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Quiz Session - Attempts With Random Questions

BCEN CFRN CTRN Exam Questions

Page 3 of 50

41.

Night-vision deterioration begins to occur at what altitude? 

  • 5,000 feet

  • 10,000 feet

  • 15,000 feet

  • 4,000 feet

Correct answer: 5,000 feet

Vision is the first of the senses to be affected by a lack of oxygen. This is especially true of night vision, which begins to deteriorate at 5,000 feet of altitude. Color vision starts to deteriorate between 5,000 and 10,000 feet. 

42.

Regarding the Commission on Accreditation of Medical Transport Systems (CAMTS) safety initiatives, which of the following statements is most accurate?

  • Medical air crew must perform adult, pediatric, and infant intubations on a quarterly basis to maintain competency

  • The provision of patient care is paramount during medical air transport missions

  • Crew members of medical air transport may remove seatbelts as needed to deliver patient care

  • Flight crew suits must be able to be pulled 1/8" away from the body

Correct answer: Medical air crew must perform adult, pediatric, and infant intubations on a quarterly basis to maintain competency

The Commission on Accreditation of Medical Transport Systems (CAMTS) has established safety initiatives which must be adhered to by all members of the medical air transport crew in order to maintain accreditation. Of paramount importance is that safe aircraft operations must take precedence over the provision of patient care during medical air transport missions. All flight crew members are required to wear flight suits, which are flame retardant, and can be pulled away from the body by 1/4". The crew is expected to wear seatbelts at all times except when traveling at altitude during level flight, or if the pilot in command (PIC) requests that seatbelts be removed. 

Medical air crew members are required to complete at least 5 endotracheal intubations prior to beginning flying missions; these may be performed live, on cadavers, or another high fidelity intubation (not simulation). Once approved for flying missions, current CAMTS safety initiatives requires that the air medical crew complete 9 intubations (3 infant, 3 pediatric, and 3 adult) each quarter.

43.

The medical crew of an air transport program is preparing to transport a patient with an esophageal obstruction. All of the following most important patient assessment criteria should be determined prior to transport except:

  • Propensity for motion sickness

  • Gastric venting property

  • Ability to swallow secretions

  • Ability to protect the airway

Correct answer: Propensity for motion sickness

Esophageal obstructions commonly occur as a result of foreign body, tumors, and esophageal strictures. The ability to vent the upper gastrointestinal tract is critically important during air transport, particularly if the flight path occurs through very high altitude (35,000 feet) and there is risk of rapid decompression. If possible, a gastric tube for decompression should be placed prior to air transport, and intermittent suction applied to allow for equalization of pressure. Also of critical importance is the patient's ability to clear upper airway secretions through swallowing, and the ability to protect their own airway.

Concern of motion sickness is legitimate during air transport, for all patients, and while this potential should be assessed for, it is not one of the most important assessment criteria, and can be attended to once the other assessment components have been addressed.

44.

An adult patient is loaded head forward into the air medical transport aircraft in preparation for departure. According to patient transport standards established by the Commission for Accreditation of Medical Transport Systems (CAMTS), how must this patient be secured prior to liftoff?

  • With the use of 3 cross straps and a shoulder harness

  • With the use of 3 cross straps

  • With the use of a shoulder harness

  • With the use of pads inserted into the pad voids and 2 cross straps and a shoulder harness

Correct answer: With the use of 3 cross straps and a shoulder harness

The Commission for Accreditation of Medical Transport Systems (CAMTS) is responsible for patient safety standards which must be maintained during medical air transport. Regardless of patient position in the aircraft, the patient must be secured by the use of 3 cross straps—positioned at the chest, hips, and knees. In addition, when patients are positioned head forward in the aircraft, a shoulder harness must also be fastened.

Pediatric patients will need to be secured using a specifically sized device used to secure smaller individuals and, if an infant is to be transported using a car seat, the seat must be one that is approved by the Federal Aviation Administration (FAA) and have an FAA approval sticker already in place.

45.

Which of the following transport ventilator options is the best option for a medical air transport team trained in basic pulmonary pathophysiology and basic ventilator usage?

