Certified Emergency Nurse (CEN) Practice
Examination with NGN – 100 Screenshot
Questions & 100% Verified Answers # Ace Your
2026 RN ATI Med-Surg Proctored Exam with
Confidence!
1. A patient presents to the ED after a bee sting with acute onset of facial swelling, stridor, and
wheezing. Vital signs: BP 80/50, HR 130. What is the first-line medication and route?
a) IV Diphenhydramine.
b) IV Methylprednisolone.
c) IM Epinephrine 1:1,000.
d) Nebulized Albuterol.
Answer: c) IM Epinephrine 1:1,000.
Rationale: The patient is experiencing anaphylactic shock with airway compromise and hypotension.
Epinephrine is the first-line drug. The intramuscular route into the vastus lateralis (anterolateral thigh)
provides the fastest absorption in a non-IV-established patient. Concentration is 1:1,000 (0.3-0.5 mg).
---
2. A 6-year-old with a history of sickle cell disease presents with a fever of 39.5°C. The priority
intervention is:
a) Apply cold compresses and administer acetaminophen.
b) Initiate a blood transfusion immediately.
c) Obtain blood cultures and administer IV antibiotics within 1 hour.
d) Administer high-flow oxygen via non-rebreather mask.
,Answer: c) Obtain blood cultures and administer IV antibiotics within 1 hour.
Rationale: Children with sickle cell disease are functionally asplenic and at extreme risk of sepsis from
encapsulated organisms like S. pneumoniae. Fever is a medical emergency; broad-spectrum antibiotics
must be started within 60 minutes of presentation after obtaining blood cultures.
---
3. A patient with a history of cirrhosis presents with massive, bright red hematemesis. The most likely
source is:
a) Peptic ulcer disease.
b) Mallory-Weiss tear.
c) Esophageal varices.
d) Acute gastritis.
Answer: c) Esophageal varices.
Rationale: Portal hypertension secondary to cirrhosis leads to the development of collateral veins in the
esophagus. These varices are fragile and can rupture, causing painless, massive, life-threatening
hemorrhage.
---
4. A 24-year-old male is brought in after a motorcycle crash. He is unconscious, has a large laceration on
his forehead, and has blood draining from his right ear. What is the most concerning finding?
a) The scalp laceration.
b) The loss of consciousness.
c) Hemotympanum or Battle's sign.
d) The mechanism of injury.
Answer: c) Hemotympanum or Battle's sign.
Rationale: Blood or clear fluid (CSF) draining from the ear in the setting of trauma indicates a basilar
skull fracture. This is a critical finding requiring elevation of the head of the bed, sterile loose gauze
placement (not packing), and monitoring for meningitis.
,---
5. The emergency nurse receives a trauma patient with a knife impaled in the left chest. The patient is
awake but in severe pain. The nurse should:
a) Carefully remove the knife and apply a pressure dressing.
b) Stabilize the object in place with bulky dressings.
c) Cut the object close to the skin to make imaging easier.
d) Remove the object and prepare the patient for an immediate chest tube.
Answer: b) Stabilize the object in place with bulky dressings.
Rationale: An impaled object should never be removed in the ED unless it is obstructing the airway or
CPR. The object may be providing direct tamponade of a major vessel. It should be stabilized for
transport to the OR where it can be removed under controlled circumstances.
---
6. A patient with known depression is given a food tray. After picking at the food, the nurse later finds
the patient smiling and socializing. The priority nursing action is to:
a) Document the patient's improved mood.
b) Ask the patient why they are suddenly happy.
c) Perform an environmental safety check of the patient's belongings.
d) Discontinue 1:1 observation.
Answer: c) Perform an environmental safety check of the patient's belongings.
Rationale: A sudden elevation in mood in a severely depressed patient can be a red flag. It may indicate
the patient has made a decision to complete suicide and feels a sense of relief. A safety check for hidden
medications or sharp objects is critical.
---
, 7. A patient with a tension pneumothorax develops cardiac arrest. What is the priority intervention?
a) Needle decompression at the 2nd intercostal space, midclavicular line.
b) Pericardiocentesis.
c) Endotracheal intubation.
d) Initiate CPR with chest compressions.
Answer: a) Needle decompression at the 2nd intercostal space, midclavicular line.
Rationale: In cardiac arrest from tension pneumothorax, chest compressions alone are ineffective due to
obstructive shock. Immediate needle decompression converts the tension pneumothorax to a simple
pneumothorax, allowing the heart to refill and compressions to be effective.
---
8. A child presents with a "barky" cough, inspiratory stridor at rest, and retractions. What is the priority
intervention?
a) Administer IV antibiotics.
b) Obtain a lateral neck X-ray.
c) Administer nebulized racemic epinephrine.
d) Perform immediate endotracheal intubation.
Answer: c) Administer nebulized racemic epinephrine.
Rationale: The presentation is classic for moderate to severe croup (laryngotracheobronchitis). Racemic
epinephrine is a vasoconstrictor that reduces subglottic edema, providing temporary relief.
Corticosteroids are also essential for the inflammatory component.
---
9. A patient with hyperosmolar hyperglycemic state (HHS) presents with a glucose of 900 mg/dL but no
ketones. The nurse understands the priority fluid is:
a) 0.45% Normal Saline.
b) D5 0.45% Normal Saline.
Examination with NGN – 100 Screenshot
Questions & 100% Verified Answers # Ace Your
2026 RN ATI Med-Surg Proctored Exam with
Confidence!
1. A patient presents to the ED after a bee sting with acute onset of facial swelling, stridor, and
wheezing. Vital signs: BP 80/50, HR 130. What is the first-line medication and route?
a) IV Diphenhydramine.
b) IV Methylprednisolone.
c) IM Epinephrine 1:1,000.
d) Nebulized Albuterol.
Answer: c) IM Epinephrine 1:1,000.
Rationale: The patient is experiencing anaphylactic shock with airway compromise and hypotension.
Epinephrine is the first-line drug. The intramuscular route into the vastus lateralis (anterolateral thigh)
provides the fastest absorption in a non-IV-established patient. Concentration is 1:1,000 (0.3-0.5 mg).
---
2. A 6-year-old with a history of sickle cell disease presents with a fever of 39.5°C. The priority
intervention is:
a) Apply cold compresses and administer acetaminophen.
b) Initiate a blood transfusion immediately.
c) Obtain blood cultures and administer IV antibiotics within 1 hour.
d) Administer high-flow oxygen via non-rebreather mask.
,Answer: c) Obtain blood cultures and administer IV antibiotics within 1 hour.
Rationale: Children with sickle cell disease are functionally asplenic and at extreme risk of sepsis from
encapsulated organisms like S. pneumoniae. Fever is a medical emergency; broad-spectrum antibiotics
must be started within 60 minutes of presentation after obtaining blood cultures.
---
3. A patient with a history of cirrhosis presents with massive, bright red hematemesis. The most likely
source is:
a) Peptic ulcer disease.
b) Mallory-Weiss tear.
c) Esophageal varices.
d) Acute gastritis.
Answer: c) Esophageal varices.
Rationale: Portal hypertension secondary to cirrhosis leads to the development of collateral veins in the
esophagus. These varices are fragile and can rupture, causing painless, massive, life-threatening
hemorrhage.
---
4. A 24-year-old male is brought in after a motorcycle crash. He is unconscious, has a large laceration on
his forehead, and has blood draining from his right ear. What is the most concerning finding?
a) The scalp laceration.
b) The loss of consciousness.
c) Hemotympanum or Battle's sign.
d) The mechanism of injury.
Answer: c) Hemotympanum or Battle's sign.
Rationale: Blood or clear fluid (CSF) draining from the ear in the setting of trauma indicates a basilar
skull fracture. This is a critical finding requiring elevation of the head of the bed, sterile loose gauze
placement (not packing), and monitoring for meningitis.
,---
5. The emergency nurse receives a trauma patient with a knife impaled in the left chest. The patient is
awake but in severe pain. The nurse should:
a) Carefully remove the knife and apply a pressure dressing.
b) Stabilize the object in place with bulky dressings.
c) Cut the object close to the skin to make imaging easier.
d) Remove the object and prepare the patient for an immediate chest tube.
Answer: b) Stabilize the object in place with bulky dressings.
Rationale: An impaled object should never be removed in the ED unless it is obstructing the airway or
CPR. The object may be providing direct tamponade of a major vessel. It should be stabilized for
transport to the OR where it can be removed under controlled circumstances.
---
6. A patient with known depression is given a food tray. After picking at the food, the nurse later finds
the patient smiling and socializing. The priority nursing action is to:
a) Document the patient's improved mood.
b) Ask the patient why they are suddenly happy.
c) Perform an environmental safety check of the patient's belongings.
d) Discontinue 1:1 observation.
Answer: c) Perform an environmental safety check of the patient's belongings.
Rationale: A sudden elevation in mood in a severely depressed patient can be a red flag. It may indicate
the patient has made a decision to complete suicide and feels a sense of relief. A safety check for hidden
medications or sharp objects is critical.
---
, 7. A patient with a tension pneumothorax develops cardiac arrest. What is the priority intervention?
a) Needle decompression at the 2nd intercostal space, midclavicular line.
b) Pericardiocentesis.
c) Endotracheal intubation.
d) Initiate CPR with chest compressions.
Answer: a) Needle decompression at the 2nd intercostal space, midclavicular line.
Rationale: In cardiac arrest from tension pneumothorax, chest compressions alone are ineffective due to
obstructive shock. Immediate needle decompression converts the tension pneumothorax to a simple
pneumothorax, allowing the heart to refill and compressions to be effective.
---
8. A child presents with a "barky" cough, inspiratory stridor at rest, and retractions. What is the priority
intervention?
a) Administer IV antibiotics.
b) Obtain a lateral neck X-ray.
c) Administer nebulized racemic epinephrine.
d) Perform immediate endotracheal intubation.
Answer: c) Administer nebulized racemic epinephrine.
Rationale: The presentation is classic for moderate to severe croup (laryngotracheobronchitis). Racemic
epinephrine is a vasoconstrictor that reduces subglottic edema, providing temporary relief.
Corticosteroids are also essential for the inflammatory component.
---
9. A patient with hyperosmolar hyperglycemic state (HHS) presents with a glucose of 900 mg/dL but no
ketones. The nurse understands the priority fluid is:
a) 0.45% Normal Saline.
b) D5 0.45% Normal Saline.
