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Quiz Session - Attempts With Random Questions

BCEN CFRN CTRN Exam Questions

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1.

What will deliver the highest concentration of inspired oxygen to an eight-year-old child suffering from a severe asthma exacerbation?

  • Non-rebreather mask

  • Simple mask

  • Venturi mask

  • Face tent

Correct answer: Non-rebreather mask

The choice of oxygen delivery device depends not only on the efficacy of the device, reliability and ease of application but, more importantly, the patient’s O2 requirement and patient acceptance; as such, clinical assessment and performance are the ultimate determinate.  

A standard nasal cannula delivers an FiO2 of 24-44% at a flow from 1-8 liters per minute (LPM) [FiO2 = 20% + (4 x oxygen liter flow)]. 

A simple mask provides an Fio2 of 35% to 50% at flow rates of 5 to 10 L/min.

A Venturi mask mixes oxygen with room air, creating high-flow enriched oxygen typically set at 24, 28, 31, 35 and 40% oxygen, providing an accurate and constant FiO2 despite varied respiratory rates and tidal volumes. 

Non-rebreather masks are indicated when an FiO2 > 40% is necessary for acute desaturation. It may deliver an FiO2 up to 90% at flow settings greater than 10 liters. The major drawback is that the mask must be tightly sealed on the face, which may be difficult in a child.

2.

Which of the following statements regarding medical transport of a pregnant patient experiencing third-trimester bleeding is most accurate?

  • The patient may be safely transported by a general transport team that has received high-risk obstetrical training

  • The patient should be transported by a specialized maternal transport team

  • The patient should be transported by a team consisting of both maternal and neonatal specialists

  • The patient may be safely transported by a general transport team

Correct answer: The patient may be safely transported by a general transport team that has received high-risk obstetrical training

Medical transport of pregnant patients has generated controversy for years regarding the necessary or required team composition for safe transport of these patients. While some medical transport programs may have transport teams comprised of individuals trained in the delivery of specialized maternal, fetal, or neonatal care, more often than not, nonspeciality teams are responsible for the delivery of care to pregnant patients who require medical transport. 

Most sources agree that should a pregnant patient who is experiencing third-trimester bleeding require medical transport, this may be safely undertaken by a general transport team that has received specialized training in high-risk obstetrical care from obstetric specialists. Patients who are preeclamptic may also be safely transported in this manner. Patients who are severely preeclamptic require transport by a specialized maternal transport team, and laboring patients should be transported with both a specialty maternal and neonatal team present.

3.

Which of the following statements most accurately describes the delivery of damage control resuscitation?

  • Administration of packed red blood cells, plasma, and platelets for resuscitation, limiting infusion of crystalloid fluids

  • Use of non-surgical methods to control bleeding in a trauma patient, such as balloon occlusion of bleeding vessels

  • Delaying of definitive surgical repair of injuries in a trauma patient, instead focusing solely on surgical cessation of immediate sources of bleeding

  • Placing an endovascular balloon into the aorta to treat a trauma patient who has experienced hemorrhagic shock

Correct answer: Administration of packed red blood cells, plasma, and platelets for resuscitation, limiting infusion of crystalloid fluids

Damage control resuscitation is a concept for treating victims of hemorrhagic shock which came into existence through an extension of what is known as damage control surgery. It involves the administration of a carefully controlled ratio of blood products, including packed red blood cells, plasma, and platelets (1:1:1) early during resuscitation, oftentimes even at the scene of the trauma, while limiting the administration of crystalloid fluids.

The transport resuscitation providers typically will administer type-O uncross-matched blood, and will use a systolic blood pressure range of 80 mm Hg to 100 mm Hg (adult patients) as their goal when determining how much blood product to administer. All of the other options in this scenario are considered part of damage control surgery, which should follow the administration of damage control resuscitation. The overall goal of all the damage control interventions is to bring about cessation of bleeding and provide hemodynamic stability for 1 to 2 days prior to definitive repair of injury.

4.

When communicating during patient transport, transport team members should not do which of the following?

  • Assume the intent, content, or meaning of the message if it is not clear

  • Assume positive intent for everyone involved

  • Verify the information that has been transmitted by a Communication Center

  • Ask for a repeat if the transmission is not clear

Correct answer: Assume the intent, content, or meaning of the message if it is not clear

High-quality communication is the responsibility of every individual involved with transport to ensure that their message is being conveyed clearly and concisely. Transport team members should assume positive intent for everyone involved in the communication process. However, communication should always be verified, and the intent and content of the message should be as clear as possible. If the transmission is unclear, ask for the message to be repeated. 