  • A ventilator with fixed FiO2 and set parameters of rate and tidal volume (Vt)

  • A ventilator that offers demand flow for patients that are spontaneously breathing

  • A ventilator with fully adjustable CPAP and SIMV settings

  • A ventilator that allows for setting mode of ventilation, FiO2, and Vt

Correct answer: A ventilator with fixed FiO2 and set parameters of rate and tidal volume (Vt)

Each medical air transport program should be equipped with transport ventilators that not only best meet the needs of the patients they serve, but that also are commensurate with the training that the medical transport team has received. A medical team that has only received basic training in pulmonary pathophysiology and basic ventilator management would be in jeopardy of causing harm to their patients if they were provided with sophisticated ventilators equipped with complex options such as fully adjustable CPAP (continuous positive airway pressure) and SIMV (synchronous intermittent mandatory ventilation) modes, or even ventilators that were equipped with adjustable modes for patients that are spontaneously breathing or that require knowledge of when and how to adjust FiO2 and Vt. 

An automatic ventilator, which is equipped with a preset, fixed FiO2 and set rate and Vt is the best option for a medical transport crew with only limited pulmonary and ventilator training.

46.

According to the National Fire Protection Agency, designated signage is used to identify types and severity of hazards at a site. The signage shown is used to identify a chemical which is:

  • Low-level flammable and water reactive risk

  • Slight health hazard and corrosive risk

  • Water-contact stable and slight health hazard risk

  • Unstable when heated

Correct answer: Low-level flammable and water reactive risk

The National Fire Protection Agency developed signage used today to aid in identifying the characteristics of potentially hazardous materials located at a site. The sign involves a diamond shape comprised of four different colored squares—red, yellow, white, and blue—and then further designation within each square with letter or number designations.

The red square represents any fire hazard presented by the substance, the yellow square represents the reactivity of the substance, the blue square represents any health hazards posed by the substance, and the white square represents any additional specific hazards presented by the substance. Risk of fire hazard is rated from 0 to 4, with 0 indicating the substance will not burn, and 4 indicating the substance is highly flammable and will burn below a level of 73 degrees Fahrenheit. Reactivity of the substance is also rated from 0 to 4, with a 0 rating indicating that the substance is stable, and 4 indicating the substance will detonate. A health hazard rating of 0 indicates that the substance is a normal substance and poses no health risk, while a rating of 4 indicates the substance is deadly to human health.

Finally, additional specific hazards which may be posed include radiation hazard, acid or alkaline designation, identification as an oxidizer or as a corrosive material, and as a substance which will react when in contact with water (indicated by the presence of a capital "W" with a strike through it).

47.

A patient with esophageal varices and portal hypertension is being transported by medical air transport. A review of the patient's chart reveals a history of alcoholism. Which of the following potential complications is this patient at risk for due to his specific history?

  • Seizures

  • Clotting problems

  • Bleeding

  • Hypotension

Correct answer: Seizures

Esophageal varices, dilated esophageal veins which become fragile and twisted, are associated with an increase in portal hypertension, and most commonly occur as a result of hepatic congestion. Patients with a history of liver disease, congestive heart failure, and coronary artery disease may ultimately develop esophageal varices; alcoholism is also a major factor in the development of esophageal varices. Patients with a history of alcoholism may experience seizure activity as a result of alcohol withdrawal during transport. 

Coagulopathies may be seen in patients with a history of liver disease.

48.

What is the difference in volume versus pressure when in relation to ventilator delivery methods?

  • Volume: a preset tidal volume is delivered by the ventilator. After the set volume is given, the exhalation phase begins. Volumes are consistent every breath. 

    Pressure: a preset inspiratory pressure is given by the ventilator. Once the pressure is achieved, the exhalation phase begins. Volumes can change from breath to breath. 

  • Volume: a preset pressure is delivered by the ventilator. After pressure is achieved, the exhalation begins. Volumes can change breath to breath. 

    Pressure: a preset tidal volume is delivered by the ventilator. After the set volume is given, the exhalation phase begins. Volumes are consistent every breath. 

  • Volume: tidal volume is determined by a preset amount of pressure. 

    Pressure: pressure is determined by a preset amount of volume. 

  • The only difference between volume and pressure is the units used to measure the amount of air given.

Correct answer: Volume: a preset tidal volume is delivered by the ventilator. After the set volume is given, the exhalation phase begins. Volumes are consistent every breath.

Pressure: a preset inspiratory pressure is given by the ventilator. Once the pressure is achieved, the exhalation phase begins. Volumes can change from breath to breath.

