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Nursing Leadership and Management · Nursing Leadership NCLEX Practice Questions

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Showing all 15 practice questions with expert explanatory rationales.

Question 1 of 15

Case excerpt

At 0645, the night nurse reports that a postoperative patient became suddenly confused and has an oxygen saturation of 86%. The day team is waiting for report.

Which action takes priority before routine handoff continues?

A. Complete the written handoff before entering the room
B. Request that the nursing assistant repeat the oxygen reading later
C. Finish medication reconciliation first
D. Assess the patient immediately and initiate urgent escalation
E. Ask the family whether confusion is usual

Expert Explanatory Rationale

Correct Answer: D. Assess the patient immediately and initiate urgent escalation

An acute change with hypoxemia requires immediate assessment and escalation; routine report can be paused.

Question 2 of 15

Case excerpt

A nurse discovers that a colleague documented a wound assessment as completed, although the dressing has remained untouched.

Which response best protects the patient and the integrity of the record?

A. Write that the colleague falsified documentation in the patient's chart
B. Ask the colleague to correct the record and independently assess the wound
C. Leave the entry because the next shift can reassess
D. Edit the colleague's entry using the colleague's login
E. Wait until the weekly staff meeting

Expert Explanatory Rationale

Correct Answer: B. Ask the colleague to correct the record and independently assess the wound

The wound needs a valid assessment and the inaccurate record must be addressed through proper documentation and reporting channels.

Question 3 of 15

Case excerpt

A patient with decision-making capacity declines a recommended amputation after the surgeon explains the consequences. The family demands that the operation proceed.

What should the nurse advocate for?

A. A delay until the family reaches agreement
B. The patient's informed refusal and continued discussion of acceptable alternatives
C. The family's preference because they will provide care
D. The surgeon's decision without further discussion
E. Discharge without documenting the discussion

Expert Explanatory Rationale

Correct Answer: B. The patient's informed refusal and continued discussion of acceptable alternatives

A capable adult has the right to refuse treatment; the nurse supports informed choice and communication.

Question 4 of 15

Case excerpt

During a shift, two nurses each believe the other is responsible for checking a blood product that is ready to start.

What should the charge nurse do?

A. Allow administration because the order is signed
B. Ask an unlicensed staff member to verify the blood
C. Clarify the assigned roles and ensure the required verification occurs before administration
D. Document that both nurses accepted responsibility
E. Tell the nurses to decide after the transfusion

Expert Explanatory Rationale

Correct Answer: C. Clarify the assigned roles and ensure the required verification occurs before administration

Role clarity and required independent checks must be established before a high-risk intervention.

Question 5 of 15

Case excerpt

A novice nurse is asked to care for a patient receiving a titrated vasoactive infusion. The nurse has not completed the unit's competency validation.

Which assignment decision is safest?

A. Ask the novice to read the policy during the shift
B. Assign the patient with a verbal promise of help
C. Assign the patient because the infusion is already running
D. Transfer all monitoring to assistive personnel
E. Pair the novice with an appropriate preceptor but retain a competent nurse responsible for the titration

Expert Explanatory Rationale

Correct Answer: E. Pair the novice with an appropriate preceptor but retain a competent nurse responsible for the titration

Assignments must match demonstrated competence; a high-risk infusion requires a validated nurse and appropriate supervision.

Question 6 of 15

Case excerpt

A nurse manager receives a report that a staff member has been taking photographs of patients on a personal phone.

Which management response is most appropriate?

A. Protect patient privacy, follow reporting procedures and notify the appropriate privacy leadership
B. Discuss the photographs at the next staff social event
C. Ask the employee to delete the images and take no further action
D. Allow the practice if names are not visible
E. Ask patients to sign a blanket consent after the fact

Expert Explanatory Rationale

Correct Answer: A. Protect patient privacy, follow reporting procedures and notify the appropriate privacy leadership

Unauthorized patient images may be a serious privacy breach and require prompt containment and formal review.

Question 7 of 15

Case excerpt

A patient falls while walking to the bathroom. The nurse manager notices the call bell was out of reach and the mobility plan was not included in handoff.

Which review approach is most useful?

A. Examine environmental setup, handoff reliability and implementation of the mobility plan
B. Require a new fall-risk score without examining the event
C. Remove bathroom privileges for all patients
D. Focus exclusively on which nurse was assigned
E. Close the review because no fracture occurred

Expert Explanatory Rationale

Correct Answer: A. Examine environmental setup, handoff reliability and implementation of the mobility plan

A systems review examines interacting process and environmental factors rather than stopping at individual blame.

Question 8 of 15

Case excerpt

A staff nurse reports that a physician has repeatedly spoken disrespectfully during emergency calls, causing nurses to hesitate before escalating concerns.

What should the nurse leader do?

