NGN Management Exam Welcome to your NGN Management Exam 1. Question 54 MCM The nurse manager in a not-for-profit healthcare facility is aware of what issues may arise due to the funding for this type of organization. Please select your answer If available funds are reduced, managers will be let go and each unit will run itself. The health-care organization will move all inpatient to outpatient care. There is a possibility that staff must be reduced because of decreased available funds. The care provided to patients is of lower quality than the care given in for-profit health-care organizations. 2. Question 37 MCM Elizabeth Thompson, a 52-year-old African American female with a history of rheumatoid arthritis and recently diagnosed stage II breast cancer, was admitted to the oncology ward following her first round of chemotherapy. Elizabeth has been struggling with severe fatigue, occasional shortness of breath, and a lack of appetite. Her vital signs at admission were: blood pressure 130/85 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, and oxygen saturation 96% on room air. The nurse’s notes highlighted her concerns about managing her pain and maintaining her independence during her hospital stay. Elizabeth lives alone and has expressed feelings of anxiety regarding her diagnosis and treatment plan. Her lab results showed mild anemia and slightly elevated liver enzymes, which the healthcare team attributes to her chemotherapy. Additionally, she reported a persistent dry cough, which was noted during her physical examination. The multidisciplinary team, including a dietician, physiotherapist, and social worker, has been involved in her care plan to address her nutritional needs, physical mobility, and psychosocial support. Considering the comprehensive care needs of Elizabeth Thompson, how does the optimal healing environment, as a component of the Patient-Centered Care Quality and Safety Education in Nursing (QSEN) competency, assist the patient? Implementing a diet plan customized for her nutritional needs during chemotherapy. Adjusting medication schedules to better manage her post-chemotherapy fatigue. Organizing gentle exercise sessions with a physiotherapist to maintain her mobility. Ensuring her room is close to the nursing station for quick response to her needs. Arranging counseling sessions to address her anxiety about her diagnosis and treatment. Providing a quiet room with comfortable bedding to enhance rest and reduce stress. Including her family in care discussions and decision-making processes. 3. Question 48 MCM A student nurse is on her clinical rotation in a medical-surgical ward. She has been shadowing a registered nurse for the past few weeks and has been gradually given more responsibilities. Today, she's been asked to perform a new procedure on a real patient for the first time. She recalls practicing the procedure in the simulation lab but is unsure about some specifics. Wanting to ensure patient safety and the correct process, she decided to approach her clinical instructor.By asking her clinical instructor a clarifying question regarding the procedure, the student nurse demonstrates which critical thinking attitude? Please select your answer Risk taking. Independence. Intellectual humility. Flexibility. Confidence. Curiosity. 4. Question 63 MCM The nurse is conducting pre-operative assessments on a group of clients scheduled for surgeries later in the day. Among the various assessments, determining the risk for latex allergies is critical to avoid potential complications during and after the surgical procedure.Which two client has the greatest risk for latex allergies? Select all that apply A man who has a history of eczema. A woman who is admitted for their seventh surgery. A child with spina bifida. A woman who is having laser surgery. A man who works as a sales clerk. A woman with a known banana allergy. A man with well-controlled type 2 diabetes. A woman who frequently visits a nail salon. A man who works in construction. 5. Question 70 MCM The nurse on duty at a specialized burn treatment unit received a change-of-shift report concerning four patients with varying degrees of burn injuries and complications. Based on the change-of-shift report, in what order should the nurse attend to these four clients? Prioritize the nurse’s actions by placing each client in the correct order. Patient 4 Patient 1 Patient 3 Patient 2 Fourth Third Second First 6. Nurse's notesHealth historyLab results Upon admission, her blood glucose levels were erratically fluctuating, and she showed signs of fluid overload, with peripheral edema and shortness of breath. Maria’s vital signs indicated hypertension (BP 160/100 mmHg), tachycardia (HR 110 bpm), and tachypnea (RR 24 breaths per minute). Her lab results revealed elevated creatinine and urea levels, suggesting worsening renal function. Maria's expressed concerns about her deteriorating health and her fear of becoming dialysis-dependent. She lives with her husband