Question 1

A charge nurse is supervising a newly licensed nurse who is preparing to administer intravenous medication. Which of the following actions by the new nurse requires immediate intervention by the charge nurse?

Accepted Answer

Answer reason: The supervising nurse must intervene when a supervised nurse performs an unsafe action that can harm the client. Administering medication without confirming allergies violates the medication rights and compromises patient safety, requiring immediate corrective action.

Question 2

What is the process directed towards the personal and professional growth of nurses and other personnel while they are employed by a health care agency called?

Accepted Answer

Answer reason: Staff development refers to organized programs within a health care agency aimed at enhancing employees’ personal and professional growth (orientation, in-service, continuing education).

Question 3

The nurse manager identifies that time spent by staff in charting is excessive, requiring overtime for completion. The nurse manager requests that staff form a task force to investigate and develop potential solutions to the problem, and report on this at the next staff meeting. The nurse manager's leadership style is BEST described as?

Accepted Answer

Answer reason: Forming a staff task force to investigate and propose solutions engages staff in decision-making, which characterizes a participative leadership style. Autocratic is top-down, laissez-faire is hands-off, and "Group" is not a standard leadership style label.

Question 4

The charge nurse overhears the patient care assistant speaking harshly to the client with dementia. The charge nurse should?

Accepted Answer

Answer reason: After overhearing harsh communication (potential verbal abuse), the charge nurse should address it directly with the assistant to assess what occurred and provide corrective feedback/education per policy. Changing assignments or arranging groups avoids the issue, and involving the family breaches confidentiality and is not the first step.

Question 5

The nurse notes the patient care assistant looking through the personal items of the client with cancer. Which action should be taken by the registered nurse?

Accepted Answer

Answer reason: The RN observes misconduct by unlicensed staff. Follow the chain of command and supervise UAP by reporting to the charge nurse for appropriate action. Notifying police is premature; monitoring or ignoring fails to address potential breach of patient rights.

Question 6

A nurse manager is using the technique of brainstorming to help staff solve a problem. One nurse criticizes a contribution and begins to find objections to the suggestion. The nurse manager's BEST response is?

Accepted Answer

Answer reason: During brainstorming, the goal is to promote idea generation without judgment. Redirecting the criticism into potential spin‑off ideas keeps creativity flowing and can yield additional options while avoiding negative shut‑down.

Question 7

Which of the following management styles BEST demonstrates the end of the continuum of management behaviors referred to by Douglas McGregor as theory Y?

Accepted Answer

Answer reason: McGregor’s Theory Y assumes people are intrinsically motivated, seek responsibility, and align with organizational goals. Option B matches this. A reflects Theory X, C describes laissez-faire, and D concerns team compensation rather than Theory Y assumptions.

Question 8

You are the charge nurse on the night shift at an urgent care center. Due to a large fire in the area, your facility is admitting clients of higher acuity than usual. Which style of leadership and decision-making would be best in this circumstance?

Accepted Answer

Answer reason: In emergencies, an authoritarian leadership style with decisive, leader-driven decisions is most effective to ensure rapid, coordinated action. Seeking input, non-directive, or shared decision-making delays care.

Question 9

As a nurse manager, it is important to give positive and negative feedback to staff as appropriate. Which of the following BEST describes the characteristic of an effective reward-feedback system?

Accepted Answer

Answer reason: Effective feedback is timely and specific; immediate feedback reinforces desired behavior and facilitates correction. Equal feedback regardless of performance, mandatory positive-before-negative, and unattainable goals are not effective strategies.

Question 10

A nurse who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. The most appropriate initial action by the nurse is which of the following?

Accepted Answer

Answer reason: Suspected impaired practice should be reported through the chain of command. Notifying the nursing supervisor is the appropriate initial action to ensure immediate removal from patient care and initiation of institutional procedures, rather than calling police/security or detaining the coworker.

Question 11

A new nurse on the unit notes that the nurse manager seems to be highly respected by the nursing staff. The new nurse is surprised to find that the manager makes all decisions and rarely asks for staff input. The BEST description of the nurse manager's management style is?

Accepted Answer

Answer reason: Making all decisions with minimal staff input characterizes an autocratic/authoritarian leadership style.

Question 12

A new nurse manager is seeking a mentor for the role. Which of the following BEST describes what is ideal for a positive experience with a mentor?

