BCEN CTRN® (Certified Transport Registered
Nurse) ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
SECTION 1: GENERAL PRINCIPLES OF TRANSPORT NURSING
Transport Physiology and Environmental Considerations
Question 1
A transport nurse is preparing to move a patient from a rural hospital to a tertiary care center
via ground ambulance. The patient has a known small bowel obstruction. According to Boyle's
Law, which physiological change is the greatest concern during transport, even at ground-level
altitudes?
• A. Decreased oxygen saturation
• B. Expansion of trapped intestinal gas
• C. Increased risk of barotrauma to the lungs
• D. Decreased partial pressure of nitrogen
Answer: B. Expansion of trapped intestinal gas
Rationale: Boyle's Law states that the volume of a gas is inversely proportional to its pressure.
Even during ground transport, changes in altitude (particularly when crossing mountain
passes) can cause trapped gas to expand. In a patient with a bowel obstruction, this can lead
to abdominal distention, pain, vomiting, and potential perforation. The transport nurse must
anticipate this and consider nasogastric tube placement before or during transport. While
decreased oxygen saturation is also a concern, the immediate life-threatening risk from an
obstructed bowel is gas expansion.
,Question 2
According to Dalton's Law, which gas is most affected by changes in altitude during ground
transport?
• A. Nitrogen
• B. Carbon dioxide
• C. Oxygen
• D. Carbon monoxide
Answer: C. Oxygen
Rationale: Dalton's Law states that the total pressure of a gas mixture is the sum of the partial
pressures of individual gases. As altitude increases, barometric pressure decreases, and the
partial pressure of oxygen (PaO₂) decreases proportionally. This is why patients may become
hypoxemic during transport even if they were stable at the originating facility, particularly
when transporting through mountainous terrain.
Question 3
A transport nurse is caring for a patient on a mechanical ventilator during a 2-hour ground
transport. The ventilator is set to deliver a tidal volume of 500 mL at sea level. If the transport
route crosses a mountain pass at 8,000 feet, what adjustment should the nurse anticipate?
• A. The tidal volume will decrease due to increased atmospheric pressure
• B. The tidal volume will increase due to decreased atmospheric pressure
• C. The tidal volume will remain unchanged as ventilators compensate automatically
• D. The tidal volume will decrease due to decreased gas density
Answer: B. The tidal volume will increase due to decreased atmospheric pressure
Rationale: According to Boyle's Law, at higher altitudes with decreased atmospheric pressure,
gas expands. For a patient on a ventilator, the volume of gas delivered may increase if the
ventilator is volume-cycled, potentially leading to barotrauma. The transport nurse must
monitor airway pressures closely and be prepared to adjust ventilator settings. Many
transport ventilators have altitude compensation, but the nurse should verify this before
transport.
,Question 4
A transport nurse is preparing for a ground transport of a patient with a pneumothorax who
has a chest tube in place. At altitude (e.g., crossing a mountain pass), which finding should the
nurse anticipate?
• A. Decreased chest tube output
• B. Increased bubbling in the water seal chamber
• C. Decreased bubbling in the water seal chamber
• D. No change in chest tube function
Answer: B. Increased bubbling in the water seal chamber
Rationale: According to Boyle's Law, trapped air within the pleural space expands at altitude.
This can increase the volume of air being evacuated through the chest tube, leading to
increased bubbling in the water seal chamber. The transport nurse should monitor for signs of
tension pneumothorax and ensure the chest tube remains patent. A flutter valve (Heimlich
valve) or suction may be needed during transport.
Question 5
A patient is being transported via ground ambulance and develops acute oxygen desaturation
despite being on a non-rebreather mask at 15 L/min. The transport nurse notes the
ambulance is climbing a mountain pass. Which intervention is most appropriate?
• A. Increase the oxygen flow rate to 20 L/min
• B. Switch to a bag-valve-mask with an oxygen reservoir
• C. Consider intubation and mechanical ventilation
• D. Request the driver to descend to a lower altitude
Answer: C. Consider intubation and mechanical ventilation
Rationale: When a patient is hypoxemic despite high-flow oxygen via non-rebreather mask,
the next step is to consider intubation and mechanical ventilation. At altitude, the reduced
barometric pressure makes oxygenation more challenging. Mechanical ventilation allows the
transport nurse to control FiO₂, PEEP, and minute ventilation, providing more reliable
oxygenation and ventilation. Increasing flow rate on a non-rebreather mask will not
significantly improve oxygenation if the patient is already on 15 L/min.
, Question 6
Henry's Law is most relevant to transport nursing when considering which condition?
• A. Decompression sickness
• B. Hypoxia
• C. Hypothermia
• D. Motion sickness
Answer: A. Decompression sickness
Rationale: Henry's Law states that the amount of gas dissolved in a liquid is proportional to
the partial pressure of that gas above the liquid. In transport nursing, this is most relevant to
decompression sickness, where nitrogen dissolved in tissues forms bubbles as ambient
pressure decreases. While classically associated with diving and flight, this can also occur
during rapid altitude changes in ground transport, particularly when crossing mountain
passes.
Question 7
A transport nurse is preparing to transport a patient with a history of sickle cell anemia. At
altitude, which complication is of greatest concern?
• A. Increased risk of sickling due to hypoxemia
• B. Increased risk of bleeding
• C. Decreased risk of infection
• D. Increased risk of thrombosis
Answer: A. Increased risk of sickling due to hypoxemia
Rationale: Sickle cell anemia predisposes patients to sickling in low-oxygen environments. At
altitude, the decreased partial pressure of oxygen can trigger a sickle cell crisis. The transport
nurse should ensure the patient receives supplemental oxygen throughout transport and
monitor for signs of pain, fever, or respiratory distress. The patient should be kept warm and
well-hydrated.
