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NURS 450: Nursing Leadership &
Management – Final Exam QUESTIONS
AND ANSWERS WITH RATIONALES
/GRADED A +/2026 UPDATE/100%
CORRECT!
Domain I: Foundations of Leadership & Management (Questions
1. A nurse manager is implementing transformational leadership. Which action best exemplifies this style? a. Assigning tasks based on seniority b. Using rewards and punishments to motivate staff c. Inspiring staff to exceed their own individual performance goals d. Maintaining strict adherence to hospital policies without deviation
Rationale: Transformational leadership focuses on inspiration, vision, and empowering
staff to achieve higher levels of performance.
2. A charge nurse notices that staff are avoiding a new floating nurse. Which leadership behavior best promotes inclusion? a. Ignoring the situation to allow natural group dynamics to resolve it b. Publicly welcoming the nurse and pairing them with a mentor c. Assigning the nurse only to tasks that do not require teamwork d. Sending an email reminding staff to be polite
Rationale: Active, visible support and structured mentorship reduce lateral violence and promote psychological safety.
3. A unit manager is using situational leadership. A new graduate nurse is highly motivated but lacks experience in wound VAC changes. Which leadership style should the manager use? a. Delegating b. Telling c. Participating d. Selling
Rationale: Situational leadership: High readiness (motivated) but low competence → “Participating” (high support, low direction) is appropriate.
4. According to Kouzes and Posner’s model, which behavior is a key practice of exemplary leadership? a. Maintaining the status quo b. Enabling others to act c. Avoiding risk at all costs d. Centralizing decision-making
Rationale: Enabling others to act fosters collaboration and trust.
5. A nurse leader advocates for shared governance. What is the primary goal? a. Reducing nursing salaries b. Giving staff nurses control over practice decisions c. Eliminating nurse manager positions d. Increasing physician authority on patient care units
Rationale: Shared governance empowers clinical nurses in decisions about practice, quality, and professional development.
6. A unit has high turnover and low morale. The manager implements daily 10-minute huddles to celebrate wins and identify barriers. This is an example of: a. Autocratic leadership b. Relationship-focused leadership c. Laissez-faire management d. Transactional leadership
11. Which leadership theory emphasizes that leaders are born, not made? a. Behavioral theory b. Situational theory c. Trait theory d. Contingency theory
Rationale: Trait theory proposes innate qualities (e.g., charisma, confidence) distinguish leaders.
12. A manager allows staff to make most decisions and intervenes only when asked. This is: a. Autocratic leadership b. Laissez-faire leadership c. Democratic leadership d. Transactional leadership
Rationale: Laissez-faire = hands-off, staff self-directed.
13. A nurse executive implements a “just culture” model. What is the primary focus? a. Punishing all errors equally b. Distinguishing human error from reckless behavior c. Eliminating all error reporting d. Blaming the last person who touched the patient
Rationale: Just culture balances accountability and learning, not punishment for honest errors.
14. Which behavior by a nurse manager best promotes staff empowerment? a. Micromanaging all nursing tasks b. Providing resources and autonomy for clinical decision-making c. Requiring approval for all supply orders d. Limiting continuing education opportunities
Rationale: Empowerment = autonomy, resources, and support.
15. A new nurse resists a change in IV flush protocol because “we’ve always done it this way.” This is an example of: a. Transformational acceptance b. Resistance due to habit
c. Evidence-based compliance d. Proactive adaptation
Rationale: Routine and comfort with old methods are common barriers to change.
Domain II: Legal, Ethical, and Regulatory Issues (Questions 16–30)
16. A nurse manager discovers a staff nurse administered the wrong medication but did not harm the patient. According to just culture, the manager should: a. Immediately terminate the nurse b. Investigate system factors and the nurse’s behavioral choices c. Report the nurse to the Board of Nursing without discussion d. Ignore the error since no harm occurred
Rationale: Just culture examines human error, at-risk behavior, and reckless behavior differently.