Accepted Answer

Answer reason: An effective mentoring relationship is characterized by a mentor who is actively engaged as a teacher-coach. Other options either describe mentee behaviors or an inappropriate assignment method, not the ideal mentor role.

Question 13

Ms. Valencia is responsible to the number of personnel reporting to her. This principle refers to?

Accepted Answer

Answer reason: The principle describing how many staff members report directly to a manager is the span of control. It addresses the appropriate number of subordinates a supervisor can effectively oversee to ensure communication, coordination, and performance. Unity of command refers to each worker having one direct supervisor, while esprit d’ corps concerns team morale, and the carrot-and-stick principle refers to motivation through rewards and punishment.

Question 14

The Nurse Manager is appropriately using an autocratic method of leading the team. Which situation does the staff nurse determine demonstrates this form of leadership?

Accepted Answer

Answer reason: Autocratic leadership is characterized by a leader making rapid decisions and giving clear, direct instructions with minimal group input. During a cardiac arrest, the team must act immediately and follow one coordinated plan, making directive leadership appropriate for patient safety and efficiency. Options involving planning vacations or evaluating processes/media are typically collaborative or participative activities rather than autocratic, urgent command-and-control situations.

Question 15

A small fire breaks out in the waiting room of an intensive care unit (ICU). The nurse manager removes the visitors, assigns staff roles to ensure client safety, and uses a fire extinguisher to stop the fire. When using an autocratic leadership style what is the responsibility of the nurse manager?

Accepted Answer

Answer reason: In an autocratic leadership style, the leader makes rapid decisions and directs others’ actions, which is appropriate in urgent situations like a fire. Because the manager is directing roles and actions, they are accountable for the outcomes that result from those decisions. Options about investigating the fire’s cause are secondary to immediate leadership accountability, and it is incorrect that the manager would not hold responsibility for directing others during an emergency.

Question 16

A nurse is observing unlicensed assistive personnel (UAP) take a client's blood pressure. It would require follow-up if the UAP?

Accepted Answer

Answer reason: Slowly releases the pressure bulb valve at a rate of 5 mmHg per second. The cuff should be deflated at about 2–3 mmHg per second; deflating at 5 mmHg per second is too fast and can underestimate systolic pressure and/or overestimate diastolic pressure, producing an inaccurate reading. The other actions reflect correct technique that helps ensure accuracy (proper artery location, avoiding crossed legs, and inflating ~30 mmHg above estimated systolic to prevent auscultatory gap errors). Therefore, this observed practice requires follow-up teaching/correction.

Question 17

During nursing round total number of staff members in the group excluding group leader should not be more than-?

Accepted Answer

Answer reason: Effective nursing rounds rely on a small enough group to maintain patient privacy, minimize disruption, and allow coordinated communication at the bedside. A group size of four staff (excluding the leader) is commonly taught as an ideal maximum to ensure everyone can participate meaningfully without crowding. Larger groups tend to reduce efficiency and can increase safety risks and confidentiality concerns during bedside discussions.

Question 18

A client recovering from a myocardial infarction requires a complete bed bath, the nurse tells the unlicensed assistive personnel (UAP). The nurse should intervene if the nurse observed the UAP performing which action during the bath?

Accepted Answer

Answer reason: A complete bed bath is indicated when the client needs total hygiene care and should avoid exertion. Having a post–myocardial infarction client perform part of the bath increases energy expenditure and oxygen demand, which can precipitate fatigue, dyspnea, or ischemic symptoms. The nurse should therefore stop this action and ensure the UAP provides full assistance while monitoring tolerance to activity.

Question 19

An experienced nurse uses knowledge of patient medical conditions and intuition to identify patient problems. The nurse often fulfills the role of a resource for other nurses on the unit. At what point in this stage of proficiency has this nurse achieved?

Accepted Answer

Answer reason: This description matches Benner’s expert stage, characterized by intuitive grasp of clinical situations, rapid pattern recognition, and fluid, flexible performance without reliance on explicit rules. Experts anticipate problems based on deep experiential knowledge and often serve as resources/mentors for other staff. Novice and advanced beginner rely heavily on rules and limited situational perception, while competent nurses plan and prioritize but typically lack the intuitive, holistic understanding described.

Question 20

The experienced pediatric intensive care unit nurse is precepting a new nurse. The experienced nurse should intervene if the new nurse administers?

