CEN Certified Emergency Nurse
Exam ACTUAL EXAM 2026/2027 |
Complete Exam-Style Q&A | Verified
Q&A | Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Total Questions: 150
Passing Score: 70% (105/150)
Section 1: Cardiovascular Emergencies (Q1-20)
Section 2: Respiratory Emergencies (Q21-35)
Section 3: Neurological Emergencies (Q36-50)
Section 4: Gastrointestinal Emergencies (Q51-62)
Section 5: Genitourinary & Renal Emergencies (Q63-70)
Section 6: Endocrine & Metabolic Emergencies (Q71-80)
Section 7: Toxicological Emergencies (Q81-90)
Section 8: Environmental Emergencies (Q91-98)
[Section 1: Cardiovascular Emergencies]
Q1: A 58-year-old male presents with sudden-onset tearing chest pain radiating to the back. BP 100/60
in the right arm, 85/50 in the left arm. Heart rate 110. What is the priority nursing intervention?
,A. Administer sublingual nitroglycerin
B. Obtain a 12-lead ECG immediately
C. Prepare for emergent CT angiography and IV beta-blockade. [CORRECT]
D. Give aspirin 325 mg orally
Correct Answer: C
Rationale: The presentation is classic for aortic dissection (tearing chest pain, pulse/BP differential
between arms). Emergent CT angiography confirms diagnosis, and IV beta-blockade (e.g., esmolol or
labetalol) reduces shear stress on the aorta to prevent rupture. Nitroglycerin and aspirin are appropriate
for ACS but could worsen hypotension here.
Q2: A 67-year-old female presents with crushing substernal chest pain, diaphoresis, and nausea. Her 12-
lead ECG shows ST-segment elevation in leads V1-V4. Which medication should be administered first?
A. Clopidogrel 600 mg loading dose
B. Aspirin 325 mg chewable
C. Nitroglycerin 0.4 mg sublingual
D. Morphine sulfate 2-4 mg IV
Correct Answer: B
Rationale: Aspirin is the first medication given in suspected STEMI because it inhibits platelet
aggregation, reduces mortality, and should be administered immediately—ideally within 10 minutes of
arrival. It is given before nitroglycerin or morphine.
Q3: A patient with acute inferior wall MI (ST elevation in II, III, aVF) develops bradycardia with a heart
rate of 42, BP 88/50, and complaints of dizziness. The rhythm strip shows third-degree AV block. What is
the first intervention?
A. Atropine 0.5 mg IV push
B. Transcutaneous pacing
C. Dopamine infusion at 5 mcg/kg/min
D. Epinephrine 1 mg IV push
Correct Answer: A
Rationale: For symptomatic bradycardia with hypotension and altered mental status, atropine 0.5 mg IV
is the first-line intervention per ACLS. It blocks vagal tone and increases heart rate. Transcutaneous
pacing is prepared if atropine is ineffective.
,Q4: A patient in rapid atrial fibrillation with a rate of 160 presents with hypotension (BP 78/50) and
altered mental status. Which intervention is most appropriate?
A. Metoprolol 5 mg IV push
B. Diltiazem 0.25 mg/kg IV bolus
C. Synchronized cardioversion at 100-200 joules. [CORRECT]
D. Adenosine 6 mg rapid IV push
Correct Answer: C
Rationale: Unstable atrial fibrillation with hypotension and altered mental status requires immediate
synchronized cardioversion. Rate-control agents (metoprolol, diltiazem) and adenosine are
contraindicated in unstable patients as they may worsen hemodynamics.
Q5: A 72-year-old male with a history of CHF presents with severe dyspnea, orthopnea, JVD, and
bilateral crackles. BP 190/110, HR 120, SpO2 88% on room air. Which medication is contraindicated?
A. Furosemide 40 mg IV push
B. Nitroglycerin 0.4 mg sublingual
C. Morphine sulfate 2-4 mg IV
D. Metoprolol 25 mg PO
Correct Answer: D
Rationale: Beta-blockers like metoprolol are contraindicated in acute decompensated heart failure
because they cause negative inotropy and can worsen cardiogenic shock. Furosemide, nitroglycerin, and
morphine are standard acute CHF treatments.
Q6: A patient with suspected ACS has a blood pressure of 90/60. Which action should the nurse take
before administering nitroglycerin?
A. Give nitroglycerin immediately to reduce cardiac workload
B. Hold nitroglycerin and notify the provider due to hypotension. [CORRECT]
C. Give a fluid bolus of 500 mL NS, then administer nitroglycerin
D. Administer nitroglycerin only if the patient is still having pain
Correct Answer: B
Rationale: Nitroglycerin is contraindicated with SBP <90 mmHg or >30 mmHg below baseline because it
causes venodilation and can precipitate profound hypotension, syncope, or cardiovascular collapse. The
provider must be notified.
, Q7: A patient with hypertensive emergency (BP 220/130) has altered mental status and papilledema on
exam. Which medication is most appropriate for initial management?
A. Nitroprusside IV infusion
B. Nicardipine IV infusion
C. Labetalol IV bolus followed by infusion
D. Any of the above with careful titration to reduce MAP by 10-20% in the first hour. [CORRECT]
Correct Answer: D
Rationale: In hypertensive emergency with end-organ damage, the goal is controlled reduction of mean
arterial pressure by 10-20% in the first hour using IV agents (nitroprusside, nicardipine, or labetalol).
Rapid, uncontrolled drops can cause cerebral, coronary, or renal ischemia.