17. A nurse is asked to float to a medical-surgical unit but has no experience with telemetry. The nurse should: a. Refuse to float and stay on own unit b. Accept the assignment but notify the charge nurse of the skill limitation c. Go to the unit and ignore telemetry alarms d. Report the hospital to The Joint Commission immediately
Rationale: Nurses can float but must advocate for safe assignments. Refusal without communication may be insubordination.
18. A patient with DNR/DNI orders experiences respiratory distress. The nurse provides oxygen and comfort care but does not intubate. This is: a. Negligence b. Legally and ethically correct c. Assisted suicide d. Battery
Rationale: DNR/DNI means no intubation or CPR; oxygen and comfort are appropriate.
b. Respect the refusal and notify the provider c. Call a ethics committee without informing patient d. Force the patient to sign a waiver
Rationale: Informed refusal must be respected; document and notify provider.
24. A nurse manager overhears a physician making a disrespectful comment about a patient’s weight. The manager should: a. Ignore it to maintain good physician relations b. Address the behavior privately with the physician using “I” statements c. Report the physician to the medical board d. Laugh along to avoid conflict
Rationale: Professional conduct standards apply to all team members; address directly and respectfully.
25. A staff nurse falsifies a medication administration record. This is: a. A minor error b. Fraud and grounds for license revocation c. Acceptable if no patient harm d. A manager’s responsibility
Rationale: Falsifying records is fraud, unethical, and illegal.
26. Which situation requires the nurse manager to file an incident report? a. A patient vomits after chemotherapy (expected side effect) b. A visitor slips on a wet floor but refuses treatment c. A patient requests a chaplain d. A staff nurse loses a hospital ID badge
Rationale: Incident reports are for unexpected occurrences with risk of harm.
27. A nurse refuses to participate in a termination of pregnancy based on religious beliefs. The hospital can: a. Immediately fire the nurse b. Accommodate the refusal if patient safety is not compromised c. Force the nurse to participate anyway d. Deny future employment in any unit
Rationale: Conscience clauses protect refusal; employer must reasonably accommodate.
28. A nurse manager is sued for negligence. Which element must be proven for liability? a. The nurse intended to cause harm b. The nurse owed a duty, breached it, causing injury c. The hospital has a no-blame policy d. The patient had a poor outcome regardless of care
Rationale: Negligence = duty, breach, causation, damages.
29. A charge nurse assigns a new graduate to care for a patient on a titratable heparin drip. The graduate has not been certified for IV titration. This is: a. Appropriate delegation b. Improper assignment and potential liability c. Good learning opportunity d. The graduate’s responsibility to refuse
Rationale: Assigner (charge nurse) is responsible for matching competency to task.
30. A patient with capacity threatens to leave against medical advice (AMA). The nurse should: a. Physically block the door b. Inform the patient of risks, document, and notify provider c. Call security to restrain the patient d. Ignore the patient’s statement
Rationale: Competent patients have right to leave AMA after informed refusal.
Domain III: Quality Improvement & Patient Safety (Questions 31–
31. A nurse manager implements a rapid response team (RRT). What is the primary goal? a. Replace ICU nurses b. Prevent cardiac arrest by early intervention c. Increase hospital revenue d. Reduce family visiting hours
Rationale: RRTs reduce failure to rescue and improve outcomes.
c. Report to the Board of Nursing immediately d. Refuse to work with that nurse forever
Rationale: Peer-to-peer reminders improve safety culture.
37. Which tool is best for identifying the most frequent cause of medication errors on a unit? a. Fishbone diagram b. Pareto chart c. Scatter diagram d. Gantt chart
Rationale: Pareto principle (80/20 rule) – bar chart showing frequency.
38. A hospital implements bedside shift report (BSR). The primary benefit is: a. Nurses finish faster b. Improved patient engagement and safety c. Eliminating nursing notes d. Reducing staffing needs
Rationale: BSR involves patient, improves accuracy and satisfaction.
39. A nurse manager calculates the unit’s pressure injury rate as 8% versus national benchmark of 3%. The manager should: a. Ignore the data as inaccurate b. Conduct a gap analysis and implement turning protocols c. Blame the night shift exclusively d. Reduce staffing to save money
Rationale: Benchmarking identifies gaps; then plan improvement.