Accepted Answer

Answer reason: Gastrointestinal symptoms such as nausea, abdominal pain, and vomiting can be early signs of digoxin toxicity and warrant holding the dose and further assessment (including apical pulse and serum level as ordered). Administering digoxin in the setting of possible toxicity increases risk for serious dysrhythmias and hemodynamic instability. The other options describe generally appropriate therapies for the conditions listed when clinically indicated and monitored (e.g., aspirin in Kawasaki under provider direction, opioid analgesia for vaso-occlusive crisis, macrolide alternative with severe penicillin allergy).

Question 21

A charge nurse notes that a staff nurse delegates an unfair share of tasks to the assistive personnel (AP) and the nurses on next shift report the staff nurse frequently leaves tasks uncompleted. Which of the following statements should the charge nurse make to resolve this conflict?

Accepted Answer

Answer reason: This approach is objective, professional, and focuses on clear performance expectations, which is the first step in addressing delegation and accountability concerns. It opens a two-way conversation to assess barriers (workload, time management, understanding of delegation principles) and promotes constructive problem-solving. The other statements are accusatory or threatening, which escalates conflict, reduces psychological safety, and is less likely to lead to sustainable behavior change.

Question 22

The nurse is caring for a client with a cerebrovascular accident (CVA) who is receiving enteral tube feedings. Which task performed by the UAP requires immediate intervention by the nurse?

Accepted Answer

Answer reason: A patient with CVA receiving tube feedings is at high risk for aspiration, and the head of bed should generally be maintained at least 30–45 degrees during and after feeding. Flattening the bed, even briefly, increases reflux and aspiration risk, which can rapidly lead to airway compromise or aspiration pneumonia. The nurse must immediately stop this unsafe practice and reinforce positioning precautions and feeding-related safety measures. The other tasks are not inherently unsafe when performed correctly and do not pose the same immediate aspiration threat.

Question 23

Reprimanding a staff nurse for work that is done incorrectly is an example of what type of reinforcement?

Accepted Answer

Answer reason: Reprimanding an employee for incorrectly completed work is a direct, corrective communication aimed at changing future behavior and improving job performance. Positive reinforcement involves rewarding desired behavior to increase its frequency, which does not fit a reprimand. Negative reinforcement removes an unpleasant stimulus to increase a behavior, whereas a reprimand is more consistent with correction/discipline rather than reinforcement theory in this context.

Question 24

The public health nurse is the supervisor of rural health midwives. Which of the following is a supervisory function of the public health nurse?

Accepted Answer

Answer reason: Giving technical guidance is a core supervisory activity because it improves the midwife’s competence and performance at the point of care while maintaining accountability for quality. Referral of patients or personally providing direct nursing care are service delivery tasks rather than oversight functions and do not represent supervising the midwife’s practice. While developing training programs relates to staff development, the most direct and routine supervisory function tested here is ongoing technical guidance in day-to-day clinical work.

Question 25

The nurse assigns an unlicensed assistive personnel (UAP) to care for a client with a musculoskeletal disorder. The client ambulates with a leg splint. Which task requires supervision of the UAP?

Accepted Answer

Answer reason:  UAPs can assist with routine, predictable tasks, but assessment and clinical judgment remain the nurse’s responsibility. Evaluating a client’s physiologic tolerance to ambulation with a splint (e.g., pain escalation, dizziness, gait instability, neurovascular compromise) is an assessment function and may require immediate nursing intervention. A UAP may help the client walk, but the nurse must supervise and interpret the client’s response and decide whether to stop activity or escalate care. In contrast, transfers and reporting simple observations can be delegated with clear instructions and follow-up.

Question 26

During the interview of a prospective employee who just completed the agency orientation, which approach would be the best for the nurse manager to use to assess competence?

Accepted Answer

Answer reason: Competence is best assessed using objective, validated evidence of performance rather than self-reported comfort or preferences. A skills checklist tied to agency standards documents what the employee has been taught, observed doing, and verified as proficient, allowing the manager to match assignment complexity to demonstrated ability. Questions about desired supervision or comfort working independently are subjective and may underestimate or overestimate actual capability, creating safety risk. Reviewing verified skills also helps identify gaps that require remediation before independent practice or delegation decisions are made.

Question 27

After working with a very demanding client, an unlicensed assistive personnel (UAP) tells the nurse, "I have had it with that client. I just can't do anything that pleases him. I'm not going in there again." The nurse should respond by saying?

