02.01 Brief CPR (Cardiopulmonary Resuscitation) Overview

Question 2 of 10 The nurse is performing cardiopulmonary resuscitation as part of a hospital team for a client in cardiac arrest. In which of the following scenarios would CPR be discontinued? Select all that apply. When the victim responds When the person performing chest compressions is too exhausted to continue When a family member is able to produce DNR documentation When the victim vomits When a provider decides to call the death

Answer ✅When the victim responds The end goal of CPR is return of spontaneous circulation (ROSC), which is evident when the client begins to respond. When the victim vomits If a client vomits, often they have ROSC. However, it is possible that the client still does not have a pulse after an emesis, so CPR would continue. ✅When a provider decides to call the death If CPR has been performed for a certain time frame and the provider is confident that the client will not have ROSC, the provider may call the death, which means resuscitation efforts cease. ✅When a family member is able to produce DNR documentation DNR documentation carries legal force and demonstrates that the client does not want to be resuscitated. In this situation, CPR efforts would cease. When the person performing chest compressions is too exhausted to continue In a setting outside of the hospital in which there is not a back up person to perform chest compressions, a person cannot continue chest compressions if they are too exhausted, and they are not liable for stopping CPR in this situation. However, this is a hospital team setting. If the nurse is too exhausted to continue chest compressions, the next team member does them.

Question 10 of 10 Two nurses have responded to help an adult family member of a client who collapsed in the hallway. The person is not responding to stimulation and the first nurse checks for a carotid pulse, but does not feel anything. The client has snoring respirations. What describes the appropriate actions the nurses should perform with CPR? Select all that apply. Deliver 2 breaths after giving 30 compressions Open the airway using the head-tilt-chin-lift Perform chest compressions at a rate of 100 per minute Apply chest compressions at a depth of 2 inches Check for a pulse using the brachial artery

Answer ✅Open the airway using the head-tilt-chin-lift The steps of performing CPR include assessing responsiveness, calling for help, and if there is no pulse, providing compressions at a rate of 100-120/minute. This client's breathing is described as 'snoring', which is also known as agonal breathing. These are not true breaths, but simply the brain stem's automatic response in a compromised person. Check for a pulse using the brachial artery The pulse on an adult should be checked at the carotid artery, not the brachial artery. ✅Perform chest compressions at a rate of 100 per minute The correct rate of compressions is 100-120 per minute. ✅Apply chest compressions at a depth of 2 inches A depth of 2 inches ensures effective compressions. If the depth is less than 2 inches, the client's blood is not moving through the heart appropriately. ✅Deliver 2 breaths after giving 30 compressions With 2-person CPR, 2 breaths can be given after 30 compressions. After 2 minutes, the people performing CPR must rotate.

Question 1 of 10 The nurse prepares the client for defibrillation due to sustained and pulseless ventricular tachycardia. Which of the following measures should the nurse ensure before delivering the shock? The client has been NPO No one is touching the client CPR is continued during the defibrillation It is synchronized with the R waves

Answer B It is synchronized with the R waves A client with pulseless VT will get unsynchronized cardioversion. No one is touching the client The nurse must prevent anyone else from accidentally getting shocked. The client has been NPO This is irrelevant if a client has no pulse. CPR is continued during the defibrillation CPR must be stopped during defibrillation.

Question 3 of 10 A client has gone into ventricular fibrillation. Two nurses run into the room and one nurse tries unsuccessfully to find a pulse. The other nurse immediately begins CPR while the first nurse calls a code and grabs the ambu bag. What is the most important aspect of this attempted resuscitation? Immediate advanced airway placement Obtaining a STAT 12-lead ECG Minimizing interruptions for effective compressions Initiating a hypothermia protocol as soon as ROSC is obtained

Answer C Minimizing interruptions for effective compressions The most crucial aspect of resuscitation is quality compressions with minimal interruptions. It takes several compressions for blood to circulate throughout the body, and stopping compressions greatly compromises this cycle. Obtaining a STAT 12-lead ECG This is not necessary because the client will be attached to a defibrillator for shocks. Immediate advanced airway placement An advanced airway will be helpful, but CPR is the first priority because compressions create circulation AND allow some air to enter into the lungs with each compression. Initiating a hypothermia protocol as soon as ROSC is obtained A hypothermia protocol may or may not be necessary for this client, but even if that is the appropriate measure, it will not be implemented without quality CPR to bring act as the client's heartbeat.

Question 5 of 10 A nurse is working on a team performing CPR on a client who has coded in the hospital. The nurse sets up the monitor and notes that the client has a pulseless electrical activity (PEA) rhythm. The provider tells the nurse to set up for a shock. Which response from the nurse is correct? Set up and prepare to deliver the shock Administer atropine before giving the shock Continue to provide bag-mask ventilation and prepare for cardioversion instead Clarify the client's heart rhythm with the provider before giving the shock

Answer D Clarify the client's heart rhythm with the provider before giving the shock Pulseless electrical activity (PEA) is considered a non-shockable rhythm because the client does not produce enough electrical activity to respond to a shock. The ACLS algorithm says to continue with CPR when the client is in PEA. The nurse should clarify with the provider first before proceeding instead of delivering the shock because a shock will only cause a delay in CPR. Set up and prepare to deliver the shock In this situation, the provider's order is inappropriate for the circumstance, so the nurse should quickly clarify before proceeding. Administer atropine before giving the shock Atropine used to be appropriate to administer in PEA, but was removed from the ACLS algorithm in 2010. Continue to provide bag-mask ventilation and prepare for cardioversion instead The nurse should work as a team along with the provider, and should simply clarify understanding before proceeding in the code. A registered nurse does not have the authority to prescribe and treat the client outside of the provider's direction.

