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Quiz Session - Attempts With Random Questions

BCEN CPEN Exam Questions

Page 3 of 25

41.

A nurse is caring for a two-year-old child who has been hospitalized for hemophilia. The nurse is providing education to the parents on home care once the child is discharged. Which statement, if made by the parents, indicates a need for further teaching?

  • "We will avoid live-attenuated immunizations and dental hygiene treatments for our child."

  • "We will supervise our child closely when at home."

  • "We will pad the corners of furniture."

  • "We will remove household items that can easily fall."

Correct answer: "We will avoid live-attenuated immunizations and dental hygiene treatments for our child."

Hemophilia is a disorder of hemostasis of one or more clotting factors. The nurse should stress the importance of receiving all childhood immunizations (including the live-attenuated ones) and staying current on the child's vaccine schedule. Dental hygiene and routine well-child examinations should also be highly encouraged.

The child must be supervised closely, and measures must be taken at home to ensure the child is safe when they fall. In the event of blunt trauma, especially trauma that involves the joints, the parents should be instructed to apply prolonged pressure to superficial wounds until the bleeding has ceased.

42.

A nurse is caring for a child with thrombocytopenia who received a platelet transfusion approximately 12 hours ago. Which finding indicates the patient is benefiting from this therapy?

  • Decreased oozing from puncture sites and gums when brushing teeth

  • Increased hematocrit level

  • Increased hemoglobin level

  • Normothermic temperature 

Correct answer: Decreased oozing from puncture sites and gums when brushing teeth

A platelet transfusion is indicated in the case of thrombocytopenia when platelet counts fall below 10,000-20,000 or below 50,000 with active bleeding. In addition, abnormal platelet function could warrant a platelet transfusion.

Since a patient with insufficient platelet counts often manifests frank bleeding or oozing of blood from puncture sites, wounds, and mucous membranes, a platelet transfusion should decrease or eliminate this problem, and the patient's ability to clot should return to normal.

43.

A nurse is caring for an infant with a meningocele. After performing a routine assessment, feeding, and a diaper change, the nurse should ensure the infant is placed in which position?

  • Prone with the hips flexed

  • Side-lying with a pad placed between the infant's legs

  • Supine with linen rolls anchored at either side of the infant

  • Supine with the crib or incubator in a slight Trendelenburg slope

Correct answer: Prone with the hips flexed

A meningocele is a saclike protrusion on the back containing meninges and cerebrospinal fluid (CSF), which bulge through a gap in the spine secondary to a congenital vertebral defect. Correct positioning of any patient with a meningocele is vitally important in treating and managing this condition.

Because this sac can be easily damaged or injured, pressure on the sac should be avoided at all costs. The infant should be kept prone with the hips slightly flexed to protect the defect (the defect is covered with saline-moistened gauze), promote the best possible spinal alignment, and decrease the risk of hip dysplasia and/or foot deformities. In addition to keeping the infant prone, a slight Trendelenburg slope of the crib or incubator helps reduce spinal fluid pressure in the meningocele. Once the infant has undergone surgical repair and the back is sufficiently healed, the infant can be picked up and held prone for feeding.

44.

The presence of a large, isolated patent ductus arteriosus (PDA) in which the ductus fails to close normally results in which condition?

  • Low diastolic pressure

  • High diastolic pressure

  • Low systolic pressure

  • High systolic pressure

Correct answer: Low diastolic pressure

In isolated PDA, blood shunts from left to right into the pulmonary artery (PA) and lungs. This occurs as the PVR drops and the pressure in the aorta exceeds that of the PA. The clinical presentation depends on the size and diameter of the ductus; the degree of shunting, compensatory mechanisms, and the stage of lung development.

The presence of a large PDA results in low diastolic pressure, leading to low cardiac output and poor coronary perfusion. Surgical closure is required to restore adequate diastolic pressure and myocardial perfusion.

45.

In the Synergy Model for Patient Care, what refers to the ability of a nurse to utilize their skillset and knowledge base to comprehend how one decision can impact health care as a whole?

  • Systems thinking

  • Advocacy/moral agency

  • Caring practices

  • Clinical judgment

Correct answer: Systems thinking

The AACN Synergy Model for Patient Care focuses on the extent to which nurses' competencies match patient characteristics. The goal of this model is to restore the patient to an optimal level of wellness, as defined by the patient and their family.