and two young children and worries about her ability to care for her family. Question 38 MCM Maria Garcia, a 40-year-old Hispanic woman with a history of Type 1 Diabetes and recent acute kidney injury, was admitted to a specialized renal unit in a tertiary care hospital. Maria's complex health situation is further complicated by her limited health literacy and difficulty understanding her condition and treatment plan. The healthcare team, including a diabetes educator and renal dietitian, has been involved in her care, but there's a growing realization among the nursing staff that current care approaches are not effectively meeting her needs. In the context of Maria Garcia's case, where current care strategies seem insufficient, what is the first step nurses should take in integrating evidence-based practice (EBP) in a nursing unit? Conducting a thorough literature review on the latest diabetes and renal care practices. Surveying patients and families about their satisfaction and care experiences. Reviewing and analyzing Maria's case to identify specific areas for improvement. Attending a workshop or seminar on evidence-based practices in nursing. Consulting with experts in diabetes and renal care for specialized input. Organizing a team meeting to discuss and identify gaps in current patient care. Implementing new protocols based on recent clinical guidelines without team consultation. 7. Question 45 MCM Margaret Lee, a 65-year-old Asian woman, was admitted to the cardiology unit with a diagnosis of congestive heart failure. Her past medical history includes hypertension, type 2 diabetes, and a previous myocardial infarction. Upon admission, Margaret's vital signs were stable, and she was comfortable, with the Nurse’s notes indicating she was in good spirits, engaging with staff, and adhering to her treatment plan. However, during a routine check, the nurse observed that Margaret had suddenly become short of breath. Her respiratory rate had increased to 28 breaths per minute, and she appeared visibly distressed. Oxygen saturation had dropped to 88% on room air, a significant decrease from her previous readings of 95%. The nurse quickly administered supplemental oxygen, which improved her saturation to 92%. Recognizing the urgency of the situation, the nurse prepared to contact the healthcare provider (HCP) using the SBAR (Situation, Background, Assessment, Recommendation) communication format to ensure clarity and efficiency in the communication. As the nurse prepares to use the SBAR format to communicate with the healthcare provider about Margaret Lee’s sudden onset of shortness of breath, which of the following should be included when addressing the "Situation" in the SBAR format? Please select your answer Discuss the patient's long-term prognosis as understood from previous consultations. State the patient's room number and the urgency of the situation. Identify the patient’s ethnicity and religious affiliation. Detail the patient's current medication regimen and any recent changes. Include the patient's dietary preferences and last meal. Explain the nurse’s personal opinion about the likely cause of the patient’s symptoms. Mention any recent family visits or interactions that may have impacted the patient's emotional state. Provide a brief overview of the patient’s current symptoms and vital sign changes. Summarize the patient’s entire medical history and previous hospitalizations. 8. Question 66 MCM The nurse manager uses the Principles of Collaborative Relationships: Effective Communication by the American Nurses Association (ANA) to improve communication in the nursing unit and knows that these principles require the staff nurses to use what communication practices? Select all that apply. Use active listening techniques. Know the purpose of the message transmitted. Speak to multiple persons about the issue. Keep the environment closed and private. Practice empathy and understanding. Ensure accuracy in the information transmitted. Utilize non-verbal communication effectively. 9. Question 65 MCM An elderly patient with a history of hypertension and diabetes presents with new symptoms suggestive of a neurological issue. The primary care nurse realizes that a referral may be necessary.Which of the following actions is most appropriate for the primary care nurse concerned about the patient's new neurological symptoms? Obtain vital signs and a detailed history of the symptoms. Advise the patient to rest and monitor symptoms. Advise the patient to book a routine follow-up in 6 months. Immediately consult with a neurologist without any orders. Recommend over-the-counter pain medications. Refer the patient to a nutritionist to discuss diet. Obtain an order from the primary care physician for a neurology consult. Direct the patient to the nearest emergency room. 10. Question 47 MCM The nurse is working in a busy surgical unit. Today, there are several clients scheduled for surgeries. The nurse is responsible for ensuring that pre-operative protocols, including blood glucose level checks, are followed to ensure patient safety.The nurse should review the glucose level of which client(s) going to surgery today. Select all that apply. A client who has been fasting for 24 hours prior to surgery. A client with diabetes mellitus controlled by diet. A client with a family history of diabetes receiving dextrose 5% in lactated Ringer’s solution (D5LR) intravenous (IV) fluids. A client receiving corticosteroids for the past 3 months. A client on beta-blockers for hypertension. A client with a high stress response to surgery. A client with a recent diagnosis of hypothyroidism. A client who consumes a high-carbohydrate diet. A client diagnosed with Cushing's syndrome. 