Question 1

Supervision of delegated client care responsibilities, tasks, and activities is essential to the delivery of quality, cost-effective, multidisciplinary client care. What is the correct definition of supervision?

Accepted Answer

Answer reason: Supervision in nursing is defined by the RN’s ongoing accountability to monitor, guide, and evaluate delegated care to ensure it meets standards and is completed safely. Direct oversight includes observing performance as needed, reviewing outcomes, and providing feedback or intervention when care is not appropriate. Option A describes delegation (transfer of task responsibility), which is a distinct concept from supervision. Options C and D refer more to care coordination and informal leadership, neither of which captures the core requirement of monitoring and evaluating others’ work.

Question 2

Supervision is an essential component of the appropriate delegation of client care. Which example demonstrates inappropriate supervision?

Accepted Answer

Answer reason: Safe delegation requires that the RN retains accountability and provides appropriate oversight, especially for high-risk tasks. Administering IV medications is a complex, high-alert activity with significant potential for rapid harm, so it requires direct supervision and clear lines of responsibility. Allowing a student to perform this independently indicates a failure to supervise and violates safe clinical practice standards. In contrast, using acuity/competency to assign clients and providing precepted orientation are examples of appropriate oversight structures that promote safety.

Question 3

Nurse with less than one year of experience complains to an experienced nurse, “The charge nurses are always checking up on me and evaluating my client care. I feel as if the charge nurses do not trust me to give good care to my clients.” Which response by the experienced nurse demonstrates an understanding of appropriate staff supervision?

Accepted Answer

Answer reason: The charge nurses are accountable for supervising client care and client safety after delegating the client care assignments. The management staff may believe that they are being supportive by being available to you for help or advice. In nursing leadership, supervision and follow-up are required after assignments are made to ensure safe, effective care and to meet accountability standards. This response correctly frames charge nurse check-ins as a normal safety and quality function tied to responsibility for delegated care, not as personal mistrust. It also reframes monitoring as support and availability for guidance, which promotes safe practice for a novice nurse. Options that minimize the concern or attribute it to the new nurse’s inadequacy do not accurately emphasize the charge nurse’s ongoing accountability and appropriate oversight duties.

Question 4

The nurse is supervising a new graduate nurse who is administering medications to a 38-year-old female client with heart failure who is being started on benazepril and furosemide. Which of the following statements by the new graduate nurse would require follow-up by the supervising nurse?

Accepted Answer

Answer reason: ” ACE inhibitors tend to increase serum potassium by decreasing aldosterone-mediated potassium excretion, whereas loop diuretics increase potassium loss in the urine. Holding both medications due to concern for low potassium reflects incorrect pharmacologic understanding and could inappropriately delay therapy in heart failure. These medications are commonly used together; the appropriate action is to monitor electrolytes and renal function rather than automatically separating doses. A common safety concern when starting an ACE inhibitor (especially with a diuretic) is hypotension and renal impairment, not additive hypokalemia.

Question 5

The nurse manager is conducting a staff in-service and announces that the staff nurses may decide when to take meal breaks, and the assignment for new admissions may be decided upon themselves. The nurse manager is demonstrating?

Accepted Answer

Answer reason: This scenario describes a leadership approach where decision-making is largely left to staff with minimal direction from the manager. Allowing nurses to independently determine meal breaks and self-assign new admissions reflects a hands-off style rather than structured oversight. In contrast, democratic/participative styles still involve leader facilitation and shared decision-making within a guided process, not simply turning decisions over to staff. Because the manager is relinquishing control over unit workflow decisions, this best fits a laissez-faire approach, which can risk uneven workload distribution and gaps in coordination.

Question 6

A nurse is working with an unlicensed assistive personnel (UAP) to perform a bed bath on a client. The nurse notes the smell of alcohol on the UAP's breath. Which is the priority nursing action?

Accepted Answer

Answer reason: Patient safety is the priority, and suspected impairment in any staff member requires immediate action to remove the person from patient care and activate the chain of command. A strong odor of alcohol is a red flag for potential impairment that can lead to errors, injury, and unsafe care even during basic tasks like bathing and transfers. Reporting to the charge nurse/unit manager ensures appropriate assessment, documentation, and adherence to facility policy while maintaining client safety and staffing coverage. Options that “watch,” ignore, or mask the issue delay intervention and increase risk, and they fail the nurse’s duty to supervise and protect clients.

Question 7

The charge nurse is supervising unlicensed assistive personnel (UAPs). The charge nurse should immediately intervene when a UAP is observed?