40. A patient falls and fractures a hip. The nurse manager’s priority after immediate patient care is: a. Write up the nurse who was assigned b. Complete an incident report and notify risk management c. Hide the fall from administration d. Tell family it was the patient’s fault
Rationale: Incident reporting is mandatory and non-punitive in safety systems.
41. A nurse leader implements hourly rounding. Which outcome is expected? a. Increased call light use b. Decreased patient falls c. Lower patient satisfaction d. Higher nurse burnout
Rationale: Evidence shows hourly rounding reduces falls and call lights.
42. Which is a core principle of High Reliability Organizations (HROs)? a. Blaming individuals for errors b. Preoccupation with failure c. Ignoring small problems d. Siloing departments
Rationale: HROs constantly look for small failures before they grow.
43. A nurse manager wants to improve handoff communication between shifts. Which tool is evidence-based? a. SBAR (Situation, Background, Assessment, Recommendation) b. I-PASS (Illness severity, Patient summary, Action list, Situation awareness, Synthesis) c. SOAP note d. PQRST
Rationale: I-PASS and SBAR are both effective; I-PASS is specifically for handoffs.
44. A unit has high CLABSI rates. The nurse manager should first: a. Suspend all central line insertions b. Implement a central line bundle checklist c. Fire the infection control nurse d. Blame the ICU
Rationale: Evidence-based bundles reduce CLABSI.
45. A nurse participates in a morbidity and mortality conference. The primary purpose is: a. Assign legal blame b. Identify system improvements c. Shame the involved physicians d. Reduce hospital accreditation
Rationale: Decentralized = unit-level control.
50. Which is a legitimate reason for mandatory overtime? a. To give manager a bonus b. Unforeseen emergency patient surge c. To cover a nurse’s vacation d. Because a nurse arrived late
Rationale: Mandatory overtime must meet emergency exceptions; otherwise unsafe.
51. A nurse manager calculates full-time equivalents (FTEs) for a unit needing 168 hours of RN coverage per day. Each RN works 12-hour shifts. How many FTEs (1.0 FTE = 36 hours/week) are needed? a. 10 FTEs b. 14 FTEs c. 28 FTEs d. 42 FTEs
Rationale: 168 hours/day ÷ 12 hours/shift = 14 RNs per day. For 7-day coverage, need ~14 FTEs (each works 3 shifts/week).
52. Which is a primary goal of a nursing productivity metric? a. Maximize profit by reducing nurses b. Match staffing to patient acuity efficiently c. Eliminate all breaks d. Replace RNs with unlicensed staff
Rationale: Productivity balances quality, safety, and cost.
53. A nurse manager is developing a budget. Capital budget includes: a. Salaries for new nurses b. Purchase of a new vital signs monitor c. Monthly utility bills d. Disposable gloves
Rationale: Capital = equipment with >1 year useful life.
54. A hospital uses a “grid scheduling” system. What is a disadvantage? a. No staff input at all b. May not accommodate individual preferences
c. Too flexible for unit needs d. Increases overtime always
Rationale: Grids provide structure but may limit flexibility.
55. A nurse manager receives a request for unpaid leave. The manager should consider: a. Only personal feelings about the nurse b. Staffing needs, policy, and fairness c. Denying all requests automatically d. Ignoring the request
Rationale: Fair, consistent, policy-based decisions.
56. Which staffing model assigns the same nurse to the same group of patients each shift? a. Team nursing b. Functional nursing c. Primary nursing d. Agency pool
Rationale: Primary nursing = continuity, one nurse responsible for 24-hour plan.
57. A charge nurse notes that a traveler is being paid 2x the staff nurse rate for same work. This could lead to: a. No effect on morale b. Decreased staff morale and retention c. Better teamwork d. Lower turnover
Rationale: Pay inequity harms internal equity and satisfaction.
