CEN – Certified Emergency Nurse Certification
Complete Emergency Nursing Study Guide,
Trauma Care, Emergency Assessment, Critical
Interventions, Practice Questions, and
Certification Review
1. A 45-year-old patient presents to the emergency department with chest pain
radiating to the left arm, diaphoresis, and nausea. The pain started 45 minutes
ago. Which of the following is the priority triage classification using the
Emergency Severity Index (ESI)?
a. ESI Level 1 (immediate life threat)
b. ESI Level 2 (high risk)
c. ESI Level 3 (urgent)
d. ESI Level 4 (semi-urgent)
ANSWER: A
Rationale: ESI Level 1 is assigned to patients with an immediate life threat
requiring immediate intervention. This patient's symptoms of acute MI with
hemodynamic instability risk classify as Level 1. ESI Level 2 (B) is for high-risk
situations that are not immediately life-threatening. The patient requires immediate
ECG and treatment per STEMI protocols.
DIF: Cognitive Level: Analyze
TOP: Triage
2. The triage nurse is assessing a patient who reports difficulty breathing, a
"ripping" sensation in the chest, and unequal blood pressures in the arms.
Which of the following conditions should the nurse suspect?
a. Myocardial infarction
b. Aortic dissection
c. Pulmonary embolism
d. Pericarditis
ANSWER: B
,Rationale: Aortic dissection presents with a "ripping" or "tearing" chest pain,
which may radiate to the back. Unequal blood pressures in the arms (>20 mmHg
difference) is a classic finding. MI (A) typically presents with pressure or crushing
pain. PE (C) presents with sudden dyspnea. Pericarditis (D) pain is pleuritic and
relieved by sitting forward.
DIF: Cognitive Level: Analyze
TOP: Vascular Emergencies
3. A patient arrives with a gunshot wound to the abdomen. The patient is
awake but confused, with a blood pressure of 85/50 mmHg and heart rate of
130 bpm. What is the priority intervention?
a. Initiate massive transfusion protocol and prepare for surgery
b. Perform a focused abdominal ultrasound (FAST)
c. Administer pain medication
d. Place a nasogastric tube
ANSWER: A
Rationale: This patient is in hemorrhagic shock from an abdominal gunshot
wound. The priority is fluid resuscitation, blood products, and immediate surgical
intervention. While FAST (B) can be helpful, it should not delay definitive
treatment. Pain medication (C) and NG tube (D) are secondary.
DIF: Cognitive Level: Analyze
TOP: Trauma Resuscitation
4. A patient who is 7 months pregnant presents with vaginal bleeding and
abdominal pain. The nurse notes the uterus is firm and tender. Which of the
following is the priority assessment?
a. Fetal heart rate
b. Maternal vital signs
c. Cervical examination
d. Urine output
ANSWER: B
,Rationale: Maternal vital signs are the priority to assess for hemorrhagic shock.
While fetal heart rate (A) is important, maternal stabilization takes precedence.
Cervical examination (C) is contraindicated with suspected placental abruption
until the provider evaluates the patient. Urine output (D) is important but
secondary.
DIF: Cognitive Level: Analyze
TOP: OB Emergencies
5. A 3-year-old child presents with stridor, drooling, and a fever of 102.5°F.
The child is sitting upright and appears anxious. Which of the following is the
priority nursing action?
a. Prepare for airway management and do not examine the throat
b. Perform a throat culture
c. Administer oral antibiotics
d. Place the child supine for examination
ANSWER: A
Rationale: This presentation is classic for epiglottitis, a life-threatening airway
emergency. The priority is to prepare for airway management and avoid any
examination that could precipitate complete airway obstruction (e.g., throat culture,
B). Antibiotics (C) are not the priority. Supine positioning (D) could worsen the
airway obstruction.
DIF: Cognitive Level: Analyze
TOP: Pediatric Emergencies
6. A patient presents with confusion, fever, and a petechial rash. The nurse
notes the rash does not blanch with pressure. Which of the following is the
priority intervention?
a. Initiate IV antibiotics immediately
b. Administer antipyretics
c. Draw blood cultures
d. Obtain a head CT
ANSWER: A
, Rationale: A non-blanching petechial rash with fever and confusion is suspicious
for meningococcemia, a medical emergency requiring immediate IV antibiotics.
While blood cultures (C) are important, antibiotics should not be delayed.
Antipyretics (B) and head CT (D) are secondary.
DIF: Cognitive Level: Analyze
TOP: Infectious Emergencies
7. A patient is brought in after a motor vehicle collision. The nurse notes
paradoxical movement of the chest wall during respiration. Which of the
following is the most likely diagnosis?
a. Pneumothorax
b. Flail chest
c. Cardiac tamponade
d. Pulmonary contusion
ANSWER: B
Rationale: Flail chest is characterized by paradoxical chest wall movement caused
by two or more adjacent ribs fractured in two or more places. Pneumothorax (A)
presents with decreased breath sounds. Cardiac tamponade (C) presents with
muffled heart sounds and JVD. Pulmonary contusion (D) would be seen on
imaging.
DIF: Cognitive Level: Apply
TOP: Thoracic Trauma
8. A patient presents with a chemical burn to the eye from an alkali substance.
Which of the following is the priority nursing intervention?
a. Irrigate the eye immediately with normal saline
b. Apply antibiotic ointment
c. Patch the eye
d. Perform a visual acuity test
ANSWER: A
Rationale: Alkali burns require immediate copious irrigation with normal saline or
lactated Ringer's solution to neutralize the pH and prevent further damage.
