BCEN CEN Practice Test

After establishing an effective airway and adequate ventilation, and confirming a stable heart rate of over 100 bpm along with improved skin coloration, the appropriate next step is to monitor the baby and maintain temperature control. This step is vital as newborns are prone to hypothermia, which can complicate recovery. Immediate, aggressive interventions like administering intravenous fluids or supplemental oxygen might not be necessary with the stabilization of vital parameters and can in fact complicate the clinical scenario if not indicated.

Noncardiac pulmonary edema involves the accumulation of fluid in the alveoli primarily due to reasons other than the failure of the left ventricle. This can include conditions such as ARDS (Acute Respiratory Distress Syndrome), inhalation injuries, or renal failure, among others. The categorization 'noncardic' specifically indicates that the edema is not driven by cardiac failure, importantly distinguishing it from cardiogenic pulmonary edema.

The correct answer is to administer oxygen therapy to maintain SpO2 between 88-92%. In COPD exacerbations, oxygen therapy is crucial but must be carefully titrated. Unlike other respiratory conditions, COPD patients often rely on hypoxic drive for respiratory stimulation. Maintaining SpO2 between 88-92% helps prevent hypercapnia while ensuring adequate oxygenation.

While bronchodilators are important in COPD management, they are not the first priority. Corticosteroids, although beneficial, are not the immediate intervention. Intubation is typically reserved for severe cases unresponsive to non-invasive measures. Always start with less invasive interventions in COPD exacerbations, progressing to more aggressive treatments if necessary.

The patient is presenting with symptoms consistent with mild to moderate hypothermia. Gradual rewarming with blankets and a controlled environment is appropriate to avoid rapid vasodilation and potential hypotension. Warming methods such as heated IV fluids and airway rewarming are generally reserved for moderate to severe hypothermia with a temperature below 32°C (89.6°F). Active external rewarming such as a warm bath can lead to afterdrop, where cold peripheral blood returns to the central circulation, further decreasing core temperature and leading to worsening hypothermia. Preventing further heat loss is crucial, but will not treat the existing hypothermia.

Contact precautions are the most appropriate infection control measure for patients with known MRSA. This includes wearing gloves and a gown when entering the patient's room or care area. While standard precautions are always necessary, they are not sufficient alone for MRSA patients. Airborne precautions are not required for MRSA, as it is primarily spread through direct contact. Droplet precautions are used for organisms spread by respiratory droplets, which is not the primary mode of MRSA transmission.

The correct answer is 'Reduction in staff turnover rates related to workplace stress'. While all the options presented are relevant to workplace violence prevention, staff turnover rates provide a comprehensive, long-term indicator of the program's effectiveness.

A reduction in staff turnover rates suggests that the work environment has become safer and less stressful, leading to increased job satisfaction and retention. This metric reflects not only a decrease in violent incidents but also improvements in staff perception of safety, support, and overall work culture.

The number of reported violent incidents, while important, may not accurately reflect the program's effectiveness due to potential underreporting or initial increases in reporting due to heightened awareness. Similarly, the percentage of staff completing violence prevention training is an input measure rather than an outcome measure. It doesn't necessarily correlate with reduced violence or improved safety perceptions.

The number of security interventions could be influenced by various factors and might not directly indicate a safer environment. An effective program might actually lead to fewer security interventions as staff become more skilled at de-escalation.

By focusing on staff turnover rates related to workplace stress, healthcare organizations can gauge the holistic impact of their violence prevention efforts on staff well-being, job satisfaction, and the overall safety culture in the emergency department.

Organ and tissue donation in the context of palliative care aims to enhance the quality of life for other individuals through the life-saving and life-improving gifts of organ and tissue transplants. While palliative care focuses on the comfort and support of the individual patient, organ and tissue donation provides an opportunity for the patient to contribute to the well-being of others even after death. The incorrect answers do not represent the primary goal of organ and tissue donation, as they either misunderstand the concept or relate to broader aspects of palliative care rather than the specific intention behind donation.

A threatened abortion is characterized by vaginal bleeding during early pregnancy without dilation of the cervix or passage of tissue. It is a situation where the pregnancy may continue normally, or it may progress to a spontaneous abortion. Understanding this helps differentiate it from the conditions detailed in the other answers which either involve progression to loss of pregnancy or other obstetric complications.

