A ward introduces hourly rounding and bed alarms to reduce falls. After 3 months, falls have dropped from 4.8 to 2.0 per 1,000 patient-days, but patients complain of broken sleep and night-time sedative use has doubled. In the Plan-Do-Study-Act cycle, what is the best next step?

Adapt the change and test it in a new cycle

Abandon the change because sedation has risen

Adopt the change and spread it hospital-wide

Stop measuring because the falls target is met

After a patient dies following a wrong-blood transfusion, the hospital carries out a root cause analysis. The main focus of this analysis is to:

Identify the system and process failures behind the event

Predict failures in a new process before it is started

Calculate the financial cost of the event to the hospital

Identify which staff member should be disciplined

A nurse often skips barcode scanning at the bedside because "everyone does it to save time". No patient has been harmed. Under a just culture, the best response is:

Coaching the nurse and fixing the reasons staff skip scanning

Disciplinary action because this is reckless behaviour

No action because no patient has come to any harm

Consoling the nurse because this was a simple human error

Four medicines are due at 0900 on a medical ward. Which one should the nurse give first?

First IV dose of piperacillin-tazobactam for suspected sepsis

Oral atorvastatin for a stable patient with high cholesterol

Subcutaneous enoxaparin prophylaxis for a mobile patient

Oral omeprazole for a patient with known reflux disease

Leadership, delegation and unit management

34 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Leadership, delegation and unit management, part of Leadership, Ethics and Professional Practice. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A ward introduces hourly rounding and bed alarms to reduce falls. After 3 months, falls have dropped from 4.8 to 2.0 per 1,000 patient-days, but patients complain of broken sleep and night-time sedative use has doubled. In the Plan-Do-Study-Act cycle, what is the best next step?
1. AAdapt the change and test it in a new cycle
2. BAbandon the change because sedation has risen
3. CAdopt the change and spread it hospital-wide
4. DStop measuring because the falls target is met
Show answerHide answer
Answer: A · Adapt the change and test it in a new cycle
In the Act step, the team decides to adopt, adapt or abandon a change based on the Study results. Falls fell, so the change works, but a balancing measure worsened: more sedatives and poor sleep can themselves cause delirium and falls. The best step is to adapt the change, for example quieter rounding at night, and test it again in another PDSA cycle. Spreading it now would spread the harm as well.
- B: The main outcome improved, so abandoning the change wastes a real gain.
- C: Spreading a change with a worsening balancing measure spreads the harm.
- D: Measurement must continue to confirm the gain holds and the harm is fixed.
Question 2 · Medium
After a patient dies following a wrong-blood transfusion, the hospital carries out a root cause analysis. The main focus of this analysis is to:
1. AIdentify the system and process failures behind the event
2. BPredict failures in a new process before it is started
3. CCalculate the financial cost of the event to the hospital
4. DIdentify which staff member should be disciplined
Show answerHide answer
Answer: A · Identify the system and process failures behind the event
Root cause analysis is a structured, retrospective review that asks why an event happened, repeatedly, until the underlying system causes are found. It looks at processes such as patient identification, labelling and staffing rather than blaming individuals. The result is an action plan to prevent recurrence. JCI requires a root cause analysis for every sentinel event.
- B: Predicting failures before a process starts is FMEA.
- C: Cost is not the purpose of the analysis.
- D: RCA focuses on systems, not on blaming individuals.
Question 3 · Medium
A nurse often skips barcode scanning at the bedside because "everyone does it to save time". No patient has been harmed. Under a just culture, the best response is:
1. ACoaching the nurse and fixing the reasons staff skip scanning
2. BDisciplinary action because this is reckless behaviour
3. CNo action because no patient has come to any harm
4. DConsoling the nurse because this was a simple human error
Show answerHide answer
Answer: A · Coaching the nurse and fixing the reasons staff skip scanning
Just culture separates human error (consoled), at-risk behaviour (coached) and reckless behaviour (sanctioned). Taking a shortcut because the risk is not recognised and others do it is at-risk behaviour, a drift from safe practice. The manager coaches the nurse about the risk and looks for system causes, such as slow scanners or workflow pressures. The response depends on the behaviour, not on whether harm occurred.
- B: Reckless behaviour is conscious disregard of a known, substantial risk.
