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Quiz Session - Attempts With Random Questions

BCEN CFRN CTRN Exam Questions

Page 8 of 50

141.

You are the CTRN/CFRN caring for a neonate who is being transferred by helicopter emergency medical services (HEMS) for a possible need for surgical ligation of a patent ductus arteriosus (PDA). Which of the following medications do you anticipate administering?  

  • Indomethacin 

  • Milrinone

  • Nitric oxide (NO)

  • Prostaglandins (PGE)

Correct answer: Indomethacin 

The PDA is a vessel that allows blood to flow from the aorta to the pulmonary artery and is normal in fetal circulation but typically closes 12-24 hours after birth. If it fails to close, it will affect the way blood flows through the lungs. Indomethacin (Indocin) is a prostaglandin synthase inhibitor used before 10 days of life to facilitate PDA closure. 

Milrinone and NO are pulmonary vasodilators and do not affect PDA. Prostaglandins reopen or maintain the PDA, and they may be indicated in the case of a cyanotic heart defect or an obstructive blood flow defect. 

142.

The motion of objects relative to the patient during rotor-wing transport may contribute to:

  • Elevated respiration rate

  • Reduced muscular contraction

  • Decreased pain

  • Improved visual acuity

Correct answer: Elevated respiration rate

Both air and land vehicle transportation result in vibration (motion of object relative to the patient) during transport and contribute to that patient experiencing increased pain, muscular contraction and respiratory rate, as well as decreased visual acuity.

143.

Which of the following sets of vital signs indicate adult sepsis?

  • HR: 110, RR: 24, Temp: 101.2, BP: 80/40

  • HR: 89, RR: 20, Temp: 104.2, BP: 189/110

  • HR: 114, RR: 14, Temp: 97.1, BP: 120/74

  • HR: 76, RR: 20, Temp: 97.1, BP: 84/43

Correct answer: HR: 110, RR: 24, Temp: 101.2, BP: 80/40

Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. Clinical criteria for sepsis is related to suspected or documented infection and an acute increase of > 2 SOFA points; a positive qSOFA (quick SOFA) criteria should also prompt consideration of possible infection in patients not previously recognized as infected.  

qSOFA criteria: Altered mental status (GCS score < 15);  systolic blood pressure < 100 mmHg; respiratory rate > 22 breaths per min.

144.

Which is considered to be the least frequent cause of death in burn patients?

  • Hypovolemic shock

  • Inhalation injury 

  • Sepsis

  • Multi-organ failure 

Correct answer: Hypovolemic shock 

Burn injury is a common type of traumatic injury, causing considerable morbidity and mortality. Sepsis, inhalation injury, and multi-organ failure are the most common causes of death in burn patients. 

Hypovolemic shock is a complication associated with burn injury but is less likely to be fatal. 

145.

Which of the following symptoms may be observed in cases of severe acetylsalicylic acid (aspirin) poisoning?

  • Liver failure and increased intracranial pressure

  • Cardiopulmonary failure and pulmonary edema

  • Hypocoagulability and hypothermia

  • Cardiac arrhythmias and hyperthermia

Correct answer: Liver failure and increased intracranial pressure

Patients who experience severe acetylsalicylic acid (aspirin) toxicity typically experience severe acid-base and electrolyte imbalances as a result of the significant anion gap metabolic acidosis that ultimately develops in aspirin poisoning. Patients with severe poisoning also frequently experience seizures, coma, hyperthermia, pulmonary edema (noncardiac), liver failure, increased intracranial pressure, and encephalopathy. 

Treatment for aspirin poisoning consists of the administration of alkaline diuresis to increase the hourly renal clearance of the salicylate, and if necessary, hemodialysis. Initial treatment with activated charcoal may also be given.

146.

You are the CFRN/CTRN caring for a 24-year-old female patient who has just delivered her baby. You note that the patient has soaked through several chux pads and is still bleeding. You estimate the amount of blood loss is over 500 mL. What medication should you administer?

  • Pitocin and methergine

  • Tranexamic acid (TXA)

  • Terbutaline

  • Glucocorticoids

Correct answer: Pitocin and methergine 

Postpartum hemorrhage can have several causes. One way to help stop bleeding is to make the uterus contract. Pitocin is naturally released during childbirth and while nursing the child. Pitocin along with methergine causes uterine contraction. 

TXA does not cause uterine contraction; while it does help prevent the breakdown of blood clots, the need here is to cause uterine contraction. Terbutaline is given to postpone preterm labor. Glucocorticoids are given to stimulate lung development. 

147.

An 23-year-old male who was serving as pitcher during a non-competitive baseball game was struck in the head by a baseball hit from home plate by the batter. He experienced a brief loss of consciousness, and then quickly regained consciousness and appeared alert and oriented, and so returned to the game after sitting out for an inning. He subsequently began complaining of a severe headache, and when his teammates noted a change in his level of consciousness, they contacted emergency medical services (EMS). Upon your arrival, you observe the patient to appear weak, lethargic and confused, and note dilation of only one pupil. Which of the following etiologies is most likely contributing to the ocular symptoms described in this scenario?

