Evolve HESI Leadership/Management
1. Which actions of the nurse
exhibit transactional lead-
ership? Select all that ap-
ply.
1 Motivating or inspiring
the employees
2 Meeting the targets within
the deadline
3 Working according to or-
ganizational rules
4 Correcting the errors in a
reactive manner
5 Increasing the employee
commitment of an organi-
zation
2, 3, 4
The characteristics of transactional leadership
include valuing the orders and structures of an
organization. The nurse who exhibits transac-
tional leadership will meet the targets within
the deadline given by the organization. The
nurse will also follow the rules of an organiza-
tion and will correct the errors of an employee
in a reactive manner.
Motivating or inspiring the employees and in-
creasing employee commitment are the char-
acteristics of transformational leadership.
2. The unit nurse manager
comes to work obviously
intoxicated. Which action is
the staff nurse ethically ob-
ligated to take?
1 Call the security guard.
2 Tell the nurse manager to
go home.
3 Have the supervisor vali-
date the observation.
4 Offer the nurse manager
a large cup of coffee
3 Have the supervisor validate the observa-
tion.
The staff nurse should call the hospital super-
visor to confirm and handle the problem. The
security guard has no authority in this situation.
Although sending the nurse manager home
removes the nurse manager from the clinical
setting, this action misses an opportunity for
documenting the situation and the nurse man-
ager is in no condition to drive safely. Drinking
coffee does not make a person less intoxicat-
ed.
3. Which aspects are consid-
ered when determining the
willingness of a nursing as-
sistant before delegating a
task? Select all that apply.
1 Ability
2 Attitude
2, 4, 5
An individual's willingness is related to attitude,
confidence, and commitment.
Ability is related to knowledge and skills in
a specific situation. Personality characteristics
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3 Personality
4 Confidence
5 Commitment
can influence the effectiveness of the delega-
tor.
4. Which performance ap-
praisal method is used by
nurse managers to mea-
sure the performance of
the nurse both qualitatively
and quantitatively?
1 Narrative method
2 Critical incidents method
3 Graphic rating scale form
4 Behaviorally anchored
rating scales
4
The behaviorally anchored rating scale is a
performance appraisal method that provides
an overview of nursing standards by determin-
ing performance both qualitatively and quanti-
tatively.
The narrative method requires a manager to
write a statement about the nurse's perfor-
mance. The critical incidents type is a perfor-
mance appraisal method in which a manager
keeps a written record of positive and negative
performance. The graphic rating scale form is
a performance appraisal checklist on which a
manager rates the nurse's performance on a
continuum such as excellent, good, average,
and poor.
5. The healthcare team is car-
ing for clients in an emer-
gency department. How
soon should the clients
triaged as an emergency
severity index-3 (ESI-3) be
seen by the physician ac-
cording to the five level
triage system?
1 Immediately
2 Within 1 hour
3 Could be delayed
4 Within 10 minutes
2 Within 1 hour
The clients triaged as an ESI-3 should be seen
by the physician within an hour.
The clients with life-threatening problems are
triaged as ESI-1, and they should be provided
with immediate care. The care of the clients in
ESI-4 and ESI-5 can be delayed for some time
because the condition of the clients in this level
is stable. Clients with major injuries are triaged
as an ESI-2 and require treatment within 10
minutes.
6. Which question does the
registered nurse recognize
1 "Is the delegation appropriate to the situa-
tion?"
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as related to the right of cir-
cumstance when delegat-
ing?
1 "Is the delegation appro-
priate to the situation?"
2 "Is the task within the
delegatee's scope of prac-
tice?"
3 "Is the prospective dele-
gate a willing and able em-
ployee?"
4 "Is the delegator able to
monitor and evaluate the
client appropriately?"
The question, "Is the delegation appropriate to
the situation?" is related to right circumstance.
The question, "Is the task within the delega-
tee's scope of practice?" is related to right task.
The question, "Is the prospective delegate a
willing and able employee?" is related to right
person. The question, "Is the delegator able to
monitor and evaluate the client appropriately?"
is related to right supervision.
7. Which factors does the reg-
istered nurse consider in
the decision to delegate
process? Select all that ap-
ply.
