HESI Leadership

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Several nurses who work on a postoperative surgical unit have reported to the charge nurse their concerns about a particular surgeon's treatment of clients during invasive procedures. Adult clients are often in tears after this particular physician performs central IV line insertions or other invasive procedures. After the charge nurse confronts the healthcare provider who dismisses the concerns, the charge nurse reports the surgeon's behavior to the nurse manager who listens but does nothing about the situation. What action is most important for the charge nurse to take?

  • A. Confront the nurse manager as a group and ask why nothing has been done to change the surgeon's behavior.
  • B. Attend procedures performed by the surgeon and demand halting the procedure if the client becomes distressed.
  • C. Document client reactions to invasive procedures performed by the physician in their medical record.
  • D. Report the physician's lack of concern for clients' pain during invasive procedures to the Director of Nursing.
Correct Answer: D

Rationale: Reporting the physician's lack of concern to the Director of Nursing is the most effective action as it escalates the issue to a higher authority with the power to investigate and implement corrective measures, ensuring client safety and welfare. Confronting the nurse manager as a group may create conflict without resolving the issue. Attending procedures and intervening directly could be seen as insubordination and may compromise client safety. Documenting reactions is important but does not address the root cause of the surgeon's behavior.

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The nurse determines that an elderly client with pneumonia has a nursing problem of 'altered nutrition, less than body requirements.' Which instruction should the nurse give the unlicensed assistive personnel (UAP) helping with the care of this client?

  • A. Offer to assist the client with meal preparation and feeding.
  • B. Thicken the client's liquids if aspiration seems likely.
  • C. Listen to the client's breath sounds before and after meals.
  • D. Assist the client in selecting high protein foods on the menu.
Correct Answer: A

Rationale: Assisting with feeding is within the UAP's scope and addresses the client's nutritional needs. Thickening liquids, listening to breath sounds, and selecting foods require RN judgment.

A client with life-threatening injuries from a gunshot wound to the abdomen is mechanically ventilated and sedated. The client has a large family present who are asking multiple and repetitive questions. Which intervention should the nurse implement first?

  • A. Let each family member ask a question one at a time.
  • B. Request the healthcare provider to speak with the family.
  • C. Ask the family to identify a specific spokesperson.
  • D. Page a chaplain on call to be present for questions.
Correct Answer: C

Rationale: Designating a spokesperson streamlines communication, reducing repetitive questions and respecting client privacy. Individual questioning, provider involvement, or chaplain support are less immediate solutions.

The fire alarm goes off while the charge nurse is receiving the shift report. Which action should the charge nurse implement first?

  • A. Call the hospital operator to determine if this is indeed a real emergency or a fire drill.
  • B. Instruct the clients' family members to stay in the visitor waiting area until further notice.
  • C. Direct the nursing staff to evacuate the clients using the stairs in a calm and orderly manner.
  • D. Tell the staff to keep all clients and visitors in the client rooms with the doors closed.
Correct Answer: D

Rationale: Keeping clients and visitors in rooms with closed doors follows the RACE protocol, containing fire and smoke. Calling the operator, directing to the waiting area, or evacuating may delay safety measures.

The practical nurse reports that a client with a deep vein thrombosis (DVT) was mistakenly given heparin in addition to the prescribed warfarin. Which priority action should the nurse take?

  • A. Notify the healthcare provider.
  • B. Monitor for signs of bleeding.
  • C. Complete an adverse occurrence report.
  • D. Obtain blood for coagulation studies.
Correct Answer: A

Rationale: Notifying the healthcare provider ensures prompt intervention to reverse anticoagulation and prevent bleeding. Monitoring, reporting, and testing are important but follow provider notification.

A client with tachycardia and hypotension presents to the emergency department (ED) reporting severe vomiting and diarrhea for three days. Which action is most important for the nurse to implement?

  • A. Monitor for impending signs of shock.
  • B. Initiate enteric precaution procedures.
  • C. Reduce light, noise and temperature.
  • D. Encourage electrolyte supplements.
Correct Answer: A

Rationale: Monitoring for signs of shock is critical due to the client's dehydration and fluid volume deficit, which could lead to organ failure. Enteric precautions, environmental adjustments, and electrolyte supplements are important but secondary to preventing life-threatening shock.

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