BCEN CEN Practice Test

These symptoms are indicative of measles, which is a highly contagious viral disease that is a reportable condition in every state. Health professionals are required to report suspected cases to the local or state health department immediately, often within 24 hours. While obtaining lab confirmation is a crucial step, the priority is to report the suspected disease to initiate public health interventions and prevent further transmission. Notifying only the infection control department or waiting to report the disease until after discharge may delay necessary immediate public health response.

Starting with a root cause analysis is the most effective initial step because it helps to identify the underlying causes of the increased wait times and decreased satisfaction. Once the root causes are understood, targeted strategies to address these specific issues can be developed, potentially leading to more effective solutions. Simply expanding staff or revising scheduling without understanding the root causes may lead to ineffective use of resources or fail to address the actual issues. Changing leadership practices without evidence may cause disruption and is not directly linked to wait times and patient satisfaction without further analysis.

The START (Simple Triage and Rapid Treatment) triage system prioritizes patients based on their ability to walk, presence of spontaneous respiration, respiratory rate, perfusion, and mental status. The patient with a respiratory rate of 10 breaths per minute is breathing spontaneously and falls within the normal range of 12-20 breaths per minute, which suggests adequate perfusion and mental status, but they may need urgent care because they are not obeying commands. This patient should be tagged as 'Immediate' or red, indicating they require immediate life-saving interventions. The patient with a respiratory rate of 28 breaths per minute may be in respiratory distress and could also be tagged as 'Immediate' if they don't follow commands or don't have a peripheral pulse. The ambulatory patient and the patient with a respiratory rate of 32 breaths per minute may be tagged as 'Delayed' or yellow, indicating their condition is less severe than that of an 'Immediate' patient. The patient who is not breathing even after airway repositioning would typically be tagged as 'Deceased' or black after a quick attempt to open the airway fails to produce spontaneous breathing, indicating a very low chance of survival.

High-quality chest compressions are critical in cardiopulmonary resuscitation (CPR) for maintaining circulation to vital organs until normal heart rhythm is restored. According to current resuscitation guidelines, chest compressions should be initiated within 10 seconds of identifying cardiopulmonary arrest. Defibrillation is important if a shockable rhythm is present, but the immediate priority is to initiate CPR with chest compressions. Assessing for potential airway obstruction and delivering two rescue breaths are components of the CPR process but are secondary to starting chest compressions in the adult chain of survival.

The presence of clear rhinorrhea following blunt trauma to the face may indicate a basilar skull fracture with a possible cerebrospinal fluid leak, which is a serious condition that requires immediate intervention to prevent complications such as infection. While periorbital ecchymosis (commonly known as 'raccoon eyes') and epistaxis may also accompany facial trauma, they are not as acutely concerning as a potential CSF leak. Difficulty articulating speech, while important to address, is not as critical as securing the integrity of the cranial vault and preventing central nervous system infection.

Patients presenting with symptoms of pulmonary hypertension and a history of scleroderectomy are at risk for pulmonary arterial hypertension, which classically is associated with connective tissue diseases like scleroderma. While diuretics and oxygen could be used as supportive therapy, the initiation of endothelin receptor antagonists, such as bosentan, specifically targets pulmonary arterial hypertension by blocking endothelin, a substance that causes blood vessels to constrict. Calcium channel blockers are generally not the initial treatment of choice as they can be harmful in patients with pulmonary arterial hypertension unless they responded positively to a vasodilator challenge, which is not indicated in the information provided. Empiric antibiotics without evidence of infection would not address her pulmonary hypertension and syncope.

Healthcare guidelines advise that competent adult patients should be asked for permission before involving law enforcement, unless the situation meets mandatory reporting criteria (e.g., minor, vulnerable adult, or imminent danger). This respects patient autonomy, builds trust, and reduces the risk of retaliation by traffickers. Immediate notification without consent (Option A) can endanger the patient; simply discharging without offering help (Option C) neglects duty of care; detaining the patient until police arrive (Option D) violates legal and ethical standards.

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count) is a life-threatening obstetric emergency that may develop ante-partum or post-partum. It represents a severe form of pre-eclampsia and is defined by laboratory evidence of red-cell destruction, markedly elevated AST/ALT, and platelet counts typically below 100 000 /µL. Acute fatty liver of pregnancy can also raise liver enzymes but lacks the classic hemolysis and marked thrombocytopenia. Disseminated intravascular coagulation produces thrombocytopenia and hemolysis yet is a secondary coagulopathy rather than a hypertensive variant. Gestational diabetes mellitus involves carbohydrate intolerance and does not present with this hematologic-hepatic triad.

These findings are characteristic of Ludwig's angina-a rapidly spreading cellulitis of the floor of the mouth that often follows an infected lower molar. Bilateral submandibular swelling, tongue elevation, dysphagia, and a muffled voice indicate impending airway compromise. Peritonsillar abscess usually causes unilateral tonsillar swelling and uvular deviation. Epiglottitis causes severe sore throat with stridor, and mumps produces parotid gland swelling rather than floor-of-mouth cellulitis.

Immediate irrigation of the eye is crucial in the management of a chemical burn to reduce tissue damage and remove the offending substance. Delaying this step can result in more severe injury or complications. Other options, though important in overall patient care, are secondary to the urgency of washing out the chemical.

Consulting with a mental health professional is the most direct and effective initial approach to address symptoms of burnes and assess needs for further interventions or supports. While supporting each other among colleagues and discussing experiences can provide peer support, professional advice is crucial for individualized assessment and management strategies. Vacation time may provide temporary relief but doesn't address the underlying issues directly. Relying on overtime for financial reasons might contribute further to burnout rather than resolving it.

