CEN Exam New Latest 2025 Version by BCEN
with All Questions from Actual Exam and
Correct Answers and Rationale
Question 1
A client arrives with a stab wound to the chest and a BP of 70/40 mmHg. The nurse notes
muffled heart sounds. What should the nurse suspect?
A) Hemothorax
B) Cardiac tamponade
C) Tension pneumothorax
D) Pulmonary contusion
Correct Answer: B) Cardiac tamponade
Rationale: Hypotension and muffled heart sounds (Beck’s triad) post-chest trauma suggest
cardiac tamponade. Pericardiocentesis is urgent, distinguishing it from hemothorax or
pneumothorax.
Question 2
A 60-year-old presents with sudden severe headache, vomiting, and a stiff neck. What is the
priority diagnostic test?
A) CT scan of the head
B) Lumbar puncture
C) MRI of the brain
D) EEG
Correct Answer: A) CT scan of the head
Rationale: Symptoms suggest subarachnoid hemorrhage. A non-contrast CT is the fastest way to
detect bleeding, preceding lumbar puncture to avoid herniation risk.
Question 3
A client with asthma has no improvement after three albuterol treatments. What should the nurse
anticipate next?
A) Magnesium sulfate IV
B) Epinephrine IM
C) Intubation
D) Chest X-ray
Correct Answer: A) Magnesium sulfate IV
Rationale: Refractory asthma (status asthmaticus) benefits from magnesium sulfate as a
bronchodilator per emergency protocols, before escalating to intubation.
Question 4
A 25-year-old motorcyclist has a deformed left leg and no pulse in the foot. What should the
nurse do first?
A) Apply a splint
B) Notify orthopedics
,C) Check for compartment syndrome
D) Attempt to realign the limb
Correct Answer: A) Apply a splint
Rationale: A pulseless, deformed limb indicates fracture with vascular compromise. Splinting
stabilizes it, restores alignment, and may improve perfusion, preceding surgical consult.
Question 5
A client with a history of alcohol use presents with confusion, ataxia, and nystagmus. What
should the nurse administer first?
A) Glucose IV
B) Thiamine IV
C) Lorazepam IV
D) Naloxone IV
Correct Answer: B) Thiamine IV
Rationale: Wernicke’s encephalopathy (confusion, ataxia, nystagmus) from alcohol-related
thiamine deficiency requires thiamine before glucose to prevent worsening.
Question 6
A 45-year-old with chest pain has an ECG showing new Q waves in leads II, III, and aVF. What
does this indicate?
A) Anterior MI
B) Inferior MI
C) Lateral MI
D) Pericarditis
Correct Answer: B) Inferior MI
Rationale: Q waves in II, III, and aVF indicate a prior or evolving inferior wall MI, typically
from right coronary artery occlusion, guiding reperfusion urgency.
Question 7
A child ingested bleach 20 minutes ago. What is the nurse’s first action?
A) Induce vomiting
B) Administer activated charcoal
C) Dilute with water or milk
D) Obtain an abdominal X-ray
Correct Answer: C) Dilute with water or milk
Rationale: For caustic ingestion like bleach, dilution with water or milk reduces tissue damage.
Vomiting risks further injury; charcoal is ineffective for caustics.
Question 8
A client with a head injury has unequal pupils and a BP of 180/100 mmHg. What should the
nurse prepare for?
A) Mannitol administration
B) Hyperventilation
C) Seizure precautions
D) Lumbar puncture
Correct Answer: A) Mannitol administration
, Rationale: Unequal pupils and hypertension (Cushing’s triad) suggest increased ICP from head
injury. Mannitol reduces swelling, a priority over other interventions.
Question 9
A 30-year-old presents with burns to the face, singed nasal hairs, and hoarseness. What is the
priority action?
A) Administer oxygen
B) Prepare for intubation
C) Apply burn dressings
D) Start IV fluids
Correct Answer: B) Prepare for intubation
Rationale: Signs of inhalation injury (singed hairs, hoarseness) indicate airway edema risk.
Intubation secures the airway preemptively, per burn protocols.
Question 10
A client in cardiac arrest has asystole on the monitor. What is the nurse’s first action?
A) Defibrillate at 360 J
B) Administer epinephrine
C) Begin chest compressions
D) Check lead placement
Correct Answer: C) Begin chest compressions
Rationale: Asystole, a non-shockable rhythm, requires immediate CPR per ACLS. Compressions
take precedence over drugs or lead checks to restore circulation.
Question 11
A 50-year-old with abdominal pain has a rigid abdomen and rebound tenderness. What should
the nurse suspect?
A) Appendicitis
B) Peritonitis
C) Pancreatitis
D) Bowel obstruction
Correct Answer: B) Peritonitis
Rationale: Rigid abdomen and rebound tenderness suggest peritoneal irritation (e.g., perforation),
more severe than appendicitis alone, requiring urgent surgical consult.
Question 12
A client with a history of opioid use is unresponsive with pinpoint pupils. What should the nurse
administer?
