BCEN practice test
Which of the following indicates significant dehydration in a B. Does not urinate for more than 8 hours
6-month-old infant with a history of vomiting and diarrhea?
Normal urinary output in a well-hydrated child is 1 mL/kg/h. Decreased urine output
A. Has two bouts of projectile vomiting is a sign for the need to be evaluated in an emergency department setting. _____
B. Does not urinate for more than 8 hours Reference: Wong's Nursing Care of Infants and Children, 11th Edition (2018), p.
C. Cries loudly during the physical examination 742-743
D. has three loose stools in 3 hours
How long after initial acetaminophen levels that are below serum acetaminophen levels of 200 mcg/mL or greater 4 hours after ingestion are
toxic levels should be reevaluated. considered toxic and treatment should be initiated. Acetaminophen levels may
continue to rise up to 4 hours after ingestion of a toxic amount. _____ Reference:
Sheehy's Emergency Nursing: Principles and Practice, 7th Edition (2019), p. 344
What would be the MOST serious indication of a low dislodged endotracheal tube
pressure alarm
A sickle cell crisis may be precipitated by what Exposure to cold, Infection, High altitude, and dehydration
A patient is brought into the ED after being found Loss of laryngeal spasms
unconscious in shallow water. The nurse knows that this
patient likely experienced aspiration of water due to During a submersion injury, liquid entering the mouth can stimulate involuntary
laryngospasms, which protect the airway from aspiration. Upon becoming
unconscious, this spasm relaxes allowing liquid to flood the lungs. This can cause
cardiac dysrhythmias due to hypoxia, but would not be the reason for aspiration.
The type of water and submersion time are relevant to patient treatment, but not the
cause of aspiration. _____Sheehy's Manual of Emergency Care, 8th Edition (2024),
p. 124
An infant dies suddenly in the emergency department. Offer to provide a lock of the infant's hair.
Which of the following BEST assists the family members in
the grieving process In unexpected infant death, there is no warning or way to prepare. By providing a
lock of hair or other mementos, the nurse will give the parents something by which
to remember the child as they go through the grieving process. _____Reference:
Trauma Nursing: From Resuscitation Through Rehabilitation, 5th Ed. (2020), p. 692
A patient presents with left eye pain and swelling after Request cervical spine clearance
sustaining blunt trauma from a glass bottle. The nurse
should PRIOITIZE which of the following interventions? Once the cervical spine has been cleared, the next action would be elevating the
head of the bed to help prevent an increase in intraocular pressure that could lead
to loss of vision. Irrigation should not be performed until the possibility of a ruptured
globe has been ruled out. Applying gauze could apply additional pressure to the
eye. _____ Sheehy's Manual of Emergency Care, 8th Edition (2024), p. 221
A patient is brought to the ED for severe anxiety, sweating, Opioid
abdominal cramping, and tremors. Their significant other
reports they abruptly stopped their prescription alprazolam The patient's presentation and symptoms are most characteristic of opioid
(Xanax) and oxycodone (Roxicodone) three days prior. withdrawal. Although uncomfortable, opioid withdrawal is rarely life- threatening.
Additionally, they quit smoking and drinking alcohol at the Patients with alcohol and benzodiazepine withdrawal often present with tremors,
same time. On arrival, they are alert but restless, with anxiety, autonomic instability, and risk for seizures, but piloerection and severe
dilated pupils, piloerection and hypertension. Based on the abdominal cramping are not hallmark features. The signs and symptoms are not
presentation, which withdrawal syndrome is most likely the those of nicotine withdrawal. _____Sheehy's Manual of Emergency Care, 8th
PRIMARY cause of their current symptoms? Edition (2024), p. 419
A patient is diagnosed with a traumatic intracerebral 3% sodium chloride
hemorrhage. The patient's current vital signs are heart rate
of 83 beats/min, blood pressure of 82/40 mmHg, and Administration of 3% sodium chloride will help to decrease the patient's ICP without
ventilations are being assisted via bag-mask device. The concern for diuresis. Labetalol and nicardipine are not clinically indicated due to the
nurse anticipates the administration of hypotension. Mannitol is to be avoided due to its potential diuretic effects and
potential hypotension. _____ Reference: Trauma Nurse Core Course (TNCC)
Provider Manual, 8th Edition (2020), p.114
, BCEN practice test
The skin of a patient in early septic shock is most likely to warm and flushed.
