BCEN Certified Flight Registered Nurse (CFRN) Practice Test

Just Culture emphasizes learning and accountability while differentiating between human error, at-risk behavior, and reckless behavior. The most appropriate initial response includes a focus on non-punitive actions that encourage reporting and identify the root cause to prevent future errors. Conducting a root cause analysis and providing education help in making systematic improvements rather than assigning blame.

The tear-shaped pupil and presence of blood in the anterior chamber (hyphema) indicate a likely globe rupture, which is a medical emergency. In this situation, shielding the eye is critical to prevent further damage. Avoiding any manipulation or pressure on the injured eye is crucial, and the patient should be referred to an ophthalmologist immediately for surgical evaluation.

Norepinephrine is considered the first-line vasopressor for septic shock due to its strong alpha-adrenergic effects, which increase vascular tone and blood pressure. Dopamine is less preferred because it can lead to arrhythmias and has variable effects depending on the dose, making it less reliable for managing septic shock. Phenylephrine and vasopressin are generally not considered first-line treatments for septic shock.

The most appropriate initial intervention when a patient on a balloon pump develops a new dysrhythmia is to assess and adjust the timing of the pump. The device's effectiveness heavily relies on proper timing relative to the cardiac cycle, which can be disrupted by dysrhythmias. Administering antiarrhythmic medications or defibrillation may also be necessary, but these are secondary steps. Simply increasing the pump frequency without addressing the timing would not resolve the issue and may worsen the patient's hemodynamic status.

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.

Hypoxia is a major concern at high altitudes and can lead to symptoms such as fatigue, decreased cognitive function, and impaired judgment. This makes it especially critical for air medical crew to monitor their own physiological status as well as that of their patients. Dehydration and vibration are also possible stressors but are less directly linked to the described symptoms. Temperature fluctuations can cause discomfort and thermal regulation issues, but the primary cause of fatigue and decreased cognitive function is hypoxia.

Administering supplemental oxygen is the most appropriate initial intervention in this scenario. Acute pulmonary edema, which is indicated by symptoms of shortness of breath and frothy sputum, can deprive tissues of oxygen. Administering oxygen helps to increase oxygen saturation and reduce the work of breathing. While diuretics and vasodilators are also important in managing acute heart failure exacerbations, they are not the immediate first-line intervention.

Acetaminophen is generally considered the safest analgesic for use during the first trimester of pregnancy because it does not have significant adverse effects on fetal development. Nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Diclofenac are generally avoided due to risks, such as potential closure of the fetal ductus arteriosus and other complications. Fentanyl, while a potent analgesic, is a narcotic and should be used cautiously as it can affect both the mother and the fetus.

In submersion injuries, maintaining an open airway and ensuring adequate oxygenation is crucial. Administering high-flow oxygen helps mitigate hypoxia, a common complication. Given the patient's unconscious state and breathing difficulty, continually monitoring oxygen saturation and being prepared to intubate if conditions worsen is essential. IV fluids might be useful in specific cases, but they are not the immediate priority if the airway and oxygenation are compromised. Checking for spinal injuries is important, but not the first step in this scenario.

The most appropriate initial intervention for suspected abdominal compartment syndrome (ACS) is decompression of the abdomen, ideally through surgical means. While managing the patient's blood pressure and respiratory status are also critical, decompression directly addresses the underlying issue causing the symptoms of ACS. Administering fluids or vasopressors alone may not be sufficient to relieve the increased intra-abdominal pressure.

In the context of trauma presenting with left upper quadrant pain and bruising over the lower chest, the spleen is the most likely solid organ injured. The initial management priority for a suspected splenic injury is to stabilize the patient with fluid resuscitation and monitor for signs of ongoing bleeding or hemodynamic instability. If the patient remains unstable after resuscitation, surgical intervention may be necessary. The incorrect options either refer to different organs or improper initial management steps.

Hydroxocobalamin is the correct choice for treating cyanide poisoning in a pediatric patient, particularly because it is approved for use in children and has a relatively safe profile. Sodium nitrite, sodium thiosulfate, and amyl nitrite can be used in cyanide poisoning cases, but they have more significant side effects and are less commonly recommended in pediatric cases.

The correct answer is to measure the compartment pressures. When clinical signs and symptoms suggest compartment syndrome, confirming the diagnosis through pressure measurement is crucial. A compartment pressure greater than 30 mm Hg often indicates the need for fasciotomy. Simply elevating the limb, administering analgesics, or waiting for further signs can delay necessary treatment and increase the risk of irreversible damage.

Flank ecchymosis, also known as Grey Turner's sign, is indicative of retroperitoneal hemorrhage, often associated with kidney injuries. Hemodynamic instability in the context of trauma further supports this diagnosis. While abdominal aortic injury, diaphragmatic rupture, and pancreatic injury are also possible, they typically present with different clinical signs and have other distinguishing features.

Securing cervical spine immobilization is essential to prevent further injury to the spine during transport. This involves using a cervical collar and appropriate immobilization techniques to maintain spinal alignment. Administering pain management or oxygen, while also important, do not address the critical need to protect the spinal column from additional injury.