Clinical Nurse Leader Practice Test

AACN-CNL test Format | Course Contents | Course Outline | test Syllabus | test Objectives

Exam Code: CNL
Exam Name: AACN Clinical Nurse Leader (CNL)
Total Questions: 140 multiple-choice questions (some are unscored pretest questions)
Time Allotted: 3 hours
Passing Marks: Minimum scaled score of 350 out of 500

- Nursing Leadership (~36%)
- Clinical Outcomes Management (~34%)
- Care Environment Management (~30%)

- Nursing Leadership
- Horizontal Leadership
- Apply leadership change and complexity theories
- Guide the healthcare team to use clinical judgement when providing patient care
- Facilitate delegation of patient care coordination activities
- Provide coaching and mentoring to the healthcare team
- Act as a role model for the healthcare team
- Coordinate the evaluating and updating plans of care with the healthcare team
- Facilitate coordination of applicable healthcare team members and stakeholders to meet care objectives
- Manage the healthcare team to provide timely and efficient care
- Develop effective working relationships across the healthcare system
- Advocate for the CNL role

- Interprofessional Communication and Collaboration Skills
- Analyze communication structures and chain of command that impact care within the healthcare team and across settings
- Demonstrate effective written spoken and non-verbal communication skills
- Utilize communication skills that effectively navigate high-stakes or difficult conversations within the healthcare team
- Employ strategies to build relationships within healthcare team including both clinical and administrative members
- Employ strategies that promote diversity equity and inclusion to bridge barriers across the healthcare system
- Integrate emotional intelligence in communication and collaboration with patients’ families and the healthcare team
- Leverage the roles and responsibilities of the interprofessional team to influence care delivery
- Utilize effective communication strategies to adapt information to the target audience

- Healthcare Advocacy
- Identify health disparities across populations
- Perform an advanced assessment of microsystems across the care continuum to determine patient population care needs
- Protect patient rights by being an advocate in the healthcare system
- Ensure that patients’ families and communities are well informed in creating a patient-centered plan of care
- Advocate for necessary healthcare delivery changes and advancements to key stakeholders
- Identify and propose microsystem resources to meet the needs of target populations
- Determine shared understanding among the healthcare team before decisions are made
- Advocate for patients particularly the most vulnerable

- Implementation of the CNL Role
- Demonstrate professional identity and practice in developing the CNL role
- Explain the capacity of CNL practice to Excellerate healthcare processes and outcomes
- Exhibit qualities of a microsystem leader within and across interprofessional teams
- Apply current and new CNL evidence and competencies into practice
- Disseminate CNL practice outcomes at system regional national or international level
- Collaborate with a network of CNL professionals at the system regional national or international level

- Lateral Integration of Care Services
- Coordinate the healthcare of patients across the care continuum
- Integrate an interprofessional approach to identify and acquire resources for patient populations
- Coordinate patient care within and across specific episodes of illness and throughout the care continuum
- Apply systems and organization theory in the design delivery and evaluation of healthcare delivery across the care continuum
- Patient Assessment
- Perform an advanced comprehensive assessment of the patient across the lifespan (e.g. culture socioeconomic status health literacy vulnerabilities)
- Perform an advanced assessment of microsystems across the care continuum to determine patient population care needs

- Ethics
- Apply patient-centered ethical decision-making framework to clinical situations
- Apply legal and ethical guidelines to advocate for patient well-being and preferences
- Identify ethical dilemmas and the impact on patient care and outcomes
- Analyze how ethical decision making from both a personal and organizational perspectives may create conflicts of interest
- Collaborate with ethics committees or resources and recognize their role in health care delivery
- Demonstrate knowledge of professional and ethical boundaries (e.g. power dynamics dual relationships)