1 Evaluation
2 Nursing judgment
3 Predictability of out-
comes
4 Pervasive functions of as-
sessment
5 Complexity of the task to
be performed
3, 5
Two factors responsible for the decision to del-
egate process are predictability of outcomes
and complexity of the task to be performed.
Evaluation, nursing judgment, and pervasive
functions are not factors in the decision to del-
egate process.
8. Under a leader, a team
of followers has failed
to achieve success in
conducting research. What
does an effective leader do
in this situation?
1 Criticizes the team mem-
4 Accepts failure and gains experience from it
An effective leader should accept the failure
and gain experience from it to avoid repetition
of the same errors.
The effective leader should counsel and mo-
tivate the team members for future success
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Evolve HESI Leadership/Management
bers for failure
2 Provides excuses for the
negative outcome
3 Refuses to take the re-
sponsibility for failure
4 Accepts failure and gains
experience from it
and should not criticize them. Making excuses
for the negative outcome is not the correct ac-
tion of the effective leader. The effective leader
should take responsibility for the failure and the
growth he or she will gain from it.
9. The nursing manag-
er wants to implement
transformational leader-
ship qualities. Which ac-
tions best describe this
style of leadership? Select
all that apply.
1 Providing intellectual
stimulation
2 Intervening only when
problems exist
3 Performing experiments
with system redesign
4 Using motivator factors
to inspire work perfor-
mance
5 Monitoring performance
and taking action to correct
1, 3, 4
Transformational leaders provide intellectual
stimulation and encourage follower creativity.
They experiment with systems redesign, em-
power staff, create enthusiasm for practice,
and promote scholarship of practice in client
care. They use motivator factors liberally to
inspire work performance.
Intervening only when problems exist is a
behavior related to transactional leadership.
Monitoring performance and taking corrective
action is a transactional leadership quality.
10. Which component of del-
egation is defined as the
ability to perform duties in
a specific role?
1 Authority
2 Supervision
3 Responsibility
4 Accountability
1
Authority is the ability to perform duties in a
specific role.
Supervision is the provision of guidance and
oversight of a delegated task. Responsibility
refers to reliability, dependability, and oblig-
ation to accomplish work. Accountability in-
volves determining whether the actions are ap-
propriate and providing a detailed explanation
of what has occurred.
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11. The healthcare team is car-
ing for a client with neu-
tropenia. Which task is del-
egated to unlicensed assis-
tive personnel?
1 Administering antibiotics
2 Assisting with personal
hygiene
3 Monitoring for signs and
symptoms of infection
4 Teaching the client and
caregivers about how to
avoid infection
2
Unlicensed assistive personnel assisting with
the client's personal hygiene.
The licensed practical nurse administers an-
tibiotics. Monitoring for signs and symptoms
is performed by the licensed practical nurse.
The registered nurse teaches the client and
caregivers how to avoid infection.
12. A client's serum potassium
level has increased to 5.8
mEq/L (5.8 mmol/L). What
action should the nurse im-
plement first?
1 Call the laboratory to re-
peat the test.
2 Take vital signs and notify
the healthcare provider.
3 Inform the cardiac arrest
team to place them on alert.
4 Take an electrocardio-
gram and have lidocaine
available.
2
Vital signs monitor cardiorespiratory status;
hyperkalemia causes cardiac dysrhythmias.
The healthcare provider should be notified be-
cause medical intervention may be necessary.
A repeat laboratory test will take time and
probably reaffirm the original results; the client
needs immediate attention. The cardiac arrest
team is always on alert and will respond when
called for a cardiac arrest. Taking an electro-
cardiogram and having lidocaine available are
insufficient interventions.
13. The nurse has accepted
a position as a navigator.
What should the nurse ex-
pect to learn during train-
ing for this role? Select all
that apply.
1 Approaches to reduce the
2, 3, 4, 5
Navigators are responsible for overcoming
health system barriers, providing health edu-
cation about diseases from prevention to treat-
ment, addressing barriers to care, and provid-
ing psychosocial support. These are the areas
the nurse should expect to focus on when be-
ing trained in the role.
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Evolve HESI Leadership/Management
cost of health care
2 Learning ways to work
through the health systems
3 Strategies to teach
clients about disease, in-
cluding prevention and
treatment
4 Assessing barriers that
clients have encountered
while attempting to receive
care
5 Helping clients cope with
delays in receiving treat-
ment until barriers are
overcome
Learning approaches to reduce the cost of
health care would be appropriate for a case
manager to learn.
