NGN Leadership Exam I

In a bustling suburban hospital, Nurse Anderson, a highly experienced Registered Nurse (RN), leads a diverse and dynamic healthcare team on a busy medical-surgical floor.
The team includes another RN, Nurse Blake, who has recently graduated and is still acclimating to the fast-paced environment; a competent Licensed Practical Nurse (LPN), Nurse Carter, with five years of experience in various healthcare settings; and a dedicated Certified Nursing Assistant (CNA), Alex, known for his compassion and efficiency. 

Nurse Anderson is responsible for ensuring efficient patient care delivery, maintaining high standards of practice, and overseeing the delegation of tasks in a way that optimizes each team member's scope of practice and skill level.

On a typical day, the team faces tasks such as administering medications, performing wound care, monitoring vital signs, updating patient records, assisting patients with activities of daily living, and educating patients and their families.
The complexity of patient needs requires Nurse Anderson to make judicious decisions about task delegation to ensure patient safety, legal compliance, and effective team functioning.

A registered nurse (RN) like Nurse Anderson manages a team that includes a licensed practical nurse (LPN), a certified nursing assistant (CNA), and another RN.
Which of the following tasks is appropriate for the RN to delegate to the LPN? Select all that apply.

In healthcare settings, nurses often face the challenge of managing their workload when short-staffed. The increased patient demand and limited resources can create overwhelming situations for nurses, potentially compromising patient care and staff well-being. Therefore, effectively managing workload becomes crucial to ensure patient needs are met while maintaining the overall quality of care.
How can nurses effectively manage their workload when they are short-staffed?

At a busy urban hospital, the nursing staff is organized into a functional nursing model, where each nurse is assigned specific tasks rather than specific patients.
Nurse Jessica is responsible for administering medications, while Nurse Amanda handles wound care, and Nurse Michael is tasked with patient education. Recently, the hospital has been facing challenges with continuity of care, as patients express frustration over seeing multiple nurses for different aspects of their care.
The nursing team is aware that while the functional model increases efficiency in some areas, it may also have drawbacks that need addressing.

What is a common drawback of the functional nursing model that the nursing team should be aware of?

A nursing manager reviews the different leadership styles of nursing students. During the discussion, the manager explains the Laissez-faire leadership approach. Then, the manager provides examples of this leadership style to help the students better understand its characteristics and potential applications.

Which of the following three examples best describes the Laissez-faire leadership approach?

In a large metropolitan hospital, Nurse Manager Emily Davis oversees a diverse team of nurses in a high-pressure surgical unit. Recently, tensions have been rising between two senior nurses, Karen and Lisa, regarding the assignment of complex cases.
Karen feels that she is consistently being given the more challenging patients, while Lisa believes that Karen is unwilling to share the workload. These tensions have led to a breakdown in communication, affecting team morale and potentially compromising patient care.
Nurse Manager Emily is aware that resolving this conflict is essential to maintaining a cohesive and effective team.

What is the most effective strategy for Nurse Manager Emily to use in resolving the conflict between Karen and Lisa?

Sarah, a 68-year-old Caucasian female with a history of chronic obstructive pulmonary disease (COPD) and congestive heart failure, is admitted to the medical-surgical unit with increasing shortness of breath. 
At 1000, Sarah reports feeling increasingly breathless, stating, “I can’t get enough air.” Nurse Lee assesses her and notes fine crackles in the bilateral lung bases, indicative of possible fluid accumulation.
At 1010, following the prescribed protocol for managing respiratory distress, Nurse Lee increased Sarah’s oxygen delivery to 4 LPM via nasal cannula.
Nurse Lee closely monitors Sarah's response to the intervention, noting any changes in her respiratory status and oxygen saturation levels.

At 1000, Sarah states, “I can’t get enough air,” and Nurse Lee assesses fine crackles in Sarah’s bilateral lung bases. At 1010, the nurse increases Sarah’s oxygen (O2) from 2 LPM per NC to 4 LPM per protocol.
Which is the most appropriate nursing documentation?

Samantha is a nurse working in a hospital that is seeking Magnet™ status. Hospital leadership recently implemented a new governance structure, which includes a clinical nursing council that oversees clinical nursing standards and care for the organization. Samantha is interested in learning more about leadership styles and how they relate to this new governance structure.

Which two (2) leadership styles are exemplified by the hospital's implementation of a clinical nursing council that governs clinical nursing standards and care for the organization?

