Nr 341 exam 1 ( 3 versions ) latest
updated 2025
The nurse is caring for a mechanically ventilated patient. The nurse understands that
strategies to prevent ventilator-associated pneumonia include which of the following?
(Select all that apply.)
a. Drain condensate from the ventilator tubing away from the patient.
b. Elevate the head of the bed 30 to 45 degrees.
c. Instill normal saline as part of the suctioning procedure.
d. Perform regular oral care with chlorhexidine.
e. Awaken the patient daily to determine the need for continued ventilation. -
ANSWERS-a,b,d
The patient is admitted with a suspected acute myocardial infarction (AMI). In assessing
the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the
nurse that the patient is in the process of an evolving Q wave myocardial infarction
(MI)?
a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels
b. Depressed ST-segment on ECG and elevated total CPK
c. Depressed ST-segment on ECG and normal cardiac enzymes
d. Q wave on ECG with normal enzymes and troponin levels - ANSWERS-a
left sided heart failure - ANSWERS-
right sided heart failure - ANSWERS-
A patient is admitted with an acute myocardial infarction (AMI). The nurse knows that an
angiotensin-converting enzyme (ACE) inhibitor should be started within 24 hours to
reduce the incidence of which process?
a. Myocardial stunning
b. Hibernating myocardium
c. Myocardial remodeling
d. Tachycardia - ANSWERS-c
A patient presents to the emergency department (ED) with chest pain that he has had
for the past 2 hours. The patient is nauseated and diaphoretic, with dusky skin color.
The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic
intervention would the nurse question?
a. Emergent pacemaker insertion
b. Emergent percutaneous coronary intervention
c. Emergent thrombolytic therapy
,d. Immediate coronary artery bypass graft surgery - ANSWERS-A
The goals of management of AMI are to dissolve the lesion that is occluding the
coronary artery and to increase blood flow to the myocardium.
A patient is admitted with the diagnosis of unstable angina. The nurse knows that the
physiological mechanism present is most likely which of the following?
a. Complete occlusion of a coronary artery
b. Fatty streak within the intima of a coronary artery
c. Partial occlusion of a coronary artery with a thrombus
d. Vasospasm of a coronary artery - ANSWERS-C
In unstable angina, some blood continues to flow through the affected coronary artery;
however, flow is diminished related to partial occlusion.
A patient is admitted with angina. The nurse anticipates which drug regimen to be
initiated?
a. ACE inhibitors and diuretics
b. Morphine sulfate and oxygen
c. Nitroglycerin, oxygen, and beta blockers
d. Statins, bile acid, and nicotinic acid - ANSWERS-c
A patient is having a cardiac evaluation to assess for possible valvular disease. Which
study best identifies valvular function and measures the size of the cardiac chambers?
a. 12-lead electrocardiogram
b. Cardiac catheterization
c. Echocardiogram
d. Electrophysiology study - ANSWERS-c
The patient is admitted with an acute myocardial infarction (AMI). Three days later the
nurse is concerned that the patient may have a papillary muscle rupture. Which
assessment data may indicate a papillary muscle rupture?
a. Gallop rhythm
b. New murmur
c. S1 heart sound
d. S3 heart sound - ANSWERS-b
A 72-year-old woman is brought to the ED by her family. The family states that she's
"just not herself." Her respirations are slightly labored, and her heart monitor shows
sinus tachycardia (rate 110 beats/min) with frequent premature ventricular contractions
(PVCs). She denies any chest pain, jaw pain, back discomfort, or nausea. Her troponin
levels are elevated, and her 12-lead electrocardiogram (ECG) shows elevated ST
segments in leads II, III, and aVF. The nurse knows that these symptoms are most likely
associated with which diagnosis?
a. Hypokalemia
b. Non-Q wave MI
c. Silent myocardial infarction
d. Unstable angina - ANSWERS-c
,Which of the following professional organizations best supports critical care nursing
practice?
a. American Association of Critical-Care Nurses
b. American Heart Association
c. American Nurses Association
d. Society of Critical Care Medicine - ANSWERS-a
The synergy model of practice focuses on:
a. allowing unrestricted visiting for the patient 24 hours each day.
b. holistic and alternative therapies.
c. needs of patients and their families, which drives nursing competency.
d. patients' needs for energy and support. - ANSWERS-c
The family of your critically ill patient tells you that they have not spoken with the
physician in over 24 hours and they have some questions that they want clarified.
