HESI CASE STUDY ACLS
• The code team arrives with the crash cart. The carotid artery is reassessed and there is still
no pulse. Cardiac leads are placed and pulseless ventricular tachycardia is confirmed. What is
the priority nursing action?
Answer: Shock the clientschest
• After shocking the clients chest, what is the nurses next action?
Answer: Beginchest compressions
• The client remains in pulseless ventricular tachycardia and is unresponsive. The team
intubates him and administers the second shock. What medication does the nurse anticipate
administering after the second shock?
Answer: Epinephrine
• Which is the primary reason for administering epinephrine 1 mg every 3 to5 minutes
during a cardiac arrest?
Answer: Increases cardiac output
• Despite the teams efforts, Mr.Azizi remains unresponsive and the telemetry monitor shows
asystole. Mrs. Azizi, who has been in the room the entire time, asks the team to stop. She
cannot bear to see her husbands chest "crushed"anymore. What is the nurses best response?
Answer: Stop coding the client
• The nurse is aware that the older adult client is at an increased risk for surgical
complications due to normal physiological functions and comorbidities.Which risk factors
place the older adult client at increased risk for surgical complications?
Answer: Decreased respiratory muscle strength
• Upon completing the client's assessment, the nurse determines that theclient has which
surgical risk factors? (Select all that apply.)
Answer:
Metoprolol
Poor appetite
Diabetes mellitus
Albumin 3.0 g/dL
• What is the priority preoperative nursing action to prevent postoperativeatelectasis?
Answer: Instruct on incentive spirometer use
• Which is the likely reason for the elevated serum creatinine in the absenceof kidney
disease?
Answer: dehydration
• The code team arrives with the crash cart. The carotid artery is reassessed and there is still
no pulse. Cardiac leads are placed and pulseless ventricular tachycardia is confirmed. What is
the priority nursing action?
Answer: Shock the clientschest
• After shocking the clients chest, what is the nurses next action?
Answer: Beginchest compressions
• The client remains in pulseless ventricular tachycardia and is unresponsive. The team
intubates him and administers the second shock. What medication does the nurse anticipate
administering after the second shock?
Answer: Epinephrine
• Which is the primary reason for administering epinephrine 1 mg every 3 to5 minutes
during a cardiac arrest?
Answer: Increases cardiac output
• Despite the teams efforts, Mr.Azizi remains unresponsive and the telemetry monitor shows
asystole. Mrs. Azizi, who has been in the room the entire time, asks the team to stop. She
cannot bear to see her husbands chest "crushed"anymore. What is the nurses best response?
Answer: Stop coding the client
• The nurse is aware that the older adult client is at an increased risk for surgical
complications due to normal physiological functions and comorbidities.Which risk factors
place the older adult client at increased risk for surgical complications?
Answer: Decreased respiratory muscle strength
• Upon completing the client's assessment, the nurse determines that theclient has which
surgical risk factors? (Select all that apply.)
Answer:
Metoprolol
Poor appetite
Diabetes mellitus
Albumin 3.0 g/dL
• What is the priority preoperative nursing action to prevent postoperativeatelectasis?
Answer: Instruct on incentive spirometer use
• Which is the likely reason for the elevated serum creatinine in the absenceof kidney
disease?
Answer: dehydration
