CEA EMERGENCY NURSING EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant Download
PDF
EXAM COVERAGE
1. Trauma and Resuscitation Management
2. Cardiovascular and Medical Emergencies
3. Neurocritical Care and Toxicology
4. Pediatric and Obstetric Emergency Care
5. Environmental, Disaster, and Triage Management
1. A 45-year-old male is brought to the emergency department following a high-speed motor
vehicle collision. He is hypotensive (BP 80/50 mmHg), tachycardic (HR 135 bpm), and
confused. Focused Assessment with Sonography for Trauma (FAST) reveals free fluid in the
peritoneal cavity. After initiating a massive transfusion protocol, the patient experiences sudden
cardiac arrest with pulseless electrical activity (PEA). What is the most appropriate immediate
life-saving intervention?
A. Administer 1 mg of intravenous epinephrine every 3 to 5 minutes per standard cardiac arrest
protocol
B. Perform immediate emergency resuscitative thoracotomy to relieve cardiac tamponade
and cross-clamp the aorta
C. Administer systemic thrombolytic therapy to dissolve potential massive pulmonary
thromboembolism
D. Perform needle decompression of bilateral chest cavities to rule out tension pneumothorax
CORRECT ANSWER : B
Rationale: A patient presenting with severe hemorrhagic shock who arrests with PEA following
blunt trauma requires immediate resuscitative thoracotomy if life signs were recently present.
This procedure allows direct relief of pericardial tamponade, open cardiac massage, and cross-
clamping of the descending thoracic aorta to redirect blood flow to the brain and heart.
, Standard medical arrest protocols and thrombolytics are ineffective for traumatic
exsanguination.
2. A 62-year-old female presents with acute onset of severe, tearing chest pain radiating to her
back. Her initial blood pressure is 210/110 mmHg in the right arm and 150/90 mmHg in the left
arm. A bedside FAST scan shows no pericardial effusion, but a widened mediastinum is noted
on chest radiography. What is the primary initial medical management priority prior to surgical
evaluation?
A. Administer a rapid-acting fluid bolus of 500 mL normal saline to maintain organ perfusion
B. Initiate aggressive intravenous antihypertensive therapy with esmolol and labetalol to
control heart rate and blood pressure
C. Administer immediate intravenous unfractionated heparin to prevent propagation of coronary
thrombosis
D. Perform emergency needle pericardiocentesis to relieve occult cardiac tamponade pressure
CORRECT ANSWER : B
Rationale: The clinical presentation points to an acute aortic dissection (Stanford Type A or B).
The primary goal of medical management is to reduce aortic wall shear stress by strictly
controlling heart rate (target HR < 60 bpm) and systolic blood pressure (target 100-120 mmHg)
using titratable beta-blockers before vasodilators. Fluids and anticoagulation are
contraindicated as they exacerbate bleeding and shear forces.
3. A 28-year-old male is admitted after being pulled from a burning residential structure. He
exhibits facial burns, carbonaceous sputum, hoarseness, and inspiratory stridor. Arterial blood
gases on a non-rebreather mask reveal pH 7.38, PaCO2 42 mmHg, PaO2 95 mmHg, and SaO2
98%. What is the most appropriate immediate airway management strategy?
A. Continue high-flow oxygen via non-rebreather mask and observe closely for 24 hours
B. Proceed with immediate prophylactic endotracheal intubation before upper airway
edema causes complete obstruction
C. Perform an emergency surgical cricothyroidotomy due to distorted external laryngeal
landmarks
D. Initiate non-invasive bi-level positive airway pressure to stent open the upper airway passages
CORRECT ANSWER : B
Rationale: Inhalation injury causes progressive and rapid upper airway edema due to thermal
and chemical burns. Waiting for overt respiratory failure or oxygen desaturation is dangerous;
, prophylactic endotracheal intubation should be performed immediately while the airway is still
patent. Non-invasive ventilation fails to protect against sudden catastrophic soft tissue
obstruction.