Volume and pressure are both settings that can be set by the CFRN/CTRN. When controlling volume, each breath delivered will be at the chosen volume (i.e., 450 mL). The pressure between each breath can change due to lung compliance and if the equipment is in working order. It is imperative the CFRN/CTRN monitor pressures when delivering set volumes. If the CFRN/CTRN elects to use pressure delivery mode, the ventilator will deliver each breath up to a certain preset pressure (i.e., 30 cm H2O). Once the pressure has been delivered, the exhalation phase begins. In this setting, the volumes of air delivered will vary and therefore, minute volume must be monitored to ensure the patient is adequately ventilated.

49.

Which of the following statements regarding breech presentation of the fetus is most accurate?

  • Breech presentation of the fetus is more likely in grand multiparity

  • The fetus is more likely to present in breech position in pregnancies ≤ 36 weeks gestation

  • The presence of oligohydramnios decreases the risk of breech presentation

  • Women who are over the age of 35 are more likely to have a fetus in breech presentation

Correct answer: Breech presentation of the fetus is more likely in grand multiparity

Breech presentation of the fetus may present significant complication at time of delivery. The fetus may be positioned in any of several breech positions: with legs flexed on the abdomen and feet alongside the buttocks (complete breech presentation), with legs extended upward and feet near the head (frank breech presentation), with one foot presenting (footling breech presentation), or with a knee presenting (incomplete breech). Prior to 34 weeks gestation, the fetus is more likely to be positioned in a breech position due to the head being significantly larger than the rest of the body with the upper segment of the uterus providing more space for the larger fetal part. 

Breech presentation is more likely in women who are grand multiparas (have had more than 5 pregnancies past 20 weeks) or who are carrying more than one fetus; with polyhydramnios and oligohydramnios; placenta previa; and with uterine anomalies such as uterine tumors, septate uterus, and bicornuate uterus; or when there are fetal congenital anomalies, such as hydrocephalus.

50.

Your patient develops sudden onset narrow-complex tachycardia at a rate of 208 bpm, with BP 128/56, ETCO2 of 36 mm Hg, and SpO2 of 97%. Two large-bore IVs have been placed, and a 12-lead ECG shows SVT without evidence of ischemia/infarction. Vagal maneuvers have no visible effect.

What is the next best step?

  • Adenosine 6 mg IV push

  • Amiodarone 300 mg IV push

  • Synchronized cardioversion at 50 J

  • Synchronized cardioversion at 200 J

Correct answer: Adenosine 6 mg IV push

The 2020 AHA guidelines for ACLS state that for a regular narrow-complex tachycardia, without evidence of hypotension, altered mental status, signs of shock, or chest pain/discomfort, the next treatment options are vagal maneuvers, adenosine, administration of a β-Blocker or calcium channel blocker, and the consideration of obtaining expert consultation.

51.

Which electrolyte should the CFRN/CTRN be most concerned with when treating a patient with rhabdomyolysis?

  • Potassium 

  • Sodium

  • Chloride

  • Magnesium 

Correct answer: Potassium

Rhabdomyolysis is the result of muscle breakdown or muscle damage. Potassium is the primary intracellular electrolyte and a large release of it can cause hyperkalemia. Hyperkalemia can produce life threatening arrhythmias. 

Sodium is the primary extracellular electrolyte and is not drastically affected by the breakdown of muscle fibers. Chloride is another extracellular electrolyte. Magnesium is also not drastically affected by muscle breakdown. 

52.

You are preparing to place an endotracheal tube (ETT) using rapid sequence intubation (RSI) in a patient who has sustained a closed-head injury. You are concerned the patient will begin coughing and gagging in response to the ETT once you begin intubating, putting the patient at risk for even greater increases in intracranial pressure (ICP). 

Which of the following steps can you take to prevent this situation from occurring?

  • Administer lidocaine intravenously (IV) prior to beginning RSI

  • Ensure the ETT is adequately lubricated prior to beginning insertion

  • Administer 4% topical lidocaine to the airway using an atomizer prior to beginning RSI

  • Utilize video-assisted laryngoscopy during the intubation process

Correct answer: Administer lidocaine intravenously (IV) prior to beginning RSI

The insertion of an ETT and the manipulation of the airway during endotracheal intubation cause a reflex sympathetic nervous system response which leads to a catecholamine surge, which in turns causes an increase in blood pressure, heart rate, and ICP. In patients with head injuries, this increase in ICP can be particularly dangerous, and the medical crew should be proactive in taking steps to mitigate this response. 