Complete Emergency Nursing Study Guide,
Trauma Care, Emergency Assessment, Critical
Interventions, Practice Questions, and
Certification Review
1. A 45-year-old patient presents to the emergency department with chest pain
radiating to the left arm, diaphoresis, and nausea. The pain started 45 minutes
ago. Which of the following is the priority triage classification using the
Emergency Severity Index (ESI)?
a. ESI Level 1 (immediate life threat)
b. ESI Level 2 (high risk)
c. ESI Level 3 (urgent)
d. ESI Level 4 (semi-urgent)
ANSWER: A
Rationale: ESI Level 1 is assigned to patients with an immediate life threat
requiring immediate intervention. This patient's symptoms of acute MI with
hemodynamic instability risk classify as Level 1. ESI Level 2 (B) is for high-risk
situations that are not immediately life-threatening. The patient requires immediate
ECG and treatment per STEMI protocols.
DIF: Cognitive Level: Analyze
TOP: Triage
2. The triage nurse is assessing a patient who reports difficulty breathing, a
"ripping" sensation in the chest, and unequal blood pressures in the arms.
Which of the following conditions should the nurse suspect?
a. Myocardial infarction
b. Aortic dissection
c. Pulmonary embolism
d. Pericarditis
ANSWER: B
,Rationale: Aortic dissection presents with a "ripping" or "tearing" chest pain,
which may radiate to the back. Unequal blood pressures in the arms (>20 mmHg
difference) is a classic finding. MI (A) typically presents with pressure or crushing
pain. PE (C) presents with sudden dyspnea. Pericarditis (D) pain is pleuritic and
relieved by sitting forward.
DIF: Cognitive Level: Analyze
TOP: Vascular Emergencies
3. A patient arrives with a gunshot wound to the abdomen. The patient is
awake but confused, with a blood pressure of 85/50 mmHg and heart rate of
130 bpm. What is the priority intervention?
a. Initiate massive transfusion protocol and prepare for surgery
b. Perform a focused abdominal ultrasound (FAST)
c. Administer pain medication
d. Place a nasogastric tube
ANSWER: A
Rationale: This patient is in hemorrhagic shock from an abdominal gunshot
wound. The priority is fluid resuscitation, blood products, and immediate surgical
intervention. While FAST (B) can be helpful, it should not delay definitive
treatment. Pain medication (C) and NG tube (D) are secondary.
DIF: Cognitive Level: Analyze
TOP: Trauma Resuscitation
4. A patient who is 7 months pregnant presents with vaginal bleeding and
abdominal pain. The nurse notes the uterus is firm and tender. Which of the
following is the priority assessment?
a. Fetal heart rate
b. Maternal vital signs
c. Cervical examination
d. Urine output
ANSWER: B
,Rationale: Maternal vital signs are the priority to assess for hemorrhagic shock.
While fetal heart rate (A) is important, maternal stabilization takes precedence.
Cervical examination (C) is contraindicated with suspected placental abruption
until the provider evaluates the patient. Urine output (D) is important but
secondary.
DIF: Cognitive Level: Analyze
TOP: OB Emergencies
5. A 3-year-old child presents with stridor, drooling, and a fever of 102.5°F.
The child is sitting upright and appears anxious. Which of the following is the
priority nursing action?
a. Prepare for airway management and do not examine the throat
b. Perform a throat culture
c. Administer oral antibiotics
d. Place the child supine for examination
ANSWER: A
Rationale: This presentation is classic for epiglottitis, a life-threatening airway
emergency. The priority is to prepare for airway management and avoid any
examination that could precipitate complete airway obstruction (e.g., throat culture,
B). Antibiotics (C) are not the priority. Supine positioning (D) could worsen the
airway obstruction.
DIF: Cognitive Level: Analyze
TOP: Pediatric Emergencies
6. A patient presents with confusion, fever, and a petechial rash. The nurse
notes the rash does not blanch with pressure. Which of the following is the
priority intervention?
a. Initiate IV antibiotics immediately
b. Administer antipyretics
c. Draw blood cultures
d. Obtain a head CT
ANSWER: A
, Rationale: A non-blanching petechial rash with fever and confusion is suspicious
for meningococcemia, a medical emergency requiring immediate IV antibiotics.
While blood cultures (C) are important, antibiotics should not be delayed.
Antipyretics (B) and head CT (D) are secondary.
DIF: Cognitive Level: Analyze
TOP: Infectious Emergencies
7. A patient is brought in after a motor vehicle collision. The nurse notes
paradoxical movement of the chest wall during respiration. Which of the
following is the most likely diagnosis?
a. Pneumothorax
b. Flail chest
c. Cardiac tamponade
d. Pulmonary contusion
ANSWER: B
Rationale: Flail chest is characterized by paradoxical chest wall movement caused
by two or more adjacent ribs fractured in two or more places. Pneumothorax (A)
presents with decreased breath sounds. Cardiac tamponade (C) presents with
muffled heart sounds and JVD. Pulmonary contusion (D) would be seen on
imaging.
DIF: Cognitive Level: Apply
TOP: Thoracic Trauma
8. A patient presents with a chemical burn to the eye from an alkali substance.
Which of the following is the priority nursing intervention?
a. Irrigate the eye immediately with normal saline
b. Apply antibiotic ointment
c. Patch the eye
d. Perform a visual acuity test
ANSWER: A
Rationale: Alkali burns require immediate copious irrigation with normal saline or
lactated Ringer's solution to neutralize the pH and prevent further damage.
