Nr 341 Final Exam Latest Updated 2025 Questions With Detailed Answers
The nurse is caring for a patient who is on a cardiac monitor. The nurse realizes that the sinus node
is the pacemaker of the heart because it is:
a. the fastest pacemaker cell in the heart.
b. the only pacemaker cell in the heart.
c. the only cell that does not affect the cardiac cycle.
d. located in the left side of the heart. -ANS A
The cardiac cycle begins with an impulse that is generated from a small concentrated area of
pacemaker cells high in the right atria called the sinoatrial node (sinus node or SA node). The SA
node has the fastest rate of discharge and thus is the dominant pacemaker of the heart. The AV
node has pacemaker properties and can discharge an impulse if the SA node fails. The ventricles
have pacemaker capabilities if the sinus node or the AV node ceases to generate impulses.
One of the functions of the atrioventricular (AV) node is to:
a. pace the heart if the ventricles fail.
b. slow the impulse arriving from the SA node.
c. send the impulse to the SA node.
d. allow for ventricular filling during systole. -ANS b
The normal rate for the SA node when the patient is at rest is:
a. 40 to 60 beats per minute.
b. 60 to 100 beats per minute.
c. 20 to 40 beats per minute.
d. more than100 beats per minute. -ANS b
When assessing the 12-lead electrocardiogram (ECG) or a rhythm strip, it is helpful to understand
that the electrical activity is viewed in relation to the positive electrode of that particular lead.
When an electrical signal is aimed directly at the positive electrode, the inflection will be:
a. negative.
b. upside down.
c. upright.
d. equally positive and negative. -ANS c
The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P
waves are upright and look the same except one that has a different shape and is inverted. The
nurse realizes that the P wave with the abnormal shape is probably:
a. from the SA node since all P waves come from the SA node.
b. from some area in the atria other than the SA node.
c. indicative of ventricular depolarization.
d. normal even though it is inverted in lead II. -ANS b
,Normally a P wave indicates that the SA node initiated the impulse that depolarized the atrium.
However, a change in the shape of the P wave may indicate that the impulse arose from a site in the
atria other than the SA node. The P wave represents atrial depolarization. It is usually upright in
leads I and II and has a rounded, symmetrical shape. The amplitude of the P wave is measured at
the center of the waveform and normally does not exceed three boxes, or 3 millimeters, in height.
The QT interval is the total time taken for ventricular depolarization and repolarization.
Prolongation of the QT interval:
a. decreases the risk of lethal dysrhythmias.
b. usually occurs when heart rate increases.
c. increases the risk of lethal dysrhythmias.
d. can only be measured with irregular rhythms. -ANS 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 -ANS 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. -ANS 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 -ANS 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 -ANS 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 -ANS 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. -ANS 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. -ANS 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. -ANS 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 -ANS 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. -ANS c,d
Which strategy is important to addressing issues associated with the aging workforce? (Select all
that apply.)
a. Allowing nurses to work flexible shift durations
b. Encouraging older nurses to transfer to an outpatient setting that is less stressful
c. Hiring nurse technicians that are available to assist with patient care, such as turning the patient
d. Remodeling patient care rooms to include devices to assist in patient lifting -ANS a,c,d
Which of the following strategies will assist in creating a healthy work environment for the critical
care nurse? (Select all that apply.)
a. Celebrating improved outcomes from a nurse-driven protocol with a pizza party
b. Implementing a medication safety program designed by pharmacists
c. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio
d. Offering quarterly joint nurse-physician workshops to discuss unit issues
e. Using the Situation-Background-Assessment-Recommendation (SBAR) technique for handoff
communication -ANS a,d,e
The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse first:
a. identifies the markers on the ECG paper that indicate a 6-second strip.
b. counts the number of large boxes between two consecutive P waves.
c. counts the number of small boxes between two consecutive QRS complexes.
d. divides the number of complexes in a 6-second strip by 10. -ANS A
Six-second method: A quick and easy estimate of heart rate can be accomplished by counting the
number of P waves or QRS waves within a 6-second strip to obtain atrial and ventricular heart
rates per minute. This is the optimal method for irregular rhythms. Identify the lines above the ECG
paper that represent 6 seconds, and count the number of P waves within the lines; then add a zero
(multiply by 10) to identify the atrial heart rate estimate for 1 minute. Next, identify the number of
QRS waves in the 6-second strip and again add a zero to identify the ventricular rate.
