×

Quiz Session - Attempts With Random Questions

BCEN CPEN Exam Questions

Page 8 of 25

141.

Which ventilatory mode is defined by a preset respiratory rate that also allows the patient to breathe spontaneously between the machine-delivered breaths?

  • Intermittent mandatory ventilation (IMV)

  • Controlled mandatory ventilation (CMV)

  • Assist/control ventilation (A/C)

  • Pressure support ventilation (PSV)

Correct answer: Intermittent mandatory ventilation (IMV)

IMV is a mode through which a preset respiratory rate with other preset limits (tidal volume and inspiratory flow rate) is delivered to the patient. The patient can breathe spontaneously from the circuit, but the ventilator does not interface with these efforts. If the patient is midway into a spontaneous breath when the machine timing initiates a breath, the patient will receive a larger, more uncomfortable breath.

In CMV mode, the patient cannot initiate spontaneous breaths; the ventilator controls and delivers every breath within preset parameters.

In A/C mode, the ventilator breaths are regulated as in CMV. If the patient initiates an unassisted spontaneous breath, the ventilator will complete the effort with the preset mechanisms. The only effort the patient exerts is the initial breath effort.

PSV allows the patient to breathe spontaneously, providing pressure/flow support with each effort. The pressure support is predetermined by the physician.

142.

A nurse is caring for a pediatric patient in septic shock after they sustained third-degree burns from an apartment fire. The nurse suspects the patient is experiencing acute disseminated intravascular coagulation (DIC) disorder.

Which of the following laboratory results is indicative of DIC?

  • Decreased platelet counts

  • Increased fibrinogen levels

  • Decreased D-dimer levels

  • Shortened prothrombin (PT) and partial thromboplastin times (PTT)

Correct answer: Decreased platelet counts

DIC is a life-threatening bleeding disorder resulting from the activation of the body's coagulation cascade. It is always the result of another disease or condition (e.g., shock, infection, severe tissue damage, and cancer) and leads to uncontrolled bleeding secondary to a decrease in clotting factors and platelets.

Platelet count is decreased in approximately 50% of patients secondary to platelet consumption. PT and PTT are prolonged, fibrinogen levels are decreased, and fibrinogen degradation products (FDPs) and D-dimer levels are elevated.

Treating the underlying cause is essential for addressing DIC.

143.

When teaching a caregiver to perform an aspect of patient care, a pediatric critical care nurse must recognize which of the following?

  • The best learning occurs when the caregiver perceives a need to learn

  • Caregivers are unaffected by the timing of teaching

  • Caregivers learn best if shown a complicated aspect of care in a single teaching session

  • Caregivers are unaffected by the purpose of a task

Correct answer: The best learning occurs when the caregiver perceives a need to learn

According to adult learning theory, establishing a perception of a need to learn prior to providing education is an important first step toward optimal educational efforts. Caregivers are affected by the timing of teaching and the purpose of a task, and they often need to be shown complex procedures over several teaching sessions before fully grasping information.

144.

A pediatric patient is being treated for cardiogenic shock secondary to myocarditis. Which of the following statements describes this form of shock?

  • Cardiogenic shock leads to pulmonary and systemic congestion, resulting in pulmonary and peripheral edema and respiratory compromise.

  • Cardiogenic shock leads to increased preload, afterload, and contractility.

  • Cardiogenic shock is characterized by extreme tachycardia, low systemic vascular resistance (SVR), and decreased cardiac output (CO).

  • Cardiogenic shock occurs because the heart has an inadequate volume of blood to pump and insufficient oxygen-carrying capacity.

Correct answer: Cardiogenic shock leads to pulmonary and systemic congestion, resulting in pulmonary and peripheral edema and respiratory compromise.

Cardiogenic shock is the result of the heart's inability to pump enough blood to the rest of the body (i.e., inadequate perfusion due to a weakened heart muscle) resulting from myocardial dysfunction. Hypovolemic shock is due to inadequate blood volume, usually from blood loss related to trauma). Causes include congenital heart disease (CHD), myocarditis, cardiomyopathy, arrhythmias, sepsis, poisoning or drug toxicity, and myocardial injury.

