BCEN CFRN Practice Test

The immediate priority in managing a patient with suspected pelvic fracture is to stabilize the pelvis to reduce further bleeding and prevent additional injury. A pelvic binder should be applied as soon as possible to provide this stabilization. Manual traction is not applicable in this scenario, as it is typically used for long bone fractures, and while IV fluids and immobilization are important, they are secondary to the immediate stabilization of the pelvis.

Hypoxia is the most likely cause of acute dyspnea in helicopter transportation due to altitude changes. The decreased partial pressure of oxygen at higher altitudes reduces the amount of oxygen available for the patient to breathe. Pneumothorax and air embolism are potential complications but are less likely causes in this specific scenario. Additionally, engine noise or vibrations do not typically cause dyspnea.

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 most likely diagnosis is a flail chest, indicated by the paradoxical movement of the chest wall segment. This injury results when multiple adjacent ribs are fractured in at least two places, creating a free-floating segment that moves inward on inspiration and outward on expiration. Pneumothorax, tension pneumothorax and hemothorax can also produce dyspnea and chest pain but do not cause a discrete paradoxically moving chest wall segment.

The correct answer is to apply a pelvic binder. Open book pelvic fractures can lead to significant blood loss and instability. A pelvic binder helps stabilize the pelvis, reduce bleeding, and improve hemodynamic status. Administering IV fluids and blood products is also critical but should follow initial stabilization. Performing an external fixation is usually a later step after initial stabilization in the operating room or interventional radiology suite. Immediate surgical repair is not the priority in the initial management phase.

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.

An electrocardiogram (ECG) is essential for patients with electrical burns as the electrical current can cause cardiac arrhythmias, including ventricular fibrillation and acute myocardial infarction. Assessing the cardiac system promptly helps in early identification and treatment of any life-threatening arrhythmias. Measuring oxygen saturation is also important but is not specific to the unique complications electrical burns present. Similarly, estimating body surface area involvement and checking for circumferential burns are significant assessments but not the immediate first step.

The correct initial intervention for a patient in septic shock with poor perfusion is fluid resuscitation. This helps to restore intravascular volume, increasing cardiac output and ultimately improving tissue perfusion. Blood products are typically reserved for patients with significant blood loss or anemia, while vasopressors are often used after ensuring adequate fluid resuscitation.

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.

The correct answer is essential as it involves immediate decontamination to remove any residual radiation particles, minimizing further exposure and injury to both the patient and healthcare providers. Other options, while important, do not address the primary and immediate need to stop further radiation exposure.

Melena, or black, tarry stools, is most characteristic of an upper GI bleed as it indicates the digestion of blood in the gastrointestinal tract. Bright red blood in the stool or hematochezia typically indicates a lower GI bleed. Coffee ground emesis suggests the presence of digested blood, usually from an upper GI source, but is less common than melena. Abdominal pain can be associated with multiple causes and is not specific to GI bleeds.

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.

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 combination of markedly greater motor weakness in the upper than in the lower extremities, sensory loss predominantly affecting pain and temperature, preserved proprioception, and a hyper-extension cervical mechanism is classic for central cord syndrome. Central cord injuries involve the central corticospinal tracts that contain fibers for the arms situated more medially, producing the characteristic arm-dominant motor deficit. Anterior cord syndrome causes bilateral motor and pain/temperature loss below the lesion with preserved dorsal-column sensation; Brown-Sequard syndrome produces ipsilateral motor loss with contralateral pain/temperature loss; cauda equina syndrome involves lower-motor-neuron leg weakness and saddle anesthesia.

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.

Initial management of thermal burns includes stopping the burning process, cooling the burns with tepid water, covering the burns with a clean, dry cloth, and managing pain. Applying cold water excessively can lead to hypothermia, which should be avoided.

Ensuring the landing zone (LZ) is clear of obstacles like trees, wires, and poles is crucial for pilot visibility and helicopter safety. Obstacles can cause collisions, especially at night when visibility is reduced. While the LZ should also be well-lit and easily accessible, the presence of obstacles poses the most immediate danger to safe landing and takeoff operations.

In submersion injuries, maintaining an open airway and ensuring adequate oxygenation is crucial. Administering high-flow oxygen helps mitigate hypoxia, a common complication. Given the patient's unconscious state and breathing difficulty, continually monitoring oxygen saturation and being prepared to intubate if conditions worsen is essential. IV fluids might be useful in specific cases, but they are not the immediate priority if the airway and oxygenation are compromised. Checking for spinal injuries is important, but not the first step in this scenario.

Ensuring scene safety by establishing a safe perimeter and identifying safe entry points is crucial to prevent additional exposure to hazardous substances. Direct patient care cannot be safely performed until the nurse verifies the area is secure and appropriate PPE is available. Initiating decontamination procedures or administering life-saving interventions within the hot zone before ensuring it's safe poses risks to both the nurse and the patients. Waiting for a hazmat team without taking any preparatory actions might delay critical safety measures.

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.