CEN Certification Exam Prep 2026 Updated Practice
Questions Comprehensive Emergency Nursing Review |
Detailed Explanations | Verified Answers | Complete
Success Study Workbook
Domain Scored Items
Cardiovascular Emergencies 18
Respiratory Emergencies 17
Neurological Emergencies 17
Medical Emergencies 15
Gastrointestinal Emergencies 14
Mental Health Emergencies 13
Environment, Toxicology & Communicable Diseases 13
Professional Issues 12
Musculoskeletal & Wound Emergencies 11
Genitourinary, Gynecology & Obstetrical Emergencies 10
Head, Eye, Ear, Nose, Throat (HEENT) Emergencies 10
,Domain Scored Items
Total 150
DOMAIN 1: CARDIOVASCULAR EMERGENCIES (18 Questions)
QUESTION 1
A 62-year-old male presents to the emergency department with substernal
chest pressure radiating to the left arm, diaphoresis, and nausea. The 12-lead
ECG shows ST-segment elevation in leads V1-V4. Which intervention should
the nurse prioritize?
A. Administer sublingual nitroglycerin
B. Activate the STEMI alert and prepare for immediate PCI
C. Administer morphine sulfate for pain
D. Obtain a chest X-ray
Answer: B. Activate the STEMI alert and prepare for immediate PCI
Rationale: The patient is experiencing an anterior ST-segment elevation
myocardial infarction (STEMI) as evidenced by ST elevation in leads V1-V4.
The priority is to activate the STEMI alert and prepare for immediate
percutaneous coronary intervention (PCI), as door-to-balloon time is critical
(goal <90 minutes). While nitroglycerin, morphine, and chest X-ray may be
appropriate, they should not delay activation of the STEMI protocol.
QUESTION 2
A patient with a suspected acute coronary syndrome has received aspirin and
sublingual nitroglycerin. The patient's chest pain persists. Vital signs: BP
98/62 mmHg, HR 112 bpm, RR 20/min, SpO2 96%. Which medication should
the nurse anticipate administering?
A. Additional sublingual nitroglycerin
B. Oral metoprolol
,C. IV morphine sulfate
D. IV adenosine
Answer: C. IV morphine sulfate
Rationale: Morphine sulfate is indicated for ongoing chest pain in acute
coronary syndrome, particularly when the patient is hemodynamically stable
but symptomatic. However, caution is needed in patients with hypotension.
Metoprolol should be used cautiously with the patient's borderline low blood
pressure. Adenosine is for supraventricular tachycardia, not ischemic chest
pain.
QUESTION 3
During a cardiac arrest, the cardiac monitor shows a rhythm of ventricular
fibrillation. The patient has received one shock and 2 minutes of CPR. What is
the next appropriate action?
A. Administer amiodarone
B. Resume CPR immediately
C. Check for a pulse
D. Deliver a second shock
Answer: B. Resume CPR immediately
Rationale: According to ACLS guidelines, after a shock is delivered, CPR
should be resumed immediately for 2 minutes before checking for a pulse or
rhythm. This ensures continuous coronary perfusion. Amiodarone is
administered after the third shock if the rhythm persists.
QUESTION 4
A patient presents with sudden onset of severe "tearing" chest pain radiating
to the back. The patient's blood pressure is 160/94 mmHg in the right arm
and 130/80 mmHg in the left arm. The nurse suspects:
A. Acute myocardial infarction
B. Pulmonary embolism
, C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: The classic presentation of aortic dissection includes sudden,
severe "tearing" or "ripping" chest pain radiating to the back, along with pulse
or blood pressure differential between arms. This is a life-threatening
emergency requiring immediate blood pressure control (beta-blockers) and
surgical consultation.
QUESTION 5
A patient with heart failure and pulmonary edema has crackles in all lung
fields, an SpO2 of 88% on 4 L/min nasal cannula, and is in respiratory
distress. Which intervention should the nurse anticipate first?
A. IV furosemide
B. Sublingual nitroglycerin
C. Non-invasive positive pressure ventilation (BiPAP)
D. IV morphine sulfate
Answer: C. Non-invasive positive pressure ventilation (BiPAP)
Rationale: The patient is in acute decompensated heart failure with
pulmonary edema and hypoxemia. BiPAP provides positive pressure that
reduces preload and afterload, improves oxygenation, and decreases the work
of breathing. This is the priority intervention to support ventilation and
oxygenation.
QUESTION 6
A patient with atrial fibrillation has a ventricular rate of 130 bpm and is
experiencing dizziness and chest discomfort. The patient is hemodynamically
stable. Which medication is most appropriate for rate control?