A. Post an anonymous accusation on the unit noticeboard
B. Tell nurses to avoid calling that physician
C. Use the established professionalism and safety escalation process and reinforce speaking-up expectations
D. Wait until a patient is harmed
E. Ask the nurses to tolerate the behavior because the physician is busy

Expert Explanatory Rationale

Correct Answer: C. Use the established professionalism and safety escalation process and reinforce speaking-up expectations

Disrespect that suppresses safety communication requires formal intervention and a clear route for escalation.

Question 9 of 15

Case excerpt

A clinical supervisor is reviewing whether a delegation decision was appropriate for a stable rehabilitation patient.

Which activities may be assigned to trained assistive personnel when policy permits? Select all that apply.

A. Evaluate the patient's response to a first dose of analgesia
B. Help the patient dress after occupational therapy
C. Assess a new complaint of calf pain
D. Reinforce a previously taught call-bell instruction
E. Transport the stable patient to a scheduled test
F. Record routine oral intake

Expert Explanatory Rationale

Correct Answer: B. Help the patient dress after occupational therapy; D. Reinforce a previously taught call-bell instruction; E. Transport the stable patient to a scheduled test; F. Record routine oral intake

Routine, predictable activities may be delegated; new assessment and evaluation require a licensed nurse.

Question 10 of 15

Case excerpt

A nurse manager is preparing an action plan after a near miss involving a concentrated electrolyte solution.

Which system safeguards should be considered? Select all that apply.

A. Assess whether standardized concentrations are available
B. Examine labeling and barcode alerts
C. Check access controls and dispensing cabinet configuration
D. Encourage staff to report similar near misses
E. Review storage location and separation from routine fluids
F. Remove independent checks without risk review

Expert Explanatory Rationale

Correct Answer: A. Assess whether standardized concentrations are available; B. Examine labeling and barcode alerts; C. Check access controls and dispensing cabinet configuration; D. Encourage staff to report similar near misses; E. Review storage location and separation from routine fluids

Storage, standardization, labeling, reporting and access controls can reduce the chance of a repeat event.

Question 11 of 15

Case excerpt

A nurse leader is planning a fair performance appraisal.

Which information should contribute to the appraisal? Select all that apply.

A. Unverified rumors from coworkers
B. Progress on previously agreed development goals
C. Examples of observed clinical practice
D. Relevant quality and safety measures interpreted in context
E. Validated competency results
F. The nurse's input and professional goals

Expert Explanatory Rationale

Correct Answer: B. Progress on previously agreed development goals; C. Examples of observed clinical practice; D. Relevant quality and safety measures interpreted in context; E. Validated competency results; F. The nurse's input and professional goals

A fair appraisal uses objective evidence, employee input and progress against role expectations.

Question 12 of 15

Case excerpt

A unit is revising its process for identifying patients at risk of deterioration.

Which implementation elements are important? Select all that apply.

A. Provide a backup escalation route if the first contact does not respond
B. Audit response times and patient outcomes
C. Train staff to recognize and communicate warning signs
D. Assume experienced nurses do not need orientation
E. Test the process during realistic scenarios
F. Define escalation thresholds and response roles

Expert Explanatory Rationale

Correct Answer: A. Provide a backup escalation route if the first contact does not respond; B. Audit response times and patient outcomes; C. Train staff to recognize and communicate warning signs; E. Test the process during realistic scenarios; F. Define escalation thresholds and response roles

A reliable escalation system needs clear thresholds, trained staff, backup pathways and outcome monitoring.

Question 13 of 15

Case excerpt

A manager is investigating why staff turnover is highest among nurses in their first year.

Which information may help identify actionable causes? Select all that apply.

A. Exit interview themes
B. Access to mentoring and professional development
C. Assuming all departures are caused by salary
D. New-hire interviews at defined intervals
E. Assignment acuity and schedule patterns
F. Orientation and preceptor workload data

Expert Explanatory Rationale

Correct Answer: A. Exit interview themes; B. Access to mentoring and professional development; D. New-hire interviews at defined intervals; E. Assignment acuity and schedule patterns; F. Orientation and preceptor workload data

Combining staff feedback with onboarding, workload and development data can reveal modifiable retention factors.

Question 14 of 15

Case excerpt

A quality dashboard shows 9 medication omissions among 300 medication opportunities.

Calculate the omission rate as a percentage. Enter a whole number.

Expert Explanatory Rationale

Correct Answer: 3

9 ÷ 300 × 100 = 3%.

Question 15 of 15

Case excerpt

A rapid response team is called for a patient with acute respiratory compromise.

Arrange the team leader's actions in a safe sequence.

A. Recognize the emergency and activate the response
B. State the immediate concern and assign clear roles
C. Reassess the patient after interventions
D. Assign a team member to obtain vital signs and focused data

Expert Explanatory Rationale

Correct Answer: A. Recognize the emergency and activate the response; B. State the immediate concern and assign clear roles; D. Assign a team member to obtain vital signs and focused data; C. Reassess the patient after interventions

The leader activates the response, communicates the concern, assigns tasks and reassesses the patient's response.

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