NGN Leadership Exam I Are you Ready to take your NGN Leadership Exam I? 1. Question 12. Leadership 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? Appropiate No appropriate Completing the easiest tasks first Prioritizing tasks based on patient acuity Working on tasks as they come up Waiting for the charge nurse to assign tasks Delaying tasks until later in the shift Assigning tasks to nursing assistants Skipping breaks to complete tasks on time 2. Question 34. Leadership 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. Delay treatment until insurance status is clarified. Initiate a social worker consult after stabilizing and treating the client. Treat the client respectfully and honor the client’s request to be seen. Provide care according to the standard of care and emergency protocols. Ask the healthcare provider (HCP) to see the client before admission. Ensure the client understands the financial implications of treatment. Refer the client to the nearest hospital that provides charity care. Immediately administer pain relief without assessment by the healthcare provider. Prioritize the client based on the severity of symptoms, not insurance status. 3. The nurse is caring for a client who presents in the emergency room with left-sided weakness. The client is accompanied by the spouse. The nurse is reviewing the client’s medical record to prepare the client’s plan of care. Health historyNursing notesVital signsLab results N/A 1600: The client is accompanied by a spouse. Left-sided ptosis with facial drooping and slurred speech is noted. Left-sided weakness is noted in extremities. The client is alert but having difficulty answering questions. Spouse reports client had similar symptoms a few days earlier, but they went away after a few hours. Symptoms started at 0600 and have not improved and believes the leg weakness is worse since the client cannot stand on the leg. Pupils are reactive but the right is smaller. Bowel sounds are present in all quadrants, skin is warm and dry. Lung sounds are clear. 1630: Spouse shares that the client is not eating well and has not voided in 24 hours. Temperature 98.4 degrees F, P 130, RR 18, BP 190/94, pulse oximetry 92% on room air. Question 14. Leadership 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. Nursing actions Obtain a blood glucose measurement. Obtain a urine sample for analysis Request an order for normal saline to be administered intravenously Request an order for an anti-hypertensive medication Start range-of-motion exercises on the affected side Potential condition Dehydration Hypoglycemia Transient ischemic attack/stroke Migraine Parameters to monitor Electrocardiogram (EKG) Neurologic status Intake and output Fall precautions Serum glucose level 4. Question 17. Leadership Which action should the nurse take to manage their workload during a busy shift effectively? Prioritize non-patient care tasks over patient care tasks. Wait for physician orders before completing any tasks. Delay documentation until the end of the shift Multitask and complete multiple tasks at once Work through breaks and mealtimes to finish tasks. Delegate tasks to other nurses or nursing assistants Follow a strict task completion schedule. 5. Question 24. Leadership 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: Sentinel event Retrospective review Safety hazard monitoring Adverse event management Quality control program Risk management Route cause analysis 6. Nurse's notesHealth historyLab results Upon assessment, her vital signs are as follows: blood pressure 145/90 mmHg, heart rate 98 bpm, respiratory rate 24 breaths per minute, and oxygen saturation 89% on 2 liters per minute (LPM) nasal cannula (NC). Question 35. Leadership 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? Please select your answer 1010: Noted increased respiratory distress. Enhanced O2 delivery to 4 LPM per NC. Monitoring response. 1020: Client dyspneic. Oxygen to 4 LPM/mask. O2 saturation improved, and client denies dyspnea. 1010: Increased oxygen to 4 L/NC. 1010: Client dyspneic. Lung sounds bilateral crackles in bases. Increased O2 to 4 LPM per NC per protocol. Dyspnea resolved. 1000: Client dyspneic. Left message for healthcare provider (HCP) to return call; will wait for plan. 1010: Administered 4 LPM O2 via NC, following protocol for dyspnea in COPD patients. 1020: Client’s respiratory rate and O2 saturation monitored post intervention. No distress observed. 1015: Reviewed client’s history of COPD and heart failure. Adjusted oxygen therapy accordingly. 1005: Notified HCP of patient's status. Awaiting further orders. 7. Question 25. Leadership A new nurse is attending the new employee orientation at the facility. She is not sure about the National Patient Safety Goals. When she questioned the nurse manager regarding the safety goals, she was informed that they are used to: Focus performance in areas of patient safety. Complete the employee assessment review. Determine which equipment to purchase for the unit. Complete incident reports properly Evaluate employee job satisfaction. Satisfy regulatory requirements for employee training. Determine whether or not the employee will receive additional pay. Meet the facility's productivity goals. 