- Clinical Outcomes Management
- Illness/Disease Management
- Coordinate the provision and management of care at the microsystem level and across the care continuum
- Evaluate care for patients with emphasis on health promotion and risk reduction
- Evaluate readiness needs and interventions for safe transition of care
- Evaluate patient care based on analysis of outcomes evidence-based knowledge and patient's goals
- Analyze microsystems of care and outcome datasets to anticipate patient risk and Excellerate quality of care delivery
- Apply theories of chronic illness care and population health management to patient and families
- Coordinate community resources social networks and decision support mechanisms into care management
- Recognize differences in responses to illness and therapies based on patient's risk factors and preferences
- Apply advanced pathophysiology assessment and pharmacology to anticipate illness progression response to therapy and to guide teach and engage patients and families regarding care
- Use knowledge of cost and affordability issues in managing patient illness/disease across the care continuum
- Synthesize literature and research findings as the foundation for the design of interventions for illness and disease management
- Coordinate and implement education programs for patients and health professionals
- Identify epidemiological patterns in order to manage illness and disease

- Health Promotion, Disease Prevention & Risk Reduction
- Collaborate with the healthcare team to promote health and/or prevent disease
- Employ strategies to engage patients in therapeutic partnerships with the healthcare team
- Apply interventions based on evidence to meet specific patient needs
- Design and implement interventions to modify risk factors and promote engagement in healthy lifestyles for diverse populations
- Assess risk predictive and genetic factors that influence the health of patients
- Coordinate clinical and health promotion programs for patient populations to reduce risk prevent disease and prevent disease sequelae (e.g. heart failure Enhanced Recovery After Surgery (ERAS) diabetes)
- Incorporate principles of diversity equity and inclusion into health promotion and disease prevention strategies
- Incorporate theories and research in creating patient engagement strategies to promote and preserve health
- Develop community partnerships to establish risk reduction strategies to address identified needs of the microsystem population

- Healthcare Policy
- Recognize the effect of healthcare policy on health promotion risk reduction and disease and injury prevention
- Recognize the interactive effect of socioeconomics on national/global health policy related to health outcomes
- Analyze the effect of local state and/or national healthcare policy as they apply to the standards of care and scope of practice in the microsystem
- Identify the influence of regulatory guidelines and quality controls within the healthcare delivery system

- Care Environment Management
- Knowledge Management
- Collect data that documents the characteristics conditions and outcomes for various patient groups
- Apply knowledge of technology equipment treatment regimens and medication therapies for various patient groups
- Compare and evaluate trends of institutional and unit data to national benchmarks
- Analyze variations in clinical outcomes to determine where nurses have the greatest impact at the microsystem level
- Synthesize data information and knowledge to evaluate and achieve optimal clinical outcomes
- Integrate assessment data into information management systems to support shared decision making
- Disseminate microsystem data that impacts health outcomes
- Employ strategies to engage the healthcare team to impact clinical outcomes

- Healthcare Systems/Organizations
- Apply knowledge of change theory to manage group dynamics and promote information dissemination across healthcare systems
- Appraise existing organizational policies and procedures based on current evidence
- Implement system-based strategies that decrease healthcare disparities
- Apply systems thinking theories to address problems and develop solutions
- Evaluate how health care delivery systems are organized and their effect on patient care within microsystems
- Evaluate the economic legal and political factors that influence health care delivery

- Team Coordination
- Employ strategies to ensure skilled nursing procedures are incorporated to promote safety
- Evaluate the microsystem culture/climate that influence healthcare team dynamics
- Establish strategies to maintain effective team structures to ensure shared decision making
- Employ conflict mitigation and resolutions strategies
- Promote a positive and healthy work environment and a culture of retention

- Quality Improvement & Safety
- Employ quality improvement methods in evaluating individual and aggregate patient care processes
- Evaluate healthcare outcomes through the acquisition of data and the questioning of inconsistencies
- Redesign patient care utilizing quality improvement tools (e.g. Failure Modes Effect Analysis (FMEA) Root Cause Analysis (RCA) Plan-Do-Study-Act (PDSA) Cycles)
- Employ strategies to guide the healthcare team in quality improvement activities
- Identify variability and/or gaps in care practices and processes
- Employ standardized work practices to address and Excellerate gaps in processes