During morning rounds, you convey this concern to the attending intensivist and arrange
for her to meet with the family at 4:00 PM in the conference room. Which competency of
critical care nursing does this represent?
a. Advocacy and moral agency in solving ethical issues
b. Clinical judgment and clinical reasoning skills
c. Collaboration with patients, families, and team members
d. Facilitation of learning for patients, families, and team members - ANSWERS-c
The charge nurse is responsible for making the patient assignments on the critical care
unit. She assigns the experienced, certified nurse to care for the acutely ill patient with
sepsis who also requires continuous renal replacement therapy and mechanical
ventilation. She assigns the nurse with less than 1 year of experience to two patients
who are more stable. This assignment reflects implementation of the:
a. crew resource management model
b. National Patient Safety Goals
c. Quality and Safety Education for Nurses (QSEN) model
d. synergy model of practice - ANSWERS-d
The family members of a critically ill, 90-year-old patient bring in a copy of the patient's
living will to the hospital, which identifies the patient's wishes regarding health care. You
discuss contents of the living will with the patient's physician. This is an example of
implementation of which of the AACN Standards of Professional Performance?
a. Acquires and maintains current knowledge of practice
b. Acts ethically on the behalf of the patient and family
c. Considers factors related to safe patient care
d. Uses clinical inquiry and integrates research findings in practice - ANSWERS-b
As part of nursing management of a critically ill patient, orders are written to keep the
head of the bed elevated at 30 degrees, awaken the patient from sedation each
morning to assess readiness to wean from mechanical ventilation, and implement oral
, care protocols every 4 hours. These interventions are done as a group to reduce the
risk of ventilator-associated pneumonia. This group of evidence-based interventions is
often called a:
a. bundle of care.
b. clinical practice guideline.
c. patient safety goal.
d. quality improvement initiative. - ANSWERS-a
Which of the following statements describes the core concept of the synergy model of
practice?
a. All nurses must be certified in order to have the synergy model implemented.
b. Family members must be included in daily interdisciplinary rounds.
c. Nurses and physicians must work collaboratively and synergistically to influence care.
d. Unique needs of patients and their families influence nursing competencies. -
ANSWERS-d
Which of the following is a National Patient Safety Goal? (Select all that apply.)
a. Accurately identify patients.
b. Eliminate use of patient restraints.
c. Reconcile medications across the continuum of care.
d. Reduce risks of healthcare-acquired infection. - ANSWERS-a,c,d
Which of the following nursing activities demonstrates implementation of the AACN
Standards of Professional Performance? (Select all that apply.)
a. Attending a meeting of the local chapter of the American Association of Critical-Care
Nurses in which a continuing education program on sepsis is being taught
b. Collaborating with a pastoral services colleague to assist in meeting spiritual needs of
the patient and family
c. Participating on the unit's nurse practice council
d. Posting an article from Critical Care Nurse on management of venous
thromboembolism for your colleagues to read
e. Using evidence-based strategies to prevent ventilator-associated pneumonia -
ANSWERS-a,b,c,d,e
Which scenarios contribute to effective handoff communication at change of shift?
(Select all that apply.)
a. The nephrology consultant physician is making rounds and asks you to update her on
the patient's status and assist in placing a central line for hemodialysis.
b. The noise level is high because twice as many staff members are present and
everyone is giving report in the nurse's station.
c. The unit has decided to use a standardized checklist/tool for change-of-shift reports
and patient transfers.
d. You and the oncoming nurse conduct a standardized report at the patient's bedside
and review key assessment findings. - ANSWERS-c,d
updated 2025
The nurse is caring for a mechanically ventilated patient. The nurse understands that
strategies to prevent ventilator-associated pneumonia include which of the following?
