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Quiz Session - Attempts With Random Questions

BCEN CEN Exam Questions

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21.

A urinalysis is MOST likely to show which of the following when a Urinary Tract Infection (UTI) is present?

  • Many white blood cells and positive leukocyte esterase

  • Many white blood cells and negative leukocyte esterase

  • Few white blood cells and positive nitrites

  • Negative leukocyte esterase and positive nitrites

Correct answer: Many white blood cells and positive leukocyte esterase

The most common organism causing a UTI infection is E. coli. An infection results when the organism migrates from the urethra to the bladder. Common complaints include irritative voiding symptoms, foul-smelling urine, low-grade fever, and pressure or pain in the suprapubic area.

A urinalysis will confirm the clinical diagnosis and may reveal microscopic or gross hematuria, many white blood cells, positive leukocyte esterase, and positive nitrites.

22.

A patient who survives a pulmonary embolism is MOST at risk of developing which of the following conditions?

  • Pulmonary hypertension

  • Reoccuring pneumonia

  • Chronic Obstructive Pulmonary Disorder (COPD)

  • Right-sided heart failure

Correct answer: Pulmonary hypertension

Up to 70% of patients who survive a pulmonary embolism are likely to develop pulmonary hypertension. This happens when clots in the lungs don't dissolve entirely and lead to narrowing or scarring of the pulmonary arteries. Over time, this can increase the pressure in the pulmonary arteries (pulmonary hypertension), making it harder for the heart to pump blood through the lungs. This condition can lead to right heart failure if left untreated.

Reoccurring pneumonia or COPD is unlikely to occur due to pulmonary embolism, as this condition affects pulmonary vasculature, not the airways. Right-sided heart failure is a risk of pulmonary hypertension. However, the risk of pulmonary hypertension is higher than the risk of a condition that will occur only in some patients who develop pulmonary hypertension.

23.

A nurse is caring for two patients who have identical injuries. One of the patients is a friend of her family, and the other patient is an unknown. Since the nurse knows one patient, she spends more time and care attending to their injuries while leaving the unknown patient unattended. Which ethical principle is the nurse disregarding?

  • Justice

  • Paternalism

  • Beneficence

  • Autonomy

Correct answer: Justice

Justice is the ethical principle that requires a nurse to be fair to all people. Therefore, the nurse is disregarding justice by not providing the same care to both patients.

Paternalism is the ethical principle that requires a nurse to help a patient make decisions when they do not have the data or expertise to do so on their own. Beneficence means a nurse is obligated to only do good, not harm. Autonomy requires a nurse to allow a patient to make their own decisions about their care.

24.

The classic triad of heroin use includes central nervous system depression, respiratory depression, and which of the following?

  • Miosis

  • Restlessness

  • Diplopia

  • Weakness

Correct answer: Miosis

Heroin, a naturally occurring substance, is an opiate drug that may be administered through inhalation, injection, or smoking. The classic triad of heroin use is central nervous system depression, respiratory depression, and miosis (pinpoint pupils), not diplopia (double vision). Patients who are suspected of heroin overdose should first be resuscitated as indicated, then administered naloxone (Narcan).

Weakness, particularly limp arms and legs, is a sign of an overdose but is not a part of the classic triad, and restlessness is a less common sign of opioid overdose. 

25.

What is the MOST appropriate intervention for an infant with a foreign body lodged in the trachea, causing complete airway obstruction?

  • Administer five back blows followed by up to five chest thrusts

  • Hold the patient upright and administer back blows

  • Administer three back blows followed by up to three chest thrusts

  • Administer up to five subdiaphragmatic abdominal thrusts

Correct answer: Administer five back blows followed by up to five chest thrusts

For the infant presenting to the emergency department with complete airway obstruction and no air movement, it is critical to attempt to dislodge the object and free the airway. To do this, the nurse or physician should hold the patient in the prone position and administer five back blows followed by five chest thrusts. When the object dislodges, the procedure may be stopped and the patient ventilated.

26.

You are admitting a 22-year-old male patient who has overdosed on amphetamines. What is the BEST strategy to use when interacting with this patient?

