CEN (Certified Emergency Nurse) Certification Exam
New 2026 Version with All 175 Questions from Actual
Exam and 100% Correct Answers and Rationale
Section 1: Cardiovascular Emergencies (Questions 1–11)
1. A 58-year-old male presents to the ED with chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST elevation in leads II, III, aVF. What is the
priority intervention?
A) Administer aspirin 325 mg PO.
B) Prepare for emergent PCI.
C) Start nitroglycerin SL if BP >90 mm Hg systolic.
D) Obtain troponin levels. Correct Answer: B) Prepare for emergent PCI.
Rationale: Inferior STEMI requires reperfusion within 90 minutes per AHA/ACEP
guidelines. PCI is the priority for ST elevation. ENA cardiovascular protocols prioritize
rapid intervention.
2. A patient with suspected aortic dissection presents with tearing chest pain and unequal
pulses. What imaging confirms the diagnosis?
A) Chest X-ray.
B) CT angiography of the chest.
C) Transthoracic echocardiogram.
D) D-dimer alone. Correct Answer: B) CT angiography of the chest.
Rationale: CTA is the gold standard for aortic dissection due to high
sensitivity/specificity. ENA vascular emergency guidelines emphasize rapid imaging.
3. A 45-year-old female with SVT (HR 180 bpm) is hemodynamically stable. What is the
initial treatment?
A) Synchronized cardioversion at 50 J.
B) Vagal maneuvers.
C) Amiodarone 150 mg IV.
D) Adenosine 6 mg IV push. Correct Answer: B) Vagal maneuvers.
Rationale: Stable SVT is first treated with non-invasive vagal maneuvers (e.g., Valsalva)
per ACLS. ENA dysrhythmia management prioritizes least invasive.
4. In a patient with cardiogenic shock (BP 80/50 mm Hg, CI 1.7 L/min/m²), what is the
first-line vasopressor?
A) Norepinephrine.
B) Dopamine.
C) Epinephrine.
D) Phenylephrine. Correct Answer: A) Norepinephrine.
Rationale: Norepinephrine improves MAP with balanced vasoconstriction and inotropy
in cardiogenic shock. ENA shock protocols align with AHA.
5. A patient post-MI develops ventricular fibrillation. After defibrillation, what medication
is given?
A) Amiodarone 300 mg IV.
B) Lidocaine 1 mg/kg IV.
C) Epinephrine 1 mg IV.
, D) Magnesium 2 g IV. Correct Answer: A) Amiodarone 300 mg IV.
Rationale: Amiodarone is first-line for VF/pulseless VT post-shock per ACLS. ENA
cardiac arrest protocols.
6. A patient with pericarditis reports positional chest pain. What ECG finding is expected?
A) Diffuse ST elevation with PR depression.
B) Q waves in V1–V4.
C) T-wave inversion only.
D) Normal ECG. Correct Answer: A) Diffuse ST elevation with PR depression.
Rationale: Pericarditis causes widespread ST elevation and PR depression. ENA
cardiovascular assessment.
7. For a patient with acute heart failure and pulmonary edema, what is the initial
intervention?
A) Furosemide 40 mg IV.
B) Oxygen via non-rebreather mask.
C) Nitroglycerin SL.
D) Intubation. Correct Answer: B) Oxygen via non-rebreather mask.
Rationale: Oxygenation corrects hypoxemia first. ENA heart failure management follows
AHA.
8. A patient with bradycardia (HR 35 bpm) and hypotension is unresponsive to atropine.
What is the next step?
A) Transcutaneous pacing.
B) Dopamine infusion.
C) Epinephrine bolus.
D) Repeat atropine. Correct Answer: A) Transcutaneous pacing.
Rationale: Symptomatic bradycardia unresponsive to atropine requires pacing per ACLS.
ENA dysrhythmia protocols.
9. In a patient with suspected pulmonary embolism, what diagnostic test is most
appropriate?
A) D-dimer only.
B) CT pulmonary angiography.
C) V/Q scan for all patients.
D) Chest X-ray. Correct Answer: B) CT pulmonary angiography.
Rationale: CTPA is the gold standard for PE diagnosis in stable patients. ENA pulmonary
embolism guidelines.
10. A patient with STEMI receives heparin. What lab monitors therapeutic effect?
A) aPTT 1.5–2.5x normal.
B) PT/INR.
C) Platelet count.
D) ACT only. Correct Answer: A) aPTT 1.5–2.5x normal.
Rationale: Heparin is monitored via aPTT in ACS. ENA pharmacology standards.
11. A patient with cardiac tamponade has muffled heart sounds and JVD. What is the
definitive treatment?
A) Pericardiocentesis.
B) Fluid bolus.
C) Vasopressors.
D) Diuretics. Correct Answer: A) Pericardiocentesis.
, Rationale: Removes pericardial fluid to relieve compression. ENA cardiovascular
emergencies.