Systems thinking is a nurse competency best defined as the ability of a nurse to manage environmental and system resources through the use of their knowledge and skills in a way that enables them to comprehend how one decision can impact the system as a whole; it is the recognition of interrelationship within and across healthcare systems.

Advocacy/moral agency is the nurse's ability to work on each patient's behalf, resolving ethical concerns. Caring practices involve ensuring a therapeutic environment is established based on the unique needs of the patient and family. Clinical judgment is the nurse's possession of clinical reasoning and critical thinking skills.

46.

Which of the following would be the least important consideration when implementing a disaster risk management initiative?

  • Planning for every potential disaster situation

  • Identifying disasters that are likely to occur

  • Reducing the likelihood of disasters

  • Identifying who will respond during a disaster

Correct answer: Planning for every potential disaster situation

When implementing a disaster risk management initiative, it is important to prepare for common disaster situations and establish guiding principles for every situation. Planning for every potential situation, however, is not possible.

Identifying disasters likely to occur, reducing the likelihood of disasters, and identifying who will respond during a disaster are all important components of implementing disaster risk management initiatives.

47.

A nurse is caring for a child with a suspected small bowel obstruction (SBO). Which of the following tests will be performed first?

  • Plain abdominal radiography

  • Abdominal ultrasound

  • Magnetic resonance imaging (MRI)

  • Abdominal computed tomography (CT)

Correct answer: Plain abdominal radiography

Abdominal X-ray examination may reveal a paucity of gas, dilated loops of bowel, or air-fluid levels with a bowel obstruction. It is usually the first radiologic study done. A lateral view reveals the presence of free air with bowel perforation.

An abdominal U/S and CT scan may be indicated, but they are generally not the first diagnostic tests that are ordered.

An abdominal U/S or MRI is often done to evaluate for appendicitis, as nonionizing radiation is employed. MRI is not indicated for the diagnosis of SBO.

48.

Which of the following types of skin grafts is considered to be a permanent wound-closure method for pediatric burn-wound management?

  • Autograft

  • Allograft

  • Heterograft

  • Homograft

Correct answer: Autograft

Once a burn wound has been debrided, a skin graft that is taken from the patient's unburned or healed skin can be transferred to the injured area. This is referred to as an autograft and is utilized for permanent wound coverage. Autografts can be described based on the thickness of the graft as well as the meshing ratio (i.e., full-thickness or split-thickness grafts).

An allograft (also known as a homograft) is a biological skin graft dressing from a human donor, often cadaver skin. It provides a temporary wound covering until the area can be covered with a permanent wound-closure method. A heterograft is a temporary skin graft from a different species (usually pig); it is often used to cover a superficial partial-thickness burn while the underlying wound heals.

49.

A seven-year-old patient is admitted to the emergency department after a motor vehicle crash. The child experienced blunt trauma to the abdomen as a result of direct compression from external forces related to the crash. Which of the following imaging studies would best assess for renal trauma in this patient?

  • Computed tomography (CT) scan

  • Abdominal X-ray

  • Arteriography

  • Intravenous pyelogram (IVP)

Correct answer: Computed tomography (CT) scan

CT is the gold-standard imaging study for renal trauma in children. Advantages include a more accurate demonstration of renal injury, visualization of nonvascularized regions, and simultaneous visualization of the other intraabdominal organs. Abdominal or kidney, ureter, and bladder (KUB) film demonstrating obliteration of the renal shadow suggests renal trauma. Up to 85% of plain abdominal X-ray films demonstrate normal findings despite proven renal trauma.

Arteriography may assist in planning surgical intervention if vascular disruption has occurred. IVP may be done if an isolated urogenital injury is suspected, allowing visualization of all genitourinary structures.

50.

A pediatric patient is being evaluated for suspected acute kidney injury (AKI). When reviewing laboratory findings, the critical care nurse notes an increase in blood urea nitrogen (BUN) without an increase in serum creatinine. This would not be an indication of which of the following conditions?