11. Question 52 MCM The nurse manager is making rounds on her unit, keenly observing the day-to-day operations, staff interactions, and overall environment. As she navigates through different areas, she witnesses a series of events involving various staff members. Given her role, she understands the importance of ensuring a safe, respectful, and efficient working environment.Which situation, if observed, would warrant immediate action by the nurse manager? Unit secretary asks the nurses to answer the unit phone when she is busy. Staff nurse asks for additional clarification from the physician related to a written order. A nurse uses her personal phone while attending to a non-critical patient. Unit secretary draws caricature images of nursing staff with sarcastic comments. A nurse takes a short break without informing her colleagues. A patient's family member shares a concern about delayed medication. Two nurses who work days are switching their days for the last 2 weeks of the schedule. 12. Question 62 MCM The nurse manager is preparing to institute SBAR for interprofessional communication. The nurse manager has based this decision on what benefits of this tool. Select all that apply. Decreased continuity of patient care Assertive dialogue between professionals Enhanced interdisciplinary collaboration Improved patient outcomes Most essential information delivery Increased time spent in interprofessional communication Safer delivery of patient care 13. Question 41 MCM Complete the sentences by choosing the most probable option for the missing information that corresponds with the same numbered list of options provided.In nursing care for elderly patients, especially those with Alzheimer's disease, delegator-related barriers can significantly affect the quality of care. One of the primary delegator barriers is(are) the in assigning responsibilities. The nurse must be clear about their delegating tasks, especially since Alzheimer's patients require consistent, specialized care. Furthermore, the delegator might harbor doubts about the competence or training of the delegatee in handling Alzheimer's patients, leading to hesitancy in assigning critical tasks. This hesitancy can disrupt Additionally, there may be a lack of understanding or communication about the specific needs and preferences of the patient. A 72-year-old with Alzheimer's might have particular routines or triggers, and any oversight due to poor delegation can result in episodes of for the patient. Effective delegation, therefore, is crucial in ensuring seamless, patient-centered care for those with Alzheimer's disease. 14. Question 60 MCM Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided.The nurse is working with an AP to provide care for a bedridden patient. The patient is unable to move or turn in bed without assistance.The nurse may delegate the AP to and the patient every 15. Health historyNurse's notesVital signsLab results HypertensionDiabetes mellitus type 2 John appeared anxious, reported a pain level of 8 out of 10, and described the pain as a crushing sensation in his chest radiating to his left arm. His vital signs upon arrival were: Blood pressure 160/95 mmHg, Heart rate 102 bpm, Respiratory rate 22 breaths per minute, and oxygen saturation 94% on room air. His electrocardiogram (ECG) showed ST-segment elevation in the anterior leads, and his initial blood work revealed elevated cardiac troponin levels. Question 67 MCM John Arler, a 68-year-old Caucasian male, arrived at the rural emergency department (ED) with complaints of chest pain and shortness of breath that began earlier in the morning. He has a known history of hypertension and type 2 diabetes. The decision was made to transfer John to a higher-level facility for cardiac catheterization. Given the client's situation in a rural ED being transferred to another hospital for cardiac catheterization, which essential documents should the nurse send with the client? Select all that apply. HCP (Health Care Provider) progress notes Nurse’s notes EMTALA (Emergency Medical Treatment and Labor Act) form HCD (Health Care Directive) brought from home MAR (Medication Administration Record) Recent ECG and lab results Consent forms for transfer and procedures Nurse initial log 