  • Avoid overstimulating the patient

  • Speak loudly to the patient

  • Approach the patient from behind

  • Leave the patient alone until he is less agitated

Correct answer: Avoid overstimulating the patient

Patients with amphetamine toxicity can be unpredictable and volatile, so it is important to maintain a calm, quiet environment. Bright lights in the room should be kept to a minimum to avoid sensory overstimulation. Do not speak loudly, move quickly, approach from behind, or touch the patient. However, a patient who has overdosed on amphetamines should not be left unsupervised.

27.

Which of the following is the MOST important chemical buffer of acid-base regulation?

  • Bicarbonate

  • Phosphate 

  • Ammonium

  • Hgb and other proteins

Correct answer: Bicarbonate

Bicarbonate, phosphate, ammonium, Hgb, and other proteins are all chemical buffers of acid-base regulation; however, bicarbonate is the most important.

Bicarbonate aids in the destruction of hydrogen and is generated by the kidneys. Chemical buffers of acid-base regulation have both a weak acid and a strong base.

28.

Which of the following clinical findings is a contraindication to administering activated charcoal?

  • Decreased or absent bowel sounds

  • Decreased respiratory rate

  • Decreased heart rate

  • Decreased level of consciousness

Correct answer: Decreased or absent bowel sounds

Activated charcoal is given by mouth or gastric tube and is relatively easy to administer in both children and adults. Contraindications to its use include decreased or absent bowel sounds, ingestion of a corrosive agent, and ingestion of toxins not bound by charcoal, such as iron, hydrocarbons, lead, and lithium. Decreased or absent bowel sounds indicate a risk of bowel obstruction or perforation, which can be exacerbated by the administration of activated charcoal.

Decreased respiratory rate can indicate respiratory depression but is not a direct contraindication to activated charcoal. Bradycardia is not a specific contraindication to the use of activated charcoal. Decreased level of consciousness poses a risk of aspiration if charcoal is administered orally, but it can still be given if the airway is protected through endotracheal intubation.

29.

A patient presents to the emergency department triage area with complaints of a three-day history of cough with yellow sputum production. What IMMEDIATE nursing intervention should be implemented? 

  • Provide a surgical mask and place the patient in a private room

  • Prepare to intubate the patient

  • Ask the patient if they have traveled to a foreign country within the last three months

  • Provide a sterile cup and ask the patient to provide a sputum sample

Correct answer: Provide a surgical mask and place the patient in a private room

Especially in the emergency department, preventing the spread of respiratory illness is a priority. To minimize the spread of respiratory pathogens, it is important to identify and isolate patients with infections as soon as possible. Handwashing is the single most effective measure to limit the spread of infection. For patients identified with a potential respiratory illness, a surgical mask should be given and the patient should immediately be placed in a private room.

While obtaining an oxygen saturation, inquiring about foreign travel, and requesting a sputum sample may be appropriate in the future treatment plan, they are not the immediate intervention for patients who present in triage with a potential respiratory illness.

30.

What is the PRIMARY concern with nasal foreign bodies in pediatric patients? 

  • Aspiration

  • Nare obstruction

  • Bleeding

  • Infection

Correct answer: Aspiration

While nasal foreign bodies occur most often in the pediatric population, the main concern is the potential for aspiration. Removal can happen while creating positive pressure: the patient blocks the unaffected nare while blowing their nose. If unsuccessful, more invasive removal techniques may be necessary using direct instrumentation, such as a balloon catheter or suction device. An ENT consultation may be required to assist with foreign body removal.

Nasal obstruction, bleeding, and infection are signs and symptoms of a foreign body in the nasal passageway. 

31.

A 25-year-old female patient presents to the emergency department with panic attacks. Which statement BEST explains her condition to a family member?

  • Panic attacks are sudden periods of intense fear that can include palpitations, sweating, and feelings of impending doom

  • Panic attacks are chronic and persistent feelings of sadness 

  • Panic attacks commonly occur during stressful situations and are rare

  • Panic attacks often indicate a physical illness, not a mental health issue

Correct answer: Panic attacks are sudden periods of intense fear that can include palpitations, sweating, and feelings of impending doom

Panic attacks are characterized by sudden and intense fear and often come with physical symptoms like palpitations, sweating, and feelings of impending doom. These can occur unexpectedly and are a key feature of panic disorder.

