CEN EXAM 2 MOCK TEST WITH ANSWER RATIONALES 2026
TABLE OF CONTENTS
Domain Questions
Cardiovascular Emergencies 1–18
Respiratory Emergencies 19–31
Neurological Emergencies 32–43
Gastrointestinal Emergencies 44–51
Genitourinary, Gynecology & Obstetrical Emergencies 52–60
Medical Emergencies 61–77
Trauma Emergencies 78–93
Environmental & Toxicology Emergencies 94–102
Communicable Diseases 103–108
Head, Eye, Ear, Nose, Throat (HEENT) Emergencies 109–117
Musculoskeletal & Wound Emergencies 118–125
Mental Health Emergencies 126–128
Professional Issues 129–130
SECTION 1: CARDIOVASCULAR EMERGENCIES (Questions 1–18)
Question 1
A 62-year-old male presents to the emergency department with crushing substernal chest pain radiating to his left jaw,
accompanied by diaphoresis and nausea. His initial 12-lead ECG shows ST-segment elevation of 4 mm in leads V1–V4.
Which of the following is the priority intervention?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a chest X-ray
C. Activate the STEMI protocol for immediate percutaneous coronary intervention (PCI)
D. Administer morphine sulfate 4 mg IV
,🔴 A. Administer sublingual nitroglycerin 0.4 mg
🔵 B. Obtain a chest X-ray
🔵 C. Activate the STEMI protocol for immediate percutaneous coronary intervention (PCI)
🔵 D. Administer morphine sulfate 4 mg IV
Correct Answer: C
Rationale: The patient is experiencing an acute anterior ST-segment elevation myocardial infarction (STEMI) as evidenced
by ST elevation in V1–V4 (anterior wall). The priority intervention for STEMI is rapid reperfusion therapy, preferably PCI
within 90 minutes of first medical contact. While nitroglycerin and morphine are important adjunctive therapies for pain and
preload reduction, they do not address the underlying coronary occlusion. Activating the STEMI protocol and arranging
immediate PCI is the definitive, life-saving intervention. Delaying reperfusion increases myocardial damage and mortality. A
chest X-ray is not the priority in the acute phase of STEMI.
Question 2
A 55-year-old female with a history of hypertension presents with acute onset of severe, tearing chest pain radiating to her
back. Her blood pressure is 180/110 mmHg in the right arm and 140/90 mmHg in the left arm. Which of the following is the
most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
🔵 A. Acute myocardial infarction
🔵 B. Pulmonary embolism
🔴 C. Aortic dissection
🔵 D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with sudden, severe, tearing chest pain that radiates to the back. A key
distinguishing feature is a blood pressure differential between arms (≥20 mmHg systolic difference), as seen in this patient.
Risk factors include hypertension. Acute myocardial infarction typically presents with pressure-type pain without arm
differentials. Pulmonary embolism presents with pleuritic chest pain, dyspnea, and hypoxia. Pericarditis presents with
positional chest pain that improves with leaning forward and may have a pericardial friction rub. Immediate management
includes blood pressure control and surgical consultation.
Question 3
A 68-year-old male presents with acute shortness of breath and productive cough with pink, frothy sputum. He has a
history of hypertension and coronary artery disease. On auscultation, you hear crackles throughout both lung fields. Which
medication should the nurse anticipate administering first?
A. Digoxin
B. Furosemide
C. Dobutamine
D. Metoprolol
🔵 A. Digoxin
🔴 B. Furosemide
🔵 C. Dobutamine
🔵 D. Metoprolol
Correct Answer: B
,Rationale: The patient is presenting with acute pulmonary edema, likely due to acute decompensated heart failure. The
pink, frothy sputum and bilateral crackles are classic findings. Furosemide is the first-line medication to reduce preload
through diuresis, which decreases pulmonary congestion. Digoxin is used for chronic heart failure and atrial fibrillation but
is not the first-line agent in acute pulmonary edema. Dobutamine is an inotropic agent used in cardiogenic shock with low
cardiac output. Metoprolol is a beta-blocker used for chronic management; in acute decompensated heart failure, it may
worsen the condition.
Question 4
A patient with atrial fibrillation with rapid ventricular response has a heart rate of 150 bpm and is hemodynamically
unstable with hypotension and altered mental status. Which intervention should the nurse prepare for immediately?