  • Compression of the third cranial nerve due to tentorial herniation

  • Hemorrhage into the intraventricular system from the subarachnoid space

  • Cerebral contusion of the temporal lobe

  • Entrapment of the inferior rectus muscle as a result of an orbital blowout fracture

Correct answer: Compression of the third cranial nerve due to tentorial herniation

Compression of the third cranial nerve often occurs in the secondary stage of epidural hematoma as a result of tentorial herniation of the temporal structures of the brain. Typically, the adult-aged patient who experiences a traumatic injury to the head which results in an acute epidural hematoma will experience a brief loss of consciousness, followed by a recovery period during which the patient is alert and oriented and appears normal and has normal neurologic findings. The patient's initial loss of consciousness, caused by the trauma, was caused by a tear of the middle meningeal artery, which subsequently experiences spasm and clots, stopping or significantly slowing the bleeding. Over the next several hours, the artery continues to bleed, causing the development of the hematoma, causing a subsequent increase in pressure in the epidural space, ultimately leading to stripping of the dura from the skull. As intracranial pressure (ICP) rises, the patient begins to experience neurologic symptoms again, typically headache and changes in the level of consciousness, due to the brain herniating through the tentorium in response to the increased ICP. Compression on the third cranial nerve results, causing ipsilateral dilation of the pupil, and the patient's level of consciousness and overall condition continues to rapidly worsen.

148.

You are caring for a critically ill patient during medical air transport who suddenly experiences an acute ST elevation myocardial infarction (STEMI). Which of the following statements regarding STEMI is most accurate?

  • During acute STEMI, cardiac death is actively occurring

  • Acute STEMI is caused by an acute change in the diameter of a coronary artery due to plaque rupture

  • During acute STEMI, occlusion of a coronary artery is prolonged resulting in occlusion of smaller distal coronary vessels

  • The ECG changes observed in acute STEMI reflect an ST elevation greater than 2 mm in two contiguous leads

Correct answer: During acute STEMI, cardiac death is actively occurring

While unstable angina, acute non-ST elevation myocardial infarction (NSTEMI), and acute STEMI are all considered acute coronary syndrome (ACS) events, only acute STEMI can be said to represent a time of active cardiac muscle death. During acute STEMI, coronary arteries become totally occluded due to rupture of an atherosclerotic plaque which leads to (at least) partial occlusion of the artery, followed by the inflammatory response and thrombus formation that results from the body's attempts to repair the damage. The stable thrombus that results from plaque rupture in acute STEMI causes unrelenting chest pain and ST segment elevation which can only be resolved through immediate reperfusion of the cardiac muscle. 

In order to be considered an acute STEMI, the ST elevations observed must reflect an elevation greater than or equal to 1 mm in two contiguous ECG leads, or be greater than or equal to 2 mm of elevation in leads V2 and V3.

149.

Which of the following statements best describes amniotic fluid embolism?

  • Anaphylactic reaction to amniotic fluid and fetal cells

  • Obstruction of the pulmonary vasculature by amniotic fluid embolus

  • Obstruction of the pulmonary vasculature by an embolus comprised of amniotic fluid, fetal cells, and lanugo hairs

  • Disseminated intravascular coagulation (DIC) resulting from the presence of an obstructing amniotic fluid embolus in the pulmonary vasculature

Correct answer: Anaphylactic reaction to amniotic fluid and fetal cells

Amniotic fluid embolism has received a new nomenclature, due to what is now believed to be the etiology of this deadly pregnancy-related process. Anaphylactoid syndrome of pregnancy (or anaphylaxis syndrome of pregnancy) is believed to occur as a result of maternal anaphylactoid reaction to the presence of amniotic fluid and fetal cells within the maternal circulation as a result of labor and delivery. It is suspected that amniotic fluid and fetal cells enter the maternal circulation through the following three most likely routes: microscopic lacerations to the endocervical veins and to the lower uterine segment (occuring during cervical dilation), the placental attachment site (after delivery of the placenta), and the uterine veins (as a result of trauma). Disseminated intravascular coagulation (DIC) occurs in conjunction with the anaphylaxis; the etiology of the DIC is unclear. Amniotic fluid embolism is much more likely to occur when there have been interventions during the labor, particularly the use of uterine stimulant medications to augment or induce labor, surgical delivery methods, or when uterine rupture occurs. Other risk factors include fetal demise, meconium in the amniotic fluid, placental abruption, large fetus, and precipitous delivery (among others).

150.

With regard to magnesium as a neuroprotective agent for patients with traumatic brain injury, which of the following statements is true?