- C: Just culture judges the behaviour, not the outcome.
- D: Human error is an unintended slip; this was a repeated choice.
Question 4 · Easy
During a fire evacuation of a surgical ward, which leadership style should the charge nurse use?
1. ADemocratic
2. BLaissez-faire
3. CAutocratic
4. DServant
Show answerHide answer
Answer: C · Autocratic
In an emergency such as a fire or a cardiac arrest there is no time for discussion, so a leader who gives short, direct orders and expects them to be carried out at once is most effective. Autocratic leadership centralises decisions and gives clear roles, which reduces confusion. Once the crisis is over, a more participative style suits routine unit work. Good leaders adapt their style to the situation.
- A: Seeking group opinion wastes vital time during an evacuation.
- B: Leaving staff to decide alone in a crisis causes confusion and delay.
- D: Servant leadership focuses on growing staff, not on rapid crisis control.
Question 5 · Medium
Four medicines are due at 0900 on a medical ward. Which one should the nurse give first?
1. AOral atorvastatin for a stable patient with high cholesterol
2. BFirst IV dose of piperacillin-tazobactam for suspected sepsis
3. CSubcutaneous enoxaparin prophylaxis for a mobile patient
4. DOral omeprazole for a patient with known reflux disease
Show answerHide answer
Answer: B · First IV dose of piperacillin-tazobactam for suspected sepsis
Delay in the first dose of antibiotics in sepsis increases mortality, so the Surviving Sepsis Campaign recommends giving them as soon as possible, ideally within 1 hour of recognition. This makes the first antibiotic dose time-critical. The statin, proton pump inhibitor and prophylactic enoxaparin can safely be given a little later within the usual window. Time-critical medicines are given first when several are due.
- A: A short delay in a statin dose causes no harm.
- C: Prophylactic enoxaparin in a mobile patient is not time-critical to the minute.
- D: A short delay in omeprazole for chronic reflux is safe.
Question 6 · Medium
On a busy medical ward, the RN can appropriately delegate to a trained nursing assistant:
1. ATeaching a patient with asthma how to use an inhaler spacer
2. BWalking a patient for the first time after surgery
3. CRecording oral intake for a patient on fluid restriction
4. DAssessing the pressure areas of a new admission
Answer and explanation in LearnFree account
Question 7 · Easy
Which type of evidence ranks lowest in the usual hierarchy of evidence for nursing practice?
1. AOpinion of expert committees
2. BA well-designed cohort study
3. CA systematic review of controlled trials
4. DA single randomised controlled trial
Answer and explanation in LearnFree account
Question 8 · Medium
Avoiding is an appropriate conflict strategy when:
1. AThe issue is important and a lasting solution is needed
2. BKeeping goodwill matters more to you than the issue
3. CThe issue is minor or a cooling-off period is needed
4. DOne party is clearly unsafe and must be stopped at once
Answer and explanation in LearnFree account
Question 9 · Medium
Staff on a ward follow a senior nurse's advice on wound care because of her known skill, although she holds no management title. This type of power is:
1. AReward power
2. BCoercive power
3. CExpert power
4. DLegitimate power
Answer and explanation in LearnFree account
Question 10 · Medium
During a day shift a nurse notices that a colleague smells of alcohol, has slurred speech and is unsteady while preparing medications. What should the nurse do?
1. AAsk the colleague to stay away from medicines
2. BReport the colleague to the charge nurse at once
3. CTake no action unless an error actually occurs
4. DSpeak to the colleague privately after the shift
Answer and explanation in LearnFree account
Question 11 · Easy
Two staff nurses both ask for the same week of leave over Eid. The manager gives each nurse half the week off. Which conflict strategy has been used?
1. ACompromising
2. BAccommodating
3. CCollaborating
4. DAvoiding
Answer and explanation in LearnFree account
Question 12 · Medium
A nurse realises she has just given 8 units of rapid-acting insulin to the wrong patient, who does not have diabetes. Her first action is to:
1. AComplete an incident report on the hospital system
2. BInform the nurse manager about the medication error
3. CGive the intended patient his correct insulin dose
4. DCheck the patient's blood glucose and assess him
Answer and explanation in LearnFree account
Question 13 · Hard
The emergency department needs a surgical bed now for a patient with acute appendicitis, and the ward is full. Which current patient is the most appropriate to discharge first, if the surgeon agrees?
1. ADay 1 after prostate resection, catheter draining clots, on bladder irrigation
2. BNew atrial fibrillation, heart rate 128/min, awaiting rate control
3. CDay 3 after hernia repair, afebrile, eating, pain 2/10 on oral analgesia
4. DDay 1 of IV antibiotics for pneumonia, temperature 38.9 C
