BCEN CFRN Practice Test

Acute Respiratory Distress Syndrome (ARDS) is characterized by the sudden onset of widespread inflammation in the lungs. This leads to the accumulation of fluid in the alveoli, causing bilateral pulmonary infiltrates and non-cardiogenic pulmonary edema. Unlike cardiogenic pulmonary edema, ARDS is not related to heart failure and instead is primarily due to direct or indirect lung injury. Understanding these features helps clinicians distinguish ARDS from other respiratory conditions.

Conducting a root cause analysis allows you to systematically investigate the delays, identify underlying issues, and implement targeted improvements, ensuring a comprehensive understanding and resolution of the problem. Changing crew schedules or suggesting discipline without analysis may not address the core issue, and adding more checkpoints could exacerbate the delays.

The purpose of using the SBAR tool in patient handoff is to provide a structured method of communication. SBAR helps ensure all important information is conveyed clearly and systematically, thus reducing the risk of miscommunication and errors during transitions of care.

Administering nebulized albuterol is the most appropriate initial intervention as it directly targets the bronchospasm that is causing the respiratory distress. While oxygen is important and steroids have a role, the immediate need is bronchodilation, which albuterol provides. Monitoring with a pulse oximeter is essential but is not a treatment.

Hemophilia A is characterized by a deficiency of clotting Factor VIII, which results in impaired blood clotting. This hereditary disorder leads to prolonged bleeding times, making management and transport of such patients critical in the flight nursing environment.

Facial trauma is the correct answer because it can cause significant swelling, bleeding, and disruption of normal airway anatomy, making intubation or securing the airway more challenging. Obesity, while also complicating airway management, primarily involves issues with positioning and mask ventilation rather than the acute challenges seen with facial trauma. Hyperventilation is less directly associated with mechanical difficulties in airway management, although it can complicate the overall clinical picture. Allergic reactions can result in airway edema but are less commonly encountered compared to trauma situations in emergency transports.

Pulmonary edema is characterized by the accumulation of fluid in the alveoli and interstitial spaces of the lungs, leading to impaired gas exchange and potentially severe respiratory distress. It is often caused by heart failure, where increased pressure in the pulmonary capillaries drives fluid into the lung tissues.

Diabetes insipidus is characterized by polyuria (excessive urination) and polydipsia (excessive thirst) due to a deficiency in antidiuretic hormone (ADH), which results in the kidneys' inability to conserve water. This contrasts with SIADH, where excessive ADH production leads to water retention.

In high-speed motor vehicle collisions, especially when ejection from the vehicle occurs, the patient is at a high risk for multiple severe injuries including traumatic brain injuries, internal bleeding, spinal injuries, and long bone fractures. The kinetic energy transfer from ejection usually leads to injuries in multiple organ systems.

The patient is likely experiencing obstructive shock due to cardiac tamponade, which is indicated by his hypotension, jugular venous distension, and muffled heart sounds. Pericardiocentesis is the most appropriate intervention to relieve the pressure around the heart and restore cardiovascular stability. Administering intravenous fluids and blood products can support blood pressure but will not directly address the cause. Vasopressors may temporarily increase blood pressure but still do not remove the underlying obstruction.

Administering supplemental oxygen to maintain the patient's oxygen saturation between 94-98% is crucial to prevent hypoxia, which can exacerbate brain injuries and contribute to secondary brain injury. Hyperventilation to reduce PaCO2 is generally avoided as it can lead to decreased cerebral blood flow, potentially worsening the injury. Administering isotonic fluids helps to maintain adequate blood pressure and cerebral perfusion, but without focusing on oxygenation, the intervention would be incomplete. Elevating the head of the bed can help reduce intracranial pressure, but it is less immediately important compared to oxygenation.

The most likely complication is preeclampsia, which is characterized by hypertension and proteinuria occurring after 20 weeks of gestation. The severe headache further supports this diagnosis. Eclampsia would also present with seizures, which are not mentioned in this scenario. Gestational diabetes typically involves issues with blood sugar regulation rather than hypertension and proteinuria. Placenta previa is characterized by painless bleeding without hypertension and proteinuria.

In a handoff report, using the SBAR (Situation, Background, Assessment, Recommendation) method ensures that critical information about the patient's condition, recent treatments, and ongoing care needs are communicated clearly. The patient's current medical status update informs the receiving provider of any recent changes in condition or treatments, which is crucial for planning continued care. Pre-existing medical conditions are also important but are part of the 'Background' and not as critical in immediate handoff. Contact information for the referring provider is useful but less crucial in the direct care handoff.

A Just Culture approach to handling errors involves understanding the context in which errors occur and differentiating between human errors, risky behaviors, and intentional wrongdoings. The focus should be on discussing the error transparently, understanding the root cause, and improving processes to prevent future occurrences. Punitive actions are reserved for willful negligence or malicious actions.

The correct answer is to irrigate the affected area with copious amounts of water. This helps to dilute and remove the chemical agent, reducing tissue damage. Neutralizing agents should generally be avoided as they can often cause additional reactions or burns. Covering the burns with dressings should occur after thorough decontamination to avoid trapping the chemical on the skin. Monitoring for signs of systemic toxicity is essential, but the immediate priority is decontaminating the area.

In pediatric trauma, the primary survey follows the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) sequence. Gurgling respirations indicate a partially obstructed airway, which is an immediate life threat that must be addressed first. While the patient also shows signs of shock (tachycardia, pale/cool skin), establishing a patent airway is the priority. Without a clear airway, all other resuscitation efforts, such as fluid administration, will be ineffective. Therefore, suctioning the airway is the most critical initial intervention.

A neurological assessment is critical before securing the patient on the transport stretcher. This includes checking the patient's level of consciousness, pupil response, and motor function to identify any immediate life-threatening injuries and ensure appropriate precautions are taken to prevent secondary spinal injuries during transport. Other assessments are important but can follow once the initial neurological status has been established.

For a patient presenting with respiratory distress and a neck hematoma following trauma, securing the airway is the most critical initial step. Edema or expanding hematoma can quickly compromise the airway, therefore, early airway control can prevent deterioration. Other interventions like cervical spine immobilization, obtaining imaging, or monitoring for vascular injury are important but secondary to airway management.

Acetaminophen is generally considered the safest analgesic for use during the first trimester of pregnancy because it does not have significant adverse effects on fetal development. Nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Diclofenac are generally avoided due to risks, such as potential closure of the fetal ductus arteriosus and other complications. Fentanyl, while a potent analgesic, is a narcotic and should be used cautiously as it can affect both the mother and the fetus.

Geriatric patients often have altered pharmacokinetics and pharmacodynamics due to factors such as impaired renal and hepatic function, reduced body water, and increased body fat. These changes increase the likelihood of adverse drug reactions and toxicity, requiring careful dose adjustments. Reduced renal function can lead to the accumulation of medications that are renally excreted, increasing the risk of toxicity. Monitoring renal function and adjusting medication dosages accordingly is crucial.