I received via email this in my opinion poorly-written question, which happens so many times when tests are put together. I am open to discussion from you! April 30 2015
QUESTION: I wrote the emergency nursing certification exam this past weekend and of course now I’m obsessing over the questions that I wasn’t sure about. I’m hoping that you can answer one of them for me as everyone’s opinion that I ask differs.
The scenario was of a patient who is in a rapid unstable rhythm and the team cardioverts them. The patient immediately then goes into Vfib. What do you do?
The two answers that I struggled between were whether to immediately defibrillate them or to start chest compressions. I ultimately chose to defibrillate them but I’m second guessing my choice. My reasoning for the choice is that if the patient is already connected to the pads, it’s a witnessed arrest, we should shock them as soon as possible because we would be able to do it within seconds. BUT the HSF voice in my head is saying “chest compressions, chest compressions.
What is the right answer?"
"Clinical Educator. Northern Ontario"
RESPONSE: So, in answer...when we run ACLS we always incorporate this into one of the scenarios. Both answers would be correct depending on how many seconds it would take you to defibrillate. I would agree with your answer: defibrillate immediately. You're all connected and all you would have to do is ensure the syncrhonized button is 'off' and the correct joules are chosen and then shock. This can easily be done within 10 seconds, which is the HSF voice in our head saying " no more than 10 seconds interruptions in compressions". Many times when we do run this scenario, people suddenly experience a mental block and it does take longer than 10 seconds.....in that case, definitely have compressions started while preparing to defibrillate would be equally appropriate.
If one answer indicated that you were an ACLS and Hospital-certified member of the Code Team with the ability to defibrillate, what would you do? The answer then is very clear.
However, are we to assume that they assume you have this capability? Or would they argue that the answer you chose was incorrect because, in fact, it's the doc who cardioverted and they will be the one to defibrillate, therefore you should start compressions while the machine is being prepared by the doc.
I hope you're able to find the correct answer, from their perspective.
I would love to be able to challenge the people who write these types of questions and gently ask them to reword the questions.