The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P
wave and 20 small boxes between each R wave. What is the ventricular rate?
a. 50 beats/min
b. 75 beats/min
The nurse is caring for a patient who is on a cardiac monitor. The nurse realizes that the sinus node
is the pacemaker of the heart because it is:
a. the fastest pacemaker cell in the heart.
b. the only pacemaker cell in the heart.
c. the only cell that does not affect the cardiac cycle.
d. located in the left side of the heart. -ANS A
The cardiac cycle begins with an impulse that is generated from a small concentrated area of
pacemaker cells high in the right atria called the sinoatrial node (sinus node or SA node). The SA
node has the fastest rate of discharge and thus is the dominant pacemaker of the heart. The AV
node has pacemaker properties and can discharge an impulse if the SA node fails. The ventricles
have pacemaker capabilities if the sinus node or the AV node ceases to generate impulses.
One of the functions of the atrioventricular (AV) node is to:
a. pace the heart if the ventricles fail.
b. slow the impulse arriving from the SA node.
c. send the impulse to the SA node.
d. allow for ventricular filling during systole. -ANS b
The normal rate for the SA node when the patient is at rest is:
a. 40 to 60 beats per minute.
b. 60 to 100 beats per minute.
c. 20 to 40 beats per minute.
d. more than100 beats per minute. -ANS b
When assessing the 12-lead electrocardiogram (ECG) or a rhythm strip, it is helpful to understand
that the electrical activity is viewed in relation to the positive electrode of that particular lead.
When an electrical signal is aimed directly at the positive electrode, the inflection will be:
a. negative.
b. upside down.
c. upright.
d. equally positive and negative. -ANS c
The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P
waves are upright and look the same except one that has a different shape and is inverted. The
nurse realizes that the P wave with the abnormal shape is probably:
a. from the SA node since all P waves come from the SA node.
b. from some area in the atria other than the SA node.
c. indicative of ventricular depolarization.
d. normal even though it is inverted in lead II. -ANS b
,Normally a P wave indicates that the SA node initiated the impulse that depolarized the atrium.
However, a change in the shape of the P wave may indicate that the impulse arose from a site in the
atria other than the SA node. The P wave represents atrial depolarization. It is usually upright in
leads I and II and has a rounded, symmetrical shape. The amplitude of the P wave is measured at
the center of the waveform and normally does not exceed three boxes, or 3 millimeters, in height.
The QT interval is the total time taken for ventricular depolarization and repolarization.
Prolongation of the QT interval:
a. decreases the risk of lethal dysrhythmias.
b. usually occurs when heart rate increases.
c. increases the risk of lethal dysrhythmias.
d. can only be measured with irregular rhythms. -ANS 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 -ANS 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. -ANS 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 -ANS 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 -ANS 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 -ANS 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. -ANS 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. -ANS 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. -ANS 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 -ANS 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. -ANS c,d
Which strategy is important to addressing issues associated with the aging workforce? (Select all
that apply.)
a. Allowing nurses to work flexible shift durations
b. Encouraging older nurses to transfer to an outpatient setting that is less stressful
c. Hiring nurse technicians that are available to assist with patient care, such as turning the patient
d. Remodeling patient care rooms to include devices to assist in patient lifting -ANS a,c,d
Which of the following strategies will assist in creating a healthy work environment for the critical
care nurse? (Select all that apply.)
a. Celebrating improved outcomes from a nurse-driven protocol with a pizza party
b. Implementing a medication safety program designed by pharmacists
c. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio
d. Offering quarterly joint nurse-physician workshops to discuss unit issues
e. Using the Situation-Background-Assessment-Recommendation (SBAR) technique for handoff
communication -ANS a,d,e
The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse first:
a. identifies the markers on the ECG paper that indicate a 6-second strip.
b. counts the number of large boxes between two consecutive P waves.
c. counts the number of small boxes between two consecutive QRS complexes.
d. divides the number of complexes in a 6-second strip by 10. -ANS A
Six-second method: A quick and easy estimate of heart rate can be accomplished by counting the
number of P waves or QRS waves within a 6-second strip to obtain atrial and ventricular heart
rates per minute. This is the optimal method for irregular rhythms. Identify the lines above the ECG
paper that represent 6 seconds, and count the number of P waves within the lines; then add a zero
(multiply by 10) to identify the atrial heart rate estimate for 1 minute. Next, identify the number of
QRS waves in the 6-second strip and again add a zero to identify the ventricular rate.
The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P
wave and 20 small boxes between each R wave. What is the ventricular rate?
a. 50 beats/min
b. 75 beats/min
