NURSING 3210 HESI EXIT LEADERSHIP AND MANAGEMENT
EXAMINATION STUDY GUIDE 2022
Leadership and Management
• Legal Aspects of Nursing
o Often an NCLEX-RN® question asks who should explain a surgical procedure to the client. The
answer is the health care provider. Remember that it is the nurse’s responsibility to be sure that the
operative permit is signed and is on the chart. It is not the nurse’s responsibility to explain the
procedure to the client.
o Often questions are asked regarding the Good Samaritan Act, which is the means of protecting a
nurse when she or he is performing emergency care.
▪ Good Samaritan Act: Protects health practitioners against malpractice claims for care
provided in emergency situations (e.g., the nurse gives aid at the scene to an automobile
accident victim).
o If the nurse carries out a health care provider’s prescription for which he or she is not prepared and
does not inform the health care provider of his or her lack of preparation, the nurse is solely liable
for any damages.
▪ If the nurse informs the health care provider of his or her lack of preparation in carrying out
a prescription and carries out the prescription anyway, the nurse and the health care
provider are liable for any damages.
o Assignments are often tested on the NCLEX-RN. The Nurse Practice Acts of each state governs
policies related to making assignments. Usually, when determining who should be assigned to do a
sterile dressing change, for example, a licensed nurse should be chosen—that is, an RN or licensed
practical nurse (LPN) that has been checked off on this procedure.
o Restraints of any kind may constitute false imprisonment. Freedom from unlawful restraint is a
basic human right and is protected by law.
▪ Apply restraints properly; check restraints frequently to see that they are not causing injury
and record such monitoring; remove restraints as soon as possible; use restraints only as a
last resort
o A patient must give written consent before health care providers can use or disclose personal health
information; health care providers must give patients notice about providers’ responsibilities
regarding patient confidentiality; patients must have access to their medical records; providers who
restrict access must explain why and must offer patients a description of the complaint process;
patients have the right to request that changes be made in their medical records to correct
inaccuracies; health care providers must follow specific tracking procedures for any disclosures
made that ensure accountability for maintenance of patient confidentiality; patients have the right
to request that health care providers restrict the use and disclosure of their personal health
information, though the provider may decline to do so.
• Leadership and Management
o Assertive communication starts with “I need” rather than with “You must.”
o Motivation comes from within an individual. A nurse leader can provide an environment that will
promote motivation through positive feedback, respect, and seeking input. Look for responses that
demonstrate these behaviors.
o Effective leadership involves assertive management skills (i.e. democratic/participative). Look for
responses that demonstrate that the nurse is using assertive communication skills.
o Delegating to the right person requires that the nurse be aware of the qualifications of the
delegator: appropriate education, training, skills, experience, and demonstrated and documented
competence.
▪ Five Rights of Delegation (as defined by the National Council of State Boards of Nursing)
• Right task: Is this a task that can be delegated by a nurse?
• Right circumstance: Considering the setting and available resources, should
delegation take place?
• Right person: Is the task being delegated by the right person to the right person?
,NURSING 3210 HESI EXIT LEADERSHIP AND MANAGEMENT
EXAMINATION STUDY GUIDE 2022
• Right direction/communication: Is the nurse providing a clear, concise description
,NURSING 3210 HESI EXIT LEADERSHIP AND MANAGEMENT
EXAMINATION STUDY GUIDE 2022
of the task, including limits and expectations?
• Right supervision: Once the task has been delegated, is appropriate supervision
maintained.
▪ UAPs generally do not perform invasive or sterile procedures.
▪ The RN is accountable for adhering to the three basic aspects of supervision when
delegating to other health care personnel, such as LPNs, graduate nurses, inexperienced
nurses, student nurses, and UAPs.
▪ Remember the nursing process: Assessments, analysis, diagnosis, planning, and evaluation
(any activity requiring nursing judgment) may not be delegated to UAP. Delegated activities
fall within the implementation phase of the nursing process.
▪ Priorities often center on which client should be assessed first by the nurse. Ask yourself:
Which client is the most critically ill? Which client is most likely to experience a significant
change in condition? Which client requires assessment by an RN?
▪ Delegation is as follows:
• Inserting a Foley catheter is a sterile invasive procedure and should not be delegated
to a UAP
• Measuring and recording intake and output falls within the implementation phase of
the nursing process and does not require nursing judgment. However, evaluation of
the intake and output (I&O) must be done by the nurse.