Chronic and persistent feelings of sadness describe depression, not panic attacks. Panic attacks can occur without a specific trigger, so they do not necessarily occur only during stressful situations. They are recognized as a mental health issue, not merely a physical illness.

32.

An 18-year-old male patient is brought to the emergency department by his friends. They report that he ingested cocaine about an hour ago. He is agitated, sweating profusely, and complaining of chest pain. His blood pressure is 180/100 mmHg, his heart rate is 120 bpm, and he appears very anxious. 

As the nurse assessing this patient, which of the following statements is TRUE regarding the effects of cocaine ingestion?

  • Cocaine ingestion can lead to myocardial ischemia and infarction

  • Cocaine ingestion can cause severe hypotension and bradycardia

  • Cocaine ingestion typically results in hypothermia and lethargy

  • Cocaine ingestion commonly causes a decrease in respiratory rate and depth

Correct answer: Cocaine ingestion can lead to myocardial ischemia and infarction

Cocaine is a powerful stimulant that increases sympathetic nervous system activity, leading to elevated heart rate, blood pressure, and myocardial oxygen demand. This can cause coronary artery vasoconstriction and increase the risk of myocardial ischemia and infarction. It also typically causes an increase in respiratory rate and temperature.

33.

Which of the following age groups are obligate nose breathers?

  • Birth to 6 months

  • Six months to two years

  • Two to four years

  • Four to six years

Correct answer: Birth to six months

For patients between zero and six months of age, it is essential to recognize that they are obligate nose breathers. Therefore, if an obstruction occurs within their nasal airway, it can be life-threatening. Treatment for nasopharyngeal obstruction in infants includes administration of high-flow oxygen and assistance with foreign body removal and/or nasal suctioning, as indicated. Adjunct airways may be necessary to ensure adequate ventilation until the obstruction is cleared.

34.

Which formula is commonly used to calculate fluid resuscitation needs in a pediatric burn patient?

  • Parkland formula

  • Brooke formula 

  • Modified Brooke formula

  • Munro formula

Correct answer: Parkland formula

The Parkland formula is commonly used to estimate 24-hour fluid resuscitation needs for burn patients, including children. It recommends 4 mL of lactated Ringer's solution per kilogram of body weight per percentage of Total Body Surface Area (TBSA) burned, administered in the first 24 hours post-burn, with half of the total volume given in the first eight hours.

The Brooke formula was one of the earlier formulas developed for burn fluid resuscitation. The original Brooke formula recommends 1.5 mL of lactated Ringer's solution per kilogram of body weight per percentage of TBSA burned plus 0.5 mL of plasma or albumin per kilogram of body weight per percentage of TBSA burned for the first 24 hours. Additionally, maintenance fluids with dextrose and electrolytes are given to meet the patient's basic hydration needs.

The Modified Brooke formula simplifies the fluid calculation and eliminates the colloid component in the initial 24 hours, recommending 2 mL of lactated Ringer's solution per kilogram of body weight per percentage of TBSA burned for the first 24 hours. Maintenance fluid requirements are calculated separately.

The Munro approach emphasizes careful monitoring and adjustment of fluids based on physiological markers like urine output rather than strictly adhering to a calculated volume, addressing concerns about fluid overload. The formula suggests a target urine output of 0.5-1 mL/kg/hr for adults and 1–2 mL/kg/hr for children as a guide to adjust fluid rates rather than calculating a total volume up front for the first 24 hours.

35.

Which of the following complications is MOST associated with untreated Pelvic Inflammatory Disease (PID)?

  • Infertility

  • Ovarian cyst

  • Uterine fibroids

  • Cervical cancer 

Correct answer: Infertility

Untreated PID can lead to infertility due to damage and scarring of the fallopian tubes, which can prevent the egg from traveling to the uterus, thus making it the most associated complication. Ovarian cysts are fluid-filled sacs within or on the ovary and are not typically caused by PID. Uterine fibroids are benign uterine growths that are unrelated to PID. Cervical cancer is primarily caused by Human Papillomavirus (HPV) infection and is not a direct complication of PID.

