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Quiz Session - Attempts With Random Questions

BCEN CEN Exam Questions

Page 9 of 50

161.

Which of the following statements accurately describes the symptoms of a Transient Ischemic Attack (TIA)?

 

  • Symptoms have a sudden onset

  • Symptoms include some form of unilateral weakness

  • Symptoms include some form of visual disturbance

  • Symptoms resolve within 12 hours or less

Correct answer: Symptoms have a sudden onset

The symptoms of TIA typically have a sudden onset and present with some form of neurological dysfunction. The symptoms of TIA may include unilateral weakness or visual disturbances. However, symptoms vary based on the individual. Symptoms of TIA can resolve in under an hour or can last for many hours. They generally resolve within 24 hours or less.

162.

Which of the following variables does NOT typically impair the accuracy of pulse oximetry readings?

  • Hyperthermia

  • Pierced earlobe

  • Ambient light

  • Motion artifact

Correct answer: Hyperthermia

Hyperthermia does not typically impair the accuracy of pulse oximetry readings. Pulse oximetry measures the oxygen saturation of hemoglobin in the blood, and hyperthermia does not significantly affect peripheral circulation or the properties of hemoglobin that would influence these readings.

In contrast, variables such as pierced earlobes, ambient light, and motion artifacts can cause inaccuracies. For example, motion artifacts can disrupt the sensor's ability to detect a stable signal, ambient light can interfere with the sensor's ability to read the light absorption correctly, and a pierced earlobe can affect sensor placement and signal detection. A normal arterial oxygen saturation is greater than 95%.

163.

A 72-year-old male patient on warfarin therapy for a previous Deep Vein Thrombosis (DVT) presents with signs of a new DVT. What is the MOST appropriate next step in management?

  • Order a venous duplex ultrasound

  • Increase the warfarin dosage

  • Switch to a Direct Oral Anticoagulant (DOAC)

  • Administer Low Molecular Weight Heparin (LMWH)

Correct answer: Order a venous duplex ultrasound

Venous-doppler sonography will confirm the presence of a new DVT and is the most appropriate next step in management before making any changes to the treatment plan.

Increasing the warfarin dosage should not be done without confirming the diagnosis and considering other potential causes of the symptoms. Switching to a DOAC could be considered, but it should be based on a confirmed diagnosis and a comprehensive review of the patient's medical history and current status, including an ultrasound. Administering LMWH could be an option for immediate anticoagulation, but confirming the diagnosis with imaging is essential first.

164.

In assessing a pregnant patient, it is important to understand which of the following cardiovascular changes occurs in pregnancy?

  • Cardiac output increases by 30%, heart rate increases 15–20 beats/minute, blood pressure decreases 15–20 mm Hg

  • Cardiac output increases by 30%, heart rate decreases 15–20 beats/minute, blood pressure increases 15–20 mm Hg

  • Cardiac output decreases by 30%, heart rate increases 15–20 beats/minute, blood pressure decreases 15–20 mm Hg

  • Cardiac output increases by 30%, heart rate increases 15–20 beats/minute, blood pressure increases 15–20 mm Hg

Correct answer: Cardiac output increases by 30%, heart rate increases 15–20 beats/minute, blood pressure decreases 15–20 mmHg

Normal physiologic changes occur during pregnancy, and these changes should be considered during the assessment of a pregnant woman in the emergency department. From a cardiovascular standpoint, mild hypotension and heart rate elevation are expected findings during pregnancy. Specific changes include an increase of 30% in cardiac output, increase in heart rate by 15–20 beats/minute, and decrease in blood pressure by 15–20 mmHg. It is also important to note that a pregnant woman's circulating blood volume increases by 40% during pregnancy.

165.

A patient expresses concern that they will develop endocarditis. Which of the following recommendations is MOST likely to reduce the risk of endocarditis in the future? 

  • Stop using heroin

  • Avoid going to the dentist

  • Stop smoking

  • Stop using marijuana

Correct answer: Stop using heroin

Intravenous (IV) drug abuse is a significant risk factor for endocarditis, and heroin is a drug that is almost always used intravenously. Stopping heroin use would decrease the risk of developing infective endocarditis. 

While dental procedures do increase the risk of endocarditis, avoiding going to the dentist increases the risk of tooth decay and infection, which can lead to endocarditis. Rather, when going to the dentist, precautions should be taken to reduce the risk of endocarditis. Marijuana is not an IV drug, so stopping marijuana is unlikely to reduce the risk of endocarditis.

166.

Which of the following BEST describes a hard splint?

