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Quiz Session - Attempts With Random Questions

BCEN CFRN CTRN Exam Questions

Page 6 of 50

101.

While transporting a patient with an IABP, the cardiac monitor indicates asystole/pulseless electrical activity. Which of the following interventions is correct?

  • Initiate ACLS guidelines and change the IABP to pressure mode during compression

  • Provide afterload reduction or decrease augmentation volume in the IABP if possible

  • Attach a 60-mL syringe to the proximal stopcock and inflate the IABP catheter once every 3-5 minutes to prevent clot formation on the catheter

  • Remove the IABP as soon as possible

Correct answer: Initiate ACLS guidelines and change the IABP to pressure mode during compression

For a patient with an IABP who goes into cardiopulmonary arrest/asystole or pulseless electrical activity, the flight crew should initiate ACLS guidelines and change the IABP to pressure mode during compression.  

For a patient with an IABP experiencing ventricular fibrillation or pulseless ventricular tachycardia arrest, initiate ACLS guidelines and leave the IABP in current settings. The pump is grounded and can accommodate electrical shocks. If diastolic hypertension is detected, provide afterload reduction or decrease augmentation volume in the IABP if possible. If the IABP experiences power failure, attach a 60-mL syringe to the proximal stopcock and inflate the IABP catheter once every 3-5 minutes to prevent clot formation on the catheter. If the patient develops a rapid heart rate > 200, leave the IABP in 1:1 counterpulsation. In the event of a balloon rupture (blood in the sheath, loss of gas alarm, and rust-colored flecks), contact medical direction, as removal the IABP as soon as possible is needed.

102.

A patient with which of the following would be at most risk for sepsis?

  • Colon rupture

  • Splenic rupture

  • Liver laceration 

  • Pneumothorax

Correct answer: Colon rupture

Bacteria will enter the peritoneal cavity with a colon rupture and can cause sepsis. 

103.

What is defined as a massive hemothorax?

  • Greater than 1500 mL

  • Greater than 100 mL

  • Greater than 500 mL

  • Greater than 1000 mL

Correct answer: Greater than 1500 mL

This amount of blood defines massive hemothorax and surgical intervention is needed. This is approximately 1/3 of the patient’s blood volume and would cause stage 3 hypovolemic shock by itself, not including any other insults to the body.

104.

Which of the following statements regarding fluid resuscitation for pediatric-aged burn patients is most accurate?

  • Only the minimum amount of intravenous fluid (IV) necessary for maintaining vital organ function should be administered to the pediatric-aged burn patient

  • The goal of fluid resuscitation is a urine output of 0.5 mL/kg/hour to 1.0 mL/kg/hour

  • Pediatric-aged burn patients are unable to tolerate rapid initial fluid volume resuscitation

  • Intravenous fluid (IV) resuscitation of pediatric-aged burn patients is completed using unaltered universal fluid resuscitation formula guidelines

Correct answer: Only the minimum amount of intravenous fluid (IV) necessary for maintaining vital organ function should be administered to the pediatric-aged burn patient

Burn formulas for calculation of appropriate administration of IV fluids to burn patients are in standard use within the United States (US), to guide practice and to prevent inappropriate under- or over-fluid resuscitation of burn patients. Burn patients continue to be mostly over-resuscitated, risking complications of the initial burn injuries and even death. Pediatric-aged burn patients fare best when fluid resuscitation is administered at a rate capable of producing 1 mL/kg/hr to 1.5 mL/kg/hr of urine, rather than using a standardized formula administration rate. That being said, many burn treatment centers in the US provide fluid resuscitation to their pediatric-aged patient using the standardized formulas; typically, the pediatric burn patient is much more able to tolerate rapid initial volume infusion than the adult burn patient, with half of the total calculated fluid resuscitation being delivered in the first four hours after the injury in the pediatric patient (versus eight hours for the adult).

105.

Which of the following breathing techniques most accurately describes the use of tactical breathing?

  • Inhaling for 4 seconds, holding the inhaled breath for 4 seconds, exhaling for 4 seconds, then holding the exhale for 4 seconds

  • Inhaling for 4 seconds, holding the inhaled breath for 7 seconds, then exhaling for 8 seconds

  • Breathe in slowly through the nose, then exhale slowly through pursed lips

  • Inhale slowly for a count of 15, then exhale slowly for a count of 30

Correct answer: Inhaling for 4 seconds, holding the inhaled breath for 4 seconds, exhaling for 4 seconds, then holding the exhale for 4 seconds

Tactical breathing is a breathing technique that was designed by the military for use in extremely stressful situations to try to help military personnel quickly de-escalate from their stress and be able to continue working within the stressful environment. This breathing technique aids in lowering heart rate and stress levels, and can help in moderating the surge in sympathetic nervous system activity in direct response to stress.