A. Administer amiodarone 150 mg IV push
B. Administer diltiazem 0.25 mg/kg IV
C. Synchronized cardioversion
D. Administer digoxin 0.5 mg IV
🔵 A. Administer amiodarone 150 mg IV push
🔵 B. Administer diltiazem 0.25 mg/kg IV
🔴 C. Synchronized cardioversion
🔵 D. Administer digoxin 0.5 mg IV
Correct Answer: C
Rationale: In atrial fibrillation with rapid ventricular response, synchronized cardioversion is indicated when the patient is
hemodynamically unstable (hypotension, altered mental status, chest pain, or heart failure). This patient meets criteria for
immediate synchronized cardioversion. Amiodarone and diltiazem are rate-control or rhythm-control medications used in
stable patients. Digoxin is used for chronic rate control and is not appropriate for acute, unstable atrial fibrillation.
Question 5
A 45-year-old male with no significant medical history presents with palpitations and lightheadedness. His ECG shows a
regular, narrow-complex tachycardia at 180 bpm with no visible P waves. Which of the following is the most appropriate
initial intervention?
A. Adenosine 6 mg rapid IV push
B. Amiodarone 150 mg IV
C. Synchronized cardioversion
D. Vagal maneuvers
🔵 A. Adenosine 6 mg rapid IV push
🔵 B. Amiodarone 150 mg IV
🔵 C. Synchronized cardioversion
🔴 D. Vagal maneuvers
Correct Answer: D
Rationale: The patient is presenting with supraventricular tachycardia (SVT), characterized by a regular, narrow-complex
tachycardia without visible P waves. In a hemodynamically stable patient, vagal maneuvers (e.g., carotid sinus massage,
Valsalva maneuver) are the first-line intervention. If vagal maneuvers fail, adenosine 6 mg rapid IV push is the next step.
Amiodarone is used for wide-complex tachycardia or unstable rhythms. Synchronized cardioversion is reserved for unstable
patients. This patient is stable (only lightheadedness, no hypotension or altered mental status), so vagal maneuvers are
appropriate first.
, Question 6
A 72-year-old female with a history of heart failure presents with worsening dyspnea, orthopnea, and peripheral edema. On
assessment, she has jugular venous distention, hepatomegaly, and S3 gallop. Which classification of heart failure best
describes this presentation?
A. Heart failure with preserved ejection fraction (HFpEF)
B. Heart failure with reduced ejection fraction (HFrEF)
C. Right-sided heart failure
D. Left-sided heart failure
🔵 A. Heart failure with preserved ejection fraction (HFpEF)
🔵 B. Heart failure with reduced ejection fraction (HFrEF)
🔴 C. Right-sided heart failure
🔵 D. Left-sided heart failure
Correct Answer: C
Rationale: Right-sided heart failure is characterized by signs of systemic venous congestion: jugular venous distention
(JVD), hepatomegaly (congested liver), peripheral edema, and ascites. An S3 gallop is more commonly associated with left-
sided heart failure. HFpEF and HFrEF are classifications based on ejection fraction and describe left-sided heart failure. Left-
sided heart failure presents with pulmonary congestion (dyspnea, crackles, orthopnea) rather than systemic signs.
Question 7
A patient with acute coronary syndrome is receiving a heparin infusion. Which laboratory value should the nurse monitor
most closely to assess the therapeutic effect of heparin?
A. International normalized ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Prothrombin time (PT)
D. Platelet count
🔵 A. International normalized ratio (INR)
🔴 B. Activated partial thromboplastin time (aPTT)
🔵 C. Prothrombin time (PT)
🔵 D. Platelet count
Correct Answer: B
Rationale: Unfractionated heparin is monitored using the activated partial thromboplastin time (aPTT), with a therapeutic
goal typically 1.5 to 2.5 times the control value. INR and PT are used to monitor warfarin therapy. Platelet count is
monitored to detect heparin-induced thrombocytopenia (HIT), but it does not assess therapeutic effect.
Question 8
A 50-year-old male presents with chest pain that is reproducible with palpation of the chest wall. The pain is sharp and
worsens with deep inspiration. Which of the following is the most likely diagnosis?