- Evidence-Based Practice
- Create framework within the microsystem to integrate patient and family preferences interprofessional clinical expertise and best evidence into clinical decisions
- Develop advanced assessment for clinical decisions by applying evidence-based practice
- Synthesize quantitative or qualitative evidence to promote critical thinking
- Select relevant sources of evidence to meet specific needs of patients microsystems or communities when planning care
- Identify relevant measurement strategies that will Excellerate patient outcomes and promote cost effective care
- Demonstrate expertise in the evidence appraisal process

- Healthcare Finance & Economics
- Propose cost effective strategies to the healthcare team that Excellerate efficiency and patient care outcomes
- Employ financial stewardship for the environmental human and material resources while coordinating patient care
- Identify high cost /high volume activities to benchmark costs nationally and across care settings
- Identify the impact of financial policies on healthcare delivery and patient outcomes
- Interpret the impact of both public and private reimbursement policies that may affect patient care decisions
- Evaluate the effect of healthcare financing on access to care and patient outcomes
- Demonstrate knowledge of healthcare economic concepts (e.g. Return on Investment (ROI) Value-Based Purchasing (VBP) bundled payments)

- Healthcare Informatics
- Analyze information health technology sources
- Evaluate care utilizing informatics and patient care technology
- Apply multiple sources of systems data in designing processes for care delivery
- Evaluate clinical information systems to provide feedback related to efficient and accurate documentation
- Evaluate the impact of new technologies on patients’ families and healthcare delivery
- Assess the relationships between information systems accurate communication error reduction and healthcare system operation
- Utilize technology for health promotion and disease prevention
- Collaborate with quality improvement and information technology teams to design and implement processes for improving patient outcomes
- Evaluate innovative technologies for inclusion in processes to anticipate patient risk
- Demonstrate efficient and appropriate use of healthcare technologies to maximize healthcare outcomes

