CEN Certified Emergency Nurse
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A Instant Download Pdf
1. A 68-year-old patient presents with crushing substernal chest pain,
diaphoresis, and nausea. The ECG shows ST-segment elevation in leads II,
III, and aVF with reciprocal ST depression in I and aVL. Blood pressure is
86/54 mmHg, and lungs are clear. Which intervention is most appropriate
initially?
A. Administer sublingual nitroglycerin
B. Administer an IV crystalloid bolus and reassess
C. Administer IV furosemide
D. Initiate noninvasive positive-pressure ventilation
Answer: B. Administer an IV crystalloid bolus and reassess
Rationale: Inferior STEMI with hypotension and clear lungs raises concern for
right ventricular involvement, which makes preload particularly important. A
cautious IV fluid bolus may improve right ventricular filling and cardiac output.
Nitroglycerin can worsen hypotension in preload-dependent patients.
2. A patient with severe asthma develops increasing fatigue, a respiratory rate
of 8/min, and a PaCO₂ that has risen from 32 to 58 mmHg. Which finding is
most concerning?
,A. Expiratory wheezing
B. Oxygen saturation of 92%
C. Rising PaCO₂ with respiratory fatigue
D. Heart rate of 118/min
Answer: C. Rising PaCO₂ with respiratory fatigue
Rationale: In severe asthma, a rising PaCO₂ indicates worsening alveolar
ventilation and respiratory muscle fatigue. This may precede impending
respiratory arrest and should prompt preparation for advanced airway
management.
3. A trauma patient has hypotension, distended neck veins, muffled heart
sounds, and narrow pulse pressure after a penetrating chest injury. Which
intervention should the emergency nurse anticipate?
A. Immediate pericardiocentesis or surgical decompression
B. Administration of IV furosemide
C. High-dose beta-blocker therapy
D. Trendelenburg positioning alone
Answer: A. Immediate pericardiocentesis or surgical decompression
Rationale: The findings are classic for cardiac tamponade causing obstructive
shock. Definitive management requires urgent decompression of the pericardial
space, with surgical management preferred when traumatic tamponade is
suspected.
4. A patient with diabetic ketoacidosis has a serum potassium of 2.8 mEq/L
before insulin therapy is initiated. Which action is most appropriate?
A. Begin IV insulin immediately
B. Administer sodium bicarbonate routinely
C. Replace potassium before starting insulin
D. Restrict IV fluids
Answer: C. Replace potassium before starting insulin
,Rationale: Insulin shifts potassium intracellularly and can precipitate life-
threatening hypokalemia. When serum potassium is significantly low, potassium
replacement takes priority before insulin administration.
5. A patient develops sudden aphasia and right-sided weakness 45 minutes
before arrival. CT shows no intracranial hemorrhage. Which information is
most important before administering thrombolytic therapy?
A. The patient's last oral intake
B. The exact time the patient was last known well
C. The patient's vaccination history
D. The patient's baseline body temperature
Answer: B. The exact time the patient was last known well
Rationale: Stroke reperfusion decisions depend heavily on the time the patient
was last known to be neurologically normal. Establishing this time helps
determine eligibility for time-sensitive therapies.
6. A patient with suspected opioid overdose has respirations of 5/min and
pinpoint pupils. Which intervention has the highest priority?
A. Obtain a urine toxicology screen
B. Administer naloxone and support ventilation
C. Administer activated charcoal
D. Obtain a psychiatric consultation
Answer: B. Administer naloxone and support ventilation
Rationale: Respiratory depression is the immediate life threat in opioid toxicity.
Airway and ventilation support are essential, with naloxone used to reverse
opioid-induced respiratory depression.
7. A patient with septic shock remains hypotensive after appropriate
crystalloid administration. Which medication is generally the preferred
first-line vasopressor?
, A. Norepinephrine
B. Dopamine
C. Phenylephrine
D. Dobutamine
Answer: A. Norepinephrine
Rationale: Norepinephrine is generally recommended as the first-line
vasopressor for septic shock when hypotension persists despite adequate fluid
resuscitation. It primarily increases vascular tone through alpha-adrenergic
effects.
8. A patient with suspected pulmonary embolism suddenly becomes
hypotensive and develops severe dyspnea. Which finding most strongly
indicates hemodynamic instability?
A. Heart rate of 102/min
B. Oxygen saturation of 94%
C. Systolic blood pressure of 78 mmHg
D. Mild pleuritic chest pain
Answer: C. Systolic blood pressure of 78 mmHg
Rationale: Significant hypotension indicates obstructive shock from a potentially
massive pulmonary embolism and places the patient in a high-risk category
requiring immediate resuscitative management.
9. A patient with hyperkalemia has peaked T waves and widening of the QRS
complex. Which medication should be administered first to stabilize the
cardiac membrane?
