CERTIFIED EMERGENCY NURSE
(CEN) EXAM QUESTION AND CORRECT
ANSWER 2026.
1. A 45-year-old male is brought to the emergency department with chest pain
and shortness of breath. He is diaphoretic and appears anxious. His vital signs
are BP 135/85 mmHg, HR 105, RR 22, and O2 saturation 92% on room air.
What is the first priority in managing this patient?
a) Obtain a 12-lead ECG
b) Administer oxygen
c) Administer nitroglycerin
d) Start an IV line
Answer: b) Administer oxygen
Rationale: Administering oxygen is the first step in stabilizing a patient with chest pain and
signs of respiratory distress. Ensuring adequate oxygenation helps prevent further ischemic
damage. A 12-lead ECG and other interventions are important but are secondary to ensuring
oxygenation.
2. A 10-year-old presents with an asthma attack. The child is using accessory
muscles to breathe and has a respiratory rate of 32/min. What is the most
appropriate intervention?
a) Administer a corticosteroid
b) Give a nebulized beta-agonist
c) Perform endotracheal intubation
d) Administer an opioid analgesic
Answer: b) Give a nebulized beta-agonist
Rationale: A nebulized beta-agonist (e.g., albuterol) is the first-line treatment for acute asthma
exacerbations to relax bronchial smooth muscle and improve airflow. Corticosteroids may be
given later, but immediate bronchodilation is the priority.
,3. A 60-year-old male is brought to the ED after a fall from a height of 10 feet.
His vitals are BP 90/60 mmHg, HR 115, RR 24, and O2 saturation 94%. His
pupils are equal and reactive, and his abdomen is tender. Which action is most
important?
a) Obtain a CT scan of the head
b) Begin fluid resuscitation
c) Administer pain medications
d) Perform a FAST exam
Answer: b) Begin fluid resuscitation
Rationale: The patient is showing signs of hypovolemic shock, likely due to internal bleeding.
Fluid resuscitation is crucial to stabilize the patient before further diagnostic procedures can be
performed.
4. Which of the following is the most common cause of upper gastrointestinal
bleeding in adults?
a) Esophageal varices
b) Gastric ulcer
c) Duodenal ulcer
d) Mallory-Weiss tear
Answer: c) Duodenal ulcer
Rationale: Duodenal ulcers are the most common cause of upper gastrointestinal bleeding in
adults, often due to Helicobacter pylori infection or NSAID use. Gastric ulcers and esophageal
varices are also common causes but less frequent than duodenal ulcers.
5. A patient presents with severe abdominal pain, rigidity, and a positive
Murphy's sign. Which condition is most likely?
a) Acute pancreatitis
b) Cholecystitis
c) Gastroenteritis
d) Appendicitis
Answer: b) Cholecystitis
,Rationale: A positive Murphy's sign (pain upon palpation of the right upper quadrant during
deep inspiration) is highly suggestive of cholecystitis, which is inflammation of the gallbladder.
6. What is the primary goal when treating a patient with a suspected ischemic
stroke?
a) Lower the blood pressure immediately
b) Ensure a rapid diagnosis and administer thrombolytics if appropriate
c) Give a large dose of aspirin
d) Obtain a CT scan of the head
Answer: b) Ensure a rapid diagnosis and administer thrombolytics if appropriate
Rationale: The primary goal in ischemic stroke is rapid diagnosis and, if within the treatment
window, administration of thrombolytics (e.g., alteplase) to dissolve the clot. Blood pressure
management is important but secondary.
7. A 25-year-old female presents with a history of recent heavy menstrual
periods, fatigue, and palpitations. Her hemoglobin level is 7 g/dL. What is the
most appropriate initial management?
a) Blood transfusion
b) Intravenous iron supplementation
c) Oral iron supplementation
d) Platelet transfusion
Answer: c) Oral iron supplementation
Rationale: For iron-deficiency anemia, oral iron supplements are typically the first-line
treatment. Blood transfusion is only indicated in cases of severe anemia or hemodynamic
instability.
8. A 50-year-old male presents with difficulty breathing after using an
insecticide. He is experiencing stridor, drooling, and agitation. What is the most
likely cause of his symptoms?
a) Anaphylaxis
b) Inhalation injury
, c) Organophosphate poisoning
d) Asthma exacerbation
Answer: c) Organophosphate poisoning
Rationale: Organophosphate poisoning can cause cholinergic symptoms, including difficulty
breathing, stridor, and drooling due to airway compromise. Antidotes such as atropine and
pralidoxime are used in treatment.
9. What is the most important intervention for a patient in anaphylactic shock?
a) Administer corticosteroids
b) Start an IV and administer fluids
c) Administer epinephrine
d) Apply oxygen via nasal cannula
Answer: c) Administer epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis, as it works to reverse
bronchoconstriction, improve circulation, and reduce swelling. Other interventions, such as
fluids and oxygen, are supportive but secondary.
10. A 35-year-old female presents with confusion, fever, and a rash that started
on her wrists and ankles and has spread to her palms and soles. She recently
returned from a camping trip. What is the most likely diagnosis?
a) Rocky Mountain spotted fever
b) Lyme disease
c) Meningococcal meningitis
d) Measles
Answer: a) Rocky Mountain spotted fever
Rationale: The patient's symptoms of fever, rash, and recent camping trip suggest Rocky
Mountain spotted fever, which is transmitted by tick bites. The rash typically starts on wrists and
ankles and can involve palms and soles.
11. A 45-year-old male presents with severe flank pain radiating to the groin and
hematuria. What is the most likely diagnosis?