The technique of inhaling for 4 seconds, holding holding the inhaled breath for 7 seconds, then exhaling for 8 seconds, is referred to as "relaxing breath" or the "4-7-8 breathing technique" and is used to help in falling asleep or decreasing anxiety.

Pursed lip breathing is useful for improving shortness of breath.

106.

The medical air transport team has been asked to respond to the scene where an individual has been abusing Molly's plant food. Patients who abuse this drug are most likely to experience which of the following symptoms?

  • Feeling connected to others

  • Seizures

  • Increased thirst

  • Uncontrollable laughter

Correct answer: Feeling connected to others

The use of Molly's plant food, also referred to as Molly, a synthetic hallucinogenic amphetamine, increases serotonin levels and causes an increase in the release of oxytocin, both of which cause users to experience pleasant sensations of euphoria, connectedness to others, and an increased desire to be with people. Individuals who use Molly's plant food often engage in risky sexual behavior (or sexual assault) as a result of these sensations. Antidiuretic hormone (ADH) release, which causes a decrease in the thirst sensation, is also increased with use of Molly's plant food; individuals who abuse this drug on a regular basis are known to grossly increase their fluid intake to compensate for this, which leads to hyponatremia (and hyponatremic seizures). 

107.

Health Insurance Portability and Accountability Act (HIPAA) is a federal law intended to protect patient health information (PHI) and simplify the means by which healthcare providers electronically file and transmit healthcare claims. 

Implications of this law to transport teams include all the following, except: 

  • Team members must obtain a signed Notice of Privacy from the patient and/or the family before transport.

  • Oral and written information about the patient must be protected and appropriately stored. 

  • Team members must undergo mandatory HIPAA training on how to comply with HIPAA regulations.

  • Team members may share PHI about the patient with providers at a scene and at a referring hospital without the patient's consent. 

Correct answer: Team members must obtain a signed Notice of Privacy from the patient and/or the family before transport.

Patients should receive a Notice of Privacy Practices. However, this notice is not given before/during the transport process but should be provided after the emergency has passed. 

The other answer choices are correct. 

108.

A five-month-old infant was transported to the emergency department after a daycare worker noted the infant to be lethargic and witnessed what she believed to be seizure activity. After assessing the infant and collecting information from the providers at the daycare, the medical transport team suspects non-accidental head trauma. Which of the following types of intracranial hemorrhage is most likely to present as a crescent shape on radiological examination?

  • Subdural hematoma

  • Epidural hematoma

  • Subarachnoid hemorrhage

  • Intracerebral hematoma

Correct answer: Subdural hematoma

A subdural hematoma may result from head trauma (accidental or non-accidental) causing damage to the intracranial vasculature. The result is a collection of blood, often referred to as a venous lake, in the space between the arachnoid mater and the dura mater (the subdural space), two of the membranes covering the brain. When seen on radiologic examination, the subdural hematoma tends to have a crescent-shaped appearance as it follows the dural layer and is not impinged upon by the skull sutures. Subdural hematoma may be classified as being acute, subacute, or chronic, dependent upon when symptoms of the intracranial hemorrhage appear. An acute subdural hematoma is discovered within 24 hours of the traumatic injury due to symptom presentation, while subacute bleeds are discovered between 2 to 10 days following the injury, and chronic subdural hematoma does not present with symptoms until approximately 2 weeks following the initial insult.

Infants and young children, along with the elderly, are most vulnerable in susceptibility to sustaining a subdural hematoma as a result of head trauma. This is due to the increased fragility of the intracranial vasculature.

109.

A patient who experienced near-drowning is being packaged for medical air transport from the field site of the accident. The initial focus of the medical air transport team interventions should be on each of the following, except:

  • Treatment of alkalosis

  • Treatment of hypovolemia

  • Ventilation using high PEEP levels

  • Prevention of barotrauma

Correct answer: Treatment of alkalosis

Victims of near-drowning have almost always sustained aspiration of water into the lungs (90%), as well as swallowing of large volumes of water; a small percentage of individuals who experience near-drowning also experience spasms of the larynx which prevents water from entering the lungs. These individuals typically experience asphyxia, as do the rest of near-drowning victims. Aspiration of fluid into the lungs causes bronchospasms, atelectasis, damage to the alveolar capillary bed, consolidation of the alveoli, and a decrease in surfactant which subsequently causes an increase in surface tension. All of these combined lead to hypoxia, with the majority of morbidity and mortality resulting from cerebral hypoxia.

