CEN 2026 COMPREHENSIVE PRACTICE EXAM
TABLE OF CONTENTS
Section Topic Questions
1 Cardiovascular Emergencies 1–20
2 Respiratory Emergencies 21–35
3 Neurological Emergencies 36–50
4 Gastrointestinal & Genitourinary Emergencies 51–65
Musculoskeletal, Wound & Soft Tissue
5 66–80
Emergencies
6 Environmental & Toxicological Emergencies 81–95
7 OB/GYN & Sexual Assault Emergencies 96–108
8 Psychosocial & Behavioral Emergencies 109–118
9 Professional Issues, Triage & Ethics 119–130
SECTION 1: CARDIOVASCULAR EMERGENCIES (Questions 1–20)
1. A 62-year-old male presents with crushing substernal chest pain radiating to his jaw, diaphoresis, and nausea. ECG
shows 3-mm ST-segment elevation in leads V1–V4. Which intervention is the absolute priority within 10 minutes of
arrival?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead ECG and interpret it
C) Start two large-bore IV lines
D) Administer aspirin 324 mg chewed
🔴 Correct Answer: B
Rationale: The priority in any suspected STEMI is to obtain and interpret a 12-lead ECG within 10 minutes of arrival to
determine if emergent PCI or thrombolytics are indicated. While aspirin and IV access are critical, they come after the initial
ECG per ACLS guidelines.
2. A patient with acute pulmonary edema is tachypneic, hypoxic (SpO2 88%), and has BP 160/98. Which intervention
should the nurse implement first?
A) Place the patient in a supine position
, B) Administer furosemide 40 mg IV push
C) Apply non-invasive positive pressure ventilation (CPAP/BiPAP)
D) Give morphine sulfate 2 mg IV
🔴 Correct Answer: C
Rationale: CPAP/BiPAP reduces preload and afterload, improves oxygenation, and can prevent intubation in acute
cardiogenic pulmonary edema. It is the first-line intervention for severe respiratory distress with hypoxia. Supine positioning
worsens breathing.
3. A 55-year-old female with a history of hypertension reports sudden onset of "tearing" chest pain radiating to her
back. BP is 180/110 in the right arm and 100/70 in the left arm. Which diagnosis is most likely?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
🔴 Correct Answer: C
Rationale: Aortic dissection presents with abrupt, severe "tearing" or "ripping" chest pain radiating to the back, with pulse
or blood pressure differentials between arms. Immediate CT angiography is diagnostic.
4. Which of the following ECG findings is most consistent with pericarditis? (SATA)
A) Diffuse ST-segment elevation
B) PR-segment depression
C) Q waves in leads II, III, aVF
D) Electrical alternans
E) ST-segment depression in V1–V3
🔴 Correct Answers: A, B
Rationale: Pericarditis classically shows diffuse ST-segment elevation (concave upward) and PR-segment depression. Q
waves indicate prior MI. Electrical alternans suggests large pericardial effusion/tamponade, not pericarditis itself.
5. A patient in cardiac arrest is in pulseless ventricular tachycardia. The defibrillator is charged to 200 J biphasic. After
the shock, CPR is resumed. When should rhythm be rechecked?
A) Immediately after the shock
B) After 1 minute of CPR
C) After 2 minutes of CPR (5 cycles)
D) After 5 minutes of CPR
🔴 Correct Answer: C
Rationale: Per ACLS, immediately resume CPR for 2 minutes (5 cycles) after a shock, then recheck the rhythm. This
minimizes interruptions in chest compressions.
,6. A patient with acute decompensated heart failure has an ejection fraction of 25% and is on dobutamine. The nurse
notes frequent premature ventricular contractions (PVCs). What is the priority action?
A) Decrease the dobutamine infusion rate
B) Administer amiodarone IV push
C) Check serum potassium and magnesium levels
D) Prepare for synchronized cardioversion
🔴 Correct Answer: A
Rationale: Dobutamine is a beta-agonist that increases myocardial contractility but also increases automaticity and can
cause dysrhythmias. The priority is to reduce the infusion rate. Electrolyte repletion is important but the immediate action is
rate adjustment.
7. Which of the following are contraindications to the administration of tissue plasminogen activator (tPA) in a STEMI
patient? (SATA)
A) Systolic BP > 180 mm Hg
B) History of ischemic stroke within 3 months
C) Age > 75 years
D) Current oral anticoagulant use with INR > 1.7
E) Chest pain duration of 4 hours
🔴 Correct Answers: A, B, D
Rationale: Absolute contraindications to tPA include: active bleeding, prior ICH, ischemic stroke within 3 months, suspected
aortic dissection, severe uncontrolled hypertension (SBP >180), and INR >1.7 on anticoagulants. Age >75 is a relative, not
absolute, contraindication. 4-hour duration is within the 6-hour window.
8. A patient with an inferior wall STEMI (leads II, III, aVF) develops bradycardia and hypotension. Which medication
should the nurse anticipate administering first?