  • Magnesium has been shown to increase mortality at both high and low doses

  • Magnesium has been shown to increase mortality at both high, but improve outcomes at low doses

  • Magnesium has been shown to decrease mortality at low doses, but worsen outcomes at high doses

  • Magnesium has been shown to increase mortality at low doses, but improve outcomes at high doses

Correct answer: Magnesium has been shown to increase mortality at both high and low doses

Post-traumatic seizures (PTS) are common complications of traumatic brain injury (TBI). The USPSTF recommendation for patients with TBI states they should receive 7 days of prophylaxis with either levetiracetam or phenytoin.

As an anti-seizure prophylactic, it is recommended that for pre-eclampsia, EMS provide dose of 50 grams of magnesium sulfate in 500 mL of Ringer's' lactate solution, with a bolus of 4-6 grams over 15-30 minutes, followed by 2-4 g/hour infusion. A therapeutic range is considered achieved when deep-tendon reflexes are depressed, but not absent; loss of DTR indicates potential toxicity. Changes in consciousness, respiratory depression, and cardiac arrest are seen with highly toxic levels.

However, in a randomized controlled trial for evaluating seizure prophylaxis in traumatic brain injury patients, magnesium sulfate provided no significant positive effect on the primary outcome measure at the higher dose, and those assigned at the lower dose did significantly worsen. Additionally, there was higher mortality with the higher dose than with placebo. Lower magnesium groups had a slight excess of pulmonary edema and respiratory failure. There were no subgroups in which magnesium had a significantly positive effect.

With regard to seizure prophylaxis, as with all medical situations, adhere to local protocols and orders from medical direction.

151.

You are the CFRN/CTRN called to the scene of a patient with burns to his face, arms, and upper torso region. You determine that the affected body surface area is 20 percent. You estimate that patients weight at 100 kg. You work for a company that has the Brooke Formula of fluid resuscitation in their protocols. How much fluid should you give the patient in the first 24 hours?

  • 4000 mL

  • 2000 mL

  • 1000 mL

  • 8000 mL

Correct answer: 4000 mL

The Brooke Formula is 2 mL x kg x BSA = Total fluids in first 24 hours. According to the information in the question, this would be 2 mL x 100 kg x 20 percent BSA = 4000 mL.

2000 and 1000 are both too little volume for proper fluid volumes. 8000 mL would be the correct volume for Parkland Formula. The difference between Parkland and Brooke Formulas is Brooke is 2 mL x kg x BSA and Parkland is 4 mL x kg x BSA. So, Parkland is just twice the volume of Brooke. The way to remember this is Brooke requires 2 mL and Brooke starts with a “B” which is the 2nd letter of the alphabet.

152.

What is the antidote used for acetaminophen poisoning?

  • N-acetylcysteine 

  • Activated charcoal 

  • Naloxone

  • Flumazenil 

Correct answer: N-acetylcysteine 

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, and then hepatic failure. Those with a history of alcohol abuse or liver disease are at an increased risk for toxicity. 

Ingestions of more than 150 mg/kg are considered toxic. If the acetaminophen level is still toxic at 4 hours after ingestion or if the level cannot be assayed after 8 hours have passed and the history of evaluation of the hepatic transaminases suggests toxic ingestion, N-acetylcysteine (NAC) should be administered to reverse the toxic effects. To have the most benefit, the administration should occur within 8 hours of ingestion; there is little benefit after 24 hours post-ingestion.

Activated charcoal may be helpful but must be administered within a few hours of the ingestion (it absorbs acetaminophen in the GI tract but does not reverse its effects on the body). Naloxone (Narcan) reverses the toxic effects of opioids. Flumazenil is the antidote for benzodiazepines. 

153.

You and your team are called to a rural hospital for the emergent transport of a newborn to a higher level of care facility. The sending facility nurse tells you the neonate has been diagnosed with coarctation of the aorta and that the baby has absent femoral pulses. Which medication would keep the patent ductus arteriosus open?

  • Prostaglandin E1

  • Indocin

  • Terbutaline

  • Surfactant

Correct answer: Prostaglandin E1

Prostaglandin E1 or PGE1 keeps the patent ductus arteriosus (PDA) open, which may be required in patients suffering from coarctation of the aorta (PDA). The two medications that act on the PDA are PGE1 and Indocin. 

Indocin is used to close a PDA. Neither terbutaline nor surfactant act on PDA and will not be useful to this infant.

154.

A CFRN/CTRN is caring for a patient with suspected benzodiazepine overdose. The patient is very drowsy and only minimally responds to verbal stimuli. What should be the CFRN/CTRN’s first action?