(Select all that apply.)
a. Drain condensate from the ventilator tubing away from the patient.
b. Elevate the head of the bed 30 to 45 degrees.
c. Instill normal saline as part of the suctioning procedure.
d. Perform regular oral care with chlorhexidine.
e. Awaken the patient daily to determine the need for continued ventilation. -
ANSWERS-a,b,d
The patient is admitted with a suspected acute myocardial infarction (AMI). In assessing
the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the
nurse that the patient is in the process of an evolving Q wave myocardial infarction
(MI)?
a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels
b. Depressed ST-segment on ECG and elevated total CPK
c. Depressed ST-segment on ECG and normal cardiac enzymes
d. Q wave on ECG with normal enzymes and troponin levels - ANSWERS-a
left sided heart failure - ANSWERS-
right sided heart failure - ANSWERS-
A patient is admitted with an acute myocardial infarction (AMI). The nurse knows that an
angiotensin-converting enzyme (ACE) inhibitor should be started within 24 hours to
reduce the incidence of which process?
a. Myocardial stunning
b. Hibernating myocardium
c. Myocardial remodeling
d. Tachycardia - ANSWERS-c
A patient presents to the emergency department (ED) with chest pain that he has had
for the past 2 hours. The patient is nauseated and diaphoretic, with dusky skin color.
The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic
intervention would the nurse question?
a. Emergent pacemaker insertion
b. Emergent percutaneous coronary intervention
c. Emergent thrombolytic therapy
,d. Immediate coronary artery bypass graft surgery - ANSWERS-A
The goals of management of AMI are to dissolve the lesion that is occluding the
coronary artery and to increase blood flow to the myocardium.
A patient is admitted with the diagnosis of unstable angina. The nurse knows that the
physiological mechanism present is most likely which of the following?
a. Complete occlusion of a coronary artery
b. Fatty streak within the intima of a coronary artery
c. Partial occlusion of a coronary artery with a thrombus
d. Vasospasm of a coronary artery - ANSWERS-C
In unstable angina, some blood continues to flow through the affected coronary artery;
however, flow is diminished related to partial occlusion.
A patient is admitted with angina. The nurse anticipates which drug regimen to be
initiated?
a. ACE inhibitors and diuretics
b. Morphine sulfate and oxygen
c. Nitroglycerin, oxygen, and beta blockers
d. Statins, bile acid, and nicotinic acid - ANSWERS-c
A patient is having a cardiac evaluation to assess for possible valvular disease. Which
study best identifies valvular function and measures the size of the cardiac chambers?
a. 12-lead electrocardiogram
b. Cardiac catheterization
c. Echocardiogram
d. Electrophysiology study - ANSWERS-c
The patient is admitted with an acute myocardial infarction (AMI). Three days later the
nurse is concerned that the patient may have a papillary muscle rupture. Which
assessment data may indicate a papillary muscle rupture?
a. Gallop rhythm
b. New murmur
c. S1 heart sound
d. S3 heart sound - ANSWERS-b
A 72-year-old woman is brought to the ED by her family. The family states that she's
"just not herself." Her respirations are slightly labored, and her heart monitor shows
sinus tachycardia (rate 110 beats/min) with frequent premature ventricular contractions
(PVCs). She denies any chest pain, jaw pain, back discomfort, or nausea. Her troponin
levels are elevated, and her 12-lead electrocardiogram (ECG) shows elevated ST
segments in leads II, III, and aVF. The nurse knows that these symptoms are most likely
associated with which diagnosis?
a. Hypokalemia
b. Non-Q wave MI
c. Silent myocardial infarction
d. Unstable angina - ANSWERS-c
,Which of the following professional organizations best supports critical care nursing
practice?
a. American Association of Critical-Care Nurses
b. American Heart Association
c. American Nurses Association
d. Society of Critical Care Medicine - ANSWERS-a
The synergy model of practice focuses on:
a. allowing unrestricted visiting for the patient 24 hours each day.
b. holistic and alternative therapies.
c. needs of patients and their families, which drives nursing competency.
d. patients' needs for energy and support. - ANSWERS-c
The family of your critically ill patient tells you that they have not spoken with the
physician in over 24 hours and they have some questions that they want clarified.