The administration of IV lidocaine prior to beginning RSI is the best choice in preventing the development of increased ICP.

53.

A 15-year-old male high school sophomore who was a member of his school's football team sustained a spinal cord injury (SCI) when he inadvertently put his head down while running and drove the crown of his head into the shoulder of the ball carrier during a tackle. When the medical transport arrives, the patient has been placed on a backboard by the field team and is already intubated due to the inability to breathe on his own. The ground team reports the patient had been alert and was attempting to speak at the time of their arrival, and was noted to be able to turn his head. Primary assessment by the air transport team reveals full loss of motor and sensory function of upper and lower extremities.

Based on the information provided in this scenario, which of the following levels of SCI is this patient most likely to have experienced?

  • C3-C4 SCI

  • C5-C6 SCI

  • C1-C2 SCI

  • C7-C8 SCI

Correct answer: C3-C4 SCI

Pediatric-aged patients between the ages of 8 to 15 years are at greatest risk of spinal cord injury (SCI) with subaxial vertebral body fractures affecting the C3 to C7 level of the spine as a result of injuries sustained during sports activities, falls, diving accidents, and motor vehicle crashes. A SCI to the C3-C4 level occurs during trauma when the head is bent forward and the spinal cord is compressed at great force when the head is driven into an object in front of it. Fracture of the vertebral body is typically followed by edema of the spinal cord, resulting in life-threatening disability. A C3-C4 SCI may result in the injured patient being unable to breathe on his own, and with full loss of motor and sensory functions of both his upper and lower extremities, but with the ability to move his head and speak. The C3-C4 spinal cord injured patient will most likely require full care with all activities and functions of daily life for the rest of his life.

A C1-C2 SCI, also referred to as an atlantoaxial injury, is the most serious of the SCIs, and may result in immediate death.

A C5-C6 SCI may result in full loss of function of the lower extremities, and limited function of the upper extremities, with likely paralysis of some portion of the trunk, as well as the hands and wrists. Breathing may be affected, but the patient should be able to sustain breathing on his own. The patient will have no control of his bowel and bladder function.

A C7-C8 SCI may result in retention of some arm function and the ability to move the shoulders, as well as limited hand mobility. There is full loss of motor and sensory function of the lower extremities, and bowel and bladder function is impaired.

54.

After administration of first-line medication treatment for acute coronary syndrome (ACS), all of the following medications may be used as next steps in treatment of ACS, except:

  • Nitroglycerin

  • Heparin

  • Metoprolol

  • Abciximab

Correct answer: Nitroglycerin

Acute coronary syndrome (ACS), which encompasses three acute cardiac events (unstable angina, non-ST elevation myocardial infarction [NSTEMI], and acute ST elevation myocardial infarction [STEMI]), results from atherosclerotic plaque rupture within the coronary vessels, and may ultimately lead to the patient's death from sudden cardiac death. Patients who are believed to be experiencing an ACS event should be rapidly evaluated and provided with initial treatment, which includes the administration of oxygen, nitroglycerin, aspirin, and morphine (some programs do not use morphine in treatment of the chest pain associated with ACS, and simply rely on nitroglycerin for this). 

Once initial treatment has been administered, additional medications may be used to continue treatment of ACS. These include the administration of beta blocker medications, such as metoprolol, to decrease myocardial oxygen consumption; heparin, to reduce the further formation of thromboses (heparin does not dissolve already established clots); and a glycoprotein IIb/IIIa inhibitor, such as abciximab, which inhibits platelet aggregation.

55.

Which of the following statements regarding a sinusoidal fetal heart rate (FHR) pattern is most accurate?