A) Naloxone
B) Flumazenil
C) Glucose
D) Atropine
Correct Answer: A) Naloxone
Rationale: Unresponsiveness and pinpoint pupils indicate opioid overdose. Naloxone reverses it
rapidly, a standard emergency intervention.
with All Questions from Actual Exam and
Correct Answers and Rationale
Question 1
A client arrives with a stab wound to the chest and a BP of 70/40 mmHg. The nurse notes
muffled heart sounds. What should the nurse suspect?
A) Hemothorax
B) Cardiac tamponade
C) Tension pneumothorax
D) Pulmonary contusion
Correct Answer: B) Cardiac tamponade
Rationale: Hypotension and muffled heart sounds (Beck’s triad) post-chest trauma suggest
cardiac tamponade. Pericardiocentesis is urgent, distinguishing it from hemothorax or
pneumothorax.
Question 2
A 60-year-old presents with sudden severe headache, vomiting, and a stiff neck. What is the
priority diagnostic test?
A) CT scan of the head
B) Lumbar puncture
C) MRI of the brain
D) EEG
Correct Answer: A) CT scan of the head
Rationale: Symptoms suggest subarachnoid hemorrhage. A non-contrast CT is the fastest way to
detect bleeding, preceding lumbar puncture to avoid herniation risk.
Question 3
A client with asthma has no improvement after three albuterol treatments. What should the nurse
anticipate next?
A) Magnesium sulfate IV
B) Epinephrine IM
C) Intubation
D) Chest X-ray
Correct Answer: A) Magnesium sulfate IV
Rationale: Refractory asthma (status asthmaticus) benefits from magnesium sulfate as a
bronchodilator per emergency protocols, before escalating to intubation.
Question 4
A 25-year-old motorcyclist has a deformed left leg and no pulse in the foot. What should the
nurse do first?
A) Apply a splint
B) Notify orthopedics
,C) Check for compartment syndrome
D) Attempt to realign the limb
Correct Answer: A) Apply a splint
Rationale: A pulseless, deformed limb indicates fracture with vascular compromise. Splinting
stabilizes it, restores alignment, and may improve perfusion, preceding surgical consult.
Question 5
A client with a history of alcohol use presents with confusion, ataxia, and nystagmus. What
should the nurse administer first?
A) Glucose IV
B) Thiamine IV
C) Lorazepam IV
D) Naloxone IV
Correct Answer: B) Thiamine IV
Rationale: Wernicke’s encephalopathy (confusion, ataxia, nystagmus) from alcohol-related
thiamine deficiency requires thiamine before glucose to prevent worsening.
Question 6
A 45-year-old with chest pain has an ECG showing new Q waves in leads II, III, and aVF. What
does this indicate?
A) Anterior MI
B) Inferior MI
C) Lateral MI
D) Pericarditis
Correct Answer: B) Inferior MI
Rationale: Q waves in II, III, and aVF indicate a prior or evolving inferior wall MI, typically
from right coronary artery occlusion, guiding reperfusion urgency.
Question 7
A child ingested bleach 20 minutes ago. What is the nurse’s first action?
A) Induce vomiting
B) Administer activated charcoal
C) Dilute with water or milk
D) Obtain an abdominal X-ray
Correct Answer: C) Dilute with water or milk
Rationale: For caustic ingestion like bleach, dilution with water or milk reduces tissue damage.
Vomiting risks further injury; charcoal is ineffective for caustics.
Question 8
A client with a head injury has unequal pupils and a BP of 180/100 mmHg. What should the
nurse prepare for?
A) Mannitol administration
B) Hyperventilation
C) Seizure precautions
D) Lumbar puncture
Correct Answer: A) Mannitol administration
, Rationale: Unequal pupils and hypertension (Cushing’s triad) suggest increased ICP from head
injury. Mannitol reduces swelling, a priority over other interventions.
Question 9
A 30-year-old presents with burns to the face, singed nasal hairs, and hoarseness. What is the
priority action?
A) Administer oxygen
B) Prepare for intubation
C) Apply burn dressings
D) Start IV fluids
Correct Answer: B) Prepare for intubation
Rationale: Signs of inhalation injury (singed hairs, hoarseness) indicate airway edema risk.
Intubation secures the airway preemptively, per burn protocols.
Question 10
A client in cardiac arrest has asystole on the monitor. What is the nurse’s first action?
A) Defibrillate at 360 J
B) Administer epinephrine
C) Begin chest compressions
D) Check lead placement
Correct Answer: C) Begin chest compressions
Rationale: Asystole, a non-shockable rhythm, requires immediate CPR per ACLS. Compressions
take precedence over drugs or lead checks to restore circulation.
Question 11
A 50-year-old with abdominal pain has a rigid abdomen and rebound tenderness. What should
the nurse suspect?
A) Appendicitis
B) Peritonitis
C) Pancreatitis
D) Bowel obstruction
Correct Answer: B) Peritonitis
Rationale: Rigid abdomen and rebound tenderness suggest peritoneal irritation (e.g., perforation),
more severe than appendicitis alone, requiring urgent surgical consult.
Question 12
A client with a history of opioid use is unresponsive with pinpoint pupils. What should the nurse
administer?
A) Naloxone
B) Flumazenil
C) Glucose
D) Atropine
Correct Answer: A) Naloxone
Rationale: Unresponsiveness and pinpoint pupils indicate opioid overdose. Naloxone reverses it
rapidly, a standard emergency intervention.