Accepted Answer

Answer reason: "He is scared and taking it out on you. Let's talk to figure out what to do." Effective supervision includes acknowledging staff feelings, reframing the patient’s behavior in a clinically meaningful way, and coaching the UAP toward a safe plan to continue care. This response validates the UAP’s frustration without judging them, offers a plausible explanation for the client’s demanding behavior, and opens problem-solving to identify strategies or support. In contrast, blaming the UAP to “have patience” dismisses the concern, and telling the UAP the nurse will handle it promotes avoidance rather than skill-building and appropriate team functioning. Reassigning the patient for the day without addressing the underlying issue risks fragmented care and does not help the UAP develop coping and communication strategies.

Question 28

As the nurse observes the student nurse during the administration of a narcotic analgesic IM injection, the nurse notes that the student begins to give the medication without first aspirating. What should the nurse do?

Accepted Answer

Answer reason: Walk up and whisper in the student's ear "Stop. Aspirate. Then inject." Immediate patient safety takes priority when an unsafe technique is observed during medication administration, so the instructor should intervene at once to prevent inadvertent intravascular injection. A quiet, direct correction maintains control of the procedure while minimizing embarrassment and preserving the therapeutic learning environment. This approach corrects the error in real time and allows the student to complete the injection safely under supervision. Options that question or lecture before stopping delay the safety-critical action, and a loud public correction is unprofessional and can impair the student’s performance.

Question 29

The nurse manager hears a health care provider loudly criticize one of the staff nurses within the hearing of others. The employee does not respond to the health care provider's complaints. The nurse manager's next action should be to?

Accepted Answer

Answer reason: " The core principle is that leaders must intervene immediately to stop disruptive conduct that threatens a respectful, psychologically safe work environment and can undermine patient safety and team functioning. Addressing the behavior in the moment, calmly and privately as possible, sets a clear boundary and protects the staff member from публич humiliation while limiting escalation. Waiting for the staff nurse to manage it alone fails the manager’s supervisory responsibility and can normalize intimidation. Escalating to administration may be appropriate if the behavior persists or is severe, but stopping the behavior promptly is the priority before pursuing follow-up reporting or meetings.

Question 30

The home care nurse has been managing a client for 6 weeks. What is the best method to determine the quality of care provided by a home health care aide assigned to assist with the care of this client?

Accepted Answer

Answer reason: This approach evaluates adherence to prescribed interventions, expected outcomes, and scope-limited duties for the aide, which directly reflects care quality and patient safety. Satisfaction and punctuality are indirect measures that can miss unsafe or incorrect care. Documentation review supports evaluation, but it is secondary to verifying that actual care delivered matches the ordered plan and standards.

Question 31

After all non-physical attempts of controlling a patient's behavior had failed, it was deemed necessary to place the patient in seclusion. Which of the following staff members should initiate and monitor patients in seclusion?

Accepted Answer

Answer reason: Training ensures the staff member can appropriately initiate seclusion per protocol and perform continuous/required interval monitoring for airway, circulation, behavior escalation, and basic needs. Limiting initiation/monitoring to only RNs or only the practitioner is overly restrictive and not required in many settings, while allowing any licensed staff member without verifying competency creates avoidable safety and legal risks. The safest standard is to permit only staff with documented education/competency to carry out and monitor seclusion.

Question 32

Client call lights come on while the unlicensed assistive personnel (UAP) sits at a desk and reads a magazine. When the nurse asks the UAP to answer the lights the UAP says, "Those aren't my clients." What is the best response by the nurse?

Accepted Answer

Answer reason: " Delegation requires the nurse to give clear, direct instructions and reinforce that unit tasks are prioritized by patient needs, not ownership of specific assignments. This response sets an expectation for performance while keeping the focus on patient safety and timely responsiveness to call lights. It also uses appropriate supervision/communication before escalating to punitive action. Asking “would you mind” weakens authority and accountability, while immediately going to discipline/manager escalation is premature unless the UAP continues to refuse after clear direction.

Question 33

The nurse observes a nursing assistant assigned to a client who just returned from having a bronchoscopy. Which action by the nursing assistant would prompt the nurse to intervene?

