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Quiz Session - Attempts With Random Questions

BCEN CEN Exam Questions

Page 3 of 50

41.

During the initial assessment of a patient with suspected STEMI, which of the following is the MOST critical intervention?

  • Performing a 12-lead ECG

  • Administering supplemental oxygen

  • Establishing IV access

  • Providing pain relief

Correct answer: Performing a 12-lead ECG

Performing a 12-lead ECG is the most critical intervention because it provides essential diagnostic information to confirm the presence of a STEMI (ST-Elevation Myocardial Infarction). Identifying the characteristic ST-segment elevation allows healthcare providers to rapidly initiate appropriate treatment protocols, such as reperfusion therapy, which is time-sensitive and can significantly reduce myocardial damage and improve patient outcomes.

While oxygen therapy can be important, it is not the most critical initial intervention unless the patient is hypoxic (SpO2 < 90%). Recent guidelines suggest that routine oxygen administration to all patients with suspected STEMI is not necessary and may not provide benefit if the patient is not hypoxic. Establishing IV access is important for administering medications and fluids, but it is not as immediately critical as performing a 12-lead ECG. Managing pain is important in the treatment of STEMI, as it can reduce sympathetic stimulation and myocardial oxygen demand. However, it is not the most critical initial intervention.

42.

If a patient has penetrating or blunt trauma above the nipple line, what MUST occur with the assessment of the airway?

  • Cervical spine immobilization

  • Oropharyngeal airway adjunct to hold the tongue

  • Intubation

  • Administration of oxygen

Correct answer: Cervical spine immobilization

When a patient has penetrating or blunt trauma above the nipple line, the cervical spine must be immobilized with the assessment of the airway. An oropharyngeal airway adjunct may be necessary in patients with altered LOC in order to hold the tongue away from the hypopharynx. To maintain a patient's airway after a trauma accident, oxygen may need to be administered and intubation may be required, but this does not need to be done with the assessment of the patient's airway.

43.

What is the normal hematocrit percentage range for women?

 

  • Approximately 37% to 47%

  • Approximately 42% to 52%

  • Approximately 14% to 18%

  • Approximately 12% to 16%

Correct answer: Approximately 37% to 47%

In regard to hematology, hematocrit is considered normal in women when it is between 37% and 47%. It is considered normal in men when it is between 42% and 52%.

Hemoglobin is normal in men when it is at 14–18 g/dL and in women when it is 12–16 g/dL. 

44.

At which of the following intervals would you expect to see an elevated troponin following infarct?

  • Three to 12 hours

  • One to two hours

  • 12 to 24 hours

  • Ten to 24 hours

Correct answer: Three to 12 hours

Cardiac biomarkers are used as a diagnostic tool in determining the presence of acute myocardial injury, such as in a non-STEMI or STEMI. It is typical for troponin to elevate between three and 12 hours after an infarct. The level peaks between ten and 24 hours after an infarct. Creatinine kinase-MB is another cardiac biomarker used as a diagnostic tool in determining the presence of acute myocardial injury. It elevates between four and 12 hours, then peaks between ten and 24 hours after infarct. Troponin levels remain elevated for up to nine days, while CK-MB levels return to normal within about 72 hours.

45.

HELLP syndrome is diagnosed based on the presence of hemolysis, elevated liver enzymes, and which of the following?

  • Low platelets

  • Low potassium

  • Low protein

  • Low pulse

Correct answer: Low platelets

Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome is an obstetric emergency and a variant of severe preeclampsia. Since preeclampsia is the second leading cause of maternal mortality, early diagnosis and treatment are essential to survival. 

The most common treatment for HELLP syndrome is delivery of the baby, though blood transfusion and steroid administration may be given throughout the pregnancy as supportive care for both mother and baby.

Hypokalemia (low potassium) is often caused by an excessive loss of potassium in the digestive tract due to vomiting, diarrhea, or laxative use. Low protein is often a cause of a nutritional deficiency (not enough protein in the diet). Bradycardia (low pulse) can be caused by a variety of factors and is not generally related to HELLP syndrome. 

46.

The triage nurse notices an uncharacteristically large number of patients presenting with fevers, headaches, and a similar rash over the course of three days. Which of the following should the nurse recognize?