A. Amiodarone
B. Lidocaine
Questions Comprehensive Emergency Nursing Review |
Detailed Explanations | Verified Answers | Complete
Success Study Workbook
Domain Scored Items
Cardiovascular Emergencies 18
Respiratory Emergencies 17
Neurological Emergencies 17
Medical Emergencies 15
Gastrointestinal Emergencies 14
Mental Health Emergencies 13
Environment, Toxicology & Communicable Diseases 13
Professional Issues 12
Musculoskeletal & Wound Emergencies 11
Genitourinary, Gynecology & Obstetrical Emergencies 10
Head, Eye, Ear, Nose, Throat (HEENT) Emergencies 10
,Domain Scored Items
Total 150
DOMAIN 1: CARDIOVASCULAR EMERGENCIES (18 Questions)
QUESTION 1
A 62-year-old male presents to the emergency department with substernal
chest pressure radiating to the left arm, diaphoresis, and nausea. The 12-lead
ECG shows ST-segment elevation in leads V1-V4. Which intervention should
the nurse prioritize?
A. Administer sublingual nitroglycerin
B. Activate the STEMI alert and prepare for immediate PCI
C. Administer morphine sulfate for pain
D. Obtain a chest X-ray
Answer: B. Activate the STEMI alert and prepare for immediate PCI
Rationale: The patient is experiencing an anterior ST-segment elevation
myocardial infarction (STEMI) as evidenced by ST elevation in leads V1-V4.
The priority is to activate the STEMI alert and prepare for immediate
percutaneous coronary intervention (PCI), as door-to-balloon time is critical
(goal <90 minutes). While nitroglycerin, morphine, and chest X-ray may be
appropriate, they should not delay activation of the STEMI protocol.
QUESTION 2
A patient with a suspected acute coronary syndrome has received aspirin and
sublingual nitroglycerin. The patient's chest pain persists. Vital signs: BP
98/62 mmHg, HR 112 bpm, RR 20/min, SpO2 96%. Which medication should
the nurse anticipate administering?
A. Additional sublingual nitroglycerin
B. Oral metoprolol
,C. IV morphine sulfate
D. IV adenosine
Answer: C. IV morphine sulfate
Rationale: Morphine sulfate is indicated for ongoing chest pain in acute
coronary syndrome, particularly when the patient is hemodynamically stable
but symptomatic. However, caution is needed in patients with hypotension.
Metoprolol should be used cautiously with the patient's borderline low blood
pressure. Adenosine is for supraventricular tachycardia, not ischemic chest
pain.
QUESTION 3
During a cardiac arrest, the cardiac monitor shows a rhythm of ventricular
fibrillation. The patient has received one shock and 2 minutes of CPR. What is
the next appropriate action?
A. Administer amiodarone
B. Resume CPR immediately
C. Check for a pulse
D. Deliver a second shock
Answer: B. Resume CPR immediately
Rationale: According to ACLS guidelines, after a shock is delivered, CPR
should be resumed immediately for 2 minutes before checking for a pulse or
rhythm. This ensures continuous coronary perfusion. Amiodarone is
administered after the third shock if the rhythm persists.
QUESTION 4
A patient presents with sudden onset of severe "tearing" chest pain radiating
to the back. The patient's blood pressure is 160/94 mmHg in the right arm
and 130/80 mmHg in the left arm. The nurse suspects:
A. Acute myocardial infarction
B. Pulmonary embolism
, C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: The classic presentation of aortic dissection includes sudden,
severe "tearing" or "ripping" chest pain radiating to the back, along with pulse
or blood pressure differential between arms. This is a life-threatening
emergency requiring immediate blood pressure control (beta-blockers) and
surgical consultation.
QUESTION 5
A patient with heart failure and pulmonary edema has crackles in all lung
fields, an SpO2 of 88% on 4 L/min nasal cannula, and is in respiratory
distress. Which intervention should the nurse anticipate first?
A. IV furosemide
B. Sublingual nitroglycerin
C. Non-invasive positive pressure ventilation (BiPAP)
D. IV morphine sulfate
Answer: C. Non-invasive positive pressure ventilation (BiPAP)
Rationale: The patient is in acute decompensated heart failure with
pulmonary edema and hypoxemia. BiPAP provides positive pressure that
reduces preload and afterload, improves oxygenation, and decreases the work
of breathing. This is the priority intervention to support ventilation and
oxygenation.
QUESTION 6
A patient with atrial fibrillation has a ventricular rate of 130 bpm and is
experiencing dizziness and chest discomfort. The patient is hemodynamically
stable. Which medication is most appropriate for rate control?
A. Amiodarone
B. Lidocaine
