A nurse is caring for a client who becomes unresponsive.
While administering CPR, which of the following actions should the nurse take?
Complete two cycles of compression/rescue breathing before attaching the automated external defibrillator (AED)
Provide chest compressions at a rate of 100/min.
Check for a brachial pulse.
After a set of 50 compressions, give the client 2 rescue breaths.
The Correct Answer is B
Choice A rationale:
While it’s important to start CPR as soon as possible, the AED should be attached as soon as it’s available.
Choice B rationale:
The American Heart Association recommends providing chest compressions at a rate of 100-120/min during CPR.
Choice C rationale:
Checking for a brachial pulse is not a priority during CPR. The focus should be on providing chest compressions and rescue breaths.
Choice D rationale:
The correct ratio of compressions to breaths during CPR is 30:2, not 50:2.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Low blood pressure (BP) is a symptom of hypovolemic shock due to decreased blood volume, but the pulse rate typically increases as the body tries to compensate for the low BP, not decrease.
Choice B rationale:
Hypovolemic shock is characterized by low BP due to loss of blood or fluid volume and a high pulse rate as the body tries to compensate for the decreased blood flow.
Choice C rationale:
High BP is not typically associated with hypovolemic shock. Instead, BP is usually low due to decreased blood volume.
Choice D rationale:
High BP is not typically a symptom of hypovolemic shock. While the pulse rate may be high as the body tries to compensate for low blood volume, the BP is usually low.
Correct Answer is ["C","D","E"]
Explanation
Choice A rationale:
Encouraging range-of-motion exercises of the foot is not advisable because it can cause further injury to the ankle.
Choice B rationale:
Providing the client with a light snack is not directly related to the care of an ankle injury.
Choice C rationale:
Applying ice to the ankle can help reduce swelling and pain.
Choice D rationale:
Applying a compression bandage can help reduce swelling.
Choice E rationale:
Elevating the foot can help reduce swelling by promoting venous return.
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