A. Acute coronary syndrome
B. Pericarditis
C. Musculoskeletal chest pain
D. Pulmonary embolism
🔵 A. Acute coronary syndrome
🔵 B. Pericarditis
TABLE OF CONTENTS
Domain Questions
Cardiovascular Emergencies 1–18
Respiratory Emergencies 19–31
Neurological Emergencies 32–43
Gastrointestinal Emergencies 44–51
Genitourinary, Gynecology & Obstetrical Emergencies 52–60
Medical Emergencies 61–77
Trauma Emergencies 78–93
Environmental & Toxicology Emergencies 94–102
Communicable Diseases 103–108
Head, Eye, Ear, Nose, Throat (HEENT) Emergencies 109–117
Musculoskeletal & Wound Emergencies 118–125
Mental Health Emergencies 126–128
Professional Issues 129–130
SECTION 1: CARDIOVASCULAR EMERGENCIES (Questions 1–18)
Question 1
A 62-year-old male presents to the emergency department with crushing substernal chest pain radiating to his left jaw,
accompanied by diaphoresis and nausea. His initial 12-lead ECG shows ST-segment elevation of 4 mm in leads V1–V4.
Which of the following is the priority intervention?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a chest X-ray
C. Activate the STEMI protocol for immediate percutaneous coronary intervention (PCI)
D. Administer morphine sulfate 4 mg IV
,🔴 A. Administer sublingual nitroglycerin 0.4 mg
🔵 B. Obtain a chest X-ray
🔵 C. Activate the STEMI protocol for immediate percutaneous coronary intervention (PCI)
🔵 D. Administer morphine sulfate 4 mg IV
Correct Answer: C
Rationale: The patient is experiencing an acute anterior ST-segment elevation myocardial infarction (STEMI) as evidenced
by ST elevation in V1–V4 (anterior wall). The priority intervention for STEMI is rapid reperfusion therapy, preferably PCI
within 90 minutes of first medical contact. While nitroglycerin and morphine are important adjunctive therapies for pain and
preload reduction, they do not address the underlying coronary occlusion. Activating the STEMI protocol and arranging
immediate PCI is the definitive, life-saving intervention. Delaying reperfusion increases myocardial damage and mortality. A
chest X-ray is not the priority in the acute phase of STEMI.
Question 2
A 55-year-old female with a history of hypertension presents with acute onset of severe, tearing chest pain radiating to her
back. Her blood pressure is 180/110 mmHg in the right arm and 140/90 mmHg in the left arm. Which of the following is the
most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
🔵 A. Acute myocardial infarction
🔵 B. Pulmonary embolism
🔴 C. Aortic dissection
🔵 D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with sudden, severe, tearing chest pain that radiates to the back. A key
distinguishing feature is a blood pressure differential between arms (≥20 mmHg systolic difference), as seen in this patient.
Risk factors include hypertension. Acute myocardial infarction typically presents with pressure-type pain without arm
differentials. Pulmonary embolism presents with pleuritic chest pain, dyspnea, and hypoxia. Pericarditis presents with
positional chest pain that improves with leaning forward and may have a pericardial friction rub. Immediate management
includes blood pressure control and surgical consultation.
Question 3
A 68-year-old male presents with acute shortness of breath and productive cough with pink, frothy sputum. He has a
history of hypertension and coronary artery disease. On auscultation, you hear crackles throughout both lung fields. Which
medication should the nurse anticipate administering first?
A. Digoxin
B. Furosemide
C. Dobutamine
D. Metoprolol
🔵 A. Digoxin
🔴 B. Furosemide
🔵 C. Dobutamine
🔵 D. Metoprolol
Correct Answer: B
,Rationale: The patient is presenting with acute pulmonary edema, likely due to acute decompensated heart failure. The
pink, frothy sputum and bilateral crackles are classic findings. Furosemide is the first-line medication to reduce preload
through diuresis, which decreases pulmonary congestion. Digoxin is used for chronic heart failure and atrial fibrillation but
is not the first-line agent in acute pulmonary edema. Dobutamine is an inotropic agent used in cardiogenic shock with low
cardiac output. Metoprolol is a beta-blocker used for chronic management; in acute decompensated heart failure, it may
worsen the condition.
Question 4
A patient with atrial fibrillation with rapid ventricular response has a heart rate of 150 bpm and is hemodynamically
unstable with hypotension and altered mental status. Which intervention should the nurse prepare for immediately?
