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HESI Evolve Leadership/Management Practice Exam with Answers (114 Solved Questions)

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    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 1 / 64

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    Evolve HESI Leadership/Management 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?" 2 / 64

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    Evolve HESI Leadership/Management 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 3 / 64

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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. 4 / 64

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    Evolve HESI Leadership/Management 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. 5 / 64

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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- 6 / 64

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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 7 / 64

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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- 8 / 64

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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." 9 / 64

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    Evolve HESI Leadership/Management 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. 10 / 64

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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 11 / 64

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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 12 / 64

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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- 13 / 64

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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 14 / 64

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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 15 / 64

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