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HESI Nursing Leadership in High-Acuity
Care | Safety, Delegation & Prioritization
Table of Contents
Subtopic 1: Prioritization of Care in High-Acuity Settings.................................2
Subtopic 2: Delegation & Supervision in High-Acuity Environments..............10
Subtopic 3: Emergency Response and Rapid Clinical Decision-Making..........19
Subtopic 4: Ethical and Legal Issues in High-Acuity Leadership....................28
Subtopic 5: Leadership, Team Dynamics & Crisis Communication.................37
Subtopic 6: Risk Management, Quality Improvement & Incident Reporting. .46
Subtopic 7: Strategic Planning & Resource Allocation in High-Acuity Settings
.......................................................................................................................55
Subtopic 8: Staff Education, Supervision & Delegation for High-Acuity Units 64
Subtopic 9: Quality Improvement, Risk Management, & Auditing in High-
Acuity Units (Questions 161–180)..................................................................73
Subtopic 10: Technology Integration, Informatics, & Evidence-Based Practice
in High-Acuity Leadership..............................................................................83
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Subtopic 1: Prioritization of Care in High-
Acuity Settings
Question 1
A nurse in the emergency department receives report on four clients. Which
client should the nurse assess first?
A. A client with a compound fracture and stable vital signs
B. A client with suspected appendicitis and moderate abdominal pain
C. A client with shortness of breath, restlessness, and SpO₂ of 85%
D. A client with nausea and vomiting for the past 12 hours
Correct Answer: C. A client with shortness of breath, restlessness, and SpO₂
of 85%
Rationale: This client shows signs of hypoxia, which is a life-threatening
priority. Airway and breathing take precedence in high-acuity settings over
other non-immediate conditions.
Question 2
Which task should the nurse delegate to a licensed practical nurse (LPN) in a
high-acuity medical-surgical unit?
A. Teaching insulin self-administration
B. Initial assessment of a newly admitted client
C. Administering enteral tube feedings to a stable client
D. Evaluating pain management effectiveness post-op
Correct Answer: C. Administering enteral tube feedings to a stable client
Rationale: LPNs can administer enteral feedings to stable patients. Teaching
and evaluations require RN-level skills due to their complexity and need for
critical thinking.
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Question 3
A nurse is prioritizing care for clients during a mass casualty incident. Which
client should receive care first?
A. Client with a femur fracture and bleeding controlled
B. Client with a spinal cord injury and flaccid paralysis
C. Client with an open chest wound and dyspnea
D. Client with a closed head injury, responsive to verbal stimuli
Correct Answer: C. Client with an open chest wound and dyspnea
Rationale: This is an airway and breathing emergency. Immediate care is
essential to prevent death, fitting the highest priority under triage protocols.
Question 4
During morning rounds, which of the following clients should the nurse see
first?
A. A client scheduled for a dressing change
B. A client needing a routine medication
C. A client newly reporting chest tightness
D. A client requesting assistance to ambulate
Correct Answer: C. A client newly reporting chest tightness
Rationale: Chest tightness may indicate cardiac ischemia or infarction and
must be evaluated immediately to rule out life-threatening complications.
Question 5
Which scenario best illustrates appropriate time management in
prioritization?
, 4
A. Administering medications before non-urgent dressing changes
B. Helping a client make a menu selection before charting
C. Reassessing pain last on the list of interventions
D. Conducting teaching before completing vital signs
Correct Answer: A. Administering medications before non-urgent dressing
changes
Rationale: Medication administration has time-critical implications and should
be prioritized over non-urgent tasks such as routine dressing changes.
Question 6
Which client should be prioritized for discharge to accommodate a new ICU
admission?
A. Client with postoperative pneumonia on oxygen
B. Client with GI bleeding awaiting endoscopy
C. Client with resolved DVT receiving routine anticoagulant education
D. Client with unstable glucose readings on insulin drip
Correct Answer: C. Client with resolved DVT receiving routine anticoagulant
education
Rationale: This client is clinically stable and appropriate for discharge,
allowing resources to be allocated to higher-acuity clients.
Question 7
Which action should the nurse take first when responding to a client with
signs of stroke?