A. Administer amiodarone 150 mg IV push
B. Administer diltiazem 0.25 mg/kg IV
C. Synchronized cardioversion
D. Administer digoxin 0.5 mg IV
🔵 A. Administer amiodarone 150 mg IV push
🔵 B. Administer diltiazem 0.25 mg/kg IV
🔴 C. Synchronized cardioversion
🔵 D. Administer digoxin 0.5 mg IV
Correct Answer: C
Rationale: In atrial fibrillation with rapid ventricular response, synchronized cardioversion is indicated when the patient is
hemodynamically unstable (hypotension, altered mental status, chest pain, or heart failure). This patient meets criteria for
immediate synchronized cardioversion. Amiodarone and diltiazem are rate-control or rhythm-control medications used in
stable patients. Digoxin is used for chronic rate control and is not appropriate for acute, unstable atrial fibrillation.
Question 5
A 45-year-old male with no significant medical history presents with palpitations and lightheadedness. His ECG shows a
regular, narrow-complex tachycardia at 180 bpm with no visible P waves. Which of the following is the most appropriate
initial intervention?
A. Adenosine 6 mg rapid IV push
B. Amiodarone 150 mg IV
C. Synchronized cardioversion
D. Vagal maneuvers
🔵 A. Adenosine 6 mg rapid IV push
🔵 B. Amiodarone 150 mg IV
🔵 C. Synchronized cardioversion
🔴 D. Vagal maneuvers
Correct Answer: D
Rationale: The patient is presenting with supraventricular tachycardia (SVT), characterized by a regular, narrow-complex
tachycardia without visible P waves. In a hemodynamically stable patient, vagal maneuvers (e.g., carotid sinus massage,
Valsalva maneuver) are the first-line intervention. If vagal maneuvers fail, adenosine 6 mg rapid IV push is the next step.
Amiodarone is used for wide-complex tachycardia or unstable rhythms. Synchronized cardioversion is reserved for unstable
patients. This patient is stable (only lightheadedness, no hypotension or altered mental status), so vagal maneuvers are
appropriate first.
, Question 6
A 72-year-old female with a history of heart failure presents with worsening dyspnea, orthopnea, and peripheral edema. On
assessment, she has jugular venous distention, hepatomegaly, and S3 gallop. Which classification of heart failure best
describes this presentation?
A. Heart failure with preserved ejection fraction (HFpEF)
B. Heart failure with reduced ejection fraction (HFrEF)
C. Right-sided heart failure
D. Left-sided heart failure
🔵 A. Heart failure with preserved ejection fraction (HFpEF)
🔵 B. Heart failure with reduced ejection fraction (HFrEF)
🔴 C. Right-sided heart failure
🔵 D. Left-sided heart failure
Correct Answer: C
Rationale: Right-sided heart failure is characterized by signs of systemic venous congestion: jugular venous distention
(JVD), hepatomegaly (congested liver), peripheral edema, and ascites. An S3 gallop is more commonly associated with left-
sided heart failure. HFpEF and HFrEF are classifications based on ejection fraction and describe left-sided heart failure. Left-
sided heart failure presents with pulmonary congestion (dyspnea, crackles, orthopnea) rather than systemic signs.
Question 7
A patient with acute coronary syndrome is receiving a heparin infusion. Which laboratory value should the nurse monitor
most closely to assess the therapeutic effect of heparin?
A. International normalized ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Prothrombin time (PT)
D. Platelet count
🔵 A. International normalized ratio (INR)
🔴 B. Activated partial thromboplastin time (aPTT)
🔵 C. Prothrombin time (PT)
🔵 D. Platelet count
Correct Answer: B
Rationale: Unfractionated heparin is monitored using the activated partial thromboplastin time (aPTT), with a therapeutic
goal typically 1.5 to 2.5 times the control value. INR and PT are used to monitor warfarin therapy. Platelet count is
monitored to detect heparin-induced thrombocytopenia (HIT), but it does not assess therapeutic effect.
Question 8
A 50-year-old male presents with chest pain that is reproducible with palpation of the chest wall. The pain is sharp and
worsens with deep inspiration. Which of the following is the most likely diagnosis?
A. Acute coronary syndrome
B. Pericarditis
C. Musculoskeletal chest pain
D. Pulmonary embolism
🔵 A. Acute coronary syndrome
🔵 B. Pericarditis