• Client teaching requires the abilities of a nurse and should not be delegated. The
UAP may be instructed to report anything unusual that is observed and any
symptoms reported by the client, but this does not replace assessment by the nurse.
• Assessment must be performed by the nurse and should not be delegated. The UAP
may be instructed to report anything unusual that is observed, or any symptoms
reported by the client, but this does not replace assessment by the nurse.
o The nurse manager must analyze all the desired outcomes involved when assigning rooms for
clients or assigning client care responsibilities. A client with an infection should not be assigned to
share a room with a surgical or immunocompromised client. A nurse’s client care management
should be based on the nurse’s abilities, the individual client’s needs, and the needs of the entire
group of assigned clients. Safety and infection control are high priorities.
o Change causes anxiety. An effective nurse change agent uses problem-solving skills to recognize
factors such as anxiety that contribute to resistance to change and uses decision-making and
interpersonal skills to overcome that resistance. Interventions that demonstrate these skills include
seeking input, showing respect, valuing opinions, and building trust.
• Disaster Nursing
o It is important to remember that in disaster and bioterrorism management, the nurse must
consider both the individual and the community.
Advanced Clinical Concepts
• Respiratory Failure
o ARDS is an unexpected, catastrophic pulmonary complication occurring in a person with no
previous pulmonary problems. Clients are critically ill and are managed in an intensive care setting.
The mortality rate is high (50%).
o Interventions to prevent complications of clients on mechanical ventilation with ARDS:
▪ Elevate head of bed (HOB) to at least 30 degrees.
▪ Assist with daily awakening (“sedation vacation”).
▪ Implement a comprehensive oral hygiene program.
▪ Implement a comprehensive mobilization program.
o Suction only when secretions are present.
o Before drawing a sample for ABGs from the radial artery, perform the Allen test to assess collateral
, NURSING 3210 HESI EXIT LEADERSHIP AND MANAGEMENT
EXAMINATION STUDY GUIDE 2022
circulation.
▪ Make the client’s hand blanch by obliterating both the radial and the ulnar pulses. Then
release the pressure over the ulnar artery only. If flow through the ulnar artery is good,
EXAMINATION STUDY GUIDE 2022
Leadership and Management
• Legal Aspects of Nursing
o Often an NCLEX-RN® question asks who should explain a surgical procedure to the client. The
answer is the health care provider. Remember that it is the nurse’s responsibility to be sure that the
operative permit is signed and is on the chart. It is not the nurse’s responsibility to explain the
procedure to the client.
o Often questions are asked regarding the Good Samaritan Act, which is the means of protecting a
nurse when she or he is performing emergency care.
▪ Good Samaritan Act: Protects health practitioners against malpractice claims for care
provided in emergency situations (e.g., the nurse gives aid at the scene to an automobile
accident victim).
o If the nurse carries out a health care provider’s prescription for which he or she is not prepared and
does not inform the health care provider of his or her lack of preparation, the nurse is solely liable
for any damages.
▪ If the nurse informs the health care provider of his or her lack of preparation in carrying out
a prescription and carries out the prescription anyway, the nurse and the health care
provider are liable for any damages.
o Assignments are often tested on the NCLEX-RN. The Nurse Practice Acts of each state governs
policies related to making assignments. Usually, when determining who should be assigned to do a
sterile dressing change, for example, a licensed nurse should be chosen—that is, an RN or licensed
practical nurse (LPN) that has been checked off on this procedure.
o Restraints of any kind may constitute false imprisonment. Freedom from unlawful restraint is a
basic human right and is protected by law.
▪ Apply restraints properly; check restraints frequently to see that they are not causing injury
and record such monitoring; remove restraints as soon as possible; use restraints only as a
last resort
o A patient must give written consent before health care providers can use or disclose personal health
information; health care providers must give patients notice about providers’ responsibilities
regarding patient confidentiality; patients must have access to their medical records; providers who
restrict access must explain why and must offer patients a description of the complaint process;
patients have the right to request that changes be made in their medical records to correct
inaccuracies; health care providers must follow specific tracking procedures for any disclosures
made that ensure accountability for maintenance of patient confidentiality; patients have the right
to request that health care providers restrict the use and disclosure of their personal health
information, though the provider may decline to do so.