During morning rounds, you convey this concern to the attending intensivist and arrange
for her to meet with the family at 4:00 PM in the conference room. Which competency of
critical care nursing does this represent?
a. Advocacy and moral agency in solving ethical issues
b. Clinical judgment and clinical reasoning skills
c. Collaboration with patients, families, and team members
d. Facilitation of learning for patients, families, and team members - ANSWERS-c
The charge nurse is responsible for making the patient assignments on the critical care
unit. She assigns the experienced, certified nurse to care for the acutely ill patient with
sepsis who also requires continuous renal replacement therapy and mechanical
ventilation. She assigns the nurse with less than 1 year of experience to two patients
who are more stable. This assignment reflects implementation of the:
a. crew resource management model
b. National Patient Safety Goals
c. Quality and Safety Education for Nurses (QSEN) model
d. synergy model of practice - ANSWERS-d
The family members of a critically ill, 90-year-old patient bring in a copy of the patient's
living will to the hospital, which identifies the patient's wishes regarding health care. You
discuss contents of the living will with the patient's physician. This is an example of
implementation of which of the AACN Standards of Professional Performance?
a. Acquires and maintains current knowledge of practice
b. Acts ethically on the behalf of the patient and family
c. Considers factors related to safe patient care
d. Uses clinical inquiry and integrates research findings in practice - ANSWERS-b
As part of nursing management of a critically ill patient, orders are written to keep the
head of the bed elevated at 30 degrees, awaken the patient from sedation each
morning to assess readiness to wean from mechanical ventilation, and implement oral
, care protocols every 4 hours. These interventions are done as a group to reduce the
risk of ventilator-associated pneumonia. This group of evidence-based interventions is
often called a:
a. bundle of care.
b. clinical practice guideline.
c. patient safety goal.
d. quality improvement initiative. - ANSWERS-a
Which of the following statements describes the core concept of the synergy model of
practice?
a. All nurses must be certified in order to have the synergy model implemented.
b. Family members must be included in daily interdisciplinary rounds.
c. Nurses and physicians must work collaboratively and synergistically to influence care.
d. Unique needs of patients and their families influence nursing competencies. -
ANSWERS-d
Which of the following is a National Patient Safety Goal? (Select all that apply.)
a. Accurately identify patients.
b. Eliminate use of patient restraints.
c. Reconcile medications across the continuum of care.
d. Reduce risks of healthcare-acquired infection. - ANSWERS-a,c,d
Which of the following nursing activities demonstrates implementation of the AACN
Standards of Professional Performance? (Select all that apply.)
a. Attending a meeting of the local chapter of the American Association of Critical-Care
Nurses in which a continuing education program on sepsis is being taught
b. Collaborating with a pastoral services colleague to assist in meeting spiritual needs of
the patient and family
c. Participating on the unit's nurse practice council
d. Posting an article from Critical Care Nurse on management of venous
thromboembolism for your colleagues to read
e. Using evidence-based strategies to prevent ventilator-associated pneumonia -
ANSWERS-a,b,c,d,e
Which scenarios contribute to effective handoff communication at change of shift?
(Select all that apply.)
a. The nephrology consultant physician is making rounds and asks you to update her on
the patient's status and assist in placing a central line for hemodialysis.
b. The noise level is high because twice as many staff members are present and
everyone is giving report in the nurse's station.
c. The unit has decided to use a standardized checklist/tool for change-of-shift reports
and patient transfers.
d. You and the oncoming nurse conduct a standardized report at the patient's bedside
and review key assessment findings. - ANSWERS-c,d