(CEN) EXAM QUESTION AND CORRECT
ANSWER 2026.
1. A 45-year-old male is brought to the emergency department with chest pain
and shortness of breath. He is diaphoretic and appears anxious. His vital signs
are BP 135/85 mmHg, HR 105, RR 22, and O2 saturation 92% on room air.
What is the first priority in managing this patient?
a) Obtain a 12-lead ECG
b) Administer oxygen
c) Administer nitroglycerin
d) Start an IV line
Answer: b) Administer oxygen
Rationale: Administering oxygen is the first step in stabilizing a patient with chest pain and
signs of respiratory distress. Ensuring adequate oxygenation helps prevent further ischemic
damage. A 12-lead ECG and other interventions are important but are secondary to ensuring
oxygenation.
2. A 10-year-old presents with an asthma attack. The child is using accessory
muscles to breathe and has a respiratory rate of 32/min. What is the most
appropriate intervention?
a) Administer a corticosteroid
b) Give a nebulized beta-agonist
c) Perform endotracheal intubation
d) Administer an opioid analgesic
Answer: b) Give a nebulized beta-agonist
Rationale: A nebulized beta-agonist (e.g., albuterol) is the first-line treatment for acute asthma
exacerbations to relax bronchial smooth muscle and improve airflow. Corticosteroids may be
given later, but immediate bronchodilation is the priority.
,3. A 60-year-old male is brought to the ED after a fall from a height of 10 feet.
His vitals are BP 90/60 mmHg, HR 115, RR 24, and O2 saturation 94%. His
pupils are equal and reactive, and his abdomen is tender. Which action is most
important?
a) Obtain a CT scan of the head
b) Begin fluid resuscitation
c) Administer pain medications
d) Perform a FAST exam
Answer: b) Begin fluid resuscitation
Rationale: The patient is showing signs of hypovolemic shock, likely due to internal bleeding.
Fluid resuscitation is crucial to stabilize the patient before further diagnostic procedures can be
performed.
4. Which of the following is the most common cause of upper gastrointestinal
bleeding in adults?
a) Esophageal varices
b) Gastric ulcer
c) Duodenal ulcer
d) Mallory-Weiss tear
Answer: c) Duodenal ulcer
Rationale: Duodenal ulcers are the most common cause of upper gastrointestinal bleeding in
adults, often due to Helicobacter pylori infection or NSAID use. Gastric ulcers and esophageal
varices are also common causes but less frequent than duodenal ulcers.
5. A patient presents with severe abdominal pain, rigidity, and a positive
Murphy's sign. Which condition is most likely?
a) Acute pancreatitis
b) Cholecystitis
c) Gastroenteritis
d) Appendicitis
Answer: b) Cholecystitis
,Rationale: A positive Murphy's sign (pain upon palpation of the right upper quadrant during
deep inspiration) is highly suggestive of cholecystitis, which is inflammation of the gallbladder.
6. What is the primary goal when treating a patient with a suspected ischemic
stroke?
a) Lower the blood pressure immediately
b) Ensure a rapid diagnosis and administer thrombolytics if appropriate
c) Give a large dose of aspirin
d) Obtain a CT scan of the head
Answer: b) Ensure a rapid diagnosis and administer thrombolytics if appropriate
Rationale: The primary goal in ischemic stroke is rapid diagnosis and, if within the treatment
window, administration of thrombolytics (e.g., alteplase) to dissolve the clot. Blood pressure
management is important but secondary.
7. A 25-year-old female presents with a history of recent heavy menstrual
periods, fatigue, and palpitations. Her hemoglobin level is 7 g/dL. What is the
most appropriate initial management?
a) Blood transfusion
b) Intravenous iron supplementation
c) Oral iron supplementation
d) Platelet transfusion
Answer: c) Oral iron supplementation
Rationale: For iron-deficiency anemia, oral iron supplements are typically the first-line
treatment. Blood transfusion is only indicated in cases of severe anemia or hemodynamic
instability.
8. A 50-year-old male presents with difficulty breathing after using an
insecticide. He is experiencing stridor, drooling, and agitation. What is the most
likely cause of his symptoms?
a) Anaphylaxis
b) Inhalation injury
, c) Organophosphate poisoning
d) Asthma exacerbation
Answer: c) Organophosphate poisoning
Rationale: Organophosphate poisoning can cause cholinergic symptoms, including difficulty
breathing, stridor, and drooling due to airway compromise. Antidotes such as atropine and
pralidoxime are used in treatment.
9. What is the most important intervention for a patient in anaphylactic shock?
a) Administer corticosteroids
b) Start an IV and administer fluids
c) Administer epinephrine
d) Apply oxygen via nasal cannula
Answer: c) Administer epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis, as it works to reverse
bronchoconstriction, improve circulation, and reduce swelling. Other interventions, such as
fluids and oxygen, are supportive but secondary.
10. A 35-year-old female presents with confusion, fever, and a rash that started
on her wrists and ankles and has spread to her palms and soles. She recently
returned from a camping trip. What is the most likely diagnosis?
a) Rocky Mountain spotted fever
b) Lyme disease
c) Meningococcal meningitis
d) Measles
Answer: a) Rocky Mountain spotted fever
Rationale: The patient's symptoms of fever, rash, and recent camping trip suggest Rocky
Mountain spotted fever, which is transmitted by tick bites. The rash typically starts on wrists and
ankles and can involve palms and soles.
11. A 45-year-old male presents with severe flank pain radiating to the groin and
hematuria. What is the most likely diagnosis?