Initial treatment focus of the near-drowning victim should primarily be on the establishment of effective mechanical ventilation to correct hypoxia, hypercapnia, and acidosis. To prevent barotrauma and lung injury, high PEEP should be used. Hypovolemia also often occurs as a result of the hydrostatic pressure of water causing fluid shifts out of the vascular bed.

110.

You are the CTRN/CFRN assigned to a transport team en route to the scene of a rollover motor vehicle accident (MVA) by rotor-wing aircraft. Prearrival considerations include all the following components, except: 

  • Type of insurance victims have

  • Time of day

  • Number of victims 

  • Weather conditions 

Correct answer: Type of insurance victims have

Prearrival/en route considerations include communication through a communications center about the location, terrain, number of victims, weather conditions, and time of day, as well as information about any fire, spilled fuel, toxic chemicals, overturned or entangled vehicles, and downed electrical lines. 

Collecting information about the type of insurance that the victims may have is not an important consideration at this point. 

111.

Which of the following is considered a hallmark sign of pediatric asthma exacerbation?

  • Expiratory wheezing

  • Inspiratory wheezing

  • Stridor

  • Excessive mucosal secretions

Correct answer: Expiratory wheezing

Asthma is the most common cause of chronic cough in children. Expiratory wheezing is a hallmark finding in patients experiencing an exacerbation of asthma, as the tracheobronchial lumen narrows on expiration due to increased intrathoracic pressure. Other frequent signs of asthma exacerbation include dyspnea, chest tightness, nasal flaring, accessory muscle use, retractions, and cyanosis. Severe exacerbation in children may cause tachypnea, tachycardia, and pulsus paradoxus. 

Inspiratory wheezing, stridor, and excessive mucosal secretions may also be associated with asthma, but are equally associated with a number of other serious conditions.

112.

You are air transporting a 55-year-old male patient with acute cardiovascular disease from a rural hospital to the nearest critical care cardiac center which is 150 miles away. During the air transport, the patient begins to show signs of hypoxia. Which of the following types of hypoxia is this patient most likely experiencing?

  • Hypoxic hypoxia

  • Stagnant hypoxia

  • Hypemic hypoxia

  • Histotoxic hypoxia

Correct answer: Hypoxic hypoxia

Patients with acute cardiovascular disease are at great risk of hypoxic hypoxia when being transported at high altitude. As barometric pressure decreases with the increase in altitude, the partial pressure of oxygen decreases as well, necessitating the body to take steps to try to counter the effects of hypoxia. In hypoxic hypoxia, oxygen levels drop in the tissues, driving cardiac output, heart rate, and respiratory rate to all increase in the compensatory attempt, even as the pulmonary arteries and systemic vessels constrict in response to the hypoxia. Patients with acute cardiovascular disease may suffer impairment at altitudes as low as 6000 feet. 

Stagnant hypoxia is caused by poor or reduced blood flow, as the result of decreased cardiac output or pooling of blood.

In hypemic hypoxia, the blood has a decreased capacity for transporting/carrying oxygen; this may result from conditions such as anemia or carbon monoxide poisoning.

Histotoxic hypoxia occurs at the cellular level as a result of poisoning which impairs the body's cytochrome oxidase system. Alcohol, cyanide, or prescription drug poisoning may all contribute to the development of histotoxic hypoxia.

113.

You have been called to transport a 66-year-old male patient with suspected varicella-zoster virus (VZV) to a tertiary care center. Which of the following best characterizes this virus? 

  • It develops along one or two dermatomes. 

  • It consists of a bilateral vesicular rash. 

  • It is reactivated by mechanical trauma. 

  • It requires prior exposure to genital herpes. 

Correct answer: It develops along one or two dermatomes. 

VZV is highly contagious and is transmitted by direct contact with either vesicular fluid or airborne droplets from the infected host's respiratory tract; it causes two distinct clinical diseases: varicella (chickenpox) and herpes zoster (shingles). Primary infection with VZV causes chickenpox and reactivation of the virus later in life causes shingles. While varicella is often mild in children, it can progress to life-threatening when the initial presentation is in adults or immunocompromised patients. 

