Chapter 29: Emergency Measures for Life Support in the Hospital Setting

Chapter 29: Emergency Measures for Life Support in the Hospital Setting

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1.   The nurse is caring for four patients on the intermediate care unit and plans emergency care for the patients. Which patient is unsuitable for cardiopulmonary resuscitation (CPR)?

a.
An 88-year-old patient with end-stage lung disease
b.
The patient with a valid order for a no-code status
c.
The patient who specifies not to perform chest compressions
d.
The patient whose family does not want the patient resuscitated
 

ANS:  B

The patient who has a valid order to withhold patient resuscitation from the  healthcare provider or according to agency policy should not receive CPR if breathing stops, the heart stops beating, or the patient cannot maintain an airway. The nurse communicates the patient’s directive to withhold resuscitative measures to the entire nursing staff because inadvertent CPR can result in legal liability. Unless the patient specifies that CPR is to be withheld, the nurse must institute resuscitative measures as the need arises despite a grim diagnosis or advanced age. A patient who specifies no chest compressions allows the nurse to provide an airway and breathing; thus the nurse implements resuscitative measures except for chest compressions. Unless the patient is incompetent, the family cannot decide his or her code status because it violates the patient’s right to self-determination and to refuse treatment.

 

DIF:    Cognitive Level: Apply                   REF:   Page 782

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Assessment

 

2.   The nurse walks into a male patient’s room and finds him on the floor with his eyes closed. Which should the nurse implement first?

a.
Initiate cardiac compressions.
b.
Call for a code from the room.
c.
Help the patient back into the bed.
d.
Verify patient unresponsiveness.
 

ANS:  D

The nurse should assess the patient for unresponsiveness by touching him and calling, “Are you okay?” before activating a code. Although unresponsiveness can be caused by many factors, the nurse wants to stimulate the patient and improve breathing first if possible. The nurse avoids initiating chest compressions until assessing for a pulse because chest compressions over a beating heart can precipitate arrhythmias. Until the patient’s status is assessed, a code should not be activated. The nurse should not move the patient until the spine is cleared. The nurse is not aware of why he is on the floor; thus he must be treated as though he has a spinal injury until that possibility is eliminated.

 

DIF:    Cognitive Level: Comprehend          REF:   Page 788

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning

 

3.   The nurse determines that the patient is in cardiac arrest. Which does the nurse delegate to nursing assistive personnel (NAP)?

a.
Deliver chest compressions.
b.
Help with patient positioning as directed.
c.
Inform the family about the patient.
d.
Prepare emergency medications.
 

ANS:  B

The nurse instructs the NAP to help position the patient, including logrolling onto a backboard or other positions for resuscitative measures, because the NAP receives training to perform the task. Agency policy usually dictates nursing responsibilities during a code. Although NAP are trained to perform basic cardiopulmonary resuscitation (CPR) and use the automatic external defibrillator (AED), the nurse is present; thus the nurse delivers chest compressions. The nurse avoids delegating family communication to the NAP because the nurse has the critical thinking skills and clinical judgment to discuss the patient with the family and provide meaningful information. The nurse retains responsibility for medications during a code because he or she receives training to administer emergency medications properly.

 

DIF:    Cognitive Level: Analyze                REF:   Page 790

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation

 

4.   The nurse participates in the patient’s resuscitation. Which patient assessment finding does the nurse determine to be an undesirable event during cardiopulmonary resuscitation (CPR)?

a.
Bruising is present over the anterior thorax.
b.
The abdomen has become distended.
c.
The patient has an advance directive.
d.
An airway is in place without gagging.
 

ANS:  B

Abdominal distention is undesirable during CPR because it is consistent with clinical indicators of air in the stomach, which can potentially occur from esophageal intubation with the endotracheal tube or ventilating the patient with an Ambu bag and airway. Because distention increases the risk of patient aspiration or expiration, the resuscitation team investigates the distention, verifies endotracheal tube placement, and inserts a nasogastric tube for decompression. Thoracic bruising from chest compressions is usually unavoidable; however, since the bruises can upset the family, the nurse should discuss them with the family to ensure understanding. The healthcare team welcomes the patient’s advance directive to clarify resuscitative measures promptly. Maintaining an airway without patient gagging is a desirable event during the code because it facilitates patient oxygenation and ventilation. However, although this allows for breathing, the code team would rather discontinue the airway with spontaneous patient respirations and airway maintenance.

 

DIF:    Cognitive Level: Apply                   REF:   Page 791| Page 794

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Evaluation

 

5.   The nurse determines that the infant is in respiratory arrest from an airway obstruction caused by a foreign object. Which does the nurse implement to clear the infant’s airway?

a.
Applies several back slaps followed by chest thrusts
b.
Aspirates the foreign object with a Yankauer suction tip
c.
Holds the child upside down and strikes the anterior chest
d.
Holds the child on his or her side and performs a blind finger sweep
 

ANS:  A

The best chance that the nurse has to remove the foreign object from an infant’s airway is to deliver back slaps followed by chest thrusts. This creates bursts of positive pressure in the infant’s airway to loosen and expel the object. The nurse avoids using a Yankauer suction tip because it is probably too big for the infant’s airway and increases the risk of lodging the object more firmly in the airway. Striking the child on the anterior chest is risky because it mimics chest compressions and, for an infant in sinus rhythm, risks causing an arrhythmia. The American Heart Association does not recommend blind finger sweeps; however if the object is visible, the rescuer can attempt to remove it if it can be removed without lodging the object more firmly in the airway.

 

DIF:    Cognitive Level: Apply                   REF:   Page 789

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation