CEN CERTIFIED EMERGENCY NURSE PRACTICE
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | PRACTICE QUESTIONS AND
ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A 62-year-old male presents with sudden onset of severe, tearing chest pain
radiating to the back. Blood pressure is 190/100 mm Hg in the right arm and
150/80 in the left arm. What is the priority nursing action?
A) Administer nitroglycerin sublingually
B) Initiate a beta-blocker infusion
C) Obtain a chest CT angiogram immediately
D) Assess for abdominal bruit and notify the provider
Correct Answer: C
The findings suggest aortic dissection; immediate diagnostic imaging with CT
angiography is essential to confirm and guide management. Nitroglycerin and
beta-blockers may be used after diagnosis but CT is the priority. Abdominal bruit is
not the critical next step.
2. A client with asthma presents with a peak expiratory flow rate of 35% of
personal best, severe dyspnea, and silent chest. What is the immediate
intervention?
A) Administer oral prednisone
B) Start continuous nebulized albuterol and ipratropium
C) Give subcutaneous epinephrine
D) Prepare for discharge after one treatment
,Correct Answer: B
Silent chest and severe obstruction require aggressive bronchodilation with
continuous albuterol and ipratropium. Oral prednisone takes hours. Epinephrine is
not first-line for asthma. Discharge is inappropriate with severe distress.
3. A patient is brought in after a motor vehicle crash with hypotension,
distended neck veins, and muffled heart sounds. Which condition is most
likely?
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive hemothorax
D) Aortic rupture
Correct Answer: B
Beck's triad (hypotension, JVD, muffled heart sounds) suggests cardiac
tamponade. Tension pneumothorax has absent breath sounds and tracheal
deviation. Hemothorax has absent breath sounds but no JVD. Aortic rupture has
tearing pain and may not show Beck's triad.
4. A child presents with a barking cough, stridor, and low-grade fever. What is
the most likely diagnosis?
A) Epiglottitis
B) Croup
C) Bacterial tracheitis
D) Foreign body aspiration
Correct Answer: B
Croup (laryngotracheobronchitis) presents with barky cough, stridor, and low-
grade fever. Epiglottitis has high fever, drooling, and toxic appearance. Bacterial
tracheitis is more severe. Foreign body has sudden onset without fever.
5. A patient with a possible cervical spine injury is being logrolled. Which
action is most important?
A) Keep the cervical collar loose for comfort
B) Maintain inline stabilization of the head and neck
, C) Rotate the patient rapidly
D) Allow the head to fall forward
Correct Answer: B
Inline stabilization is critical to prevent spinal cord injury during logrolling. The
collar should remain snug. Rapid rotation or allowing head movement can cause
permanent injury.
6. A 30-year-old female presents with right lower quadrant pain, nausea, and
rebound tenderness at McBurney point. What is the most likely diagnosis?
A) Cholecystitis
B) Appendicitis
C) Ectopic pregnancy
D) Pancreatitis
Correct Answer: B
McBurney point tenderness and rebound suggest appendicitis. Cholecystitis is RUQ
pain. Ectopic pregnancy may have adnexal tenderness and vaginal bleeding.
Pancreatitis has epigastric pain radiating to back.
7. A patient with a suspected opioid overdose has pinpoint pupils, respiratory
rate of 6, and is unresponsive. What is the first medication?
A) Naloxone
B) Flumazenil
C) Thiamine
D) Dextrose
Correct Answer: A
Naloxone reverses opioid-induced respiratory depression. Flumazenil is for
benzodiazepines. Thiamine is for Wernicke's, and dextrose for hypoglycemia.
Naloxone is the priority for suspected opioid overdose.
8. A patient presents with sudden severe headache, nuchal rigidity, and
photophobia. CT shows blood in the subarachnoid space. What is the most
common cause?
A) Berry aneurysm rupture
, B) Arteriovenous malformation
C) Ischemic stroke
D) Hypertensive hemorrhage
Correct Answer: A
Spontaneous subarachnoid hemorrhage is most commonly due to ruptured berry
aneurysm. AVM is less common. Ischemic stroke does not cause SAH. Hypertensive
hemorrhage is usually intraparenchymal.
9. A patient with a burn injury to the face has singed nasal hairs, carbonaceous
sputum, and hoarseness. What is the priority?
A) Start IV fluids
B) Prepare for early intubation
C) Apply silver sulfadiazine
D) Administer pain medication
Correct Answer: B
Signs of inhalation injury indicate the need for early intubation to prevent airway
edema. IV fluids and pain meds are important but airway is priority. Topical silver
sulfadiazine is not for inhalation.
10.A 45-year-old male with chest pain has ST-segment elevation in leads II, III,
and aVF. Which artery is most likely occluded?
A) Left anterior descending
B) Right coronary artery
C) Left circumflex
D) Left main
Correct Answer: B
Inferior wall MI (leads II, III, aVF) is usually due to right coronary artery occlusion.
LAD affects anterior leads V1–V4. Circumflex affects lateral leads I, aVL, V5–V6.
Left main affects widespread leads.
11.A patient presents with a large, painful, red, swollen area on the skin with a
well-demarcated border and fever. What is the most likely diagnosis?