  • Renal dysfunction

  • Dehydration

  • Renal hypoperfusion

  • Catabolism

Correct answer: Renal dysfunction

Creatinine is the end product of protein metabolism. It is completely filtered by the proximal tubules and excreted in the urine under normal circumstances. Due to its complete elimination, it is an excellent marker of renal function. Creatinine levels are proportional to the BUN level, with a normal BUN-to-creatinine ratio of 10:1 to 15:1.

An increase in BUN without a rise in creatinine could indicate dehydration, decreased renal perfusion, or catabolism (digestion). Increases in both BUN and creatinine signal renal dysfunction, confirming suspected AKI.

51.

Which of the following interventions does the American Academy of Pediatrics (AAP) recommend to prevent sudden infant death syndrome (SIDS)?

  • Proper sleep positioning

  • Side-lying positioning devices

  • Home pulse oximetry monitoring during sleep

  • Swaddling during sleep

Correct answer: Proper sleep positioning

The most recent AAP position paper on infant sleep states that healthy infants should be placed only in the supine position for sleep, beginning immediately after birth, to decrease the risk of SIDS. Side-lying for sleep is not recommended because the infant may spontaneously roll from side-lying to prone.

Home pulse oximetry monitoring may be indicated for infants at risk for apnea, bradycardia, and hypoxemia post-discharge, but the AAP does not recommend it for the prevention of SIDS. Swaddling is associated with a small but significant risk of SIDS when infants are placed on their backs for sleep, and swaddled infants placed prone have the highest risk of SIDS. While swaddling can be beneficial to infants for several reasons, the AAP does not recommend it for the prevention of SIDS.

52.

Which phase of shock is characterized as unmanageable, involving irreversible injury?

  • Refractory phase

  • Compensated phase

  • Uncompensated phase

  • Initial phase

Correct answer: Refractory phase

The refractory phase is the last phase of shock; it is unmanageable and irreversible. Bradycardia and profound hypotension occur with no response to potent vasopressors. Ultimately, this phase results in multisystem organ failure and death.

53.

Which of the following is considered to be a late sign of compartment syndrome?

  • Loss of pulse

  • Pain and swelling

  • Paresthesia

  • Inability to maintain normothermia

Correct answer: Loss of pulse

Compartment syndrome, a dangerous complication of a casted extremity, occurs when pressure increases within one or more muscle compartments, leading to decreased blood flow, tissue ischemia, and neurovascular impairment. Within 4 to 6 hours of the onset of compartment syndrome, neurovascular damage is irreversible if not treated.

Signs and symptoms include unrelieved pain or increased pain in the affected limb (early sign); tissue that is distal to the involved area becoming cool to the touch, pale, dusky, or edematous; pain with passive movement or joint dysfunction; loss of sensation (paresthesia); and pulselessness of the affected limb (a late sign). Poikilothermia is the inability to regulate body temperature, which may also be present.

54.

A nurse is caring for a child with bronchiectasis secondary to pneumonia and is performing a morning assessment. The nurse expects this patient's cough to have which of the following characteristics?

  • Loose and productive

  • Croupy

  • Paroxysmal and nocturnal

  • Brassy

Correct answer: Loose and productive

Bronchiectasis is a chronic lung condition in which the bronchi become irreversibly damaged and dilated, making it hard for the patient to clear mucus. The patient attempts to clear mucous by coughing, and the cough is loose and productive.

Viral laryngotracheobronchitis (LTB) produces a "croupy" cough, which is a characteristic barking cough. Paroxysmal coughing is characterized by recurrent, intense episodes of coughing. The most common causes are pertussis, mycoplasma, foreign body, and chlamydia. Nocturnal means the coughing happens at night and is seen in asthma, sinusitis, GERD, and upper respiratory tract disease. A brassy cough is a loud, metallic, barking cough that is heard in tracheitis and with upper airway drainage.

55.

A child with suspected tuberculosis (TB) presents to the emergency department (ED). As the triage nurse on duty, you plan to institute which of the following types of isolation precautions?

  • Standard and airborne

  • Standard and droplet 

  • Contact and airborne 

  • Contact and droplet 

Correct answer: Standard and airborne

A patient with active TB is contagious. The source of TB infection in children is usually an infected member of the household or a frequent visitor to the home. The airway is the usual portal of entry for the organism.