• Leadership and Management
o Assertive communication starts with “I need” rather than with “You must.”
o Motivation comes from within an individual. A nurse leader can provide an environment that will
promote motivation through positive feedback, respect, and seeking input. Look for responses that
demonstrate these behaviors.
o Effective leadership involves assertive management skills (i.e. democratic/participative). Look for
responses that demonstrate that the nurse is using assertive communication skills.
o Delegating to the right person requires that the nurse be aware of the qualifications of the
delegator: appropriate education, training, skills, experience, and demonstrated and documented
competence.
▪ Five Rights of Delegation (as defined by the National Council of State Boards of Nursing)
• Right task: Is this a task that can be delegated by a nurse?
• Right circumstance: Considering the setting and available resources, should
delegation take place?
• Right person: Is the task being delegated by the right person to the right person?
,NURSING 3210 HESI EXIT LEADERSHIP AND MANAGEMENT
EXAMINATION STUDY GUIDE 2022
• Right direction/communication: Is the nurse providing a clear, concise description
,NURSING 3210 HESI EXIT LEADERSHIP AND MANAGEMENT
EXAMINATION STUDY GUIDE 2022
of the task, including limits and expectations?
• Right supervision: Once the task has been delegated, is appropriate supervision
maintained.
▪ UAPs generally do not perform invasive or sterile procedures.
▪ The RN is accountable for adhering to the three basic aspects of supervision when
delegating to other health care personnel, such as LPNs, graduate nurses, inexperienced
nurses, student nurses, and UAPs.
▪ Remember the nursing process: Assessments, analysis, diagnosis, planning, and evaluation
(any activity requiring nursing judgment) may not be delegated to UAP. Delegated activities
fall within the implementation phase of the nursing process.
▪ Priorities often center on which client should be assessed first by the nurse. Ask yourself:
Which client is the most critically ill? Which client is most likely to experience a significant
change in condition? Which client requires assessment by an RN?
▪ Delegation is as follows:
• Inserting a Foley catheter is a sterile invasive procedure and should not be delegated
to a UAP
• Measuring and recording intake and output falls within the implementation phase of
the nursing process and does not require nursing judgment. However, evaluation of
the intake and output (I&O) must be done by the nurse.
• Client teaching requires the abilities of a nurse and should not be delegated. The
UAP may be instructed to report anything unusual that is observed and any
symptoms reported by the client, but this does not replace assessment by the nurse.
• Assessment must be performed by the nurse and should not be delegated. The UAP
may be instructed to report anything unusual that is observed, or any symptoms
reported by the client, but this does not replace assessment by the nurse.
o The nurse manager must analyze all the desired outcomes involved when assigning rooms for
clients or assigning client care responsibilities. A client with an infection should not be assigned to
share a room with a surgical or immunocompromised client. A nurse’s client care management
should be based on the nurse’s abilities, the individual client’s needs, and the needs of the entire
group of assigned clients. Safety and infection control are high priorities.
o Change causes anxiety. An effective nurse change agent uses problem-solving skills to recognize
factors such as anxiety that contribute to resistance to change and uses decision-making and
interpersonal skills to overcome that resistance. Interventions that demonstrate these skills include
seeking input, showing respect, valuing opinions, and building trust.
• Disaster Nursing
o It is important to remember that in disaster and bioterrorism management, the nurse must
consider both the individual and the community.
Advanced Clinical Concepts
• Respiratory Failure
o ARDS is an unexpected, catastrophic pulmonary complication occurring in a person with no
previous pulmonary problems. Clients are critically ill and are managed in an intensive care setting.
The mortality rate is high (50%).
o Interventions to prevent complications of clients on mechanical ventilation with ARDS:
▪ Elevate head of bed (HOB) to at least 30 degrees.
▪ Assist with daily awakening (“sedation vacation”).
▪ Implement a comprehensive oral hygiene program.
▪ Implement a comprehensive mobilization program.
o Suction only when secretions are present.
o Before drawing a sample for ABGs from the radial artery, perform the Allen test to assess collateral
, NURSING 3210 HESI EXIT LEADERSHIP AND MANAGEMENT
EXAMINATION STUDY GUIDE 2022
circulation.
▪ Make the client’s hand blanch by obliterating both the radial and the ulnar pulses. Then
release the pressure over the ulnar artery only. If flow through the ulnar artery is good,
