Certified Emergency Nurse (CEN)
Challenge Questions – Updated 2025
A patient presents to the ED in the manic phase of a bipolar affective disorder. Which of the following
statements made by the ER Nurse, is most therapeutic for a patient with this diagnosis?
1. "I want you to ell me what you are feeling right now"
2. "I need you to stay in this room and someone will stay here with you"
3. "Tell me what is going on in your life right now that may have made you feel out of control for the
past few days"
4. "We are worried that you may be a danger to yourself of others in your present state, so we are going
to have someone from psychiatry come down and discuss with you what you are feeling". -
ANSWER ✨✔---2. "I need you to stay in this room and someone will stay here with you"
With Mania, keep sentences brief and direct. Do not encourage the pt to speak and avoid rambling.
Atropine is effective for overdoses caused by:
1. antihistamines
2. posion mushrooms
3. lysergic acid diethylamide (LSD)
4. the seeds of the Jimson weed plant. - ANSWER ✨✔---2. Poison mushrooms
,OD on certain mushrooms=Cholinergic effect, Atropine is an Anti-Cholinergic drug. Antihistamines are
their own toxindrome, LSD is sympathomimetic, Jimson week is an anticholinergic substance.
The ED nurse notices 3rd Degree Heart Block on telemetry...
Which of the following substances did this patient most likely overdose on?
1. Digoxin
2. Lorazepam
3. Ethylene glycol
4. Acetaminophen - ANSWER ✨✔---1. Digoxin
this is the only option that will cause heart block in particular.
Effective Treatment for an overdose on tricyclic antidepressants should cause
1. widening QT interval
2. serum pH above normal.
3. decreasing BP
4. Dilation of pupils - ANSWER ✨✔---2. serum pH above normal
GOAL is a pH of 7.5-5.5, Pts who OD on this substance already have wide QTs and are already
hypotensive. Pupils are irrelevant.
Effective treatment for heat stroke should result in:
1. the onset of shivering
2. the cessation of sweating
3. A GCS above 8.
, 4. a core body temperature of 102F (38.9C). - ANSWER ✨✔---4. a core body temperature of 102F
(38.9C).
shivering heats the body back up, sweating helps with heat loss through evaporation, main goal is to
decrease the body temp!!
Which of the following lab studies is most likely to be altered in the hours after envenomation by coral
snakes?
1. Coag studies
2. ABGs
3. Hematology studies
4. Renal function tests - ANSWER ✨✔---2. ABGs
due to the neurotoxic effects this can decrease respiratory drive and cause hypoxia. Coag. studies great
for Crotalid envenomation. Hematology/renal function not useful for either.
A patient, bitten by a bat, asks what may happen if they refuse prophylaxis for rabies. The emergency
nurse explains that infection by the rabies virus can lead to:
1. encephalitis causing fear of air currents and water.
2. a descending paralysis leading to respiratory failure.
3. cardiomyopathies requiring treatment with a pacemaker.
4. An inflammatory response causing fluid shifting and hypotension. - ANSWER ✨✔---1.
encephalitis causing fear of air currents and water.
This is the pathology of the rabies virus, once this stage of disease progression is reached, death is
imminent.
A wound infected with MRSA is mostly likely to present as a:
Challenge Questions – Updated 2025
A patient presents to the ED in the manic phase of a bipolar affective disorder. Which of the following
statements made by the ER Nurse, is most therapeutic for a patient with this diagnosis?
1. "I want you to ell me what you are feeling right now"
2. "I need you to stay in this room and someone will stay here with you"
3. "Tell me what is going on in your life right now that may have made you feel out of control for the
past few days"
4. "We are worried that you may be a danger to yourself of others in your present state, so we are going
to have someone from psychiatry come down and discuss with you what you are feeling". -
ANSWER ✨✔---2. "I need you to stay in this room and someone will stay here with you"
With Mania, keep sentences brief and direct. Do not encourage the pt to speak and avoid rambling.
Atropine is effective for overdoses caused by:
1. antihistamines
2. posion mushrooms
3. lysergic acid diethylamide (LSD)
4. the seeds of the Jimson weed plant. - ANSWER ✨✔---2. Poison mushrooms
,OD on certain mushrooms=Cholinergic effect, Atropine is an Anti-Cholinergic drug. Antihistamines are
their own toxindrome, LSD is sympathomimetic, Jimson week is an anticholinergic substance.
The ED nurse notices 3rd Degree Heart Block on telemetry...
Which of the following substances did this patient most likely overdose on?
1. Digoxin
2. Lorazepam
3. Ethylene glycol
4. Acetaminophen - ANSWER ✨✔---1. Digoxin
this is the only option that will cause heart block in particular.
Effective Treatment for an overdose on tricyclic antidepressants should cause
1. widening QT interval
2. serum pH above normal.
3. decreasing BP
4. Dilation of pupils - ANSWER ✨✔---2. serum pH above normal
GOAL is a pH of 7.5-5.5, Pts who OD on this substance already have wide QTs and are already
hypotensive. Pupils are irrelevant.
Effective treatment for heat stroke should result in:
1. the onset of shivering
2. the cessation of sweating
3. A GCS above 8.
, 4. a core body temperature of 102F (38.9C). - ANSWER ✨✔---4. a core body temperature of 102F
(38.9C).
shivering heats the body back up, sweating helps with heat loss through evaporation, main goal is to
decrease the body temp!!
Which of the following lab studies is most likely to be altered in the hours after envenomation by coral
snakes?
1. Coag studies
2. ABGs
3. Hematology studies
4. Renal function tests - ANSWER ✨✔---2. ABGs
due to the neurotoxic effects this can decrease respiratory drive and cause hypoxia. Coag. studies great
for Crotalid envenomation. Hematology/renal function not useful for either.
A patient, bitten by a bat, asks what may happen if they refuse prophylaxis for rabies. The emergency
nurse explains that infection by the rabies virus can lead to:
1. encephalitis causing fear of air currents and water.
2. a descending paralysis leading to respiratory failure.
3. cardiomyopathies requiring treatment with a pacemaker.
4. An inflammatory response causing fluid shifting and hypotension. - ANSWER ✨✔---1.
encephalitis causing fear of air currents and water.
This is the pathology of the rabies virus, once this stage of disease progression is reached, death is
imminent.
A wound infected with MRSA is mostly likely to present as a:
