BCEN Certified Flight Registered Nurse (CFRN) Practice Test

The correct initial intervention for a patient in septic shock with poor perfusion is fluid resuscitation. This helps to restore intravascular volume, increasing cardiac output and ultimately improving tissue perfusion. Blood products are typically reserved for patients with significant blood loss or anemia, while vasopressors are often used after ensuring adequate fluid resuscitation.

The first priority in a post-crash scenario is to secure the scene and ensure all crew and patients are accounted for and safe. Securing the scene mitigates any potential hazards and gathers all individuals in a safe and manageable area. This is essential before administering any medical care or setting up communication equipment.

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.

For a patient presenting with respiratory distress and a neck hematoma following trauma, securing the airway is the most critical initial step. Edema or expanding hematoma can quickly compromise the airway, therefore, early airway control can prevent deterioration. Other interventions like cervical spine immobilization, obtaining imaging, or monitoring for vascular injury are important but secondary to airway management.

In high-speed motor vehicle collisions, especially when ejection from the vehicle occurs, the patient is at a high risk for multiple severe injuries including traumatic brain injuries, internal bleeding, spinal injuries, and long bone fractures. The kinetic energy transfer from ejection usually leads to injuries in multiple organ systems.

The correct action is to follow the advanced directive and refrain from initiating life-saving measures, as this legally honors the patient’s wishes. Ignoring an advanced directive and providing resuscitation could lead to ethical and legal consequences, including violating patient autonomy and potential legal repercussions for disregarding their expressed directives.

Given the severity of septic shock, monitoring and optimizing tissue perfusion is paramount. Central venous oxygen saturation (ScvO2) monitoring helps assess whether the tissues are receiving adequate oxygen. If ScvO2 is low despite appropriate initial steps, further interventions such as optimizing cardiac output, transfusion of red blood cells, or increasing oxygen delivery may be necessary. Administering a broad-spectrum antibiotic is critical at the beginning of sepsis treatment, not next step after vasopressors. Increasing vasopressor dose can maintain blood pressure but does not directly improve tissue oxygenation. Initiating hemodialysis is needed in cases of acute kidney injury and not directly related to improving perfusion in septic shock.

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.

Managing airway and ensuring adequate oxygenation is critical in preventing secondary brain injury in pediatric patients with head trauma. Hypoxia can exacerbate cerebral edema and increase intracranial pressure, leading to further neurological damage. Maintaining proper ventilation and oxygenation should be prioritized over other interventions such as fluid administration or ICP monitoring.

The immediate priority after ensuring everyone's safety is to secure emergency communication to get help. This enables rescue operations to commence and increases the chances of survival. While other actions are also important, contacting help is the most critical initial step.

The correct answer is to prevent further hypothermia. Hypothermia exacerbates both coagulopathy and metabolic acidosis by decreasing blood clotting efficiency and reducing the body's ability to buffer acid. Addressing hypothermia quickly helps improve overall patient stability. Administering IV fluids and controlling pain are also important but are secondary to stabilizing the patient's core temperature. While close monitoring of vitals is essential, it does not intervene in altering the traumatic triad directly.

Implementing regular debriefings helps manage stress by providing a structured opportunity for flight transport nurses to process the events of the mission, share experiences, and receive emotional support from peers and supervisors. This strategy promotes mental well-being and team cohesion.

In emergency situations where the patient is unable to give consent and no legal representative is available, implied consent is typically assumed. This means that it is presumed the patient would consent to the treatment if they were able to do so, particularly when the treatment is necessary to prevent death or serious harm. This principle allows medical personnel to provide necessary care without explicit consent from the patient.

The correct answer is 'Intestinal obstruction'. This condition is characterized by severe abdominal pain, vomiting, distension, and absent bowel sounds due to a blockage that prevents the normal flow of contents through the intestines. 'Gastroenteritis' usually includes symptoms like diarrhea and less commonly results in absent bowel sounds. 'Peptic ulcer' can cause severe pain but not typically lead to abdominal distension and absent bowel sounds. 'Diverticulitis' often presents with localized pain, usually in the lower left abdomen, accompanied by fever and bowel changes, but not commonly with absent bowel sounds and significant distension.

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.