BCEN CFRN Practice Test

The primary concern when establishing a landing zone in the presence of a chemical spill is ensuring the area is free from hazardous materials and safe for the helicopter and crew. Safety precautions must be taken to prevent exposure to harmful substances. The other options, although important, do not directly address the immediate hazard posed by the chemical spill.

The most likely cause of the patient's sudden unresponsiveness and unequal, unreactive pupils is increased intracranial pressure (ICP) due to the cranial tumor. Space-occupying lesions like tumors can lead to significant shifts in brain structure, causing increased ICP, which, in turn, can lead to herniation and neurological deterioration. Tumors, bleeding, and abscesses can rapidly alter intracranial dynamics, necessitating swift intervention to prevent permanent damage or death. Conditions such as a stroke, electrolyte imbalance, or seizure are also critical but are less associated with the described symptoms of unequal and unreactive pupils.

A generalized tonic-clonic seizure, also known as a grand mal seizure, involves both tonic and clonic phases. The tonic phase is characterized by a sudden loss of consciousness and muscle stiffening, while the clonic phase involves rhythmic muscle contractions. This type of seizure typically lasts several minutes and may result in postictal confusion.

The primary goal in the blood pressure management of a patient with acute aortic dissection is to lower blood pressure to minimize shear stress on the aorta. This helps prevent the dissection from worsening. Beta-blockers are commonly used for this purpose because they effectively reduce both heart rate and blood pressure, thereby lowering shear stress. Although alleviating pain and maintaining normal heart rate are significant, they are secondary to the priority of reducing blood pressure.

The most crucial initial step in stabilizing a patient with a suspected spinal cord injury is maintaining proper immobilization techniques to prevent further spinal damage. Manual in-line stabilization minimizes movement of the spine and helps avoid exacerbating the injury. Administering IV fluids and monitoring neurological status are essential but secondary measures following proper immobilization.

The most immediate concern in a suspected case of heatstroke is to rapidly lower the patient's core temperature to prevent further organ damage and complications. Initiating active cooling measures, such as immersing the patient in cold water, applying ice packs to major arteries, or using a cooling blanket, should be done promptly. Other options like administering IV fluids and providing oxygen are supportive but won't address the critical need to rapidly reduce the core temperature.

The immediate next step is to open the airway using a jaw-thrust maneuver because gurgling indicates possible airway obstruction from fluids or foreign objects. This maneuver helps to maintain cervical spine precautions while allowing for airway clearance. Checking for spontaneous breathing and providing oxygen must follow after ensuring the airway is patent. Waiting for suctioning equipment delays critical initial management.

The Health Insurance Portability and Accountability Act (HIPAA) mandates the confidentiality of patients' medical information. Nurses must not disclose patient information to unauthorized individuals to protect the patient's privacy rights. EMTALA regulates treatment and transfer of patients in emergency settings, but it does not cover confidentiality in this context. Informed consent pertains to obtaining permission from the patient before performing medical procedures, and mandatory reporting involves reporting specific conditions to authorities, which is not relevant in this scenario.

The correct answer is to measure the compartment pressures. When clinical signs and symptoms suggest compartment syndrome, confirming the diagnosis through pressure measurement is crucial. A compartment pressure greater than 30 mm Hg often indicates the need for fasciotomy. Simply elevating the limb, administering analgesics, or waiting for further signs can delay necessary treatment and increase the risk of irreversible damage.

The correct answer is Respiratory Syncytial Virus (RSV) bronchiolitis. Premature infants are particularly vulnerable to RSV bronchiolitis, which often presents with symptoms of worsening respiratory distress such as tachypnea, nasal flaring, and intercostal retractions. Asthma is unlikely in such a young infant, given it typically presents later in childhood. Croup generally presents with a characteristic barking cough, which is not described here. GERD usually presents with feeding difficulties and poor weight gain, not acute respiratory distress.

The first priority after an emergency landing is to ensure the immediate safety and health of the crew and patient by checking for injuries and providing necessary medical care. While contacting emergency services, using location devices, and assessing supplies are essential, they come after securing the immediate safety of everyone on board. Checking for injuries allows the nurse to determine if anyone needs immediate medical intervention, which is critical in the first moments post-crash.

In a critical situation, assessing the patient's airway, breathing, and circulation (ABCs) is the top priority. These are the most immediately life-threatening conditions and must be stabilized first to ensure the patient's survival. While other assessments are important, they should follow the ABCs.

The trauma triad of death consists of hypothermia, acidosis, and coagulopathies. Hypothermia can be caused by environmental exposure or shock, and it impairs the clotting cascade, leading to coagulopathies. Acidosis, commonly a result of poor tissue perfusion and hypoxia, further exacerbates coagulopathies and reduces cardiac function. Recognizing these interconnected factors is essential in managing severely injured trauma patients.

For patients experiencing an ischemic stroke and eligible for thrombolytic therapy, the target systolic blood pressure range is less than 185 mmHg to reduce the risk of hemorrhagic transformation. Management of blood pressure is crucial to ensure the effectiveness and safety of the therapy. Lowering blood pressure too aggressively can also be harmful, as it may reduce perfusion to the already ischemic brain tissue.

Intestinal obstruction is characterized by a blockage that prevents the normal flow of contents through the intestines. This can result in symptoms such as severe abdominal pain, vomiting, and abdominal distension. Causes can include adhesions, hernias, or tumors. Although peptic ulcer disease, appendicitis, and cholecystitis involve abdominal pain, they do not involve blockages in the intestines preventing the movement of contents.