be
Signs and symptoms of early septic shock include increased heart rate, increased
respiratory rate, and warm, flushed skin, hence the term, "warm shock." _____
Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018), p.477-478
A patient is diagnosed with hepatitis A. Which of the I understand that my close contacts may need treatment.
following statements indicates this patient has a good
understanding of the discharge instructions? Hepatitis A virus is transmitted by the fecal-oral route and is infectious 2 weeks
before and 1 week after jaundice. Others who have been in close contact with the
patient may need treatment. Transmission in this case may not have come from the
sexual partner. Alcohol is contraindicated during the acute phase and rebuilding
strength is not the best choice. _____ Reference: Emergency Nursing Core
Curriculum, 7th Ed. (2018), p. 316-317
A patient presents to the emergency department with central retinal artery occlusion
complaints of blindness in the right eye. The patient
reports three similar episodes lasting a few seconds The sudden unilateral loss of vision, known as central retinal artery occlusion, is
occurring over the last few days. The emergency nurse caused by a thrombus or embolus. This condition may be preceded by moments of
anticipates the patient to be experiencing which of the temporary visual loss, lasting seconds to minutes. Patients with anterior uveitis will
following? experience "floaters" in the eye, redness, and pain. Patients with a retinal
detachment will have visual field disturbances but not a temporary loss of vision. In
acute angle-closure glaucoma, symptoms include blurred vision, halos around
lights, eye redness and pain. _____Reference: Emergency Nursing Core
Curriculum, 7th Ed. (2018), p. 256
After an emergent delivery, the neonate is unresponsive. assess the neonate's respiratory rate and heart rate
Stimulation, warming and suction are performed with no
success. The immediate next step the nurse should take is Resuscitation begins with assessment of the neonate's heart rate and respiratory
to: rate. A neonate with a heart rate of less than 60 beats per minute and/or decreased
or absent respirations requires immediate lifesaving interventions such as intubation
and chest compressions. These lifesaving measures should not be delayed to
obtain 1- or 5-minute APGAR scores. Medications are usually last resort attempts
during neonatal resuscitation efforts. _____ Reference: Sheehy's Emergency
Nursing: Principles and Practice, 7th Edition (2019), p. 546
A patient presents to the emergency department reporting Beta Blockers
numbness and tingling in their fingers. Initially, the nurse
notices pallor in the fingers, followed by cyanosis, lasting The patient has Raynaud's disease, a circulatory condition marked by sudden,
about 20 minutes. The nurse should question the patient's intense vasospasms of small arteries. These episodes, mostly affecting the fingers
use of which medication? but also the toes, nose, or ears, decrease blood flow and are usually triggered by
cold exposure, emotional stress, or smoking.
Patients should avoid beta blockers and cold medications with pseudoephedrine, as
these can worsen vasospasms. Treatment options include calcium channel blockers
or topical vasodilators to help relax and expand the small vessels in the hands and
feet.____Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018), p. 177.
The FIRST step in the triage assessment of a patient with across the room assessment.
a behavioral health concern is the:
Triage of the patient with a behavioral health concern begins with the across-the-
room assessment, which can provide the triage nurse important information. Health
history, the environment of care checklist, and the chief complaint are important but
not as important as the initial across the room survey. Bizarre dress, loud or rapid
speech, odor of alcohol, demeanor, and activity level can often be determined by an
across the room survey. _____Reference: Sheehy's Manual of Emergency Care,
7th Edition (2013), p. 64
The nurse is caring for a patient complaining of shortness factor Xa inhibitor
of breath and swelling to one leg after a long drive. The
nurse anticipates administration of this class of medication The patient likely needs treatment for a venous thrombus which is treated with
for definitive treatment factor Xa inhibitors (such as Eliquis (apixaban)). Thrombolytics are not used to treat
an isolated deep vein thrombus. Antifibrinolytics (such as TXA) are not indicated for
treatment for this scenario as this class of medication reduces bleeding by inhibiting
the process that dissolves clots. Prothrombin complex concentrate is used to
reverse the effects of an anticoagulant. _____Sheehy's Manual of Emergency Care,
8th Edition (2024), p. 123
, BCEN practice test
The nurse is caring for a patient with a known intracranial BP 194/132 mmHg
hemorrhage. The patient is experiencing nausea,
headache, and lethargy but is awake and follows Goals of blood pressure management should be to adequately perfuse the brain
commands. The nurse understands the MOST important without increasing the risk of hemorrhage expansion. Emergency Neurological Life
vital sign reading to immediately address is: Support (ENLS) guidelines recommend keeping the systolic blood pressure
between 140-180mmHg. Consider blood pressure reduction with continuous
intravenous infusion and frequent monitoring every 5 minutes._____Reference:
Sheehy's Manual of Emergency Care, 8th Edition (2024), p. 189.
