NURS 4021
Leadership Competencies in
Nursing & Healthcare
Midterm Exam Review
2025
,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 extubation. Which additional
information should the nurse provide to complete this report?
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
, 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 respecVul client care strategies.
, o Call a staff meeting to encourage more professional behaviors.
9. The nurse is planning care for a client who is experiencing acute pain. Which intervention can be
implemented by the unlicensed assistive personnel (UAP) in providing personal care for this
client?
o Guided imagery
o Patient-controlled analgesia
o Distraction
o Biofeedback
10. The nurse calls a surgeon about a male client who is having abdominal pain after a bowel
resection. He received hydromorphone 2 hours ago and is now requesting additional pain
medication. Vital signs include temperature 97.8 F (36.6 C), heart rate 112 beats/minute,
respirations 24 breaths/minute, and blood pressure is 98/62 mmHg, which is lower from
previous reading one hour ago. The client has a history of chronic atrial fibrillation and takes
clopidogrel, which was continued until one day prior to surgery. The nurse recommends that the
surgeon see the client immediately to evaluate the situation. What information makes this
report complete?
o Nasogastric suction is draining bile-colored secretions
o Lungs are clear bilaterally and oxygen saturation is 97%
o The abdomen is rigid, tender to touch, and distended
o Client’s history includes cardioversion and ablation therapy
11. An older female client who was recently widowed has become increasingly confused and
disoriented. Her family tells the healthcare provider’s office nurse that it is imperative for their
mother to be admitted to the hospital for medical evaluation. The client is a member of a
managed healthcare plan. Which information is best for the nurse to provide this family?
o Managed care providers have mandatory pre-certification requirements for
hospitalization.
o Managed healthcare plans do not pay for any in-hospital medical evaluations.
o The client is grieving normally in response to her husband’s death and
hospitalizations is not necessary.
o Healthcare costs are escalating because clients want to have diagnostic testing
conducted in the hospital.
12. The charge nurse on a surgical unit is assessing the morning lab work on four clients. Which
client’s lab finding should be reported to the healthcare provider immediately?
Leadership Competencies in
Nursing & Healthcare
Midterm Exam Review
2025
,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 extubation. Which additional
information should the nurse provide to complete this report?
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
, 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 respecVul client care strategies.
, o Call a staff meeting to encourage more professional behaviors.
9. The nurse is planning care for a client who is experiencing acute pain. Which intervention can be
implemented by the unlicensed assistive personnel (UAP) in providing personal care for this
client?
o Guided imagery
o Patient-controlled analgesia
o Distraction
o Biofeedback
10. The nurse calls a surgeon about a male client who is having abdominal pain after a bowel
resection. He received hydromorphone 2 hours ago and is now requesting additional pain
medication. Vital signs include temperature 97.8 F (36.6 C), heart rate 112 beats/minute,
respirations 24 breaths/minute, and blood pressure is 98/62 mmHg, which is lower from
previous reading one hour ago. The client has a history of chronic atrial fibrillation and takes
clopidogrel, which was continued until one day prior to surgery. The nurse recommends that the
surgeon see the client immediately to evaluate the situation. What information makes this
report complete?
o Nasogastric suction is draining bile-colored secretions
o Lungs are clear bilaterally and oxygen saturation is 97%
o The abdomen is rigid, tender to touch, and distended
o Client’s history includes cardioversion and ablation therapy
11. An older female client who was recently widowed has become increasingly confused and
disoriented. Her family tells the healthcare provider’s office nurse that it is imperative for their
mother to be admitted to the hospital for medical evaluation. The client is a member of a
managed healthcare plan. Which information is best for the nurse to provide this family?
o Managed care providers have mandatory pre-certification requirements for
hospitalization.
o Managed healthcare plans do not pay for any in-hospital medical evaluations.
o The client is grieving normally in response to her husband’s death and
hospitalizations is not necessary.
o Healthcare costs are escalating because clients want to have diagnostic testing
conducted in the hospital.
12. The charge nurse on a surgical unit is assessing the morning lab work on four clients. Which
client’s lab finding should be reported to the healthcare provider immediately?