14. What aspect of total client
care needs to be taken into
consideration if used on a
24-bed care area?
1 Cost of nurses
2 Training needs
3 Documentation
4 Time commitment
1 Cost of nurses
Since total client care is provided by a reg-
istered nurse (RN) it can be very expensive
and not realistic to use a highly skilled and
extremely knowledgeable professional nurse
to provide all the care required in a unit of 24
clients.
There are no particular issues with training,
documentation, or time commitment with total
client care.
15. For which situations would
total client care be an ap-
propriate delivery system?
Select all that apply.
1 Client scheduled for
lithotripsy for renal calculi
2 Client with an endotra-
cheal tube for pulmonary
sepsis
2, 3, 4
Total client care is used in critical care settings
where one nurse provides total care to one or
two critically ill clients. The client with an en-
dotracheal tube for pulmonary sepsis and the
client recovering from cardiovascular bypass
graft surgery are considered acutely ill and will
be receiving care in a critical care area. The
client recovering from cranial surgery to place
a cerebrospinal fluid shunt would be appropri-
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Evolve HESI Leadership/Management
3 Client recovering
from cardiovascular by-
pass graft surgery
4 Client recovering from
the placement of a cere-
brospinal fluid shunt
5 Client transferring to a re-
habilitation unit after total
hip replacement surgery
ate for total client care.
Total client care would not be an ideal care
approach for the client scheduled for lithotripsy
or the client being transferred to a rehabilitation
unit.
16. Which intervention should
the charge nurse perform
to manage a task when
the unlicensed nursing per-
sonal (UNP) is lacking com-
petence?
1 Provide constructive
feedback and assign an-
other task.
2 Provide open vocal feed-
back and withdraw the UNP
from task.
3 Provide additional sup-
port and temporarily lower
expectations.
4 Provide accountability to
the organization and un-
dergo training again.
3 Provide additional support and temporarily
lower expectations.
The charge nurse should manage a task by
temporarily lowering expectations and provid-
ing additional support to an unlicensed nurs-
ing personal (UNP) who is lacking compe-
tence. This strategy allows the UNP to build
on strengths, minimize weaknesses, and gain
confidence.
Providing constructive feedback and assigning
another task may not improve the strategy of
the UNP and may affect the productivity of
the new task. Withdrawing the UNP from the
task and providing open vocal feedback may
weaken the working relationship and the UNP
may lose confidence or become frustrated.
The charge nurse should be aware of account-
ability to the organization in case of a failure
of the delegation, but assigning the UNP for
further training may lead to high risk for legal
liability.
17. Which statement would
most likely be made by
a client who is receiving
care through the functional
method?
3 "I have to wait until the medication nurse is
available for a pain pill."
In the functional method, staff are assigned
tasks according to scope of practice. In this
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Evolve HESI Leadership/Management
1 "My nurse's name is
Amy."
2 "Susan will be caring for
me until 7 pm."
3 "I have to wait until the
medication nurse is avail-
able for a pain pill."
4 "Barbara coordinated all
of my care but I might re-
ceive the care from other
nurses."
approach a medication nurse will be identified.
Knowing the nurse's name would more likely
be a characteristic of team or primary nursing.
Knowing which nurse will provide care for a
specific period of time would indicate the case
approach to care. Knowing which nurse coordi-
nated the care that might be provided by others
would more likely indicate primary nursing or
case management.
18. Which constructive as-
pects of conflict does the
nurse leader identify? Se-
lect all that apply.
1 Polarizes groups
2 Releases pent-up emo-
tions
3 Promotes ineffective
communication
4 Helps individuals grow
personally
5 Builds cohesiveness
among people
2, 4, 5
Conflict serves as a release for pent-up emo-
tion, anxiety, and stress. It helps individuals to
grow personally and apply what they learn to
future situations. It helps to build cohesiveness
among people sharing the conflict, celebrating
in its settlement and learning more about each
other.
It polarizes groups so they increase internal
cohesiveness and reduce intergroup coopera-
tion; this is a destructive aspect of conflict. Au-
thentic communication is an aspect of conflict
but not improbable communication.
