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A client has been defibrillated at 360 joules (monophasic) and the attempts to convert the ventricular fibrillation (VF) were unsuccessful. Based on an evaluation of the situation, the nurse determines that which action is best?

  • A. Terminating the resuscitation effort
  • B. Preparing for the administration of sodium bicarbonate intravenously
  • C. Performing cardiopulmonary resuscitation (CPR) for 5 cycles or about 2 minutes
  • D. Performing CPR for 5 minutes, then defibrillating 3 more times at 400 joules
Correct Answer: C

Rationale: Defibrillation is an asynchronous countershock used to terminate pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF). The defibrillator is charged to 120 to 200 joules (biphasic) or 300 joules (monophasic) for 1 countershock from the defibrillator, and then CPR is immediately resumed and continued for 5 cycles or about 2 minutes. The rhythm is reassessed after 2 minutes and if VF or pulseless VT continues, the defibrillator is charged to give a second shock at the same energy level previously used. CPR is resumed after the shock if needed and the life support protocol is continued. There is no information in the question to indicate that life support should be terminated. Sodium bicarbonate may be prescribed but is not the best action. Giving CPR for 5 minutes may not help oxygenation to the brain and myocardium and is not the best action.

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The nurse teaches a pregnant client to perform Kegel exercises. Which statement by the client indicates an understanding of the purpose of these types of exercises?

  • A. The exercises will help reduce backache.
  • B. The exercises will help prevent ankle edema.
  • C. The exercises will help strengthen the pelvic floor.
  • D. The exercises will help prevent urinary tract infections.
Correct Answer: C

Rationale: Kegel exercises assist in strengthening the pelvic floor (pubococcygeal muscle). Pelvic tilt exercises help reduce backaches. Leg elevation assists in preventing ankle edema. Instructing a client to drink 8 ounces of fluids 6 times a day helps prevent urinary tract infections.

The nurse notices drops of a liquid on the hallway floor of a health care facility. The nurse should do which of the following first?

  • A. Place paper towels over the drops of liquid.
  • B. Don clean gloves and wipe up the drops of liquid.
  • C. Post 'wet floor' signs around the area.
  • D. Call the Environmental Services Department.
Correct Answer: C

Rationale: Posting 'wet floor' signs first ensures immediate safety by alerting others to the hazard, preventing slips. Then, the nurse can proceed with cleanup or notify appropriate personnel.

Select the member of the multidisciplinary team that you would most likely collaborate with when the client can benefit from the use of adaptive devices for cutting food?

  • A. The physical therapist
  • B. The occupational therapist
  • C. The dietician
  • D. The podiatrist
Correct Answer: B

Rationale: An occupational therapist specializes in helping clients use adaptive devices to perform activities of daily living, such as cutting food, making them the most appropriate team member for this need.

The nurse is caring for a client with a venous leg ulcer. Which of the following interventions should be included in the plan of care?

  • A. Apply compression bandages.
  • B. Keep the leg in a dependent position.
  • C. Clean the ulcer with alcohol-based solution.
  • D. Restrict fluid intake.
Correct Answer: A

Rationale: Compression bandages promote venous return and healing in venous leg ulcers.

The nurse should give which medication instructions to the client prescribed quinapril hydrochloride?

  • A. Take the medication with food only.
  • B. Expect a therapeutic effect immediately.
  • C. Discontinue the medication if nausea occurs.
  • D. Rise slowly from a lying to a sitting position.
Correct Answer: D

Rationale: Quinapril hydrochloride is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. A full therapeutic effect may be noted in 1 to 2 weeks. If nausea occurs, the client should be instructed to take a noncola carbonated beverage and salted crackers or dry toast.

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