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CNL (CLINICAL NURSE LEADER) CERTIFICATION
EXAM 2025 SUMMER – ACTUAL EXAM QUESTION
AND ANSWERS GRADED A 500 QUESTIONS
(VERIFIED EXAM)
- Roles of the CNL include: a. leadership. b. risk anticipation. c. evidence-based practice. d. all of the above d. all of the above The importance of approaching CNL implementation by first developing a ________ cannot be overemphasized. a. vision of the CNL role imposed from authorities outside the organization b. statement excluding stakeholders from the planning phase c. shared vision and understanding of the CNL role d. none of the above a. vision of the CNL role imposed from authorities outside the organization
The CNL Spread Plan was designed to cover a ________ - year period. a. 1 b. 5 c. 10 d. 25 b. 5 Stakeholders were ________ the CNL Spread Plan. a. an important part of b. not involved in c. deliberately avoided in creating d. eventually eliminated from a. an important part of The professional values of a CNL include: a. collaboration. b. accountability.
Therapeutic use of self is an example of a CNL: a. professional value. b. core competency. c. role. d. all of the above b. core competency. Incorporating a "4-D" cycle, "AI" stands for a. appreciative inquiry. b. absolute integrity. c. artificial input. d. active inquiry. a. appreciative inquiry. ________ occurs when two or more values, beliefs, and opinions are incongruous and reconciliation of differences has not occurred. a. Increased productivity b. Appreciative inquiry c. Conflict
d. Higher morale c. Conflict A new graduate nurse, Jenny, approaches you and states she needs help removing a peripherally inserted central catheter (PICC). Which of the following is the best response when acting as a horizontal leader? A. Remove the PICC yourself B. Tell Jenny to find the policy and then remove the PICC C. Help Jenny find the policy and review it with her. Coach Jenny while she removes the PICC and provide feedback D. Help Jenny find the policy and refer her to a nurse with 12 years of experience for assistance Answer C—Rationale: The clinical nurse leader (CNL) acts as a horizontal leader by helping the new graduate nurse to learn through sharing knowledge and coaching, rather than doing the task for the nurse.
- What organizational theory is used with rapid, unpredictable, and constant change? A. Systems theory B. Chaos theory C. Change theory D. Traditional theory Answer B—Rationale: Chaos theory is used to understand rapidly changing, unpredictable health care environments.
Answer B—Rationale: The CNL should present the effect and outcomes to illustrate the importance of the integration of his or her role. Increased patient satisfaction is not necessarily directly related to the CNL. Presentation of projects and tasks completed does not address measurable outcomes. Performance review of the individual does not indicate outcomes were affected.
- You are a CNL on an oncology unit. Recently, there has been an increase in the number of catheter- associated urinary tract infections (CAUTIs) on your unit. After shadowing nurses and aides you observed a variety of practices, techniques, and expectations surrounding daily catheter care. Your hospital does not have a current policy or procedure regarding catheter care. As the CNL, what should you do next? A. Review current evidence for catheter care practice and disseminate evidence to the staff B. Form an interdisciplinary team meeting to evaluate current hospital catheter care policies C. Create a rubric for educating patients and staff on catheter care D. Discuss with the unit manager the clinical issue and create a set of evidence-based unit expectations and practices for the oncology unit. Evaluate the need to address this issue with a hospital-wide policy or procedure Answer D—Rationale: CNLs should gather and disseminate evidence to solve clinical problems; however, that should not be the initial step. Further review of hospital practices and policies may come after this issue is addressed. Creation of a rubric for educating patients and staff on catheter care may come after reviewing evidence. The CNL should act to solve the clinical issue in the short term, and evaluate the need for a larger policy to address gaps in practice hospital- wide.
- A 50-year-old woman with a history of stage 3 chronic obstructive pulmonary disease (COPD) presents to the emergency department (ED) with increased shortness of breath. Based on your lab results, what is the acid-base disorder? Labs as follows: pH 7.25 PaCO2 50 mmHg HCO3 22 mEq/L PO2 75 SpO2 88% Na + 136 BUN 1 8
A. Uncompensated respiratory acidosis B. Metabolic acidosis C. Respiratory acidosis D. Uncompensated respiratory acidosis Answer A—Rationale: Based on the clinical scenario, the pH is decreased (less than 7.35); therefore, the patient has acidosis. The PaCO2 is elevated (more than 45 mmHg), which is also consistent with the pH.', 'The HCO3 is within normal limits, which suggests the kidneys are not compensating. COPD is commonly associated with respiratory acidosis.
- A CNL evaluates a 17-year-old patient who has been a victim of rape. The patient has visible bruising and a head laceration. After the CNL's assessment, law enforcement officials have contacted the CNL requesting information regarding the attack and the visible injuries seen during the visit. The CNL knows she must first: A. Take pictures and complete the rape kit B. Provide law enforcement with a record as requested C. Call the patient's parents first D. Explain to the patient in order to obtain consent for release of records Answer D—Rationale: Legally, there must be consent from the patient to share information with law enforcement and to abide by Health Insurance Portability and Accountability Act (HIPAA) regulations.