Symptoms include severe tachycardia, high SVR (not low SVR), and decreased CO from the reduction in stroke volume (SV). Pulmonary congestion leads to pulmonary edema and respiratory compromise. Systemic congestion leads to effusions, ascites, and peripheral edema. Preload is variable, afterload is increased, and contractility is decreased. This causes decreased tissue perfusion and injury to the cells of the tissues/organs.

145.

A nurse is auscultating the lungs of a patient and notes inspiratory stridor. This finding is most consistent with which diagnosis?

  • Laryngotracheomalacia

  • Pneumonia

  • Asthma exacerbation

  • Exposure to second-hand smoke

Correct answer: Laryngotracheomalacia

Stridor is noisy breathing caused by increased turbulence of airflow through a lumen and a sign of upper airway obstruction. Inspiratory stridor is related to the inward collapse of structures during inspiration. In children, laryngotracheomalacia and viral croup are the most common causes of inspiratory stridor. Postextubation endotracheal tube (ETT) trauma is another possible source of stridor.

Pneumonia, asthma exacerbations, and second-hand smoke exposure are not likely causes of inspiratory stridor.

146.

A two-year-old male is admitted to the emergency department with a suspected pneumothorax after a motor vehicle accident. The child presents in severe respiratory distress, showing distended neck veins on physical assessment and a displaced trachea.

Which of the following X-ray findings would confirm the presence of a pneumothorax?

  • Unilateral hyperlucency

  • Increased pulmonary vascular markings

  • Narrow intercostal spaces

  • Decreased lucency

Correct answer: Unilateral hyperlucency

Children with significant intrathoracic injuries may not have suggestive external evidence of these injuries. Therefore, radiographic evaluation of the chest is standard in thoracic trauma cases. Pediatric nurses should observe for chest-wall ecchymosis, bruising, abrasions, a sensation of crepitus, point tenderness over a rib, or a displaced trachea.

A sharp edge sign, in which the cardiac border and the diaphragm are seen in sharp contrast, is an X-ray finding of a pneumothorax (the most common air leak). Other findings of pneumothorax include unilateral hyperlucency (blackness indicating air), an overall increase in size, a flattened diaphragm on the affected side, widened intercostal spaces, and decreased or absent pulmonary vascular markings.

A tension pneumothorax results in mediastinal shifts with decreased volume, increased opacity of the opposite lung, and deviation of the heart and trachea to the opposite side (shifted away from the side of the pneumothorax). If a tension pneumothorax is left untreated, the underlying lung will collapse.

147.

What is the neuroimaging study of choice for a suspected intraventricular hemorrhage (IVH) in a pediatric patient?

  • Cranial ultrasound (CUS)

  • Doppler ultrasound

  • CT scan of the head

  • MRI of the head

Correct answer: Cranial ultrasound (CUS)

IVH is most commonly associated with prematurity. This is due to the immaturity and fragility of the brain's germinal matrix, as well as the immaturity of the infant's ability to autoregulate cerebral blood flow. In the case of a suspected IVH, based on history and/or physical findings, a CUS is most often performed to identify the degree and location of the bleeding.

Doppler ultrasound may be used for imaging and flow-velocity measurements. CT scanning and MRI identify structures, but disadvantages include transporting the patient to a different location, maintaining patient stability during the procedure, and the difficulty of doing serial examinations. CT scans also involve the adverse effects of radiation.

MRI is superior to CUS only when it is important to detect white matter abnormalities.

148.

As the triage nurse on duty, you admit a 13-year-old male who was at a movie theater with his friends when an explosion of unknown origin occurred. The paramedics report suspicion of terrorism and suspect the cause of the explosion was a dirty bomb. The patient's clothing was removed en route to the emergency department (ED). You plan to decontaminate the patient using which of the following immediately?