8. Question 8. Leadership Scenario: An older patient with early-stage Alzheimer’s disease sustained a hip fracture after falling. He has been discharged and is returning home to live with his wife. He qualifies for home health visits through Medicare. The home health team includes an RN, an LPN, a physical therapist, a social worker, and a home health aide.Which member of the home health team is best to assign or delegate for each intervention? Instructions: Staff members are listed in the left-hand column. In the right-hand column, in the space provided, write the letter for the best member of the home health team for each intervention. Note that all responses will be used and may be used more than once. RN Social worker Home Health Aide LPN/LVN Physical Therapist Help patients and families to understand Medicare benefits. Assess the patient’s memory and level of cognitive function. Assess the patient’s strength, balance, and movement. Administer prescribed medications Assist the patient in taking a bath. 9. Question 6. Leadership 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. Administering intravenous (IV) medications. Performing initial patient assessments. Educating patients about complex new diagnoses. Providing wound care for a stable patient. Assisting a patient with activities of daily living. Monitoring and reporting changes in patient condition. Developing a nursing care plan for a newly admitted patient. Supervising the CNA during patient care activities. Implementing physician orders for routine patient care. 10. Question 7. Leadership 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? Leaders encourage subordinates to participate in decision-making and offer their opinions and suggestions. Leaders set clear expectations and provide detailed instructions for completing tasks and responsibilities. An executive who delegates decision-making authority to subordinates without providing input or feedback on their decisions. A team leader who delegates a project to team members without guiding how to proceed Leaders make decisions without consulting with or seeking input from their subordinates. Leaders delegate tasks and responsibilities to their subordinates without providing guidance or direction. 11. Nurse's notesVital signs Samantha is a former smoker with a 30-pack-year history and quit smoking 10 years ago. PE: Her lung examination reveals decreased breath sounds and coarse crackles in the right lower lobe. A chest X-ray is performed and shows a consolidation in the right lower lobe, consistent with pneumonia. She is admitted to the medical unit for further management. On examination, she appears in mild respiratory distress with a respiratory rate of 26/min, oxygen saturation of 92% on room air, blood pressure of 155/90 mm Hg, and heart rate of 110 beats/min. Question 3. Leadership 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 Communications Change-of-shift report Information exchange Handoff Interdisciplinary consultation Transition documentation Continuity brief Clinical briefing Case transfer dialogue 12. Question 15. Leadership 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? Nurses are immune to experiencing negative emotional responses to workplace violence. Violence in the workplace is caused solely by external factors. Education and restaurant workers have the highest incidence of injuries from workplace assaults. Horizontal violence is common in nursing and is a form of bullying. Most researchers agree that violence against nurses is significantly over-reported. The effects of violence toward nurses are predominantly positive. Intimidation can be a form of violence but is not an implied threat when objects are thrown, or stares are given. 13. Question 26. Leadership 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: Confirming the patient's identity by comparing their wristband to the medication administration record. Asking the patient's family members to confirm their identity. Checking the medication administration record to verify the patient's name and room number. Relying on the patient's verbal identity confirmation without checking their wristband or medication administration record. Skipping the identification process if the patient is a frequent visitor to the unit. Asking the patient their name and date of birth before administering medication. Administering medication to the patient without verifying their identity. 