Question 1

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 automated external defibrillator (AE
D) 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 automated external defibrillator (AE
D) is available. C

Question 2

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 D

Question 3

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 D

Question 4

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

Question 5

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 6

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 7

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 8

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 9

A patient has been found with no pulse or respirations.The cardiopulmonary arrest team has been called.What should the nurse do while awaiting the team's arrival?

Accepted Answer

A)  Gather the patient's medical record and medication administration record. 
B)  Obtain the crash cart. 
C)  Notify the patient's primary care provider. 
D)  Perform cardiopulmonary resuscitation (CPR). 
A)  Gather the patient's medical record and medication administration record. 
B)  Obtain the crash cart. 
C)  Notify the patient's primary care provider. 
D)  Perform cardiopulmonary resuscitation (CPR).

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

The nurse in the critical care unit (CCU)is caring for a newly admitted patient with chest pain.She is aware that arrhythmia 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 the above 
A)  Electrolyte disturbances 
B)  Heart damage 
C)  Medications 
D)  Respiratory arrest 
E)  None of the above

Question 12

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

Question 13

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)  Prepare supplies for the code team to intubate the patient. 
C)  Begin cardiopulmonary resuscitation (CPR). 
D)  Obtain automated external defibrillator (AE
D) . 
A)  Immediately intubate the patient. 
B)  Prepare supplies for the code team to intubate the patient. 
C)  Begin cardiopulmonary resuscitation (CPR). 
D)  Obtain automated external defibrillator (AE
D) .

Question 14

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 15

When using an automated external defibrillator (AED),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 16

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)  Monitor the carbon dioxide detector. 
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)  Monitor the carbon dioxide detector. 
C)  Auscultate both lungs. 
D)  Call for a chest radiograph.

Question 17

The nurse walks into his or her patient's room to find him unresponsive.He or she begins cardiopulmonary resuscitation (CPR),knowing that during a "code" situation,chest compressions should be interrupted for which of the following? (Select all that apply.)

Accepted Answer

A)  Ventilation 
B)  Pulse checks 
C)  Intubation 
D)  Defibrillation 
E)  None of the above 
A)  Ventilation 
B)  Pulse checks 
C)  Intubation 
D)  Defibrillation 
E)  None of the above

Question 18

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 19

The nurse is providing cardiopulmonary resuscitation (CPR)to an unresponsive patient according to the 2015 American Heart Association (AHA)resuscitation guidelines.The nurse is performing chest compressions correctly when he or she performs them at which rate?

Accepted Answer

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

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

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?

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?

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 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?

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 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

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.

A patient has been found with no pulse or respirations.The cardiopulmonary arrest team has been called.What should the nurse do while awaiting the team's arrival?

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

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

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

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 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?

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

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

The nurse walks into his or her patient's room to find him unresponsive.He or she begins cardiopulmonary resuscitation (CPR),knowing that during a "code" situation,chest compressions should be interrupted for which of the following? (Select all that apply.)

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 is providing cardiopulmonary resuscitation (CPR)to an unresponsive patient according to the 2015 American Heart Association (AHA)resuscitation guidelines.The nurse is performing chest compressions correctly when he or she performs them at which rate?

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:

Evidence-Informed Nursing Practice

Transitions in Care

Communication and Collaboration

Documentation and Informatics

Medical Asepsis

Sterile Technique

Vital Signs

Health Assessment

Specimen Collection

Diagnostic Procedures

Safe Patient Handling, transfer, and Positioning

Exercise Mobility

Support Surfaces and Special Beds

Patient Safety

Emergency Preparedness and Disaster Management

Pain Assessment and Management

Palliative Care

Personal Hygiene and Bed Making

Care of the Eye and Ear

Safe Medication Preparation

Nonparenteral Medications

Parenteral Medications

Oxygen Therapy

Performing Chest Physiotherapy

Airway Management

Cardiac Care

Closed Chest Drainage Systems

Vascular Access and Infusion Therapy

Blood Therapy

Oral Nutrition

Enteral Nutrition

Parenteral Nutrition

Urinary Elimination and Catheterization

Bowel Elimination and Gastric Intubation

Ostomy Care

Preoperative and Postoperative Care

Intraoperative Care

Prevention and Care of Skin Breakdown

Wound Care Management and Dressings

Therapeutic Use of Heat and Cold

Safety in the Community

Self-Care Teaching in the Community

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.