CEN Exam 2 | Actual Questions and Answers Latest Updated
2026/2027 (Graded A+)
• Question
1. A pt presents to the ED complaining of a 2 day history of a dull substernal ache that
has continued to
increase in intensity. The pt states that they had some relief after taking nitro yesterday.
Vitals: 114/68 BP, 68 HR, 22RR. The EKG demonstrates a new onset of left bundle
branch block. The priority intervention for this pt is:
A. Continue monitoring for development of ST segment elevation
B. Serial cardiac markers
C. Preparing the pt for transport to interventional cardiology
D. Admission to a telemetry unit for observation
Correct Answer: C. Preparing the pt for transport to interventional cardiology
New onset of a left bundle branch block is treated as ST segment elevation MI. The pt
should be prepared for percutaneous transluminal coronary angioplasty and early
reperfusion of the myocardium
• Question
2. During the completion of a 12 lead EKG, the nurse identifies excessive artifact in lead
II and III. To
resolve this technical difficulty, the nurse should:
A. Change the R arm electrode
B. Check for cable movement
C. Change the L Leg electrode
D. Instruct the pt to momentarily hold their breath
Correct Answer: C. Change the L leg electrode
The L leg electrode is common to both lead II and III. The development of artifact and
decreased conductivity results when the conducting gel in the electrode becomes dry
• Question
3. When determining the presence of ST segment elevation on an EKG, the ST segment
is compared to
which interval or segment of the EKG?
A. P-R interval
B. T-P interval
C. Q-T interval
D. P-R segment
Correct Answer: B. T-P interval
T-P interval represents the interval between the end of ventricular re-polarization and
the beginning of atrial depolarization. This interval represents an absence of electrical
,heart activity and therefore is used as the isoelectric reference for the presence of ST
segment elevation or depression
• Question
4. A middle aged pt presents to the ED via EMS. The pt states that they were awoken
from sleep with
midsternal chest pain approx 4-5 hours ago. In the presence of an acute MI, the initial
elevation of the troponin cardiac biomarkers occur within:
A. 1-2 hours after onset of an AMI
B. 4-8 hours after onset of an AMI
C. 24-30 hours after onset of an AMI
D. 10-24 hours after onset of an AMI
Correct Answer: B. 4-8 hours after onset of an AMI
Troponin biomarkers provide a bioassay to measure proteins found in the myofibrils of
the heart muscle. Troponin are detectable based on assay 4-8 hours after the AMI.
Troponin levels will peak at 18- 24 hours following AMI
• Question
5. The nurse suspects a patient may have an acute aortic-dissection when, during the
history taking
process, the pt describes the pain as:
A. Squeezing, burning epigastric pain that may radiate to the middle back area
B. Right upper quadrant pain referred to right scapula and shoulder
C. Sudden, severe tearing or ripping chest, interscapular or back pain
D. Sharp, stabbing chest pain radiating to neck, arms or left shoulder
Correct Answer: C. Sudden, severe tearing or ripping chest, intrscapular or back pain
This is a presentation of AAA
• Question
6. You are assisting in the resuscitation of an elderly patient in cardiac arrest. A
waveform capnography
is in place and high-quality CPR is being preformed. A sudden increase in the level of the
end-total CO2 indicates:
A. Need for deeper and faster chest compressions
B. Need for additional dose of vasopressor, such as IV bolus EPI
C. Presence of an irreversible cardiac arrest
D. Return of spontaneous circulation
Correct Answer: D. Return of spontaneous circulation
It may be reasonable to use physiological parameters (quantitative waveform
capnography, arterial relaxation diastolic pressure, arterial pressure monitoring and
central venous oxygen sats) when feasible to monitor and optimize CPR quality, guide
,vasopressor therapy and detect return of spontaneous circulation
• Question
7. A Patient in cardiac arrest presents to the ED receiving CPR by EMS. The cardiac
monitor displays sinus
rhythm, but no palpable pulse can be detected. The most likely cause of this PEA is:
A. Glucose level of 145
B. Potassium value of 1.3
C. Arterial pH of 7.36
D. Magnesium level of 3.0
Correct Answer: B. Potassium level of 1.3
Hypokalemia may cause PEA in a cardiac arrest pt. Electrical activity may be present in
the heart muscles with absence of contractility. A normal potassium is 3.5-5.0
• Question
8. Which of the following physiological conditions would result in the loss of ventricular
capture for a
patient being transcutaneously paced?
