Question 1

During the secondary survey of the code event, the nurse realizes that the patient is not breathing on his own.What should the nurse do next?

Accepted Answer

A) Immediately intubate the patient. 
B) Have a laryngoscope handle and curved blades available. 
C) Ensure that the light source on the laryngoscope is functional. 
D) Have a laryngoscope handle and straight blades available. 
A) Immediately intubate the patient. 
B) Have a laryngoscope handle and curved blades available. 
C) Ensure that the light source on the laryngoscope is functional. 
D) Have a laryngoscope handle and straight blades available. C

Question 2

The nurse sees on the cardiorespiratory monitor that the patient's cardiac rhythm has changed from normal sinus rhythm to ventricular fibrillation.The nurse knows that the most effective means of converting this rhythm is:

Accepted Answer

A) CPR. 
B) defibrillation. 
C) oxygen. 
D) precordial thump. 
A) CPR. 
B) defibrillation. 
C) oxygen. 
D) precordial thump. B

Question 3

The nurse is caring for an unconscious patient who has an oral airway in place, and who has copious amounts of oral secretions.What may the nurse have to do while caring for this patient? (Select all that apply.)

Accepted Answer

A) Cleanse the mouth frequently using lemon glycerin swabs. 
B) Replace or clean the oral airway. 
C) Suction the oral cavity frequently. 
D) Keep the airway in place for extended periods. 
A) Cleanse the mouth frequently using lemon glycerin swabs. 
B) Replace or clean the oral airway. 
C) Suction the oral cavity frequently. 
D) Keep the airway in place for extended periods. B, C

Question 4

The nurse is performing cardiac compressions on a 4-year-old child with the assistance of another nurse.The nurses would deliver breaths and compressions at a ratio of _____ compressions for _____ breaths.

Accepted Answer

A) 30; 2 
B) 5; 1 
C) 15; 2 
D) 5; 2 
A) 30; 2 
B) 5; 1 
C) 15; 2 
D) 5; 2

Question 5

The nurse is preparing to insert an oral airway in a patient who is exhibiting signs of potential respiratory distress.The nurse knows that candidates for oral airway placement are those:

Accepted Answer

A) with oral trauma. 
B) with loose teeth. 
C) who are unconscious. 
D) who have had recent oral surgery. 
A) with oral trauma. 
B) with loose teeth. 
C) who are unconscious. 
D) who have had recent oral surgery.

Question 6

Many cardiac arrests are caused by irregular heart rhythms known as ________________.

Accepted Answer

dysrhythmias
Many ca

Question 7

The nurse is working in the emergency department when an 8-year-old patient is brought in with respiratory distress.The nurse is preparing to insert an oral airway.Which of the following is the appropriate size for this patient?

Accepted Answer

A) Size 1 
B) Size 2 
C) Size 3 
D) Size 7 
A) Size 1 
B) Size 2 
C) Size 3 
D) Size 7

Question 8

While measuring an oral airway for proper fit, the nurse places the airway so that the flange is held parallel to the front teeth with the airway against the patient's cheek.Where is the end of the curve?

Accepted Answer

A) At the angle of the jaw 
B) Above the ear 
C) To the level of the nose 
D) Upside down 
A) At the angle of the jaw 
B) Above the ear 
C) To the level of the nose 
D) Upside down

Question 9

The most common cause of airway obstruction in an unresponsive patient is the __________.

Accepted Answer

tongue
The tongue is

Question 10

The patient is brought to the emergency department after a motor vehicle accident.The patient has head and neck trauma and has stopped breathing.What should the nurse do?

Accepted Answer

A) Open the airway using the head tilt-chin lift method. 
B) Open the airway using the jaw-thrust method. 
C) Give two breaths using mouth-to-mouth and a barrier device. 
D) Give two breaths using a bag-mask device. 
A) Open the airway using the head tilt-chin lift method. 
B) Open the airway using the jaw-thrust method. 
C) Give two breaths using mouth-to-mouth and a barrier device. 
D) Give two breaths using a bag-mask device.

Question 11

The nurse finds a patient lying on the bathroom floor.The patient is unresponsive and has a pulse but is not breathing.What is the nurse's first action?

