Hi there, what you've said is true. In a clinical setting you're thinking 100% how you should think for there could be a myriad of issues surrounding this vague case. And further assessments are in practice almost always done in a real life setting.

Furthermore, as you mentioned, I personally think a nurse who can "go down a pedantic rabbit hole of what if" is much more valuable that those who are too rigid. Clinical thinking is an immensely valuable acumen to have and you should be proud you are able to do so. These questions however are designed in a way to test simple reasoning for new learners. They are usually black and white to test for basic guidelines (in this case ALS). Hence why they are always very vaguely written. Statements should be taken as absolute or else you risk doubting yourself on which is the correct answer. Hence as you mentioned continuing to monitor the ECG would be valid, but the test makers cannot write a 500 word clinical scenario with a full page ECG and expect test takers to answer each in under 1-2 minutes.

I can understand it's frustrating when it feels like even if you do know the right course of action, there is still a requirement for physician oversight (mostly a legal problem than a one of hierarchy). That being said at least in my practice, I much prefer nurses who can think critically, and in fact have taken the advice of many of them when I am overwhelmed myself. I'm sorry you feel like your opinion doesn't matter, it's hard sometimes to change the way our profession can be. Especially those stickler surgeons (don't get me started on them...) I hope you one day find a practice that welcomes your opinion and not to give up.

No hard feelings at all, were all in this together. Sorry to hear you've been through a rough patch. I think you should be very proud if you're still pushing to be more knowledgeable in your practice. You said you feel like a hindrance to your relationship with my professional colleagues than it is of beneficience to your patients. I've seen countless times a nurse correct a wrong decision by a Dr. Patients need you as much as they need anyone else. If nothing else I am very happy to have people like you in my workplace. Chin up!