The most appropriate next step in managing this patient's condition is an immediate surgical consultation for fasciotomy. This patient is showing signs of acute compartment syndrome, which is characterized by increased pressure within a muscle compartment that can impair circulation and cause muscle and nerve damage. Immediate intervention is critical to release the pressure and prevent permanent damage. Measuring compartment pressures might support the diagnosis but does not address the urgency of surgical intervention. Administering additional analgesia might help in managing pain but does not treat the underlying compartment syndrome. Reassessment in several hours could lead to worsening of the condition and is inappropriate given the current signs and symptoms.

The correct answer is 'Hypovolemic shock.' This is because the patient's history of severe diarrhea and vomiting likely led to a significant loss of fluids and electrolytes, reducing blood volume, which typically causes hypovolemic shock. Hypovolemic shock is characterized by signs such as rapid heartbeat, low blood pressure, and cold, clammy skin due to reduced circulation. In contrast, distributive shock involves a problem with vascular tone and often presents with warm, flushed skin as seen in septic shock. Cardiogenic shock, attributable to heart failure, typically presents with symptoms related to cardiac dysfunction and not primarily due to fluid loss. Neurogenic shock, caused by spinal cord or nervous system injuries, results in blood vessel dilation that would not commonly be associated with diarrhea and vomiting.

Alkali substances cause liquefactive necrosis because they saponify fats, leading to deep penetrating injuries that can continue to cause tissue damage even after the initial exposure. Acids typically cause a coagulative necrosis, forming a protective eschar that limits the depth of tissue injury.

High-pressure injection injuries are surgical emergencies. The initial presentation of a small puncture wound is misleading and belies the extensive underlying tissue damage caused by the force and chemical nature of the injected substance. The priority is to prepare for emergent surgical decompression and debridement to remove the foreign material and reduce pressure. Therefore, the most appropriate initial actions include immobilizing the extremity, administering tetanus prophylaxis and broad-spectrum antibiotics, and ensuring an urgent surgical consultation. Applying a pressure dressing or performing a digital nerve block is contraindicated as it can further increase compartment pressure. Irrigating the wound in the emergency department is not recommended as it may not be effective for deep contamination and could potentially spread the toxic substance further into the tissue planes.

The correct answer is artificial tears and cold compresses. These interventions are the initial treatment for viral conjunctivitis, which is the most common form of conjunctivitis. Artificial tears help lubricate the eye and wash away irritants, while cold compresses can reduce inflammation and provide symptomatic relief.

Topical antibiotics are not initially recommended for viral conjunctivitis, as they are ineffective against viruses and may contribute to antibiotic resistance. Oral antihistamines are more appropriate for allergic conjunctivitis and may not be necessary for viral cases. Steroid eye drops, while sometimes used in severe cases, are not a first-line treatment and should only be prescribed under ophthalmological supervision due to potential side effects.

It's important to note that while this presentation is suggestive of viral conjunctivitis, a thorough assessment should be performed to rule out other potential causes, such as bacterial infection or allergic reactions, which may require different treatment approaches.

The correct answer is 'Green'. In mass casualty triage systems, such as START (Simple Triage and Rapid Treatment), patients are categorized into four color-coded groups based on the severity of their condition and need for immediate treatment. The color green is used for patients with minor injuries who can walk and whose treatment can be delayed. These patients are also sometimes referred to as the 'walking wounded'.

Red is used for patients requiring immediate treatment (critical), yellow for those whose treatment can be delayed (serious but stable), and black for those who are deceased or have injuries incompatible with life. Understanding this color-coding system is crucial for emergency nurses to efficiently prioritize patient care during mass casualty events, ensuring that limited resources are allocated effectively to save the most lives possible.

The correct answer is to administer systemic corticosteroids. In acute asthma exacerbations, systemic corticosteroids are a crucial component of treatment. They help reduce airway inflammation, decrease mucus production, and enhance the effectiveness of beta-2 agonists. Corticosteroids should be given early in the course of treatment, usually within the first hour of presentation, to all patients with acute asthma exacerbations except those with very mild symptoms.

While continuous nebulized beta-2 agonists can be beneficial, they are typically used in conjunction with corticosteroids rather than as a sole next step. Intubation is reserved for severe cases unresponsive to other treatments and would be premature at this stage. Administering IV magnesium sulfate, while sometimes used in severe asthma exacerbations, is not the most appropriate next step for a patient showing partial improvement with initial treatment.

The presentation is suggestive of acute decompensated heart failure with pulmonary edema. The administration of intravenous diuretics, such as furosemide, is a key initial treatment in managing fluid overload and reducing pulmonary congestion in this situation. Nitroglycerin may also be used to reduce preload and afterload but is not the initial medication of choice. Oxygen therapy alone will not address the fluid overload and is an adjunct treatment. Intravenous morphine is not the primary treatment for heart failure and is used cautiously, mainly for palliative care to ease dyspnea and anxiety in end-stage heart failure, not as an initial line of treatment.

The most appropriate initial diagnostic test for suspected pulmonary embolism is a D-dimer test. D-dimer is a fibrin degradation product that is elevated in the presence of blood clots. It has a high sensitivity but low specificity for pulmonary embolism. A negative D-dimer test can effectively rule out pulmonary embolism in patients with low to moderate clinical probability, while a positive result warrants further imaging studies.

CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism, but it is not typically the initial test due to radiation exposure and potential contrast-related complications. Chest X-ray may show nonspecific findings but cannot definitively diagnose or rule out pulmonary embolism. Echocardiography can be useful in assessing right ventricular function and identifying signs of right heart strain, but it is not the initial diagnostic test of choice for suspected pulmonary embolism.