Leadership Hesi
Review
1. The charge nurse, along with one nurse, two practical nurses (PN), a unit secretary, and
two unlicensed assistive personal (UAP), is caring for 24 clients on a medical surgical
unit. Which task is best for the charge nurse to assign to the nurse?
o The admission assessment of a client diagnosed with bacterial pneumonia
o The subclavian dressing change on a client diagnosed with inflammatory
bowel disease
o Transcription of the healthcare provider’s treatment plan for a client
transferred from a critical care unit
o the insertion of a foley catheter for a client diagnosed with septicemia
2. The nurse manager observes that the staff nurse has used wrist restraints to help secure
an elderly female in her wheelchair. The client is pleading for the nurse to release her
arms. The nurse explains to the nurse-manager that the client needs to be retrained in
the wheelchair so that the nurse can change her bed linens. What is the priority action
by the nurse-manager?
o Close the door to the room to avoid disturbing other clients in nearby
rooms.
o Advise the staff nurse to remove the restraints from the client’s wrists
o Contact the healthcare provider to ensure that a prescription for restraints
was written
o Determine if the client has a PRN prescription for an antianxiety agent
3. After having coronary artery bypass surgery, a client develops a deep venous thrombosis
in the left leg. Which nurse should be responsible for coordinating the progression of the
client’s care?
o Risk management nurse
o Nurse case manager
o Cardiology unit supervisor
o Adult nurse practitioner
4. A client is transferred to the surgical unit following a strangulated inguinal hernia repair.
The post anesthesia care unit nurse reports the total intake and output that occurred during
surgery, the sedation reversal agent, and two episodes of emesis post extubating. Which
additional information should the nurse provide to complete this report?
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,o Soft abdomen, absent bowel sounds, no bleeding on dressing
o Peripheral pulses present with full range of motion of both legs
o History of vomiting at home for 3 days prior to surgery
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, o Refuses to take ice chips for complaints of dry mouth
5. When assessing a client who is returned to the unit following a left nephrectomy, the
nurse notes a small amount of bloody drainage at the drain site. Which intervention is
most important for the nurse to include in this client’s plan of care?
o Document temperature every four hours
o Turn, cough, deep breath
o Provide sips of water and ice chips
o Monitor urinary output hourly
6. The nurse assigns collection of a sputum specimen to an unlicensed assistive personnel
(UAP). Before delegating this task to the UAP, which action is most important for the
nurse to implement?
o Verify the UAP has read the procedure for collection of sputum specimen.
o Determine if the UAP received training to collect sputum specimen.
o Assess the client’s willingness to allow the UAP to collect the specimen.
o Review the institutional policy for delegation with the nursing supervisor.
7. A nurse is performing telephone triage at the clinic office. Which client has the
most acute problem and should be scheduled for the first available appointment?
o A 2-year-old girl with a history of a “cold.” Today she is tugging on her
ear and has a fever of 102 F (38.9 C).
o A 42-year-old male who hurt his back while lifting yesterday. Today
he has non-radiating, low- pain rated at 10 on a scale of 1 to 10.
o A client at 38-weeks’ gestation who today noted a small amount of
bright red blood on the toilet paper after passing stool.
o A 21-year-old with a history of a kidney transplant. Today the client
reports “flu- like” symptoms with a fever of 100.4 F (38 C).
8. The nurse hears a newly employed unlicensed assistive personnel (UAP) who is
working in a long-term care facility calling the adult residents “honey” and “dearie.”
What is the best action for the nurse to take?
o Role model the correct approach for addressing the residents.
o Ask the long-term care facility supervisor to rebuke the UAP.
o Meet with the UAP to discuss respectful client care strategies.
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