Author Question: The nurse is preparing to document care provided to a client who received rescue breathing while ... (Read 34 times)

jasdeep_brar · **on:** Jun 25, 2018

The nurse is preparing to document care provided to a client who received rescue breathing while being transported to radiology. Which items will the nurse include in the documentation for this client?

Select all that apply.

1. Date and time of event
2. Factors that precipitated the event
3. Length of time with no breathing
4. Response to rescue breathing
5. Tasks assigned to the unlicensed assistive personnel

Question 2

The nurse is attending a football game when another spectator reports chest pain and collapses. The nurse assesses the client and finds he is pulseless and not breathing. After the nurse calls for help, someone brings an AED.

Which action by the nurse is the most appropriate?
1. Not using the device, because it needs to be plugged in and there is no electricity
2. Turning the machine on, placing the patches, and then plugging in the cable
3. Connecting the cables, placing the patches, and then turning on the machine
4. Placing the patches, turning on the machine, and then plugging in the cable

fwbard · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Correct Answer: 1,2,3,4

When documenting this event in the medical record, the nurse will include the date and time the event occurred, any factors that precipitated the event, the length of time that the client was not breathing, and the client's response to rescue breathing. It is unnecessary to document the tasks that were assigned to the unlicensed assistive personnel during this event.

Answer to Question 2

Correct Answer: 2

The machine should be turned on and then the patches should be placed. Only after the patches are in place and the nurse has assured that no one is touching the client should the cable be plugged into the machine. The machine will begin analyzing the rhythm and deliver a shock as soon as the cables are connected.