The statement is false because the use of tourniquets is reserved for life-threatening extremity hemorrhage where direct pressure cannot control bleeding. Facial lacerations typically do not require tourniquets due to the risk of significant complications such as nerve damage or loss of facial tissue viability. Initial management of facial lacerations involves direct pressure, wound cleaning, and possibly suturing by a healthcare provider.

Providing a calm, quiet environment is the most appropriate initial intervention for a patient experiencing acute grief and shock from a sudden loss. This approach helps reduce external stimuli that may overwhelm the patient and allows them to process their emotions in a safe space. While the other options may be beneficial later in the patient's care, they are not the immediate priority in this acute crisis situation. Encouraging the patient to talk about their feelings should only be done when they are ready, not forced. Administering sedatives without a thorough assessment could mask important symptoms or reactions. Contacting family members, while important, should be done with the patient's consent and after their immediate emotional needs are addressed.

The correct diagnosis is hyphema. Hyphema is the presence of blood in the anterior chamber of the eye, which is the space between the cornea and the iris. It is typically caused by blunt trauma to the eye, such as being hit with a ball. The pooling of blood in the anterior chamber is a characteristic sign of hyphema.

It's important to differentiate hyphema from other ocular traumas:

• Globe rupture typically presents with a misshapen pupil, decreased visual acuity, and possibly extruded ocular contents.
• Retinal detachment usually presents with visual field defects or the sensation of a curtain falling over the vision.
• Corneal abrasion would show a scratch on the surface of the eye, visible with fluorescein staining.

Prompt diagnosis and management of hyphema is crucial to prevent complications such as increased intraocular pressure, corneal blood staining, and optic atrophy. Treatment typically involves rest, elevation of the head, and possibly eye drops to control inflammation and intraocular pressure.

Endocarditis is an infection of the inner lining of the heart, primarily affecting the heart valves. It frequently occurs when bacteria or other infectious substances enter the bloodstream and settle on damaged heart tissue or artificial valves. Dental procedures, particularly those causing bleeding, can provide a pathway for these bacteria to enter the bloodstream. Knowing this link helps in preventative strategies for at-risk patients, such as prophylactic antibiotics for those with known valve disease before dental procedures.

This statement is incorrect. Patients with a spontaneous abortion, also known as miscarriage, typically present with bleeding, cramping, and an open cervical os. An open cervical os allows the passage of products of conception, which is characteristic of a miscarriage that has already occurred or is in progress. Conversely, a threatened abortion may present with vaginal bleeding, but the cervical os remains closed, and the pregnancy may continue without incident.

Tuberculosis is an airborne infectious disease. Patients suspected or confirmed to have TB should be placed in airborne isolation precautions, which include placing the patient in a negative pressure room and using respiratory protective equipment such as N95 respirators. Contact precautions involve the use of gloves and gowns and are more appropriate for diseases spread by direct contact. Droplet precautions are not sufficient for TB as the infectious agent can remain suspended in the air and may transmit over greater distances than droplets. Reverse isolation is used to protect immunocompromised patients from getting an infection, not to prevent the spread of disease from an infected patient.

This statement is true. Alternating current (AC) is generally considered more dangerous than direct current (DC) in electrical injuries for several reasons:

1. Muscle contraction: AC causes repetitive muscle contractions, which can lead to the inability to let go of the electrical source, prolonging exposure.

2. Cardiac effects: AC is more likely to cause ventricular fibrillation, a life-threatening arrhythmia, even at lower voltages.

3. Nervous system impact: AC interferes more with the body's natural electrical signals, potentially causing more severe neurological damage.

4. Frequency: Most household and industrial AC operates at frequencies (50-60 Hz) that closely match the heart's natural rhythm, increasing the risk of cardiac disturbances.

While DC can still cause severe injuries, its continuous flow tends to cause a single muscle contraction, often allowing the victim to break contact with the source more quickly. However, it's important to note that both AC and DC can be lethal, and all electrical injuries should be treated as potentially severe medical emergencies.