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Question: 1306
A CNL in a community health clinic aims to Excellerate retention after a 28% turnover rate due to low engagement (HWE score 60). Which strategy best promotes a positive work environment?
1. Provide biweekly team-building workshops
2. Increase base pay for all clinicians
3. Offer hybrid work options
4. Implement a staff recognition and reward program Answer: D
Explanation: Implementing a staff recognition and reward program boosts engagement and fosters a positive work environment, supporting retention. Increasing pay or hybrid work may not address engagement directly. Team-building workshops are less impactful than recognition for sustained retention.
Question: 1307
A CNL is analyzing the ROI for a new wound care program costing $150,000 annually. The program reduces pressure injury rates by 20%, saving $200,000 in penalties. Calculate the ROI and determine the appropriate action.
1. Reduce program costs by limiting wound care supplies
2. Discontinue the program due to high costs
3. Expand the program to include more patients
4. Continue the program as it yields a positive ROI of 33.3% Answer: D
Explanation: ROI = [(Gain � Cost) / Cost] � 100 = [($200,000 � $150,000) / $150,000] � 100 = 33.3%. A positive ROI of 33.3% supports continuing the program. Discontinuing the program ignores the positive ROI. Expanding the program requires further analysis. Reducing supplies risks reducing effectiveness.
Question: 1308
The CNL leads a team reviewing 12-month hospital data. The data reveal that 40% of readmitted CHF patients had poor medication adherence. Which intervention would best target this health system risk factor?
1. Adjust discharge formula to exclude medication lists
2. Limit prescriptions to a single pharmacy
3. Decrease hospital length of stay for CHF patients
4. Create nurse-led home telemonitoring for CHF medication compliance Answer: D
Explanation: Nurse-led telemonitoring provides evidence-based follow up, real-time education, and support for therapy adherence, directly addressing the identified risk factor. The other options do not address medication adherence barriers.
Question: 1309
A multidisciplinary team disagrees on pain management strategies for a patient with stage 4 cancer and elevated calcium (14.2 mg/dL) despite treatment. Which leadership action by the Clinical Nurse Leader most positively influences care delivery?
1. Unilaterally implement the oncology consultant�s plan
2. Reassess evidence for hypercalcemia pain interventions and facilitate consensus
3. Defer to the patient�s family only
4. Continue with current ineffective regimen Answer: B
Explanation: Reassessing evidence promotes interprofessional engagement and consensus, improving care. Unilateral decisions reduce buy-in, family-only decisions neglect clinical evidence, and continuing ineffective care is not patient-centered.
Question: 1310
While reviewing adverse events, the CNL notes an increasing incidence of central line-associated bloodstream infections (CLABSIs). Which process step should be prioritized?
1. Implement a checklist and ensure 100% compliance with line insertion bundle elements
2. Focus only on physician technique during insertion
3. Increase patient satisfaction rounding
4. Ignore as a system-level issue Answer: A
Explanation: Implementing evidence-based checklists with bundle compliance at every insertion step reduces CLABSIs. Focusing on only physicians, or on patient satisfaction rounding, does not address the specific, proven prevention strategy.
Question: 1311
A Clinical Nurse Leader oversees a patient with a hemoglobin of 7.2 g/dL who refuses a blood transfusion due to religious beliefs. The physician insists on administering blood, citing medical
necessity. How should the Clinical Nurse Leader apply legal and ethical guidelines to advocate for the patient�s well-being and preferences?
1. Document the refusal and proceed with alternative treatments
2. Administer the transfusion as ordered to prevent harm
3. Request a court order to override the patient�s refusal
4. Seek an ethics consult to force the transfusion Answer: A
Explanation: Documenting the refusal and proceeding with alternative treatments respects the patient�s autonomy and adheres to legal and ethical guidelines, such as those in the ANA Code of Ethics, which emphasize patient rights. Administering the transfusion violates autonomy and could lead to legal consequences. Seeking a court order or an ethics consult to force the transfusion disregards the patient�s competent decision unless there is evidence of incapacity, which is not indicated. The Clinical Nurse Leader must advocate for the patient�s preferences while exploring alternatives like iron supplementation or erythropoietin.
Question: 1312