5.

A 10-year-old girl living in a gated community suffered a severe open tibia/fibula fracture after falling off the golf cart which she was driving and being run over and dragged by the vehicle. When emergency medical services (EMS) arrived, the girl appeared to be in shock and was noted to be hemorrhaging from her injured limb, and as well had sustained multiple "road rash" injuries and contusions to her face and trunk. Which of the following statements regarding the management of compressible limb hemorrhage is true?

  • Bulky dressings applied to treat hemorrhage may be ineffective at controlling bleeding

  • Direct pressure should be applied on the site of the wound hemorrhage

  • A commercial tourniquet should be applied to the injured extremity distal to the site of the bleeding

  • Commercial tourniquet application should take place early in management of limb hemorrhage

Correct answer: Bulky dressings applied to treat hemorrhage may be ineffective at controlling bleeding

The prompt application of firm direct pressure in the management of compressible extremity hemorrhage should be the first step in treating patients who have sustained severe limb injuries resulting in hemorrhage. Typically, bleeding can be controlled in areas of the body which can be easily compressed—extremities and scalp—if uninterrupted direct pressure can be applied and maintained by the transport provider. If this intervention does not serve to provide rapid decrease or cessation of bleeding, the transport provider should confirm they are appropriately applying the pressure. Direct pressure applied on a wound will not serve to stop hemorrhage; direct pressure must be placed within the edges of the wound to ensure adequate pressure forces are applied to the bleeding vessels, ultimately overcoming the vascular pressure contributing to the bleeding. Similarly, the placement of bulky dressings on or in wounds without the application of direct pressure will not serve to control hemorrhage. 

If the medical transport provider has confirmed appropriate use of direct pressure on a compressible limb hemorrhage site without any improvement (or minimal improvement) in the bleeding, a commercial tourniquet should be placed proximal to the site of the hemorrhaging. The tourniquet should be tightened until the distal pulses are obliterated; this typically results in intense pain for the patient, who may then resist the correct application of the tourniquet. Additionally, if the medical transport provider is unable to provide undistracted direct wound pressure early in the management of the hemorrhage, or if massive hemorrhage is recognized early in the care of the patient, then a commercial tourniquet should be applied early in the management of the bleeding.

6.

The medical transport team has been called to the scene of an incident in which a patient was found lying on the sidewalk appearing unharmed. When the team arrives, the patient is awake but appears disoriented and confused, and when asked to state his name, the patient's speech is slurred and he appears to have difficulty concentrating. He is able to move all four extremities equally, but his responses are slowed. The patient appears clean and neatly dressed and there are no foul odors noted about the patient. The patient's vital signs are all within normal range, except a heart rate of 116. Which of the following possible etiologies is most likely contributing to the patient's altered mental state?

  • Hypoglycemia

  • Cerebrovascular accident (CVA)

  • Alcohol intoxication

  • Hyperglycemia

Correct answer: Hypoglycemia

Diabetic patients with both types I and II diabetes may experience hypoglycemia as a result of an overcorrection of a hyperglycemic state through use of insulin; hypoglycemia may also result from the use of oral agents such as the sulfonylureas (which stimulate insulin production) and the meglitinides (which stimulate a short burst of insulin). Type II diabetic patients who take combinations of oral agents may also experience hypoglycemia. 

Glucose is the primary source of energy for the brain and is unable to store glucose. During a hypoglycemic event, when blood glucose levels drop significantly, the brain loses its main source of energy, causing the symptoms of hypoglycemia to manifest: neurological symptoms such as confusion, disorientation, irritability, slurred speech, headaches, unsteady gait, difficulties in concentration, loss of consciousness, and even coma. The patient's vital signs have a tendency toward normal with the exception of tachycardia. 

Any patient who presents with changes in mental status or who is found unresponsive should be evaluated for hypoglycemia.

7.

Which of the following diagnostic tests can be utilized to distinguish between central diabetes insipidus (DI) and nephrogenic DI?

  • Water deprivation test

  • Urine osmolality

  • Serum sodium level

  • Serum ADH level

Correct answer: Water deprivation test

The water deprivation test, during which a patient is deliberately deprived of water (or other oral fluids) for 8 hours (or until 5% of the body mass is lost) and then monitored hourly for up to 18 hours, is used to determine the cause of the excessive urine output. During this time, the patient is weighed every hour, the urine output and osmolality is measured every 2 hours, and serum osmolality is measured every 4 hours. At the end of the 8 hours of fasting from water, the patient receives an injection of desmopressin acetate, and the clinician continues to measure the urine and serum osmolality. This diagnostic tool is different from a simple urine osmolality test which solely measures the concentration of the urine.  