  • Soap and water

  • Water alone

  • Chlorhexidine wipes

  • An alcohol-based solution 

Correct answer: Soap and water

Most patients that require decontamination from a possible chemical attack can be decontaminated with soap and water. Emergency staff should be trained to decontaminate patients appropriately and should have the appropriate personal protective equipment (PPE). Hospitals should have the equipment required to decontaminate victims as required.

149.

Which common pacemaker mode is indicated as an emergent treatment to establish ventricular activity when AV dissociation is present, maintaining cardiac output (CO) without an atrial kick?

  • VVI (ventricular demand pacing)

  • VOO (ventricular asynchronous pacing)

  • DDD (dual-chambered pacing)

  • AAI (atrial demand pacing)

Correct answer: VVI (ventricular demand pacing)

Pacemakers deliver an electrical stimulus to the heart to initiate depolarization and stimulate cardiac contraction. Common indications for pediatric pacemaker placement include surgically induced heart block, congenital complete heart block, SSS and other symptomatic bradyarrhythmias, long QT syndrome (LQTS), and neurocardiogenic syncope.

Ventricular demand pacing mode (VVI) prevents ventricular bradycardia and is primarily used in emergencies for patients with atrial fibrillation who have a slow ventricular response to establish ventricular activity and maintain CO. In this pacemaker mode, the ventricle is paced and sensed, and the pulse generator inhibits pacing output in response to a sensed ventricular event.

VOO pacing is indicated for asystole and is dangerous, as it can cause an R-on-T phenomenon with ventricular fibrillation (use DDD or VVI instead). DDD pacing is indicated for any arrhythmia without AV conduction (blocks); it should be avoided for patients with atrial fibrillation or flutter since it tracks atrial rate. AAI pacing is indicated for sinus or high-junctional bradycardias when the AV conduction system is intact.

150.

You are triaging a 17-year-old male patient who was in a fight and sustained multiple wounds. The patient presents with hematuria, flank pain, and abdominal pain. You suspect which of the following organs has been injured? 

  • Kidney

  • Liver

  • Pancreas

  • Spleen 

Correct answer: Kidney 

These assessment findings are consistent with renal damage. The patient may present with bruising over the umbilicus and flank area known as Grey-Turner's sign, hematuria, abdominal pain, and dyspnea. 

Patients with liver damage often experience right shoulder pain, while splenic injury leads to left shoulder pain. Abdominal pain, nausea, vomiting, and elevated serum amylase are associated with injury to the pancreas. 

151.

An 18-month-old child is diagnosed with acute laryngotracheobronchitis (LTB) in the pediatric emergency department. The patient is treated and stabilized, and the nurse is preparing to discharge the toddler home. When educating the parents, the nurse explains which home treatment to implement?

  • Cool-mist humidifier at bedtime

  • Antibiotic therapy as prescribed by a physician

  • Over-the-counter decongestants

  • Aspirin for fever and/or pain

Correct answer: Cool-mist humidifier at bedtime

Acute LTB is an inflammatory swelling of the submucosa in the subglottic area. Croup is a general medical term that refers to this inflammatory process, which results in stridor, coughing, and hoarseness. It is most often viral in etiology, and antibiotics are not generally prescribed unless there is another underlying bacterial infection. Racemic epinephrine reduces mucosal edema and is frequently administered in an emergency setting. Oral steroids are often given as a single dose of dexamethasone.

A cool-mist humidifier or placing the child in a steam-filled room, such as a bathroom with a hot running shower, can help moisten the airway and liquefy mucus secretions. This is often helpful for supportive care immediately following emergency treatment and is often prescribed on hospital discharge. Aspirin should never be given to a child due to the risk of Reye's syndrome. Antipyretics (acetaminophen and/or ibuprofen) may be indicated for discomfort and fever.

152.

Which pediatric burn injuries should not be referred to a burn center?