- A CNL in the neonatal intensive care unit (NICU) is collecting data on the hours worked weekly by the staff nurses. The CNL wants to see if there is a normal distribution of hours worked. What technique is the best to display the distribution of the data collected?
B. Patients, providers, policies, patterns, prevention C. Purpose, patients, providers, patterns, prevention D. Patients, process, professionals, policies, patterns', ' Answer A—Rationale: These answers make up the 5 Ps; the others are components of other aspects of the CNL's functions or tools.
- Mr. Johnson is an 80-year-old patient who lives alone. He had fallen and was found by his neighbors. Mr. Johnson has a history of multiple falls, congestive heart failure (CHF), myocardial infarction (MI), diabetes mellitus (DM), and asthma. Mr. Johnson is admitted to the hospital with a hip fracture. Using an interdisciplinary approach, who should the CNL include in the plan of care initially? A. Clinical care manager, medical social worker, clinical nutritionist, CNL, and physician B. Clinical care manager, medical social worker, clinical nutritionist, physical therapist, registered nurse, CNL, and physician C. Speech therapist, clinical care manager, medical social worker, CNL, registered nurse, and nursing supervisor D. Clinical care manager, medical social worker, CNL, registered nurse, and nurse manager Answer B—Rationale: An interdisciplinary team is composed of many disciplines who work together toward a patient's and family's common goals, such as safe discharge coordination. Learning to advocate for clients occurs by communicating effectively with other interdisciplinary team members, including nurses in other settings. The opportunity to learn and work in an interdisciplinary team will provide the best opportunity to give patients the best outcome.
- As the CNL on a cardiac telemetry unit, you are performing a root cause analysis (RCA) due to the high volume of catheter-associated urinary tract infections (CAUTIs) over the last 6 months. Realizing that the Centers for Medicare & Medicaid are on a pay-for-performance basis, you develop a CAUTI task force in an effort to reduce costs. This is an example of which of the following? A. Implementing cost reduction and savings B. Anticipating risk and designing plans of care to improve outcomes C. Evaluating the effect of the health care financing on care access and patient outcomes D. Applying basic business and economic principles to the microsystem Answer B—Rationale: CNLs must have the ability to critically evaluate and anticipate risks to client safety; this is a critical component role.
- You notice a trend of increased central line bloodstream infection (CLBSI) on your unit. You conduct a literature search and, after critiquing and synthesizing the available evidence, you find that central line bundles have been shown to decrease CLBSI. You want to implement this bundle on your unit, and plan to evaluate the effect of this change. Which of the following best describes this process? A. Plan-Do-Study-Act (PDSA) B. Research C. Process improvement D. Evidence-based practice (EBP) Answer D—Rationale: EBP involves applying the best available research evidence, clinical expertise, and patient preferences to improve a clinical outcome.
- The unit implemented bedside reporting 6 months ago, but the change has not been sustained. As a CNL, you begin to participate in bedside reporting and provide constructive, immediate feedback to the nurses for improvement. What best describes this situation? A. Mentoring B. Transformational leadership C. Coaching D. Precepting Answer C—Rationale: The CNL coaches by evaluating team members and providing constructive feedback. Mentoring is a long-term relationship between two individuals focused on clinical advancement.
- Jane, a CNL, successfully implemented an evidence-based practice (EBP) project utilizing music therapy to help with pain control in sickle cell patients on a medical-surgical unit. Jane was asked by the chief nursing officer (CNO) to implement the project within the medical division. What system will Jane be working in? A. Mesosystem B. Macrosystem C. Microsystem D. Unit system Answer A—Rationale: The mesosystem encompasses multiple microsystems, such as a medical division within a hospital.
- Judy has a family history of type 2 diabetes. After education, Judy knows she can help to prevent diabetes by maintaining a healthy weight, healthy eating habits, and daily physical activity. Judy is exhibiting what type of prevention strategies? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Quaternary prevention Answer A—Rationale: The purpose of primary prevention is to prevent the onset of chronic illness, focusing on healthy lifestyle habits and behaviors.
- You are a CNL on a surgical unit. Your unit has just hired several new graduate nurses. As the CNL, what is your role in relationship to these new team members? A. Provider of all clinical education B. Evaluator for performance reviews C. Coach and mentor D. Individual with a hands-off approach to allow new nurses to develop skills independently Answer C—Rationale: The role of the CNL is to mentor and support all nurses on the unit, especially new nurses. Although the CNL may act as an educator, he or she does not guide the education and training of nurses on the unit. The CNL is not a member of management and does not complete employee performance reviews. While the CNL may take a hands-off approach, he or she should still offer support and mentorship to his or her peers.
C. Cystic fibrosis D. Croup Answer C—Rationale: Cough, recurring respiratory infections, fatty stool, and failure to thrive are all symptoms of cystic fibrosis. Many children with cystic fibrosis have colonizing Staphylococcus aureus in their airways.
