**The Leadership & Delegation Final: NGN
Management of Care and Professional
Practice**
1. A charge nurse is assigning staff on a medical-surgical unit. Which client should be assigned to a
licensed practical nurse (LPN)?
A) Client with new onset of atrial fibrillation on a diltiazem drip
B) Client requiring a straight catheterization for urinary retention
C) Client 1 hour post-cardiac catheterization with bleeding
D) Client newly admitted with diabetic ketoacidosis
💫RATIONALE✔️✔️: Straight catheterization is within LPN scope; unstable clients and titratable drips
require RN assignment.
💫ANSWER✔️✔️: B) Client requiring a straight catheterization for urinary retention
---
2. A nurse is caring for a client who refuses a blood transfusion due to religious beliefs. Which action by
the nurse is appropriate?
A) Notify the provider to obtain a court order
B) Respect the client’s wishes and explore alternatives
C) Convince the client that the transfusion is necessary
D) Administer the transfusion and document the refusal
💫RATIONALE✔️✔️: Client autonomy must be respected; explore alternative treatments and notify the
provider.
💫ANSWER✔️✔️: B) Respect the client’s wishes and explore alternatives
---
,3. A charge nurse observes a new RN failing to perform hand hygiene before donning gloves. Which
action by the charge nurse is best?
A) Report the RN to the nurse manager
B) Provide immediate constructive feedback at the bedside
C) Ignore the behavior as a one-time event
D) Write a formal disciplinary report
💫RATIONALE✔️✔️: Immediate, private feedback corrects behavior and promotes a just culture.
💫ANSWER✔️✔️: B) Provide immediate constructive feedback at the bedside
---
4. A nurse on a medical-surgical unit receives a change-of-shift report. Which client should the nurse
assess first?
A) Client with pneumonia and SpO2 94% on 2L NC
B) Client with heart failure and new-onset confusion
C) Client with diabetes and blood glucose 180 mg/dL
D) Client post-appendectomy with pain 4/10
💫RATIONALE✔️✔️: New confusion in a heart failure client suggests worsening cerebral hypoxia or
electrolyte imbalance.
💫ANSWER✔️✔️: B) Client with heart failure and new-onset confusion
---
5. A client with a terminal illness tells the nurse, “I want to stop all treatments and go home on hospice.”
Which response is most appropriate?
A) “You should discuss this with your family first”
B) “Let me call the provider to discuss your wishes”
C) “You will feel better after we adjust your medications”
D) “Why do you want to give up so soon?”
💫RATIONALE✔️✔️: The nurse advocates for the client by notifying the provider to initiate goals-of-care
discussion.
💫ANSWER✔️✔️: B) “Let me call the provider to discuss your wishes”
,---
6. A charge nurse is making assignments for a team consisting of an RN, LPN, and UAP. Which client
should the charge nurse assign to the UAP?
A) Client requiring a Foley catheter insertion
B) Client needing assistance with ambulation after hip surgery
C) Client receiving a blood transfusion
D) Client with a new tracheostomy requiring suctioning
💫RATIONALE✔️✔️: Ambulation is within UAP scope after RN assessment of stability; catheter insertion
requires LPN/RN.
💫ANSWER✔️✔️: B) Client needing assistance with ambulation after hip surgery
---
7. A nurse is preparing to administer a medication and notes that the prescription is illegible. Which
action is correct?
A) Ask the pharmacist to interpret the prescription
B) Contact the provider to clarify the order
C) Administer the medication based on previous doses
D) Ask another nurse to read the prescription
💫RATIONALE✔️✔️: Illegible orders must be clarified with the prescribing provider before administration.
💫ANSWER✔️✔️: B) Contact the provider to clarify the order
---
8. A nurse is leading a family meeting for a client with advanced dementia. The family disagrees on the
plan of care. Which action by the nurse is most appropriate?
A) Side with the majority of the family members
B) Refer the family to the ethics committee
C) Facilitate a discussion of each member’s concerns
D) Make the decision for the family based on best evidence
💫RATIONALE✔️✔️: The nurse facilitates open communication to help the family reach a consensus.
, 💫ANSWER✔️✔️: C) Facilitate a discussion of each member’s concerns
---
9. A charge nurse is evaluating a new RN’s performance. Which action by the new RN requires
immediate intervention?
A) Documenting vital signs in the electronic health record
B) Asking the charge nurse to verify a high-risk medication
C) Using an alcohol-based hand rub before client contact
D) Leaving a client’s personal health information visible on a computer screen
💫RATIONALE✔️✔️: Visible PHI violates HIPAA; the RN must secure the screen immediately.
💫ANSWER✔️✔️: D) Leaving a client’s personal health information visible on a computer screen
---
10. A nurse is caring for a client who is scheduled for surgery but has not signed the consent form.
Which action by the nurse is correct?
A) Have the client sign the consent form after explaining the procedure
B) Ask the client’s spouse to sign the consent form
C) Verify that the provider obtained informed consent and witness the signature
D) Proceed with surgery without a signed consent in an emergency
💫RATIONALE✔️✔️: The nurse witnesses the signature after the provider explains risks/benefits; never
explain the procedure.
💫ANSWER✔️✔️: C) Verify that the provider obtained informed consent and witness the signature
---
11. A charge nurse notes that a staff member is frequently late and appears fatigued. Which action
should the charge nurse take first?