  • The cluster of patients may indicate an outbreak that should be reported

  • It is typical for emergency rooms to see clusters of patients with similar symptoms

  • The cluster of patients with similar symptoms is likely a statistical anomaly 

  • This cluster of patients with similar symptoms indicates a biological terrorist attack has occurred

Correct answer: The cluster of patients may indicate an outbreak that should be reported

A cluster of patients who exhibit similar symptoms can indicate a disease outbreak and should be reported. This cluster could indicate that a biological terrorist attack has occurred but could also indicate an infectious outbreak or other epidemiological anomaly. The nurse should not treat this finding as if it is just a statistical anomaly. Emergency rooms may see clusters of patients with similar symptoms, but epidemiologically significant clusters should be reported.

47.

Which of the following types of evidence is considered the "gold standard" in regard to evidence-based practice?

  • Randomized controlled trials

  • Prospective cohort studies

  • Case reports

  • Manufacturer's recommendations

Correct answer: Randomized controlled trials

Randomized controlled trials are considered the gold standard for evidence; however, many nursing questions are not answered using randomized controlled trials.

Prospective cohort studies, case reports, and manufacturer's recommendations are all methods of seeking evidence, but they are not considered the gold standard.

48.

A 49-year-old female patient who has been on prolonged antibiotic therapy presents with fever, abdominal pain, and severe diarrhea. How does Clostridium difficile cause these symptoms?

  • By producing toxins that damage the intestinal lining

  • By invading the bloodstream and causing systemic infection

  • By blocking the absorption of nutrients in the intestines

  • By secreting enzymes that digest the intestinal mucosa

Correct answer: By producing toxins that damage the intestinal lining

C. difficile produces toxins, specifically toxin A and toxin B, that damage the intestinal lining. These toxins lead to inflammation, cell death, and the classic symptoms of severe diarrhea, abdominal pain, and fever.

C. difficile typically does not invade the bloodstream to cause systemic infection; its primary effects are localized in the intestines. Blocked absorption of nutrients and secretion of enzymes that digest the intestinal mucosa are also not the causes of the damage; the toxins produced by C. difficile are.

49.

An 83-year-old female patient arrives at the emergency department via EMS with apparent tachycardia and dizziness. Twenty minutes after she arrives, you notice a change in her cardiac rhythm, now a narrow complex tachycardia. Further assessment reveals the patient is unresponsive and without a pulse. 

This is classified as which of the following types of cardiac arrest?

  • Pulseless electrical activity

  • Pulseless ventricular tachycardia

  • Asystole

  • Symptomatic bradycardia

Correct answer: Pulseless electrical activity

Pulseless electrical activity, or PEA, refers to a heterogeneous group of organized electrical rhythms that fail to produce effective contraction and a palpable pulse. A PEA arrest is most commonly treated in the same manner as asystole. The most prevalent underlying cause of PEA is hypovolemia. 

Pulseless ventricular tachycardia is a serious cardiac rhythm disturbance in which the lower chambers of the heart (the ventricles) beat very rapidly and are unable to pump blood effectively through the body because they are not functioning properly. This condition is characterized by the absence of a detectable pulse, which indicates a severe decrease in cardiac output and signifies a life-threatening situation.

Asystole is a severe form of cardiac arrest characterized by a total lack of electrical activity in the heart. This condition is often referred to as "flatline" because, on an Electrocardiogram (ECG), the heart's electrical tracing shows a flat line without any movement, indicating no electrical activity and consequently no heartbeat. Symptomatic bradycardia is a condition in which the heart rate is slower than normal (typically less than 60 beats per minute). The heart's slower pace fails to provide adequate blood flow to meet the body's needs, which can result in a variety of symptoms and potentially serious complications.

50.

Which of the following is a potential complication of placenta previa that you should monitor for in a patient presenting to the emergency department with this condition?

  • Sudden fetal distress 

  • Abrupt onset maternal hypertension 

  • Decreased fetal movement 

  • Hyperemesis gravidarum

Correct answer: Sudden fetal distress 

Placenta previa is a condition characterized by the placenta partially or wholly covering the cervix, the opening to the uterus, at any time during the last two trimesters of pregnancy. This placement is problematic because the placenta can cover the cervical opening, through which the baby must pass during delivery.

