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Quiz Session - Attempts With Random Questions

BCEN CEN Exam Questions

Page 8 of 50

141.

Right Upper Quadrant (RUQ) pain would BEST be evaluated by which of the following?

  • Ultrasound

  • Computed Tomography (CT)

  • Magnetic Resonance Imaging (MRI)

  • Endoscopy

Correct answer: Ultrasound

American College of Radiology guidelines recommend ultrasound as the initial imaging study for RUQ pain due to its effectiveness in diagnosing conditions such as cholecystitis, gallstones, and liver pathology.

If the pain is located in the right or left lower quadrant, a CT scan is recommended for assessment. MRI is usually considered when further evaluation is needed after initial ultrasound or CT scans. Endoscopy is used primarily to evaluate the gastrointestinal tract, including the esophagus, stomach, and duodenum. It is not typically used for the initial evaluation of RUQ pain as it does not provide images of the liver, gallbladder, or biliary system.

142.

You are instructing a patient in the proper way to administer ophthalmic medication. Which of the following should you AVOID including in your instructions?

  • Pull up the upper eyelid

  • Have the patient look up

  • Have the patient blink gently to distribute the solution

  • Instruct the patient not to close their eyelids tightly

Correct answer: Pull up the upper eyelid 

Interventions for ocular emergencies, especially bacterial conjunctivitis, often involve the administration of ophthalmic medications. It is the responsibility of the nurse to instruct the patient in proper administration, which should include a demonstration: pull the lower eyelid down, have the patient look up, instill one or two drops into the cul-de-sac, then have the patient blink gently to distribute the solution. Instruct the patient not to squeeze the eyelids tightly, as this will cause medication to leak out of the eye.

143.

A 37-year-old patient presents to the emergency department with difficulty breathing and a hoarse voice following a sudden onset of symptoms. On examination, the patient is found to have swelling in the region containing the vocal cords. 

Which part of the pharynx is MOST likely affected?

  • Larynx

  • Epiglottis

  • Tonsils

  • Adenoids

Correct answer: Larynx

The larynx, also known as the voice box, contains the vocal cords, which are crucial for breathing, swallowing, and vocalization. The vocal cords open during inhalation and close during swallowing and vocalization.

The epiglottis is a flap of tissue that prevents food and irritants from entering the lungs during swallowing. The tonsils and adenoids are part of the immune system and help protect against infections but are not involved in vocalization or breathing.

144.

In the management of a patient with hemorrhagic stroke, which of the following is the MOST appropriate initial step?

  • Control of blood pressure 

  • Administration of intravenous alteplase

  • Immediate anticoagulation therapy

  • Physical therapy assessment

Correct answer: Control of blood pressure 

A hemorrhagic stroke occurs when a blood vessel in the brain ruptures or leaks blood. This bleeding can occur within the brain tissue itself (intracerebral hemorrhage) or in the spaces surrounding the brain (subarachnoid hemorrhage). While it is less common than ischemic stroke, it does tend to be more lethal. High blood pressure is aggressively managed in hemorrhagic stroke to prevent further bleeding. 

Alteplase, a thrombolytic agent, is contraindicated in hemorrhagic stroke as it can increase bleeding. Anticoagulants are also contraindicated due to the risk of exacerbating bleeding. While important in rehabilitation, physical therapy assessment is not an initial acute management step.

145.

What is the MOST common risk factor for acute aortic dissection?

  • Familial history

  • Atherosclerosis

  • Cocaine use

  • Bicuspid aortic valve

Correct answer: Familial history

This life-threatening condition is a result of a tear in the intimal layer of the aorta, allowing blood flow to enter the aortic media. As blood surges through the tear, propelled by the pulsatile flow and high pressures within the aorta, the inner and middle layers of the aorta dissect. Pressures within this blood-filled channel can compress the true aortic lumen and reduce blood flow through aortic branch vessels. If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is often fatal.

Hypertension and/or immediate familial history are the most common risk factors, followed by atherosclerosis. Bicuspid aortic valve and cocaine use are also risk factors for this emergent condition. Most often, the patient experiences sudden severe chest or upper back pain, described as a tearing, ripping or shearing sensation that radiates to the neck or down the back.