A. Lactic acidosis
B. Hypomagnesemia
C. Metabolic alkalosis
D. Hypokalemia
Correct Answer: A. Lactic acidosis
The presence of lactic acidosis resulting from decreased tissue oxygenation alters
myocardial contractility, leading to a decreased ability to achieve ventricular capture
• Question
9. A pt arrives to the ED by EMS with a complaint of weakness and near syncope. The
pmts HR is 24 and
BP 80/60. The pt underwent a heart transplant 6 months ago and the cardiac monitor
displays 3rd degree heart block. The ER nurse is aware the pt will immediately require
which med to increase the pts HR?:
A. Atropine sulfate
B. Isoproterenol
C. Digoxin
D. Amiodarone
Correct Answer: B. Isoproterenol
A transplanted heart will not respond to the drugs that act to block parasympathetic
tone. Isoproterenol, glucagon or epi would increase the HR, but they do not act to block
the parasympathetic tone. This is the most commonly used drug to increase the HR
following a heart transplant
, • Question
10. On examination of the febrile pt presenting to the ED with a chief complaint of
"flulike symptoms"
and a history of drug use, the nurse notes a cardiac murmur, crackles in bilateral lung
bases, subungual hemorrhages, nontender erythematous macules on the palms of the
hand and soles of feet and painful erythematous nodules on the tips of the fingers and
toes. Which is the most important initial intervention for this pt?
A. Echocardiogram
B. Chest radiography (x-ray)
C. Surgery
D. Antibiotics
Correct Answer: D. Antibiotics
Pts with a history of IV drug use are at risk for endocarditis. The impurities in the
injectable substance can attach to an d invade the heart valve leaflets, resulting in a
murmur. Empirical therapy for infective endocarditis includes prompt initiation of
antibiotics
• Question
11. A pt presents with an episode of acute worsening of chronic systolic CHF. Blood
pressure is 150/70.
The pt complains of dyspnea and rales are heard bilaterally. The pt is not hypoxic, nor
does the EKG demonstrate evidence of an acute MI or ischemia. Which of the following
medications would be harmful to administer to the pt at this time?:
A. Vasodilators
B. Vasopressor agents
C. Diuretics
D. Opiates
Correct Answer: B. Vasopressor agents
The pt is not currently hypertensive and does not need treatment with vasopressor
agents
• Question
12. A pt presents to the ED complaining of a severe headache. Vital signs reveal a BP of
270/170, HR 80
and RR 20. The pt is alert and describes being recently diagnosed with high BP. A
priority intervention for this pt would be to:
A. Initiate IV meds to lower the pts BP immediately
B. Obtain baseline lab data
C. Consider emergency cardio version for BP control
D. Evaluate BP cuff size for accuracy
Correct Answer: D. Evaluate the BP cuff size for accuracy
2026/2027 (Graded A+)
• Question
1. A pt presents to the ED complaining of a 2 day history of a dull substernal ache that
has continued to
increase in intensity. The pt states that they had some relief after taking nitro yesterday.
Vitals: 114/68 BP, 68 HR, 22RR. The EKG demonstrates a new onset of left bundle
branch block. The priority intervention for this pt is:
A. Continue monitoring for development of ST segment elevation
B. Serial cardiac markers
C. Preparing the pt for transport to interventional cardiology
D. Admission to a telemetry unit for observation
Correct Answer: C. Preparing the pt for transport to interventional cardiology
New onset of a left bundle branch block is treated as ST segment elevation MI. The pt
should be prepared for percutaneous transluminal coronary angioplasty and early
reperfusion of the myocardium
• Question
2. During the completion of a 12 lead EKG, the nurse identifies excessive artifact in lead
II and III. To
resolve this technical difficulty, the nurse should:
A. Change the R arm electrode
B. Check for cable movement
C. Change the L Leg electrode
D. Instruct the pt to momentarily hold their breath
Correct Answer: C. Change the L leg electrode
The L leg electrode is common to both lead II and III. The development of artifact and
decreased conductivity results when the conducting gel in the electrode becomes dry
• Question
3. When determining the presence of ST segment elevation on an EKG, the ST segment
is compared to
which interval or segment of the EKG?
A. P-R interval
B. T-P interval
C. Q-T interval
D. P-R segment
Correct Answer: B. T-P interval
T-P interval represents the interval between the end of ventricular re-polarization and
the beginning of atrial depolarization. This interval represents an absence of electrical
,heart activity and therefore is used as the isoelectric reference for the presence of ST
segment elevation or depression
• Question
4. A middle aged pt presents to the ED via EMS. The pt states that they were awoken
from sleep with
midsternal chest pain approx 4-5 hours ago. In the presence of an acute MI, the initial
elevation of the troponin cardiac biomarkers occur within:
A. 1-2 hours after onset of an AMI
B. 4-8 hours after onset of an AMI
C. 24-30 hours after onset of an AMI
D. 10-24 hours after onset of an AMI
Correct Answer: B. 4-8 hours after onset of an AMI
Troponin biomarkers provide a bioassay to measure proteins found in the myofibrils of
the heart muscle. Troponin are detectable based on assay 4-8 hours after the AMI.
