Nokea
The nurse determines clinical death and initiates CPR immediately. How long is resuscitation considered possible?
- A. If cardiopulmonary arrest has existed for no more 2 minutes
- B. If cardiopulmonary arrest has existed for no more 3 minutes
- C. If cardiopulmonary arrest has existed for no more 4 minutes
- D. If cardiopulmonary arrest has existed for no more 5 minutes
Correct Answer: C
Rationale: CPR can reverse clinical death if initiated before 4 minutes.
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When treating an infant choking on a foreign body the nurse should use a combination of __ and chest thrusts.
Correct Answer: blows
Rationale: If the nurse is assisting a child who has aspirated a foreign body, the nurse may treat the child in a manner similar to the adult with performance of abdominal thrusts. However, there is a potential for injury if the nurse uses this maneuver in the infant. The nurse should use a combination of back blows and chest thrusts with an infant.
A nurse assesses an accident victim who has bright red blood spurting from a laceration on his right forearm. Where will the nurse apply pressure after applying direct pressure and elevating the limb?
- A. Right subclavian artery
- B. Right radial artery
- C. Right ulnar artery
- D. Right brachial artery
Correct Answer: D
Rationale: Arterial bleeding is characterized by the spurting of bright red blood and can be controlled by direct pressure, elevation, and indirect pressure on the appropriate pressure point. The brachial artery is the closest pressure point to the injury.
The patient arrived at the emergency department in pain and bleeding profusely with the following vital signs: BP 80/54 P 102 RR 22. What does the nurse recognize that these symptoms indicate?
- A. Inadequate perfusion
- B. Circulatory shock
- C. Massive vasodilation
- D. Heart failure
Correct Answer: B
Rationale: Shock results from failure of the circulatory system to provide sufficient blood circulation.
A nurse is assessing victims in an emergency situation. What will the nurse assess for first?
- A. Hemorrhage
- B. Fractures
- C. Mobility
- D. Abnormal breathing
Correct Answer: D
Rationale: A life-threatening situation of the highest priority is arrested or abnormal breathing.
When assessing a patient who has suffered a burn injury the nurse classifies the burn as a deep partial-thickness burn. What is this observation most likely based upon?
- A. Painful reddened skin
- B. Charred skin with milky-white areas
- C. Erythema and blisters
- D. Erythema pain and swelling
Correct Answer: C
Rationale: With deep partial-thickness burns, blister formation may be seen with erythema.