BCEN CEN Practice Test

Intravenous fluid administration is the most appropriate initial step in the management of neurogenic shock. Neurogenic shock is characterized by the loss of sympathetic tone following a spinal cord injury, which leads to vasodilation, decreased systemic vascular resistance, and resulting hypotension. While atropine and vasopressors may also be used, they are typically secondary interventions after adequate fluid resuscitation has been initiated to restore intravascular volume. High-dose methylprednisolone is not recommended as a first-line treatment due to lack of evidence supporting its use in acute spinal cord injury and potential for harm.

Airborne precautions are the best initial action for a patient with suspected tuberculosis. TB spreads via airborne droplet nuclei, so the nurse should immediately place the patient in a negative-pressure room, don an N95 (or higher-level) respirator, and limit patient movement. Further diagnostic steps such as obtaining serial sputum samples can follow. Administering antituberculosis drugs or notifying public-health authorities are important but not the first priority because staff, visitors, and other patients must be protected from exposure before additional measures are taken.

Post-bronchodilator spirometry is used to differentiate obstructive lung diseases. If the FEV1/FVC ratio rises to ≥0.70 (or returns to the lower limit of normal) after bronchodilator, the airflow limitation is considered reversible-typical of asthma. In COPD, airflow limitation is largely irreversible and the post-bronchodilator FEV1/FVC ratio remains persistently <0.70. Thus, an increased ratio after bronchodilator supports asthma rather than COPD.

Increased pain out of proportion to the injury, especially on passive stretch of muscles within the involved compartment, is a crucial indication of developing compartment syndrome. Paresthesia, pallor, and paralysis are also signs of compartment syndrome, but they typically appear later in the condition's progression. Pulselessness is a late and unreliable sign due to the potential for collateral circulation.

Chest ultrasonography is the most appropriate initial diagnostic test for suspected pleural effusion. It is highly sensitive and specific, can be performed at the bedside, and does not expose the patient to radiation. Ultrasound can detect as little as 20 mL of pleural fluid and can also help guide thoracentesis if needed. While chest X-ray can detect pleural effusions, it requires at least 200-300 mL of fluid to be visible and may not detect smaller effusions. CT scan, although highly accurate, involves radiation exposure and is usually reserved for more complex cases or when other pathologies are suspected. Pulmonary function tests are not typically used for acute diagnosis of pleural effusion and would not provide immediate information about fluid in the pleural space.

The diagnosis of acute pancreatitis requires meeting at least two of three criteria: characteristic abdominal pain, serum amylase or lipase levels at least three times the upper limit of normal, and characteristic imaging findings. Therefore, significantly elevated serum lipase and amylase are the most direct and indicative laboratory findings for acute pancreatitis. While leukocytosis (elevated WBC) and an elevated C-reactive protein are common due to inflammation, they are nonspecific. Elevated liver enzymes (AST/ALT) may suggest a biliary cause but are not primary diagnostic markers for pancreatitis itself. Hyperglycemia and hypocalcemia can be complications of pancreatitis but are not primary diagnostic indicators.

The correct answer is to administer intramuscular epinephrine. In cases of anaphylaxis, epinephrine is the first-line treatment and should be given immediately. It helps to reverse the life-threatening effects of anaphylaxis by constricting blood vessels, relaxing bronchial smooth muscles, and reducing inflammation.

While oxygen therapy and IV fluids are important supportive measures, they are secondary to epinephrine administration. Diphenhydramine (an antihistamine) can help with itching and hives but does not address the life-threatening aspects of anaphylaxis and should not be used as the initial treatment. The rapid onset of symptoms after shellfish exposure, combined with respiratory distress, hypotension, and widespread urticaria, clearly indicates anaphylaxis, requiring immediate epinephrine administration.

Intrathoracic airway lesions, including foreign bodies below the thoracic inlet, are compressed by positive pleural pressure during expiration. This dynamic narrowing, combined with the ball-valve effect often produced by a tracheal foreign body, permits relatively easier inspiratory flow but impedes exhalation. Airway resistance therefore peaks during expiration, leading to air trapping, hyperinflation, and possible barotrauma. Inspiratory obstruction is more typical of extrathoracic lesions above the vocal cords; fixed obstructions may cause biphasic resistance.

True. Fecal impaction can obstruct the colon when a rock-hard fecaloma lodges in the rectosigmoid or proximal colon, producing distention, pain, and obstipation. However, epidemiologic reviews show that the majority of large-bowel obstructions are produced by colorectal cancer, diverticular strictures, or volvulus. Fecal impaction is therefore classified as an uncommon but important etiology, particularly in frail, immobilised, or opioid-treated patients. Prompt recognition allows non-operative therapies such as enemas, osmotic laxatives, or manual disimpaction, reserving surgery for complications like stercoral perforation.