Accepted Answer

Answer reason: After bronchoscopy, the gag and swallow reflex may be depressed from topical anesthetic and/or sedation, creating a high aspiration risk. Oral fluids should be withheld until the nurse confirms return of protective airway reflexes and adequate alertness. Providing water too early can precipitate choking, aspiration, and subsequent respiratory compromise. In contrast, checking oxygen saturation and positioning with the head of bed elevated are appropriate immediate post-procedure supportive measures.

Question 34

The team leader notices at the beginning of the shift that all of the I.V. antibiotics for a client are still in the medication room. Which action should the team leader take first?

Accepted Answer

Answer reason: The priority is to rapidly clarify whether the antibiotics were administered, intentionally held, or omitted, because missed IV antibiotics can lead to treatment failure and sepsis risk. The nurse from the previous shift is the most reliable immediate source for what occurred, including clinical rationale, provider notifications, and documentation/recording issues. Asking the client is less dependable due to limited medication knowledge and recall, and returning meds to pharmacy focuses on billing rather than patient safety. Escalation to the nurse manager is appropriate only after first gathering facts and confirming whether there is an actual medication error or systems issue requiring reporting.

Question 35

A new graduate nurse has started at the medical center and is assigned to a preceptor. The preceptor and other staff report that the nurse is uncooperative and unwilling to take direction. Which action by the preceptor is appropriate?

Accepted Answer

Answer reason: Effective precepting uses supervision and coaching to set clear expectations, identify barriers to learning, and create measurable performance objectives. Re-setting goals with the orientee creates a structured plan for required behaviors (accepting direction, communication standards) and allows the preceptor to clarify responsibilities and timelines. This is an appropriate first-line management step before punitive measures, because it supports remediation and fair evaluation of progress. A confrontational warning or questioning motives is less likely to change behavior and can escalate conflict, while initiating discipline is typically reserved for continued unsafe or noncompliant behavior after expectations and support have been formally addressed.

Question 36

The nurse and a UAP are caring for a client with right-sided paralysis secondary to a CVA. Which action by the UAP requires the nurse to intervene?

Accepted Answer

Answer reason: This situation tests the nurse’s duty to supervise UAP care and intervene when an action creates an unsafe environment or breaks basic hygiene/comfort standards. Leaving a full urinal at the bedside increases odor, contamination risk, and spill risk, and it can also discourage toileting and contribute to skin breakdown if elimination needs are delayed in a client with mobility deficits after stroke. The nurse should redirect the UAP to promptly empty/clean the urinal and perform hand hygiene and appropriate environmental cleaning. By contrast, positioning with a pillow and encouraging/assisting safe mobility and self-care are generally appropriate supportive measures for a client with hemiparesis when done within the client’s abilities and safety precautions.

Question 37

A nurse caring for a client with acquired immunodeficiency syndrome is working with a nursing student. She notes that the student doesn’t attempt to suction or assist with care of the client. What is the most appropriate action by the nurse?

Accepted Answer

Answer reason: The priority in supervising a learner is to directly assess barriers to safe participation and provide immediate guidance. Avoidance of suctioning/care may reflect fear of contagion, stigma, or knowledge deficits about standard precautions, and these must be explored privately with the student first. Addressing the issue directly promotes learning, corrects misconceptions about HIV transmission, and protects the client from missed care. Escalating to the charge nurse or discussing with coworkers is premature and can be perceived as punitive or unprofessional unless the problem persists or creates ongoing safety risk. The instructor may be involved after initial direct coaching or if performance concerns continue despite intervention.

Question 38

The nurse observes a colleague caring for the client who had a hypophysectomy via the transsphenoidal approach 12 hours ago. Which action would require the observing nurse to intervene?

Accepted Answer

Answer reason: Replacing nasal packing can traumatize fragile tissues and precipitate bleeding or worsen a potential CSF leak, requiring provider evaluation rather than a nurse proceeding to change it. Appropriate nursing actions include elevating the HOB to reduce edema and promote drainage, providing frequent oral care because the client may be mouth-breathing, and using cool compresses for facial/periorbital swelling. A key safety red flag is any significant bleeding or clear nasal drainage; the correct response is to notify the provider, not prepare to replace packing.

Question 39

The nurse manager, concerned about the potential for staff harm on a behavioral health unit, is assessing the unit’s milieu. Which milieu situation should the nurse manager address because it is a predictive factor for violence?