  • Partial-thickness burns greater than 9% total body surface area (TBSA)

  • Suspected inhalation injury

  • Any full-thickness burn across all pediatric age groups

  • Any chemical burn

Correct answer: Partial-thickness burns greater than 9% total body surface area (TBSA)

The American Burn Association (ABA) has established a set of criteria for referring patients to a burn-specific critical care environment to receive specialized care for certain types of burn injuries. Any child who suffered partial-thickness (second-degree) burns over greater than 10% of their total body surface should be referred to a burn center.

Additional criteria include burns that involve the face, hands, feet, genitalia, perineum, or major joints; third-degree (full-thickness) burns in any age group; electrical burns; chemical burns; inhalation injury; burns on patients with preexisting medical conditions that could complicate management; any patient with burns and concomitant trauma in which the burn poses the greatest risk of morbidity and mortality; and burn injury in patients requiring specialized social, emotional, or rehabilitative intervention.

153.

A nurse is caring for a patient with a Sengstaken-Blakemore tube in place for bleeding esophageal varices. The nurse is preparing a plan of care for this patient and anticipates deflation of the balloons at which intervals?

  • Every 12 to 24 hours

  • Every 4 to 6 hours

  • Every 8 to 12 hours

  • Every 48 hours

Correct answer: Every 12 to 24 hours

Insertion of a Sengstaken-Blakemore tube may be performed on a patient with esophageal varices if endoscopy is not available. It is often placed in emergency situations to stop bleeding in the stomach or esophagus.

The tube has three separate lumens for gastric suction, inflation of the gastric balloon, and inflation of the esophageal balloon. Nursing interventions include deflation of the balloons every 12 to 24 hours, as well as ensuring patency of the gastric suction lumen by irrigating frequently. Frequent serious complications of the Sengstaken-Blakemore tube include perforation or erosion of the esophagus or stomach from hyperinflation or prolonged inflation of the balloons. For these reasons, its usefulness is limited.

154.

A nurse is caring for a two-year-old toddler who just underwent a diagnostic cardiac catheterization via the right groin. As part of the head-to-toe assessment, the nurse checks bilateral pedal pulses frequently to monitor for which complication?

  • Thrombosis

  • Hemorrhage

  • Stroke

  • Cardiac tamponade

Correct answer: Thrombosis

Caring for a child post-cardiac catheterization includes checking bilateral pedal pulses to ensure they are present and equal; a loss of pulse or a decrease in pulse strength could indicate the formation of a potential blood clot (arterial or venous thrombosis).

Hemorrhage, stroke, and cardiac tamponade are also all potential complications of cardiac catheterization, but they are not monitored with a pulse assessment.

155.

Which of the following types of open fracture injuries is/are often treated with external fixation?

  • Types II and III

  • Type III only 

  • Types I and II

  • Type II only

Correct answer: Types II and III

Open fractures are divided into three types:

  • Type I: Clean puncture with minimal soft-tissue involvement; treat with casting with a window cut to allow for healing visualization and dressing changes
  • Type II: >1 cm laceration with slight or moderate crushing and no extensive soft-tissue damage
  • Type III: Extensive damage to soft tissues, muscle, skin, and neurovascular structures; contamination is present; treatment with wound irrigation and IV antibiotics is necessary; debridement every 24 to 48 hours until the wound is clean

Types II and III injuries may be treated with external fixation.

156.

In children, bacterial meningitis often presents with three classic signs. Which of the following is not typically seen in pediatric bacterial meningitis?

  • Petechial rash

  • Nuchal rigidity

  • Brudzinski's sign

  • Kernig's sign

Correct answer: Petechial rash

In children, the three classic signs of bacterial meningitis are a stiff neck (nuchal rigidity), Brudzinski's sign (flexion of the hips and knees with passive flexion of the neck), and Kernig's sign (back pain and resistance after passive extension of the lower legs). Although these signs are commonly present, they do not reliably occur in all children and cannot be used to diagnose or exclude meningitis.

A petechial rash may occur with Neisseria meningitidis, otherwise known as meningococcal disease.

157.

A patient with a head injury and suspected damage to the hypothalamus will need which of the following vital signs to be closely monitored? 