  • Firm and rigid

  • Nonrigid

  • Inflatable

  • Supportive while providing traction

Correct answer: Firm and rigid

A hard splint is firm and rigid. A soft splint is nonrigid, an air splint is inflatable, and a traction splint has the ability to support fractures while providing traction. Splints are generally removable and come with Velcro straps.

167.

A female patient presents to the emergency department with complaints of lower right quadrant pain. Based on this data alone, which of the following diagnoses can be ruled out? 

  • Splenic infarct

  • Acute appendicitis

  • Ruptured ectopic pregnancy

  • Ovarian torsion

Correct answer: Splenic infarct

Abdominal pain is one of the most common complaints of patients presenting to emergency departments. It is important to adequately assess the pain through inspection, auscultation, percussion, and palpation. Location of the pain should be noted with respect to a specific quadrant. Abdominal pain patterns often correspond to specific etiologies.

Right lower quadrant pain may be caused by an inguinal hernia, acute appendicitis, ovarian torsion or cyst, ruptured ectopic pregnancy, PID, tubo-ovarian abscess, mesenteric adenitis, or Meckel's diverticulitis.

A splenic infarct would most often produce left upper quadrant pain, as this is the location of the spleen.

168.

A 39-year-old female presents to the emergency department after falling onto an outstretched hand during a run. She complains of wrist pain, and you note a deformity of the distal forearm. 

Based on the likely diagnosis of a Colles' fracture, which of the following assessments is MOST critical to perform initially?

  • Check the radial pulse distal to the fracture site

  • Assess for capillary refill in the fingernails

  • Perform a Glasgow Coma Scale (GCS) evaluation

  • Inspect for abdominal trauma

Correct answer: Check the radial pulse distal to the fracture site

In the case of a Colles' fracture, it is crucial to assess for potential vascular injury or compromise, which can be indicated by an absent or weak radial pulse. This assessment is essential for ensuring blood flow to the hand is not compromised. 

While assessing capillary refill can provide information about peripheral circulation, it is not as specific or critical as checking the radial pulse directly at the site of injury to assess vascular integrity specific to the injury. The GCS is important for assessing neurological status, particularly in trauma patients, but it is not the most critical initial assessment for a suspected Colles' fracture. Inspecting for abdominal trauma is important in the context of polytrauma or if the patient's mechanism of injury suggests such injuries, but it is not directly relevant to the initial assessment of a Colles' fracture.

169.

Which neurotransmitter is MOST commonly associated with depressive disorders?

  • Serotonin 

  • Dopamine 

  • Acetylcholine

  • GABA

Correct answer: Serotonin 

Serotonin is the neurotransmitter most commonly linked to depressive disorders due to its crucial role in mood regulation. Low serotonin levels in the brain are strongly associated with depression symptoms. Many antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRIs), increase serotonin availability in the brain to help alleviate these symptoms.

Dopamine, while involved in the brain's reward and pleasure systems and playing a role in mood regulation, is not the primary neurotransmitter associated with depressive disorders. Dopamine dysregulation is more commonly linked to conditions like Parkinson's disease and schizophrenia. Acetylcholine primarily functions in the peripheral nervous system and muscle activation and is involved in memory and learning. Although it has some role in mood regulation, it is not as directly linked to depressive disorders as serotonin. Gamma-Aminobutyric Acid (GABA), the brain's main inhibitory neurotransmitter, helps regulate neuronal excitability and maintain a calming effect. While GABA dysfunction can be related to anxiety and some mood disorders, it is not as strongly associated with depression as serotonin is.

170.

Which of the following medications would NOT be recommended to prevent or treat gout pain and discomfort?

  • Aspirin

  • Ibuprofen

  • Prednisone

  • Colchicine

Correct answer: Aspirin

Aspirin should not be given to gout patients as it interferes with the excretion of uric acid. Ibuprofen is an NSAID, and fast-acting NSAIDs are administered to stop an acute attack. Colchicine can be given to gout patients as long as they are young and healthy and they have acute gout. It is known as the classic gout antidote and is thought to reduce the uric acid crystallization that leads to inflammation. Prednisone and ibuprofen are both recommended for gout patients. Corticosteroids, such as prednisone, help to control inflammation and subsequent pain.

171.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 does which of the following?

  • Protects the patient's privacy in regard to identifiable health information

  • Ensures that all patients receive the same level of care

  • Ensures that all patients are protected from unfair treatment on the basis of race, religion, origin, age, gender, or disability

  • Ensures that all practitioners are qualified to perform their duties

Correct answer: Protects the patient's privacy in regard to identifiable health information

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects the patient's privacy by directing the ways in which health information may be stored, shared, or released.

