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NUR 431L FINAL EXAM QUESTIONS WITH CORRECT ANSWERS
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NUR 431L FINAL EXAM QUESTIONS WITH CORRECT ANSWERS
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NUR 431L FINAL EXAM QUESTIONSWITH CORRECT ANSWERS
*Quickly determine if the victim is conscious and scan the chest for breathing (5-10 sec)
→not breathing.
-"Are you alright?!"
*Tell someone to activate the emergency response system and bring a crash cart.
-Do not leave the patient.
*Check the carotid pulse (5-10 sec)→no pulse.
*Place a cardiac board behind the patient.
*Bare the patient's chest and place heel of hand on center of chest, lower half of
sternum. Place other hand on top with interlaced fingers.
*Deliver compressions - Answer-ACLS: step 1
-Attach defibrillator pads.
-Give O2/insert oropharyngeal, nasopharyngeal airway, or ETT
-Obtain IV access - Answer-during initial chest compression someone else will
*Determine if rhythm is shockable.
-If yes, charge and shock/defibrillate.
-"I'm clear, you're clear, we're all clear!" - Answer-ACLS step 2
-Resume CPR for 2 minutes.
-Once the patient receives an advanced airway, give 1 breath every 6 seconds (10
breaths per minute), in addition to continuous chest compressions (100-120
compressions/minute).
-Medication administration every 3-5 minutes depending on rhythm.
-Re-analyze rhythm after 2 minutes to determine if shockable.
-Continue until ROSC - Answer-ACLS step 3
*epinephrine 1mg every 3-5minutes
*amiodarone:
-first dose: 300mg bolus
-second dose: 150mg - Answer-drug therapy in a pulseless v-tach, v-fib
*the patient's nurse or charge nurse until code team arrives
-Report to code team when they arrive
-Ensures BLS is being done effectively
-Assigns roles to other staff
-Should position themselves to see everything going on
-Gives orders according to ACLS algorithm
-Only one code leader - Answer-Code leader
,*RT or anesthesiologist/CRNA
-Uses ambu bag and mask to ventilate patient
-Constantly assesses chest rise and fall
-Inserts oral airway/ETT
-Assesses pulse ox - Answer-Airway manager:
-Continually check hand placement
-Compress at 100-120 times/minute
-Synchronize compressions with ventilations (30:2) until ETT is in place
-This person needs to be relieved every 2 minutes! - Answer-compression manager
-Must be familiar with crash cart
-Sets up suction, airway equipment, etc
-Operates defibrillator
-Prepares meds and flushes for medication manager - Answer-Crash cart and
equipment manager
-Gives meds via IV
-Communicates when a med has been given
-Follow meds with flush solution - Answer-medication manager
-Check carotid pulse for 5-10 seconds. (chest compressions should begin no longer
than 10 sec later)
-If no pulse- begin CPR with chest compression (30:2) until an AED arrives .
-If you witness the patient collapse, activate the EMS first, then begin CPR. If you find a
patient unresponsive, give 5 cycles of CPR then activate the EMS system.
-Start compressions ASAP due to unknown amount of down time.
-Recheck pulse after 5 cycles of CPR (approx. 2 min)
-Switch compressors every 2 minutes to prevent fatigue - Answer-circulation in a code
-Do rescue breathing if the patient has a pulse. oAssisted breathing rate is 1 breath
every 5-6 seconds or 10-12 breaths per minute.
-If the patient does not have a pulse, do 30 compressions: 2 breaths.
-After an advanced airway is placed, no more pauses for ventilation- give breath every 6
seconds or 10 breaths/min without pausing while compressor gives 100-120
compressions/minute.
-Avoid excessive ventilation!! - Answer-BREATHING in a code
-Power- turn on AED
-Attach- Electrode pads (adult pads for age 8 and older)
-Analyze- rhythm (clear the patient during analysis)
-Shock- if advisedoIf no shock advised, continue CPR immediately with chest
compressions.
-Resume CPR if AED does not analyze promptly - Answer-AED
-V-Fib
, -Pulseless V-tach - Answer-SHOCKABLE LETHAL RHYTHMS
-Asystole
-PEA - Answer-NON-SHOCKABLE LETHAL RHYTHMS
-Narrow Regular (SVT): 50-100J
-Narrow Irregular (Afib): 120-200J biphasic or 200J monophasic
-Wide Regular (Vtach): 100J
-Wide Irregular (Polymorphic Vtach/Torsades): Defibrillation dose (not synchronized)
-Enusre "sync" mode is on - Answer-SYNCHRONIZED CARDIOVERSION
-Hemodynamically unstable bradycardia if atropine ineffective
-Do not delay if rapid deterioration or IV unavailable
-Ensure "pacer" mode is on
-Set rate to approximately 60/min (adjust per patient response)
-Dial up current milleamperes until capture and set 2 mA above the dose with consistent
capture for safety margin.
-Sedate if possible - Answer-PACING
-Maintain SBP of at least 90 mmHg and O2 sat of at least 94%.
-May give 1-2 L NS or LR and/or give vasopressor infusion.
-Consider therapeutic hypothermia if patient remains unconscious after ROSC to
optimize neurologic recovery.
-Optimizing oxygenation, ventilation and perfusion, especially to brain and heart, is
primary goal after ROSC is achieved.
-Identify and treat causes of arrest to prevent recurrence.
-Transport to hospital if out of hospital or ICU if on the hospital floor - Answer-RETURN
OF SPONTANEOUS CIRCULATION (ROSC)
-Hypovolemia
-Hypothermia
-Hypo/hyper-kalemia
-Hypoxia
-Hydrogen ion (acidosis)
-Tension pneumothorax
-Tamponade, cardiac
-Thrombosis, pulmonary
-Thrombosis, coronary
-Toxins - Answer-causes of v-fib, pulseless v-tach
shock and CPR are the primary interventions - Answer-V-fib/pulseless V-tach-->
-drug therapy
-synchronized cardioversion - Answer-V-tach WITH a pulse-->
*DO NOT SHOCK
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