A. Ask the client when symptoms began
B. Notify the healthcare provider
C. Perform a rapid neurologic assessment
HESI Nursing Leadership in High-Acuity
Care | Safety, Delegation & Prioritization
Table of Contents
Subtopic 1: Prioritization of Care in High-Acuity Settings.................................2
Subtopic 2: Delegation & Supervision in High-Acuity Environments..............10
Subtopic 3: Emergency Response and Rapid Clinical Decision-Making..........19
Subtopic 4: Ethical and Legal Issues in High-Acuity Leadership....................28
Subtopic 5: Leadership, Team Dynamics & Crisis Communication.................37
Subtopic 6: Risk Management, Quality Improvement & Incident Reporting. .46
Subtopic 7: Strategic Planning & Resource Allocation in High-Acuity Settings
.......................................................................................................................55
Subtopic 8: Staff Education, Supervision & Delegation for High-Acuity Units 64
Subtopic 9: Quality Improvement, Risk Management, & Auditing in High-
Acuity Units (Questions 161–180)..................................................................73
Subtopic 10: Technology Integration, Informatics, & Evidence-Based Practice
in High-Acuity Leadership..............................................................................83
, 2
Subtopic 1: Prioritization of Care in High-
Acuity Settings
Question 1
A nurse in the emergency department receives report on four clients. Which
client should the nurse assess first?
A. A client with a compound fracture and stable vital signs
B. A client with suspected appendicitis and moderate abdominal pain
C. A client with shortness of breath, restlessness, and SpO₂ of 85%
D. A client with nausea and vomiting for the past 12 hours
Correct Answer: C. A client with shortness of breath, restlessness, and SpO₂
of 85%
Rationale: This client shows signs of hypoxia, which is a life-threatening
priority. Airway and breathing take precedence in high-acuity settings over
other non-immediate conditions.
Question 2
Which task should the nurse delegate to a licensed practical nurse (LPN) in a
high-acuity medical-surgical unit?
A. Teaching insulin self-administration
B. Initial assessment of a newly admitted client
C. Administering enteral tube feedings to a stable client
D. Evaluating pain management effectiveness post-op
Correct Answer: C. Administering enteral tube feedings to a stable client
Rationale: LPNs can administer enteral feedings to stable patients. Teaching
and evaluations require RN-level skills due to their complexity and need for
critical thinking.
, 3
Question 3
A nurse is prioritizing care for clients during a mass casualty incident. Which
client should receive care first?
A. Client with a femur fracture and bleeding controlled
B. Client with a spinal cord injury and flaccid paralysis
C. Client with an open chest wound and dyspnea
D. Client with a closed head injury, responsive to verbal stimuli
Correct Answer: C. Client with an open chest wound and dyspnea
Rationale: This is an airway and breathing emergency. Immediate care is
essential to prevent death, fitting the highest priority under triage protocols.
Question 4
During morning rounds, which of the following clients should the nurse see
first?
A. A client scheduled for a dressing change
B. A client needing a routine medication
C. A client newly reporting chest tightness
D. A client requesting assistance to ambulate
Correct Answer: C. A client newly reporting chest tightness
Rationale: Chest tightness may indicate cardiac ischemia or infarction and
must be evaluated immediately to rule out life-threatening complications.
Question 5
Which scenario best illustrates appropriate time management in
prioritization?
, 4
A. Administering medications before non-urgent dressing changes
B. Helping a client make a menu selection before charting
C. Reassessing pain last on the list of interventions
D. Conducting teaching before completing vital signs
Correct Answer: A. Administering medications before non-urgent dressing
changes
Rationale: Medication administration has time-critical implications and should
be prioritized over non-urgent tasks such as routine dressing changes.
Question 6
Which client should be prioritized for discharge to accommodate a new ICU
admission?
A. Client with postoperative pneumonia on oxygen
B. Client with GI bleeding awaiting endoscopy
C. Client with resolved DVT receiving routine anticoagulant education
D. Client with unstable glucose readings on insulin drip
Correct Answer: C. Client with resolved DVT receiving routine anticoagulant
education
Rationale: This client is clinically stable and appropriate for discharge,
allowing resources to be allocated to higher-acuity clients.
Question 7
Which action should the nurse take first when responding to a client with
signs of stroke?
A. Ask the client when symptoms began
B. Notify the healthcare provider
C. Perform a rapid neurologic assessment