Accepted Answer

A) Give two breaths using mouth-to-mouth without a barrier device. 
B) Give two breaths using mouth-to-mouth without a barrier device and watch for chest movement. 
C) Give two breaths using a bag-mask device. 
D) Start chest compressions until an AED is available. 
A) Give two breaths using mouth-to-mouth without a barrier device. 
B) Give two breaths using mouth-to-mouth without a barrier device and watch for chest movement. 
C) Give two breaths using a bag-mask device. 
D) Start chest compressions until an AED is available.

Question 12

The nurse is performing CPR on an adult patient who has an endotracheal tube in place.At what rate does the nurse, who is alone, administer breaths?

Accepted Answer

A) 8 per minute 
B) 12 per minute 
C) 20 per minute 
D) 24 per minute 
A) 8 per minute 
B) 12 per minute 
C) 20 per minute 
D) 24 per minute

Question 13

A semicircular, minimally flexible, curved piece of hard plastic that is inserted into the mouth so it extends from just outside the lips to the pharynx is known as an ____________.

Accepted Answer

oral airway
An oral airway is a semicirc

Question 14

When applying an automated external defibrillator, the nurse would:

Accepted Answer

A) connect the cable to the machine, apply the pads, and turn on the power. 
B) turn on the power, apply the pads, and connect the cable. 
C) turn on the power, connect the cable, and apply the pads. 
D) connect the cable, turn on the power, and apply the pads. 
A) connect the cable to the machine, apply the pads, and turn on the power. 
B) turn on the power, apply the pads, and connect the cable. 
C) turn on the power, connect the cable, and apply the pads. 
D) connect the cable, turn on the power, and apply the pads.

Question 15

In the event of cardiopulmonary arrest, all patients receive CPR unless otherwise indicated in the patient's _________________.

Accepted Answer

advance directive
Unless other

Question 16

The nurse is providing an educational seminar to a group of nursing students on the advantages of using an automated external defibrillator ( AED ).She knows that her teaching has been effective when the students reply:

Accepted Answer

A) "Health care providers do not need to learn CPR to use the AED." 
B) "The health care provider is given a printout of the rhythm change." 
C) "The health care provider can safely use both CPR skills and AED skills." 
D) "The health care provider can adjust the level of shock administered." 
A) "Health care providers do not need to learn CPR to use the AED." 
B) "The health care provider is given a printout of the rhythm change." 
C) "The health care provider can safely use both CPR skills and AED skills." 
D) "The health care provider can adjust the level of shock administered."

Question 17

The nurse in the ICU is caring for a newly admitted patient with chest pain.She is aware that dysrhythmia may be caused by which of the following? (Select all that apply.)

Accepted Answer

A) Electrolyte disturbances 
B) Heart damage 
C) Medications 
D) Respiratory arrest 
E) None of above 
A) Electrolyte disturbances 
B) Heart damage 
C) Medications 
D) Respiratory arrest 
E) None of above

Question 18

What is the nurse's responsibility for the patient after he has been intubated during a code event? (Select all that apply.)

Accepted Answer

A) Ventilate using a bag-mask device at a rate of 22 breaths per minute. 
B) Auscultate the epigastric area. 
C) Auscultate both lungs. 
D) Call for a chest radiograph. 
A) Ventilate using a bag-mask device at a rate of 22 breaths per minute. 
B) Auscultate the epigastric area. 
C) Auscultate both lungs. 
D) Call for a chest radiograph.

Question 19

For which of the following patients would the nurse request the rapid response team's immediate intervention?

Accepted Answer

A) A patient complaining of severe postoperative incisional pain 
B) A patient with no pulse who is not breathing 
C) A patient complaining of chest pain, hypotension, and shortness of breath 
D) A patient with blood pressure of 164/96 
A) A patient complaining of severe postoperative incisional pain 
B) A patient with no pulse who is not breathing 
C) A patient complaining of chest pain, hypotension, and shortness of breath 
D) A patient with blood pressure of 164/96

Question 20

The nurse enters her patient's room to find him unresponsive.She begins CPR according to protocol.How deep should the nurse do chest compressions in this pulseless adult?

