During CPR for an adult, the rescuers' hand should be placed two fingers width above the lower end of the sternum. Which organ would be most likely at risk for laceration by forceful compressions over the xiphoid process?

1. A

   lung

2. B

   liver

3. C

   stomach

4. D

   diaphragm

Appeared in: NHM MP Staff Nurse-2022

Explanation

• The liver is a large, solid organ situated in the upper right quadrant of the abdomen, directly inferior to the xiphoid process.
• Improper hand placement during CPR, with pressure applied over the xiphoid process, can drive the structure inward.
• A fractured or depressed xiphoid process can act as a sharp object, leading to the laceration of the underlying liver and causing severe internal hemorrhage.

Why Other Options Were Wrong

• Option A: The lungs are located superior and lateral to the xiphoid process, protected within the rib cage. They are not directly in the path of force from the xiphoid.
• Option C: The stomach is located primarily in the left upper quadrant of the abdomen, not centrally beneath the xiphoid process.
• Option D: The diaphragm is a strong, flexible sheet of muscle. While it is positioned between the xiphoid and the liver, it is less likely to be lacerated than the solid, friable parenchyma of the liver.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Anatomical knowledge related to CPR and its potential complications helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses must master correct CPR technique, including precise hand placement on the lower half of the sternum, to ensure effective resuscitation while preventing iatrogenic injuries like liver laceration or rib fractures.
• This knowledge underscores the importance of regular CPR certification and skills practice for all healthcare professionals to maintain patient safety during emergencies.
• What if? If the patient were an infant, the correct technique would be to use two fingers or two thumbs on the sternum just below the nipple line. Using the adult heel-of-hand technique would almost certainly cause severe internal injuries, including liver laceration.

How to Approach the Question

• First, identify the key anatomical landmark in the question: the xiphoid process, located at the inferior tip of the sternum.
• Next, mentally map or recall the organs situated directly beneath and around this landmark in the upper abdomen.
• Consider the mechanism of injury described: 'forceful compressions' leading to 'laceration' (a tear or cut).
• Evaluate each option based on its location and tissue type. The liver is a large, solid, and relatively fragile organ directly under the xiphoid process.
• Compare this to the other options: the lungs are protected by ribs, the stomach is more to the left, and the diaphragm is a tough muscle.
• Conclude that the liver is the most vulnerable organ to laceration from downward pressure on the xiphoid process.

Concept Tested & Keywords

• Concept Tested: Anatomical knowledge related to CPR and its potential complications.
• Stem keywords: CPR, adult, hand placement, sternum, xiphoid process, laceration
• Lead-in keywords: most likely at risk
• Negative lead-in flag: false

Question ID

QIUmj9e-b-MRxDgwdFlgjU

Copy ID

Reference Book

E6 Anatomy MindMaps BDChaurasia V2 10e p. 9-11

E6 Anatomy BDChaurasia V2 10e Part 2 p. 91-93