Herpes zoster is contagious to patients who have never had VZV but not to individuals who have already had VZV. Herpes zoster is an infection within the epidermis that is characteristically unilateral (not bilateral) and occurs along one or two adjacent dermatome distributions. Fever and malaise are quickly followed by a general vesicular rash within 24 hours. This rash begins as macules and papules that progress to characteristic vesicles, which are extremely pruritic, and then crust over to form crusted papules. 

VZV is reactivated by the virus later in life and causes shingles (that are not reactivated by mechanical trauma). It requires prior exposure to varicella, or chickenpox (not genital herpes). 

114.

A 37-week gestation neonate who has been diagnosed with persistent pulmonary hypertension of the newborn (PPHN) is being considered for extracorporeal membrane oxygenation (ECMO) after meeting the severity of illness criteria. Patients with PPHN who are being considered for ECMO must also meet additional criteria, which includes all of the following except:

  • No presence of intracranial hemorrhage

  • Gestational age over 34 weeks

  • No presence of lethal congenital anomalies

  • Has been sustained on mechanical ventilation for at least 10 to 14 days

Correct answer: No presence of intracranial hemorrhage

The neonate with PPHN who does not improve with standard invasive measures used to treat the disorder, including the administration of 100% oxygen using mechanical ventilation, the administration of nitric oxide, inotropes to support adequate peripheral perfusion and oxygenation, high-frequency ventilation including jet ventilator or oscillator, administration of surfactant (when appropriate), and the correction of acidosis or alkalosis, should be considered for cardiopulmonary support using ECMO. Since the purpose of ECMO is to support the neonate until the pulmonary and cardiac dysfunction is improved, the use of ECMO requires that the infant meet the severity of illness criteria, which is determined through calculation of the oxygen index (OI). The OI is calculated through use of the following formula:

Oxygenation Index = (FiO2  * Mean Airway Pressure * 100)/PaO2

If the severity of illness criteria is met, the clinicians must determine if the neonate meets further criteria used to determine patients selected for ECMO: 

  • The birth weight must have been > 2000 grams
  • Gestational age over 34 weeks
  • No uncontrolled bleeding
  • No major intracranial bleeding
  • Neonate has been sustained on mechanical ventilation for at least 10 to 14 days
  • No uncorrectable congenital heart disease
  • No lethal congenital anomalies
  • No irreversible brain damage

115.

Which of the following congenital cardiac defects occurs most frequently?

  • Ventricular septal defect (VSD)

  • Patent ductus arteriosus (PDA)

  • Tetralogy of Fallot

  • Coarctation of the aorta

Correct answer: Ventricular septal defect (VSD)

Congenital heart defects comprise by far the greatest number of congenital defects in the newborn, with 1 in 110 births resulting in a neonate born with a cardiac defect. The most commonly occuring of the congenital heart defects is the ventricular septal defect (VSD), and despite large defects often being noticed due to the infant becoming cyanotic (small defects may go unnoticed due to limited or no symptoms) with crying, the VSD is considered to be one of the acyanotic cardiac defects. In neonates with VSD, blood from the left ventricle flows through the defect opening into the right ventricle, and from there into pulmonary circulation, over time contributing to pulmonary hypertension and congestive heart failure. 

116.

Which of the following sets of RSI steps is in the correct procedural order?

  • Set up IV access, cardiac monitoring, oximetry, and capnography; Assess physiologic status and airway difficulty; Administer sedative, followed by neuromuscular blocking agent; Secure tube

  • Pre-oxygenate; Prepare equipment, suction, and potential rescue devices; Set up IV access, cardiac monitoring, oximetry, and capnography; Administer sedative, followed by neuromuscular blocking agent

  • Prepare equipment, suction, and potential rescue devices; Assess physiologic status and airway difficulty; Set up IV access, cardiac monitoring, oximetry, and capnography; Administer sedative, followed by neuromuscular blocking agent

  • Discuss airway management strategy with your team; Pre-oxygenate; Prepare equipment, suction, and potential rescue devices; Secure tube

Correct answer: Set up IV access, cardiac monitoring, oximetry, and capnography; Assess physiologic status and airway difficulty; Administer sedative, followed by neuromuscular blocking agent; Secure tube

Airway management is an initial step in stabilizing the pediatric patient. Rapid-sequence intubation (RSI) is the preferred method for establishing a definitive pediatric airway and utilizes administration of an induction agent and neuromuscular blocking agent to enable rapid endotracheal intubation. The goal is rapid insertion of the ETT with minimal physiologic damage and irritation. RSI is superior to sedation alone and provides the highest intubation success rate in properly selected emergency airway cases. It is the method of choice for emergency airway management.

