BCEN Medical Emergencies and Conditions 2 — Questions and Answers
Question 1: A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' What is the priority nursing action?
- Administer acetaminophen and reassess in 30 minutes
- Prepare for emergent CT scan of the head (Correct answer)
- Perform a detailed neurological assessment and document findings
- Apply ice pack and dim lights for comfort
Correct answer: Prepare for emergent CT scan of the head
A thunderclap headache is classic for subarachnoid hemorrhage, requiring emergent non-contrast CT to detect blood before lumbar puncture.
Question 2: Which electrocardiogram finding is most characteristic of hyperkalemia?
- Prolonged QT interval
- ST-segment depression in V4-V6
- Peaked T waves and widened QRS complex (Correct answer)
- Shortened PR interval with delta waves
Correct answer: Peaked T waves and widened QRS complex
Hyperkalemia causes peaked T waves, widened QRS, and eventually a sine-wave pattern due to impaired cardiac conduction.
Question 3: A patient with known COPD presents with increasing dyspnea and SpO2 of 82%. Which oxygen delivery is most appropriate initially?
- Non-rebreather mask at 15 L/min
- Nasal cannula at 1-2 L/min titrated to SpO2 88-92% (Correct answer)
- Venturi mask at 40% FiO2
- Bag-valve-mask ventilation at 100% O2
Correct answer: Nasal cannula at 1-2 L/min titrated to SpO2 88-92%
COPD patients may rely on hypoxic drive; target SpO2 88-92% with low-flow O2 via nasal cannula to avoid suppressing respiratory drive.
Question 4: A patient presents with diaphoresis, confusion, and blood glucose of 38 mg/dL. The patient is unable to swallow safely. What is the best intervention?
- Oral glucose gel placed between cheek and gum
- 50 mL of 50% dextrose (D50W) IV push (Correct answer)
- Subcutaneous insulin to prevent rebound hyperglycemia
- Nasogastric tube feeding with glucose solution
Correct answer: 50 mL of 50% dextrose (D50W) IV push
IV dextrose 50% is the preferred treatment for severe symptomatic hypoglycemia when the patient cannot safely swallow.
Question 5: Which finding in a patient with acute pancreatitis indicates severe disease requiring ICU-level care?
- Epigastric pain radiating to the back
- Serum lipase three times upper normal limit
- PaO2 < 60 mmHg despite supplemental oxygen (Correct answer)
- Nausea and vomiting with inability to tolerate oral intake
Correct answer: PaO2 < 60 mmHg despite supplemental oxygen
Hypoxemia unresponsive to supplemental oxygen indicates ARDS or pleural effusion, a severe complication requiring intensive monitoring.
Question 6: A patient on warfarin presents with INR of 9.2 and active GI bleeding. Which reversal agent is most appropriate?
- Vitamin K 10 mg IV only
- Protamine sulfate IV
- 4-factor prothrombin complex concentrate (4F-PCC) plus Vitamin K (Correct answer)
- Fresh frozen plasma alone
Correct answer: 4-factor prothrombin complex concentrate (4F-PCC) plus Vitamin K
4F-PCC provides immediate reversal of warfarin's anticoagulant effect, while Vitamin K provides sustained reversal; this combination is preferred for life-threatening bleeding.
Question 7: Which assessment finding best distinguishes ischemic stroke from hemorrhagic stroke in the emergency department?
- Facial droop and arm weakness
- Non-contrast CT scan of the head (Correct answer)
- Sudden onset of symptoms
- Elevated blood pressure
Correct answer: Non-contrast CT scan of the head
Non-contrast CT scan reliably differentiates ischemic from hemorrhagic stroke and must be obtained before any thrombolytic therapy.
BCEN Medical Emergencies and Conditions 2
A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' What is the priority nursing action?