BCEN Certified Emergency Nurse (CEN) Practice Test

Ménière's disease is correctly identified by its classical symptoms which include episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness. These symptoms distinguish it from other vestibular disorders. Labyrinthitis, although it presents with vertigo, typically does not include the fluctuating hearing loss or the sensation of aural fullness associated with Ménière's disease. Otosclerosis is primarily a conductive hearing loss condition and does not generally include vertigo or tinnitus. Sensorineural hearing loss is a broad diagnosis and lacks the specific combination of symptoms compared to Ménière's disease.

The correct answer is taking vital signs. Delegation is a crucial skill for nurses to manage their workload effectively and ensure that all patients receive timely care. When delegating tasks, it's important to consider the skill level and scope of practice of the assistive personnel.

Taking vital signs is within the scope of practice for a nursing assistant and does not require the advanced assessment skills of a registered nurse. This task can be safely delegated while allowing the nurse to focus on more complex patient care activities.

Performing a focused assessment requires the skills and knowledge of a registered nurse and should not be delegated. Administering medications is also outside the scope of practice for a nursing assistant and must be performed by a licensed nurse. Obtaining informed consent involves explaining procedures and risks, which requires the expertise of a registered nurse or physician and cannot be delegated to assistive personnel.

By appropriately delegating tasks like vital signs to nursing assistants, emergency nurses can optimize patient care and workflow efficiency in the busy emergency department setting.

The most characteristic symptom of acute pericarditis is chest pain that is typically sharp and pleuritic, often worsening when lying down and improving when sitting up or leaning forward. This pain is caused by inflammation of the pericardium, the protective sac surrounding the heart. Unlike the pain associated with myocardial infarction, pericarditis pain often changes with position and respiration. While fever and tachycardia can occur in pericarditis, they are not as specific or characteristic as the positional chest pain. Shortness of breath may be present but is typically not the primary or most characteristic symptom.

This statement is true because priapism is a urological emergency where prolonged erection exceeds four hours without sexual stimulation. It can lead to ischemia, fibrosis, and eventually, permanent erectile dysfunction if not adequately managed in a timely manner. Understanding the urgency and implications of priapism helps ensure prompt and effective patient care in the emergency setting.

The correct answer is to speak with the patient alone. This is crucial because traffickers often accompany their victims and may pose as family members or friends. Speaking with the patient alone allows for a safe environment where the victim might feel more comfortable disclosing information. It's important to note that while involving law enforcement or social services may be necessary later, it's not the best first step, as it could potentially endanger the victim if done prematurely. Likewise, confronting a suspected trafficker could put both the patient and healthcare staff at risk. Documenting suspicions is important but should not take precedence over directly addressing the patient's immediate safety and needs.

Noncardiac pulmonary edema involves the accumulation of fluid in the alveoli primarily due to reasons other than the failure of the left ventricle. This can include conditions such as ARDS (Acute Respiratory Distress Syndrome), inhalation injuries, or renal failure, among others. The categorization 'noncardic' specifically indicates that the edema is not driven by cardiac failure, importantly distinguishing it from cardiogenic pulmonary edema.

Increased pain out of proportion to the injury, especially on passive stretch of muscles within the involved compartment, is a crucial indication of developing compartment syndrome. Paresthesia, pallor, and paralysis are also signs of compartment syndrome, but they typically appear later in the condition's progression. Pulselessness is a late and unreliable sign due to the potential for collateral circulation.

The patient's symptoms of severe, sudden pain in the lower extremity, absence of pulses, and a cool, pale presentation are characteristic of acute arterial occlusion, which is a manifestation of peripheral vascular disease. Acute arterial occlusion requires immediate intervention to restore blood flow and prevent tissue death. Chronic arterial insufficiency typically presents gradually with intermittent claudication, not sudden severe pain. Deep vein thrombosis (DVT) presents with pain, swelling, and erythema, primarily in the calf, and would not typically cause absent arterial pulses or a pale foot. Venous insufficiency results in symptoms such as varicose veins, edema, and skin changes but not sudden severe pain and pulselessness.