RSI Procedural Steps:

1. Discuss airway management strategy with the team

2. Set up IV access, cardiac monitoring, oximetry, and capnography/capnometry

3. Assess physiologic status and airway difficulty

4. Prepare equipment, suction, and potential rescue devices

5. Pre-oxygenate

6. Give sedative agent immediately followed by neuromuscular blocking agent

7. Intubate trachea

8. Confirm tube placement

9. Secure tube

10.Adjust mechanical ventilation and provide post-intubation sedation

117.

As part of the medical transport team, you are responsible for the care of a full-term, newborn infant who has been diagnosed with a congenital heart defect and is being transported for intervention at a tertiary care center. The infant is being maintained on a prostaglandin E1 infusion. Which of the following congenital heart defects is most likely to always benefit from administration of a continuous prostaglandin E1 infusion?

  • Transposition of the great arteries

  • Truncus arteriosus

  • Tetralogy of Fallot

  • Ventricular septal defect (VSD)

Correct answer: Transposition of the great arteries

Continuous infusion of prostaglandin E1 is frequently administered to neonates who present at delivery with congenital heart defects which make the infant dependent upon maintaining patency of the ductus arteriosus (PDA) in order to survive. As the infant transitions from fetal life to neonatal life, the cardiac circulation should also transition from reliance upon a PDA through which blood had been shunted as it bypassed the lungs, to reliance upon the pulmonary system, a decreasing of the right ventricular pressure, and an increase in the left ventricular pressure, effectively closing the ductus arteriosus. Not all congenital heart disease conditions cause the neonate to remain dependent upon a PDA for survival, but defects such as transposition of the great arteries, pulmonary atresia, tricuspid atresia, coarctation of the aorta, hypoplastic left heart syndrome, among others. Infants who have tetralogy of Fallot with pulmonary atresia will benefit from the administration of a prostaglandin E1 infusion.

118.

You are providing emergency medical air transport for a patient in septic shock who requires the administration of both norepinephrine and vasopressin to maintain a mean arterial pressure (MAP) of ≥ 65 mm Hg. The administration of which additional drug(s) is recommended for this patient to provide the most benefit?

  • Fludrocortisone and hydrocortisone

  • Dopamine and phenylephrine

  • Epinephrine

  • Phenylephrine

Correct answer: Fludrocortisone and hydrocortisone

Patients in septic shock require the same methods of resuscitation and support required for patients experiencing any type of shock: fluid volume administration, the administration of vasopressors, and ventilation support (the "3 Vs"). Patients in septic shock may require the administration of two vasopressor drugs to maintain a MAP ≥ 65 mm Hg due to their poor status. Studies continue to find that these patients benefit from the additional administration of a mineralocorticoid steroid, typically a combination of fludrocortisone and hydrocortisone. While the actual rationale behind why mineralocorticoid steroid administration benefits these patients is unclear, it is believed to be due to the immune system-boosting effects of decreasing inflammation and aiding in resolving organ failure.

119.

A landing zone should generally be what size?

  • 100 ft x 100 ft

  • 25 ft x 25 ft

  • 70 ft x 70 ft

  • 60 ft x 60 ft

Correct answer: 100 ft x 100 ft

Generally 100 ft x 100 ft is a large enough landing zone. The other options are too small. 

120.

When providing bag-valve-mask (BMV) ventilation as part of emergency medical air transport, which of the following is a mandatory component?

  • Placement of a nasal airway

  • Raising the head of the bed

  • Suctioning the oral cavity

  • Insertion of a laryngeal mask airway (LMA)

Correct answer: Placement of a nasal airway

Unless contraindicated due to extent of injuries, placement of a nasal or oral airway is a mandatory component when providing BVM ventilation during emergency transport. Use of these devices improves the effectiveness of the ventilations being provided, improving overall oxygen saturation. 

Steps to improve the delivery of BVM ventilation include elevating the head of the bed, suctioning the oral cavity, nares, and pharynx, making sure the mask is tightly applied to the face, repositioning the head, opening the patient's mouth, and increasing the pressure of the positive pressure ventilation (PPV) to no more than 40 cm H2O.

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