14. Question 27. Leadership At the end of a shift, a new RN tells the charge nurse that she has not documented her medications. You should: Please select your answer Tell her to leave the documentation blank and verbally report the medications to the next shift. Tell her to falsify the records to show that she administered the medications. Tell her you will pay her overtime for proper documentation completion. Tell her it's not a big deal and to document them tomorrow. Ask her why she was unable to chart medications. Ask her if she would like the charge nurse to complete the documentation. Tell the nurse manager about the situation. 15. Question 13. Leadership A 71-year-old woman is admitted to the long-term care facility for confusion, wandering, and frequent falls. She is alert, conversant, and immediately interested in exploring the facility. The daughter says, “Mom does many things for herself. She likes morning walks and prefers to wear long flowing clothes and high heels. She has eyeglasses and a cane, but she forgets or sometimes denies the need for those items. She has fallen several times but rejects help or suggestions; she has always been very independent.” The RN and LPN/LVN plan initial interventions to prevent falls for this resident. Which team member is the best to assign or delegate for each intervention? Perform hourly environmental checks, such as: call bell and personal items within reach and walkways free of clutter. Assess baseline cognitive status. Perform frequent rounding to evaluate residents’ receptiveness to fall prevention interventions. Remind the resident to sit slowly and dangle before getting out of bed in the morning. Perform initial gait testing, such as the Timed Up and Go test. Conduct medication reconciliation Assist resident in donning slip-resistant and safe footwear Monitor resident’s ongoing abilities to perform activities of daily living. Help residents to dress in comfortable, well-fitting clothing. Obtain admission and weekly vital signs to include orthostatic blood pressure measurements. AP AP RN RN AP LPN/LVN RN RN AP AP 16. Question 31. Leadership 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: Ability to be close-minded and to ignore negative feedback Skill in delegating tasks and empowering team members Capacity to manage stress and maintain composure in challenging situations Ability to communicate effectively with others Commitment to continuous learning and professional development Ability to be firm and inflexible Ability to follow orders without questioning them Expertise in clinical knowledge and evidence-based practices Proficiency in conflict resolution and team-building 17. Question 30. Leadership An extensive hospital system is implementing a new program to encourage career advancement for its nursing staff. As part of this program, nurses can participate in various professional development activities and receive recognition and rewards for their achievements. The hospital system is referring to this program as: Please select your answer Annual salary increase for all staff Does not keep the nurses at the bedside Present at conferences. Educational seminars Performance-based promotion Mandatory continuing education sessions Clinical ladders 18. Question 22. Leadership 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 Providing patient education Administering medications Restocking shelves and patient rooms Assisting with bathing and grooming Performing an electrocardiogram Monitoring vital signs Asking patients what they request when their light is on, then informing the RN. Transporting patients 19. Question 16. Leadership 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? This patient's belief in coincidence indicates a lack of critical thinking skills. This patient is not a spiritual person. This patient will experience difficulty coping with life changes. This patient is more likely to suffer from depression. This patient's perspective on spirituality is abnormal and concerning. This patient experiences emotion and should be asked about the effects of health changes. This patient's lack of religiosity suggests a lack of moral compass. 20. Question 9. Leadership 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? Administer a normal saline bolus to the first client to help stabilize their blood pressure. Pause the transfusion of the first client and notify the healthcare provider of the blood pressure drop. Ask another nurse to verify the compatibility of both units simultaneously. Ask another nurse to call for and hang the blood for the second client. Call for both clients’ blood transfusions at the same time. Increase the flow rate of the first client's IV line to help improve blood pressure. Recheck the vital signs of the second client and address any abnormal findings before continuing with the transfusion. Call for and hang the first client’s blood transfusion. Time is Up! Time's upYou cannot switch tabs while taking this quiz!You are not allowed to switch tabs violation has been recorded.You cannot minimize full screen mode!You are in NCLEX simulator mode and not allowed to minimize full screen while taking this exam, violation has been recorded.