  • Temperature

  • Respiration

  • Blood pressure 

  • Pulse 

Correct answer: Temperature 

Trauma to the hypothalamus or the spinal cord (which carries hypothalamic messages) results in severe alterations in temperature control and leads to temperature instability. The hypothalamus does not control respiration, blood pressure, or pulse. 

158.

A pediatric critical care nurse is caring for a child with central diabetes insipidus (DI). The nurse is administering maintenance intravenous (IV) fluids slowly to correct the patient's hypernatremia and monitoring the child's laboratory values closely. This patient's sodium levels should fall no faster than which of the following?

  • 0.5 mEq/L per hour over 48 to 72 hours

  • 0.5 mEq/L per hour over 12 to 24 hours

  • 1 mEq/L per hour over 48 to 72 hours

  • 1 mEq/L per hour over 12 to 24 hours

Correct answer: 0.5 mEq/L per hour over 48 to 72 hours

Fluid is given to children with central DI as maintenance IV fluids plus urine replacement at 1 mL per 1 mL for all urine output greater than 2 mL/kg/hr. In severe cases, such as when shock or seizures are present, airway management, fluid resuscitation, and seizure control must take priority. If dehydration is present, normal saline should be bolused at 20 mL/kg. Anticonvulsant therapy with lorazepam or Valium should be administered.

Fluid and sodium levels should be normalized slowly over 48 to 72 hours. Hypernatremia is corrected slowly, as rapid correction of osmolality can result in cerebral edema. Sodium levels should fall no faster than 0.5 mEq/L per hour over 48 to 72 hours.

159.

A nurse is providing education to the family of an infant with DiGeorge syndrome and associated congenital heart disease (CHD). The family was unaware of the infant's condition prior to delivery.

Which support and anticipatory guidance measures would be appropriate to discuss?

  • Encourage breastfeeding and pumping to maintain supply

  • Arrange social work, palliative care, and genetics referrals

  • During resuscitative measures and procedures, limit and/or avoid family presence since the diagnosis was a shock

  • Reassure the family that the infant's condition will not interfere with normal growth and development

Correct answer: Encourage breastfeeding and pumping to maintain supply

This infant may be intubated and will not be able to eat prior to surgery (NPO). In addition, the infant's bowel function may be at risk due to surgery, and the incidence of necrotizing enterocolitis (NEC) is higher in these infants. Critical illness, genetic predisposition, and the use of cardiopulmonary bypass during surgical repair all place the infant at higher risk of immunosuppression.

Breastmilk provides an easily digestible feeding that includes antibodies to assist with immune suppression, decrease the risk of NEC, and optimize feeding progression. Pumping should be encouraged to maintain the breast milk supply until the infant can tolerate enteral feedings. This will require support from nursing, lactation, nutrition, and social work.

160.

A pediatric critical care nurse is caring for an 11-year-old male experiencing rhabdomyolysis from acute renal failure. When formulating a plan of care for this patient, the nurse would not consider which intervention?

  • Maintaining NPO (nothing by mouth) status

  • Ensuring proper fluid resuscitation

  • Giving electrolyte replacement

  • Placing a Foley catheter and closely monitoring output

Correct answer: Maintaining NPO (nothing by mouth) status

The manifestations and complications of rhabdomyolysis result from muscle cell death, with the release of intracellular muscle constituents (particularly, myoglobin, potassium, phosphorous, and enzymes) into the bloodstream. This condition can be caused directly by muscle injury or indirectly by various medical conditions.

Some nursing considerations are to ensure proper fluid resuscitation, record the patient's intake and output (the patient will need a Foley catheter to monitor output status), monitor serum electrolytes and laboratory values (serum creatinine kinase, bicarbonate, electrolytes, kidney function, etc), replace electrolytes as ordered, monitor for signs of compartment syndrome, and offer discharge planning on prevention.

Desired outcomes for this patient include maintaining adequate hydration and normal electrolyte levels, implementing a proper diet, and using caution when exercising to avoid further skeletal muscle breakdown.

×