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Author Question: The nurse finds a client pulseless and breathless. The client's skin is pale and cool, but not ... (Read 29 times)

kamilo84

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The nurse finds a client pulseless and breathless. The client's skin is pale and cool, but not cyanotic. Because of this finding, what should the nurse suspect?
 
  1. Respiratory arrest occurred prior to cardiac arrest.
  2. Cardiac arrest occurred prior to respiratory arrest.
  3. The client cannot be resuscitated.
  4. Arrest was caused by airway obstruction.

Question 2

A client is on strict bed rest following hip surgery. What nursing intervention would support vascular health?
 
  1. Place pillows under the unaffected knee for support.
  2. Position the bed to flex the knees at least 20 degrees.
  3. Have the client alternately flex and extend the feet several times a day.
  4. Keep the client in a prone position for at least 20 minutes twice a day.



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Kdiggy

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Answer to Question 1

Correct Answer: 2
Rationale 1: In the absence of cyanosis, the logical sequence of events would be cardiac arrest followed by respiratory arrest.
Rationale 2: In the absence of cyanosis, the logical sequence of events would be cardiac arrest followed by respiratory arrest.
Rationale 3: Unless the client has do-not-resuscitate orders, a code should be called.
Rationale 4: There is no indication that the arrest was caused by airway obstruction or that the client cannot be resuscitated.

Answer to Question 2

Correct Answer: 3
Rationale 1: Placing pillows under the knees supports the development of clotting.
Rationale 2: Positioning the bed so that the knees are in more than 15 degrees of flexion supports the development of clotting.
Rationale 3: Alternating flexion and extension of the feet will help keep clots from forming in the extremities. Active contraction and relaxation of the calf muscles is also used for this purpose.
Rationale 4: The client would not be placed in the prone (on abdomen) position.




Kdiggy

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