A) Cellulitis
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | PRACTICE QUESTIONS AND
ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A 62-year-old male presents with sudden onset of severe, tearing chest pain
radiating to the back. Blood pressure is 190/100 mm Hg in the right arm and
150/80 in the left arm. What is the priority nursing action?
A) Administer nitroglycerin sublingually
B) Initiate a beta-blocker infusion
C) Obtain a chest CT angiogram immediately
D) Assess for abdominal bruit and notify the provider
Correct Answer: C
The findings suggest aortic dissection; immediate diagnostic imaging with CT
angiography is essential to confirm and guide management. Nitroglycerin and
beta-blockers may be used after diagnosis but CT is the priority. Abdominal bruit is
not the critical next step.
2. A client with asthma presents with a peak expiratory flow rate of 35% of
personal best, severe dyspnea, and silent chest. What is the immediate
intervention?
A) Administer oral prednisone
B) Start continuous nebulized albuterol and ipratropium
C) Give subcutaneous epinephrine
D) Prepare for discharge after one treatment
,Correct Answer: B
Silent chest and severe obstruction require aggressive bronchodilation with
continuous albuterol and ipratropium. Oral prednisone takes hours. Epinephrine is
not first-line for asthma. Discharge is inappropriate with severe distress.
3. A patient is brought in after a motor vehicle crash with hypotension,
distended neck veins, and muffled heart sounds. Which condition is most
likely?
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive hemothorax
D) Aortic rupture
Correct Answer: B
Beck's triad (hypotension, JVD, muffled heart sounds) suggests cardiac
tamponade. Tension pneumothorax has absent breath sounds and tracheal
deviation. Hemothorax has absent breath sounds but no JVD. Aortic rupture has
tearing pain and may not show Beck's triad.
4. A child presents with a barking cough, stridor, and low-grade fever. What is
the most likely diagnosis?
A) Epiglottitis
B) Croup
C) Bacterial tracheitis
D) Foreign body aspiration
Correct Answer: B
Croup (laryngotracheobronchitis) presents with barky cough, stridor, and low-
grade fever. Epiglottitis has high fever, drooling, and toxic appearance. Bacterial
tracheitis is more severe. Foreign body has sudden onset without fever.
5. A patient with a possible cervical spine injury is being logrolled. Which
action is most important?
A) Keep the cervical collar loose for comfort
B) Maintain inline stabilization of the head and neck
, C) Rotate the patient rapidly
D) Allow the head to fall forward
Correct Answer: B
Inline stabilization is critical to prevent spinal cord injury during logrolling. The
collar should remain snug. Rapid rotation or allowing head movement can cause
permanent injury.
6. A 30-year-old female presents with right lower quadrant pain, nausea, and
rebound tenderness at McBurney point. What is the most likely diagnosis?
A) Cholecystitis
B) Appendicitis
C) Ectopic pregnancy
D) Pancreatitis
Correct Answer: B
McBurney point tenderness and rebound suggest appendicitis. Cholecystitis is RUQ
pain. Ectopic pregnancy may have adnexal tenderness and vaginal bleeding.
Pancreatitis has epigastric pain radiating to back.
7. A patient with a suspected opioid overdose has pinpoint pupils, respiratory
rate of 6, and is unresponsive. What is the first medication?
A) Naloxone
B) Flumazenil
C) Thiamine
D) Dextrose
Correct Answer: A
Naloxone reverses opioid-induced respiratory depression. Flumazenil is for
benzodiazepines. Thiamine is for Wernicke's, and dextrose for hypoglycemia.
Naloxone is the priority for suspected opioid overdose.
8. A patient presents with sudden severe headache, nuchal rigidity, and
photophobia. CT shows blood in the subarachnoid space. What is the most
common cause?
A) Berry aneurysm rupture
, B) Arteriovenous malformation
C) Ischemic stroke
D) Hypertensive hemorrhage
Correct Answer: A
Spontaneous subarachnoid hemorrhage is most commonly due to ruptured berry
aneurysm. AVM is less common. Ischemic stroke does not cause SAH. Hypertensive
hemorrhage is usually intraparenchymal.
9. A patient with a burn injury to the face has singed nasal hairs, carbonaceous
sputum, and hoarseness. What is the priority?
A) Start IV fluids
B) Prepare for early intubation
C) Apply silver sulfadiazine
D) Administer pain medication
Correct Answer: B
Signs of inhalation injury indicate the need for early intubation to prevent airway
edema. IV fluids and pain meds are important but airway is priority. Topical silver
sulfadiazine is not for inhalation.
10.A 45-year-old male with chest pain has ST-segment elevation in leads II, III,
and aVF. Which artery is most likely occluded?
A) Left anterior descending
B) Right coronary artery
C) Left circumflex
D) Left main
Correct Answer: B
Inferior wall MI (leads II, III, aVF) is usually due to right coronary artery occlusion.
LAD affects anterior leads V1–V4. Circumflex affects lateral leads I, aVL, V5–V6.
Left main affects widespread leads.
11.A patient presents with a large, painful, red, swollen area on the skin with a
well-demarcated border and fever. What is the most likely diagnosis?
A) Cellulitis
