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CFRN environmental emergencies
CFRN Examination Review
Jill Johnson, BSN, CEN, CCRN, CFRN
CFRN Environmental Emergencies Editor’s note: This occasional column will feature review questions and rationales for the correct answers to help crewmembers preparing to take the certified flight registered nurse examination, as well as those who want to sharpen their clinical skills through a review of relevant flight physiology. If you would like to submit questions to be considered for this column, please E-mail them to [email protected]. 1. Bacterial meningitis is confirmed by a laboratory procedure that shows: A. White blood count (WBC) > 10,000, decreased glucose, and elevated protein level B. WBC > 10,000, normal glucose, and decreased protein C. WBC < 500, normal glucose, and normal protein level D. Cloudy CSF, elevated glucose, and decreased protein 2. The hallmark symptoms of Reyes syndrome after a minor viral illness are? A. Fever and uticaria B. Petechia and congestion C. Altered level of consciousness with recurrent vomiting D. Diarrhea and fever 3. You are transporting a 65-year-old woman who was mowing her lawn and passed out. She is unconscious, and her breathing is shallow. Vital signs are BP 86/54,
A. B. C. D.
P 136, R 28, Temp 105.6. One of your primary interventions after doing your ABCs is: Start an IV and give fluids to hydrate Remove clothing, wrap in wet clothes and try to cool patient Conduct neurologic assessment and record deficits Monitor rectal temperature
4. Which of the following would you watch to monitor for rhabdomyolyis in the heat stroke victim? A. Level of consciousness B. Respiratory status C. Changes in pulse pressure D. Urine output and color 5. A. B. C. D.
Which of the following is not a symptom of frostbite? Firm to hard tissue Blistering skin Pale tissue Yellow appearance of tissue as freezing occurs
6. Which of the following is a symptom of “after drop” in the hypothermic patient? A. Drop in heart rate and shivering B. Normothermia and hypoventilation C. Hyperthermia and hypertension D. Cardiac dysrhythmias and hypotension Answers and rationale on page 48
continued from page 14
Rationale 1. A. Bacterial meningitis CSF usually is cloudy with a WBC up to 20,000, decreased glucose, and elevated protein levels. Viral meningitis CSF will be clear, WBC < 500, normal glucose, and normal protein levels. 2. C. Altered mental status and recurrent vomiting usually follow a mild viral illness, such as upper respiratory infection or chicken pox. 3. B. After the ABCs are done, the primary care of the heat stroke victim is rapid cooling, which can be done with ice packs, wet clothes, or rectal and gastric lavage with cold saline. 4. D. Blood or dark colored urine, muscle cramps, and hyperkalemia are signs of rhabdomyolyis. 5. D. Symptoms of frostbite are pale to erythemic tissue, firm to hard tissue, blistering, and blackening of the injured tissue. 6. D. After drop occurs when rewarming a patient. As the periphery is warmed, acidotic blood is dumped into the central circulation, causing a drop in BP and dysrhythmia. Jill Johnson, BSN, CEN, CCRN, CFRN, is a flight nurse with AirLife of Denver and president of ASTNA. doi:10.1067/mmj.2001.118653
14
Air Medical Journal 20:5
Jill Johnson, BSN, CEN, CCRN, CFRN
CFRN Environmental Emergencies Editor’s note: This occasional column will feature review questions and rationales for the correct answers to help crewmembers preparing to take the certified flight registered nurse examination, as well as those who want to sharpen their clinical skills through a review of relevant flight physiology. If you would like to submit questions to be considered for this column, please E-mail them to [email protected]. 1. Bacterial meningitis is confirmed by a laboratory procedure that shows: A. White blood count (WBC) > 10,000, decreased glucose, and elevated protein level B. WBC > 10,000, normal glucose, and decreased protein C. WBC < 500, normal glucose, and normal protein level D. Cloudy CSF, elevated glucose, and decreased protein 2. The hallmark symptoms of Reyes syndrome after a minor viral illness are? A. Fever and uticaria B. Petechia and congestion C. Altered level of consciousness with recurrent vomiting D. Diarrhea and fever 3. You are transporting a 65-year-old woman who was mowing her lawn and passed out. She is unconscious, and her breathing is shallow. Vital signs are BP 86/54,
A. B. C. D.
P 136, R 28, Temp 105.6. One of your primary interventions after doing your ABCs is: Start an IV and give fluids to hydrate Remove clothing, wrap in wet clothes and try to cool patient Conduct neurologic assessment and record deficits Monitor rectal temperature
4. Which of the following would you watch to monitor for rhabdomyolyis in the heat stroke victim? A. Level of consciousness B. Respiratory status C. Changes in pulse pressure D. Urine output and color 5. A. B. C. D.
Which of the following is not a symptom of frostbite? Firm to hard tissue Blistering skin Pale tissue Yellow appearance of tissue as freezing occurs
6. Which of the following is a symptom of “after drop” in the hypothermic patient? A. Drop in heart rate and shivering B. Normothermia and hypoventilation C. Hyperthermia and hypertension D. Cardiac dysrhythmias and hypotension Answers and rationale on page 48
continued from page 14
Rationale 1. A. Bacterial meningitis CSF usually is cloudy with a WBC up to 20,000, decreased glucose, and elevated protein levels. Viral meningitis CSF will be clear, WBC < 500, normal glucose, and normal protein levels. 2. C. Altered mental status and recurrent vomiting usually follow a mild viral illness, such as upper respiratory infection or chicken pox. 3. B. After the ABCs are done, the primary care of the heat stroke victim is rapid cooling, which can be done with ice packs, wet clothes, or rectal and gastric lavage with cold saline. 4. D. Blood or dark colored urine, muscle cramps, and hyperkalemia are signs of rhabdomyolyis. 5. D. Symptoms of frostbite are pale to erythemic tissue, firm to hard tissue, blistering, and blackening of the injured tissue. 6. D. After drop occurs when rewarming a patient. As the periphery is warmed, acidotic blood is dumped into the central circulation, causing a drop in BP and dysrhythmia. Jill Johnson, BSN, CEN, CCRN, CFRN, is a flight nurse with AirLife of Denver and president of ASTNA. doi:10.1067/mmj.2001.118653
14
Air Medical Journal 20:5