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Quiz Session - Attempts With Random Questions

BCEN CEN Exam Questions

Page 5 of 50

81.

A patient admitted to the emergency department with a pulmonary contusion secondary to a motor vehicle collision is MOST likely to present which of the following symptoms?

  • Dyspnea, chest wall bruising, and hemoptysis

  • Sudden onset of chest pain and hemoptysis

  • Wheezing and stridor

  • Fever and productive cough

Correct answer: Dyspnea, chest wall bruising, and hemoptysis 

Pulmonary contusion can occur with any severe blunt chest trauma and is the most common potentially life-threatening chest injury. These symptoms are characteristic of a pulmonary contusion. Respiratory distress, such as dyspnea, tachypnea, restlessness, and agitation, occurs due to impaired gas exchange in the injured lung tissue. Chest wall bruising is common due to the blunt trauma that causes the contusion, and hemoptysis results from bleeding within the lung parenchyma.

Sudden onset of chest pain is more likely to indicate conditions like a pulmonary embolism or a myocardial infarction. Pulmonary contusion typically presents with pain associated with the trauma, not sudden onset. Wheezing and stridor are associated with upper airway obstruction or bronchospasm, such as in asthma or anaphylaxis. Pulmonary contusion affects the lung parenchyma rather than the airways, so wheezing and stridor are not typical presentations. Fever and productive cough are more indicative of an infectious process like pneumonia. Pulmonary contusions result from trauma and are not typically associated with fever or productive cough unless there is a secondary infection.

82.

A 22-year-old female patient arrives at the emergency department reporting that she has been sexually assaulted. The nurse begins to provide care and support to the patient.

In addition to providing care, what is a critical responsibility of the nurse when treating a patient who has been sexually assaulted?

  • Collect evidence

  • Give personal advice

  • Provide psychological counseling

  • Provide details to the patient's family

Correct answer: Collect evidence

A nurse's primary responsibility is the patient's care. When treating a patient who has been sexually assaulted, the nurse must also collect evidence as part of the forensic process. This includes preserving the integrity of the evidence while providing compassionate care. Additionally, the nurse should follow specific protocols for evidence collection and maintain chain-of-custody procedures. Nurses must always adhere to HIPAA regulations, ensuring the patient's privacy and confidentiality are protected.

83.

A 29-year-old patient with a history of seasonal allergic rhinitis presents to the emergency department complaining of severe nasal congestion and sneezing, particularly in the springtime when pollen counts are high. The patient is seeking advice on how to manage symptoms effectively at home.

Which of the following instructions is LEAST likely to benefit this patient?

  • Engage in outdoor activity as much as possible

  • Drink plenty of water

  • Humidify your home environment

  • Use a warm saline irrigation to clean out your nose

Correct answer: Engage in outdoor activity as much as possible

Patients with allergic rhinitis should be encouraged to avoid allergens, get enough rest, and use symptomatic treatments. Outdoor activity during high-pollen seasons can exacerbate symptoms due to increased exposure to allergens like pollen. Drinking plenty of water helps thin mucus secretions, humidifying the home can reduce airborne allergens, and warm saline nasal irrigation is effective for clearing nasal passages and reducing symptoms.

84.

Which of the following is responsible for controlling balance and synchronizing muscle action?

  • Cerebellum

  • Brainstem

  • Diencephalon

  • Telencephalon

Correct answer: Cerebellum

The cerebellum is a crucial part of the brain located under the cerebrum in the back of the skull. Functionally, the cerebellum plays a vital role in coordinating voluntary movements, such as posture, balance, coordination, and speech, resulting in smooth and balanced muscular activity. It is also involved in motor learning, helping the body to fine-tune motor activities through practice and repetition.

The telencephalon is responsible for connecting the two cerebral hemispheres to the corpus callosum. The diencephalon is responsible for the regulation of temperature and food intake. The brainstem is responsible for relaying messages from the brain to the lower levels of the nervous system.

85.

If you are caring for a patient experiencing alcohol withdrawal, for which complication would you MOST likely need to monitor?

  • Delirium tremens

  • Cardiac dysrhythmias

  • Respiratory depression

  • Coma

Correct answer: Delirium tremens

Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes. A patient experiencing substance withdrawal should be monitored for delirium tremens and death. Cardiac dysrhythmias, respiratory depression, and coma are factors that should be monitored for when a patient has a substance abuse disorder. Substance abuse disorders include substance dependence and substance abuse.

86.

