BCEN CEN Exam Questions

Correct answer: Loop diuretics 

Loop diuretics, such as furosemide (Lasix), are often the first line of treatment to quickly reduce fluid overload in patients with acute decompensated heart failure. By promoting diuresis, they help decrease preload (by causing an almost immediate venous dilation) and alleviate symptoms of pulmonary congestion.

Beta-blockers are essential for managing chronic heart failure but are not typically used as initial treatment in acute decompensated heart failure due to their negative inotropic effects. ACE inhibitors are important in the long-term management of heart failure because they reduce afterload and prevent remodeling, but they are not the immediate treatment choice in acute cases. Calcium channel blockers are generally not used in acute decompensated heart failure due to their negative inotropic effects and potential to exacerbate heart failure.

Correct answer: Spinal nerves

The spinal nerves, along with the cranial and peripheral nerves, are components of the peripheral nervous system.

The brain and spinal cord are components of the central nervous system. The sympathetic and parasympathetic nervous systems are components of the autonomic nervous system.

The neurologic system includes the central nervous system, the peripheral nervous system, and the autonomic nervous system.

Correct answer: Orbital cellulitis

Orbital cellulitis is a critical condition in which the eye's surrounding soft tissue and fat become infected. This infection usually begins with bacteria, often stemming from a sinus infection or adjacent facial areas like the eyelids or tear ducts. It then extends into the eye's surrounding tissues, leading to inflammation and swelling. Without timely treatment, it could result in severe outcomes, such as vision loss or the spread of infection to the brain. Immediate medical evaluation and treatment are essential to avert these severe consequences and maintain eye health. The standard treatment involves hospitalization and intravenous antibiotics. In severe cases, surgical intervention might be necessary to remove pus or decrease pressure around the eye.

Individuals with conjunctivitis should be closely observed for signs of diminishing vision and corneal ulceration. Those with iritis and uveitis should be monitored for permanent vision loss and macular edema. Patients with glaucoma require vigilant monitoring for visual disturbances, including blind spots, tunnel vision, and complete loss of sight.

Correct answer: Increased expiratory effort 

An increased expiratory effort is an indication of worsening respiratory distress and may indicate impending respiratory failure as less air is moving into and out of the lungs efficiently. 

A respiratory rate of 30–60 breaths per minute is considered normal. Irritability, crying, and poor feeding are to be expected in the acutely ill pediatric patient.

Correct answer: Use of ACE inhibitors 

Angioedema is a medical condition characterized by deep swelling beneath the skin's surface, often around the eyes and lips, though it can also involve deeper layers of the skin, throat, hands, and feet. The swelling is usually abrupt, it can be severe, and in cases when the throat is involved, it may lead to life-threatening airway obstruction.

Angioedema is frequently associated with the use of Angiotensin-Converting Enzyme (ACE) inhibitors, which can cause an accumulation of bradykinin leading to increased vascular permeability and subsequent swelling. Chronic hypertension is a condition that might be managed with ACE inhibitors but is not a direct cause of angioedema. Long-term steroid therapy and the overuse of antihistamines are not commonly linked to the development of angioedema.

Correct answer: Hypotension 

Nursing management of a patient with increased ICP includes frequent neurological monitoring of the following early signs and symptoms:

• constant, worsening headache
• vomiting
• restlessness
• increased heart rate
• hypertensive episodes (not hypotension)
• decreased mental abilities
• confusion
• pupillary changes (double vision or pupils that do not respond to changes in light)
• reduced motor strength on the opposite side of the lesion/injury

Correct answer: With antitoxins, antibiotics, and vaccination

A tetanus infection should be managed with antitoxins, antibiotics, and vaccination. Early identification and treatment are critical for patients facing a life-threatening tetanus infection. Tetanus is characterized by an acute onset of hypertonia, painful muscular contractions (jaws and neck), and generalized muscle spasms without other apparent medical causes. The majority of patients present with "lockjaw," or an inability to open the mouth. Patients with tetanus should be monitored in an intensive care unit. 

A rabies infection should be managed by cleaning the wound with virus-killing soap. A wound botulism infection should be managed with debridement of the wound, antitoxin therapy, and antibiotics. Cat scratch fever should be managed with antipyretics, analgesics, and heat applied to the infected area.