146.

A 44-year-old female patient with a tibial fracture after a motor vehicle accident and a newly applied cast reports severe pain, a cool sensation in her foot, and an inability to move her toes. Which of the six P's is MOST concerning in this scenario?

  • Paralysis

  • Pain

  • Poikilothermia

  • Pallor

Correct answer: Paralysis

Paralysis indicates severe neurovascular compromise, possibly leading to permanent damage if not promptly addressed, and is the most concerning symptom in this context. 

Pain is also concerning but can be due to various factors, including the injury itself and inflammation. Poikilothermia (cool sensation) suggests impaired blood flow, which is concerning but secondary to the inability to move. Pallor indicates decreased blood flow but does not carry the same immediate risk of permanent damage as paralysis.

147.

Which of the following is an aggressive method of correctly treating a hordeolum?

  • Incision and drainage

  • Surgical resection

  • Antibiotic therapy

  • Warm compresses

Correct answer: Incision and drainage

A hordeolum, often referred to as a sty, is an acute infection or inflammation that occurs at the edge of the eyelid, affecting either the hair follicles of the eyelashes (external hordeolum) or the meibomian glands (internal hordeolum). This condition is typically caused by a bacterial infection, most commonly by Staphylococcus aureus. While a hordeolum often resolves on its own by rupturing, it may sometimes need more aggressive treatment, such as incision and drainage.

Warm, moist compresses for five to ten minutes three to five times a day is a more conservative method of treating a hordeolum. If the stye is unresponsive to warm compresses, ophthalmic antibiotic ointment can be used. These interventions are typically attempted prior to performing incision and drainage. Surgical resection is not an appropriate treatment method. 

148.

What is the TYPICAL causative organism of epiglottitis in children?

  • Haemophilus influenzae

  • Streptococcus pneumoniae

  • Mycoplasma pneumoniae

  • Respiratory Syncytial Virus (RSV)

Correct answer: Haemophilus influenzae

Epiglottitis is an acute inflammation of the epiglottis and is life-threatening when caused by bacteria. Other more rare etiologies of epiglottitis include upper airway burns and direct trauma. It is most common in unimmunized children, as they are more susceptible to Haemophilus influenzae. Overall, cases of bacterial epiglottitis have declined since the Haemophilus influenzae type B vaccination was approved and routinely administered.

Streptococcus pneumoniae and Mycoplasma pneumoniae are more commonly associated with pneumonia. RSV is a common cause of bronchiolitis.

149.

Which of the following is likely to be TRUE for a patient who has an intraocular foreign body?

  • Ultrasonography may be necessary to locate the foreign body

  • The presence of the foreign body will be obvious to the clinician assessing the patient 

  • The presence of the foreign body will be obvious to the patient

  • The foreign body will cause significant discomfort

Correct answer: Ultrasonography may be necessary to locate the foreign body

Intraocular foreign bodies are foreign bodies that penetrate the globe and then remain inside the globe. They are usually quite small, and the entry site is difficult to locate. The presence of a foreign body may not be obvious to the clinician assessing the patient or even to the patient. Many patients experience only slight discomfort and have normal visual acuity. Ultrasonography or a CT scan may be necessary to locate a foreign body within the globe.

150.

Increased intra-abdominal volume and pressure could decrease diaphragmatic excursion. Which of the following is LEAST likely to increase intra-abdominal volume and pressure?

  • Emphysema

  • Ascites

  • Hepatomegaly

  • Pregnancy

Correct answer: Emphysema

Emphysema would not cause an increase in intra-abdominal volume and pressure; however, it would cause an increase in intrathoracic volume.

Gaseous abdominal distension, ascites, pregnancy, and hepatomegaly could all cause an increase in intra-abdominal volume and pressure.

151.

When an individual moves his eyes from side to side, which cranial nerve is at work?

  • Abducens

  • Trochlear

  • Facial

  • Optic

Correct answer: Abducens

The abducens nerve (CN VI) is at work when the eyes move laterally. The trochlear nerve (CN IV) allows for downward and inward eye movements, and the optic nerve (CN II) controls vision. The facial nerve (CN VII) controls facial expressions as well as taste on the anterior two-thirds of the tongue. 