- An elderly Chinese woman has just been diagnosed with terminal cancer. While discussing end-of-life care decisions with the family, patient, and CNL, the CNL notices there are conflicting viewpoints between the family and patient regarding advance directives. Which of these is the best answer regarding advance directives? A. In the Chinese culture, the family makes the decisions regarding end-of-life care in order not to burden the patient. B. It is best not to fully inform the patient of his or her condition so that he or she will remain positive. C. The patient has the right to enact his or her own advance directive to guide his or her medical treatments according to the Patient Self-Determination Act. D. The interdisciplinary team has the most information on palliative care to make the best decision. Answer C—Rationale: The Patient Self-Determination Act explains the patient's right to accept or the right to refuse medical or surgical treatment. The patient is also entitled to receive information about the right to create his or her own advance directive.
- A CNL in the emergency department (ED) is auditing stroke patients' charts and the administration of tissue plasminogen activator (tPA) and notices that only 83% of patients who are eligible to receive tPA are receiving it. The CNL knows that the 83% administration rate is below the national benchmark. The CNL identifies that there is a time lag in MRI. The CNL creates a stroke team to develop a guideline implementation action plan to improve the process of timing of the MRI. What is the best tool utilized by the CNL in implementing change? A. Research study B. Meta-analysis C. Plan-Do-Study-Act (PDSA) D. Standardize-Do-Study-Act Answer C—Rationale: PDSA is a model for quickly and easily testing ideas that could lead to improvement, based on existing ideas, research, feedback, theory, reviews, audits, or evidence of what has worked elsewhere.
- A group composed of unit-based council members was put on a task force to improve the discharge planning process because patients felt unprepared and rushed at discharge. A decision was made to create a discharge planning nurse position to educate patients the night before the discharge. Even though the new nurses did not like this solution, they deferred to the senior nurses of this group who were adamant about implementing this position. Which barrier to effective teamwork does this exemplify? A. Physical threats B. Groupthink C. Team dysfunction D. Authority gradient
D. Refamiliarize staff nurses with the use of situation background assessment recommendation (SBAR), your hospital's communication standard Answer D—Rationale: While professionals should provide direct feedback to each other in a meaningful, constructive manner and limiting communication to key information is an important aspect of clear communication, the use of a standardized tool, already a standard at this hospital, would most readily help to guide nurses to communicate in a clear, concise, efficient manner to ensure high-quality communication between care team members.
- How can the CNL best provide and educate staff on giving culturally competent care within the unit? A. Educate staff on assessment questions/phrases in the most common secondary language present in the community or seen within the hospital B. Educate staff on varying cultural perceptions and beliefs surrounding the concept of health C. Provide an in-service on accessing patient education and handouts in another language D. Ensure that nurses are assigned to the most culturally appropriate patients currently on the unit Answer B—Rationale: Nurses should never attempt to use a family member or their own limited ability for conversation in another language; a certified medical interpreter should be used. An in-service on accessing education in multiple languages would likely be very useful to staff, but is not as good an intervention as education on cultural differences. Staffing and patient assignment should not be based on only cultural associations; individual preferences may also need to be considered.
- A 40-year-old postpartum patient with chronic hypertension and gestational diabetes who is gravida 5 para 4 is transferred from labor and delivery to the postpartum unit with lactated Ringer's at 125 mL/hr. Upon assessment of the patient, the nurse notices the patient's fundus is three finger breaths above umbilicus and to the right of midline and her bladder is palpable. The nurse also notes moderate to heavy bleeding and a full bladder and notifies the CNL. As a CNL, the most important nursing intervention is to:
A. Encourage the nurse to massage the fundus and heplock the patient B. Encourage the nurse to call the physician stat to order Methergine (methylergonovine maleate) C. Encourage the nurse to monitor the patient over the next hour because there are no risk factors for a postpartum hemorrhage D. Encourage the nurse to straight catherize the patient to decrease the likelihood of a postpartum hemorrhage Answer D—Rationale: The patient is at risk for a hemorrhage due to being a multipara and having a full bladder. Methergine is contraindicated in patients with hypertension. 3 9. A 6-year-old boy is in critical condition following a car accident. The patient has head trauma and internal bleeding. The patient's parents have stated multiple times that they are Jehovah's Witnesses and do not want their son to receive blood. The CNL knows that the blood transfusion is needed immediately and could save the boy's life. Which of the following statements is the best thing for the CNL to do? A. Listen to the parents, as U.S. minors have no legal rights and remain under parental jurisdiction B. Obtain a court order in the best interest of the child to receive blood, based on the avoidance of physical harm C. Based on religious beliefs, do not give blood D. Follow the physician's decision to give blood since the physician's decision overrides the parental decision', ' Answer B—Rationale: The child's interests as well as the state policies outweigh the parental rights to refuse medical treatment for a minor. A court order is needed to enforce this.