A patient experiences sudden, painless loss of vision to Supine
one eye. The healthcare team suspects a central retinal
artery occlusion. The optimal position for the patient to be The patient should be placed in the supine position in order to optimize circulation
placed in is: to the head. The other three positions would not optimize cerebral circulation.
_____Sheehy's Manual of Emergency Care, 8th Edition (2024), p. 210
A young adult arrives to the ED complaining of a sudden Chest tube insertion
onset of left-sided chest pain and shortness of breath. The
nurse knows to prepare the patient for this anticipated The patient is experiencing a spontaneous pneumothorax. Some signs and
intervention symptoms are sudden onset of pleuritic chest pain (often localized on the side of the
pneumothorax), dyspnea, and tachypnea. The treatment for this patient is a chest
tube placement to re-expand the lung. The other treatments are not indicated at this
time. _____Sheehy's Manual of Emergency Care, 8th Edition (2024), p. 122
A patient presents to the emergency department after lorazepam (Ativan)
being bitten by a black widow spider. The patient is
exhibiting classic systemic effects of the bite and the nurse Black widow spider bites are known to cause severe widespread muscle spasms.
recognizes that the PRIORITY treatment for these effects Benzodiazepines are often used to help control these muscle spasms. Calcium
is: gluconate and methocarbamol (Robaxin) have been shown to be ineffective in
controlling muscle spasms from black widow bites. Antibiotics are not typically
indicated in this situation._____Reference: Sheehy's Manual of Emergency Care,
8th Edition (2024), p. 369; Reference: Sheehy's Manual of Emergency Care, 8th
Edition (2024), p. 369; Williams M, Sehgal N, Nappe TM. Black Widow Spider
Toxicity. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK499987/.
A woman presents to the emergency department reporting Prepare the patient for surgery.
pelvic pain, nausea, and vomiting. She states she is 2-
weeks late for her menstrual cycle, and she had a positive Ectopic pregnancy commonly present around the sixth week of gestation. Signs and
pregnancy test the prior day. The physician is suspicious of symptoms can include pelvic pain, nausea/vomiting, positive pregnancy tests.
an ectopic pregnancy with possible rupture. What is the Therapeutic interventions would include initiating IV therapy with lactated Ringer's
PRIORITY intervention? solution or normal saline, administration of RhoGAM if the patient is Rh negative,
and preparation for surgery if rupture is suspected. Methotrexate is only an option
for those who are hemodynamically stable with no signs of bleeding. _____
Reference: Sheehy's Manual of Emergency Care, 7th Edition (2013), p. 483
The nurse is caring for a patient who was stung by a Rinse the affected area with salt water
jellyfish. The PRIORITY intervention is:
The nurse should immediately rinse the wound with saltwater because fresh water
will stimulate the nematocysts that have not already fired. Applying a dry dressing
and immobilizing the affected body part are not indicated in the treatment of a
jellyfish sting. _____Reference: Emergency Nursing Core Curriculum, 7th Ed.
(2018), p. 223
A patient presents with sudden onset dyspnea and pleuritic pulmonary embolism
chest pain. They are tachycardic and mildly hypoxic. An
ECG is performed and demonstrates right ventricular While not specific, right ventricular strain is a classic but uncommon finding in
strain. The nurse is MOST concerned for which condition: pulmonary embolism (PE). Sinus tachycardia is the most frequent ECG abnormality
seen in PE. Right ventricular strain is not indicative of a myocardial infarction and is
not a symptom with acute costochondritis nor with aspiration
pneumonia._____Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018),
p. 334.
