BCEN Certified Emergency Nurse (CEN) Practice Test

Hepatitis A is commonly transmitted through ingestion of food or water contaminated with the virus, often from fecal matter. However, other forms of hepatitis, such as hepatitis B and C, are primarily bloodborne and can also be spread through other bodily fluids. It's important for healthcare providers to understand the transmission routes to implement appropriate preventive measures and patient education.

Applying direct pressure to the cartilaginous part of the nose for several minutes is a first-line management approach for epistaxis. This helps to control bleeding by compressing the blood vessels. Anterior epistaxis, which is the most common type, is often managed effectively with this method. Packing and cauterization are considered if conservative measures fail, and evaluating medication use, particularly anticoagulants, is necessary if the patient reports relevant history or there is difficulty in controlling the bleeding.

While all options presented could be considered in cyanide poisoning management, hyperbaric oxygen therapy is the BEST next step after hydroxocobalamin administration. Here's why:

1. Hyperbaric oxygen therapy can help overcome cyanide-induced cellular hypoxia by increasing dissolved oxygen in the plasma, bypassing the blocked mitochondrial cytochrome oxidase.

2. It aids in displacing cyanide from cytochrome oxidase, facilitating its elimination.

3. It can be particularly beneficial for smoke inhalation victims who may have concurrent carbon monoxide poisoning.

Sodium thiosulfate, while useful, is typically given after hydroxocobalamin and wouldn't be the immediate next step. Hemodialysis isn't typically necessary unless there's severe acidosis or renal failure. Methylene blue is not indicated for cyanide poisoning; it's used for methemoglobinemia.

This question tests the candidate's ability to prioritize treatments and understand the synergistic effects of different therapies in complex toxicological emergencies.

In cases of carbon monoxide poisoning secondary to inhalation injuries, it is crucial to administer 100% oxygen. Carbon monoxide binds with hemoglobin more effectively than oxygen, forming carboxyhemoglobin, which inhibits oxygen transport and release throughout the body. Administering 100% oxygen helps displace carbon monoxide from hemoglobin, thereby restoring its oxygen-carrying capacity and alleviating the symptoms of poisoning.

This statement is correct. Urinary tract infections (UTIs) are indeed the most frequently occurring genitourinary infections in both outpatient and emergency department settings. They can affect any part of the urinary system, including the bladder (cystitis), urethra (urethritis), and kidneys (pyelonephritis). Symptoms often include a strong, persistent urge to urinate, a burning sensation while urinating, and cloudy urine. It is crucial for emergency nurses to recognize the signs and symptoms, as well as the risk factors for UTIs to initiate appropriate treatment.

The appropriate initial step for a patient presenting with symptoms suggestive of C. difficile infection is to initiate contact precautions and collect a stool sample for testing. This prevents the spread of the bacteria and confirms the diagnosis, allowing for specific treatment. Administering further antibiotics without testing may worsen the condition if wrongly selected, hydrating the patient while necessary, doesn’t address the underlying cause directly at this point, and monitoring vital signs, while important, is not specific enough as an initial intervention for suspected C. difficile.

Maintaining membership in a professional organization is an example of an action that exemplifies lifelong learning as these organizations often provide resources for continuing education, professional development opportunities, and updates on the latest research and best practices in the field of nursing.

The correct answer is to attempt removal using positive pressure. This technique, also known as the 'Parent's Kiss' or 'Mother's Kiss,' is a safe and effective first-line approach for removing nasal foreign bodies in cooperative children. The parent or caregiver blows into the child's mouth while occluding the unaffected nostril, creating positive pressure to expel the object. This method is non-invasive, doesn't require specialized equipment, and can often be successful without causing additional trauma or distress to the child.

Instrumental removal should be considered only if the positive pressure technique fails, as it carries a higher risk of injury and may be more distressing for the child. Nasal decongestant spray is not typically recommended as a first-line treatment for foreign body removal. Immediate CT scanning is unnecessary and overly invasive for an easily visible foreign body, especially before attempting non-invasive removal techniques.

The correct diagnosis is hyphema. Hyphema is the presence of blood in the anterior chamber of the eye, which is the space between the cornea and the iris. It is typically caused by blunt trauma to the eye, such as being hit with a ball. The pooling of blood in the anterior chamber is a characteristic sign of hyphema.

It's important to differentiate hyphema from other ocular traumas:

• Globe rupture typically presents with a misshapen pupil, decreased visual acuity, and possibly extruded ocular contents.
• Retinal detachment usually presents with visual field defects or the sensation of a curtain falling over the vision.
• Corneal abrasion would show a scratch on the surface of the eye, visible with fluorescein staining.

Prompt diagnosis and management of hyphema is crucial to prevent complications such as increased intraocular pressure, corneal blood staining, and optic atrophy. Treatment typically involves rest, elevation of the head, and possibly eye drops to control inflammation and intraocular pressure.

The correct answer is that the scenario described is indicative of priapism, a condition characterized by a prolonged erection not associated with sexual activity. It can result from various etiologies, including hematological disorders, such as sickle cell disease, and requires urgent medical intervention to prevent potential long-term complications such as erectile dysfunction. Other causes may include medication use or trauma, but it is not a normal physiological response to sexual arousal or desire.

The correct answer is to honor the patient's advance directive and withhold life-sustaining treatment. Advance directives are legal documents that express a person's wishes for end-of-life care when they are unable to communicate. As healthcare professionals, we are ethically and legally obligated to respect these directives when they are valid and applicable to the current situation.

While it may be tempting to initiate treatment immediately or wait for physician orders, doing so would violate the patient's expressed wishes and autonomy. Contacting the ethics committee, while sometimes appropriate in complex cases, is not the best first step when a clear, valid advance directive is present.

It's important to note that emergency nurses should still provide comfort care and ensure the patient's dignity is maintained throughout the process. Communication with the spouse and other family members about the patient's wishes and the care plan is also crucial.

This statement is correct because providing interpretive services is a matter of adhering to patients' rights and ensuring effective communication. Hospitals must comply with federal regulations, including Title VI of the Civil Rights Act of 1964, which prohibits discrimination based on national origin, which includes language. Not having appropriate language access services could lead to misunderstandings, misdiagnosis, and inappropriate treatment. Interpretive services must be offered to eliminate language barriers for the delivery of appropriate and effective care.

The best initial course of action when managing a patient with a history of seizures, who is currently stable, is to take a thorough patient history and perform a physical exam. This fundamental step helps identify any potential triggers or underlying conditions associated with the seizure, provides a basis for further diagnostic testing, and guides appropriate management. Assessing vital signs is also essential but does not provide specific information about the seizure itself. Performing an immediate blood draw or administering anti-seizure medication might not be the first measures to take without further assessment and confirmation of an ongoing seizure or specific indications guided by the patient's history and current condition.

The statement is false because while ST segment elevation on an ECG is a common indicator of STEMI, it is not always exclusively indicative of this condition. ST elevations can occasionally be seen in conditions such as pericarditis or a benign early repolarization pattern in healthy individuals, especially younger adults. Therefore, the elevation of ST segments necessitates a comprehensive clinical evaluation to confirm the diagnosis of STEMI and rule out other conditions.

This statement is false because an object lodged in the trachea increases airway resistance predominantly during expiration, not inspiration. During an obstructive event in the trachea, such as with a foreign body, air can typically enter the lungs during inspiration when the airway pressure decreases. However, the obstruction prevents air from exiting efficiently during expiration when airway pressure increases, leading to a build-up of air and potential hyperinflation or barotrauma.