152.

A patient who was diagnosed with tonsillitis and discharged with antibiotics a week ago returns with worsening symptoms that include drooling, dysphagia, and a muffled voice. 

Which of the following should you anticipate as a diagnosis?

  • Peritonsillar abscess

  • Tonsillitis exacerbation

  • Post-surgical complication

  • Ludwig's angina

Correct answer: Peritonsillar abscess

A peritonsillar abscess can develop when treatment of tonsillitis is unsuccessful. Symptoms occur due to localized swelling that occurs as the abscess develops, which can include drooling, dysphagia, and a muffled voice. A tonsillitis exacerbation does not adequately explain symptoms connected with airway changes. Postsurgical complications could explain the symptoms if the tonsillitis had been managed surgically, but this was not the case. Ludwig's angina may explain these symptoms, but a peritonsillar abscess is much more likely given the patient's history.

153.

The nurse is caring for a patient who has sustained a serious electrical burn. How should the nurse BEST document the burn?

  • Describe the injury anatomically

  • Measure the body surface area of the burn sites 

  • Measure the distance between the contact points and count the body surface area burned as the square of the distance

  • Imaging is necessary to correctly describe the burn

Correct answer: Describe the injury anatomically

For an electrical burn, documenting the injury anatomically is most important. 

Describing the injury is more important than calculating the percentage of Body Surface Area (BSA) burned. The nurse may measure the BSA at the contact sites, but this is not as important as describing the injury. Measuring the distance between the contact points and counting the body surface area burned as the square of the distance is not a correct assessment method. Imaging may help improve understanding of the extent of the burn, but the nurse can document the burn by describing it anatomically.

154.

A Waddell triad is the combination of injuries that a child often sustains when struck by a vehicle. Which of the following is NOT one of the Waddell triad injuries?

  • Wrist

  • Chest

  • Head

  • Femurs

Correct answer: Wrist

The Waddell triad is associated with high-velocity accidents, typically motor vehicle, auto-pedestrian, and bicycle collisions.

The triad includes injuries to the chest/abdomen, head, and femurs. When a child is struck by a vehicle's bumper, their leg is generally struck. When a child is struck by the hood of a vehicle, their head, chest, and abdomen are usually injured. If the child is small enough, they will be run over when struck by the hood of a vehicle, as children can go under the vehicle after they are knocked down.

155.

How should a full-thickness burn be dressed if a patient has a small burn that covers LESS than 10% of the body's total surface area?

  • Clean the wound and apply silver sulfadiazine

  • With a dry dressing

  • With a sterile sheet

  • The burn should not be dressed

Correct answer: Clean the wound and apply silver sulfadiazine

A small burn that covers less than 10% of the body's total surface area should be cleaned with warm saline and chlorhexidine gluconate solution to remove dirt and debris, and silver sulfadiazine (Silvadene) should be applied. 

A large burn that covers more than 10% of the body's total surface area should be dressed with a dry dressing or a sterile sheet. A water-based ointment, such as bacitracin, should be applied to partial-thickness burns using a primary and secondary dressing method. For burns of specialized anatomical areas (face, ear, eye, hand, genitalia, feet), a burn center should be consulted before wound management is initiated.

156.

A patient presents with sudden severe chest pain, hypotension, and jugular venous distension following a recent myocardial infarction. Which diagnosis should be highly suspected?

  • Myocardial rupture

  • Pulmonary embolism

  • Aortic dissection 

  • Tension pneumothorax

Correct answer: Myocardial rupture

Myocardial rupture should be highly suspected in a patient presenting with sudden severe chest pain, hypotension, and jugular venous distension following a recent myocardial infarction. Myocardial rupture is a catastrophic complication of myocardial infarction, occurring when the heart muscle tears. The presentation includes sudden chest pain, hemodynamic instability, and signs of cardiac tamponade (such as jugular venous distension), which result from the rupture leading to blood leaking into the pericardial sac and compressing the heart.