Sarah is a seasoned registered nurse in a bustling urban hospital's intensive care unit. Sarah juggles many tasks daily – caring for critically ill patients, coordinating with doctors and other healthcare professionals, maintaining meticulous records, and educating patients' families.
Which is the best strategy for Sarah to manage her workload effectively?

John is a 45-year-old male patient admitted to the hospital for a procedure. During the admission assessment, the nurse asks John about his spiritual beliefs as part of the routine assessment. John responds by saying, "I am not a religious person".Instead, I believe things happen in life out of pure coincidence."
The nurse is now evaluating John's response better to understand his spiritual and emotional needs in the hospital.

Which evaluation of this patient's spirituality is accurate?

A nurse is reviewing a client's care plan and needs to incorporate advance directives.
For example, the client has a Living Will, a Durable Power of Attorney for Health Care, and a Do Not Resuscitate (DNR) order.
Select the appropriate actions for the nurse to take when integrating these advance directives into the client's care plan. Select all that apply

At the end of a shift, a new RN tells the charge nurse that she has not documented her medications. You should:

Nurse Ramirez, a seasoned registered nurse with over 10 years of experience in a high-acuity surgical unit, is actively involved in performance improvement and quality enhancement initiatives at City General Hospital. Recently, the unit has experienced an uptick in post-operative infections, leading to longer hospital stays and increased patient dissatisfaction.
Nurse Ramirez, known for her meticulous approach to patient care and her dedication to evidence-based practices, has been assigned to a task force aimed at addressing this issue. She is collaborating with a multidisciplinary team comprising surgeons, infection control specialists, and hospital administrators. The team is tasked with analyzing current practices, patient outcomes, and the latest research to devise strategies that could reduce infection rates.
Nurse Ramirez has access to a wealth of patient data, including detailed post-operative infection rates, antibiotic usage statistics, patient feedback, and staff compliance reports with existing infection control protocols.
Her role is pivotal in interpreting this data, identifying areas for improvement, and helping to implement and evaluate new practices.

One nurse, like Nurse Ramirez, is participating in performance improvement projects and quality improvement processes.
Which of the following actions by the nurse would promote successful outcomes in quality improvement? Select all that apply.

As a new RN, you will attend in-service requirements before placement in your unit. An organized program to prevent the incidence of preventable accidents, injuries, and errors is referred to as:

John Bird, a 52-year-old Caucasian male with a history of Type 2 diabetes and hypertension, is admitted to a hospital for management of acute pancreatitis. He has been under the care of Nurse Smith, an experienced nurse who has recently stepped into a nurse leadership role.
John has been mostly stable during his stay, with blood pressure readings averaging 140/90 mmHg, heart rate around 78 bpm, and blood glucose levels maintained between 140-180 mg/dl through insulin therapy.
Nurse Smith's notes indicate that John has been anxious about his health and somewhat uncooperative with the necessary dietary restrictions. She has had several interactions with him to address his concerns and encourage compliance with the treatment plan.

An important competency that nurse leaders like Nurse Smith need to develop to lead effectively is the following:

A nurse is taking care of two clients who are receiving transfusions of packed red blood cells at the same time. The first client’s blood pressure dropped from the preoperative value of 120/80 mm Hg to a postoperative value of 100/50 mm Hg. 
The second client is hospitalized because they developed dehydration and anemia following pneumonia.
After checking the patency of their intravenous (IV) lines and vital signs, the nurse should perform which action next?

A nurse is preparing to administer medication to a patient. Which of the following interventions reflect(s) the nurse's efforts to identify patients correctly? Select all that apply:

Select one potential condition the client is most likely experiencing, two actions the nurse would take to address that condition, and two parameters the nurse would monitor to assess the client’s progress.

Mr. Thompson, a 78-year-old African American male, is in a comatose state due to a recent severe stroke. He has a history of diabetes and hypertension and has been incontinent since his stroke.
His current vital signs are stable, with a blood pressure of 125/80 mmHg, a heart rate of 72 bpm, and a respiratory rate of 16 breaths per minute.
Nurse Williams, along with a nursing assistant personnel (NAP), is preparing to give Mr. Thompson a bed bath. The nurse's notes indicate that Mr. Thompson's skin integrity has been maintained so far, but he requires frequent turning and positioning to prevent pressure ulcers.
The nurse has emphasized the importance of maintaining strict infection control measures while caring for him, especially since he is at increased risk for skin breakdown and infection due to his comatose state and incontinence.

