A client who has been transported to the emergency room after a motor vehicle accident is experiencing asystole. Management of asystole focuses on:

High-quality CPR with minimal interruptions

Cessation at resuscitation attempts after 2 minutes

Administration of Narcan until an electrical rhythm is obtained

Continuous defibrillation until an electrical rhythm is obtained

Answer and Explanation

The Correct Answer is A

A. High-quality CPR with minimal interruptions is the cornerstone of asystole management. Asystole is a non-shockable rhythm, so maintaining perfusion through effective chest compressions and administering appropriate medications (like epinephrine) is essential.
B. Cessation of resuscitation efforts after only 2 minutes is inappropriate; the decision to stop should be based on the clinical scenario and response to interventions over time.
C. Narcan (naloxone) is used for opioid overdose, not for treating asystole unless there is a suspected opioid-related cause—and it does not directly restore electrical cardiac rhythm.
D. Defibrillation is not indicated in asystole, as it is a non-shockable rhythm. Continuous defibrillation is ineffective and inappropriate.

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Correct Answer is A

Explanation

A. Oliguria (low urine output) is an expected finding in hypovolemic shock due to decreased renal perfusion as blood is shunted to vital organs.
B. Hypertension is not expected; hypotension is more typical as circulating blood volume decreases.
C. Bradypnea is not common; tachypnea is expected as the body tries to compensate for decreased oxygen delivery.
D. Flushing of the skin is associated with early septic shock; in hypovolemic shock, the skin is typically cool, pale, and clammy due to peripheral vasoconstriction.

A. Uses hot water to wash their hands B. Washes their hands for 10 seconds C. Turns off the faucet with their hands D. Holds their hands below the elbows while rinsing off soap

Correct Answer is D

Explanation

A. Hands should be washed with warm water, not hot, to prevent skin irritation.
B. The recommended handwashing duration is at least 20 seconds.
C. The faucet should be turned off using a paper towel or elbow to avoid recontamination.
D. Holding hands below the elbows allows water to flow downward, preventing contamination from the elbows back onto the hands.

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A client who has been transported to the emergency room after a motor vehicle accident is experiencing asystole. Management of asystole focuses on:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has hypovolemic shock. Which of the following should the nurse recognize as an expected finding?

Correct Answer is A

Explanation

A nurse is observing a newly licensed nurse perform hand hygiene. Which of the following actions by the newly licensed nurse indicates an understanding of the procedure?

Correct Answer is D

Explanation

A nurse is caring for a client on a cardiac monitor and whose rhythm suddenly changes. There are no P waves; instead she observes wavy lines. The QRS complexes measure 0.08 second and are irregular. The client's heart rate is 120 beats/minute. The nurse interprets that this rhythm is:

A nurse assessing a client determines they are in the compensatory stage of shock. Which of the following findings support this conclusion?

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