  • Ensure the patient has a patent airway

  • Immediately start two large bore IVs and administer a fluid bolus and flumazenil

  • Immediately administer intranasal Narcan

  • Perform gastric lavage

Correct answer: Ensure the patient has a patent airway

While flumazenil is a reversal agent for benzodiazepines, it can cause seizures. Narcan is not indicated for benzodiazepine overdose; neither is gastric lavage. The best course of action is to provide supportive care, beginning with ABCs.

155.

Cardiogenic shock in a pediatric patient typically presents with which of the following physiologic findings? 

  • Tachycardia 

  • Widened pulse pressure 

  • High fever 

  • Decreased systemic vascular resistance (SVR)

Correct answer: Tachycardia 

Cardiogenic shock is the inability of the heart to supply oxygen to meet the needs of the tissues. It results from pump failure (because of intrinsic cardiac disease) and an inability of the heart to provide adequate cardiac output (CO). This decreased cardiac contractility is the result of CHD in children, and physiologic signs include tachycardia, increased SVR, and decreased CO. Additional findings suggestive of cardiogenic shock include a gallop rhythm, pulmonary rales, jugular venous distention, hepatomegaly, cyanosis unresponsive to oxygen, and absent femoral pulses. 

Widened pulse pressure and a high fever are early signs of septic shock. 

156.

The primary assessment of a patient who is being transported by ground or air should include all the following components, except: 

  • Pain assessment

  • Equipment assessment

  • Airway assessment

  • Neurologic assessment

Correct answer: Pain assessment

The hands-on assessment of every patient begins with the primary assessment, which is a rapid assessment following the A-B-C-D-E mnemonic of the patient's airway, breathing, circulation, disability (including neurologic status), and exposure of the patient to assess for all potential injuries. 

In addition, an equipment assessment is a part of the primary assessment in preparing the patient for transport. Not having the appropriate equipment or what is needed to support that appropriate equipment for the patient during transport could result in additional injury (e.g., a defibrillator whose battery is not functioning when it is needed).

Pain assessment is an important component of the secondary assessment (not the primary assessment), which is done after the primary assessment is completed and involves a head-to-toe evaluation. 

157.

You and your crew are flying back to base from a patient transfer. You begin to notice you can’t pronounce your words correctly and you feel drunk. Which hypoxic zone are you in?

  • Disturbance

  • Indifferent

  • Critical

  • Compensatory

Correct answer: Disturbance

The zone of disturbance is characterized by the feeling of being drunk, motor function impairment, and impaired judgement. 

Indifferent is when the body is not experiencing any significant changes to oxygen levels. Critical is characterized by loss of consciousness and, eventually, death. Compensatory stage will show increased heart rate, increased respirations, and slower thinking.

158.

You are caring for a patient that goes into pulseless ventricular tachycardia while en route to the hospital. What is the first step in treating this patient?

  • Defibrillation

  • Administer epinephrine

  • Administer lidocaine

  • Begin pacing the patient

Correct answer: Defibrillation

Upon recognition of pulseless V-tach, the CFRN/CTRN should immediately defibrillate. Care should be taken if this occurs while flying to avoid touching the rails of the stretcher and notification is given to the pilot prior to shock delivery. ACLS protocols then call for the giving of epinephrine if the patient remains pulseless, while chest compressions are being performed. Lidocaine is given if VT is refractory to amiodarone. Pacing the patient is done when a patient is having symptomatic bradycardia.

159.

Your 62-year-old female patient reports palpitations and chest discomfort. ECG monitor shows regular wide-complex QRS. HR is 180 bpm, she is diaphoretic, and blood pressure is 80/60 mm Hg.  

What is the best next step?

  • Cardioversion

  • Contact medical direction

  • Obtain 12-lead ECG

  • Establish IV access

Correct answer: Cardioversion

The 2020 AHA ACLS guidelines recommend that for adult tachycardia with a pulse, which results in hemodynamic instability (evidenced by hypotension, altered mental status, signs of shock, ischemic heart discomfort, or acute heart failure), the first-line intervention is synchronized cardioversion. For wide-QRS complex rhythms, consider adenosine only if regular and monomorphic; additionally, consider an antiarrhythmic infusion and expert consultation.

160.

Diffuse axonal injury (DAI) typically results from:

  • Rapid acceleration-deceleration forces

  • Crushing forces

  • Compression forces

  • Blunt forces

Correct answer: Rapid acceleration-deceleration forces

Diffuse axonal injury (DAI) is a shearing or tearing of the long connective fibers of the brain as a result of shifting or twisting of the brain tissue. This most frequently occurs as a result of rapid acceleration-deceleration forces as is experienced in a front-end collision at high speed. In DAI, the brain is diffusely injured, most often resulting in coma, respiratory compromise, and decerebrate or decorticate posturing with severe traumatic brain injury (TBI), and in mild to moderate TBI, patients may experience symptoms ranging from headache to amnesia. Currently, there exists no treatment for DAI; solely supportive interventions are provided to injured patients.

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