Fetal distress can occur due to decreased oxygenation or bleeding associated with placenta previa, necessitating close monitoring. While hypertension is a concern in pregnancy, it is not directly associated with placenta previa. Decreased fetal movement could indicate a problem but is not a specific complication of placenta previa. Monitoring should focus more on fetal distress and maternal bleeding. Hyperemesis gravidarum, which is characterized by severe nausea and vomiting, is not related to placenta previa.

51.

A 38-year-old male patient arrives at the emergency department with a degloving injury to his left forearm after a bicycle accident. The skin has been completely torn off, exposing muscles and tendons. What are the critical factors to consider when deciding whether to attempt primary wound closure?

  • Extent of tissue damage, risk of infection, and blood supply to the area

  • Patient's age, tetanus immunization status, and pain level

  • Location of injury, time elapsed since injury, and patient’s medical history

  • Presence of foreign bodies, patient's allergies, and previous surgical history

Correct answer: Extent of tissue damage, risk of infection, and blood supply to the area

The extent of tissue damage, risk of infection, and blood supply to the area are crucial factors in deciding whether primary closure is appropriate. Severe tissue damage and poor blood supply can impair healing and increase the risk of infection, making delayed closure or skin grafts more suitable.

The patient's age, tetanus immunization status, and pain level are important considerations in overall management but are not the primary factors in wound closure decisions.

The location of injury, time elapsed since injury, and patient’s medical history are relevant but secondary to the condition of the wound itself and its healing potential.

The presence of foreign bodies and the patient's allergies and previous surgical history are relevant to wound management but do not directly influence the decision regarding primary closure.

52.

A 44-year-old male patient arrives at the emergency department with a history of biliary colic. He reports abrupt onset of severe right upper quadrant pain radiating to the back, fever, and chills. His vital signs are blood pressure 130/90 mmHg, heart rate 120 beats per minute, respiratory rate 22 breaths per minute, and temperature 102°F (38.9°C). 

Which intervention should the nurse anticipate FIRST for this patient?

  • Surgical consultation 

  • Administration of antacids

  • Administration of oral antibiotic therapy 

  • Insertion of a Nasogastric (NG) tube with suction

Correct answer: Surgical consultation 

The presentation of severe right upper quadrant pain, fever, and chills combined with the history of biliary colic suggests acute cholecystitis, possibly complicated by infection. Immediate surgical consultation is necessary to evaluate the need for cholecystectomy or drainage of the infected gallbladder.

Antacids are not appropriate in this context as they address gastrointestinal discomfort related to acid, not the infection and inflammation seen in acute cholecystitis. Oral antibiotics may be part of the treatment but should not be the first intervention. Intravenous antibiotics would be more appropriate initially, given the severity of symptoms and the need for prompt infection control. Some patients with severe or persistent vomiting and pain may require insertion of an NG tube with suction, but a surgical consultation should take precedence. 

53.

Which of the following is NOT one of the four sinuses surrounding and draining into the nasal cavity?

  • Septum

  • Frontal

  • Maxillary

  • Ethmoid

Correct answer: Septum

The nasal septum separates the nasal cavity into two nostrils and consists of bone and cartilage. A deviation in the septum can lead to breathing problems or persistent sinus conditions. 

The septum is not one of the four sinuses that drain into the nasal cavity: the sphenoid, ethmoid, maxillary, and frontal sinuses. The sinuses and the septum are integral components of the nasal anatomy. The sinuses are typically hollow spaces lined with a thin layer of mucus.

54.

If a patient states that they are not feeling pain but are seeing "floaters" and light flashes in the visual field, which of the following does the patient MOST likely have?

  • Retinal detachment

  • Extraocular foreign bodies

  • Corneal ulcer

  • Glaucoma

Correct answer: Retinal detachment

Retinal detachment occurs when the sensory retina becomes detached from the pigment epithelium, causing the patient to see "floaters" and light flashes in the visual field. Glaucoma occurs when the eye has abnormally high fluid pressure, causing the patient to experience headaches, eye redness, decreased vision or halos, and excessive tearing. A corneal ulcer occurs when the epithelial layer of the cornea has a defect with inflammation, causing eye discomfort, ciliary muscle spasms, eye redness, excessive tearing, and blurring. Extraocular foreign bodies are foreign substances on the eye's surface that cause the patient to experience pain, blurred vision, and sensation of the foreign body.

55.

Which of the following is LEAST likely to be a cause of pericarditis? 

