BCEN CFRN Practice Test

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.

For mild to moderate pain in pregnancy, acetaminophen is the analgesic of choice due to its established safety profile. Opioids, such as morphine, are reserved for severe pain and carry risks, including neonatal abstinence syndrome and respiratory depression. NSAIDs, including ibuprofen and aspirin, are contraindicated after 20 weeks of gestation and especially in the third trimester (which begins at 28 weeks) because they can cause premature closure of the fetal ductus arteriosus and lead to fetal renal impairment.

Endotracheal intubation is recommended for patients with severe head injuries and compromised respiratory effort to secure the airway and ensure adequate oxygenation and ventilation. Given the patient's semi-conscious state and minimal respiratory effort, less invasive measures would likely be insufficient.

A Just Culture approach to handling errors involves understanding the context in which errors occur and differentiating between human errors, risky behaviors, and intentional wrongdoings. The focus should be on discussing the error transparently, understanding the root cause, and improving processes to prevent future occurrences. Punitive actions are reserved for willful negligence or malicious actions.

Maintaining adequate oxygenation is the most critical intervention for a patient with a traumatic brain injury showing signs of increased intracranial pressure and poor neurological status. Hypoxia can exacerbate brain injury, so ensuring the patient has an adequate airway and is well oxygenated is vital. While administering hypertonic saline and reducing intracerebral pressure are important, they come after ensuring adequate oxygenation and airway protection.

The most commonly associated symptom of acute pancreatitis is severe abdominal pain. This pain is typically located in the upper abdomen and may radiate to the back. This symptom helps to differentiate pancreatitis from conditions like jaundice or diarrhea, which are more commonly associated with other disorders.

The most likely cause of increased peak inspiratory pressure in an intubated patient is the presence of a kinked or obstructed endotracheal tube. This could lead to increased resistance within the tube, causing higher pressure readings on the ventilator. Checking the tube for kinks, dislodgement, or obstructions should be the first step. Other potential causes include patient-ventilator asynchrony and bronchospasm, but a kinked or obstructed tube is the most immediate concern.

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 primary function of an Emergency Locator Transmitter (ELT) is to emit a distress signal to aid in the location and rescue of the crew and patients by search and rescue teams. This signal is detected by satellites and ground stations, enabling the timely dispatch of rescue operations to your crash site. While other devices and procedures may also be used in an emergency, the ELT is specifically designed for sending out a distress signal.

The correct answer is 'Pelvic fracture and lumbar spine fracture' because these are often associated with retroperitoneal injuries. Significant trauma to the pelvis or lumbar spine can cause bleeding from vessels located in the retroperitoneum. Abdominal bruising and Cullen's sign are indicative of intra-abdominal bleeding but are not specific to retroperitoneal injury. An isolated rib fracture is less likely to directly cause retroperitoneal bleeding.

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.

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.

A Just Culture promotes a balanced accountability for individuals and the organization. It focuses on identifying and analyzing errors without blaming caregivers, encouraging a culture of learning and improvement. Regularly conducting root cause analyses helps to uncover system issues and improve processes, aligning with the Just Culture principles. Issuing strict punishments or ignoring incidents does not align with fostering a learning environment.

Managing airway and ensuring adequate oxygenation is critical in preventing secondary brain injury in pediatric patients with head trauma. Hypoxia can exacerbate cerebral edema and increase intracranial pressure, leading to further neurological damage. Maintaining proper ventilation and oxygenation should be prioritized over other interventions such as fluid administration or ICP monitoring.

Structural defects in the heart include conditions like congenital heart defects, valvular issues, and cardiomyopathies. These abnormalities impact the heart's ability to pump blood efficiently and can lead to heart failure. Aneurysms and dysrhythmias, while serious, do not directly describe structural heart abnormalities.

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 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 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.

Magnesium sulfate is the drug of choice for severe preeclampsia to prevent seizures. It works as a central nervous system depressant and helps lower the threshold for seizure activity. Choosing another option (like antihypertensives or steroids) may address some symptoms or related issues but does not provide the symptomatic seizure prevention necessary in this scenario. Understanding the pathophysiology of preeclampsia and the pharmacological actions of medications is essential to provide the best care for the patient.

The correct answer is to perform a thorough cardiovascular and neurological assessment. Electrical burns can cause significant internal damage, including arrhythmias and neurological impairments, which may not be immediately apparent. The assessment should include continuous cardiac monitoring, as arrhythmias are a common and potentially life-threatening complication. Administering fluids is important but secondary to ensuring that life-threatening complications are not present. Applying ice to burn sites is not recommended as it can cause further tissue damage.