Correct answer: Place the patient in a lateral recumbent position

The lateral recumbent position helps maintain an open airway, which is crucial in the postictal phase to prevent aspiration of secretions and ensure the patient continues to breathe adequately. This position facilitates drainage of secretions and reduces the risk of airway obstruction.

Lorazepam is used to stop active seizures, but the patient is no longer seizing and is currently in the postictal phase. It is important to ensure the patient's safety by removing nearby hazards, but postictal physical restraint is not appropriate and can lead to additional injuries or complications. There is no indication in this context that the patient has hypoglycemia, and routine administration of dextrose without evidence of hypoglycemia is not appropriate.

Correct answer: Hormonal fluctuations

Hormonal fluctuations are a common trigger for migraines, especially in women, and can be associated with the menstrual cycle. A migraine headache is considered a primary headache, which means no organic cause can be identified. Since this patient has a history of similar headaches around her menstrual cycle, hormonal fluctuations are a likely cause.

The patient in the scenario does not report fever, stiff neck, or confusion, which are common signs of meningitis. She also does not exhibit other neurological symptoms that would suggest encephalitis. The patient is younger than the typical age group affected by temporal arteritis and does not report jaw claudication or vision problems.

Correct answer: Administration of vasoconstrictive medication 

Pulse oximetry is a noninvasive and painless test that measures the oxygen saturation level of a patient's hemoglobin. It can rapidly detect even small changes in how efficiently oxygen is being carried to the extremities farthest from the heart, including the legs and the arms. Normal values range from 95% to 100%, while readings of 85% or less may indicate inadequate tissue oxygenation. Pulse oximetry is useful when monitoring a patient during procedures such as surgery or conscious sedation, evaluating the response to an intervention, or continuously monitoring a patient at risk of desaturation and hypoxia. 

Due to the narrowing of the blood vessels and subsequent decreased blood flow to the extremities, a pulse oximetry reading may not be reliable when administering vasoconstrictive medications.

Correct answer: Hyperkalemia

Crush syndrome, also known as traumatic rhabdomyolysis, is a severe medical condition that occurs when a prolonged force or pressure is applied to a large area of the body, often resulting from being trapped under collapsed buildings or heavy machinery or after prolonged immobilization following an accident. This pressure leads to muscle cell damage and the death of muscle fibers.

Hyperkalemia is a critical complication of crush syndrome due to the massive release of intracellular potassium into the bloodstream following muscle cell destruction. It can lead to life-threatening cardiac arrhythmias. The other options, while potential metabolic disturbances, are not the primary focus in crush syndrome management.

Correct answer: N-acetylcysteine (NAC)

Acetaminophen poisoning remains the leading cause of acute liver failure in the United States. The metabolites of acetaminophen are toxic and destroy hepatocytes, leading to hepatic necrosis, then hepatic failure. Those with a history of alcohol abuse or liver disease are at an increased risk for acetaminophen poisoning. 

The antidote that is administered for acetaminophen toxicity is N-acetylcysteine (NAC). It is indicated if the patient's serum level falls within the toxic range or is >150 mg at the four-hour mark. For best results, it should be administered within eight hours of ingestion, but it may still be effective if given within 24 hours of ingestion. It can be given orally or intravenously. Activated charcoal absorbs acetaminophen in the gastrointestinal tract but does not reverse its effects in the body.

Sodium bicarbonate can be a useful therapy in toxic ingestions of sodium channel blocking agents, salicylates, and toxic alcohols. Hemodialysis may be indicated for poisoning by salicylates, theophylline, metformin, lithium, ethylene glycol, barbiturates, and valproic acid. 

Correct answer: Immediate placement of a new peritoneal dialysis catheter

Recurrent peritonitis in a patient using peritoneal dialysis typically requires antibiotic treatment, which is initiated promptly. If the infection does not resolve or is severe, the peritoneal dialysis catheter may need to be removed to prevent further complications. During this period, a hemodialysis catheter is placed to continue dialysis treatments. Placement of a new peritoneal dialysis catheter is considered after the infection is fully resolved, not during the initial treatment phase.