Accepted Answer

Answer reason: A core delegation principle is that UAPs may not be assigned tasks requiring ongoing nursing assessment, clinical judgment, or management of an unstable/high-risk patient. A client with myocardial infarction is potentially hemodynamically unstable and at risk for dysrhythmias during transport, so transport requires an RN (or appropriately trained licensed staff per facility policy) who can assess and intervene. The other actions are routine, noninvasive ADL/skills that can be delegated with appropriate instructions and supervision (e.g., assisting with hygiene, applying external devices, obtaining routine vital signs). Therefore, the unsafe assignment requiring immediate charge nurse intervention is having the UAP transport the MI client to the cath lab.

Question 8

The charge nurse is supervising administration of a blood transfusion to a client with a gastrointestinal bleed by a registered nurse (RN) who is assisted by a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP). The charge nurse should intervene if the RN?

Accepted Answer

Answer reason: A UAP cannot assess for reaction signs (e.g., fever, chills, dyspnea, hypotension, flank pain) or make urgent nursing decisions, so assigning them to monitor the patient during this window is unsafe. An RN (or appropriately trained/licensed nurse per policy) should remain with the patient initially to perform focused assessments and respond rapidly. In contrast, obtaining baseline vital signs can be delegated to UAP, and LPN tasks such as reporting stool characteristics and drawing ordered labs may be within scope depending on facility policy.

Question 9

The charge nurse is supervising a registered nurse (RN) in the care of a client on a mechanical ventilator. The charge nurse should intervene if the RN asks the unlicensed assistive personnel (UAP) to?

Accepted Answer

Answer reason: Determining when a mechanically ventilated client needs suctioning requires ongoing respiratory assessment (e.g., breath sounds, ventilator alarms, secretion burden) and is an RN responsibility, so delegating that decision is unsafe. Turning q2h and passive range-of-motion are appropriate basic care activities that can be assigned with proper instruction and monitoring. Measuring respiratory rate and pulse oximetry can be delegated as data collection, but interpretation and intervention decisions remain with the RN.

Question 10

The charge nurse is reviewing documentation completed by the RN and evaluating the RN’s delegation abilities to the LPN and NA and appropriate supervision. Which medical record documentation indicates incomplete delegation? Client Narrative Notes?

Accepted Answer

Answer reason: A blood glucose of 55 mg/dL indicates hypoglycemia, which requires immediate treatment (e.g., glucose administration), not insulin. The LPN administered insulin despite a critically low glucose level, indicating a failure in appropriate clinical judgment and supervision. The RN is responsible for ensuring safe delegation and oversight; this documentation reflects a breakdown in supervision and patient safety.
Options A, B, and D reflect appropriate delegation and follow-up. Only option C demonstrates unsafe care and incomplete supervision.

Question 11

A nurse-manager appropriately behaves as an autocrat in which situation?

Accepted Answer

Answer reason: Autocratic leadership is appropriate in emergency situations where rapid decision-making and clear direction are required. During a cardiac arrest, the nurse-manager must give direct, immediate instructions to ensure coordinated and effective intervention. The other situations are non-urgent and better suited to participative or collaborative leadership styles.

Question 12

Which style of leadership is characterized by a hands-off approach where the leader allows the team to make decisions for themselves?

Accepted Answer

Answer reason: A hands-off style with minimal guidance and high autonomy for staff aligns with a laissez-faire approach, where team members largely self-direct and self-decide. This contrasts with authoritarian leadership, which is highly directive and centralized in the leader. Transactional leadership focuses on performance through rewards and consequences rather than broadly delegating decision authority. Because the stem emphasizes letting the team make decisions for themselves, the best match is laissez-faire.

Question 13

A nurse’s aide comes to the nurse and expresses concerns about a patient’s T-tube. The aide says, “I’m kind of worried because it’s drained 700mL over the course of our shift. That’s a lot!” Which of the following responses does the nurse give to the aide?

Accepted Answer

Answer reason: A drainage amount like 700 mL in a shift can be within expected limits on the first postoperative day when output may be more brisk. The nurse should respond by providing accurate teaching and reassurance that aligns with normal postoperative expectations while still continuing routine monitoring. Option C implies this amount is clearly excessive without considering the common early-post-op pattern, and option A is inappropriate because it dismisses the concern and uses irrelevant comparison rather than patient-specific education. Option D is less appropriate because output generally trends down by later postoperative days, so labeling high output as “normal” on day five is inconsistent with expected progression.

Question 14

She came across a theory which states that the leadership style is effective depends on the situation. Which of the following styles best fits a situation when the followers are self-directed, experts, and are matured individuals?

Accepted Answer

Answer reason: When staff are experienced, self-directed, and mature, they can plan and carry out work with minimal oversight, making a hands-off approach appropriate. This style supports autonomy and empowers experts to make decisions within their scope while the leader remains available for resources and accountability. In contrast, authoritarian or bureaucratic styles are more useful when close direction, strict rules, or low staff readiness requires tighter control.