Section 2: Respiratory Emergencies (Questions 12–21)
12. A 30-year-old with asthma presents with wheezing and RR 28/min. What is the initial
treatment?
A) Albuterol nebulized 5 mg.
B) Epinephrine IM.
C) Magnesium sulfate IV.
D) Intubation. Correct Answer: A) Albuterol nebulized 5 mg.
Rationale: Beta-2 agonists are first-line for acute asthma. ENA asthma protocols per
GINA.
13. A patient with tension pneumothorax has tracheal deviation and absent breath sounds.
What is the immediate action?
A) Needle decompression 2nd ICS midclavicular line.
B) Chest tube insertion.
C) High-flow oxygen.
D) CT chest. Correct Answer: A) Needle decompression 2nd ICS midclavicular line.
Rationale: Relieves pressure emergently. ENA trauma protocols per ATLS.
14. In a COPD exacerbation, what ABG indicates need for BiPAP?
A) pH 7.28, PaCO2 60 mm Hg.
B) pH 7.40, PaCO2 40 mm Hg.
C) pH 7.50, PaCO2 30 mm Hg.
D) pH 7.35, PaCO2 45 mm Hg. Correct Answer: A) pH 7.28, PaCO2 60 mm Hg.
Rationale: Respiratory acidosis with hypercapnia indicates NIV. ENA COPD
management.
15. A patient with ARDS has SpO2 88% on 100% FiO2. What intervention?
A) Initiate prone positioning.
B) Increase tidal volume to 8 mL/kg.
C) Decrease PEEP.
D) Administer bronchodilators. Correct Answer: A) Initiate prone positioning.
Rationale: Improves V/Q matching in ARDS. ENA respiratory failure per ARDSnet.
16. A patient with massive hemoptysis is intubated. What protects the airway?
A) Double-lumen ETT.
B) Standard ETT.
C) Tracheostomy.
D) No intubation. Correct Answer: A) Double-lumen ETT.
Rationale: Isolates bleeding lung. ENA airway management.
17. For a patient with flail chest, what stabilizes the chest?
A) Positive pressure ventilation.
B) Rib taping.
C) Analgesics only.
D) Observation. Correct Answer: A) Positive pressure ventilation.
Rationale: Stabilizes paradoxical movement. ENA trauma care.
18. A patient with pneumonia develops septic shock. What is the initial fluid bolus?
A) 30 mL/kg 0.9% NS.
B) 500 mL D5W.
New 2026 Version with All 175 Questions from Actual
Exam and 100% Correct Answers and Rationale
Section 1: Cardiovascular Emergencies (Questions 1–11)
1. A 58-year-old male presents to the ED with chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST elevation in leads II, III, aVF. What is the
priority intervention?
A) Administer aspirin 325 mg PO.
B) Prepare for emergent PCI.
C) Start nitroglycerin SL if BP >90 mm Hg systolic.
D) Obtain troponin levels. Correct Answer: B) Prepare for emergent PCI.
Rationale: Inferior STEMI requires reperfusion within 90 minutes per AHA/ACEP
guidelines. PCI is the priority for ST elevation. ENA cardiovascular protocols prioritize
rapid intervention.
2. A patient with suspected aortic dissection presents with tearing chest pain and unequal
pulses. What imaging confirms the diagnosis?
A) Chest X-ray.
B) CT angiography of the chest.
C) Transthoracic echocardiogram.
D) D-dimer alone. Correct Answer: B) CT angiography of the chest.
Rationale: CTA is the gold standard for aortic dissection due to high
sensitivity/specificity. ENA vascular emergency guidelines emphasize rapid imaging.
3. A 45-year-old female with SVT (HR 180 bpm) is hemodynamically stable. What is the
initial treatment?
A) Synchronized cardioversion at 50 J.
B) Vagal maneuvers.
C) Amiodarone 150 mg IV.
D) Adenosine 6 mg IV push. Correct Answer: B) Vagal maneuvers.
Rationale: Stable SVT is first treated with non-invasive vagal maneuvers (e.g., Valsalva)
per ACLS. ENA dysrhythmia management prioritizes least invasive.
4. In a patient with cardiogenic shock (BP 80/50 mm Hg, CI 1.7 L/min/m²), what is the
first-line vasopressor?
A) Norepinephrine.
B) Dopamine.
C) Epinephrine.
D) Phenylephrine. Correct Answer: A) Norepinephrine.
Rationale: Norepinephrine improves MAP with balanced vasoconstriction and inotropy
in cardiogenic shock. ENA shock protocols align with AHA.
5. A patient post-MI develops ventricular fibrillation. After defibrillation, what medication
is given?
A) Amiodarone 300 mg IV.
B) Lidocaine 1 mg/kg IV.
C) Epinephrine 1 mg IV.
, D) Magnesium 2 g IV. Correct Answer: A) Amiodarone 300 mg IV.
