BCEN CFRN Practice Test

The correct initial step is to place the patient in a left lateral tilt position to improve venous return. This action is imperative because the gravid uterus can compress the inferior vena cava when the patient is supine, leading to reduced blood flow to the heart and subsequent hypotension. Addressing this positional issue supports overall circulation, directly impacting the mother and fetus's well-being. While stabilizing airway, breathing, and circulation is also crucial, left lateral positioning is a specific and immediate intervention tailored to pregnant trauma patients to alleviate hypotension and improve hemodynamics.

Hyperkalemia is defined by having a serum potassium level greater than 5.0 mEq/L. It can lead to serious cardiac dysrhythmias, muscle weakness, and paralysis. Knowing this helps in promptly identifying and managing at-risk patients.

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.

Flank ecchymosis, also known as Grey Turner's sign, is indicative of retroperitoneal hemorrhage, often associated with kidney injuries. Hemodynamic instability in the context of trauma further supports this diagnosis. While abdominal aortic injury, diaphragmatic rupture, and pancreatic injury are also possible, they typically present with different clinical signs and have other distinguishing features.

The immediate next step in managing a traumatic amputation with profuse bleeding is to apply a tourniquet proximal to the site of amputation. This will help control the hemorrhage, which is a life-threatening complication. Elevating the limb and applying direct pressure are also important, but they are less effective in quickly controlling severe bleeding. Not manipulating the wound further without controlling the bleeding is imperative to avoid exacerbation.

Administration of clotting factor concentrate is crucial for a patient with hemophilia to help control bleeding and stabilize their condition before reaching definitive care. IV fluids are important for maintaining hemodynamic stability, but they do not address the underlying coagulopathy. Pain management and oxygen support are supportive measures but do not target the critical issue of impaired clotting.

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.

Administering oxygen to the patient is the most appropriate immediate action in this scenario because it helps to alleviate dyspnea and supports oxygenation, which is crucial in heart failure. While managing other potential issues such as fluid overload or hypoglycemia might be important, addressing oxygenation is critical for stabilizing the patient during transport.

Managing pain in a patient with rib fractures is crucial to improving their breathing and preventing complications such as pneumonia. Administering adequate pain relief, such as an opioid analgesic, can greatly enhance comfort and respiratory function. Encouraging deep breathing exercises alone is not sufficient in the presence of severe pain, and local anesthesia may not be the most appropriate primary intervention. Monitoring vital signs continually helps detect potential complications, but it is not a primary pain management strategy.

The patient is showing signs of hypovolemic shock due to significant blood loss. Administering isotonic IV fluids is the most appropriate initial intervention to restore intravascular volume and improve perfusion. Vasopressors can worsen peripheral perfusion in hypovolemic shock until volume is adequately restored. Blood products would be the next step if the patient does not respond to initial fluid resuscitation.

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.

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 primary concern when preparing a landing zone is ensuring it is clear of any obstructions. This includes removing debris, securing any loose objects, and determining a flat area that is free from power lines, trees, and other obstacles that may pose danger to the helicopter while landing. Ensuring a clear and large enough area minimizes the risk of accidents during the helicopter's approach and landing. While safety markings and communication are important, they do not directly impact the physical safety as obstructions do.

A ventricular assist device (VAD) helps pump blood from the ventricles to the rest of the body, often used in patients with severe left ventricular heart failure. It can serve as a bridge to heart transplant or as a long-term solution for patients not eligible for a transplant. An intra-aortic balloon pump (IABP) helps decrease the workload on the heart and improve blood flow, but it does not fully assist the ventricles in pumping blood.

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.