Question 15

The patient who had a stroke needs to be fed. What instruction should you give to the nursing assistant who will feed the patient?

Accepted Answer

Answer reason: Aspiration prevention is a key safety principle when feeding a post-stroke client with potential dysphagia. Upright positioning (ideally high-Fowler’s) supports safer swallowing and reduces the chance of food or fluids entering the airway. Assessing gag/swallow is an initial nursing assessment that should be performed by the nurse and is not the most appropriate instruction for an assistant to independently carry out. Feeding quickly increases aspiration risk, and routine suctioning between bites is not a standard feeding instruction and can indicate the client is not safe for oral intake without further evaluation.

Question 16

Nurse Danita is working with clients who have personality disorders. Which of the following actions demonstrates appropriate use of supervision when a nurse’s feelings interfere with therapeutic performance?

Accepted Answer

Answer reason: Seeking peer or supervisor direction reflects appropriate use of supervision to maintain safe and effective patient care. When personal feelings interfere with therapeutic performance, consulting a supervisor helps ensure accountability, supports professional boundaries, and promotes appropriate clinical decision-making. Other options focus on client interaction rather than proper use of supervision to manage professional limitations.

Question 17

Nurse Tony stresses the need for all the employees to follow orders and instructions from him and not from anyone else. Which of the following principles does he refer to?

Accepted Answer

Answer reason: The stem describes instructing staff to take orders only from him, which matches having a single recognized source of authority. This improves clarity of responsibility and reduces errors from contradictory instructions. By contrast, discipline focuses on obedience and adherence to rules generally, not the specific issue of having only one boss. Therefore, the best answer is the principle that mandates one superior for orders.

Question 18

A client with Parkinson disease has a problem with decreased mobility related to neuromuscular impairment. The nurse observes the unlicensed assistive personnel (UAP) performing all of these actions. For which action must the nurse intervene?

Accepted Answer

Answer reason: Using visual cues (e.g., looking at the feet or stepping over lines) can help initiate movement and reduce freezing; discouraging this removes a helpful strategy and may increase fall risk. Ambulating to the bathroom with assistance and encouraging self-feeding promote safety and independence when done appropriately. The nurse should intervene to correct unsafe or incorrect mobility guidance given by the UAP.

Question 19

Which change in vital signs would you instruct the UAP to report immediately for a patient with hyperthyroidism?

Accepted Answer

Answer reason: A new or worsening rapid pulse can precipitate dysrhythmias, angina, or heart failure, so it warrants immediate reporting and RN assessment. In contrast, decreased oral temperature is inconsistent with hypermetabolic physiology, and mild increases in respiratory rate are less specific and often secondary to anxiety or heat intolerance. Prompt recognition of tachycardia supports rapid intervention (e.g., beta-blockade evaluation, assessment for fever, agitation, and dehydration).

Question 20

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

Accepted Answer

Answer reason: Suspected impairment/diversion in a staff member is a management-of-care issue requiring immediate reporting through the chain of command to protect patients and secure medications. The supervisor can promptly remove the coworker from duty, initiate facility policy (fitness-for-duty evaluation, incident documentation), and arrange safe investigation and follow-up. Calling police or security may be necessary later depending on policy and immediate threats, but the nurse’s first appropriate step is internal escalation to the supervisor. Locking the coworker in the room is unsafe, unlawful restraint, and escalates risk rather than ensuring controlled, policy-driven intervention.

Question 21

The nurse is supervising a graduate nurse (GN) on a telemetry unit. An assigned client develops asystole with no pulse, and emergency care interventions are initiated. Which action by the GN would cause the supervising nurse to intervene?

Accepted Answer

Answer reason: Delivering an unsynchronized shock in asystole does not treat the underlying problem and can interrupt chest compressions, worsening coronary and cerebral perfusion. The other listed actions align with standard resuscitation steps for pulseless arrest under appropriate team direction. Therefore, the supervising nurse should stop this unsafe, incorrect intervention immediately.

Question 22

During the shift report, the night charge nurse tells the day charge nurse that the night unlicensed assistive personnel (UAP) is totally incompetent. What is the best response for the day charge nurse to give?

Accepted Answer

Answer reason: Escalating to the nurse manager supports fair performance management, follow-up coaching or remediation, and compliance with organizational policy. It also redirects an unprofessional global judgment (“totally incompetent”) toward specific, actionable concerns and observed behaviors. Telling the night nurse to handle it alone or offering reassurance minimizes a potential safety risk and bypasses formal supervision processes.

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