Although pulmonary embolism can cause sudden severe chest pain and hypotension, it is less likely in the context of a recent myocardial infarction. Jugular venous distension can occur with massive pulmonary embolism, but it is not as strongly associated with the specific post-myocardial infarction scenario presented. Aortic dissection also presents with sudden severe chest pain and can cause hypotension. However, it is less associated with jugular venous distension and is not directly related to the recent myocardial infarction. The pain in aortic dissection is often described as tearing and radiates to the back, which differentiates it from myocardial rupture. Tension pneumothorax can present with sudden severe chest pain, hypotension, and jugular venous distension. However, this condition is usually associated with absent breath sounds on the affected side and with tracheal deviation, which are not mentioned in the scenario. Additionally, tension pneumothorax is less likely than myocardial rupture to occur after a recent myocardial infarction.

157.

Which of the following indicates that reversal of ketonemia and hyperglycemia in Diabetic Ketoacidosis (DKA) has been unsuccessful? 

  • Anion gap of more than 12 mEq/L

  • Serum glucose less than 200 mg/dL

  • Venous pH above 7.3

  • Serum bicarbonate level of 15 mmol/L or greater

Correct answer: Anion gap of more than 12 mEq/L

Reversing ketonemia and hyperglycemia is a goal when treating diabetic ketoacidosis. Reversal occurs when serum glucose is less than 200 mg/dL and at least two of the three measures of acidosis are improving: 

  • anion gap of 12 mEq/L or less
  • venous pH greater than 7.3
  • serum bicarbonate level of 15 mmol/L or greater

158.

A homeless patient is admitted to the emergency department after being outside on a cold winter night. The nurse suspects severe hypothermia in the patient due to which of the following findings?

  • Decreased heart rate 

  • Shivering 

  • Confusion 

  • Pale skin 

Correct answer: Decreased heart rate 

Hypothermia can cause a decrease in heart rate as the body's metabolic processes slow down in response to the cold. As the core temperature drops, the heart rate diminishes to conserve energy, making bradycardia a significant clinical indicator of hypothermia.

Shivering is an early sign of hypothermia, indicating the body's attempt to generate heat through muscle activity. However, shivering may cease as hypothermia progresses to a more severe stage, making it an unreliable indicator of advanced hypothermia.

Confusion is a common symptom in hypothermia due to the brain’s impaired function at lower temperatures. However, confusion can also be caused by other conditions, such as hypoglycemia, intoxication, or head injury, so it is not exclusive to hypothermia.

Pale skin is a less specific symptom that can result from various conditions, including anemia, shock, and peripheral vasoconstriction. While pale skin might be observed in hypothermia, it is not as definitive for diagnosing this condition as the decrease in heart rate.

159.

A 24-year-old female arrives at the emergency department with drowsiness, slowed breathing, and pinpoint pupils. The patient's friend suspects an unintentional overdose of a medication taken for pain. 

Which of the following substances is the patient MOST likely to have overdosed on?

  • Opioids

  • Salicylates 

  • Acetaminophen

  • Benzodiazepines 

Correct answer: Opioids

The clinical presentation of drowsiness, respiratory depression, and pinpoint pupils is characteristic of an opioid overdose. These symptoms are a direct result of opioid effects on the central nervous system and respiratory center in the brain. Acetaminophen overdose typically presents with liver toxicity and may not initially show significant symptoms. Salicylate (aspirin) overdose can lead to tinnitus, hyperventilation, and metabolic acidosis, while benzodiazepines may cause drowsiness and respiratory depression but are less likely than opioids to cause pinpoint pupils.

160.

Assessing which of the following reflexes can help the emergency nurse determine whether meningitis is present?

  • Brudzinski reflex

  • Chvostek sign

  • Babinski reflex

  • Tinel's sign

Correct answer: Brudzinski reflex

A positive Brudzinski reflex elicits flexion of the hip and knees when the neck is flexed anteriorly. A positive Brudzinski reflex is an indicator of meningeal irritation consistent with meningitis. The Chvostek sign is used to assess for hypocalcemia. The Babinski reflex is a newborn reflex and indicates severe neurological compromise in adults. Tinel's sign is used to assess for carpal tunnel syndrome.

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