A 62-year-old patient presents with a brief episode of left arm weakness and difficulty speaking, which resolves spontaneously after 30 minutes. There is no history of similar episodes. 

What is the MOST critical factor to assess to stratify the patient’s risk of a subsequent stroke?

  • Presence of atrial fibrillation on Electrocardiogram (ECG)

  • STAT serum glucose level

  • Blood pressure reading at the time of the incident

  • Use of anticoagulation medication

Correct answer: Presence of atrial fibrillation on Electrocardiogram (ECG)

Transient Ischemic Attacks (TIAs) are critical warning signs of potential stroke necessitating prompt assessment and intervention to prevent subsequent cerebrovascular events. The management strategy includes immediate neuroimaging, typically a CT scan or MRI, and further investigations like carotid ultrasonography, echocardiography, and continuous cardiac rhythm monitoring to identify the cause and implement preventive strategies.

Atrial fibrillation is a significant risk factor for stroke, and its presence can greatly influence the patient's risk profile and subsequent management, including the consideration for anticoagulation therapy. While important, checking a blood glucose level is not the most critical step in assessing future stroke risk after a TIA; however, blood glucose should be checked as part of the initial assessment to rule out hypoglycemia as a cause of neurological symptoms. High blood pressure is a risk factor for stroke, but the immediate reading is less significant in risk stratification than the identification of atrial fibrillation or other cardiac sources of emboli. Knowing whether the patient is on anticoagulants is important for managing treatment, but the immediate priority for risk stratification is identifying atrial fibrillation or other cardiac anomalies that could increase the risk of stroke.

87.

Bananas, chocolate, peanuts, and spinach are recommended food sources for which of the following electrolyte deficiencies?

  • Potassium

  • Vitamin K

  • Calcium

  • Phosphorus

Correct answer: Potassium

Food sources of potassium include bananas, peanuts, spinach, chocolate, apricots, carrots, mushrooms, pumpkin, and dried fruit. Green, leafy vegetables are the primary food sources of vitamin K. Food sources of calcium include broccoli, cheese, ice cream, milk, molasses, rhubarb, spinach, and yogurt. Food sources of phosphorus include seeds, nuts, fish, eggs, dried beans, and milk.

88.

If a patient is experiencing alcohol withdrawal, which of the following statements is accurate?

  • The patient's vital signs should be monitored every 15 to 30 minutes until they are stable

  • The patient's vital signs should be monitored every hour until they are stable

  • The patient's vital signs should be monitored every eight hours until they are stable

  • The patient's vital signs should be monitored daily until they are stable

Correct answer: The patient's vital signs should be monitored every 15 to 30 minutes until they are stable

When a patient is going through alcohol withdrawal, their vital signs, including temperature, blood pressure, respiratory rate and pulse, should be monitored every 15 to 30 minutes until the patient is stable. The patient should also be closely monitored for the progression of any symptoms.

89.

Which of the following findings would be LEAST likely in a patient who is developing noncardiogenic pulmonary edema?

  • New S3

  • Sensation of suffocation

  • Recent submersion injury

  • Diaphoresis

Correct answer: New S3

Noncardiogenic pulmonary edema is pulmonary edema that is not associated with a cardiac cause. A new S3 heart sound is a cardiac change and would not be expected when noncardiogenic pulmonary edema is present. 

A sensation of suffocation and diaphoresis are both potential symptoms of noncardiogenic pulmonary edema. Submersion injury is a potential cause of noncardiogenic pulmonary edema.

90.

A three-year-old male patient is brought to the emergency department with stridor and high fever. He is sitting forward in a tripod position, and his oxygen saturation is 88%. 

Which of the following statements is TRUE regarding the diagnosis and management of this patient?

  • Immediate airway management is critical to prevent respiratory arrest

  • Antibiotics should be administered immediately to treat the infection

  • Intravenous steroids should be initiated to reduce airway inflammation

  • A soft-tissue neck radiograph should be obtained to confirm the diagnosis

Correct answer: Immediate airway management is critical to prevent respiratory arrest

Epiglottitis is an upper airway disorder resulting from an acute inflammation of the epiglottis (the cartilage that covers the windpipe). This swelling can block the flow of air into the lungs. Epiglottitis is occasionally seen in connection with upper airway burns and direct trauma, but most frequently it is the result of a rapidly progressive, potentially lethal bacterial infection. Haemophilus influenzae B was previously considered the usual causative organism, but since the childhood vaccine became routine in 1988, cases have declined significantly. Today, no single organism is considered the usual cause of this illness. 