Accepted Answer

Answer reason: Violence risk on inpatient behavioral units increases when staffing is inexperienced, unfamiliar with unit routines, or insufficiently trained in de-escalation and safe crisis management. A float nurse from a non-psychiatric setting may be less comfortable recognizing early escalation cues, setting limits, and using therapeutic communication, which can allow agitation to progress to assault. This is a modifiable milieu factor the manager can address through appropriate staffing, orientation, and support. By contrast, reduced census typically lowers environmental crowding stressors, and the other options are not unit-wide predictive milieu factors for staff-directed violence.

Question 40

The nurse is preparing to supervise the inexperienced LPN inserting a urinary catheter. Which question by the nurse would best assess the LPN’s knowledge and skill about inserting a urinary catheter?

Accepted Answer

Answer reason: " Competent supervision requires verifying a delegatee’s current understanding of the exact steps and critical safety points before allowing performance of an invasive procedure. Asking the LPN to describe the procedure elicits technique, sterile-field maintenance, sequence, and complication-prevention actions, which directly assesses both knowledge and practical readiness. Questions about frequency or recency of prior insertions are indirect and do not confirm correct aseptic technique or adherence to current facility policy. This approach supports patient safety by identifying gaps that require teaching or direct observation before proceeding.

Question 41

A physician is preparing to perform a chest tube placement on a client with a pneumothorax. The client’s nurse informs a recently hired nurse on the unit that the chest tube placement is about to begin and gives the new hire nurse the opportunity to observe and assist with the procedure. The client’s nurse has just engaged in which form of staff education?

Accepted Answer

Answer reason: Informal staff education occurs through spontaneous, on-the-job teaching moments in the clinical setting rather than structured classes. Inviting a newly hired nurse to observe and assist during a chest tube insertion is a real-time coaching opportunity tied to immediate patient care. This fits unit-based precepting/mentoring and supervision behaviors that build competence at the bedside. Formal education would involve planned instruction such as scheduled in-services, competency modules, or organized workshops, and quality improvement focuses on system/process outcomes rather than individual bedside teaching.

Question 42

The 42-year-old client who had a partial hydatidiform molar pregnancy 3 months ago asks the nurse whether she and her husband can try conceiving again. Which response by the nurse is incorrect and warrants follow-up action by the observing nurse manager?

Accepted Answer

Answer reason: After a molar pregnancy, the key management principle is surveillance for persistent gestational trophoblastic disease with serial beta-hCG and avoidance of pregnancy during the monitoring period so rising hCG is not confused with a new pregnancy. Telling the client she can never conceive again is inaccurate and unnecessarily absolute; future pregnancy is typically possible after hCG normalizes and the recommended follow-up interval is completed. The appropriate teaching includes serial beta-hCG testing and delaying conception (often 6–12 months per protocols), not permanent infertility. While there is an increased risk of recurrence compared with the general population, it remains low overall, so counseling should be balanced and evidence-based.

Question 43

The nurse manager is planning an orientation program for new graduates. Which strategies should the nurse manager consider to promote retention of these nurses?

Accepted Answer

Answer reason: A preceptor program with engaged bedside nurses builds competence, confidence, and role socialization while reducing turnover driven by stress and perceived lack of support. Including unit staff in interviewing improves person–unit fit and promotes team buy-in, which strengthens the work environment for the novice nurse. In contrast, social events or rigid, one-size-fits-all orientation timelines do not reliably address clinical skill acquisition and ongoing support needs.

Question 44

The nurse is supervising the experienced NA who is new to the unit. Which question is best to evaluate the NA’s knowledge and skill in obtaining the client’s fingerstick blood glucose, which is a permissible NA-performed skill within the facility?

Accepted Answer

Answer reason:  Supervision requires the RN to validate competency by assessing the delegatee’s step-by-step understanding of the procedure and critical safety points before allowing independent performance. This open-ended prompt elicits the NA’s actual technique (site selection, infection control, timing, meter use/quality checks, and documentation), directly evaluating both knowledge and skill. Asking about frequency or last observation focuses on past exposure rather than current competence, which may not transfer to a new unit’s policies and equipment. Exploring what they did with an abnormal value assesses judgment and reporting, but it does not confirm correct procedural performance and can drift into actions outside the NA’s role.

Question 45

After working with the client, the UAP tells the nurse, “I have had it with that demanding client. I just can’t do anything that pleases him. I’m not going in there again.” Which should be the nurse’s response?

