what is the appropriate ratio of cardiac compressions to ventilations in an adult client for one person cpr
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Nursing Elites

NCLEX-PN

Safe and Effective Care Environment Nclex PN Questions

1. What is the appropriate ratio of cardiac compressions to ventilations in an adult client for one-person CPR?

Correct answer: C

Rationale: The correct answer is 15:2. For one-person CPR on an adult, the ratio of compressions to ventilations is 15:2. This ratio ensures adequate oxygenation while maintaining effective circulation. Choice A (5:1) and Choice B (1:5) are incorrect ratios and do not align with the recommended guidelines for adult CPR. Choice D (2:15) is also incorrect as it reverses the order of compressions and ventilations.

2. How many feet should separate the nurse and the source when extinguishing a small, wastebasket fire with an appropriate extinguisher?

Correct answer: D

Rationale: The nurse should stand about 6 feet from the source of the fire. Getting closer might put the nurse in danger. Choice A, 1 foot, is incorrect because it is too close to the fire and can expose the nurse to unnecessary risk. Choice B, 2 feet, is also too close to the fire and may lead to potential harm. Similarly, choice C, 4 feet, is not the ideal distance as it is still within the range of potential danger. The correct answer is D, 6 feet, which is a safe distance for the nurse to extinguish the fire effectively without risking personal safety.

3. Common problems for supervisors include all of the following except:

Correct answer: A

Rationale: Common problems for supervisors include micromanaging staff members, wanting to control the style in which a staff member performs a task, and not delegating tasks effectively. These behaviors can hinder team building and overall effectiveness. Facilitating the development of staff members, on the other hand, is a positive attribute for a supervisor as it helps in nurturing the skills and growth of the team members. Therefore, the correct answer is 'the supervisor facilitates development of staff members' as this is not a common problem but a desirable quality in a supervisor.

4. A client scheduled for surgery tells the nurse that he signed an informed consent for the surgical procedure but was never told about the risks of the surgery. The nurse serves as the client's advocate by undertaking which action?

Correct answer: B

Rationale: A nurse serves as a client advocate by protecting the client's right to be informed and to participate in decisions regarding care. In this scenario, the nurse should document in the client's record that the client was not informed about the risks of the surgery. This action ensures that the issue is officially noted and can be addressed by the healthcare team. Reassuring the client that the risks are minimal is incorrect because it dismisses the client's concerns and does not address the lack of information provided. Writing a note on the client's chart to inform the surgeon is not as effective as ensuring that the issue is officially documented in the client's record, where it can be reviewed and addressed by the healthcare team. Informing the surgeon verbally is not as reliable as documenting the concern in the client's record, which provides a formal and lasting record for review and follow-up.

5. A nurse sees another nurse changing an intravenous (IV) solution because the wrong solution is infusing into the client. The nurse who changed the IV solution does not report the error. What should the nurse who observed the error do first?

Correct answer: D

Rationale: The first thing the nurse who observed the error should do is ask the nurse whether she intends to report the error. Ensuring client safety is paramount, and all errors must be reported to the health care provider, but this is not the initial action. The client should also be assessed immediately. The nurse who discovered the error should complete an incident report and make appropriate documentation in the client's record. If the nurse who observed the error finds out that it will not be reported, it may be necessary to involve the supervisor. Therefore, the best course of action initially is to communicate with the nurse who made the error to understand her intentions regarding reporting.

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