once assessment data indicate a change in condition, the RN must personally
re-assess and apply clinical judgment; these actions cannot be delegated. Delaying
assessment (A, C, D) could compromise patient safety and violates the RN’s scope.
Although the UAP can gather data, the RN retains accountability for interpretation and
decision-making.
4
A nurse manager overhears two staff nurses arguing loudly at the medication cart about
who should receive the next admission. Which conflict-resolution strategy will MOST
likely produce a long-term solution?
A. Avoidance—tell them to “cool off” and resume work
B. Competition—assign the admission to the nurse with lighter load without discussion
C. Compromise—split the admission tasks so each nurse performs half
D. Collaboration—facilitate a discussion to identify underlying concerns and develop a
fair admission policy
Correct Answer: D
Rationale: Collaboration seeks a win-win outcome and addresses systemic issues, thereby
preventing future conflicts. Avoidance (A) leaves tension unresolved. Competition (B)
may breed resentment. Compromise (C) can be superficial if workflow problems are not
examined. A facilitated conversation (D) models professional communication and often
yields sustainable policy changes such as rotating admission responsibilities based on
acuity and workload.
5
, A staff nurse reports a physician who repeatedly yells and uses profanity when
questioned about orders. Which action BEST demonstrates the manager’s commitment to
a culture of safety?
A. Suggest the nurse “develop a thicker skin” when working with this physician
B. Schedule a private meeting with the physician to review the code of conduct and
outline consequences
C. Document the complaint but wait until a second nurse corroborates the behavior
before intervening
D. Reassign the nurse to a different team to avoid future interactions
Correct Answer: B
Rationale: Disruptive behavior undermines safety by silencing staff and increasing error
risk. The manager must address unprofessional conduct immediately and privately (B),
following the organization’s code of conduct and progressive-discipline policy. Option A
normalizes intimidation. Option C delays action and implies tolerance. Option D
penalizes the reporter and fails to address the perpetrator, thereby perpetuating an unsafe
climate.
6
An RN is floated to a cardiac step-down unit where the patient ratio is 1:4, all on
telemetry. The RN has not worked cardiac in five years. Which action is MOST
appropriate?
A. Accept the assignment but plan to ask coworkers for help as needed
B. Refuse the assignment and leave the facility immediately
C. Request a modified assignment with patients who have the lowest acuity and receive
an orientation to unit-specific equipment
D. Take the assignment and quickly review cardiac rhythms on a smartphone app at the
desk
Correct Answer: C
Rationale: Nurses must practice within their competency; however, they also have a duty
to accept reasonable accommodations that ensure patient safety. Requesting a low-acuity
load and brief orientation (C) balances legal obligations with safety. Refusing without
negotiation (B) constitutes abandonment. Relying solely on coworkers (A) or a quick app
review (D) does not provide sufficient competence for telemetry monitoring.
7
A quality-improvement team is analyzing a near-miss medication error in which insulin
was nearly administered intravenously instead of subcutaneously. Which QI tool will
BEST identify all contributing factors?
A. Pareto chart