Intramuscular epinephrine is the first-line treatment for anaphylaxis as it quickly works to reverse the pathophysiologic processes of anaphylaxis, which can include airway edema, hypotension, and shock. Antihistamines, while useful for symptomatic relief of urticaria and pruritus, do not address the hemodynamic and respiratory issues as effectively. Corticosteroids have a delayed onset and are not the primary treatment in the acute management of anaphylaxis. Normal saline is supportive treatment for hypotension but does not counteract the underlying anaphylactic reaction.

This statement is correct because, as mandated reporters, emergency nurses have a legal obligation to report suspected cases of abuse or neglect. Failure to report can result in legal consequences for the nurse and ongoing harm to the patient. It is important for emergency nurses to recognize the signs of abuse and neglect and understand their role as mandated reporters to ensure the safety and well-being of their patients.

The correct answer involves establishing a therapeutic alliance by showing empathy and concern, which helps build trust and opens lines of communication critical for further assessment and intervention. Isolating the patient may be perceived as punitive and could exacerbate feelings of isolation and distress, reducing communication. Discussing discharge prematurely might add to the patient’s anxiety or hopelessness, potentially risking their safety. While arranging a consultation with a psychiatrist is a valid step, it does not address the immediate need for establishing rapport and ensuring safety.

The patient's symptoms are indicative of costochondritis, especially given the localized pain aggravated by movement and respiratory actions, and tenderness at the costosternal junctions. The presence of a recent viral infection may also contribute to the inflammation of the costal cartilage. While other conditions like Tietze syndrome could present similarly, it typically involves noticeable swelling, which isn't mentioned in the scenario. Acute myocardial infarction and pulmonary embolism, although serious considerations for chest pain, typically present with additional systemic or more severe symptoms.

The best initial nursing action is administering broad-spectrum antibiotics, as it addresses the likely infection indicated by her symptoms such as fever and malodorous discharge, which are highly suggestive of a postpartum infection. Starting antibiotics after cultures ensures treatment is begun even while awaiting lab confirmation, a critical step in preventing sepsis in postpartum infections. Monitoring vitals is important but is more supportive than therapeutic. Obtaining a CT scan or performing a pelvic exam, though informative, would follow the initial administration of antibiotics as immediate treatment prioritizes controlling the infection.

The correct answer is to perform a medical screening examination and stabilize the patient if necessary. EMTALA (Emergency Medical Treatment and Labor Act) requires that all patients presenting to an emergency department receive a medical screening examination to determine if an emergency medical condition exists, regardless of their ability to pay or the hospital's capacity. If an emergency medical condition is identified, the hospital must provide stabilizing treatment within its capabilities. The hospital cannot turn away a patient or transfer them without proper screening and stabilization, even if it's at full capacity. Providing only pain medication or referring the patient to another facility without screening violates EMTALA and could result in significant penalties for the hospital.

The correct answer is a CT scan of the abdomen and pelvis with contrast. While all the listed options can be useful in evaluating a patient with suspected diverticulitis, a CT scan is considered the gold standard for diagnosis. It provides detailed images of the bowel wall and surrounding tissues, allowing for accurate identification of inflamed diverticula, abscesses, or other complications.

Although a complete blood count (CBC) can show elevated white blood cells, indicative of infection, it is not specific to diverticulitis. An abdominal X-ray may show nonspecific findings but lacks the sensitivity and specificity of a CT scan. A colonoscopy, while useful for diagnosing other colon conditions, is generally contraindicated in acute diverticulitis due to the risk of perforation.

It's important to note that the clinical presentation, along with the patient's age and symptoms, strongly suggests diverticulitis. The left lower quadrant pain is particularly characteristic of this condition, as diverticula most commonly occur in the sigmoid colon.