Question 7 of 10 A client is in the hospital after having cardiac surgery. The client's family tells the nurse that the client does not want CPR if the client's heart were to stop. During recovery from surgery, the client goes into cardiac arrest. Which action of the nurse is most appropriate? Ask the family again what they would like for the client Contact the provider about getting an order for a DNR Begin CPR using chest compressions Monitor the client and do not attempt resuscitation

Answer c Begin CPR using chest compressions The question does not state whether the client has an advance directive or DNR paperwork. Therefore, based on the information we have, the appropriate response from the nurse is to begin CPR using chest compressions. A client's family may understand what the client would want for healthcare decisions if the client cannot communicate his or her wishes, but without an advance directive in place, the healthcare facility is obligated to start CPR on the client if the client's heart stops. Ask the family again what they would like for the client The family's word is not legally binding at this point. The nurse is obligated to immediately begin CPR. Contact the provider about getting an order for a DNR CPR should be started immediately. The provider cannot obtain a DNR legally or quickly enough at this point. Monitor the client and do not attempt resuscitation Since we are not told that the client has a DNR order, the most appropriate action is to call a code, and begin CPR using chest compressions.

Question 9 of 10 The nurse is caring for a client who verbally expresses his wish to not be resuscitated. Later in the nurses shift the client codes. The nurse looks at the chart and notes that the client is listed as full code. What should the nurse do? Call the family and clarify with them Call the provider to clarify Start CPR and continue until proper paperwork had been presented Refrain from starting CPR, because the client does not want to be resuscitated

Answer c Start CPR and continue until proper paperwork had been presented This nurse should have notified the provider when the client stated he did not want to be resuscitated, but since this was not done, the nurse must start CPR, as proper documentation has not been provided for a "Do not resuscitate" (DNR) order. Refrain from starting CPR, because the client does not want to be resuscitated A DNR order is necessary in order to refrain from CPR in a code situation. Call the provider to clarify There is no time for calling the provider in a code situation. The nurse will start compressions because the client does not have a DNR order. Call the family and clarify with them There is no time for calling anyone in a code situation. The nurse would start CPR immediately.

Question 8 of 10 The care team must initiate cardiopulmonary resuscitation on a client who is on a ventilator. The nurse knows to set the ventilator at which of the following breathing rates? 12-20 respirations per minute 4-6 respirations per minute 6-8 respirations per minute 8-10 respirations per minute

Answer d 8-10 respirations per minute In giving CPR to a client on a ventilator, 8-10 respirations per minute is appropriate. 4-6 respirations per minute This is too slow of a rate for a client in cardiac arrest. 6-8 respirations per minute This is too slow of a rate for a client in cardiac arrest. 12-20 respirations per minute This is too fast of a rate for a client in cardiac arrest.

Question 6 of 10 The nurse is helping a conscious client with an upper airway obstruction. What techniques will the nurse implement to help this client? Select all that apply. Dig out the obstruction from the larynx Give 5 back blows Give abdominal thrusts Alternate back blows and abdominal thrusts Push the obstruction past the larynx

Dig out the obstruction from the larynx This carries the risk of pushing the object further down the airway. This will worsen the situation because the only way to relieve choking is for the object to be expelled out of the airway. Push the obstruction past the larynx Pushing the object further down the airway is the opposite of the desired outcome, which is that the object is expelled out of the airway. ✅Give 5 back blows Back blows are the initial action recommended for the client with an upper airway obstruction. ✅Give abdominal thrusts For a conscious client with an upper airway obstruction, abdominal thrusts are performed until the client becomes unconscious. To perform abdominal thrusts, the nurse should place the thumb side of the fist against the victim's abdomen, in the midline slightly above the navel and well below the tip of the xiphoid process. The fist is grasped with the nurse's other hand and pressed into the client's abdomen with an inward and upward thrust. ✅Alternate back blows and abdominal thrusts Back blows alternating with abdominal thrusts are performed until the obstruction is cleared, the client becomes unconscious, or EMS arrives.

Question 4 of 10 A nurse is working in the medical-surgical unit when the code alarm goes off, signifying that one of the clients on the unit is in cardiac arrest. The nurse steps in to the room to help with the code and starts to provide chest compressions to the client. Which of the following elements are part of providing external chest compressions during CPR? Select all that apply. The heel of one hand is applied over the sternum, with the second hand on top of the first Chest compressions cause blood to be pumped through the body During compressions, the nurse should push hard and fast in an attempt to perfuse the client The elbows are locked during chest compressions One knee is placed on either side of the client so that the client is straddled during compressions

✅Chest compressions cause blood to be pumped through the body The goal of chest compressions is to create circulation when the heart is unable to pump. ✅The heel of one hand is applied over the sternum, with the second hand on top of the first When performing chest compressions during CPR, the nurse follows guidelines put forth by the American Heart Association. These guidelines include performing compressions over the sternum at a rate of approximately 100 per minute, which is faster than it seems. Elbows are locked, the nurse is on one side of the client, and in the hospital setting there should be additional staff present to relieve the nurse. The person performing chest compressions becomes tired quickly, which means the compressions will not be hard enough to be effective. One knee is placed on either side of the client so that the client is straddled during compressions The person performing chest compressions should be on one side of the client. ✅During compressions, the nurse should push hard and fast in an attempt to perfuse the client Chest compressions must be done surprisingly fast. A rule of thumb is about one compression per second. ✅The elbows are locked during chest compressions The elbows must be locked in order to provide enough pressure to the heart to move blood through.