A) Report the staff member to human resources
B) Assign the staff member to less critical clients
C) Have a private conversation to assess for issues
D) Document the lateness in the staff member’s file
Management of Care and Professional
Practice**
1. A charge nurse is assigning staff on a medical-surgical unit. Which client should be assigned to a
licensed practical nurse (LPN)?
A) Client with new onset of atrial fibrillation on a diltiazem drip
B) Client requiring a straight catheterization for urinary retention
C) Client 1 hour post-cardiac catheterization with bleeding
D) Client newly admitted with diabetic ketoacidosis
💫RATIONALE✔️✔️: Straight catheterization is within LPN scope; unstable clients and titratable drips
require RN assignment.
💫ANSWER✔️✔️: B) Client requiring a straight catheterization for urinary retention
---
2. A nurse is caring for a client who refuses a blood transfusion due to religious beliefs. Which action by
the nurse is appropriate?
A) Notify the provider to obtain a court order
B) Respect the client’s wishes and explore alternatives
C) Convince the client that the transfusion is necessary
D) Administer the transfusion and document the refusal
💫RATIONALE✔️✔️: Client autonomy must be respected; explore alternative treatments and notify the
provider.
💫ANSWER✔️✔️: B) Respect the client’s wishes and explore alternatives
---
,3. A charge nurse observes a new RN failing to perform hand hygiene before donning gloves. Which
action by the charge nurse is best?
A) Report the RN to the nurse manager
B) Provide immediate constructive feedback at the bedside
C) Ignore the behavior as a one-time event
D) Write a formal disciplinary report
💫RATIONALE✔️✔️: Immediate, private feedback corrects behavior and promotes a just culture.
💫ANSWER✔️✔️: B) Provide immediate constructive feedback at the bedside
---
4. A nurse on a medical-surgical unit receives a change-of-shift report. Which client should the nurse
assess first?
A) Client with pneumonia and SpO2 94% on 2L NC
B) Client with heart failure and new-onset confusion
C) Client with diabetes and blood glucose 180 mg/dL
D) Client post-appendectomy with pain 4/10
💫RATIONALE✔️✔️: New confusion in a heart failure client suggests worsening cerebral hypoxia or
electrolyte imbalance.
💫ANSWER✔️✔️: B) Client with heart failure and new-onset confusion
---
5. A client with a terminal illness tells the nurse, “I want to stop all treatments and go home on hospice.”
Which response is most appropriate?
A) “You should discuss this with your family first”
B) “Let me call the provider to discuss your wishes”
C) “You will feel better after we adjust your medications”
D) “Why do you want to give up so soon?”
💫RATIONALE✔️✔️: The nurse advocates for the client by notifying the provider to initiate goals-of-care
discussion.
💫ANSWER✔️✔️: B) “Let me call the provider to discuss your wishes”
,---
6. A charge nurse is making assignments for a team consisting of an RN, LPN, and UAP. Which client
should the charge nurse assign to the UAP?
A) Client requiring a Foley catheter insertion
B) Client needing assistance with ambulation after hip surgery
C) Client receiving a blood transfusion
D) Client with a new tracheostomy requiring suctioning
💫RATIONALE✔️✔️: Ambulation is within UAP scope after RN assessment of stability; catheter insertion
requires LPN/RN.
💫ANSWER✔️✔️: B) Client needing assistance with ambulation after hip surgery
---
7. A nurse is preparing to administer a medication and notes that the prescription is illegible. Which
action is correct?
A) Ask the pharmacist to interpret the prescription
B) Contact the provider to clarify the order
C) Administer the medication based on previous doses
D) Ask another nurse to read the prescription
💫RATIONALE✔️✔️: Illegible orders must be clarified with the prescribing provider before administration.
💫ANSWER✔️✔️: B) Contact the provider to clarify the order
---
8. A nurse is leading a family meeting for a client with advanced dementia. The family disagrees on the
plan of care. Which action by the nurse is most appropriate?
A) Side with the majority of the family members
B) Refer the family to the ethics committee
C) Facilitate a discussion of each member’s concerns
D) Make the decision for the family based on best evidence
💫RATIONALE✔️✔️: The nurse facilitates open communication to help the family reach a consensus.
, 💫ANSWER✔️✔️: C) Facilitate a discussion of each member’s concerns
---
9. A charge nurse is evaluating a new RN’s performance. Which action by the new RN requires
immediate intervention?
A) Documenting vital signs in the electronic health record
B) Asking the charge nurse to verify a high-risk medication
C) Using an alcohol-based hand rub before client contact
D) Leaving a client’s personal health information visible on a computer screen
💫RATIONALE✔️✔️: Visible PHI violates HIPAA; the RN must secure the screen immediately.
💫ANSWER✔️✔️: D) Leaving a client’s personal health information visible on a computer screen
---
10. A nurse is caring for a client who is scheduled for surgery but has not signed the consent form.
Which action by the nurse is correct?
A) Have the client sign the consent form after explaining the procedure
B) Ask the client’s spouse to sign the consent form
C) Verify that the provider obtained informed consent and witness the signature
D) Proceed with surgery without a signed consent in an emergency
💫RATIONALE✔️✔️: The nurse witnesses the signature after the provider explains risks/benefits; never
explain the procedure.
💫ANSWER✔️✔️: C) Verify that the provider obtained informed consent and witness the signature
---
11. A charge nurse notes that a staff member is frequently late and appears fatigued. Which action
should the charge nurse take first?
A) Report the staff member to human resources
B) Assign the staff member to less critical clients
C) Have a private conversation to assess for issues
D) Document the lateness in the staff member’s file