The primary concern in epiglottitis is airway obstruction, which can rapidly progress to respiratory arrest. Ensuring a patent airway is the most critical intervention.

While antibiotics are essential to treat the underlying bacterial infection, they are secondary to airway management. Intravenous steroids may help reduce inflammation but are not the initial priority. A soft tissue neck radiograph can be useful for diagnosis, but it should not delay immediate airway management.

91.

A 59-year-old female patient presents to the emergency department with severe eye pain, headache, and nausea. She reports seeing halos around lights, and her intraocular pressure is measured at 40 mmHg. 

What is the MOST appropriate initial intervention?

  • Administer intravenous acetazolamide

  • Instill Timolol eye drops

  • Perform a peripheral iridotomy

  • Administer oral prednisolone

Correct answer: Administer intravenous acetazolamide

Administering intravenous acetazolamide is appropriate because it rapidly reduces the production of aqueous humor, thereby lowering Intraocular Pressure (IOP). This intervention is essential to prevent further optic nerve damage and vision loss.

Timolol eye drops are also used to reduce IOP, but their effects are not as immediate or potent as those of intravenous acetazolamide. They may be used after the initial pressure is brought down to maintain lower IOP levels. A peripheral iridotomy is a definitive treatment but not an immediate intervention. This procedure is typically done after the acute attack is controlled to prevent recurrence. Oral prednisolone is not appropriate for initial management as it does not address the acute rise in IOP and could delay critical treatment. 

92.

Of the following, which is considered an exclusion criterion for the administration of thrombolytic therapy?

  • Platelet count 90,000/mm3

  • INR 1.5

  • PT 10 seconds

  • Serum glucose 60 mg/dL

Correct answer: Platelet count 90,000/mm3

To safely administer thrombolytic therapy in the patient with an acute stroke, they must be without current active bleeding or laboratory values that present a risk of bleeding. The following laboratory values are considered exclusionary for the administration of rt-PA:

  • Platelet count < 100,000 mm3
  • INR > 1.7
  • PT > 15 seconds

A serum glucose should also be obtained, and if it is less than 50 mg/dL, it excludes the patient from administration of thrombolytic therapy.

93.

Which of the following statements is FALSE regarding wound management?

  • There is strong evidence that wound cleansing reduces infection

  • A good rule of thumb is to never put any substance in a wound that should not be put in an eye

  • For lacerations to the eyebrow, the eyebrow hair should never be shaved because regrowth cannot be guaranteed

  • Disinfected tap water from treated water sources is as effective as other solutions to cleanse a wound

Correct answer: There is strong evidence that wound cleansing reduces infection

Though wound cleansing is routinely performed, there is no substantial evidence that it reduces infection. It can be reserved for contaminated wounds for optimal healing and infection prevention. In addition, soaking a wound is not helpful. Surface cleaning is the initial step in wound preparation. 

The other answer choices are accurate. Tap water that is filtered or disinfected, for example, is just as effective for wound cleansing as other solutions. Eyebrows provide important landmarks for wound margin approximations and should not be shaved. In addition to this reasoning, regrowth may not occur. Shaving other hairy areas of the body where a wound may occur abrades the skin, increases the risk of infection, and is cosmetically irritating. Instead, moving hair out of the way and securing it in place with a lubricant, topical ointment, or tape is generally preferable to removal.

94.

A number of age-related physiologic changes occur over time. What change occurs within the respiratory system?

  • Decreased pO2 levels

  • Decreased CO2 levels

  • Increased lung compliance

  • Increased inspiratory volume

Correct answer: Decreased pO2 levels

Assessing a geriatric patient for consideration of a respiratory illness requires the practitioner to consider age-related physiologic changes. Geriatric patients have a lower pO2 level. Additionally, their respiratory muscles are weakened, and there are decreases in gas exchange. As a result, geriatric patients have a decreased ventilatory response to hypoxia and hypercapnia. Additionally, they are more sensitive to opioids and benzodiazepines. Administration of these agents should be done in low doses and slowly to avoid adverse pulmonary complications related to hypoxia and hypercapnia.

95.

There are many variables when conducting research. What type of variable is NOT observed and may or may not be relevant to the results of the research?

  • Extraneous variable

  • Dependent variable

  • Independent variable

  • Experimental variable

Correct answer: Extraneous variable

Variables are the measurable concepts that vary during a research study. An extraneous variable is not observed and may or may not be relevant to the results of the research. It is any variable that is not the independent variable but could affect the dependent variable in an experiment, potentially confounding the results. These variables can introduce bias and error, making it difficult to determine whether the changes in the dependent variable are truly due to the manipulation of the independent variable.