During orientation, a staff nurse repeatedly interrupts the pharmacist during med review. What is the best Clinical Nurse Leader-initiated evidence-based corrective strategy?
1. Privately coach the nurse on active listening and respectful interprofessional communication
2. Issue a written warning for unprofessionalism
3. Assign the nurse to independent projects only
4. Ignore the behavior as a learning opportunity Answer: A
Explanation: Coaching on communication skills targets the disruptive behavior and supports professional development. Written warnings are punitive, independent projects remove the opportunity for interprofessional growth, and ignoring perpetuates disruptive culture.
Question: 1313
A patient is transferred from the ICU to a medical-surgical unit with the following labs: WBC 18,200/mm�, procalcitonin 2.1 ng/mL, and creatinine 2.4 mg/dL. Which is the most important next step for the Clinical Nurse Leader coordinating care?
1. Notify palliative care
2. Escalate sepsis protocol, including two sets of blood cultures
3. Discharge patient for outpatient follow-up
4. Repeat lab tests in 48 hours Answer: B
Explanation: Elevated WBC, procalcitonin, and creatinine indicate sepsis; immediate escalation aligns with standards for care coordination in acute deterioration.
Question: 1314
A CNL evaluates an AI tool predicting AKI risk in surgical patients (e.g., creatinine >1.5 mg/dL, urine output <0.5 mL/kg/h). The tool�s specificity is 80%. A patient with normal creatinine is flagged. What is the best action?
1. Accept the flag and initiate fluid therapy
2. Lower the creatinine threshold to 1.2 mg/dL
3. Discontinue the tool due to the false positive
4. Conduct a pilot study to validate the tool�s performance Answer: D
Explanation: Conducting a pilot study validates the tool�s performance, ensuring accurate AKI risk prediction. Accepting the flag risks unnecessary interventions. Discontinuing the tool dismisses its potential. Lowering the threshold may reduce specificity.
Question: 1315
A 55-year-old patient with diabetes has a foot ulcer and an A1C of 9.0%. The CNL is coordinating a risk reduction program. Which intervention should be prioritized?
1. Administer broad-spectrum antibiotics prophylactically
2. Recommend amputation to prevent infection
3. Increase insulin dosing without monitoring
4. Implement a multidisciplinary foot care protocol with offloading and education Answer: D
Explanation: Implementing a multidisciplinary foot care protocol with offloading and education prevents ulcer progression and promotes healing, reducing amputation risk. Prophylactic antibiotics risk resistance without evidence of infection. Increasing insulin without monitoring risks hypoglycemia. Recommending amputation is premature and not a primary prevention strategy.
Question: 1316
A community survey shows high rates of obesity and low diabetes screening among Pacific Islander youth. Which intervention improves both inclusion and clinical outcome?
1. Handing out English-only flyers
2. School-based A1c screenings with parent engagement in Samoan and English
3. Text-messaging parents only in English
4. School screening for BMI only Answer: B
Explanation: School-based, bilingual, family-engaged screenings target health disparities and are proven effective. English-only approaches and BMI-only focus miss risk reduction and inclusivity.
Question: 1317
A unit�s CAUTI (catheter-associated urinary tract infection) rate is above national averages. Audits reveal nonadherence to daily catheter necessity assessments. Which best reflects the CNL�s next step?
1. Ignore the audit findings
2. Develop penalties for noncompliance
3. Remove all urinary catheters immediately
4. Implement a reminder system within the EHR to prompt daily assessment Answer: D
Explanation: Embedding EHR-based reminders integrates assessment data and supports standardized, reliable clinical practice to Excellerate outcomes.
Question: 1318
Routine lab orders include a D-dimer of 3000 ng/mL (elevated), but the nurse documents �WNL� (within normal limits) by mistake. What leadership action best addresses communication accuracy?
1. Correct the record and educate using real-time feedback and scenario-based training
2. Ignore if there is no immediate harm
3. Report the nurse to HR
4. Allow pattern to continue unless it becomes frequent Answer: A
Explanation: Timely feedback and scenario training ensures understanding and prevents recurrence. Ignoring, punitive approaches, or tolerance allows for perpetuation of unsafe practices.
Question: 1319
A CNL is evaluating a CIS for catheter-associated urinary tract infection (CAUTI) documentation. The system requires input of catheter days (5 days) and urine output (1,200 mL/day). Nurses report excessive documentation time. What feedback should the CNL provide?
1. Increase nurse training on CAUTI documentation protocols
2. Streamline CIS to reduce redundant data entry