19. When does delegation be-
come more challenging?
Select all that apply.
1 When the client is stable
2 When the client is preg-
nant
3 When the geographic
area is small
4 When the resources are
abundant
2 When the client is pregnant, 5 When school
children are receiving care
The delegation process becomes more chal-
lenging when vulnerable populations such as
pregnant women and school children are re-
ceiving care.
Delegation can be safely and successfully car-
ried out in the stable client. Delegation can
be accomplished successfully when the ge-
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Evolve HESI Leadership/Management
5 When school children are
receiving care
ographical area is small and resources are
abundant.
20. A client reports severe pain
2 days after surgery. After
assessing the characteris-
tics of the pain, which ini-
tial action should the nurse
take next?
1 Encourage rest.
2 Obtain vital signs.
3 Administer the pre-
scribed analgesic.
4 Document the client's
pain response.
2 Obtain vital signs.
Immediately before administration of an anal-
gesic, an assessment of vital signs is neces-
sary to determine whether any contraindica-
tions to the medication exist (e.g., hypotension,
respirations d12 breaths/min).
Pain prevents both psychological and physi-
ologic rest. Before administration of an anal-
gesic, the nurse must check the healthcare
provider's prescription, the time of the last ad-
ministration, and the client's vital signs. A com-
plete assessment, including vital signs, should
be done before documenting the client's pain
response.
21. A nurse leader, along with
the team, is caring for a
client who is scheduled for
colonoscopy. Which dele-
gated task requires the
leader's supervision?
1 Assisting the client with
an enema
2 Assisting the client with
bathing
3 Assisting the client with
feeding
4 Assisting the client with
ambulating
1 Assisting the client with an enema
A client who is scheduled for colonoscopy re-
quires having the gastrointestinal tract emp-
tied, mainly the colon. Before undergoing this
procedure the client is assisted with an enema
and other laxatives to expel all bowel contents
present in the gastrointestinal tract. A nurse
leader should supervise this procedure, as an
inadequately emptied colon may cause com-
plications.
Assisting the client with bathing, feeding, and
ambulating are easy tasks and may not require
supervision.
22. Which comment by a team
leader exemplifies team
nursing the way it was in-
2 "(Registered Nurse 1), check all of the intra-
venous (IV) sites and give the IV medications."
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tended?
1 "(Unlicensed assistive
personnel), I need you to
measure all vital signs."
2 "(Registered Nurse 1),
check all of the intravenous
(IV) sites and give the IV
medications."
3 "(Licensed Practical
Nurse), you pass all of
the oral medications to the
clients today."
4 "(Registered Nurse 2), Mr.
Jones has a foot wound,
two IV meds, and needs
morning insulin."
The team leader must have excellent com-
munication skills, delegation, and effective de-
cision-making abilities to provide a working
"team" environment for members. When the
team leader is not prepared for this role, the
team method becomes a miniature version of
the functional method. The assignment given
to RN 1 takes the nurse's experience and skills
into consideration and exemplifies team nurs-
ing.
The statements made to the UAP, LPN, and
RN 2 exemplify functional nursing.
23. The registered nurse finds
that two nursing students
are arguing with each oth-
er. Which action by the reg-
istered nurse best repre-
sents a leadership quality?
1 Complaining to manage-
ment and asking the stu-
dents to go outside
2 Letting them continue ar-
guing until they resolve the
matter themselves
3 Assessing the condition
and strategizing to resolve
the matter by reducing the
difference
4 Asking the reason for
their argument and repri-
manding them for having
3
Visioning is required by an efficient leader to
engage others to assess the current reality.
This skill includes determining and specifying
a desired end-point state and then strategizing
to reduce the differences.
Letting them continue arguing and waiting until
they resolve the matter may allow the argu-
ment to escalate. Complaining to management
would pass off responsibility for a resolution
and would not indicate leadership. Reprimand-
ing the nurses may stop the argument, but
would not be a constructive approach.
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Evolve HESI Leadership/Management
the argument in the hospi-
tal
24. Which point should the
nurse exclude when devel-
oping strategies to project
a powerful image?
