Nr 341 Final Exam 2022 Updated Version 2023

Nr 341 Final Exam 2022 Updated Version 2023 Questions and Correct CORRECT ANSWER wers Guaranteed Success Which of the following professional organizations best supports critical care nursing practice?

• American Association of Critical-Care Nurses
• American Heart Association
• American Nurses Association
• Society of Critical Care Medicine - CORRECT ANSWER a

The synergy model of practice focuses on:

• allowing unrestricted visiting for the patient 24 hours each day.
• holistic and alternative therapies.
• needs of patients and their families, which drives nursing competency.
• patients' needs for energy and support. - CORRECT ANSWER 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?

• Advocacy and moral agency in solving ethical issues
• Clinical judgment and clinical reasoning skills
• Collaboration with patients, families, and team members
• Facilitation of learning for patients, families, and team members - CORRECT

ANSWER 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:

• crew resource management model
• National Patient Safety Goals
• Quality and Safety Education for Nurses (QSEN) model
• synergy model of practice - CORRECT ANSWER 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?

• Acquires and maintains current knowledge of practice
• Acts ethically on the behalf of the patient and family
• Considers factors related to safe patient care 1 / 4

• Uses clinical inquiry and integrates research findings in practice - CORRECT

ANSWER 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:

• bundle of care.
• clinical practice guideline.
• patient safety goal.
• quality improvement initiative. - CORRECT ANSWER a

Which of the following statements describes the core concept of the synergy model of practice?

• All nurses must be certified in order to have the synergy model implemented.
• Family members must be included in daily interdisciplinary rounds.
• Nurses and physiciCORRECT ANSWER must work collaboratively and

synergistically to influence care.

• Unique needs of patients and their families influence nursing competencies. -

CORRECT ANSWER d

Which of the following is a National Patient Safety Goal? (Select all that apply.)

• Accurately identify patients.
• Eliminate use of patient restraints.
• Reconcile medications across the continuum of care.
• Reduce risks of healthcare-acquired infection. - CORRECT ANSWER a,c,d

Which of the following nursing activities demonstrates implementation of the AACN Standards of Professional Performance? (Select all that apply.)

• 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

• Collaborating with a pastoral services colleague to assist in meeting spiritual needs of

the patient and family

• Participating on the unit's nurse practice council
• Posting an article from Critical Care Nurse on management of venous

thromboembolism for your colleagues to read

• Using evidence-based strategies to prevent ventilator-associated pneumonia -

CORRECT ANSWER a,b,c,d,e

Which scenarios contribute to effective handoff communication at change of shift?(Select all that apply.)

• 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. 2 / 4

• The noise level is high because twice as many staff members are present and

everyone is giving report in the nurse's station.

• The unit has decided to use a standardized checklist/tool for change-of-shift reports

and patient trCORRECT ANSWER fers.

• You and the oncoming nurse conduct a standardized report at the patient's bedside

and review key assessment findings. - CORRECT ANSWER c,d

Which strategy is important to addressing issues associated with the aging workforce?(Select all that apply.)

• Allowing nurses to work flexible shift durations
• Encouraging older nurses to trCORRECT ANSWER fer to an outpatient setting that is

less stressful

• Hiring nurse techniciCORRECT ANSWER that are available to assist with patient

care, such as turning the patient

• Remodeling patient care rooms to include devices to assist in patient lifting -

CORRECT ANSWER 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.)

• Celebrating improved outcomes from a nurse-driven protocol with a pizza party
• Implementing a medication safety program designed by pharmacists

c. Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio

• Offering quarterly joint nurse-physician workshops to discuss unit issues
• Using the Situation-Background-Assessment-Recommendation (SBAR) technique for

handoff communication - CORRECT ANSWER a,d,e

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:

• the fastest pacemaker cell in the heart.
• the only pacemaker cell in the heart.
• the only cell that does not affect the cardiac cycle.
• located in the left side of the heart. - CORRECT ANSWER 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:

• pace the heart if the ventricles fail.
• slow the impulse arriving from the SA node.
• send the impulse to the SA node.
• allow for ventricular filling during systole. - CORRECT ANSWER b

The normal rate for the SA node when the patient is at rest is: 3 / 4

• 40 to 60 beats per minute.
• 60 to 100 beats per minute.
• 20 to 40 beats per minute.
• more than100 beats per minute. - CORRECT ANSWER 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:

• negative.
• upside down.
• upright.
• equally positive and negative. - CORRECT ANSWER 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:

• from the SA node since all P waves come from the SA node.
• from some area in the atria other than the SA node.
• indicative of ventricular depolarization.
• normal even though it is inverted in lead II. - CORRECT ANSWER 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:

• decreases the risk of lethal dysrhythmias.
• usually occurs when heart rate increases.
• increases the risk of lethal dysrhythmias.
• can only be measured with irregular rhythms. - CORRECT ANSWER c

The patient has an irregular heart rhythm. To determine an accurate heart rate, the

nurse first:

• identifies the markers on the ECG paper that indicate a 6-second strip.
• counts the number of large boxes between two consecutive P waves.
• counts the number of small boxes between two consecutive QRS complexes.
• divides the number of complexes in a 6-second strip by 10. - CORRECT ANSWER 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

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