BCEN Certified Flight Registered Nurse (CFRN) Practice Test

The patient is exhibiting symptoms that are highly indicative of preeclampsia, a condition specific to pregnancy. Key features include hypertension, proteinuria, and potentially abnormal liver function tests. Hyperemesis gravidarum involves severe vomiting leading to dehydration and weight loss but does not involve hypertension or proteinuria. Gestational hypertension involves elevated blood pressure but lacks the proteinuria and abnormal liver function characteristic of preeclampsia. Eclampsia is characterized by seizures in addition to the signs of preeclampsia.

The most appropriate initial action is to ensure adequate uterine perfusion by optimizing maternal hemodynamic stability. Placing the patient in the left lateral tilt position helps to displace the uterus off the inferior vena cava, which can improve venous return and cardiac output. While administering fluids and monitoring fetal heart tones are essential steps, ensuring adequate maternal hemodynamic stability is the first priority. Administering medications for pain management is important but not the initial priority.

The best initial immobilization technique for a patient with a potential vertebral injury is to use a spinal backboard and a cervical collar. This helps maintain spinal alignment and prevents further spinal cord injury. Using manual traction alone is inadequate because it does not stabilize the entire spine. A pelvic binder is inappropriate as it does not address the spinal injury. A traction splint is primarily used for isolated long bone fractures, not spinal injuries.

Presence of asymmetrical chest movements could indicate a pneumothorax or hemothorax, both of which are life-threatening conditions that require immediate attention. Dilated pupils could be due to head trauma or drug influence but are not as immediately life-threatening as compromised breathing. A Glasgow Coma Scale (GCS) score of 12 suggests moderate head injury, but does not pinpoint specific life-threatening issues. Absent bowel sounds might indicate internal injury but are less immediately critical than compromised lung function.

The primary concern when establishing a landing zone in the presence of a chemical spill is ensuring the area is free from hazardous materials and safe for the helicopter and crew. Safety precautions must be taken to prevent exposure to harmful substances. The other options, although important, do not directly address the immediate hazard posed by the chemical spill.

Ensuring scene safety by establishing a safe perimeter and identifying safe entry points is crucial to prevent additional exposure to hazardous substances. Direct patient care cannot be safely performed until the nurse verifies the area is secure and appropriate PPE is available. Initiating decontamination procedures or administering life-saving interventions within the hot zone before ensuring it's safe poses risks to both the nurse and the patients. Waiting for a hazmat team without taking any preparatory actions might delay critical safety measures.

Bowel sounds in the chest are a hallmark sign of diaphragmatic injury because they indicate that abdominal organs have herniated into the thoracic cavity through the ruptured diaphragm. Decreased breath sounds and abdominal pain are common but can be caused by other thoraco-abdominal injuries.

The patient is showing signs of hypovolemic shock due to significant blood loss. Administering isotonic IV fluids is the most appropriate initial intervention to restore intravascular volume and improve perfusion. Vasopressors can worsen peripheral perfusion in hypovolemic shock until volume is adequately restored. Blood products would be the next step if the patient does not respond to initial fluid resuscitation.

The correct diagnosis is cardiac tamponade, which is suggested by Beck's triad of muffled heart sounds, jugular venous distension, and hypotension. These findings indicate fluid accumulation in the pericardial sac, impairing cardiac output. Tension pneumothorax also presents with hypoxia and hypotension but is characterized by decreased breath sounds and tracheal deviation. Myocardial contusion may cause arrhythmias and chest pain but does not typically present with Beck's triad. Aortic dissection can cause severe chest pain and hemodynamic instability but involves a tearing pain radiating to the back and a widened mediastinum on chest x-ray.

The Behavioral Pain Scale (BPS) is designed to assess pain in sedated and ventilated patients by evaluating facial expression, movements of the upper limbs, and compliance with ventilation. Unlike numerical rating scales or verbal reports, BPS provides a systematic and observational method suited for patients who are unable to communicate verbally due to sedation or airway management. The Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) are effective for patients who can self-report their pain but are not suitable for sedated patients. The Wong-Baker FACES Pain Rating Scale is primarily used for non-verbal children or patients who have difficulty with abstract concepts like numerical scales.

Administering high-flow oxygen via a non-rebreather mask ensures that the patient receives a high concentration of oxygen to alleviate hypoxia, which is crucial given the patient's immediate symptoms. Bag-valve-mask ventilation is typically reserved for patients who are unresponsive or unable to maintain their airway, while CPAP and BiPAP are more suited for patients with stable respiratory rates who need assistance with ventilation.

In cases of severe facial trauma, establishing a patent airway is critical. Performing a chin lift or jaw thrust helps open the airway without further compromising the cervical spine. Inserting a nasopharyngeal or oropharyngeal airway might not be appropriate due to facial injury, and cricothyroidotomy is generally reserved as a last resort.

Acetaminophen is the preferred pain management medication for pregnant women due to its safety profile in pregnancy. NSAIDs like ibuprofen and aspirin can cause complications such as premature closure of the ductus arteriosus and should generally be avoided. Opioids have potential risks, including neonatal withdrawal syndrome, making acetaminophen the safer choice for this scenario.

The most likely diagnosis in this scenario is a solid organ injury. High-speed collisions often result in significant blunt abdominal trauma, leading to injuries of solid organs such as the liver and spleen, which can cause internal bleeding. The presence of free fluid, as observed on the ultrasound, is indicative of internal hemorrhage. Hollow organ injuries typically present differently and may not show free fluid unless there is a perforation and subsequent peritonitis. Diaphragmatic injuries and retroperitoneal injuries can also occur, but they are less likely to present with the described symptoms immediately and would typically be associated with other clinical signs.

Administering oxygen to the patient is the most appropriate immediate action in this scenario because it helps to alleviate dyspnea and supports oxygenation, which is crucial in heart failure. While managing other potential issues such as fluid overload or hypoglycemia might be important, addressing oxygenation is critical for stabilizing the patient during transport.