Question

The nurse walks into a patient's room and finds him unresponsive and pulseless sitting up in bed. She calls a code blue using the emergency button in the room. Which of the following should she do first?

a) Retrieve crash cart
b) Begin CPR
c) Lower head of bed
d) Remove furniture from room

Answer 1

The first action a nurse should take when finding a patient unresponsive and pulseless is to begin CPR, specifically by lowering the head of the bed to initiate effective chest compressions.

Step-by-step explanation:

When a nurse finds a patient unresponsive and pulseless, the first action should be to begin CPR (cardiopulmonary resuscitation). This immediate response is critical as it can maintain the flow of blood, especially to the brain, where irreversible damage can occur within minutes of loss of blood flow. The nurse should ensure the patient is lying flat, which involves lowering the head of the bed, to provide effective chest compressions. The furniture does not have to be removed from the room, and retrieving a crash cart, although important, comes after initiating CPR.

When performing CPR, the nurse would properly position their hands on the sternum by locating the area between the lines at T4 and T9 to effectively compress the heart and maintain circulation. This technique is performed until professional medical intervention takes over or until the patient is declared deceased by a qualified healthcare professional.