1 Using authoritative lan-
guage
2 Maintaining good body
posture
3 Making good eye contact
with clients
4 Ensuring that clothing
and hair are appropriate to
the situation
1 Using authoritative language
The nurse should treat people with courtesy
and respect. The use of authoritative language
does not help in developing a powerful image.
The nurse should also maintain good body
posture because it conveys self-confidence.
Good eye contact helps in developing trust.
Appropriate dress and hair help convey a pow-
erful image.
25. Which statement of the
nurse leader reflects the
actions suggested by the
Joint Commission for dis-
ruptive behavior by a direct
care nurse?
1 "This is the last warning
for you."
2 "You are terminated, ef-
fective now."
3 "This will affect your as-
sessment markings."
4 "You should not behave
this way because you are
very talented."
2 "You are terminated, effective now."
According to the actions suggested by the
Joint Commission, there is "zero" tolerance for
an intimidating and/or disruptive behavior. The
action to be taken for this type of behavior
should be suspension, termination, loss of clin-
ical privileges, and reporting to professional
licensure bodies.
The actions suggested by the Joint Commis-
sion do not include giving last a warning. The
nurse who has behaved disruptively is not eligi-
ble for any assessment. By saying, "You should
not behave this way because as you are very
talented," the actions suggested by Joint Com-
mission are not being carried out.
26. According to the
three-tiered triage system,
which client requires ur-
1, 4, 5
According to the three-tiered triage system, re-
nal colic, severe abdominal pain, and multiple
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Evolve HESI Leadership/Management
gent treatment? Select all
that apply.
1 A client with renal colic
2 A client with strains and
sprains
3 A client with respiratory
distress
4 A client with severe ab-
dominal pain
5 A client with multiple dis-
placed fractures
displaced fractures require urgent treatment.
Strains and sprains require nonurgent treat-
ment and respiratory distress requires emer-
gent treatment.
27. The nurse finds the respi-
ratory rate is 8 breaths per
minute in a client who is on
intravenous morphine sul-
fate. What should the nurse
do immediately in this situ-
ation?
1 Measure other vital signs.
2 Stop administering the
medication.
3 Elevate the head of the
client's bed.
4 Report to the primary
healthcare provider
2 Stop administering the medication.
Morphine sulfate is an opioid analgesic and
can depress the central nervous system,
which results in respiratory depression. A res-
piratory rate of 8 breaths per minute indicates
respiratory depression, and the nurse should
stop the medication immediately.
The nurse can measure the other vital signs
after discontinuing the medication administra-
tion. Elevating the head of the client's bed en-
sures proper breathing. Therefore the nurse
should elevate the client's bed after discontinu-
ing the medication. The nurse should report to
the primary healthcare provider for an appro-
priate antidote after stopping the medication
administration.
28. A client is admitted to
the emergency depart-
ment following a mo-
tor vehicle accident. The
client's wounds are ex-
tensive. Which healthcare
team member is best suited
2 Registered nurse
A registered nurse should be the healthcare
team member to care for the client in the emer-
gency department. The charge nurse's role in-
cludes making client assignments, scheduling
breaks for staff members, and serving as a
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Evolve HESI Leadership/Management
to care for this client in the
emergency ward?
1 Charge nurse
2 Registered nurse
3 Licensed practical nurse
4 Unlicensed nursing per-
sonnel
staff resource person. The licensed practical
nurse is involved in fast-track emergency care.
Unlicensed nursing personnel perform all hy-
gienic tasks and are not required in the emer-
gency care unit.
29. A registered nurse (RN)
delegates the task of foot
care for a client to an un-
licensed nursing personnel
(UNP). The UNP is skillful
and willing to perform the
given task, but was recent-
ly hired and is unfamiliar
with the client's condition.
What should the RN do in
this situation?
1 Provide guidance to the
UNP.
2 Observe and motivate the
UNP.
3 Establish mutual expec-
tations and conditions.
4 Explain what to do and
how to perform the task.
3 Establish mutual expectations and condi-
tions.
If the delegatee is new to the workplace, but
has the ability and willingness to perform a
task, the RN should establish mutual expecta-
tions and conditions of performance to estab-
lish a good relationship.