Mycobacterium tuberculosis, which causes this disease, is so small that it can stay suspended in the air for hours to days. Therefore, the nurse will place the patient in standard and airborne precautions. In addition, an N95 mask must be worn at all times during patient contact.

56.

Which of the following is the primary treatment concern in the management of pediatric head injury patients?

  • Airway management

  • Hemorrhage control

  • Fluid resuscitation

  • Blood sugar stabilization

Correct answer: Airway management

The most important intervention during the initial stabilization of any patient is the establishment of a functional patent airway. Some of the most common airway interventions used in the pediatric population include nasopharyngeal airways (NPAs), oropharyngeal airways (OPAs), laryngeal mask airways (LMAs), and endotracheal intubation (ETTs).

The primary concern in managing a trauma patient is ensuring a safe, effective airway.

57.

A 10-year-old boy presents to the emergency department with his mother after sustaining burns while playing with matches in his garage. His mother states the accelerant used is unknown, and the boy accidentally caught his pants on fire, which he then attempted to put out using his hands. The burns are circumferential on the right lower extremity, extending from the ankle to the mid-thigh and anteriorly on the left thigh. He also has burns to both hands on the palmar surfaces. The boy weighs 48 kg and is 135 cm in height.

When should the nurse expect maximal swelling of the burns?

  • 12 to 24 hours post-burn

  • 6 to 8 hours post-burn 

  • 24 to 48 hours post-burn 

  • 3 to 5 days post-burn 

Correct answer: 12 to 24 hours post-burn 

Children with large burns (>15% total body surface area [TBSA]) have local edema formation, as well as the potential for systemic capillary leak formation and the resultant need for fluid resuscitation to maintain homeostasis. Edema resulting from increased capillary permeability is at its peak 12 to 24 hours postburn injury. Fluid resuscitation should be initiated for the first 24 hours post-burn.

58.

To determine brain death in a child, apnea testing must be performed in conjunction with a clinical examination, following disconnection from the ventilator. What is a positive apnea test?

  • Absence of respiratory effort, PaCO2 20 mm Hg above baseline and >60 mm Hg

  • Absence of respiratory effort, PaCO2 30 mm Hg above baseline and >70 mm Hg

  • Absence of respiratory effort, PaCO2 10 mm Hg above baseline and >50 mm Hg

  • Absence of respiratory effort, PaCO2 40 mm Hg above baseline and >80 mm Hg

Correct answer: Absence of respiratory effort, PaCO2 20 mm Hg above baseline and >60 mm Hg

To determine brain death, a physical examination should demonstrate that coma and apnea coexist. Apnea testing must be performed with the clinical examination, and the patient must have a complete absence of respiratory effort with standardized apnea testing.

Following disconnection from the ventilator, allow at least 5-10 minutes for PaCO2 to increase. A positive apnea test involves a PaCO2 that is 20 mm Hg above the baseline and >60 mm Hg.

59.

Hypothermia is part of which toxidrome?

  • Opioid

  • Sympathomimetic (stimulant)

  • Anticholinergic

  • Cholinergic

Correct answer: Opioid

Hypothermia is a symptom of opioid toxidrome. Other symptoms of opioid overdose include hypotension, altered mental status, miosis, unresponsiveness/coma, respiratory depression, bradypnea and bradycardia, and decreased peristalsis/bowel sounds.

Hyperthermia is a symptom of the sympathomimetic (stimulant) and anticholinergic toxidromes. Symptoms associated with cholinergic overdose include salivation, lacrimation, urination, defecation, diarrhea, emesis, and bradycardia.

60.

A nurse is caring for a 10-year-old female who experienced abdominal trauma and received 2 units of packed red blood cells (PRBCs) approximately 24 hours ago. Which lab result demonstrates the blood transfusion was successful?

  • Hemoglobin level of 12 g/dL

  • Platelets of 200,000

  • Prothrombin time of 10 seconds

  • Hematocrit of 35%

Correct answer: Hemoglobin level of 12 g/dL

Hemoglobin levels are utilized to evaluate the effectiveness of a blood transfusion. Normal hemoglobin levels for a 10-year-old female are between 11 and 14.5 g/dL. Thus, a hemoglobin level of 12 g/dL indicates the transfusion was successful for this patient.

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