Answer and explanation in LearnFree account
Question 14 · Medium
Before new smart infusion pumps are introduced, a team maps each step of their use and asks what could fail, how likely it is and how severe it would be. This tool is:
1. AFailure mode and effects analysis
2. BRoot cause analysis
3. CA Plan-Do-Study-Act cycle
4. DA retrospective chart audit
Answer and explanation in LearnFree account
Question 15 · Medium
When a nurse calls the physician using SBAR, which statement belongs under Assessment?
1. A"Her blood pressure has fallen to 86/50 mm Hg."
2. B"I think she may be bleeding internally."
3. C"She had an abdominal hysterectomy yesterday."
4. D"Please come and see her within 15 minutes."
Answer and explanation in LearnFree account
Question 16 · Hard
A charge nurse receives four requests at the same moment: A: a nursing assistant says a patient on a morphine PCA is very hard to wake, RR 8/min B: the pharmacist calls about a discrepancy in the controlled-drug count C: a daughter asks that a female doctor examine her mother tomorrow D: a staff nurse asks for help with a complex wound dressing Which should the charge nurse deal with first?
1. ARequest A
2. BRequest B
3. CRequest D
4. DRequest C
Answer and explanation in LearnFree account
Question 17 · Hard
A bus crash brings many casualties to the emergency department, and the triage nurse uses START triage. Victim A: cannot walk, RR 24/min, radial pulse present, obeys commands Victim B: walking, forearm laceration, talking clearly Victim C: cannot walk, RR 20/min, radial pulse absent, capillary refill 4 seconds Victim D: not breathing, still apnoeic after the airway is repositioned Which victim should be tagged immediate (red)?
1. AVictim C
2. BVictim A
3. CVictim B
4. DVictim D
Answer and explanation in LearnFree account
Question 18 · Medium
The main purpose of a patient classification (acuity) system on a nursing unit is to:
1. ADecide the order in which patients will be discharged
2. BFix one nurse to every six patients on all shifts
3. CMatch staff numbers and skill mix to patients' care needs
4. DRank nurses for promotion by their years of experience
Answer and explanation in LearnFree account
Question 19 · Medium
A charge nurse leads a newly graduated nurse who is eager to learn but not yet skilled in many ward procedures. Under situational leadership theory, the best approach is:
1. ASharing decisions while giving little direction
2. BDelegating decisions and stepping well back
3. CExplaining ideas but not checking the work
4. DGiving clear direction with close supervision
Answer and explanation in LearnFree account
Question 20 · Hard
An 18-bed ward is full. Over 24 hours it is staffed by 5 RNs and 2 nursing assistants on the 12-hour day shift and 4 RNs and 1 nursing assistant on the 12-hour night shift. Counting all nursing staff, what were the nursing hours per patient day (NHPPD)?
1. A8.0
2. B6.0
3. C3.3
4. D4.7
Answer and explanation in LearnFree account
Question 21 · Medium
At the start of a night shift, two of the five nurses on a 30-bed ward call in sick. The charge nurse's best first action is to:
1. ATell the day nurses they must all stay until morning
2. BDivide the 30 patients among the three remaining nurses
3. CNotify the nursing supervisor and request extra staff
4. DStop all admissions to the ward without telling anyone
Answer and explanation in LearnFree account
Question 22 · Easy
On a ward, one nurse gives all the medications, another does all the dressings and a nursing assistant takes all the vital signs. This care delivery model is:
1. ATeam nursing
2. BFunctional nursing
3. CTotal patient care
4. DPrimary nursing
Answer and explanation in LearnFree account
Question 23 · Hard
At the start of a night shift, a staff nurse notices that a colleague smells of alcohol, has slurred speech and is unsteady while preparing an insulin dose for her patient. Which action by the nurse is most appropriate?
1. ASpeak to the colleague privately and advise her to drink coffee before giving any medicines
2. BQuietly double-check the colleague's medicines for the rest of the shift without telling anyone
3. CWait until the end of the shift and then send a written complaint to the licensing authority
4. DReport the observations to the charge nurse at once so the colleague is removed from patient care
Answer and explanation in LearnFree account
Question 24 · Easy
The right of delegation that requires the RN to describe the task clearly, state its limits and say exactly what must be reported back is the right:
1. ATask
2. BCircumstance
3. CSupervision and evaluation of the task
4. DDirection and communication
Answer and explanation in LearnFree account
Question 25 · Easy
Under JCI standards, a sentinel event is best defined as a patient safety event that:
1. AIs an expected complication of the patient's own disease
2. BResults in death, permanent harm or severe temporary harm
3. CReaches the patient but causes no harm
4. DIs caught before it reaches the patient
Answer and explanation in LearnFree account

