BCEN Patient Assessment and Diagnosis 2 — Questions and Answers
Question 1: A 45-year-old male presents with sudden onset of tearing chest pain radiating to the back. BP is 180/90 in the right arm and 140/70 in the left arm. Which diagnosis is most likely?
- Acute MI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Pericarditis
Correct answer: Aortic dissection
Unequal blood pressures between arms combined with tearing back pain are classic signs of aortic dissection.
Question 2: When assessing a trauma patient using the primary survey, which action is performed FIRST?
- Assess circulation
- Control hemorrhage
- Establish airway with C-spine precautions (Correct answer)
- Expose and examine the patient
Correct answer: Establish airway with C-spine precautions
The primary survey follows the ABCDE sequence, starting with airway management while maintaining cervical spine protection.
Question 3: A patient with suspected carbon monoxide poisoning has a pulse oximetry reading of 99%. The nurse should recognize this as:
- Reassuring — no CO toxicity present
- Falsely elevated because SpO2 cannot distinguish oxyhemoglobin from carboxyhemoglobin (Correct answer)
- Indicative of adequate tissue oxygenation
- Accurate only if the probe is placed on the earlobe
Correct answer: Falsely elevated because SpO2 cannot distinguish oxyhemoglobin from carboxyhemoglobin
Standard pulse oximetry cannot differentiate carboxyhemoglobin from oxyhemoglobin, giving a falsely normal reading in CO poisoning.
Question 4: The Cincinnati Prehospital Stroke Scale assesses which three components?
- Pupil response, grip strength, speech
- Facial droop, arm drift, speech abnormality (Correct answer)
- Level of consciousness, motor function, eye opening
- Gait, balance, cranial nerve function
Correct answer: Facial droop, arm drift, speech abnormality
The Cincinnati Stroke Scale evaluates facial droop, arm drift, and abnormal speech to rapidly identify stroke.
Question 5: A 60-year-old female presents with right lower quadrant pain, fever of 38.9°C, and a positive Rovsing's sign. Which condition does Rovsing's sign suggest?
- Ovarian torsion
- Appendicitis (Correct answer)
- Ectopic pregnancy
- Mesenteric ischemia
Correct answer: Appendicitis
Rovsing's sign — pain in the RLQ when the LLQ is palpated — is a classic physical finding suggestive of appendicitis.
Question 6: Which finding on a 12-lead ECG is MOST consistent with hyperkalemia?
- Prolonged QT interval
- ST elevation in V1-V4
- Peaked T waves (Correct answer)
- Widened P waves
Correct answer: Peaked T waves
Peaked, tall, narrow T waves are the earliest ECG manifestation of hyperkalemia.
Question 7: An unresponsive adult patient has a blood glucose of 28 mg/dL. No IV access is available. Which is the most appropriate intervention?
- Oral glucose gel under the tongue
- Glucagon 1 mg IM (Correct answer)
- D50W 25 mL IV push
- Normal saline 500 mL bolus
Correct answer: Glucagon 1 mg IM
When IV access is unavailable, glucagon 1 mg IM stimulates hepatic glycogenolysis to raise blood glucose in a hypoglycemic unresponsive patient.
BCEN Patient Assessment and Diagnosis 2
A 45-year-old male presents with sudden onset of tearing chest pain radiating to the back.
BP is 180/90 in the right arm and 140/70 in the left arm.
Which diagnosis is most likely?