  • A sinusoidal FHR pattern may indicate anemia of the fetus

  • A sinusoidal FHR pattern demonstrates less regularity in the shape and amplitude of wave variability but also maintains beat-to-beat variability

  • A sinusoidal FHR pattern is a not uncommon finding on electronic fetal monitoring and resolves with repositioning of the mother

  • A sinusoidal FHR pattern is frequently seen during tetanic uterine contractions

Correct answer: A sinusoidal FHR pattern may indicate anemia of the fetus

A sinusoidal fetal heart rate (FHR) pattern is always a concerning finding and almost always indicates a need for emergency Cesarean section. A true sinusoidal FHR pattern is rare and can be recognized by regularity in shape and amplitude of FHR waves (a sine wave) and the absence of beat-to-beat variability. The FHR remains within normal range in sinusoidal pattern, and the pattern may look saw-toothed in appearance. Sinusoidal FHR may result from severe fetal anemia, acidosis of the fetus, hypovolemia of the fetus, accidental tapping of the umbilical cord during amniocentesis, or placental abruption. Sinusoidal FHR needs to be distinguished from pseudosinusoidal pattern which can result from the administration of labor drugs to the mother, or from the use of certain illicit substances.

56.

The expansion of gases at higher altitudes can be explained by:

  • Boyle’s Law

  • Henry’s Law

  • Charles’ Law

  • Dalton’s Law

Correct answer: Boyle’s Law

The equation for Boyle’s Law is P1V1=P2V2. If the pressure P2 decreases, then the volume of the gas must increase. A helpful reminder is “Boyle’s Balloon.” Think of a balloon floating higher and higher. As it ascends, the volume of the gas inside expands, and the balloon pops.

57.

The GCS is commonly used in the pre-hospital and acute care setting, as well as over a patient’s hospital course, to evaluate mental status in both traumatic and non-traumatic presentations. 

Which of the following are components of calculating a GCS?

  • Eye, verbal, and motor responses

  • Mood, verbal, and sensory responses

  • Visual, olfactory, and reflex responses

  • Visual, sensory, and motor responses

Correct answer:  Eye, verbal, and motor responses

The purpose of the Glasgow Coma Score scale is to describe and communicate the condition of an individual patient by separate, multidimensional rating of their eye, verbal, and motor responses. It remains the appropriate method for this purpose. It is calculated by addition of the total points selected under each component (eye, verbal, motor), e.g., "15 points".

58.

What are signs and symptoms of Type 1 Decompression Sickness?

  • Painful joints, mottled skin, pruritus (itching)

  • Altered mental status, ascending paralysis, visual disturbances 

  • Hypertension, altered mental status, combative

  • Epistaxis, maxillary pain, renal failure

Correct answer: Painful joints, mottled skin, pruritus (itching)

Type 1 is classified as joint and skin symptoms; the key here is painful joints. Type 2 is classified by neuro changes.

59.

Which injury is more likely to affect a restrained driver of a motor vehicle?

  • Rupture of mitral valve or diaphragm 

  • Cardiac contusion 

  • Femur fracture 

  • Lacerated great vessels 

Correct answer: Rupture of mitral valve or diaphragm 

Due to the use of a restraining system, especially with a shoulder belt, cervical fractures and rupture of the mitral valve or diaphragm are more likely to occur in restrained drivers. 

A cardiac contusion, fractured patella and femur, and lacerated great vessels are predictable injuries that are more likely for an unrestrained driver. 

60.

According to guidelines aimed at increasing survival during active shooter (AS) situations and established by the Hartford Consensus, which of the following activities should take place in the Warm Zone of the traditionally established Zones of Safety?

  • Control of hemorrhage

  • Assessment of patients

  • Transportation of patients

  • Threat suppression

Correct answer: Control of hemorrhage

The Hartford Consensus is a document which resulted from collaboration between the American College of Surgeons and the Federal Bureau of Investigation (FBI) in Hartford, Connecticut in response to poor survival during active shooter (AS) incidents. Victims of AS incidents typically succumb to their injuries as a result of hemorrhage, resulting in control of hemorrhage becoming the most critical point to be addressed by first responders. 

According to the traditionally established Zones of Safety (Cold, Warm, Hot) which are designed to prevent or mitigate risk to responders to critical incidents in the field, the Hot Zone is considered to be the Danger Zone, the Warm Zone is considered to be a Not Secure Zone, and the Cold Zone is considered to be the Safe Zone. Despite the lack of true safety within the Warm Zone, the Hartford Consensus determined that additional loss of life due to hemorrhage during AS situations was critical enough to warrant that it be managed within the Warm Zone. Once hemorrhage has been adequately controlled, the patients should be quickly extricated and moved into the Cold Zone for further medical stabilization prior to transport.

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