A) Epinephrine
B) Atropine
C) Dopamine
D) Norepinephrine
🔴 Correct Answer: B
Rationale: Inferior wall STEMI often involves the right coronary artery and can cause vagally-mediated bradycardia and
hypotension. Atropine 0.5 mg IV is the first-line treatment for symptomatic bradycardia if no contraindications.
9. The nurse is caring for a patient with a temporary transvenous pacemaker set to VVI mode at 70 bpm. The ECG shows
paced spikes that are not followed by a QRS complex. What is the most likely cause?
A) Undersensing
B) Failure to capture
C) Failure to pace
D) Oversensing
, 🔴 Correct Answer: B
Rationale: Failure to capture means the pacemaker spike does not depolarize the myocardium (no QRS after the spike).
Causes include increased threshold, lead dislodgement, or battery depletion. Undersensing is when the pacemaker fires on
its own rhythm.
10. A 70-year-old patient presents with sudden, severe dyspnea, pleuritic chest pain, and hemoptysis. He is tachycardic
and hypoxic. Which diagnostic test is the gold standard to confirm the suspected diagnosis?
A) D-dimer
B) CT pulmonary angiography (CTPA)
C) V/Q scan
D) Echocardiogram
🔴 Correct Answer: B
Rationale: CTPA is the gold standard for diagnosing pulmonary embolism. D-dimer is a screening test with low specificity.
V/Q scan is used if CTPA is contraindicated.
11. A patient with a history of cocaine use presents with chest pain, hypertension, and tachycardia. ECG shows ST-
elevation. Which treatment is absolutely contraindicated?
A) Aspirin
B) Nitroglycerin
C) Beta-blockers (e.g., metoprolol)
D) Benzodiazepines
🔴 Correct Answer: C
Rationale: Beta-blockers are contraindicated in cocaine-associated ACS because they cause unopposed alpha-adrenergic
stimulation, leading to coronary vasospasm and worsening hypertension/ischemia. Benzodiazepines are first-line to reduce
sympathetic tone.
12. Which of the following is a classic sign of cardiac tamponade? (SATA)
A) Muffled heart sounds
B) Distended neck veins
C) Pulsus paradoxus > 10 mm Hg
D) Widening pulse pressure
E) Hypotension
🔴 Correct Answers: A, B, C, E
Rationale: Beck's triad (muffled heart sounds, distended neck veins, hypotension) plus pulsus paradoxus are classic.
Widening pulse pressure is not a sign; narrow pulse pressure is more common due to decreased stroke volume.
13. A patient with atrial fibrillation and a ventricular rate of 140 is hypotensive (BP 85/50) and confused. Which
intervention is the priority?
A) Synchronized cardioversion
TABLE OF CONTENTS
Section Topic Questions
1 Cardiovascular Emergencies 1–20
2 Respiratory Emergencies 21–35
3 Neurological Emergencies 36–50
4 Gastrointestinal & Genitourinary Emergencies 51–65
Musculoskeletal, Wound & Soft Tissue
5 66–80
Emergencies
6 Environmental & Toxicological Emergencies 81–95
7 OB/GYN & Sexual Assault Emergencies 96–108
8 Psychosocial & Behavioral Emergencies 109–118
9 Professional Issues, Triage & Ethics 119–130
SECTION 1: CARDIOVASCULAR EMERGENCIES (Questions 1–20)
1. A 62-year-old male presents with crushing substernal chest pain radiating to his jaw, diaphoresis, and nausea. ECG
shows 3-mm ST-segment elevation in leads V1–V4. Which intervention is the absolute priority within 10 minutes of
arrival?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead ECG and interpret it
C) Start two large-bore IV lines
D) Administer aspirin 324 mg chewed
🔴 Correct Answer: B
Rationale: The priority in any suspected STEMI is to obtain and interpret a 12-lead ECG within 10 minutes of arrival to
determine if emergent PCI or thrombolytics are indicated. While aspirin and IV access are critical, they come after the initial
ECG per ACLS guidelines.
2. A patient with acute pulmonary edema is tachypneic, hypoxic (SpO2 88%), and has BP 160/98. Which intervention
should the nurse implement first?
A) Place the patient in a supine position
, B) Administer furosemide 40 mg IV push
C) Apply non-invasive positive pressure ventilation (CPAP/BiPAP)
D) Give morphine sulfate 2 mg IV
🔴 Correct Answer: C
Rationale: CPAP/BiPAP reduces preload and afterload, improves oxygenation, and can prevent intubation in acute
cardiogenic pulmonary edema. It is the first-line intervention for severe respiratory distress with hypoxia. Supine positioning
worsens breathing.
3. A 55-year-old female with a history of hypertension reports sudden onset of "tearing" chest pain radiating to her
back. BP is 180/110 in the right arm and 100/70 in the left arm. Which diagnosis is most likely?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
🔴 Correct Answer: C
Rationale: Aortic dissection presents with abrupt, severe "tearing" or "ripping" chest pain radiating to the back, with pulse
or blood pressure differentials between arms. Immediate CT angiography is diagnostic.
