BCEN Medical Emergencies and Conditions 4

Question 1

A patient presents with sudden-onset pleuritic chest pain and dyspnea 3 days after a long flight. D-dimer is elevated. What is the next most appropriate diagnostic step?

Accepted Answer

CT pulmonary angiography (CTPA)

Answer

CTPA is the gold standard for diagnosing pulmonary embolism and is indicated when clinical probability combined with elevated D-dimer suggests PE.

Question 2

Which finding best differentiates hypertensive emergency from hypertensive urgency?

Accepted Answer

Presence of end-organ damage such as encephalopathy or acute renal failure

Answer

Hypertensive emergency is defined by end-organ damage (brain, heart, kidneys, eyes), regardless of absolute blood pressure value; urgency has severe hypertension without organ damage.

Question 3

A patient presents with syncope, diaphoresis, and a blood pressure of 70/40 mmHg after taking sildenafil earlier that day. What medication is contraindicated in his management?

Accepted Answer

Nitroglycerin for chest pain

Answer

Nitrates are absolutely contraindicated within 24-48 hours of PDE-5 inhibitor use (sildenafil) due to the risk of severe refractory hypotension.

Question 4

A patient with end-stage renal disease presents with peaked T waves, PR prolongation, and QRS widening on ECG. Potassium is 7.2 mEq/L. Which intervention stabilizes the cardiac membrane first?

Accepted Answer

Calcium gluconate 1-2 g IV

Answer

Calcium gluconate immediately antagonizes the cardiac membrane effects of hyperkalemia and is given first before interventions that redistribute or remove potassium.

Question 5

Which presentation is most consistent with aortic dissection rather than myocardial infarction?

Accepted Answer

Tearing chest pain radiating to the back with pulse differential between arms

Answer

Tearing or ripping chest pain radiating to the back with blood pressure differential between arms is the classic presentation of aortic dissection.

(BCEN) Board of Certification of Emergency Nursing Practice Test

(BCEN) Board of Certification of Emergency Nursing Practice Test

BCEN Medical Emergencies and Conditions 4