58. A nurse manager wants to reduce agency nurse use. Which strategy is most effective? a. Force staff to work more overtime b. Implement a flexible self-scheduling system with incentives c. Cancel all staff vacations d. Ignore the problem
Rationale: Improving staff retention and satisfaction reduces agency reliance.
63. A charge nurse uses assertive communication with a physician who refuses to order pain medication. The charge nurse says: a. “You’re a terrible doctor.” b. “I am concerned about the patient’s pain score of 8. I recommend we re- evaluate the order.” c. “I’ll just give it anyway.” d. “Fine, I don’t care.”
Rationale: Assertive = respectful, firm, patient-centered.
64. A nurse manager is leading a staff meeting where one person dominates conversation. The manager should: a. Let them continue to avoid conflict b. Say, “Thank you, Mary. Let’s hear from others now.” c. Cancel the meeting d. Yell at the person
Rationale: Redirecting ensures all voices heard.
65. Which is a sign of horizontal violence among nursing staff? a. Collaborative huddles b. Sabotaging a coworker’s assignment c. Sharing evidence-based practice articles d. Mentoring a new nurse
Rationale: Horizontal violence = bullying, undermining peers.
66. A nurse manager implements a “code of conduct” with zero tolerance for incivility. This is an example of: a. Laissez-faire management b. Establishing behavioral expectations c. Punitive only approach d. Ignoring workplace culture
Rationale: Clear standards prevent incivility.
67. Two nurses disagree about a patient’s wound care dressing. The best approach is: a. Ignore the disagreement b. Consult the wound care protocol and evidence-based guideline
c. Let the loudest nurse decide d. Flip a coin
Rationale: Evidence and policy resolve clinical disagreements.
68. A charge nurse receives a report that a staff nurse is being bullied by peers. The charge nurse’s priority is: a. Tell the bullied nurse to toughen up b. Ensure psychological safety and investigate anonymously c. Fire the entire shift d. Ignore the report as gossip
Rationale: Bullying must be investigated; support target.
69. Which conflict resolution style is best when the issue is trivial and time is short? a. Competing b. Avoiding c. Collaborating d. Compromising
Rationale: Avoiding is appropriate for low-stakes, temporary issues.
70. A nurse manager uses “crucial conversations” training. Which is a key principle? a. Avoid all conflict b. Focus on mutual purpose and respect c. Blame the other person d. Never apologize
Rationale: Crucial conversations = shared goals, psychological safety.
71. A staff nurse is consistently late for shift handoff. The manager should: a. Ignore it if patient care is okay b. Meet privately, describe the pattern, and set a clear expectation c. Publicly shame the nurse in report d. Deduct pay without notice
Rationale: Private, respectful, specific feedback with plan.
72. Which team-building stage is characterized by conflict and disagreement about roles?
76. A nurse leader is implementing a new electronic health record (EHR) system. Which change strategy is most effective? a. Force implementation without training b. Involve end-users in planning and provide ongoing support c. Delay implementation indefinitely d. Have only IT staff use it
Rationale: Participatory change management increases buy-in.
77. A unit is resistant to a new fall prevention protocol. The nurse manager should first: a. Punish resisters b. Assess the reasons for resistance (lack of knowledge, resources, or belief) c. Cancel the protocol d. Implement secretly
Rationale: Diagnosis before intervention.
78. According to Kotter’s 8-step change model, which step comes immediately after “Create urgency”? a. Declare victory early b. Form a powerful guiding coalition c. Remove the manager d. Ignore resistance
Rationale: Kotter: Urgency → Guiding coalition → Vision → Communicate → Empower → Wins → Consolidate → Anchor.
79. A nurse manager uses Lewin’s Change Model. During the “Moving” phase, the manager should: a. Freeze the old system b. Implement new processes and provide training c. Return to old ways d. Blame staff for slowness
Rationale: Lewin: Unfreezing → Moving (change) → Refreezing.
80. An innovation to reduce alarm fatigue is implemented. Evaluation shows no improvement. The manager should: a. Ignore the data b. Reassess the intervention, gather staff feedback, and modify
c. Fire the staff d. Hide the results
Rationale: Continuous quality improvement requires iteration.