36.

If the transducer of a hemodynamic monitoring system is placed too low, what will happen to its readings?

  • They will be falsely elevated 

  • They will be falsely decreased

  • The readings will not be affected

  • No readings will be present

Correct answer: They will be falsely elevated

If the transducer of a hemodynamic monitoring system is placed too low, it will result in falsely elevated pressure readings. This is because the transducer should be level with the phlebostatic axis (approximately at the level of the right atrium) to ensure accurate measurements. When it is positioned below this point, the pressure measured will be higher than the actual pressure.

When the transducer is placed too high, its readings will be too low (falsely decreased). The transducer needs to be leveled and balanced to zero before use, and the patient should be in a supine position. 

37.

A 28-year-old male patient with a history of sickle cell disease presents to the emergency department with severe pain and edema. 

Which of the following would help diagnose his condition?

  • He recently took a vacation to a city that is 7,000 ft above sea level

  • He has been spending most of the summer outside in the sun

  • He had an upper respiratory infection six months ago

  • He reports relaxing over the last three months, with limited stress in his life

Correct answer: He recently took a vacation to a city that is 7,000 ft above sea level

Sickle cell disease is a congenital hemolytic anemia in which defective hemoglobin molecules cause red blood cells to form in a sickle shape, which may also cause the cells to clump together. In a sickle cell crisis, clumping has led to capillary obstruction, which results in decreased circulation, edema, tissue ischemia, and severe pain. Several factors predispose a patient to a sickle cell crisis (also called a vaso-occlusive crisis): cold temperatures, high altitudes, recent infection, metabolic or respiratory acidosis, and stress.

38.

A patient who has just arrived home from a trip to a developing country presents to the emergency department with a bark-like cough, a headache, a gray membrane covering their tonsils, and a fever of 102°F. 

Which communicable disease is the patient MOST likely to have?

  • Diphtheria

  • Encephalitis

  • Mononucleosis

  • Pertussis

Correct answer: Diphtheria

Diphtheria, which is spread by respiratory droplets, is a bacterial infection of the mucous membranes. People living in crowded conditions with poor sanitation have an increased risk of contracting diphtheria. In this context, it is most likely to be the patient's diagnosis. The incubation period for diphtheria is one to eight days after exposure.

Symptoms Comparison:

  • Encephalitis: stiff neck, vomiting, severe headache, sudden fever, and drowsiness
  • Mononucleosis: sore throat, headache, fatigue, muscle aches, nausea, and fever
  • Pertussis: fatigue and a cough that ends with a whooping sound

39.

Which of the following conditions is LEAST likely to be associated with Biot's respiration, an abnormal respiratory rhythm? 

  • Metabolic acidosis

  • Meningitis

  • Encephalitis

  • Head trauma

Correct answer: Biot's

Biot's respiration is a type of abnormal breathing pattern characterized by irregular periods of breathing including rapid, shallow breaths followed by periods of apnea (no breathing), and no consistent pattern or rhythm. It indicates a poor prognosis and often signifies significant brain injury or dysfunction. 

This pattern is typically seen in patients with severe neurological damage, such as:

  • Increased intracranial pressure
  • Brainstem injury
  • Meningitis
  • Encephalitis
  • Head trauma

Severe metabolic acidosis is associated with Kussmaul's respirations. This deep, labored breathing pattern is the body's attempt to compensate for the acidosis by increasing the elimination of carbon dioxide.

40.

What should a nurse do to avoid malpractice claims?

  • Make sure the patient's welfare is a priority

  • Follow their intuition when providing care

  • Provide care to patients regardless of whether it is outside their area of competence

  • Mentally remember all their patients and the care provided to each one

Correct answer: Make sure the patient's welfare is a priority

To avoid malpractice claims, a nurse should always make sure the patient's welfare is a priority.

The nurse should not follow their intuition when providing care. They should make decisions based on biological, psychological, and social sciences and follow their institution's policies.

A nurse should practice only within their area of competence, not outside of it.

A nurse should always thoroughly document the care that a patient received, as it is impossible to remember what care was provided to each and every patient.

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