365 Leadership & Management questions written for the NCLEX-RN, each with a rationale explaining why the correct answer is correct and why the others are not. Free, no account required. 10 examples are shown below.
Practice all 365 questions →Answers are shown so you can read these as worked examples. To answer them yourself and track what you get wrong, start a practice set.
Post-bowel resection with sudden fever, tachycardia, peritoneal signs, and hypotension most strongly suggests an anastomotic leak causing peritonitis— a surgical emergency.
The RN should not delegate tasks requiring clinical judgment or nursing assessment - these are core RN responsibilities. Delegating assessment based solely on experience (A) is inappropriate; competency must be verified for specific tasks. The RN always retains accountability even when delegating (C). Delegation is about appropriate use of team members regardless of RN time (D).
When direct communication fails, involving nurse managers to facilitate communication with pharmacy leadership is appropriate. This follows chain of command and addresses systemic issues. Immediate reporting bypasses attempts at resolution, while accepting delays compromises patient care and avoiding conflict fails to address the problem.
This is an example of nonviolent communication (NVC), which uses observation without judgment, expresses feelings, identifies needs, and makes requests. The charge nurse observed behavior, expressed a need (patient rest), and made a collaborative request rather than accusing or criticizing. Assertive aggression would be confrontational, passive-aggressive would imply the issue indirectly with underlying anger, and collaborative is close but NVC is the more specific framework.
Training super-users who can then train other staff is an effective resource management strategy. This approach maximizes training efficiency by using internal resources rather than external trainers for all staff, and creates ongoing expertise within the unit. Purchasing additional equipment is costly, limiting implementation delays benefits, and waiting to train all staff before implementation delays necessary system adoption.
Nurses have a duty to provide safe care. When workload exceeds safe limits, the nurse must communicate with the charge nurse to request assistance or help prioritize tasks. Leaving tasks undone without notification could constitute patient abandonment or negligence. Working faster may compromise care quality. Delegating nursing tasks to unlicensed staff beyond their scope is inappropriate.
Preventing elopement in patients with dementia requires least restrictive interventions first. Placing the patient near the nursing station allows for closer monitoring. Wander guard systems provide security without restricting movement. Restraints should only be used as a last resort after other measures fail and with appropriate orders. Locking all exit doors is not appropriate as it restricts all patients and visitors.
Laissez-faire leadership is characterized by a hands-off approach where the leader provides minimal guidance or direction. Staff are given freedom to make decisions and solve problems independently. While this can work with highly skilled, self-motivated teams, it can lead to lack of direction and accountability when not appropriately applied.
The first step in fall prevention is assessment. Using a validated fall risk assessment tool (such as the Morse Fall Scale or Hendrich II Fall Risk Model) identifies the patient's specific risk factors, enabling targeted interventions. Restraints and sedation are never first-line interventions and may actually increase fall risk and cause injury.
Patient safety is the immediate priority during a busy, short-staffed shift. The nurse manager must first address the patient care issue by redistributing assignments. Formal conflict resolution can occur after patient safety is ensured. Threatening disciplinary action is not therapeutic and doesn't address the immediate care needs.