Which of the following indicates significant dehydration in a B. Does not urinate for more than 8 hours
6-month-old infant with a history of vomiting and diarrhea?
Normal urinary output in a well-hydrated child is 1 mL/kg/h. Decreased urine output
A. Has two bouts of projectile vomiting is a sign for the need to be evaluated in an emergency department setting. _____
B. Does not urinate for more than 8 hours Reference: Wong's Nursing Care of Infants and Children, 11th Edition (2018), p.
C. Cries loudly during the physical examination 742-743
D. has three loose stools in 3 hours
How long after initial acetaminophen levels that are below serum acetaminophen levels of 200 mcg/mL or greater 4 hours after ingestion are
toxic levels should be reevaluated. considered toxic and treatment should be initiated. Acetaminophen levels may
continue to rise up to 4 hours after ingestion of a toxic amount. _____ Reference:
Sheehy's Emergency Nursing: Principles and Practice, 7th Edition (2019), p. 344
What would be the MOST serious indication of a low dislodged endotracheal tube
pressure alarm
A sickle cell crisis may be precipitated by what Exposure to cold, Infection, High altitude, and dehydration
A patient is brought into the ED after being found Loss of laryngeal spasms
unconscious in shallow water. The nurse knows that this
patient likely experienced aspiration of water due to During a submersion injury, liquid entering the mouth can stimulate involuntary
laryngospasms, which protect the airway from aspiration. Upon becoming
unconscious, this spasm relaxes allowing liquid to flood the lungs. This can cause
cardiac dysrhythmias due to hypoxia, but would not be the reason for aspiration.
The type of water and submersion time are relevant to patient treatment, but not the
cause of aspiration. _____Sheehy's Manual of Emergency Care, 8th Edition (2024),
p. 124
An infant dies suddenly in the emergency department. Offer to provide a lock of the infant's hair.
Which of the following BEST assists the family members in
the grieving process In unexpected infant death, there is no warning or way to prepare. By providing a
lock of hair or other mementos, the nurse will give the parents something by which
to remember the child as they go through the grieving process. _____Reference:
Trauma Nursing: From Resuscitation Through Rehabilitation, 5th Ed. (2020), p. 692
A patient presents with left eye pain and swelling after Request cervical spine clearance
sustaining blunt trauma from a glass bottle. The nurse
should PRIOITIZE which of the following interventions? Once the cervical spine has been cleared, the next action would be elevating the
head of the bed to help prevent an increase in intraocular pressure that could lead
to loss of vision. Irrigation should not be performed until the possibility of a ruptured
globe has been ruled out. Applying gauze could apply additional pressure to the
eye. _____ Sheehy's Manual of Emergency Care, 8th Edition (2024), p. 221
A patient is brought to the ED for severe anxiety, sweating, Opioid
abdominal cramping, and tremors. Their significant other
reports they abruptly stopped their prescription alprazolam The patient's presentation and symptoms are most characteristic of opioid
(Xanax) and oxycodone (Roxicodone) three days prior. withdrawal. Although uncomfortable, opioid withdrawal is rarely life- threatening.
Additionally, they quit smoking and drinking alcohol at the Patients with alcohol and benzodiazepine withdrawal often present with tremors,
same time. On arrival, they are alert but restless, with anxiety, autonomic instability, and risk for seizures, but piloerection and severe
dilated pupils, piloerection and hypertension. Based on the abdominal cramping are not hallmark features. The signs and symptoms are not
presentation, which withdrawal syndrome is most likely the those of nicotine withdrawal. _____Sheehy's Manual of Emergency Care, 8th
PRIMARY cause of their current symptoms? Edition (2024), p. 419
A patient is diagnosed with a traumatic intracerebral 3% sodium chloride
hemorrhage. The patient's current vital signs are heart rate
of 83 beats/min, blood pressure of 82/40 mmHg, and Administration of 3% sodium chloride will help to decrease the patient's ICP without
ventilations are being assisted via bag-mask device. The concern for diuresis. Labetalol and nicardipine are not clinically indicated due to the
nurse anticipates the administration of hypotension. Mannitol is to be avoided due to its potential diuretic effects and
potential hypotension. _____ Reference: Trauma Nurse Core Course (TNCC)
Provider Manual, 8th Edition (2020), p.114
, BCEN practice test
The skin of a patient in early septic shock is most likely to warm and flushed.