9 more Leadership, delegation and unit management questions

Answer them one by one, keep your score and see your weak topics in Learn. Signed-out visitors try 25 per exam; sign in with Google to see them all.

Study Leadership, Ethics and Professional Practice

Leadership, delegation and unit management

A ward introduces hourly rounding and bed alarms to reduce falls. After 3 months, falls have dropped from 4.8 to 2.0 per 1,000 patient-days, but patients complain of broken sleep and night-time sedative use has doubled. In the Plan-Do-Study-Act cycle, what is the best next step?

After a patient dies following a wrong-blood transfusion, the hospital carries out a root cause analysis. The main focus of this analysis is to:

A nurse often skips barcode scanning at the bedside because "everyone does it to save time". No patient has been harmed. Under a just culture, the best response is:

During a fire evacuation of a surgical ward, which leadership style should the charge nurse use?

Four medicines are due at 0900 on a medical ward. Which one should the nurse give first?

On a busy medical ward, the RN can appropriately delegate to a trained nursing assistant:

Which type of evidence ranks lowest in the usual hierarchy of evidence for nursing practice?

Avoiding is an appropriate conflict strategy when:

Staff on a ward follow a senior nurse's advice on wound care because of her known skill, although she holds no management title. This type of power is:

During a day shift a nurse notices that a colleague smells of alcohol, has slurred speech and is unsteady while preparing medications. What should the nurse do?

Two staff nurses both ask for the same week of leave over Eid. The manager gives each nurse half the week off. Which conflict strategy has been used?

A nurse realises she has just given 8 units of rapid-acting insulin to the wrong patient, who does not have diabetes. Her first action is to:

The emergency department needs a surgical bed now for a patient with acute appendicitis, and the ward is full. Which current patient is the most appropriate to discharge first, if the surgeon agrees?

Before new smart infusion pumps are introduced, a team maps each step of their use and asks what could fail, how likely it is and how severe it would be. This tool is:

When a nurse calls the physician using SBAR, which statement belongs under Assessment?

The main purpose of a patient classification (acuity) system on a nursing unit is to:

A charge nurse leads a newly graduated nurse who is eager to learn but not yet skilled in many ward procedures. Under situational leadership theory, the best approach is:

An 18-bed ward is full. Over 24 hours it is staffed by 5 RNs and 2 nursing assistants on the 12-hour day shift and 4 RNs and 1 nursing assistant on the 12-hour night shift. Counting all nursing staff, what were the nursing hours per patient day (NHPPD)?

At the start of a night shift, two of the five nurses on a 30-bed ward call in sick. The charge nurse's best first action is to:

On a ward, one nurse gives all the medications, another does all the dressings and a nursing assistant takes all the vital signs. This care delivery model is:

At the start of a night shift, a staff nurse notices that a colleague smells of alcohol, has slurred speech and is unsteady while preparing an insulin dose for her patient. Which action by the nurse is most appropriate?

The right of delegation that requires the RN to describe the task clearly, state its limits and say exactly what must be reported back is the right:

Under JCI standards, a sentinel event is best defined as a patient safety event that: