BCEN CEN Practice Test

Etomidate is considered a first-line induction agent for rapid sequence intubation (RSI), especially in patients with traumatic brain injury, due to its favorable hemodynamic profile and minimal effects on cerebral perfusion pressure. It has a rapid onset and short duration of action, which are ideal characteristics for RSI. Diazepam and lorazepam are not recommended for RSI because of their slower onset, prolonged duration of action, and potential for respiratory depression. Propofol is also a rapid-acting agent but is known to cause vasodilation and hypotension, which can be detrimental to a patient with a head injury by reducing cerebral perfusion pressure.

The patient's clinical presentation and laboratory findings are indicative of iron deficiency anemia, which is commonly associated with chronic blood loss such as that from menorrhagia. The low serum iron and low MCV (microcytic anemia) confirm this diagnosis. The most appropriate initial treatment is iron supplementation, either orally or intravenously, depending on the severity of the symptoms and patient's ability to tolerate oral medications. Blood transfusion is reserved for symptomatic anemia with hemodynamic instability or when rapid replenishment is necessary, not as an initial standard treatment in stable patients. Vitamin B12 and folate supplementation are used to treat macrocytic anemias, which are not indicated by this patient's low MCV.

The Five Rights of Delegation require the nurse to delegate the right task, under the right circumstances, to the right person, with the right directions, and under the right supervision. The collection, handling, and documentation of forensic evidence are specialized nursing tasks that require clinical judgment to maintain the chain of custody and cannot be delegated to unlicensed assistive personnel (UAP). This includes collecting clothing, documenting injuries, and labeling evidence kits. However, providing comfort measures and emotional support is an appropriate and safe task to delegate to a UAP, as it falls within their scope of practice and does not require specialized forensic training.

Ménière's disease is correctly identified by its classical symptoms which include episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness. These symptoms distinguish it from other vestibular disorders. Labyrinthitis, although it presents with vertigo, typically does not include the fluctuating hearing loss or the sensation of aural fullness associated with Ménière's disease. Otosclerosis is primarily a conductive hearing loss condition and does not generally include vertigo or tinnitus. Sensorineural hearing loss is a broad diagnosis and lacks the specific combination of symptoms compared to Ménière's disease.

The third heart sound (S3) occurs in early diastole when a large volume of blood enters a dilated, compliant ventricle. Although its sensitivity is low (detected in a minority of patients), its presence is one of the most specific bedside indicators of acute heart failure, far exceeding the specificity of crackles, peripheral edema, or jugular venous distension. The other findings listed are either less specific or signify different pathologies.

The initial step in a situational crisis intervention should be to establish a supportive and empathetic connection with the patient. This foundational approach not only helps in validating the patient's feelings and distress but also builds a therapeutic alliance that is vital for further intervention and guidance. Providing detailed information about prognosis and treatment immediately might overwhelm the patient further, and suggesting resources may be perceived as dismissive if emotional support is not first established.

The correct answer is permanent erectile dysfunction. Ischemic priapism, an erection lasting longer than four hours, is a compartment syndrome of the penis. The trapped blood becomes deoxygenated, leading to an ischemic state that can cause corporal tissue necrosis and fibrosis if not resolved quickly. This tissue damage results in permanent erectile dysfunction. While acute urinary retention can occur due to urethral compression, it is not the most severe parenchymal complication. Testicular torsion is a separate urological emergency. Penile cellulitis is a possible secondary complication, but not the primary consequence of the ischemia.

Implementing a comprehensive staff training program on patient-centered communication is the most effective strategy for long-term improvement in patient satisfaction scores. While all options can contribute to patient satisfaction, addressing the fundamental interaction between staff and patients through communication training has the most profound and lasting impact.

Effective communication is at the core of patient satisfaction. It influences patients' perceptions of care quality, wait times, and overall experience. A well-designed training program equips staff with skills to explain procedures, manage expectations, show empathy, and handle difficult situations. These skills are applicable across various scenarios and patient populations, making the impact of this strategy more consistent and far-reaching.

In contrast, the other options, while potentially beneficial, have limitations:

1. Redesigning the waiting area may improve comfort but doesn't address the quality of care or staff-patient interactions.
2. Hiring additional staff might reduce wait times but doesn't necessarily improve the quality of patient interactions or overall experience.
3. Implementing a patient feedback system is valuable for identifying issues, but without proper training on how to act on this feedback, it may not lead to significant improvements.

By focusing on communication skills, the emergency department can create a culture of patient-centeredness that permeates all aspects of care, leading to more consistent and sustainable improvements in patient satisfaction.

Ménière's disease presents with a classic symptomatic quartet of episodes of vertigo, sensorineural hearing loss, tinnitus, and a sensation of aural fullness. These symptoms help differentiate Ménière's disease from other forms of acute vestibular dysfunction. Labyrinthitis typically presents with severe vertigo and hearing loss but does not usually include tinnitus or aural fullness as cardinal symptoms, and it is often associated with a recent viral infection. Vestibular neuronitis often presents with vertigo but without hearing loss, while BPPV is characterized by brief episodes of vertigo related to changes in head position and does not involve hearing loss or tinnitus.

The correct action is to report the behavior to the appropriate supervisor or manager as it may indicate potential substance use disorder and drug diversion. Reporting helps in protecting patients, providing the nurse in question with access to necessary resources and support, and maintaining a safe work environment. Confronting the colleague directly could lead to defensive behavior, denial, and potential destruction of evidence. Ignoring the signs is inappropriate and unethical, as it places patients and the institution at risk. Monitoring the colleague’s behavior without taking further steps does not address the gravity of the situation or potential patient safety concerns.

Cyclic vomiting syndrome is correctly described as a disorder marked by episodes of severe vomiting that have no apparent cause. These episodes can last for hours or days and are separated by symptom-free periods. Understanding the nature of this syndrome helps in managing care and anticipating needs during these intense episodes.

Diffuse guarding with rebound tenderness indicates irritation of the parietal peritoneum. After blunt abdominal trauma, this combination strongly points to peritonitis caused by leakage of intestinal contents from a hollow-viscus injury and warrants urgent imaging and surgical evaluation. Seatbelt abrasions, Grey Turner sign, or high-pitched bowel sounds can accompany abdominal trauma but are less specific for perforation because they may occur with contusion, retroperitoneal hemorrhage, or bowel obstruction without transmural injury.

In a patient with suspected bleeding esophageal varices, as indicated by hematemesis and a history of cirrhosis, the priority intervention is volume resuscitation to maintain hemodynamic stability. This is typically initiated with the administration of IV crystalloid fluids. Endotracheal intubation may be necessary if the airway is at risk, but it is not the first immediate intervention. The administration of beta-blockers is a long-term management strategy for esophageal varices to reduce the risk of bleeding, not an acute intervention. While proton pump inhibitors may be used in gastrointestinal bleeding, they are not the primary treatment for bleeding esophageal varices.

The visibility of an ingested foreign body on a radiograph is not guaranteed, even if it is made of a radiopaque material like metal. Radiopacity is a relative concept, and an object's visibility depends on several factors, including its size, thickness, orientation, and its X-ray attenuation compared to surrounding and overlying tissues like bone. Small or thin metallic objects, or those made of metals with lower density like aluminum, may not be visible on a standard x-ray. While most metals are radiopaque, materials like wood and plastic are typically radiolucent and not seen on x-rays. Advanced imaging, such as a CT scan, may be required for definitive localization.

The correct answer is anaphylaxis. The patient's presentation of distributive shock (hypotension, tachycardia, warm skin) immediately following multiple wasp stings is a classic presentation for anaphylaxis. Urticaria, or hives, is a common cutaneous sign of an allergic reaction. While septic shock can present with similar hemodynamic instability and lab abnormalities like elevated liver enzymes and thrombocytopenia, the extremely rapid onset tied to a known allergen exposure makes anaphylaxis the most likely diagnosis. Neurogenic shock typically presents with bradycardia, not tachycardia, due to loss of sympathetic tone. Hypovolemic shock is characterized by cool, clammy skin due to peripheral vasoconstriction, which is the opposite of the warm, flushed skin seen in this patient.