The Civil Rights Act ensures that all patients receive the same level of care regardless of their race, religion, origin, age, gender, or disability. It is the responsibility of the state's governing board to ensure that all practitioners are qualified to perform their duties.

172.

Which of the following is inflammation of the inner ear that affects the cochlear or vestibular portion?

  • Labyrinthitis

  • Mastoiditis

  • Otitis externa

  • Otitis media

Correct answer: Labyrinthitis 

Labyrinthitis is inflammation of the inner ear structure known as the labyrinth. This structure is divided into two main parts: the cochlea, resembling a snail shell, which processes sound signals for the brain, and the vestibular system, which provides the brain with information about head position and movement. Symptoms commonly associated with labyrinthitis include dizziness (vertigo), nausea, vomiting, imbalance issues, headaches, ringing in the ears (tinnitus), and possible hearing impairment.

Mastoiditis is the result of an infection in the mastoid bone, a significant component of the skull's temporal bone located just behind the ear. Otitis externa, often called "swimmer's ear," is the swelling or infection of the external auditory canal, the passage leading from the external ear to the eardrum. Otitis media is an infection within the middle ear, an air-filled cavity that is situated directly behind the eardrum.

173.

A 68-year-old male patient presents to the emergency department with significant dyspnea and has an oxygen saturation of 86% on room air. He is diagnosed with an acute exacerbation of COPD. 

Which of the following interventions should you initiate FIRST?

  • Administer supplemental oxygen therapy to maintain SpO2 between 88% and 92%

  • Administer oral corticosteroids

  • Administer intravenous antibiotic therapy

  • Administer Non-Invasive Ventilation (NIV)

Correct answer: Administer supplemental oxygen therapy to maintain SpO2 between 88% and 92%

Improving oxygenation is the initial priority in treating an acute exacerbation of COPD with hypoxemia. Oxygen therapy should be titrated to maintain SpO2 between 88% and 92% to avoid worsening hypercapnia, which can occur in COPD patients due to the risk of oxygen-induced hypercapnia.

Oral corticosteroids are an essential component of treatment, but they are not the first-line intervention for immediate relief of hypoxemia. Antibiotics are indicated in the presence of bacterial infection (i.e., increased sputum purulence) but are secondary to stabilizing the patient's oxygenation. Non-Invasive Ventilation (NIV) may be beneficial in severe exacerbations to reduce the work of breathing and improve gas exchange, but the first step is to correct hypoxemia with oxygen therapy. 

174.

Which of the following is the LEAST important consideration when diagnosing foodborne infections? 

  • History of foodborne infection

  • Onset of symptoms

  • Type of clinical symptoms

  • Population affected

Correct answer: History of foodborne infection

Most patients with a foodborne infection present with gastrointestinal symptoms, although other symptoms can be nonspecific. An early and rapid diagnosis is essential for resolution. It is also important to identify potential foodborne infections early to control the outbreak. 

To diagnose foodborne infections, healthcare professionals must consider onset of symptoms (e.g., incubation period), duration of symptoms, type of clinical symptoms, and the population affected. A history of foodborne infection is the least important consideration. 

175.

If a patient has posterior cord syndrome, what sensory loss will they MOST likely experience?

  • Preserved motor function below the lesion

  • Complete lower extremity sensory loss

  • Complete loss of pain sensation below the lesion

  • Ipsilateral paraplegia

Correct answer: Preserved motor function below the lesion

A patient with posterior cord syndrome will most likely experience a preserved perception of pain, preserved motor function, and preserved temperature sensation. In addition, they will lose perception of deep touch, proprioception, and vibration.

Patients with cauda equina syndrome will most likely experience lower extremity sensory loss. Patients with anterior cord syndrome will most likely experience the loss of pain below the lesion. Patients with Brown-Sequard syndrome will most likely experience ipsilateral paraplegia.

176.

A patient in the ER who has just had a Transient Ischemic Attack (TIA) has an ABCD score of 7. Which of the following should the nurse advocate for this patient?

  • Admission for observation

  • Emergency surgery

  • Discharge home with anticoagulants

  • Discharge home with neurology follow-up

Correct answer: Admission for observation

The ABCD assessment tool provides a score based on the following criteria:

  • Age
  • Blood pressure
  • Clinical features of a TIA
  • Duration of symptoms / Diabetes history

The lowest ABCD score is 0 and indicates a low risk of stroke following a TIA. The highest ABCD score is 7 and indicates a higher risk of stroke following a TIA.

The criteria for the ABCD score do not indicate a need for surgery. The higher risk of stroke indicates a need for monitoring, so the patient should not be discharged.