An independent variable is observed and is part of the research study. A dependent variable is observed for any change after an intervention. An experimental variable is any variable used in an experiment; it's a vague term that may include all the variable types mentioned here.

96.

Which of the following is NOT a ventilator setting? 

  • Respiratory ratio

  • Tidal volume

  • Flow rate

  • Pressure limit

Correct answer: Respiratory ratio

Settings on a ventilator are important to monitor following intubation of a patient or when transferring care of a patient. There are six main settings: 

  1. Respiratory rate: number of breaths delivered per minute
  2. Tidal volume: amount of air inhaled and exhaled per breath
  3. Flow rate: the rate at which the tidal volume is administered
  4. Fraction of Inspired Oxygen (FiO2): percentage of oxygen delivered by the ventilator
  5. Inspiratory-expiratory ratio: amount of time for inspiration in comparison to the time required for expiration
  6. Pressure limit: the maximum amount of pressure to be produced by the ventilator in order to administer the set tidal volume

97.

A patient with abdominal distress tells the nurse that he is a "body packer." The nurse recognizes that the patient's symptoms are MOST likely to be caused by which of the following conditions?

  • Bowel obstruction

  • Rhabdomyolysis

  • Dehydration

  • Splenic laceration

Correct answer: Bowel obstruction

"Body packers" are seen in the emergency department as a result of swallowing packages, condoms, or rocks (methamphetamine crystalline rock forms) while either transporting drugs or evading law enforcement detection. While this can result in rupture of the package and subsequent overdose, it can also result in bowel obstruction as nondigestible items pass through the body. 

Rhabdomyolysis may be a result of severe overdose but is not likely to result solely in abdominal pain. Dehydration and splenic laceration are not likely to cause this symptom.

98.

Which of the following Electrocardiographic (ECG) findings is MOST characteristic of acute pericarditis?

  • Widespread ST-segment elevation 

  • Deep Q waves in leads II, III, and aVF

  • ST-segment depression in the anterior leads

  • Peaked T waves in the anterior leads

Correct answer: Widespread ST-segment elevation 

Widespread ST-segment elevations that are concave upward across multiple leads are characteristic of acute pericarditis. This differs from the ECG findings in Acute Myocardial Infarction (AMI), which typically presents with ST elevations that are more localized to the area of the heart that is affected. Deep Q waves suggest old myocardial infarction, ST-segment depression may indicate ischemia, and peaked T waves can be seen in hyperkalemia.

99.

A 66-year-old female patient with a history of hypertension and recent chest trauma presents with severe chest pain radiating to the back. Her blood pressure is 190/100 mm Hg, and she has a significant pulse deficit in the right radial artery. 

Which of the following diagnostic tests is MOST likely to confirm the diagnosis of acute aortic dissection?

  • Chest Computed Tomography (CT)

  • Electrocardiogram (ECG)

  • Chest radiography

  • Echocardiogram

Correct answer: Chest Computed Tomography (CT)

Acute aortic dissection is a critical condition characterized by a tear in the inner layer of the aorta, the major artery emanating from the heart. This tear permits blood to flow between the layers of the aorta's wall, leading to separation (dissection) of the layers. If the blood-filled channel breaks through the outer wall of the aorta, it often results in a fatal outcome.

Chest CT (with or without angiography) is the gold standard for diagnosing acute aortic dissection. It provides detailed images of the aorta, allowing visualization of the dissection flap and the extent of the dissection.

ECG is important to rule out other causes of chest pain, such as myocardial infarction, but it cannot diagnose an aortic dissection. A chest x-ray might show a widened mediastinum, which can suggest an aortic dissection, but it is not definitive. It is more useful as a preliminary test. Echocardiogram, particularly transesophageal echocardiography, can be used to visualize the aorta, but it is less commonly used as the initial diagnostic test.

100.

Which of the following heart sounds would the nurse anticipate in a patient with infective endocarditis?

  • Murmur

  • Normal heart sounds

  • Gallop

  • Click

Correct answer: Murmur

Infective endocarditis is a condition in which the inner lining of the heart's chambers and valves, known as the endocardium, becomes infected. This happens when bacteria, fungi, or other microorganisms enter the bloodstream and adhere to damaged heart tissues.

When evaluating a patient with endocarditis, a murmur is typically heard because of the valvular insufficiency associated with the infection. Normal heart sounds are unlikely unless the infection is extremely mild. Gallops and clicks are generally not heard with endocarditis.

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