4. A 55-year-old male presents with acute, crushing substernal chest pain of 45 minutes duration.
The 12-lead electrocardiogram demonstrates ST-segment elevation of 3 mm in leads II, III, and
aVF with reciprocal ST-segment depression in leads I and aVL. Blood pressure is 88/50 mmHg
and jugular veins are distended with clear lung fields. Which medication must be strictly avoided
in this patient?
A. Intravenous normal saline fluid boluses
B. Sublingual or intravenous nitroglycerin
C. Aspirin and clopidogrel loading doses
D. Unfractionated heparin weight-based bolus
CORRECT ANSWER : B
Rationale: The electrocardiographic findings indicate an acute inferior wall myocardial
infarction with suspected right ventricular (RV) infarction (evidenced by hypotension and clear
lung fields with elevated jugular venous pressure). Right ventricular infarction relies entirely on
high preload to maintain cardiac output; nitrates are potent venodilators that dramatically
reduce preload, leading to profound, refractory hypotension and cardiac collapse.
5. A 30-year-old female is brought to the emergency department after intentionally ingesting an
unknown quantity of slow-release verapamil tablets two hours ago. Her blood pressure is 70/40
mmHg, heart rate is 48 bpm, and blood glucose is 280 mg/dL. Initial fluid boluses and calcium
chloride administration have failed to improve hemodynamics. What is the most appropriate next
pharmacological intervention?
A. Administer intravenous adenosine rapidly to convert underlying rhythm
B. Initiate a high-dose insulin euglycemia therapy protocol with concurrent dextrose
infusion
C. Administer beta-blocker reversal agents such as glucagon as first-line therapy
D. Initiate continuous intravenous sodium nitroprusside infusion for afterload reduction
CORRECT ANSWER : B
Rationale: Calcium channel blocker overdose leads to severe myocardial depression,
vasodilation, and hyperglycemia (due to impaired insulin release). High-dose insulin euglycemia
, (HIE) therapy improves myocardial contractility and cellular glucose uptake and is superior to
calcium or glucagon in severe toxicity. Sodium nitroprusside would worsen hypotension.
6. A 70-year-old male presents with acute onset of generalized tonic-clonic seizure activity lasting
25 minutes without regaining consciousness between episodes. Intravenous lorazepam 4 mg has
been administered twice without cessation of seizure activity. What is the next appropriate
pharmacologically indicated agent?
A. Administer a third dose of intravenous lorazepam 2 mg push
B. Administer intravenous levetiracetam, fosphenytoin, or valproate sodium as a loading
dose
C. Administer immediate oral phenytoin suspension via nasogastric tube
D. Initiate continuous infusion of neuromuscular blocking agents such as rocuronium
CORRECT ANSWER : B
Rationale: Status epilepticus refractory to initial benzodiazepines requires second-line
antiepileptic therapy such as levetiracetam, fosphenytoin, or valproate sodium. Neuromuscular
blockers paralyze skeletal muscle and stop visible twitching but do not halt cerebral seizure
activity on EEG, masking ongoing damage.
7. A 3-year-old child is brought to the emergency department after choking on a peanut. The child
presents with acute respiratory distress, unilateral wheezing, and decreased breath sounds over
the right lung field. Inspiratory and expiratory chest radiographs are inconclusive. What is the
definitive diagnostic and therapeutic procedure of choice?
A. Immediate administration of nebulized racemic epinephrine and systemic corticosteroids
B. Rigid bronchoscopy performed under general anesthesia by a specialist
C. Flexible fiberoptic bronchoscopy performed at the bedside under conscious sedation
D. Immediate endotracheal intubation and mechanical ventilation with high positive end-
expiratory pressure
CORRECT ANSWER : B
Rationale: Suspected foreign body aspiration in a pediatric patient requires rigid bronchoscopy
under general anesthesia as the gold standard for both diagnosis and safe removal. Flexible
bronchoscopy is inadequate for extracting solid foreign bodies in small airways, and medical
therapy fails to resolve the mechanical obstruction.