177.

Which finding is LEAST expected in a patient who has been diagnosed with Deep Vein Thrombosis (DVT)?

  • Hyperglycemia

  • Swelling distal to the location of pain

  • Mild elevation in temperature

  • Deep muscle tenderness

Correct answer: Hyperglycemia

Deep Vein Thrombosis (DVT) occurs when a blood clot, also known as a thrombus, develops in the deep veins of the body, often in the legs. This condition may lead to symptoms such as swelling or pain in the leg, although it can sometimes present without any noticeable symptoms. DVT is a critical condition due to the risk of the blood clot dislodging and traveling to the lungs, where it can obstruct blood circulation (known as pulmonary embolism), posing a severe, potentially fatal risk.

Symptoms of DVT include:

  • Swelling in the leg that is impacted, occasionally in both legs
  • Leg pain that typically originates in the calf, characterized by cramping or aching
  • Red or discolored skin on the affected leg
  • A sensation of warmth in the affected leg

Hyperglycemia is not associated with the development of DVT. 

178.

Which of the following is a common cause of distributive shock?

  • Sepsis

  • Myocardial infarction

  • Severe dehydration

  • Tension pneumothorax

Correct answer: Sepsis

Sepsis is a systemic inflammatory response to infection that leads to widespread vasodilation, increased capillary permeability, and eventual hypotension and shock. This process characterizes distributive shock, in which blood vessels lose their tone and blood is not effectively distributed to tissues, resulting in inadequate tissue perfusion and oxygenation. Sepsis is a well-known and common cause of distributive shock.

A myocardial infarction is primarily associated with cardiogenic shock, which occurs when the heart's ability to pump blood is severely compromised due to damage to the heart muscle, leading to reduced cardiac output and inadequate tissue perfusion. Severe dehydration leads to hypovolemic shock, which occurs due to significant fluid loss (from vomiting, diarrhea, hemorrhage, or dehydration), which reduces the overall blood volume, leading to decreased cardiac output and tissue perfusion. A tension pneumothorax causes obstructive shock, which occurs when a physical obstruction impedes blood flow, such as in a tension pneumothorax, when air trapped in the pleural space increases pressure on the heart and great vessels, reducing cardiac output and leading to shock.

179.

A 55-year-old male patient presents with symptoms of fatigue, dizziness, and dry mucous membranes. He reports that he has been experiencing persistent vomiting and diarrhea for the past three days. The patient appears to be lethargic and complains of severe thirst.

You order a series of blood tests and the results show:

  • Increased hematocrit
  • Increased serum osmolality
  • Increased serum sodium

Based on these findings, which of the following fluid and electrolyte imbalances does the patient MOST likely have?

  • Dehydration

  • Syndrome of inappropriate diuretic hormone

  • Hypervolemia

  • Water excess syndrome

Correct answer: Dehydration

Dehydration is characterized by increased hematocrit, serum osmolality, and serum sodium due to the loss of water and electrolytes, which concentrates the blood.

Syndrome of Inappropriate Diuretic Hormone (SIADH) is characterized by decreased hematocrit, serum osmolality, and BUN along with a urine specific gravity greater than 1.005.

Water excess syndrome is indicated by a serum osmolality of less than 280 mOsm/kg, decreased serum sodium, and decreased hematocrit.

Hypervolemia is characterized by decreased hematocrit, serum osmolality, and BUN, along with a urine specific gravity of less than 1.010.

180.

Which of the following statements accurately describes the condition of a patient experiencing Diabetic Ketoacidosis (DKA)?

  • The patient's blood glucose typically increases to greater than 250 mg/dL, and blood serum ketones are greater than 5 mEq/L

  • The patient's blood glucose typically increases to greater than 600 mg/dL, and blood serum ketones remain normal

  • The patient's blood glucose typically decreases to less than 250 mg/dL, and blood serum ketones are greater than 10 mEq/L

  • The patient's blood glucose typically decreases to less than 100 mg/dL, and blood serum ketones remain normal

Correct answer: The patient's blood glucose typically increases to greater than 250 mg/dL, and blood serum ketones are greater than 5 mEq/L

In DKA, the patient's blood glucose levels typically exceed 250 mg/dL, and their blood serum ketones are greater than 5 mEq/L. DKA often presents as a first sign of type I diabetes. It is characterized by metabolic acidosis and elevated ketone levels in the blood. In contrast, Hyperglycemic Hyperosmolar Syndrome (HHS) presents with blood glucose levels exceeding 600 mg/dL without significant ketone formation, as ketone levels remain normal.

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