If the delegatee has limited knowledge and
ability to perform a task, the delegator is ex-
pected to guide the UNP. The RN is expected
to observe and monitor the task performed by
the delegate to ensure the delegatee has the
ability and willingness to establish a relation-
ship and accomplish the work. The RN can
also explain the task and how to execute it if the
situation involves a new task and relationship
is ongoing.
30. Which characteristics of
a licensed practical nurse
should be considered be-
fore delegation of tasks?
Select all that apply.
1 Critical thinking
2 Effective client care
3 Diagnostic reasoning
1, 3, 4
Critical thinking, diagnostic reasoning, and the
ability to synthesize information from various
sources are three factors that are characteris-
tics of the licensed practical nurse that should
be considered before delegating tasks.
Planning effective client care is the role of
a registered nurse. Accountability for an as-
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Evolve HESI Leadership/Management
4 Synthesizing information
5 Accountability of as-
signed task
signed task is the basic responsibility of a
nurse.
31. The registered nurse is car-
ing for a client admitted to
the hospital with chronic
obstructive pulmonary dis-
ease. Which assessment
by the registered nurse be-
fore delegating would help
to determine the principle
of "right person"?
1 "Is the environment con-
ducive for completing the
task safely?"
2 "Does the licensed practi-
cal nurse (LPN) know about
polices of the institution?"
3 "Can the nursing assis-
tive personnel (NAP) eval-
uate the client's' condition
appropriately?"
4 "Does the nursing assis-
tive personnel (NAP) have
the knowledge and exper-
tise to perform the task?"
4 "Does the nursing assistive personnel (NAP)
have the knowledge and expertise to perform
the task?"
In this situation, "Does the NAP have knowl-
edge and expertise to perform the task?" is
related to the right person for delegation. The
right person deals with expertise and experi-
ence, knowledge and skills.
The assessment, "Is the environment con-
ducive for completing the task safely?" is relat-
ed to right circumstance.
The assessment, "Does the LPN know about
polices of the institution?" is related to right
task.
The assessment, "Can the NAP evaluate the
client's condition appropriately?"is related to
right supervision.
32. The nurse delegates the
tasks of caring for a post-
partum client. During as-
sessment, the nurse ob-
serves an infection in the
client caused by lack of
hygiene. Which member of
the health care team is
most likely responsible for
the client's condition? Se-
2, 5
The registered nurse may delegate the tasks
of basic client care to the unlicensed assistive
personnel (UAP), but is responsible and ac-
countable for the outcome of the task. UAP are
responsible for the client's basic hygiene and
comfort.
A physician may delegate the task of client
care to the registered nurse and other assistive
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Evolve HESI Leadership/Management
lect all that apply.
1 Physician
2 Registered nurse
3 Licensed practical nurse
4 Licensed vocational
nurse
5 Unlicensed assistive per-
sonnel
personnel. A licensed practical nurse (LPN)
or licensed vocational nurse (LVN) generally
carries out tasks such as administering oral
medication, but is not typically responsible for
client hygiene if UAP are available.
33. Why does a nurse manag-
er assign a resource per-
son in a healthcare organi-
zation?
1 To delegate tasks
2 To supervise actions
3 To serve as a mentor
4 To reassign duties to
workers
3 To serve as a mentor
The nurse manager assigns a resource person
in a healthcare organization to serve as a men-
tor for the agency nurse to prevent potential
problems that could arise if the staff member
does not know the institutional routine.
The nurse manager also delegates a task,
supervises actions, and reassigns duties to
workers.
34. A nurse is assisting anoth-
er registered nurse in the
intensive care unit who is
caring for a client with un-
controlled blood pressure.
Which action on the part of
the nurse indicates "offer-
ing" during delegation de-
cisions?
1 "Did you check the
client's blood pressure this
morning?"
2 "You can use this
stethoscope and sphyg-
momanometer to take the
blood pressure."
2 "You can use this stethoscope and sphygmo-
manometer to take the blood pressure."
Offering involves making a suggestion to facili-
tate the achievement of a desirable client care
outcome. The statement, "You can use this
stethoscope and sphygmomanometer to take
the blood pressure," is an example of offering.
Asking begins with questions related to the
problem or issue regarding client care. "Did
you check the client's blood pressure this
morning?" is an example of asking.
Doing involves demonstrating the specific task
or behavior needed to improve client care.
"Would you fetch me the client's laboratory
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