Question 1

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 mm Hg 
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 mm Hg C

Question 2

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 A

Question 3

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. B

Question 4

The nurse is providing cardiopulmonary resuscitation (CPR)to an unresponsive patient according to the 2010 American Heart Association (AHA)resuscitation guidelines.The nurse is performing chest compressions correctly when she performs them at which rate?

Accepted Answer

A) 60 to 80 per minute 
B) 120 per minute 
C) 100 per minute 
D) 40 to 60 per minute 
A) 60 to 80 per minute 
B) 120 per minute 
C) 100 per minute 
D) 40 to 60 per minute

Question 5

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

Accepted Answer

tongue
The tongue is

Question 6

The nurse in the intensive care unit (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 
A) Electrolyte disturbances 
B) Heart damage 
C) Medications 
D) Respiratory arrest

Question 7

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) cardiopulmonary resuscitation (CPR). 
B) defibrillation. 
C) oxygen. 
D) precordial thump. 
A) cardiopulmonary resuscitation (CPR). 
B) defibrillation. 
C) oxygen. 
D) precordial thump.

Question 8

Which sign or symptom of airway compromise may require insertion of an oral airway?

Accepted Answer

A) Ability of the patient to speak 
B) Ability of the patient to cough forcefully 
C) Presence of wheezing between coughs 
D) Presence of gurgling with the respiratory cycle 
A) Ability of the patient to speak 
B) Ability of the patient to cough forcefully 
C) Presence of wheezing between coughs 
D) Presence of gurgling with the respiratory cycle

Question 9

The nurse would call the code team for which of the following patients?

Accepted Answer

A) A patient with blood pressure of 60/28 mm Hg 
B) A patient experiencing severe dyspnea secondary to asthma 
C) A patient in atrial fibrillation 
D) An unconscious patient in ventricular tachycardia 
A) A patient with blood pressure of 60/28 mm Hg 
B) A patient experiencing severe dyspnea secondary to asthma 
C) A patient in atrial fibrillation 
D) An unconscious patient in ventricular tachycardia

Question 10

Which of the following is the appropriate technique for a nurse to implement when inserting an oral airway?

Accepted Answer

A) Insert the airway with the curved end up,then rotate it 180 degrees at the back of the throat. 
B) Insert the airway with the curved end down along the curve of the tongue. 
C) Use a tongue blade to insert and push the airway into position. 
D) Insert the airway sideways,then rotate it with the curved end up. 
A) Insert the airway with the curved end up,then rotate it 180 degrees at the back of the throat. 
B) Insert the airway with the curved end down along the curve of the tongue. 
C) Use a tongue blade to insert and push the airway into position. 
D) Insert the airway sideways,then rotate it with the curved end up.

Question 11

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 12

The nurse enters the patient's room and finds that the patient is not breathing and has no pulse.The patient does not have a do-not-resuscitate order.What would the nurse's most immediate action be?

Accepted Answer

A) Call the cardiac/respiratory arrest team. 
B) Begin cardiopulmonary resuscitation (CPR). 
C) Call a co-worker for help. 
D) Get the crash cart. 
A) Call the cardiac/respiratory arrest team. 
B) Begin cardiopulmonary resuscitation (CPR). 
C) Call a co-worker for help. 
D) Get the crash cart.

Question 13

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 14

The nurse enters her patient's room to find him unresponsive.She begins cardiopulmonary resuscitation (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

Question 15

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.

Question 16

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 17

The nurse is performing cardiopulmonary resuscitation (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 18

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 19

When using an automated external defibrillator,it is important for the nurse to ensure that no one is touching the patient:

Accepted Answer

A) after connecting the cable to the machine. 
B) when the machine is plugged in. 
C) while the pads are applied. 
D) while the machine analyzes the rhythm. 
A) after connecting the cable to the machine. 
B) when the machine is plugged in. 
C) while the pads are applied. 
D) while the machine analyzes the rhythm.

Question 20

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."

Exam 28: Emergency Measure for Life Support

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

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 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 is providing cardiopulmonary resuscitation (CPR)to an unresponsive patient according to the 2010 American Heart Association (AHA)resuscitation guidelines.The nurse is performing chest compressions correctly when she performs them at which rate?

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

The nurse in the intensive care unit (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. )

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:

Which sign or symptom of airway compromise may require insertion of an oral airway?

The nurse would call the code team for which of the following patients?

Which of the following is the appropriate technique for a nurse to implement when inserting an oral airway?

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

The nurse enters the patient's room and finds that the patient is not breathing and has no pulse.The patient does not have a do-not-resuscitate order.What would the nurse's most immediate action be?

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?

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

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. )

When applying an automated external defibrillator,the nurse would:

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

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.

When using an automated external defibrillator,it is important for the nurse to ensure that no one is touching the patient:

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:

Using Evidence in Practice

Admitting, Transfer, and Discharge

Communication and Collaboration

Documentation and Informatics

Vital Signs

Health Assessment

Specimen Collection

Diagnostic Procedures

Medical Asepsis

Sterile Technique

Safe Patient Handling, Transfer, and Positioning

Exercise Mobility

Support Surfaces and Special Beds

Patient Safety

Disaster Preparedness

Pain Management

Palliative Care

Personal Hygiene and Bed Making

Care of the Eye and Ear

Safe Medication Preparation

Administration of Nonparenteral Medications

Administration of Parenteral Medications

Oxygen Therapy

Performing Chest Physiotherapy

Airway Management

Cardiac Care

Closed Chest Drainage Systems

Intravenous and Vascular Access Therapy

Blood Therapy

Oral Nutrition

Enteral Nutrition

Parenteral Nutrition

Urinary Elimination

Bowel Elimination and Gastric Intubation

Ostomy Care

Preoperative and Postoperative Care

Intraoperative Care

Pressure Injury Prevention and Care

Wound Care and Irrigations

Dressings, Bandages, and Binders

Therapeutic Use of Heat and Cold

Home Care Safety

Home Care Teaching

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.