4. Which of the following ECG findings is most consistent with pericarditis? (SATA)
A) Diffuse ST-segment elevation
B) PR-segment depression
C) Q waves in leads II, III, aVF
D) Electrical alternans
E) ST-segment depression in V1–V3
🔴 Correct Answers: A, B
Rationale: Pericarditis classically shows diffuse ST-segment elevation (concave upward) and PR-segment depression. Q
waves indicate prior MI. Electrical alternans suggests large pericardial effusion/tamponade, not pericarditis itself.
5. A patient in cardiac arrest is in pulseless ventricular tachycardia. The defibrillator is charged to 200 J biphasic. After
the shock, CPR is resumed. When should rhythm be rechecked?
A) Immediately after the shock
B) After 1 minute of CPR
C) After 2 minutes of CPR (5 cycles)
D) After 5 minutes of CPR
🔴 Correct Answer: C
Rationale: Per ACLS, immediately resume CPR for 2 minutes (5 cycles) after a shock, then recheck the rhythm. This
minimizes interruptions in chest compressions.
,6. A patient with acute decompensated heart failure has an ejection fraction of 25% and is on dobutamine. The nurse
notes frequent premature ventricular contractions (PVCs). What is the priority action?
A) Decrease the dobutamine infusion rate
B) Administer amiodarone IV push
C) Check serum potassium and magnesium levels
D) Prepare for synchronized cardioversion
🔴 Correct Answer: A
Rationale: Dobutamine is a beta-agonist that increases myocardial contractility but also increases automaticity and can
cause dysrhythmias. The priority is to reduce the infusion rate. Electrolyte repletion is important but the immediate action is
rate adjustment.
7. Which of the following are contraindications to the administration of tissue plasminogen activator (tPA) in a STEMI
patient? (SATA)
A) Systolic BP > 180 mm Hg
B) History of ischemic stroke within 3 months
C) Age > 75 years
D) Current oral anticoagulant use with INR > 1.7
E) Chest pain duration of 4 hours
🔴 Correct Answers: A, B, D
Rationale: Absolute contraindications to tPA include: active bleeding, prior ICH, ischemic stroke within 3 months, suspected
aortic dissection, severe uncontrolled hypertension (SBP >180), and INR >1.7 on anticoagulants. Age >75 is a relative, not
absolute, contraindication. 4-hour duration is within the 6-hour window.
8. A patient with an inferior wall STEMI (leads II, III, aVF) develops bradycardia and hypotension. Which medication
should the nurse anticipate administering first?
A) Epinephrine
B) Atropine
C) Dopamine
D) Norepinephrine
🔴 Correct Answer: B
Rationale: Inferior wall STEMI often involves the right coronary artery and can cause vagally-mediated bradycardia and
hypotension. Atropine 0.5 mg IV is the first-line treatment for symptomatic bradycardia if no contraindications.
9. The nurse is caring for a patient with a temporary transvenous pacemaker set to VVI mode at 70 bpm. The ECG shows
paced spikes that are not followed by a QRS complex. What is the most likely cause?
A) Undersensing
B) Failure to capture
C) Failure to pace
D) Oversensing
, 🔴 Correct Answer: B
Rationale: Failure to capture means the pacemaker spike does not depolarize the myocardium (no QRS after the spike).
Causes include increased threshold, lead dislodgement, or battery depletion. Undersensing is when the pacemaker fires on
its own rhythm.
10. A 70-year-old patient presents with sudden, severe dyspnea, pleuritic chest pain, and hemoptysis. He is tachycardic
and hypoxic. Which diagnostic test is the gold standard to confirm the suspected diagnosis?
A) D-dimer
B) CT pulmonary angiography (CTPA)
C) V/Q scan
D) Echocardiogram
🔴 Correct Answer: B
Rationale: CTPA is the gold standard for diagnosing pulmonary embolism. D-dimer is a screening test with low specificity.
V/Q scan is used if CTPA is contraindicated.
11. A patient with a history of cocaine use presents with chest pain, hypertension, and tachycardia. ECG shows ST-
elevation. Which treatment is absolutely contraindicated?
A) Aspirin
B) Nitroglycerin
C) Beta-blockers (e.g., metoprolol)
D) Benzodiazepines
🔴 Correct Answer: C
Rationale: Beta-blockers are contraindicated in cocaine-associated ACS because they cause unopposed alpha-adrenergic
stimulation, leading to coronary vasospasm and worsening hypertension/ischemia. Benzodiazepines are first-line to reduce
sympathetic tone.
12. Which of the following is a classic sign of cardiac tamponade? (SATA)
A) Muffled heart sounds
B) Distended neck veins
C) Pulsus paradoxus > 10 mm Hg
D) Widening pulse pressure
E) Hypotension
🔴 Correct Answers: A, B, C, E
Rationale: Beck's triad (muffled heart sounds, distended neck veins, hypotension) plus pulsus paradoxus are classic.
Widening pulse pressure is not a sign; narrow pulse pressure is more common due to decreased stroke volume.
13. A patient with atrial fibrillation and a ventricular rate of 140 is hypotensive (BP 85/50) and confused. Which
intervention is the priority?
A) Synchronized cardioversion
