BCEN Certified Emergency Nurse (CEN) Practice Test

The priority action is to assess the patient's eligibility for thrombolytic therapy, which is time-sensitive. Strokes require rapid identification of the type (ischemic or hemorrhagic) to determine the best treatment approach. Understanding the time from symptom onset is critical, as thrombolytics can only be administered within a specific time frame after symptom onset.

The correct answer is to administer 100% oxygen via non-rebreather mask. This is the most crucial initial step in treating carbon monoxide poisoning. High-flow oxygen therapy helps to displace carbon monoxide from hemoglobin, accelerating its elimination from the body. While other treatments may be necessary, oxygen administration is the primary and most urgent intervention.

Hyperbaric oxygen therapy, while effective in severe cases, is not typically the initial treatment and may not be immediately available in all settings. Acetylcysteine is used for acetaminophen overdose, not carbon monoxide poisoning. Administering sodium bicarbonate is not a standard treatment for carbon monoxide poisoning and would not address the primary issue of oxygen displacement from hemoglobin.

The correct answer is Pneumocystis jirovecii. Transplant patients are at increased risk for opportunistic infections due to their immunosuppressed state. Pneumocystis jirovecii (formerly known as Pneumocystis carinii) is a fungal organism that commonly causes pneumonia in immunocompromised individuals, particularly organ transplant recipients. It's important to note that while all the listed pathogens can cause infections, Pneumocystis jirovecii is specifically associated with opportunistic infections in immunocompromised patients.

Streptococcus pneumoniae, while a common cause of pneumonia in the general population, is less likely to be the primary concern in an immunocompromised patient. Escherichia coli typically causes urinary tract infections rather than respiratory symptoms. Influenza virus, although it can cause severe illness in immunocompromised patients, is not as specifically associated with opportunistic infections in transplant recipients as Pneumocystis jirovecii.

As an emergency nurse, it's crucial to recognize the increased susceptibility of transplant patients to opportunistic infections and consider atypical pathogens when assessing and treating these patients.

The correct answer is to continue irrigation with normal saline and administer topical ascorbic acid (vitamin C) drops. The pH of 10 indicates an alkali burn, which is generally more severe than acid burns due to their ability to penetrate deeper into ocular tissues.

Alkali burns require prolonged irrigation, often for several hours, to ensure complete removal of the chemical. Topical ascorbic acid is specifically beneficial in alkali burns as it helps to neutralize the alkali and reduces collagen breakdown in the cornea.

While acetylcysteine is useful in some ocular conditions, it's not the primary treatment for alkali burns. Amphoteric solutions are more beneficial for acid burns. Autologous serum drops can be helpful in severe cases but are not the immediate treatment of choice. Steroids may be used later in treatment but are contraindicated in the acute phase as they can increase the risk of corneal melting.

Understanding the specific management of different types of chemical burns is crucial for optimal patient outcomes in emergency settings.

A situational crisis arises when a person faces an unexpected and significant change, such as a diagnosis of a terminal illness. This type of crisis can lead to feelings of anxiety, depression, or overwhelming stress, necessitating appropriate interventions. Other options might seem relevant but do not specifically address the acute emotional response triggered by significant life changes.

Ultrasound-guided thoracentesis is the preferred technique for diagnosis and therapeutic management of pleural effusion, particularly when the effusion is large, as it reduces the risk of complications like pneumothorax. While chest tube placement, serial chest radiographs, and commencement of antibiotics may be indicated in some clinical scenarios, the immediate need is to perform an ultrasound-guided thoracentesis to relieve the patient's symptoms and to analyze the pleural fluid, which can inform the course of treatment.

Ensuring airway patency is important due to the high risk of aspiration in near-drowning incidents. Immediate airway management prevents further complications such as hypoxia, which is critical in the survival and outcome of the patient. Monitoring for hypothermia, while important, is not the immediate priority. Chest compressions are only necessary if the patient is in cardiac arrest, which should be assessed after ensuring the airway is clear. Administration of antibiotics is not relevant until and unless there is a suspicion of infection or aspiration pneumonia, which would be assessed later.

The patient is displaying signs of Beck's triad (distant heart sounds, hypotension, and jugular vein distention) as well as pulsus paradoxus (drop in blood pressure during inspiration), which are classic signs of pericardial tamponade. This is a medical emergency that requires immediate intervention to prevent cardiovascular collapse. The best initial intervention is to perform a pericardiocentesis, which involves using a needle to aspirate fluid from the pericardial space to relieve pressure on the heart. Volume resuscitation may temporarily help manage hypotension but does not address the underlying issue, thus it is not the best option given the provided signs. Oxygen administration and cardiac monitoring are supportive measures but are not definitive treatments for tamponade.

Intussusception commonly involves the ileum telescoping into the colon, especially in pediatric cases; however, it can also occur between other segments of intestine. Therefore, stating that all cases involve the ileum and colon is inaccurate.

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.

In patients with peripheral vascular disease, particularly when ischemic complications occur such as in peripheral artery disease (PAD), limb elevation does not enhance comfort but rather exacerbates pain. This is because elevation decreases arterial blood flow to the limbs, aggravating ischemic conditions. Thus, patient discomfort actually increases. Patients often find relief when limbs are lowered, allowing gravity to aid in perfusion.

For deep lacerations that expose subcutaneous fat but do not involve muscle or tendon damage, layered closure is typically the most appropriate initial management. This approach involves closing the deeper layers of tissue with absorbable sutures before closing the skin surface. Layered closure helps to reduce dead space, decrease tension on the wound edges, and promote better healing with less scarring. While simple interrupted sutures might be sufficient for more superficial lacerations, they may not provide adequate support for deeper wounds. Tissue adhesive (glue) is generally used for smaller, less deep lacerations. Staples, while quick to apply, are not typically the first choice for arm lacerations due to cosmetic concerns and potential for more pain. It's important to note that proper wound cleaning and assessment for foreign bodies should be performed before closure, and tetanus prophylaxis should be considered based on the patient's immunization status.

The clinical presentation is indicative of temporal arteritis, characterized by severe headache, visual changes, and jaw claudication. This condition can lead to serious complications such as blindness if not treated promptly. Other options such as migraine or tension-type headache typically do not present with these systemic features.

The symptoms of dyspnea, tachypnea, and confusion, occurring a few hours after a trauma that resulted in multiple long bone fractures, suggest a fat embolus syndrome. This condition arises when embolic fat macroglobules pass into the bloodstream, often from marrow fat, which can occur after trauma to long bones. It is a life-threatening emergency requiring prompt recognition and treatment. Pulmonary embolism, while it presents with similar pulmonary symptoms, would not typically include neurological symptoms like confusion unless it leads to hypoxemia. Systemic infection and acute respiratory distress syndrome (ARDS) are less likely based on the immediate post-injury timing and specific symptom combination.

In the context of patient safety, the use of restraints is a sensitive issue that must align with legal and ethical standards. Ensuring that a physician's order is obtained before applying restraints, such as soft wrist restraints, respects the patient's rights and upholds the principle of providing safe and lawful care. Restraints should only be used as a last resort when less restrictive interventions have been considered or attempted, and always with the appropriate physician's order for the specific situation.