NORCET 7 Prelims -2024
Medical Surgical Nursing
Easy
A patient exhibits no pulse and is in a pulseless rhythm. What should the nurse do next?
Appeared in: NORCET 7 Prelims -2024
Explanation
- The patient is in cardiac arrest, a state where the heart has stopped pumping blood effectively.
- According to Basic Life Support (BLS) guidelines, the immediate priority is to restore circulation to the brain and heart.
- This is achieved by starting high-quality chest compressions without delay (the 'C' in C-A-B: Compressions, Airway, Breathing).
- Simultaneously, a defibrillator must be applied as soon as possible to analyze the heart's rhythm.
- Early defibrillation is the most effective treatment for shockable rhythms like Ventricular Fibrillation (VF) and pulseless Ventricular Tachycardia (pVT), which are common causes of cardiac arrest.
Why Other Options Were Wrong
- Option A: Administering IV fluids is not the first priority. It is a secondary intervention performed during Advanced Cardiovascular Life Support (ACLS) after high-quality CPR has been initiated.
- Option C: A patient with no pulse is apneic (not breathing). A non-rebreather mask delivers oxygen passively and is ineffective. The patient requires active ventilation with a bag-valve mask, which is integrated with chest compressions.
- Option D: Administering a vasopressor like epinephrine is an advanced intervention (ACLS). It requires establishing IV/IO access and is given after CPR has started and the rhythm has been analyzed, typically after the first or second shock.
Related Visual
- Visual 1: Flowchart - The American Heart Association (AHA) BLS algorithm for adults, illustrating the sequence: check for response, activate emergency services, start chest compressions, and use a defibrillator.
- Visual 2: Diagram - Correct hand placement on the lower half of the sternum for delivering high-quality chest compressions to an adult.
Clinical Relevance
- Nursing practice connection: Knowing Priorities in Basic Life Support (BLS) for Cardiac Arrest helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- In cardiac arrest, survival rates decrease by 7-10% for every minute that passes without CPR and defibrillation. Immediate, high-quality chest compressions are the most critical nursing action.
- The current BLS sequence is C-A-B (Compressions-Airway-Breathing) to emphasize the critical importance of minimizing interruptions in chest compressions.
- Nurses must be able to instantly recognize cardiac arrest and initiate BLS without hesitation, as they are often the first responders in a hospital setting.
How to Approach the Question
- Identify the clinical situation: The patient has 'no pulse' and a 'pulseless rhythm,' which is the definition of cardiac arrest.
- Recognize this as a top-priority, life-threatening emergency that requires immediate action based on established protocols (BLS/ACLS).
- Recall the priority sequence for BLS: C-A-B (Compressions-Airway-Breathing). The first and most critical action is to restore circulation.
- Evaluate the options based on the C-A-B priority. 'Perform chest compressions' directly addresses circulation.
- Note that 'apply the defibrillator' is the next critical step to identify and treat a shockable rhythm. The option combining these two is the most comprehensive and correct initial action.
- Rule out the other options as secondary interventions. IV fluids, advanced airways, and medications are part of ACLS and are performed only after high-quality CPR is initiated.
Concept Tested & Keywords
- Concept Tested: Priorities in Basic Life Support (BLS) for Cardiac Arrest
- Stem keywords: no pulse, pulseless rhythm
- Lead-in keywords: do next
- Clinical cues: The patient's state (no pulse) indicates cardiac arrest, which is a time-critical emergency.
Question ID
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Practise the full NORCET 7 Prelims -2024
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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