A. Regular insulin
B. Calcium gluconate
C. Sodium polystyrene sulfonate
D. Furosemide
Answer: B. Calcium gluconate
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A Instant Download Pdf
1. A 68-year-old patient presents with crushing substernal chest pain,
diaphoresis, and nausea. The ECG shows ST-segment elevation in leads II,
III, and aVF with reciprocal ST depression in I and aVL. Blood pressure is
86/54 mmHg, and lungs are clear. Which intervention is most appropriate
initially?
A. Administer sublingual nitroglycerin
B. Administer an IV crystalloid bolus and reassess
C. Administer IV furosemide
D. Initiate noninvasive positive-pressure ventilation
Answer: B. Administer an IV crystalloid bolus and reassess
Rationale: Inferior STEMI with hypotension and clear lungs raises concern for
right ventricular involvement, which makes preload particularly important. A
cautious IV fluid bolus may improve right ventricular filling and cardiac output.
Nitroglycerin can worsen hypotension in preload-dependent patients.
2. A patient with severe asthma develops increasing fatigue, a respiratory rate
of 8/min, and a PaCO₂ that has risen from 32 to 58 mmHg. Which finding is
most concerning?
,A. Expiratory wheezing
B. Oxygen saturation of 92%
C. Rising PaCO₂ with respiratory fatigue
D. Heart rate of 118/min
Answer: C. Rising PaCO₂ with respiratory fatigue
Rationale: In severe asthma, a rising PaCO₂ indicates worsening alveolar
ventilation and respiratory muscle fatigue. This may precede impending
respiratory arrest and should prompt preparation for advanced airway
management.
3. A trauma patient has hypotension, distended neck veins, muffled heart
sounds, and narrow pulse pressure after a penetrating chest injury. Which
intervention should the emergency nurse anticipate?
A. Immediate pericardiocentesis or surgical decompression
B. Administration of IV furosemide
C. High-dose beta-blocker therapy
D. Trendelenburg positioning alone
Answer: A. Immediate pericardiocentesis or surgical decompression
Rationale: The findings are classic for cardiac tamponade causing obstructive
shock. Definitive management requires urgent decompression of the pericardial
space, with surgical management preferred when traumatic tamponade is
suspected.
4. A patient with diabetic ketoacidosis has a serum potassium of 2.8 mEq/L
before insulin therapy is initiated. Which action is most appropriate?
A. Begin IV insulin immediately
B. Administer sodium bicarbonate routinely
C. Replace potassium before starting insulin
D. Restrict IV fluids
Answer: C. Replace potassium before starting insulin
,Rationale: Insulin shifts potassium intracellularly and can precipitate life-
threatening hypokalemia. When serum potassium is significantly low, potassium
replacement takes priority before insulin administration.
5. A patient develops sudden aphasia and right-sided weakness 45 minutes
before arrival. CT shows no intracranial hemorrhage. Which information is
most important before administering thrombolytic therapy?
A. The patient's last oral intake
B. The exact time the patient was last known well
C. The patient's vaccination history
D. The patient's baseline body temperature
Answer: B. The exact time the patient was last known well
Rationale: Stroke reperfusion decisions depend heavily on the time the patient
was last known to be neurologically normal. Establishing this time helps
determine eligibility for time-sensitive therapies.
6. A patient with suspected opioid overdose has respirations of 5/min and
pinpoint pupils. Which intervention has the highest priority?
A. Obtain a urine toxicology screen
B. Administer naloxone and support ventilation
C. Administer activated charcoal
D. Obtain a psychiatric consultation
Answer: B. Administer naloxone and support ventilation
Rationale: Respiratory depression is the immediate life threat in opioid toxicity.
Airway and ventilation support are essential, with naloxone used to reverse
opioid-induced respiratory depression.
7. A patient with septic shock remains hypotensive after appropriate
crystalloid administration. Which medication is generally the preferred
first-line vasopressor?
, A. Norepinephrine
B. Dopamine
C. Phenylephrine
D. Dobutamine
Answer: A. Norepinephrine
Rationale: Norepinephrine is generally recommended as the first-line
vasopressor for septic shock when hypotension persists despite adequate fluid
resuscitation. It primarily increases vascular tone through alpha-adrenergic
effects.
8. A patient with suspected pulmonary embolism suddenly becomes
hypotensive and develops severe dyspnea. Which finding most strongly
indicates hemodynamic instability?
A. Heart rate of 102/min
B. Oxygen saturation of 94%
C. Systolic blood pressure of 78 mmHg
D. Mild pleuritic chest pain
Answer: C. Systolic blood pressure of 78 mmHg
Rationale: Significant hypotension indicates obstructive shock from a potentially
massive pulmonary embolism and places the patient in a high-risk category
requiring immediate resuscitative management.
9. A patient with hyperkalemia has peaked T waves and widening of the QRS
complex. Which medication should be administered first to stabilize the
cardiac membrane?
A. Regular insulin
B. Calcium gluconate
C. Sodium polystyrene sulfonate
D. Furosemide
Answer: B. Calcium gluconate