Answers/Plus a Rationale Updated 2026 A+/Instant Download
EXAM COVERAGE
1. Trauma and Resuscitation Management
2. Cardiovascular and Medical Emergencies
3. Neurocritical Care and Toxicology
4. Pediatric and Obstetric Emergency Care
5. Environmental, Disaster, and Triage Management
1. A 45-year-old male is brought to the emergency department following a high-speed motor
vehicle collision. He is hypotensive (BP 80/50 mmHg), tachycardic (HR 135 bpm), and
confused. Focused Assessment with Sonography for Trauma (FAST) reveals free fluid in the
peritoneal cavity. After initiating a massive transfusion protocol, the patient experiences sudden
cardiac arrest with pulseless electrical activity (PEA). What is the most appropriate immediate
life-saving intervention?
A. Administer 1 mg of intravenous epinephrine every 3 to 5 minutes per standard cardiac arrest
protocol
B. Perform immediate emergency resuscitative thoracotomy to relieve cardiac tamponade
and cross-clamp the aorta
C. Administer systemic thrombolytic therapy to dissolve potential massive pulmonary
thromboembolism
D. Perform needle decompression of bilateral chest cavities to rule out tension pneumothorax
CORRECT ANSWER : B
Rationale: A patient presenting with severe hemorrhagic shock who arrests with PEA following
blunt trauma requires immediate resuscitative thoracotomy if life signs were recently present.
This procedure allows direct relief of pericardial tamponade, open cardiac massage, and cross-
clamping of the descending thoracic aorta to redirect blood flow to the brain and heart.
, Standard medical arrest protocols and thrombolytics are ineffective for traumatic
exsanguination.
2. A 62-year-old female presents with acute onset of severe, tearing chest pain radiating to her
back. Her initial blood pressure is 210/110 mmHg in the right arm and 150/90 mmHg in the left
arm. A bedside FAST scan shows no pericardial effusion, but a widened mediastinum is noted
on chest radiography. What is the primary initial medical management priority prior to surgical
evaluation?
A. Administer a rapid-acting fluid bolus of 500 mL normal saline to maintain organ perfusion
B. Initiate aggressive intravenous antihypertensive therapy with esmolol and labetalol to
control heart rate and blood pressure
C. Administer immediate intravenous unfractionated heparin to prevent propagation of coronary
thrombosis
D. Perform emergency needle pericardiocentesis to relieve occult cardiac tamponade pressure
CORRECT ANSWER : B
Rationale: The clinical presentation points to an acute aortic dissection (Stanford Type A or B).
The primary goal of medical management is to reduce aortic wall shear stress by strictly
controlling heart rate (target HR < 60 bpm) and systolic blood pressure (target 100-120 mmHg)
using titratable beta-blockers before vasodilators. Fluids and anticoagulation are
contraindicated as they exacerbate bleeding and shear forces.
3. A 28-year-old male is admitted after being pulled from a burning residential structure. He
exhibits facial burns, carbonaceous sputum, hoarseness, and inspiratory stridor. Arterial blood
gases on a non-rebreather mask reveal pH 7.38, PaCO2 42 mmHg, PaO2 95 mmHg, and SaO2
98%. What is the most appropriate immediate airway management strategy?
A. Continue high-flow oxygen via non-rebreather mask and observe closely for 24 hours
B. Proceed with immediate prophylactic endotracheal intubation before upper airway
edema causes complete obstruction
C. Perform an emergency surgical cricothyroidotomy due to distorted external laryngeal
landmarks
D. Initiate non-invasive bi-level positive airway pressure to stent open the upper airway passages
CORRECT ANSWER : B
Rationale: Inhalation injury causes progressive and rapid upper airway edema due to thermal
and chemical burns. Waiting for overt respiratory failure or oxygen desaturation is dangerous;
, prophylactic endotracheal intubation should be performed immediately while the airway is still
patent. Non-invasive ventilation fails to protect against sudden catastrophic soft tissue
obstruction.