Accepted Answer

A) 1 to   inches in depth 
B)    to 3 inches in depth 
C)    to 1 inch in depth 
D)    to 2 inches in depth 
A) 1 to   inches in depth 
B)    to 3 inches in depth 
C)    to 1 inch in depth 
D)    to 2 inches in depth

Exam 27: Emergency Measures for Life Support

During the secondary survey of the code event, the nurse realizes that the patient is not breathing on his own.What should the nurse do next?

The nurse sees on the cardiorespiratory monitor that the patient's cardiac rhythm has changed from normal sinus rhythm to ventricular fibrillation.The nurse knows that the most effective means of converting this rhythm is:

The nurse is caring for an unconscious patient who has an oral airway in place, and who has copious amounts of oral secretions.What may the nurse have to do while caring for this patient? (Select all that apply.)

The nurse is performing cardiac compressions on a 4-year-old child with the assistance of another nurse.The nurses would deliver breaths and compressions at a ratio of _____ compressions for _____ breaths.

The nurse is preparing to insert an oral airway in a patient who is exhibiting signs of potential respiratory distress.The nurse knows that candidates for oral airway placement are those:

Many cardiac arrests are caused by irregular heart rhythms known as ________________.

The nurse is working in the emergency department when an 8-year-old patient is brought in with respiratory distress.The nurse is preparing to insert an oral airway.Which of the following is the appropriate size for this patient?

While measuring an oral airway for proper fit, the nurse places the airway so that the flange is held parallel to the front teeth with the airway against the patient's cheek.Where is the end of the curve?

The most common cause of airway obstruction in an unresponsive patient is the __________.

The patient is brought to the emergency department after a motor vehicle accident.The patient has head and neck trauma and has stopped breathing.What should the nurse do?

The nurse finds a patient lying on the bathroom floor.The patient is unresponsive and has a pulse but is not breathing.What is the nurse's first action?

The nurse is performing CPR on an adult patient who has an endotracheal tube in place.At what rate does the nurse, who is alone, administer breaths?

A semicircular, minimally flexible, curved piece of hard plastic that is inserted into the mouth so it extends from just outside the lips to the pharynx is known as an ____________.

When applying an automated external defibrillator, the nurse would:

In the event of cardiopulmonary arrest, all patients receive CPR unless otherwise indicated in the patient's _________________.

The nurse is providing an educational seminar to a group of nursing students on the advantages of using an automated external defibrillator ( AED ).She knows that her teaching has been effective when the students reply:

The nurse in the ICU is caring for a newly admitted patient with chest pain.She is aware that dysrhythmia may be caused by which of the following? (Select all that apply.)

What is the nurse's responsibility for the patient after he has been intubated during a code event? (Select all that apply.)

For which of the following patients would the nurse request the rapid response team's immediate intervention?

The nurse enters her patient's room to find him unresponsive.She begins CPR according to protocol.How deep should the nurse do chest compressions in this pulseless adult?

Using Evidence in Nursing Practice

Admitting, Transfer, and Discharge

Communication

Documentation and Informatics

Vital Signs

Health Assessment

Medical Asepsis

Sterile Technique

Safe Patient Handling, Transfer, and Positioning

Exercise and Ambulation

Orthopedic Measures

Support Surfaces and Special Beds

Safety and Quality Improvement

Disaster Preparedness

Pain Assessment and Basic Comfort Measures

Palliative Care

Personal Hygiene and Bed Making

Pressure Ulcer Care

Care of the Eye and Ear

Safe Medication Preparation

Oral and Topical Medications

Parenteral Medications

Oxygen Therapy

Performing Chest Physiotherapy

Airway Management

Closed Chest Drainage Systems

Intravenous and Vascular Access Therapy

Blood Transfusions

Oral Nutrition

Enteral Nutrition

Parenteral Nutrition

Urinary Elimination

Bowel Elimination and Gastric Intubation

Ostomy Care

Preoperative and Postoperative Care

Intraoperative Care

Wound Care and Irrigations

Dressings, Bandages, and Binders

Therapeutic Use of Heat and Cold

Home Care Safety

Home Care Teaching

Specimen Collection

Diagnostic Procedures

Filters

The nurse is performing cardiac compressions on a 4-year-old child with the assistance of another nurse.The nurses would deliver breaths and compressions at a ratio of _ compressions for _ breaths.