A nurse is helping a NAP provide a bed bath to a comatose patient like Mr. Thompson, who is incontinent.
Which of the following actions requires the nurse to intervene?

Samantha, a 64-year-old woman, presents to the emergency department with a two-day history of worsening dyspnea, productive cough, and fever. She has a past medical history of type 2 diabetes, hypertension, and chronic obstructive pulmonary disease (COPD). 

As you prepare to hand over Samantha's care to the next nurse on duty, you realize the importance of communicating all relevant details to ensure continuity and safety in her care.
This process is critical for ensuring that the next nurse is fully informed about the patient's condition, treatment, and any special considerations.
In the context of nursing, the comprehensive transfer of care information between two healthcare professionals, as described in the above scenario, is best referred to as Select all that apply

Which action should the nurse take to manage their workload during a busy shift effectively?

The nurse is assigned to care for these clients. In planning client rounds, which client would the nurse assess first?

James, a 45-year-old homeless man with no known medical history, arrives at the emergency department (ED) complaining of acute chest pain. He mentions he has been living on the streets for several years and has no health insurance.
Upon examination, his vital signs are as follows: blood pressure 160/95 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, and oxygen saturation 94% on room air.
The nurse on duty, Nurse Martinez, notes that James appears anxious and is clutching his chest. There are no available medical records due to his uninsured and homeless status.
Given the presentation of chest pain, Nurse Martinez understands the urgency of the situation and the need for immediate medical evaluation and intervention, regardless of James' financial or social situation.

The client, James, who is homeless and uninsured, has chest pain and seeks care in the ED. Which actions should be taken by the nurse? Select all that apply.

A hospital is planning to implement a new electronic health record (EHR) system to improve efficiency and patient care. The nursing staff has been informed that the change will be rolled out over the next three months. However, many nurses, including those who have been with the hospital for over 20 years, are expressing concerns and resistance to the upcoming change.
Some nurses worry about the learning curve, while others fear the potential for increased workload and disruptions to their established routines.
The administration recognizes that understanding the reasons for resistance is key to successfully implementing the new system.

What are some common reasons that nurses may resist the implementation of a new electronic health record (EHR) system?

The patient is a 78-year-old who was initially admitted for elective total knee arthroplasty (TKA). The client tolerated the surgery well and was discharged to recuperate at an adult child's home. Two weeks after discharge, the client was brought to the emergency department (ED) by ambulance after reporting severe chest pain and dyspnea. In the ED, the client experienced a cardiac arrest.
Resuscitation measures were successful, and the conscious client was transferred to the cardiac intensive care unit in critical but stable condition. The client's living will states that all life-supporting measures are to be taken, and the family requests that a member be present when resuscitation measures are again instituted.

Complete the following sentences by choosing from the list of options.

To best address the family’s request, the nurse would first  

A combination of internal and external factors causes violence in hospitals. A systematic review of the literature on the effects of violence toward nurses reported the predominant responses to be anger, fear, anxiety, posttraumatic stress disorder symptoms, guilt, self-blame, and shame. Which of the following is correct regarding violence in the workplace?

A 65-year-old male with a history of diabetes, hypertension, and a recent stroke is admitted to a rehabilitation unit. As his nurse, you are participating in the planning meeting to discuss his care during his hospital stay and preparation for his discharge. The nurse manager emphasizes the importance of an interprofessional team approach for comprehensive care.
Which members would be included in an interprofessional team approach for this patient in the clinical setting? Select all that apply.

Ms. Carol is a nurse who just received a report from the night shift nurse. According to her nursing plan, she must assign direct and indirect patient care to staff members; examples of direct patient care tasks. Select all that apply

Maria Gonzalez, a 38-year-old Hispanic woman with a history of chronic asthma, was admitted to the emergency department with severe shortness of breath.
Nurse Johnson, leading the team, notes that Maria is anxious and struggling to use her inhaler correctly. The nurse's leadership approach must adapt to both the urgency of Maria's medical needs and her current ability to follow instructions.
This situation requires Nurse Johnson to adjust her leadership style according to the Situational Leadership Model.

The Situational Leadership Model, as applied by Nurse Johnson in Maria's case, focuses on: