# Stage 2 — Analyze cues. Initial bedside results are now available: the 12-lead ECG shows sinus tachycardia at 124/min without ST-segment elevation or depression; BP is 92/58 in the right arm and 94/60 in the left with equal radial pulses; and breath sounds are clear bilaterally. Laboratory and imaging results are pending. For each finding, select how it contributes to the nurse's analysis of the client's sudden chest pain and dyspnea. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617311&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question Stage 2 — Analyze cues. Initial bedside results are now available: the 12-lead ECG shows sinus tachycardia at 124/min without ST-segment elevation or depression; BP is 92/58 in the right arm and 94/60 in the left with equal radial pulses; and breath sounds are clear bilaterally. Laboratory and imaging results are pending. For each finding, select how it contributes to the nurse's analysis of the client's sudden chest pain and dyspnea. | | Increases suspicion for pulmonary embolism specifically | Signals acuity but does not distinguish among causes | Lowers suspicion for a competing emergency | | --- | --- | --- | --- | | Knee arthroplasty 7 days ago with enoxaparin stopped 2 days ago | | | | | Right-calf tenderness along the deep veins, new since discharge | | | | | BP 92/58 and HR 124 with diaphoresis | | | | | RR 28 with visible anxiety | | | | | ECG without ST-segment elevation or depression | | | | | BP within 2 mm Hg between arms with equal radial pulses | | | | ## Explanation Recent arthroplasty with interrupted thromboprophylaxis and new tenderness along the deep veins of one calf point specifically toward venous thromboembolism and pulmonary embolism. Hypotension, tachycardia, diaphoresis, tachypnea, and anxiety show how sick the client is but occur equally in acute coronary syndrome and aortic dissection, so they do not discriminate. An ECG without ST changes lowers suspicion for STEMI, and symmetric arm pressures with equal pulses lower suspicion for aortic dissection, although neither excludes those conditions. ## In-depth explanation Quick answer Surgery with stopped enoxaparin and new deep-vein calf tenderness increase PE suspicion; BP/HR with diaphoresis and RR 28 with anxiety are nonspecific acuity; the ECG without ST changes and symmetric arm pressures lower suspicion for competing emergencies. Why this is correct A strong VTE risk state and a sign of a possible deep-vein source are the cues that make PE more likely than other chest emergencies. Tachycardia, hypotension, diaphoresis, tachypnea, and anxiety are real PE findings, but because they occur just as often in ACS and dissection they measure severity, not cause. Pertinent negatives from the ECG and bilateral pressures shift probability away from STEMI and dissection without excluding them. Easy analogy or mental picture Think of a detective's evidence board: some clues point to one suspect (fingerprints), some prove only that a crime happened (a broken window), and some are alibis that make other suspects less likely. Memory hook Specific points, severity shouts, negatives narrow. NCLEX decision rule When analyzing chest pain, ask of each cue: does it favor one diagnosis, does it only show how unstable the client is, or does it make a competing diagnosis less likely? Severity cues drive urgency; specific cues drive the working diagnosis. Why the other choices are wrong Classifying BP 92/58, HR 124, or RR 28 as PE-specific is tempting because they are present in this PE, but they are equally common in ACS and aortic dissection, so they cannot separate the causes. Calling the calf tenderness nonspecific misses that new tenderness along the deep veins is a recognized clinical sign of deep-vein thrombosis and scores in PE probability tools; it does not occur with ACS or dissection. Calling the ECG or symmetric pressures PE-specific confuses the absence of competing findings with direct evidence of PE; they only lower the likelihood of STEMI and dissection and do not rule them out. References 12019 ESC Guidelines for the diagnosis and management of acute pulmonary embolismRecent surgery and immobilization are strong PE risk factors; tachycardia and hypotension reflect severity rather than diagnosis 2Pulmonary Embolism (StatPearls, NCBI Bookshelf)Hypoxemia with clear lungs and sinus tachycardia are common in PE; many presenting signs are nonspecific ## Clinical scenario Scenario (Stage 2 — Analyze cues) The ECG, bilateral arm blood pressures, and lung auscultation are available while laboratory and imaging results are pending. Clinical judgment target Weigh each cue as specific to pulmonary embolism, nonspecific acuity, or evidence that lowers suspicion for acute coronary syndrome or aortic dissection. ## Key concepts - **Pertinent negative** — An absent finding that lowers the probability of a competing diagnosis, such as equal arm pressures in suspected aortic dissection. - **Clinical signs of DVT** — Leg swelling or pain on palpation along the deep veins, which raises the probability of venous thromboembolism in scoring tools such as the Wells score. - **Venous thromboembolism risk** — Increased clot risk from recent major orthopedic surgery, immobility, and interrupted prophylaxis. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. 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