Correct answer: Mortality of depression is measurable

The mortality of depression is measurable and is due almost entirely to suicide. Suicide rates are much higher for patients with depression than for those with other mental illnesses. Most suicide attempts are expressions of extreme distress, not a bid for attention. Substance abuse is often used as a method to self-treat depression, not as preparation for a suicide attempt.

Correct answer: A 34-year-old male with bipolar disorder

Acetaminophen overdoses are generally intentional in adults and unintentional in children. In a seven-year-old female with attention-deficit/hyperactivity disorder, an acetaminophen overdose is likely to be unintentional due to her age. Lortab is a narcotic medication containing acetaminophen. A patient addicted to Lortab may have an unintentional acetaminophen overdose while misusing Lortab. A patient with acute dental pain may unintentionally overdose on acetaminophen while attempting to treat their pain. Bipolar disorder causes periods of depression and increases the likelihood that an acetaminophen overdose is intentional.

Correct answer: Oseltamivir 

Oseltamivir (Tamiflu) is an antiviral often administered to treat viral influenza. It should be administered in conjunction with supportive care treatment, including hydration and nutrition. Rapid antigen tests for influenza can be carried out using nasal or throat swabs. The most effective strategy for prevention of influenza is annual influenza vaccination. 

Entecavir, lamivudine, and tenofovir are antivirals that are FDA approved for the treatment of Hepatitis B Virus (HBV). 

Correct answer: You should squeeze the tick as you are removing it from the patient

You should not squeeze or crush the tick as you remove it from the patient, as this could cause the tick's internal contents to be inadvertently released. You can use viscous lidocaine at the site before removing the tick from the patient. You should wear gloves and remove the tick using a steady upward-pulling motion. After completely removing the tick, thoroughly disinfect the bite site and wash your hands. If the tick is to be sent for analysis, place it in a sterile specimen container and label it. 

Correct answer: There is no evidence-based blood pressure target

Medical management of acute aortic dissection is based on clinical judgment. There is not an evidence-based blood pressure target. It is important to reduce stress on the aortic aneurysm while optimizing perfusion. Intravenous beta-blockers can be used to manage blood pressure and reduce the force of the heart's contractions. Nitroglycerin and nitroprusside cause vasodilation, leading to both decreased blood pressure and afterload. 

Hypotension and hypertension should both be avoided. However, of the two, hypotension is generally considered preferable. Management should include systolic blood pressure, not MAP, as systolic blood pressure represents the maximum pressure on the aortic wall.

Correct answer: Wear glasses instead of contact lenses

Keratitis is inflammation of the cornea and is often associated with contact lens use. Reducing the use of contact lenses or using single daily-use contact lenses may help to reduce the incidence of keratitis. 

Wearing protective glasses while working will protect the eye health of people only in certain professions and will not be more protective against keratitis than reducing contact lens use. An eye with keratitis should not be patched. While it is important not to touch the infected eye and to perform hand hygiene to prevent cross-contamination, completely avoiding touching or rubbing one's eyes may not be practical and is not as helpful in resolving keratitis as avoiding the use of contact lenses. 

Correct answer: Viral croup

Viral croup, also known as laryngotracheobronchitis, is recognized as the most frequent cause of upper airway obstruction in children. This condition typically presents with a characteristic barking cough and stridor. Children may also have a hoarse voice and experience tachypnea and tachycardia. It is most common in children aged six months to three years and is usually caused by parainfluenza viruses​.

Pneumonia is an infection in the lungs, causing inflammation of the air sacs. While pneumonia is a significant illness in children, it is not a common cause of upper airway obstruction. Rather, it causes lower respiratory tract issues such as difficulty breathing, cough, and fever. Epiglottitis is a potentially life-threatening condition characterized by inflammation and swelling of the epiglottis. It can cause acute airway obstruction and requires immediate medical attention. Due to widespread vaccination against Haemophilus influenzae type B (Hib), the incidence of epiglottitis has significantly decreased, making it a less common cause of upper airway obstruction than viral croup. ​Foreign body aspiration can lead to upper airway obstruction, especially in young children. Symptoms include sudden onset of coughing, choking, and respiratory distress. While it is a critical emergency when it occurs, the overall frequency of foreign body aspiration is lower than that of viral croup.