BCEN Certified Flight Registered Nurse (CFRN) Practice Test

The most appropriate first-line treatment for an acute allergic reaction presenting with symptoms of anaphylaxis, such as hypotension, bronchospasm, and urticaria, is the administration of intramuscular epinephrine. Epinephrine acts rapidly to improve airway patency, reverse hypotension, and reduce urticaria. Antihistamines and steroids are supportive treatments but are not substitutes for the crucial first-line administration of epinephrine. IV fluids may be necessary for hypotension but should follow the administration of epinephrine.

For patients experiencing an ischemic stroke and eligible for thrombolytic therapy, the target systolic blood pressure range is less than 185 mmHg to reduce the risk of hemorrhagic transformation. Management of blood pressure is crucial to ensure the effectiveness and safety of the therapy. Lowering blood pressure too aggressively can also be harmful, as it may reduce perfusion to the already ischemic brain tissue.

A pulmonary embolism is characterized by the obstruction of blood flow in the pulmonary arteries due to a blood clot. This condition can lead to decreased oxygenation and increased strain on the heart, making prompt diagnosis and treatment vital. Other options mention related but different pathologies such as infections or pressure changes.

Peritonitis develops as a consequence of the leakage of gastric or intestinal contents into the peritoneal cavity due to a perforated hollow organ. This leads to widespread inflammation and can progress to sepsis if untreated. Hypovolemic shock can occur with solid organ injuries or extensive bleeding, but is not as directly linked to isolated hollow organ perforations. Cardiac tamponade and pneumothorax are conditions related to thoracic injuries rather than abdominal hollow organ injuries.

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.

Pulmonary hypertension is primarily caused by increased pressure within the lung arteries, often due to narrowed, blocked, or destroyed blood vessels. This leads to increased resistance and pressure in the pulmonary arteries. Heart failure and chronic lung diseases can exacerbate this condition, but they are not the root cause.

The most likely condition is hypoglycemia, which is characterized by low blood glucose levels, typically below 70 mg/dL. Symptoms include confusion, sweating, tachycardia, and seizures. Hyperglycemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS) all involve elevated blood glucose levels, not low blood glucose.

In cases of hypovolemic shock due to trauma, initial fluid resuscitation typically involves the administration of isotonic crystalloid solutions, such as normal saline or lactated Ringer's solution. This helps to restore intravascular volume quickly and improve hemodynamic stability. Hypertonic saline is used less frequently and not considered first-line in this setting. While blood products may be necessary, especially in the case of significant blood loss, they are typically considered after initial fluid resuscitation with crystalloids. Colloids, such as albumin, are also not generally used as the first line of treatment for hypovolemic shock.

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.

Ensuring adequate oxygenation and ventilation is critical in preventing hypoxia and hypercapnia, which can exacerbate secondary brain injury. Administering oxygen helps maintain adequate brain oxygen levels, reducing the risk of further neurological damage. While other interventions are important, they do not directly address the immediate need to stabilize oxygenation and prevent further deterioration of brain function.

Packed red blood cells (PRBCs) are the most appropriate initial choice for acute hemorrhage as they directly increase the oxygen-carrying capacity of the blood. Fresh frozen plasma is typically used to correct coagulopathy. Platelets are used to treat thrombocytopenia or platelet dysfunction, and cryoprecipitate is used for specific coagulation factor deficiencies.

This scenario represents a violation of HIPAA's privacy rule, which requires that healthcare professionals take reasonable efforts to minimize any incidental disclosures of protected health information. Discussing a patient’s medical condition in a manner that could be easily overheard by unauthorized individuals constitutes a breach of this rule.

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 answer is to secure the airway. Given the significant facial trauma and the presence of blood in the oral cavity, the patient is at high risk for airway obstruction. Ensuring a patent airway is the primary concern. While assessing for other fractures and controlling bleeding are important, they are secondary to establishing and maintaining the airway. Applying a cervical collar is also important in trauma cases, but airway management takes precedence in a patient exhibiting labored breathing and potential obstruction.

In patients with severe anemia and decreased hemoglobin levels, transfusing packed red blood cells (PRBCs) is the most effective intervention to increase the oxygen-carrying capacity of the blood. Hemoglobin within red blood cells is responsible for transporting oxygen, so increasing the number of red blood cells directly enhances the blood's ability to deliver oxygen to tissues. Administering crystalloids or vasopressors can be supportive but do not address the underlying issue of insufficient hemoglobin.