3. Revert to paper-based CAUTI documentation
4. Survey patients on CAUTI prevention satisfaction Answer: B
Explanation: Streamlining the CIS to reduce redundant data entry addresses documentation time concerns, improving efficiency. Increasing nurse training on CAUTI documentation protocols does not address system design issues. Reverting to paper-based documentation dismisses CIS benefits. Surveying patients on CAUTI prevention satisfaction does not Excellerate documentation processes.
Question: 1320
A CNL is leading a quality improvement project to reduce medication errors in an outpatient clinic. Data shows 12% of prescriptions have incorrect dosages, with 80% linked to weight-based calculations (e.g., mg/kg). Using PDSA, which intervention should the CNL test in the �Do� phase?
1. Conduct staff training on weight-based dosing
2. Increase pharmacy reviews of prescriptions
3. Implement a weight-based dosing calculator in the EHR
4. Revise medication order templates Answer: C
Explanation: Incorrect weight-based calculations drive 80% of dosing errors. Implementing a weight- based dosing calculator in the EHR directly addresses this issue by automating accurate calculations, aligning with the PDSA �Do� phase. Conduct staff training on weight-based dosing is supportive but less immediate. Increase pharmacy reviews of prescriptions is resource-intensive. Revise medication order templates doesn�t specifically target calculation errors.
Question: 1321
A new graduate nurse on the night shift reports feeling excluded by the day shift. As the CNL, which intervention supports team integration and retention?
1. Ignore the complaint as normal adjustment
2. Rotate new nurses off the night shift
3. Facilitate a mentorship program pairing day and night staff
4. Assign more experienced nurses only to night shifts Answer: C
Explanation: A mentorship program breaks down barriers, fosters team integration, and supports new nurse retention, particularly across shifts.
Question: 1322
A Clinical Nurse Leader is developing an education program for patients with inflammatory bowel disease. A 40-year-old male with ulcerative colitis has a Mayo score of 8 and is on mesalamine 4.8 g daily. Which teaching point should be emphasized?
1. Use over-the-counter antacids for symptom relief
2. Monitor for weight gain monthly
3. Take mesalamine only when symptoms worsen
4. Adhere to a low-fiber diet during flares Answer: D
Explanation: A low-fiber diet during ulcerative colitis flares reduces bowel irritation, aligning with evidence-based management. Monitoring weight gain is less relevant. Taking mesalamine only with symptoms risks inadequate disease control. Antacids are ineffective for ulcerative colitis symptoms.
Question: 1323
A Clinical Nurse Leader notes that non-English-speaking patients in the oncology microsystem miss 30% of follow-up visits. Which best addresses health disparities?
1. Assigning these patients to a single provider
2. Scheduling appointments only during business hours
3. Implementing interpreter services and specialized educational resources
4. Discontinuing specialty care for missed appointments Answer: C
Explanation: Providing interpreters and appropriate education ensures comprehension and engagement, reducing disparities. Limiting hours, restricting providers, or discontinuing care exacerbate inequalities.
Question: 1324
A Clinical Nurse Leader assesses a microsystem for a diabetic population. Data show 30% of patients have an A1c >9%, and 25% miss follow-up due to scheduling issues. Which action best evaluates care needs?
1. Conduct a workflow analysis to optimize scheduling
2. Increase insulin doses for all patients with high A1c
3. Order monthly A1c tests for all patients
4. Standardize education without scheduling review Answer: A
Explanation: Assessing microsystem needs requires analyzing workflows. A workflow analysis optimizes scheduling, addressing the 25% follow-up gap. Increasing insulin doses without assessment is unsafe.
Ordering monthly A1c tests is resource-intensive. Standardizing education without scheduling review misses the core issue.
Question: 1325
A 55-year-old patient with a BUN of 45 mg/dL and dehydration refuses IV fluids due to fear of needles. The physician insists on treatment, citing medical necessity. How should the Clinical Nurse Leader apply a patient-centered ethical framework?
1. Explore alternative hydration methods with the patient
2. Administer IV fluids under sedation
3. Obtain a court order to enforce treatment
4. Refer the case to the ethics committee immediately Answer: A
Explanation: Exploring alternative hydration methods respects the patient�s autonomy while addressing dehydration, aligning with patient-centered care. Administering fluids under sedation violates autonomy. Obtaining a court order is inappropriate without assessing capacity. Referring to the ethics committee is unnecessary unless a significant conflict persists. The Clinical Nurse Leader should collaborate with the patient to find acceptable solutions.