be
Signs and symptoms of early septic shock include increased heart rate, increased
respiratory rate, and warm, flushed skin, hence the term, "warm shock." _____
Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018), p.477-478
A patient is diagnosed with hepatitis A. Which of the I understand that my close contacts may need treatment.
following statements indicates this patient has a good
understanding of the discharge instructions? Hepatitis A virus is transmitted by the fecal-oral route and is infectious 2 weeks
before and 1 week after jaundice. Others who have been in close contact with the
patient may need treatment. Transmission in this case may not have come from the
sexual partner. Alcohol is contraindicated during the acute phase and rebuilding
strength is not the best choice. _____ Reference: Emergency Nursing Core
Curriculum, 7th Ed. (2018), p. 316-317
A patient presents to the emergency department with central retinal artery occlusion
complaints of blindness in the right eye. The patient
reports three similar episodes lasting a few seconds The sudden unilateral loss of vision, known as central retinal artery occlusion, is
occurring over the last few days. The emergency nurse caused by a thrombus or embolus. This condition may be preceded by moments of
anticipates the patient to be experiencing which of the temporary visual loss, lasting seconds to minutes. Patients with anterior uveitis will
following? experience "floaters" in the eye, redness, and pain. Patients with a retinal
detachment will have visual field disturbances but not a temporary loss of vision. In
acute angle-closure glaucoma, symptoms include blurred vision, halos around
lights, eye redness and pain. _____Reference: Emergency Nursing Core
Curriculum, 7th Ed. (2018), p. 256
After an emergent delivery, the neonate is unresponsive. assess the neonate's respiratory rate and heart rate
Stimulation, warming and suction are performed with no
success. The immediate next step the nurse should take is Resuscitation begins with assessment of the neonate's heart rate and respiratory
to: rate. A neonate with a heart rate of less than 60 beats per minute and/or decreased
or absent respirations requires immediate lifesaving interventions such as intubation
and chest compressions. These lifesaving measures should not be delayed to
obtain 1- or 5-minute APGAR scores. Medications are usually last resort attempts
during neonatal resuscitation efforts. _____ Reference: Sheehy's Emergency
Nursing: Principles and Practice, 7th Edition (2019), p. 546
A patient presents to the emergency department reporting Beta Blockers
numbness and tingling in their fingers. Initially, the nurse
notices pallor in the fingers, followed by cyanosis, lasting The patient has Raynaud's disease, a circulatory condition marked by sudden,
about 20 minutes. The nurse should question the patient's intense vasospasms of small arteries. These episodes, mostly affecting the fingers
use of which medication? but also the toes, nose, or ears, decrease blood flow and are usually triggered by
cold exposure, emotional stress, or smoking.
Patients should avoid beta blockers and cold medications with pseudoephedrine, as
these can worsen vasospasms. Treatment options include calcium channel blockers
or topical vasodilators to help relax and expand the small vessels in the hands and
feet.____Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018), p. 177.
The FIRST step in the triage assessment of a patient with across the room assessment.
a behavioral health concern is the:
Triage of the patient with a behavioral health concern begins with the across-the-
room assessment, which can provide the triage nurse important information. Health
history, the environment of care checklist, and the chief complaint are important but
not as important as the initial across the room survey. Bizarre dress, loud or rapid
speech, odor of alcohol, demeanor, and activity level can often be determined by an
across the room survey. _____Reference: Sheehy's Manual of Emergency Care,
7th Edition (2013), p. 64
The nurse is caring for a patient complaining of shortness factor Xa inhibitor
of breath and swelling to one leg after a long drive. The
nurse anticipates administration of this class of medication The patient likely needs treatment for a venous thrombus which is treated with
for definitive treatment factor Xa inhibitors (such as Eliquis (apixaban)). Thrombolytics are not used to treat
an isolated deep vein thrombus. Antifibrinolytics (such as TXA) are not indicated for
treatment for this scenario as this class of medication reduces bleeding by inhibiting
the process that dissolves clots. Prothrombin complex concentrate is used to
reverse the effects of an anticoagulant. _____Sheehy's Manual of Emergency Care,
8th Edition (2024), p. 123
, BCEN practice test
The nurse is caring for a patient with a known intracranial BP 194/132 mmHg
hemorrhage. The patient is experiencing nausea,
headache, and lethargy but is awake and follows Goals of blood pressure management should be to adequately perfuse the brain
commands. The nurse understands the MOST important without increasing the risk of hemorrhage expansion. Emergency Neurological Life
vital sign reading to immediately address is: Support (ENLS) guidelines recommend keeping the systolic blood pressure
between 140-180mmHg. Consider blood pressure reduction with continuous
intravenous infusion and frequent monitoring every 5 minutes._____Reference:
Sheehy's Manual of Emergency Care, 8th Edition (2024), p. 189.
