BCEN Certified Emergency Nurse (CEN) Practice Test

The START (Simple Triage and Rapid Treatment) method is the most appropriate triage system for mass casualty incidents or sudden surges in patient volume. It quickly categorizes patients into four groups based on their ability to walk, respiratory rate, and mental status. This allows for rapid assessment and prioritization of care.

While the ESI (Emergency Severity Index) is an excellent triage tool for everyday emergency department use, it may be too time-consuming in a mass casualty situation. The Manchester Triage System, although effective, is also more detailed and may slow down the triage process when rapid assessment is crucial. The Canadian Triage and Acuity Scale (CTAS) is another valid triage system but is not specifically designed for mass casualty incidents.

Lower left quadrant abdominal pain is a typical symptom of diverticulitis, reflecting the common location of the inflamed diverticula in the sigmoid colon. In contrast, symptoms like severe right lower quadrant pain or generalized abdominal swelling are more indicative of conditions such as appendicitis or ascites respectively.

This statement is correct because penetrating injuries, such as those caused by nail guns, can cause extensive damage to underlying soft tissues, vessels, and nerves. Effective management must include a thorough assessment for potential internal damage, which may not be immediately obvious, to prevent complications like bleeding, infection, or loss of limb function.

Intravenous fluid administration is the most appropriate initial step in the management of neurogenic shock. Neurogenic shock is characterized by the loss of sympathetic tone following a spinal cord injury, which leads to vasodilation, decreased systemic vascular resistance, and resulting hypotension. While atropine and vasopressors may also be used, they are typically secondary interventions after adequate fluid resuscitation has been initiated to restore intravascular volume. High-dose methylprednisolone is not recommended as a first-line treatment due to lack of evidence supporting its use in acute spinal cord injury and potential for harm.

In the event of a disaster, emergency nurses must follow the established guidelines provided by the Incident Command System to ensure the safety and health of the patients, staff, and responders. Providing direct emergency care within the scope of the nurse's practice is the primary responsibility of the emergency nurse during such situations. Organizing and directing the flow of patients, as it pertains to making strategic decisions, typically falls within the responsibility of the incident commander or their designee, as does monitoring resources and staff. While emergency nurses do play a role in assisting in those areas, their main focus should be on the provision of direct patient care.

The correct answer is bacterial infection. Osteomyelitis is primarily caused by bacterial infection of the bone. While trauma, surgery, or underlying medical conditions can increase the risk of developing osteomyelitis, they are not the primary cause. Bacteria, most commonly Staphylococcus aureus, enter the bone through various routes such as the bloodstream, direct inoculation, or spread from nearby soft tissue infections. Understanding the primary cause is crucial for emergency nurses to recognize risk factors, initiate appropriate diagnostic measures, and begin timely treatment to prevent complications.

Tocolytic therapy is used in cases of preterm labor to temporarily delay delivery, allowing time for administration of corticosteroids to accelerate fetal lung maturity or to transport the mother to a facility capable of handling preterm deliveries. Tocolytic therapy does not aim to immediately stop labor for the purpose of delivery, but to postpone it to maximize fetal outcomes.

The correct answer is to arrange for a home health nurse evaluation within 24 hours of discharge. This strategy addresses the complex needs of an elderly patient with cognitive impairment and limited support who has experienced a fall. A home health nurse can assess the patient's home environment, evaluate their ability to follow discharge instructions, ensure proper medication management, and identify any additional support needs or safety concerns. This approach is more comprehensive than simply providing written instructions or contacting family members, which may not be sufficient given the patient's cognitive status and lack of support. While involving a social worker is beneficial, it doesn't provide the immediate, hands-on assessment that a home health nurse can offer. Arranging for home health services demonstrates a proactive approach to preventing complications, reducing the risk of readmission, and ensuring continuity of care for a vulnerable patient. It also aligns with best practices in geriatric emergency medicine and discharge planning for high-risk patients.

Upon presentation of a legally valid advance directive that indicates the patient's preference for no resuscitative measures, the healthcare team must comply with the patient's wishes and cease resuscitative efforts, assuming the document has been verified as current and valid. Initiating a reflective pause honors the patient and supports the family through the transition from active treatment to allowing natural death. Continuing resuscitation disregards the patient's legally stated wishes, and waiting for the attending physician may delay the fulfillment of the patient’s end-of-life preferences.

Anterior uveitis, also known as iritis, often presents with a painful and red eye, typically affecting only one eye (unilateral). Patients may also exhibit photophobia (light sensitivity) and have a potential decrease in visual acuity. These symptoms help distinguish it from other conditions such as conjunctivitis, which does not typically cause severe pain or decreased vision.

Cardiac monitoring is essential in the initial management of patients with electrical injuries due to the potential for cardiac arrhythmias, which can be life-threatening. Maintaining airway and IV fluid therapy are also important but secondary to ensuring the patient does not develop fatal arrhythmias, which is a direct effect of electrical current passing through the heart.

Cyclic vomiting syndrome is correctly described as a disorder marked by episodes of severe vomiting that have no apparent cause. These episodes can last for hours or days and are separated by symptom-free periods. Understanding the nature of this syndrome helps in managing care and anticipating needs during these intense episodes.

The correct answer is to administer rabies immune globulin (RIG) and initiate the rabies vaccine series. This case presents a high-risk scenario for potential rabies exposure. Bats are considered high-risk animals for rabies transmission, and the inability to test the animal necessitates treating this as a potential rabies exposure. The deep lacerations increase the risk of transmission if the bat was rabid. Despite the initial wound cleaning, which was appropriate, the 36-hour delay in seeking medical attention makes immediate rabies post-exposure prophylaxis (PEP) crucial.

Rabies PEP for previously unvaccinated individuals includes both passive immunization with RIG and active immunization with the rabies vaccine series. RIG provides immediate passive immunity while the vaccine series stimulates active immunity. This combination is more effective than either component alone.

While wound irrigation is important, it's not the primary concern at this point given the time elapsed and the patient's self-cleaning. Antibiotics may be indicated but are secondary to rabies prevention. Suturing is generally avoided in animal bites to prevent sealing in pathogens. Observation without treatment is inappropriate given the high-risk nature of the exposure and the potential fatality of rabies if it develops.

Ensuring patient safety and stabilizing the patient's condition is the first priority upon their arrival in the emergency department. Establishing a secure and quiet environment helps prevent exacerbation of distress, allowing for more effective assessment and subsequent treatment. While obtaining a detailed medical history, monitoring vitals, and preparing for possible decontamination are important steps, they follow after ensuring patient safety and stabilization.

The presence of a 'seat belt sign', or ecchymosis across the abdomen after a vehicle collision, does raise suspicion for internal injury, including gastrointestinal trauma. However, the decision to proceed with exploratory laparotomy must be based on a comprehensive assessment, including patient hemodynamics, physical examination, and imaging studies. Not all patients with a 'seat belt sign' will require surgery, and some may be managed conservatively or undergo further diagnostic procedures such as CT scanning before surgical intervention is deemed necessary.