A nurse is teaching an ACLS class and is discussing heart rhythms and treatment. Which of the following rhythms would indicate the need for defibrillation?

Atrial fibrillation

Supraventricular tachycardia

Asystole

Ventricular fibrillation

Answer and Explanation

The Correct Answer is D

Choice A reason:Atrial fibrillation is not typically treated with defibrillation; it is usually managed with medication or other forms of rhythm control.

Choice B reason:Supraventricular tachycardia does not usually require defibrillation; it may be treated with vagal maneuvers or medication.

Choice C reason:Asystole, or the absence of a heartbeat, is not treated with defibrillation as there is no electrical activity to reset.

Choice D reason:Ventricular fibrillation is a life-threatening heart rhythm that requires immediate defibrillation to restore a normal heart rhythm.

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Correct Answer is ["A","B","C","E"]

Explanation

Choice A reason: Hypoxemia, or low oxygen levels in the blood, is a primary indicator of ARF as the lungs are unable to adequately oxygenate the blood.

Choice B reason: Confusion can result from hypoxemia or hypercapnia (high carbon dioxide levels) as the brain is sensitive to changes in blood gas levels.

Choice C reason: Dyspnea, or difficulty breathing, is a hallmark symptom of ARF as the lungs struggle to maintain adequate gas exchange.

Choice D reason: Bradycardia, or a slow heart rate, is not typically associated with ARF. Tachycardia, or a fast heart rate, is more common as the body attempts to compensate for hypoxemia.

Choice E reason: Hypocarbia, or low carbon dioxide levels, can occur in ARF if the body is attempting to compensate for hypoxemia by hyperventilating.

A. Test the drainage for the halo sign. B. Ask the client to blow his nose. C. Notify the physician. D. Suction the nostril.

Correct Answer is A

Explanation

Choice A reason:Testing the drainage for the halo sign is the first action the nurse should take, as clear drainage from the nose following a basal skull fracture could indicate a cerebrospinal fluid (CSF) leak, which contains glucose.

Choice B reason:Asking the client to blow his nose could potentially increase the risk of infection or worsen a CSF leak and is not recommended as a first action.

Choice C reason:While notifying the physician is important, it should be done after confirming whether the drainage is CSF, which would require immediate medical intervention.

Choice D reason:Suctioning the nostril is not the first action to take, as it could potentially disrupt the site of the leak and is not diagnostic of a CSF leak.

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A nurse is teaching an ACLS class and is discussing heart rhythms and treatment. Which of the following rhythms would indicate the need for defibrillation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has acute respiratory failure (ARF). The nurse should monitor the client for which of the following manifestations of this condition? (Select all that apply).

Correct Answer is ["A","B","C","E"]

Explanation

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Correct Answer is A

Explanation

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