Aligned with the Board of Certification for Emergency Nursing format. Authored & peer-reviewed by Certified Emergency Nurses.
Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.
A 42-year-old man presents with low back pain. Which of the following history or exam findings should raise concern for a serious cause of his pain?
Red flags of back pain should immediately alert the emergency team to a serious cause of a patient’s back pain. Back pain that is unremitting, associated with fevers or chills, in an immunocompromised patient (such as a patient with HIV or diabetes), or associated with an elevation in inflammatory markers (such as an elevated ESR or CRP) all raise concern for infection such as an epidural abscess, vertebral osteomyelitis, or discitis. Concerning findings for back pain that may require a surgical intervention such as cauda equina syndrome include midline back pain (suggesting a fracture), lower extremity weakness or paresthesias, loss of rectal tone, and urinary or fecal retention or incontinence. An elevated postvoid residual volume (with 200 mL as a common cutoff) is highly concerning for cauda equina syndrome and, in the appropriate clinical setting, warrants an MRI and spine surgery consultation.
Pain that is exacerbated by twisting (A), pain that is worse after a long workday (B), and paraspinal tenderness on exam (C), in addition to pain worse with stretching, are all suggestive of a muscle strain, which requires only analgesia, hot or cold packs, and recommendation to engage in activity as tolerated and outpatient physical therapy.
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After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.
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