A patient experiences sudden, painless loss of vision to Supine
one eye. The healthcare team suspects a central retinal
artery occlusion. The optimal position for the patient to be The patient should be placed in the supine position in order to optimize circulation
placed in is: to the head. The other three positions would not optimize cerebral circulation.
_____Sheehy's Manual of Emergency Care, 8th Edition (2024), p. 210
A young adult arrives to the ED complaining of a sudden Chest tube insertion
onset of left-sided chest pain and shortness of breath. The
nurse knows to prepare the patient for this anticipated The patient is experiencing a spontaneous pneumothorax. Some signs and
intervention symptoms are sudden onset of pleuritic chest pain (often localized on the side of the
pneumothorax), dyspnea, and tachypnea. The treatment for this patient is a chest
tube placement to re-expand the lung. The other treatments are not indicated at this
time. _____Sheehy's Manual of Emergency Care, 8th Edition (2024), p. 122
A patient presents to the emergency department after lorazepam (Ativan)
being bitten by a black widow spider. The patient is
exhibiting classic systemic effects of the bite and the nurse Black widow spider bites are known to cause severe widespread muscle spasms.
recognizes that the PRIORITY treatment for these effects Benzodiazepines are often used to help control these muscle spasms. Calcium
is: gluconate and methocarbamol (Robaxin) have been shown to be ineffective in
controlling muscle spasms from black widow bites. Antibiotics are not typically
indicated in this situation._____Reference: Sheehy's Manual of Emergency Care,
8th Edition (2024), p. 369; Reference: Sheehy's Manual of Emergency Care, 8th
Edition (2024), p. 369; Williams M, Sehgal N, Nappe TM. Black Widow Spider
Toxicity. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK499987/.
A woman presents to the emergency department reporting Prepare the patient for surgery.
pelvic pain, nausea, and vomiting. She states she is 2-
weeks late for her menstrual cycle, and she had a positive Ectopic pregnancy commonly present around the sixth week of gestation. Signs and
pregnancy test the prior day. The physician is suspicious of symptoms can include pelvic pain, nausea/vomiting, positive pregnancy tests.
an ectopic pregnancy with possible rupture. What is the Therapeutic interventions would include initiating IV therapy with lactated Ringer's
PRIORITY intervention? solution or normal saline, administration of RhoGAM if the patient is Rh negative,
and preparation for surgery if rupture is suspected. Methotrexate is only an option
for those who are hemodynamically stable with no signs of bleeding. _____
Reference: Sheehy's Manual of Emergency Care, 7th Edition (2013), p. 483
The nurse is caring for a patient who was stung by a Rinse the affected area with salt water
jellyfish. The PRIORITY intervention is:
The nurse should immediately rinse the wound with saltwater because fresh water
will stimulate the nematocysts that have not already fired. Applying a dry dressing
and immobilizing the affected body part are not indicated in the treatment of a
jellyfish sting. _____Reference: Emergency Nursing Core Curriculum, 7th Ed.
(2018), p. 223
A patient presents with sudden onset dyspnea and pleuritic pulmonary embolism
chest pain. They are tachycardic and mildly hypoxic. An
ECG is performed and demonstrates right ventricular While not specific, right ventricular strain is a classic but uncommon finding in
strain. The nurse is MOST concerned for which condition: pulmonary embolism (PE). Sinus tachycardia is the most frequent ECG abnormality
seen in PE. Right ventricular strain is not indicative of a myocardial infarction and is
not a symptom with acute costochondritis nor with aspiration
pneumonia._____Reference: Emergency Nursing Core Curriculum, 7th Ed. (2018),
p. 334.
