BCEN CFRN Practice Test

The correct answer is to measure the intracompartmental pressure. Compartment syndrome occurs when pressure within a closed muscle compartment rises to a level that decreases perfusion, leading to muscle and nerve damage. Measuring the pressure directly confirms the diagnosis. Monitoring swelling and pain are important but are not definitive assessments for compartment syndrome. Checking for pedal pulses, while essential in assessing circulatory status, does not exclude the presence of compartment syndrome since pulses can still be present despite increased compartment pressure.

Peritonitis develops as a consequence of the leakage of gastric or intestinal contents into the peritoneal cavity due to a perforated hollow organ. This leads to widespread inflammation and can progress to sepsis if untreated. Hypovolemic shock can occur with solid organ injuries or extensive bleeding, but is not as directly linked to isolated hollow organ perforations. Cardiac tamponade and pneumothorax are conditions related to thoracic injuries rather than abdominal hollow organ injuries.

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.

Given the severity of septic shock, monitoring and optimizing tissue perfusion is paramount. Central venous oxygen saturation (ScvO2) monitoring helps assess whether the tissues are receiving adequate oxygen. If ScvO2 is low despite appropriate initial steps, further interventions such as optimizing cardiac output, transfusion of red blood cells, or increasing oxygen delivery may be necessary. Administering a broad-spectrum antibiotic is critical at the beginning of sepsis treatment, not next step after vasopressors. Increasing vasopressor dose can maintain blood pressure but does not directly improve tissue oxygenation. Initiating hemodialysis is needed in cases of acute kidney injury and not directly related to improving perfusion in septic shock.

Packed red blood cells (PRBCs) are the most appropriate initial choice for acute hemorrhage as they directly increase the oxygen-carrying capacity of the blood. Fresh frozen plasma is typically used to correct coagulopathy. Platelets are used to treat thrombocytopenia or platelet dysfunction, and cryoprecipitate is used for specific coagulation factor deficiencies.

Immersing the frostbitten areas in warm water is the correct approach because it helps to gently rewarm the tissues, which is crucial for minimizing further damage. Rubbing frostbitten areas can cause additional injury due to ice crystals in the tissue. Removing blisters is not recommended as it can lead to infection. Applying direct heat, like a heating pad, can cause burns due to the patient's decreased sensation.

The most likely diagnosis is a tension pneumothorax, which can occur due to significant blunt force trauma to the chest, such as that experienced in a high-speed motor vehicle collision. The clinical signs of decreased breath sounds on one side, distended neck veins, and hypotension are classic indicators of tension pneumothorax. Hemothorax and cardiac tamponade can present with some similar signs, but the decreased breath sounds are more indicative of pneumothorax.

Maintaining adequate oxygenation is crucial in the prevention of secondary brain injury. Hypoxia can exacerbate brain injury by increasing ischemia and causing further neuronal damage. Ensuring an oxygen saturation (SpO2) greater than 94% helps to ensure that the brain is receiving sufficient oxygen supply, thus mitigating the risk of secondary injury. Other options, such as aggressive fluid resuscitation or inserting an intracranial pressure monitor, while important, are not the immediate priority for preventing secondary brain injury in the pre-hospital or initial emergency setting. Elevating the head of the bed can help reduce intracranial pressure but is secondary to ensuring oxygenation.

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.

Using the jaw-thrust maneuver instead of the head-tilt/chin-lift maneuver is correct because it allows for airway management without causing further movement of a potentially unstable cervical spine. The oropharyngeal airway can help maintain patency but should be used only if the patient does not have a gag reflex. Nasal airways should be avoided if there is any suspicion of a basilar skull fracture. RSI may be considered after securing initial airway patency, but it is not the initial step in managing difficulties encountered with the airway in this specific scenario.

The correct answer is 'Prepare for early intubation.' Inhalation injuries can quickly lead to airway obstruction due to edema. Given the signs of airway involvement, including hoarseness, stridor, and soot in the airways, early intubation is crucial to secure the airway and prevent rapid deterioration. Administering heated humidified oxygen can help in managing inhalation injuries but is not the immediate priority when signs of airway compromise are present. Administering corticosteroids has not been shown to be beneficial in acute management and can be detrimental. A complete bronchoscopy can provide detailed assessment but should not delay securing the airway through intubation when airway compromise is evident.

The primary responsibility of the flight nurse upon arrival at a mass casualty incident is to establish communication with the Incident Commander and to receive a briefing. This ensures that the flight nurse is aware of the situation, understands the chain of command, and can provide effective medical care within the established emergency response framework. Other options, while important, are tasks that would follow initial communications and situational assessment.

The most appropriate initial treatment for a patient with a blood glucose reading of 35 mg/dL is IV administration of dextrose. This approach rapidly increases blood glucose levels, which is critical in an unconscious patient. While a glucagon injection can also raise blood glucose, it is usually used in settings where IV access is not available. Oral glucose gels cannot be administered to unconscious patients due to the risk of aspiration.

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.

A pulmonary embolism is characterized by the obstruction of blood flow in the pulmonary arteries due to a blood clot. This condition can lead to decreased oxygenation and increased strain on the heart, making prompt diagnosis and treatment vital. Other options mention related but different pathologies such as infections or pressure changes.

Acute kidney injury (AKI) is marked by a rapid decrease in kidney function over a short period, resulting in the accumulation of waste products in the blood. This condition can be caused by various factors including trauma, infections, or medications.

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.

Implementing regular debriefings helps manage stress by providing a structured opportunity for flight transport nurses to process the events of the mission, share experiences, and receive emotional support from peers and supervisors. This strategy promotes mental well-being and team cohesion.

The patient is showing signs of Acute Respiratory Distress Syndrome (ARDS), indicated by severe hypoxemia and bilateral infiltrates on chest X-ray without heart failure. Providing high-flow oxygen or positive pressure ventilation is critical to maintain adequate oxygenation. Administering antibiotics is important for underlying infection but not the immediate priority. Bronchodilators are not indicated for ARDS. Diuretics are also not appropriate in this scenario since ARDS is not primarily related to fluid overload.

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.