16. Nurse's notesHealth history Upon admission, John's vital signs were a cause for concern: his respiratory rate was elevated at 26 breaths per minute, and his oxygen saturation was 89% on room air. Lab results revealed elevated white blood cell counts and chest X-rays confirmed the presence of extensive pulmonary infiltrates. Question 46 MCM John Reynolds, a 54-year-old Caucasian male, was admitted to the hospital for treatment of severe pneumonia. His health history included chronic obstructive pulmonary disease (COPD) and a mild penicillin allergy. During his treatment, a critical incident occurred. John was prescribed a specific medication that was intended for intramuscular injection, as per his treatment plan. However, due to a miscommunication, the medication was incorrectly administered intravenously by a staff nurse. Shortly after the administration, John experienced a respiratory arrest, a life-threatening event requiring immediate resuscitation and intensive care. He was stabilized and then transferred to the intensive care unit for further monitoring and treatment. This incident prompted an immediate response from the nurse manager, who recognized the gravity of the error and its implications. The nurse manager began a thorough review of the circumstances leading to the error and was preparing to address the situation with the healthcare team and hospital administration. In the context of the serious medication error involving John Reynolds, which led to his respiratory arrest and subsequent transfer to the intensive care unit, the nurse manager acknowledges that this type of error is known as: Sentinel event A medication variance. An error of commission. A process breakdown. Error of omission A compliance error. An adverse drug reaction. Near miss A communication error. 17. Health historyNurse's notesVital signsLab results Diabetes mellitus type 2COPDArterial Hypertension Robert was anxious about his health, feeling overwhelmed by his multiple chronic conditions, and concerned about the impact of his illness on his role as the primary caregiver for his wife, who has early-stage dementia. Upon admission, he presented with severe shortness of breath, fatigue, and peripheral edema. His vital signs were concerning, with a blood pressure of 170/100 mmHg, heart rate of 102 bpm, and respiratory rate of 28 breaths per minute. His oxygen saturation was 88% on room air, necessitating supplemental oxygen. Question 39 MCM Robert Johnson, a 58-year-old Black male with advanced congestive heart failure (CHF), was admitted to a large acute care facility for exacerbation of his condition. Robert has a complex medical history including type 2 diabetes, chronic obstructive pulmonary disease (COPD), and hypertension. The healthcare team observed that Robert's adherence to his complex medication regimen and dietary restrictions was inconsistent, potentially contributing to his frequent hospitalizations. His case highlighted the need for a more collaborative approach in the management of his care, involving not just the healthcare professionals but also Robert and his family in decision-making processes. In the context of the complex healthcare needs of patients like Robert Johnson, what result do the nurse leaders of a large acute care facility expect to see by implementing shared decision-making in each nursing unit? Please select your answer Simplifying complex medical regimens for chronic conditions. Reducing the use of advanced medical technology in patient care. Minimizing the involvement of family members in care discussions. Increased adherence to treatment plans by patients. Decreasing the need for interdisciplinary team meetings. Lowering the overall cost of patient care. 18. Health historyNurse's notesVital signs His medical history includes controlled hypertension and a previous episode of urinary retention. Postoperatively, Mr. Thompson's recovery was steady. He initially experienced mild urinary incontinence and discomfort, which were managed effectively. His vital signs remained stable throughout his stay: blood pressure averaged 130/80 mmHg, heart rate was around 72 bpm, and his temperature stayed within normal limits. Lab results post-surgery showed no signs of infection, and his hemoglobin levels were slightly lower than normal but stable. Question 68 MCM Mr. George Thompson, a 68-year-old Caucasian male, was admitted to the urology ward for a Transurethral Resection of the Prostate (TURP) procedure due to benign prostatic hyperplasia (BPH). As his discharge date approaches, the nursing team has been focusing on educating Mr. Thompson about post-TURP care to ensure a smooth transition home. He has been attentive and engaged during these sessions, asking several pertinent questions about his recovery. While preparing Mr. Thompson for discharge following his TURP procedure, which of the following client statements should indicate a need for further teaching before discharge? “I will need to increase fiber in my diet.” “I can resume sexual activity as soon as I feel ready.” “It's normal if I experience some burning during urination initially.” “I should call the doctor if I have a fever.” “I will need to have my yearly prostate exams.” “I will avoid lifting heavy objects for several weeks.” “I should limit fluid intake to help stop dribbling.” “I should avoid driving until I am cleared by my doctor.” “I understand that occasional blood in my urine is normal at first.” 