Never delay starting compressions to search for equipment or an IV.
Before you read
Test yourself first: 4 questions
Question 1 of 4
The nurse is providing compressions on an infant in cardiac arrest with two rescuers present. Which technique is preferred?
Answer: A. For two-rescuer infant CPR, the two-thumb encircling-hands technique is preferred. The ratio with two rescuers is 15 compressions to 2 breaths, compressing about one-third the depth of the chest.
Question 2 of 4
An adult collapses and is found unresponsive with no normal breathing and no palpable pulse after a 10-second check. What is the nurse's immediate next action?
Answer: B. For an unresponsive adult with no pulse and no normal breathing, the priority is to begin high-quality chest compressions immediately. Early, uninterrupted compressions are the single most important intervention in cardiac arrest.
Question 3 of 4
A client's ECG shows tall peaked T waves, a widening QRS, and a prolonged PR interval. The nurse correlates these changes with which electrolyte imbalance?
Answer: B. Tall, peaked (tented) T waves are the hallmark early ECG change of hyperkalemia; as potassium rises further the QRS widens, the PR interval prolongs, and the rhythm can deteriorate into a sine wave and cardiac arrest. Hypokalemia typically causes flattened T waves and U waves, while calcium imbalances affect the QT interval rather than producing peaked T waves.
Question 4 of 4
A client in cardiac arrest has an advanced airway placed. How should ventilations now be delivered?
Answer: B. With an advanced airway in place, compressions are continuous (without pausing for breaths) and ventilations are given at 1 breath every 6 seconds, about 10 breaths per minute.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Adult compressions are pushed at 100 to 120 per minute, at least 2 inches deep, allowing full chest recoil.
- Compression-to-ventilation ratio is 30:2 for single-rescuer adult CPR without an advanced airway.
- Minimize interruptions in compressions; pause less than 10 seconds for rhythm checks or defibrillation.
- Shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia; asystole and PEA are not shocked.
- Early defibrillation is the single most important factor improving survival in shockable arrest.
- Switch compressors about every 2 minutes to prevent fatigue and maintain compression quality.
Nursing priorities
- Check responsiveness and pulse for no more than 10 seconds, then start compressions immediately if pulseless.
- Call for help and activate the code team and AED/defibrillator.
- Deliver high-quality continuous compressions with minimal interruptions.
- Attach the AED/monitor and defibrillate immediately for VF or pulseless VT.
- Give epinephrine per ACLS and resume compressions right after any shock.
Labs & values
Patient teaching
- Bystanders should push hard and fast in the center of the chest and use any available AED.
- Hands-only CPR is acceptable for untrained lay rescuers of adults.
- Call 911 before starting CPR on an adult who has collapsed.
Red flags: report now
- Never delay starting compressions to search for equipment or an IV.
- Do not shock asystole or pulseless electrical activity.
- Stopping compressions for more than 10 seconds drastically reduces survival.
- Failure to allow full chest recoil reduces blood flow - avoid leaning on the chest.
References
Clinical references for this topic