Accepted Answer

Answer reason: “He may be scared and taking it out on you. Let’s figure out what to do together.” Effective supervision uses therapeutic communication, validates staff concerns, and problem-solves to ensure safe, continuous care for the client. This response acknowledges a possible cause of the client’s behavior and invites collaborative planning, which supports the UAP while maintaining accountability to the assignment. Threatening discipline escalates conflict and does not address barriers to providing care, and telling the UAP to “ignore” the client promotes neglect and safety risk. Coaching the UAP on strategies and reassessing the client’s needs best protects both patient care and team functioning.

Question 46

The UAP’s job responsibilities include checking vital signs every four hours, completing morning care on assigned clients, assisting clients with activity, answering lights, and totaling I&O records for cheats at the end of an 8-hour shift. Near the end of the shift, the LPN reports to the RN that the UAP has not completed all of the morning care on assigned clients. Which is the RN’s best action?

Accepted Answer

Answer reason: The core principle is that effective delegation requires ongoing supervision, assessment of barriers, and timely follow-up before escalating or taking corrective action. First clarifying what was and was not completed and why allows the RN to identify safety risks, reprioritize care, and provide immediate coaching or redistribution of tasks if workload or competing urgent needs interfered. Simply urging speed risks missed care and errors and does not address root cause. Escalation to the charge nurse or filing an incident report is premature without first gathering facts and attempting appropriate performance feedback and problem-solving.

Question 47

The nurse manager is reviewing assignments for an evening shift. The nurse manager should intervene if the experienced LPN is assigned which action?

Accepted Answer

Answer reason: Discharge teaching that requires initial, comprehensive education and evaluation of understanding is an RN responsibility because it involves assessment, clinical judgment, and patient education planning. A client post-mastectomy needing instruction on incision and drain care has significant teaching needs and potential complications (infection, drain management, lymphedema risk), requiring an RN to assess readiness and reinforce/adjust the plan. An experienced LPN can perform many stable, predictable tasks and reinforce previously taught information, but should not be the primary nurse for complex discharge education. The other assignments are procedure- or assistance-focused for stable postoperative clients and fall within typical LPN scope with appropriate RN oversight.

Question 48

The NA’s job responsibilities include totaling the I & O records for clients at the end of an 8-hour shift. Near the end of the shift, the LPN reports to the RN that the new NA on the unit has not completed the task. What is the RN’s best action?

Accepted Answer

Answer reason: The RN is accountable for supervision and ensuring delegated tasks are understood and completed correctly, especially with a new assistive personnel. Directly assessing the barrier (knowledge gap vs time/prioritization) and providing just-in-time teaching promotes safe, accurate documentation and supports the NA’s competency. Having the LPN do the NA’s assigned work is inappropriate task shifting and bypasses the supervisory role, and simply telling the NA to hurry does not correct a skill deficit. Escalating to the charge nurse may be appropriate later, but the best immediate action is coaching and clarifying expectations to get accurate I&O for handoff.

Question 49

The client recovering from heart failure needs to have diet teaching reinforced prior to being discharged in the afternoon. Which question by the nurse would best assess the LPN’s knowledge and skill about reinforcing the diet teaching?

Accepted Answer

Answer reason:  Effective supervision requires directly assessing the delegated staff member’s clinical understanding of the task to ensure safe, accurate patient education before discharge. This question prompts the LPN to state specific teaching points (e.g., sodium restriction, fluid guidance, label reading), revealing both knowledge gaps and readiness to perform the assignment. Questions focused on frequency or recency of teaching measure experience rather than competence and may miss critical misinformation. By eliciting the content the LPN plans to cover, the RN can verify correctness and intervene or provide coaching immediately if needed.

Question 50

The nurse determines that the NA did not complete assigned tasks. Which statement is best?

Accepted Answer

Answer reason: “I am concerned that you didn’t complete your work assignments today. What responsibilities interfered with completing the tasks I assigned?” Effective supervision uses respectful, objective communication to assess barriers, clarify expectations, and support safe task completion. This statement focuses on the performance issue without blame, invites the NA to identify competing responsibilities, and opens the door to coaching or workload adjustment to prevent recurrence. It aligns with constructive feedback and problem-solving, which improves delegation outcomes and patient safety. In contrast, the other options are accusatory or focus on others’ reactions, which can escalate defensiveness and do not identify the root cause or system issues contributing to missed care.

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