Troponin levels will peak at 18- 24 hours following AMI
• Question
5. The nurse suspects a patient may have an acute aortic-dissection when, during the
history taking
process, the pt describes the pain as:
A. Squeezing, burning epigastric pain that may radiate to the middle back area
B. Right upper quadrant pain referred to right scapula and shoulder
C. Sudden, severe tearing or ripping chest, interscapular or back pain
D. Sharp, stabbing chest pain radiating to neck, arms or left shoulder
Correct Answer: C. Sudden, severe tearing or ripping chest, intrscapular or back pain
This is a presentation of AAA
• Question
6. You are assisting in the resuscitation of an elderly patient in cardiac arrest. A
waveform capnography
is in place and high-quality CPR is being preformed. A sudden increase in the level of the
end-total CO2 indicates:
A. Need for deeper and faster chest compressions
B. Need for additional dose of vasopressor, such as IV bolus EPI
C. Presence of an irreversible cardiac arrest
D. Return of spontaneous circulation
Correct Answer: D. Return of spontaneous circulation
It may be reasonable to use physiological parameters (quantitative waveform
capnography, arterial relaxation diastolic pressure, arterial pressure monitoring and
central venous oxygen sats) when feasible to monitor and optimize CPR quality, guide
,vasopressor therapy and detect return of spontaneous circulation
• Question
7. A Patient in cardiac arrest presents to the ED receiving CPR by EMS. The cardiac
monitor displays sinus
rhythm, but no palpable pulse can be detected. The most likely cause of this PEA is:
A. Glucose level of 145
B. Potassium value of 1.3
C. Arterial pH of 7.36
D. Magnesium level of 3.0
Correct Answer: B. Potassium level of 1.3
Hypokalemia may cause PEA in a cardiac arrest pt. Electrical activity may be present in
the heart muscles with absence of contractility. A normal potassium is 3.5-5.0
• Question
8. Which of the following physiological conditions would result in the loss of ventricular
capture for a
patient being transcutaneously paced?
A. Lactic acidosis
B. Hypomagnesemia
C. Metabolic alkalosis
D. Hypokalemia
Correct Answer: A. Lactic acidosis
The presence of lactic acidosis resulting from decreased tissue oxygenation alters
myocardial contractility, leading to a decreased ability to achieve ventricular capture
• Question
9. A pt arrives to the ED by EMS with a complaint of weakness and near syncope. The
pmts HR is 24 and
BP 80/60. The pt underwent a heart transplant 6 months ago and the cardiac monitor
displays 3rd degree heart block. The ER nurse is aware the pt will immediately require
which med to increase the pts HR?:
A. Atropine sulfate
B. Isoproterenol
C. Digoxin
D. Amiodarone
Correct Answer: B. Isoproterenol
A transplanted heart will not respond to the drugs that act to block parasympathetic
tone. Isoproterenol, glucagon or epi would increase the HR, but they do not act to block
the parasympathetic tone. This is the most commonly used drug to increase the HR
following a heart transplant
, • Question
10. On examination of the febrile pt presenting to the ED with a chief complaint of
"flulike symptoms"
and a history of drug use, the nurse notes a cardiac murmur, crackles in bilateral lung
bases, subungual hemorrhages, nontender erythematous macules on the palms of the
hand and soles of feet and painful erythematous nodules on the tips of the fingers and
toes. Which is the most important initial intervention for this pt?
A. Echocardiogram
B. Chest radiography (x-ray)
C. Surgery
D. Antibiotics
Correct Answer: D. Antibiotics
Pts with a history of IV drug use are at risk for endocarditis. The impurities in the
injectable substance can attach to an d invade the heart valve leaflets, resulting in a
murmur. Empirical therapy for infective endocarditis includes prompt initiation of
antibiotics
• Question
11. A pt presents with an episode of acute worsening of chronic systolic CHF. Blood
pressure is 150/70.
The pt complains of dyspnea and rales are heard bilaterally. The pt is not hypoxic, nor
does the EKG demonstrate evidence of an acute MI or ischemia. Which of the following
medications would be harmful to administer to the pt at this time?:
A. Vasodilators
B. Vasopressor agents
C. Diuretics
D. Opiates
Correct Answer: B. Vasopressor agents
The pt is not currently hypertensive and does not need treatment with vasopressor
agents
• Question
12. A pt presents to the ED complaining of a severe headache. Vital signs reveal a BP of
270/170, HR 80
and RR 20. The pt is alert and describes being recently diagnosed with high BP. A
priority intervention for this pt would be to:
A. Initiate IV meds to lower the pts BP immediately
B. Obtain baseline lab data
C. Consider emergency cardio version for BP control
D. Evaluate BP cuff size for accuracy
Correct Answer: D. Evaluate the BP cuff size for accuracy