19. Question 69 MCM In a busy urban hospital, two clients, Mr. Johnson, and Mr. Davis, were sharing a semiprivate room. Mr. Johnson, a 60-year-old African-American male, had been admitted for routine tests following complaints of persistent fatigue and unexplained weight loss. His medical history included controlled type 2 diabetes and hypertension. The nurse's notes indicated that Mr. Johnson was anxious about his test results, which had included a series of scans and biopsies. His vital signs were stable, and he had been compliant with all diagnostic procedures. Mr. Davis, a 55-year-old Caucasian male, was recovering from a minor surgical procedure. He was scheduled for discharge later that day. The healthcare provider (HCP) was preparing to inform Mr. Johnson of his cancer diagnosis. The situation required delicate handling to maintain confidentiality and respect both patients' rights. The nurse, aware of the need for privacy and sensitivity in delivering such news, considered the best approach to ensure that Mr. Johnson could receive his diagnosis in a private and supportive environment. Considering the need to maintain client confidentiality in a semiprivate hospital room, which statement by the nurse is best when attempting to protect the privacy of Mr. Johnson as he is about to be informed of his cancer diagnosis? To Mr. Davis: “Would you mind stepping out for a short time? The doctor has to discuss some private matters with Mr. Johnson.” To Mr. Johnson and Mr. Davis: “I need to create some privacy for a confidential discussion. Mr. Davis, I will assist you to another area briefly.” To Mr. Johnson: “Would you prefer to have this conversation in a private room? We can arrange for that.” To the HCP: “Can we use the consultation room for this discussion to ensure privacy?” To Mr. Davis: “I would like to walk you down to the lounge for 10 or 15 minutes. It’s good for your lungs to do some deep breathing with activity.” To the HCP: “For privacy, could you please wait to tell Mr. Johnson about his cancer? His roommate will be going home in a couple of hours.” To Mr. Davis: “I need to check your postoperative vitals. Let's do that in the examination room down the hall.” To Mr. Davis: “This would be a good time to go for a walk. The doctor needs to tell your roommate something confidential.” To Mr. Davis: “The doctor needs to talk to your roommate. Could you please turn on your TV and not listen to what they say?” 20. Nurse's Minutes Nurse A, James, an experienced nurse, is caring for a post-operative patient whose vital signs have been gradually deviating from the expected range. He approaches the attending physician, stating, "I am concerned about Mr. Davis's blood pressure trends and heart rate; I'm uncomfortable with the current management plan. I believe this could be a safety issue requiring immediate reassessment." Nurse B, Sophia, relatively new to the ICU, notices that the medication prescribed for her patient seems unusually high. She quietly consults a colleague, expressing her unease but hesitates to escalate the issue to the healthcare team. Nurse C, Michael, observes a procedural breach in infection control by a fellow nurse during a central line insertion. He immediately reports the incident to the infection control team but does not address it directly with the involved colleague. Nurse D, Lily, attending to a critically ill patient, is concerned about the patient's declining neurological status. She calls the on-call neurologist and says, "I need to speak to you about my patient's deteriorating condition; I think we might be missing something critical." Question 51 MCM In a bustling metropolitan hospital, Nurse Manager Olivia Martinez oversees a diverse team of staff nurses in a high-acuity intensive care unit (ICU). Recently, the hospital administration implemented the CUS communication system, aimed at enhancing patient safety and staff communication. Olivia has been actively training her team on this new protocol, emphasizing its importance in critical patient care scenarios. The team comprises a mix of experienced and new nurses, each bringing different perspectives and levels of comfort with assertive communication in a high-stress environment.During a particularly busy shift, several challenging situations arise, each handled by a different staff nurseWhich statement by a staff nurse indicates the proper use of the CUS communication system in these scenarios? Nurse B Nurse D Nurse A Nurse C 1 out of 20 You 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.