4. A 55-year-old male presents with acute, crushing substernal chest pain of 45 minutes duration.
The 12-lead electrocardiogram demonstrates ST-segment elevation of 3 mm in leads II, III, and
aVF with reciprocal ST-segment depression in leads I and aVL. Blood pressure is 88/50 mmHg
and jugular veins are distended with clear lung fields. Which medication must be strictly avoided
in this patient?
A. Intravenous normal saline fluid boluses
B. Sublingual or intravenous nitroglycerin
C. Aspirin and clopidogrel loading doses
D. Unfractionated heparin weight-based bolus
CORRECT ANSWER : B
Rationale: The electrocardiographic findings indicate an acute inferior wall myocardial
infarction with suspected right ventricular (RV) infarction (evidenced by hypotension and clear
lung fields with elevated jugular venous pressure). Right ventricular infarction relies entirely on
high preload to maintain cardiac output; nitrates are potent venodilators that dramatically
reduce preload, leading to profound, refractory hypotension and cardiac collapse.
5. A 30-year-old female is brought to the emergency department after intentionally ingesting an
unknown quantity of slow-release verapamil tablets two hours ago. Her blood pressure is 70/40
mmHg, heart rate is 48 bpm, and blood glucose is 280 mg/dL. Initial fluid boluses and calcium
chloride administration have failed to improve hemodynamics. What is the most appropriate next
pharmacological intervention?
A. Administer intravenous adenosine rapidly to convert underlying rhythm
B. Initiate a high-dose insulin euglycemia therapy protocol with concurrent dextrose
infusion
C. Administer beta-blocker reversal agents such as glucagon as first-line therapy
D. Initiate continuous intravenous sodium nitroprusside infusion for afterload reduction
CORRECT ANSWER : B
Rationale: Calcium channel blocker overdose leads to severe myocardial depression,
vasodilation, and hyperglycemia (due to impaired insulin release). High-dose insulin euglycemia
, (HIE) therapy improves myocardial contractility and cellular glucose uptake and is superior to
calcium or glucagon in severe toxicity. Sodium nitroprusside would worsen hypotension.
6. A 70-year-old male presents with acute onset of generalized tonic-clonic seizure activity lasting
25 minutes without regaining consciousness between episodes. Intravenous lorazepam 4 mg has
been administered twice without cessation of seizure activity. What is the next appropriate
pharmacologically indicated agent?
A. Administer a third dose of intravenous lorazepam 2 mg push
B. Administer intravenous levetiracetam, fosphenytoin, or valproate sodium as a loading
dose
C. Administer immediate oral phenytoin suspension via nasogastric tube
D. Initiate continuous infusion of neuromuscular blocking agents such as rocuronium
CORRECT ANSWER : B
Rationale: Status epilepticus refractory to initial benzodiazepines requires second-line
antiepileptic therapy such as levetiracetam, fosphenytoin, or valproate sodium. Neuromuscular
blockers paralyze skeletal muscle and stop visible twitching but do not halt cerebral seizure
activity on EEG, masking ongoing damage.
7. A 3-year-old child is brought to the emergency department after choking on a peanut. The child
presents with acute respiratory distress, unilateral wheezing, and decreased breath sounds over
the right lung field. Inspiratory and expiratory chest radiographs are inconclusive. What is the
definitive diagnostic and therapeutic procedure of choice?
A. Immediate administration of nebulized racemic epinephrine and systemic corticosteroids
B. Rigid bronchoscopy performed under general anesthesia by a specialist
C. Flexible fiberoptic bronchoscopy performed at the bedside under conscious sedation
D. Immediate endotracheal intubation and mechanical ventilation with high positive end-
expiratory pressure
CORRECT ANSWER : B
Rationale: Suspected foreign body aspiration in a pediatric patient requires rigid bronchoscopy
under general anesthesia as the gold standard for both diagnosis and safe removal. Flexible
bronchoscopy is inadequate for extracting solid foreign bodies in small airways, and medical
therapy fails to resolve the mechanical obstruction.