Rationale: Amiodarone is first-line for VF/pulseless VT post-shock per ACLS. ENA
cardiac arrest protocols.
6. A patient with pericarditis reports positional chest pain. What ECG finding is expected?
A) Diffuse ST elevation with PR depression.
B) Q waves in V1–V4.
C) T-wave inversion only.
D) Normal ECG. Correct Answer: A) Diffuse ST elevation with PR depression.
Rationale: Pericarditis causes widespread ST elevation and PR depression. ENA
cardiovascular assessment.
7. For a patient with acute heart failure and pulmonary edema, what is the initial
intervention?
A) Furosemide 40 mg IV.
B) Oxygen via non-rebreather mask.
C) Nitroglycerin SL.
D) Intubation. Correct Answer: B) Oxygen via non-rebreather mask.
Rationale: Oxygenation corrects hypoxemia first. ENA heart failure management follows
AHA.
8. A patient with bradycardia (HR 35 bpm) and hypotension is unresponsive to atropine.
What is the next step?
A) Transcutaneous pacing.
B) Dopamine infusion.
C) Epinephrine bolus.
D) Repeat atropine. Correct Answer: A) Transcutaneous pacing.
Rationale: Symptomatic bradycardia unresponsive to atropine requires pacing per ACLS.
ENA dysrhythmia protocols.
9. In a patient with suspected pulmonary embolism, what diagnostic test is most
appropriate?
A) D-dimer only.
B) CT pulmonary angiography.
C) V/Q scan for all patients.
D) Chest X-ray. Correct Answer: B) CT pulmonary angiography.
Rationale: CTPA is the gold standard for PE diagnosis in stable patients. ENA pulmonary
embolism guidelines.
10. A patient with STEMI receives heparin. What lab monitors therapeutic effect?
A) aPTT 1.5–2.5x normal.
B) PT/INR.
C) Platelet count.
D) ACT only. Correct Answer: A) aPTT 1.5–2.5x normal.
Rationale: Heparin is monitored via aPTT in ACS. ENA pharmacology standards.
11. A patient with cardiac tamponade has muffled heart sounds and JVD. What is the
definitive treatment?
A) Pericardiocentesis.
B) Fluid bolus.
C) Vasopressors.
D) Diuretics. Correct Answer: A) Pericardiocentesis.
, Rationale: Removes pericardial fluid to relieve compression. ENA cardiovascular
emergencies.
Section 2: Respiratory Emergencies (Questions 12–21)
12. A 30-year-old with asthma presents with wheezing and RR 28/min. What is the initial
treatment?
A) Albuterol nebulized 5 mg.
B) Epinephrine IM.
C) Magnesium sulfate IV.
D) Intubation. Correct Answer: A) Albuterol nebulized 5 mg.
Rationale: Beta-2 agonists are first-line for acute asthma. ENA asthma protocols per
GINA.
13. A patient with tension pneumothorax has tracheal deviation and absent breath sounds.
What is the immediate action?
A) Needle decompression 2nd ICS midclavicular line.
B) Chest tube insertion.
C) High-flow oxygen.
D) CT chest. Correct Answer: A) Needle decompression 2nd ICS midclavicular line.
Rationale: Relieves pressure emergently. ENA trauma protocols per ATLS.
14. In a COPD exacerbation, what ABG indicates need for BiPAP?
A) pH 7.28, PaCO2 60 mm Hg.
B) pH 7.40, PaCO2 40 mm Hg.
C) pH 7.50, PaCO2 30 mm Hg.
D) pH 7.35, PaCO2 45 mm Hg. Correct Answer: A) pH 7.28, PaCO2 60 mm Hg.
Rationale: Respiratory acidosis with hypercapnia indicates NIV. ENA COPD
management.
15. A patient with ARDS has SpO2 88% on 100% FiO2. What intervention?
A) Initiate prone positioning.
B) Increase tidal volume to 8 mL/kg.
C) Decrease PEEP.
D) Administer bronchodilators. Correct Answer: A) Initiate prone positioning.
Rationale: Improves V/Q matching in ARDS. ENA respiratory failure per ARDSnet.
16. A patient with massive hemoptysis is intubated. What protects the airway?
A) Double-lumen ETT.
B) Standard ETT.
C) Tracheostomy.
D) No intubation. Correct Answer: A) Double-lumen ETT.
Rationale: Isolates bleeding lung. ENA airway management.
17. For a patient with flail chest, what stabilizes the chest?
A) Positive pressure ventilation.
B) Rib taping.
C) Analgesics only.
D) Observation. Correct Answer: A) Positive pressure ventilation.
Rationale: Stabilizes paradoxical movement. ENA trauma care.
18. A patient with pneumonia develops septic shock. What is the initial fluid bolus?
A) 30 mL/kg 0.9% NS.
B) 500 mL D5W.