Serum sodium levels are used to diagnosis syndrome of inappropriate antidiuretic hormone (SIADH).

ADH, also known as vasopressin, secretion is impaired in DI.

8.

A medical air transport helicopter has been forced to make an emergency water landing. All of the following statements regarding how to escape in this scenario are false except:

  • Wait to attempt exit from the aircraft until it is upside down

  • Swim away from the helicopter

  • Begin escape procedures immediately upon impact with the water

  • Move away from the fuselage of the aircraft before it sinks

Correct answer: Wait to attempt exit from the aircraft until it is upside down

The type of aircraft involved in an emergency water landing or crash in water determines what steps the crew members should take in escape from the aircraft. Helicopters will almost always sink, or capsize, after impact with water; an emergency escape should not be attempted until crew members can see that the rotors have stopped spinning and the helicopter has turned completely upside down.

Escape attempt should not be made until the cabin of the aircraft has almost completely filled with water, at which time crew members should release their seat belt buckle. Once the buckle is released, crew members will float, and if unsure of their position in the water, should attempt to visualize released air bubbles in the water to help determine their way to the surface. No attempts to kick or swim away from the aircraft should be made, as this is more likely to result in a crew member becoming entangled within the aircraft or accidentally injuring another crew member.

9.

Which of the following signs/symptoms of cardiac tamponade are most consistent with early findings versus late findings?

  • Pulsus paradoxus

  • Muffled heart tones

  • Narrowed pulse pressure

  • Jugular venous distention

Correct answer: Pulsus paradoxus

Pulsus paradoxus can occur as a result of several injurious factors, but cardiac tamponade is considered to be the classic cause of the finding. In pulsus paradoxus, a drop in blood pressure is observed when the patient inhales and as well, there is a diminishing of the palpated pulse with the inspiration. In cardiac tamponade it is observed as a result of the increase in pressure on the heart from the significant increase in fluid in the pericardial sac (often between 200 mLs to 300 mLs), not allowing for full expansion of the ventricles during contraction. As a result, when the right ventricle fills during inspiration, the ventricular septum bulges to the left, and vice versa, resulting in the finding of pulsus paradoxus.

Muffled heart tones, narrowed pulse pressure, and jugular venous distention comprise Beck's Triad and are considered a late finding of cardiac tamponade.

10.

A medical air transport team is called to respond to the scene of an incident in which a 32-year-old female sustained chemical burns after accidentally spilling a bottle of lye-based household drainage cleaner on her lower extremities. Which of the following findings best characterizes a chemical skin injury? 

  • Ulcerations with necrotic tissue in the wound bed 

  • Erythema with satellite lesions 

  • Erythema and erosion of skin 

  • Ulcerations with pustules 

Correct answer: Ulcerations with necrotic tissue in the wound bed 

Chemical injuries occur when the source of energy contacted is capable of causing tissue necrosis. Examples of necrosis-causing chemicals include strong acids, which cause coagulation necrosis from protein precipitation, and alkalis, which cause liquefaction necrosis. Alkalis cause deeper and more significant wounds than acids. 

With chemical burns, the burning process continues until the agent is inactivated by a reaction with the tissues, is neutralized, or is diluted with water. Treatment of chemical injuries necessitates the removal of all saturated clothing and copious irrigation of the burn wound. 

11.

The medical air transport team has been called to transport a 24-year-old female who has experienced a  medication overdose. Which of the following is the most commonly ingested drug that results in drug overdose? 

  • Acetaminophen

  • Aspirin

  • Ibuprofen

  • Vitamins

Correct answer: Acetaminophen

Acetaminophen is the most commonly ingested drug which results in drug overdose; it is contained in combination formulas of many over-the-counter (OTC) medications in addition to being available in single formulation. Individuals may experience inadvertent or accidental overdose of acetaminophen as a result of being unaware of its presence in these combination formulas when they attempt to treat symptoms through the use of several OTC medications. 

Acetaminophen is absorbed within the small intestine; however, toxicity results from the presence of metabolites that attach to the hepatic cell membrane. Glutathione, an antioxidant stored in the liver, neutralizes the effects of the acetaminophen metabolites, but in the instance of overdose, depletion of glutathione stores results and hepatic damage occurs.