  • Recent abdominal surgery

  • Neoplasm

  • Idiopathic reasons

  • Aortic dissection

Correct answer: Recent abdominal surgery

Recent abdominal surgery is unlikely to cause pericarditis unless a surgical complication, such as infection, occurs. Recent thoracic surgery, however, may cause pericarditis. 

Pericarditis is most commonly idiopathic or is caused by infections, neoplasms, and conditions like aortic dissection.

56.

Which of the following conditions MOST indicates the need for exploration of a laceration?

  • Possible damage to underlying structures

  • Presence of a foreign body in the wound

  • Uncontrolled bleeding 

  • Involvement of both epidermis and dermis

Correct answer: Possible damage to underlying structures

Under a laceration, there might be significant damage that isn't immediately visible, necessitating thorough exploration to assess and treat any hidden injuries.

Presence of a foreign body in the wound and uncontrolled bleeding also indicate serious conditions, but there are more specific scenarios that would directly suggest exploration. Involvement of both the epidermis and the dermis is a common aspect of many lacerations and does not necessarily indicate the need for exploration unless there are other signs of more severe damage.

57.

A 40-year-old male patient asks you what he can do to reduce his risk of developing Peripheral Vascular Disease (PVD). Which of the following is the BEST response?

  • "Be sure to maintain a healthy weight."

  • "You are not at risk of developing peripheral vascular disease until you reach age 60."

  • "Avoid exposure to heavy metals."

  • "There is nothing you can do to change your risk of developing peripheral vascular disease."

Correct answer: "Be sure to maintain a healthy weight."

Peripheral Vascular Disease (PVD) encompasses a range of disorders affecting blood vessels outside the heart and brain and is mainly caused by atherosclerosis. This condition involves the accumulation of plaque on the walls of arteries, leading to narrowed arteries and decreased blood flow, particularly to the legs. Among its various risk factors, obesity is significant and modifiable. Lifestyle modifications such as stopping smoking, engaging in regular physical activity, and following a nutritious diet can mitigate the risk of developing PVD.

Typically, PVD manifests later in life, but individuals as young as 40 years old can also be affected. Exposure to heavy metals is not considered a major risk factor for the onset of PVD.

58.

When auscultating your patient's chest, you hear what sounds like crackles. What is the MOST likely cause of the sound?

  • Pulmonary edema

  • Mucus in the airways

  • Tumor

  • Pulmonary infarction

Correct answer: Pulmonary edema

Pulmonary edema, atelectasis, and pulmonary fibrosis are all potential causes of crackles. Pulmonary edema is characterized by the accumulation of fluid in the extravascular spaces of the lungs.

Mucus in the airways is a potential cause of rhonchi lung sounds. A tumor is a potential cause of a wheezing sound. A pulmonary infarction is a potential cause of a pleural friction rub breathing sound.

59.

A pediatric patient tells the nurse that they want to hurt other people because they are being physically assaulted and abused by their parents. 

Which of the following interventions should the nurse perform FIRST?

  • Ask the patient whether they have any weapons on them

  • Physically restrain the patient

  • Report child abuse to the appropriate authorities

  • Alert security to respond to the patient's room

Correct answer: Ask the patient whether they have any weapons on them

When a patient discloses homicidal ideation during dialogue, the therapeutic dialogue should be maintained, and the first response should be to assess the risk. Asking about the presence of weapons is an appropriate means of assessing the potential risk. Physically restraining the patient and alerting security may be necessary if the patient begins to demonstrate that they will physically act out or if there is a high risk of violence occurring. However, if therapeutic communication is maintained, this will likely be unnecessary. Reporting child abuse to the appropriate authorities is necessary in this situation, but maintaining safety is the first priority.

60.

Which of the following BEST describes pulsus paradoxus?

  • A decrease in systolic blood pressure of at least 10 mmHg during inspiration

  • A decrease in systolic blood pressure of at least 10 mmHg during expiration

  • A decrease in diastolic blood pressure of at least 10 mmHg during inspiration

  • A decrease in diastolic blood pressure of at least 10 mmHg during expiration

Correct answer: A decrease in systolic blood pressure of at least 10 mmHg during inspiration

Pulsus paradoxus describes a decrease in systolic blood pressure of at least 10 mmHg during inspiration. This condition is commonly seen in cardiac tamponade and is caused by decreased venous return. Increased intrathoracic pressure associated with inspiration further exacerbates compression of the myocardium. 

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