Question: 1326
A CNL is applying technology to Excellerate pain management in post-operative patients. Data shows 30% of patients report pain scores >7/10 despite PCA pump use. Which strategy should the CNL employ?
1. Adjust PCA pump settings to increase bolus doses
2. Switch to oral analgesics for all patients
3. Provide patient education on PCA pump use
4. Implement a real-time pain score monitoring system Answer: D
Explanation: Implementing a real-time pain score monitoring system leverages technology to track pain levels continuously, enabling timely interventions and aligning with CNL knowledge management competencies. Adjusting PCA pump settings risks overmedication without data. Patient education is important but less impactful than real-time monitoring. Switching to oral analgesics is not feasible for all post-operative patients.
Question: 1327
A Clinical Nurse Leader is addressing a conflict between a social worker and a nurse regarding discharge planning for a patient with complex needs. Which communication strategy should the Clinical Nurse Leader use to resolve this?
1. Write a formal report to the hospital administration
2. Instruct the nurse to follow the social worker�s plan
3. Reassign the patient to a different care team
4. Facilitate a mediated discussion to clarify roles and align goals Answer: D
Explanation: Facilitating a mediated discussion to clarify roles and align goals promotes collaboration and resolves conflict through open communication. Instructing the nurse to follow the social worker�s plan dismisses the nurse�s perspective. Reassigning the patient avoids the issue. Writing a report escalates unnecessarily without fostering collaboration.
Question: 1328
A hospital upgrades from ICD-10-CM to SNOMED CT for clinical problem list coding. What is the expected primary benefit relevant for clinical data exchange?
1. Standardizes all nursing documentation formats
2. Improves billing accuracy for Medicare patients
3. Simplifies laboratory test order entry
4. Enables more granular and interoperable data sharing Answer: D
Explanation: SNOMED CT provides greater clinical data granularity and facilitates interoperable data exchange between systems. Billing accuracy and lab order entry can benefit, but are not the main reason for transition. Nursing documentation formats are not automatic outputs of coding standards.
Question: 1329
A Clinical Nurse Leader is coaching a nurse who struggles to prioritize care for a patient with a potassium level of 6.2 mEq/L. The patient is on telemetry showing occasional PVCs. What is the Clinical Nurse Leader�s best coaching strategy?
1. Demonstrate how to calculate the patient�s anion gap
2. Review the patient�s ECG strip with the nurse
3. Instruct the nurse to administer kayexalate immediately
4. Guide the nurse to use the ABC prioritization framework Answer: D
Explanation: A potassium level of 6.2 mEq/L (normal 3.5�5.0 mEq/L) and PVCs indicate hyperkalemia, a life-threatening condition requiring urgent prioritization. Guiding the nurse to use the ABC framework helps prioritize airway, breathing, and circulation, focusing on immediate risks. Calculating the anion gap is irrelevant, administering medication requires a provider order, and reviewing the ECG is less urgent
than prioritization.
Question: 1330
A patient with a potassium level of 2.8 mEq/L experiences PVCs on telemetry. The nurse hesitates to contact the provider. What action by the CNL strengthens patient safety and nursing autonomy?
1. Make the call on behalf of the nurse
2. Supervise and coach the nurse through provider communication using the SBAR
3. Ignore telemetry changes
4. Tell the nurse to wait until the next shift Answer: B
Explanation: Coaching the nurse through SBAR supports skill building, clinical safety, and future autonomy, which is preferable to doing the task for them or ignoring the issue.
Question: 1331
A resident prescribes vancomycin at 1,500 mg every 8 hours for an elderly patient with a creatinine clearance of 22 mL/min. The pharmacist raises concerns about nephrotoxicity. Which action best balances ethical advocacy and legal standards?
1. Document the pharmacist�s concern without action
2. Ignore and administer as prescribed
3. Wait for symptoms to occur before intervening
4. Adjust the dose based on evidence and consult the team Answer: D
Explanation: Adjusting the dose and consulting the team ensures safe, evidence-based, and legally compliant care, prioritizing patient safety. Ignoring concerns or waiting for harm breaches ethical and legal duties. Documentation alone, without intervention, is insufficient.

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