12.

Which of the following is an example of passive-aggressive behavior? 

  • Failing to follow through on agreements 

  • Chronic tardiness

  • Not following safe transport monitoring practices 

  • Not collaborating with other team members

Correct answer: Failing to follow through on agreements 

Disrespectful behavior is a root cause of a healthcare culture that threatens both patient safety and organizational culture by impairing communication, preventing compliance with guidelines and safe practices, undermining teamwork, and alienating patients. To counter this, healthcare organizations must actively encourage a culture of respect.

Passive-aggressive behaviors are defined by negativism and intent to cause psychological harm, including refusing to do tasks or doing them in a way intended to annoy others. They can include failing to follow through on agreements and deliberate delays or omissions in returning needed communications. 

Passive disrespect is a spectrum of uncooperative behaviors not rooted in malice yet still disrespectful to others and to the organization. Examples of passive disrespect include chronic tardiness, not following safe transport monitoring practices, and not collaborating with other team members.

13.

You are the CFRN/CTRN called to a scene of a 14-year-old girl who was found unresponsive. First responders report that the mother called EMS when she found her daughter on the bedroom floor and could not wake her up. Patient’s mother found what appears to be a suicide note on her daughter's bed. An empty pill bottle was found near the patient's bed. You place the patient on a 12 lead EKG and find a sinus tachycardia with a widened QRS and a prolonged QT interval. 

Which of the following drugs did the patient most likely take?

  • Tricyclic antidepressants

  • Acetaminophen

  • Aspirin

  • Opiates

Correct answer: Tricyclic antidepressants

Tricyclic antidepressants (TCAs) are drugs that block sodium channels. An overdose of this type of drug causes the QRS and QT interval to be extremely widened and prolonged. 

All other drugs listed do not produce the mentioned EKG changes.

14.

The communication center for a busy medical air transport program is in need of hiring a communications specialist (CS) for the site. According to the Commission on Accreditation of Medical Transport Systems (CAMTS) recommendations, which of the following statements is most accurate in regard to CS applicants?

  • CS applicants should be encouraged to obtain emergency medical technician (EMT) certification

  • CS applicants may not be related to other program employees

  • CS applicants must have medical field experience

  • CS applicants must have previous communications center experience

Correct answer: CS applicants should be encouraged to obtain emergency medical technician (EMT) certification

While the CAMTS has established minimal educational requirements which must be met in order to be considered for application as a CS, there are no current CAMTS requirements in regard to the background and experience necessary for the CS. It is advisable that the CS applicant have both medical field experience and previous communications center experience, but this decision is ultimately left up to the individual transport program. 

CAMTS does not prohibit the hiring of friends or relatives of current transport programs, but a CS applicant who is related to a current program employee should obviously not be in consideration for the position simply because of the relation. The CAMTS does recommend that the CS be encouraged to obtain certifications such as EMT, emergency medical dispatcher, or National Association of Air Medical Communication Specialists (NAACS); individual transport programs may consider these certifications as a necessity for CS applicants.

15.

You are participating in the medical air transport of a patient who was involved in a single-car accident in which the vehicle became airborne and struck a utility pole, throwing the victim from the vehicle. There are downed lines present, and you and your team members establish your staging site within the Cold Zone of the incident site. As you begin to move around within the Cold Zone, you experience a tingling sensation in your legs and lower torso. 

What should be your next move in this scenario?

  • Bend one leg at the knee, and holding your foot in your hand, turn around and hop away

  • Radio the power company representative on site and request they assess for the presence of live lines

  • Slowly walk backward away from the direction you were heading when you experienced the tingling sensation

  • Slowly turn around keeping one foot in the air, and begin jumping forward (alternating the foot on which you land) following a zigzag pattern

Correct answer: Bend one leg at the knee, and holding your foot in your hand, turn around and hop away

When responding to an incident scene in which there are downed utility lines, the medical air transport crew should always assume that any downed line they encounter is live until a representative from the power company has established that all lines are no longer energized. Live lines may appear "normal," that is, there may not be any evidence of burning or arcing of energy, and even lines that were previously determined to be de-energized may become energized minutes later in response to the automatic systems that are set in place to restore flow of energy. 