Nurse) ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
SECTION 1: GENERAL PRINCIPLES OF TRANSPORT NURSING
Transport Physiology and Environmental Considerations
Question 1
A transport nurse is preparing to move a patient from a rural hospital to a tertiary care center
via ground ambulance. The patient has a known small bowel obstruction. According to Boyle's
Law, which physiological change is the greatest concern during transport, even at ground-level
altitudes?
• A. Decreased oxygen saturation
• B. Expansion of trapped intestinal gas
• C. Increased risk of barotrauma to the lungs
• D. Decreased partial pressure of nitrogen
Answer: B. Expansion of trapped intestinal gas
Rationale: Boyle's Law states that the volume of a gas is inversely proportional to its pressure.
Even during ground transport, changes in altitude (particularly when crossing mountain
passes) can cause trapped gas to expand. In a patient with a bowel obstruction, this can lead
to abdominal distention, pain, vomiting, and potential perforation. The transport nurse must
anticipate this and consider nasogastric tube placement before or during transport. While
decreased oxygen saturation is also a concern, the immediate life-threatening risk from an
obstructed bowel is gas expansion.
,Question 2
According to Dalton's Law, which gas is most affected by changes in altitude during ground
transport?
• A. Nitrogen
• B. Carbon dioxide
• C. Oxygen
• D. Carbon monoxide
Answer: C. Oxygen
Rationale: Dalton's Law states that the total pressure of a gas mixture is the sum of the partial
pressures of individual gases. As altitude increases, barometric pressure decreases, and the
partial pressure of oxygen (PaO₂) decreases proportionally. This is why patients may become
hypoxemic during transport even if they were stable at the originating facility, particularly
when transporting through mountainous terrain.
Question 3
A transport nurse is caring for a patient on a mechanical ventilator during a 2-hour ground
transport. The ventilator is set to deliver a tidal volume of 500 mL at sea level. If the transport
route crosses a mountain pass at 8,000 feet, what adjustment should the nurse anticipate?
• A. The tidal volume will decrease due to increased atmospheric pressure
• B. The tidal volume will increase due to decreased atmospheric pressure
• C. The tidal volume will remain unchanged as ventilators compensate automatically
• D. The tidal volume will decrease due to decreased gas density
Answer: B. The tidal volume will increase due to decreased atmospheric pressure
Rationale: According to Boyle's Law, at higher altitudes with decreased atmospheric pressure,
gas expands. For a patient on a ventilator, the volume of gas delivered may increase if the
ventilator is volume-cycled, potentially leading to barotrauma. The transport nurse must
monitor airway pressures closely and be prepared to adjust ventilator settings. Many
transport ventilators have altitude compensation, but the nurse should verify this before
transport.
,Question 4
A transport nurse is preparing for a ground transport of a patient with a pneumothorax who
has a chest tube in place. At altitude (e.g., crossing a mountain pass), which finding should the
nurse anticipate?
• A. Decreased chest tube output
• B. Increased bubbling in the water seal chamber
• C. Decreased bubbling in the water seal chamber
• D. No change in chest tube function
Answer: B. Increased bubbling in the water seal chamber
Rationale: According to Boyle's Law, trapped air within the pleural space expands at altitude.
This can increase the volume of air being evacuated through the chest tube, leading to
increased bubbling in the water seal chamber. The transport nurse should monitor for signs of
tension pneumothorax and ensure the chest tube remains patent. A flutter valve (Heimlich
valve) or suction may be needed during transport.
Question 5
A patient is being transported via ground ambulance and develops acute oxygen desaturation
despite being on a non-rebreather mask at 15 L/min. The transport nurse notes the
ambulance is climbing a mountain pass. Which intervention is most appropriate?
• A. Increase the oxygen flow rate to 20 L/min
• B. Switch to a bag-valve-mask with an oxygen reservoir
• C. Consider intubation and mechanical ventilation
• D. Request the driver to descend to a lower altitude
Answer: C. Consider intubation and mechanical ventilation
Rationale: When a patient is hypoxemic despite high-flow oxygen via non-rebreather mask,
the next step is to consider intubation and mechanical ventilation. At altitude, the reduced
barometric pressure makes oxygenation more challenging. Mechanical ventilation allows the
transport nurse to control FiO₂, PEEP, and minute ventilation, providing more reliable
oxygenation and ventilation. Increasing flow rate on a non-rebreather mask will not
significantly improve oxygenation if the patient is already on 15 L/min.
, Question 6
Henry's Law is most relevant to transport nursing when considering which condition?
• A. Decompression sickness
• B. Hypoxia
• C. Hypothermia
• D. Motion sickness
Answer: A. Decompression sickness
Rationale: Henry's Law states that the amount of gas dissolved in a liquid is proportional to
the partial pressure of that gas above the liquid. In transport nursing, this is most relevant to
decompression sickness, where nitrogen dissolved in tissues forms bubbles as ambient
pressure decreases. While classically associated with diving and flight, this can also occur
during rapid altitude changes in ground transport, particularly when crossing mountain
passes.
Question 7
A transport nurse is preparing to transport a patient with a history of sickle cell anemia. At
altitude, which complication is of greatest concern?
• A. Increased risk of sickling due to hypoxemia
• B. Increased risk of bleeding
• C. Decreased risk of infection
• D. Increased risk of thrombosis
Answer: A. Increased risk of sickling due to hypoxemia
Rationale: Sickle cell anemia predisposes patients to sickling in low-oxygen environments. At
altitude, the decreased partial pressure of oxygen can trigger a sickle cell crisis. The transport
nurse should ensure the patient receives supplemental oxygen throughout transport and
monitor for signs of pain, fever, or respiratory distress. The patient should be kept warm and
well-hydrated.