The correct initial action for controlling external hemorrhage is to apply firm, direct pressure over the wound. This is the most effective first-line intervention. Elevating the injured limb above the level of the heart is an important adjunctive measure that reduces blood flow to the extremity and should be done in conjunction with direct pressure if there are no contraindications. Applying a tourniquet is a measure used for severe, life-threatening extremity hemorrhage that is not controlled by direct pressure. Applying pressure to an arterial pressure point is a secondary measure used only if direct pressure and elevation fail to control the bleeding.

The appropriate initial management for this patient involves immobilizing the cervical spine. This step is critical in preventing further injury, especially if there is a potential spinal cord injury indicated by the weakness. Other options, like providing analgesia first or immediately initiating a CT scan, fail to address the risk of exacerbating a potential spinal injury that could lead to permanent loss of function.

Covered entities such as hospital EDs must take reasonable steps to ensure meaningful access for LEP individuals. Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act prohibit national-origin discrimination, requiring qualified interpreter services to be available free of charge and in a timely manner at every point of contact, 24 hours a day. The National CLAS Standards reinforce this by stating that language assistance must be provided "at all points of contact…during all hours of operation" and that organizations should maintain written policies to operationalize these requirements. Options that limit interpreter availability to business hours, rely routinely on family members, or depend solely on slow English explanations fail to meet these legal and accreditation standards.

Administering humidified 100% oxygen is essential for patients with suspected inhalation injuries to help reduce airway inflammation, prevent hypoxemia, and treat carbon monoxide poisoning which is common in smoke inhalation. Bronchodilators may be used, but they would not be the immediate priority. Intravenous fluids and antibiotics may be important in the overall management; however, they do not address the immediate life-threatening concerns of airway protection and gas exchange.

The most effective initial response to prevent potential harm is to stop the procedure immediately and verify the patient's identity and blood type with the medical records. This action directly addresses and potentially averts the immediate risk of a mismatched blood transfusion, which can be life-threatening. Alerting the hospital administration or calling a code does not directly intervene in the impending error and may delay crucial immediate action. Documenting the incident is important but secondary to actively stopping the error.

Central retinal artery occlusion (CRAO) is an ophthalmologic emergency characterized by the sudden, painless, and severe loss of vision in one eye. It is often caused by an embolus from sources like the carotid arteries or the heart, which is why a history of atrial fibrillation is a significant risk factor. Retinal detachment typically presents with floaters, flashing lights (photopsia), and a curtain-like field defect. Acute angle-closure glaucoma is associated with severe eye pain, a fixed mid-dilated pupil, headache, and nausea. Vitreous hemorrhage can also cause sudden, painless vision loss, but it is often described as involving floaters, cobwebs, or a haze rather than a complete loss of vision.

The correct answer is 'Utilizing peer-reviewed research findings and clinical guidelines'. Evidence-based practice requires nurses to use the best available, current, peer-reviewed research when making clinical decisions. Applying interventions grounded in high-quality evidence and established guidelines leads to safer and more effective patient care. In contrast, relying on traditional habits, informal colleague advice, or basing care solely on a patient's preferences lacks the systematic evaluation and rigor that define evidence-based practice.

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.

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.

The correct answer is a CT scan of the abdomen and pelvis with contrast. While all the listed options can be useful in evaluating a patient with suspected diverticulitis, a CT scan is considered the gold standard for diagnosis. It provides detailed images of the bowel wall and surrounding tissues, allowing for accurate identification of inflamed diverticula, abscesses, or other complications.

Although a complete blood count (CBC) can show elevated white blood cells, indicative of infection, it is not specific to diverticulitis. An abdominal X-ray may show nonspecific findings but lacks the sensitivity and specificity of a CT scan. A colonoscopy, while useful for diagnosing other colon conditions, is generally contraindicated in acute diverticulitis due to the risk of perforation.

It's important to note that the clinical presentation, along with the patient's age and symptoms, strongly suggests diverticulitis. The left lower quadrant pain is particularly characteristic of this condition, as diverticula most commonly occur in the sigmoid colon.

The correct answer is to request a professional medical interpreter. While it may seem convenient to use the patient's grandson as an interpreter, this practice is not recommended for several reasons:

1. Medical terminology: Professional interpreters are trained in medical vocabulary and can accurately convey complex medical information.

2. Patient privacy: Using family members as interpreters may compromise patient confidentiality and make the patient uncomfortable discussing sensitive health issues.

3. Objectivity: Family members may inadvertently filter or modify information based on their own emotions or cultural beliefs.

4. Legal considerations: In many healthcare settings, using professional interpreters is required to ensure accurate communication and protect patient rights.

5. Emotional burden: Interpreting medical information can be stressful for family members, especially in emergency situations.

While the grandson's offer is well-intentioned, using a professional medical interpreter ensures accurate communication, maintains patient privacy, and adheres to best practices in culturally competent care.