If, while participating in the transport of a patient at an incident scene in which there are downed lines, you experience a tingling sensation in your legs and lower torso, stop moving forward. Lift one foot off the ground to "break" the circuit of energy flow which has occurred through your legs and torso, and holding your foot in your hand, turn slowly around and hop away to a safe place. In this scenario, current is flowing through the ground due to ground gradient. In ground gradient, current is transmitted from the grounded end of an energized object (the downed power line) through the surrounding media (in this case, the actual ground or dirt), with the current being strongest the nearer it is to the actual energized object, and weakening the farther away one gets from it.

16.

Which of the following statements regarding physical findings in acute heart failure (AHF) is most accurate?

  • Anorexia and early satiety may be noted as a consequence of hepatic congestion in AHF

  • Jugular venous distention (JVD) may be exacerbated in obese patients with AHF

  • Peripheral edema may be noted as a consequence of AHF

  • Atrial fibrillation may be noted as a consequence of AHF

Correct answer: Anorexia and early satiety may be noted as a consequence of hepatic congestion

As acute heart failure (AHF) typically leads to a backing up of blood into both the pulmonary and systemic circulation, patients may experience symptoms related to fluid overload in many of the body's organ systems. The presence of hepatic congestion often results in gastrointestinal symptoms such as ascites, early satiety, and anorexia, while orthopnea and jugular venous distention may result from increased resting filling pressures. Weight gain may indicate an exacerbation of heart failure or an imminent bout of AHF. Atrial fibrillation may either cause a patient to go into AHF, or it may be a consequence of AHF. Peripheral edema is typically seen in patients with a history of chronic HF, versus AHF.

17.

Reducing noise in the transport environment can:

  • Improve ability to monitor equipment

  • Increase stress among team members

  • Degrade communication among team members

  • Induce fatigue

Correct answer: Improve ability to monitor equipment

Noise in the transport environment can result in degraded communications and the ability to maintain focus, as well as increased stress and fatigue for patient and transport team. Reducing ambient noise can improve your ability to monitor equipment and the patient during transport.

18.

In regard to best practices during resuscitative care of an injured patient, to what does the acronym "FAST" refer?

  • The use of bedside sonography during resuscitative care

  • Provision of rapid airway, breathing, and circulation assessment by a select provider

  • A method of rapid sequence intubation (RSI) specific to provision of resuscitative care

  • A method of resuscitative care provided during medical air transport and devised by the Federation Aviation Administration (FAA)

Correct answer: The use of bedside sonography during resuscitative care

The use of focused assessment with sonography (FAST) during provision of other methods of resuscitation has become almost standard during emergency care. FAST provides a means of portable, accurate beside sonography which is used to identify traumatic injuries which may not be as obvious to basic visual assessment. These cost-effective, portable sonography devices are now also being commonly used during transport missions to identify nontraumatic pathology which may prove life-threatening, such as aortic aneurysm or fine asystole. When used in trauma assessments, FAST technique has typically been used to identify free fluid collections (pleural, peritoneal, etc.), or sequela related to blunt or penetrating injuries.

19.

You are the CFRN/CTRN transporting a 54-year-old female to a higher level of care. The sending facility reported that the patient has a history of sepsis and that her chest X-ray showed ground glass appearance and bilateral patchy infiltrates. The patient has pulmonary hypertension. Which condition do you suspect?

  • Acute Respiratory Distress Syndrome (ARDS)

  • Pneumonia

  • Pulmonary embolism

  • COPD

Correct answer: Acute Respiratory Distress Syndrome (ARDS)

ARDS is typically defined by bilateral patchy infiltrates on chest X-ray and shows a ”ground glass” appearance. This is due to the increased alveoli permeability causing pulmonary edema.

Pneumonia is typically localized to one lobe. Pulmonary embolism does not present as bilateral infiltrates. COPD shows as clear, large lung fields on chest X-ray.

20.

A chest radiograph (x-ray) has just been completed to confirm correct placement of an endotracheal tube (ETT). All of the following x-ray findings indicate successful placement of an ETT except:

  • Murphy's eye can be seen in the upright position

  • The distal tip of the ETT can be seen at the level of the T3 to T4 vertebrae

  • The distal tip of the ETT is located 4 to 5 cm above the carina

  • Murphy's eye can be visualized where the clavicles meet

Correct answer: Murphy's eye can be seen in the upright position

When possible, correct ETT placement should be confirmed through the use of chest x-ray. The distal tip of the ETT should be positioned at a depth 4 to 5 cm above the carina, at the level of the third and fourth thoracic vertebrae. Correct placement can quickly be confirmed by visualization of Murphy's eye, the vent hole located on the side of the ETT, at the junction of the clavicle bones.

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