BCEN CFRN Practice Test

The correct answer is to remove any contaminated clothing and thoroughly irrigate the affected area. This helps reduce contamination and thereby limits radiation exposure to both the patient and medical staff. While covering the burn with an occlusive dressing is part of wound care, it should be done after initial decontamination. Administering intravenous fluids is important for burns in general, but in the context of radiological burns, reducing radiation absorption is the priority. Conducting a full body scan is important but not the immediate priority in the initial management.

The medication that should be administered is fomepizole. Fomepizole is an alcohol dehydrogenase inhibitor, which prevents the metabolism of ethylene glycol into its toxic metabolites like glycolate and oxalate. These toxic metabolites are responsible for the metabolic acidosis, renal failure, and other severe complications associated with ethylene glycol poisoning. Ethanol can also be used as an alternative treatment since it competes with ethylene glycol for alcohol dehydrogenase, but it is less commonly used due to its side effects and the need for careful monitoring.

Bowel sounds in the chest are a hallmark sign of diaphragmatic injury because they indicate that abdominal organs have herniated into the thoracic cavity through the ruptured diaphragm. Decreased breath sounds and abdominal pain are common but can be caused by other thoraco-abdominal injuries.

Presence of asymmetrical chest movements could indicate a pneumothorax or hemothorax, both of which are life-threatening conditions that require immediate attention. Dilated pupils could be due to head trauma or drug influence but are not as immediately life-threatening as compromised breathing. A Glasgow Coma Scale (GCS) score of 12 suggests moderate head injury, but does not pinpoint specific life-threatening issues. Absent bowel sounds might indicate internal injury but are less immediately critical than compromised lung function.

The most likely condition is hypoglycemia, which is characterized by low blood glucose levels, typically below 70 mg/dL. Symptoms include confusion, sweating, tachycardia, and seizures. Hyperglycemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS) all involve elevated blood glucose levels, not low blood glucose.

Norepinephrine is considered the first-line vasopressor for patients with septic shock who remain hypotensive despite adequate fluid resuscitation. It has potent alpha-adrenergic effects, leading to vasoconstriction and increased systemic vascular resistance, which help to improve blood pressure and perfusion. Epinephrine and dopamine can be considered in specific circumstances or as additional agents, but norepinephrine is preferred due to its more favorable balance of efficacy and side effects. Phenylephrine is typically a second-line option in patients with certain contraindications to norepinephrine.

The most important initial intervention for managing a rattlesnake bite is the administration of antivenom, as it directly neutralizes the venom. Immobilizing the limb, longer shelter stays, and wound cleaning are supportive measures but do not address the systemic effects of the venom.

Limited temporomandibular joint (TMJ) mobility suggests the patient may have difficulty opening their mouth fully, which can make insertion of airway devices challenging. Identifying limited TMJ mobility helps anticipate and prepare for potential difficulties with airway management. While a history of hypertension, presence of an IV line, and sinus tachycardia are important clinical findings, they do not directly indicate difficulty with securing the airway.

Administering furosemide helps reduce fluid overload in patients with congestive heart failure by promoting diuresis. While oxygen therapy can help with respiratory distress, it does not address the underlying issue of fluid overload. Administering normal saline can exacerbate fluid overload, and placing the patient in a Trendelenburg position is not recommended as it can worsen respiratory symptoms and fluid congestion.

A hallmark symptom of abdominal compartment syndrome is a distended abdomen. This condition results from increased intra-abdominal pressure, which leads to decreased blood flow to the abdominal organs and causes them to swell. While symptoms like nausea and vomiting, lower back pain, and increased urination can be present in many different conditions, a distended abdomen is more specific to abdominal compartment syndrome.

Isotonic crystalloids, such as normal saline or lactated Ringer's solution, are typically used for initial fluid resuscitation in trauma patients with hypovolemic shock due to their ability to quickly expand intravascular volume without causing potential complications associated with other fluids. While blood products may eventually be necessary, they are not usually the first line of treatment in most cases. Hypertonic saline and colloids have specific indications and are not widely used as initial fluids in trauma resuscitation.

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.

Keeping the parents informed with regular updates about their child's condition helps alleviate their anxiety and ensures they feel included in the medical process. It is important to maintain open communication channels and explain the procedures being performed. This approach enhances trust and reduces stress for the family in a high-stress situation. Dismissing questions, providing false reassurances without details, or limiting updates to emergencies can increase anxiety and reduce trust in the care being provided.

Hyperkalemia is a common clinical feature of chronic renal failure due to the kidney's reduced ability to excrete potassium. Other symptoms like decreased urine output can be present but are less indicative early in the disease. Increased renal excretion of calcium is incorrect, as chronic renal failure more commonly leads to hyperphosphatemia and hypocalcemia.

The SBAR (Situation, Background, Assessment, Recommendation) tool is designed for standardized communication, ensuring that critical patient information is conveyed clearly and concisely during handoff. It helps avoid miscommunication and errors by providing a consistent framework for discussions.