Q8: A patient presents with chest pain and the following ECG findings: ST elevation in V1-V3 with a tall,
peaked T wave in V2. Which electrolyte imbalance should the nurse suspect?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Correct Answer: B
Rationale: Tall, peaked ("tented") T waves are the earliest ECG manifestation of hyperkalemia. The
pattern described (pseudoinfarction pattern in V1-V3) can mimic Brugada syndrome or ACS, making
electrolyte assessment critical in chest pain evaluation.
Q9: A patient with acute pulmonary edema is receiving high-flow oxygen via non-rebreather at 15
L/min. SpO2 remains 84%. What is the next priority intervention?
A. Increase oxygen flow to 20 L/min
B. Initiate bilevel positive airway pressure (BiPAP). [CORRECT]
C. Prepare for emergent intubation immediately
D. Administer furosemide 80 mg IV push
Correct Answer: B
Rationale: BiPAP provides positive pressure support that reduces preload and afterload while improving
oxygenation in acute cardiogenic pulmonary edema. It is the next step after high-flow oxygen fails,
before proceeding to intubation.
Exam ACTUAL EXAM 2026/2027 |
Complete Exam-Style Q&A | Verified
Q&A | Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Total Questions: 150
Passing Score: 70% (105/150)
Section 1: Cardiovascular Emergencies (Q1-20)
Section 2: Respiratory Emergencies (Q21-35)
Section 3: Neurological Emergencies (Q36-50)
Section 4: Gastrointestinal Emergencies (Q51-62)
Section 5: Genitourinary & Renal Emergencies (Q63-70)
Section 6: Endocrine & Metabolic Emergencies (Q71-80)
Section 7: Toxicological Emergencies (Q81-90)
Section 8: Environmental Emergencies (Q91-98)
[Section 1: Cardiovascular Emergencies]
Q1: A 58-year-old male presents with sudden-onset tearing chest pain radiating to the back. BP 100/60
in the right arm, 85/50 in the left arm. Heart rate 110. What is the priority nursing intervention?
,A. Administer sublingual nitroglycerin
B. Obtain a 12-lead ECG immediately
C. Prepare for emergent CT angiography and IV beta-blockade. [CORRECT]
D. Give aspirin 325 mg orally
Correct Answer: C
Rationale: The presentation is classic for aortic dissection (tearing chest pain, pulse/BP differential
between arms). Emergent CT angiography confirms diagnosis, and IV beta-blockade (e.g., esmolol or
labetalol) reduces shear stress on the aorta to prevent rupture. Nitroglycerin and aspirin are appropriate
for ACS but could worsen hypotension here.
Q2: A 67-year-old female presents with crushing substernal chest pain, diaphoresis, and nausea. Her 12-
lead ECG shows ST-segment elevation in leads V1-V4. Which medication should be administered first?
A. Clopidogrel 600 mg loading dose
B. Aspirin 325 mg chewable
C. Nitroglycerin 0.4 mg sublingual
D. Morphine sulfate 2-4 mg IV
Correct Answer: B
Rationale: Aspirin is the first medication given in suspected STEMI because it inhibits platelet
aggregation, reduces mortality, and should be administered immediately—ideally within 10 minutes of
arrival. It is given before nitroglycerin or morphine.
Q3: A patient with acute inferior wall MI (ST elevation in II, III, aVF) develops bradycardia with a heart
rate of 42, BP 88/50, and complaints of dizziness. The rhythm strip shows third-degree AV block. What is
the first intervention?
A. Atropine 0.5 mg IV push
B. Transcutaneous pacing
C. Dopamine infusion at 5 mcg/kg/min
D. Epinephrine 1 mg IV push
Correct Answer: A
Rationale: For symptomatic bradycardia with hypotension and altered mental status, atropine 0.5 mg IV
is the first-line intervention per ACLS. It blocks vagal tone and increases heart rate. Transcutaneous
pacing is prepared if atropine is ineffective.
,Q4: A patient in rapid atrial fibrillation with a rate of 160 presents with hypotension (BP 78/50) and
altered mental status. Which intervention is most appropriate?
A. Metoprolol 5 mg IV push
B. Diltiazem 0.25 mg/kg IV bolus
C. Synchronized cardioversion at 100-200 joules. [CORRECT]
D. Adenosine 6 mg rapid IV push
Correct Answer: C
Rationale: Unstable atrial fibrillation with hypotension and altered mental status requires immediate
synchronized cardioversion. Rate-control agents (metoprolol, diltiazem) and adenosine are
contraindicated in unstable patients as they may worsen hemodynamics.
Q5: A 72-year-old male with a history of CHF presents with severe dyspnea, orthopnea, JVD, and
bilateral crackles. BP 190/110, HR 120, SpO2 88% on room air. Which medication is contraindicated?
A. Furosemide 40 mg IV push
B. Nitroglycerin 0.4 mg sublingual
C. Morphine sulfate 2-4 mg IV
D. Metoprolol 25 mg PO
Correct Answer: D
Rationale: Beta-blockers like metoprolol are contraindicated in acute decompensated heart failure
because they cause negative inotropy and can worsen cardiogenic shock. Furosemide, nitroglycerin, and
morphine are standard acute CHF treatments.
Q6: A patient with suspected ACS has a blood pressure of 90/60. Which action should the nurse take
before administering nitroglycerin?
A. Give nitroglycerin immediately to reduce cardiac workload
B. Hold nitroglycerin and notify the provider due to hypotension. [CORRECT]
C. Give a fluid bolus of 500 mL NS, then administer nitroglycerin
D. Administer nitroglycerin only if the patient is still having pain
Correct Answer: B
Rationale: Nitroglycerin is contraindicated with SBP <90 mmHg or >30 mmHg below baseline because it
causes venodilation and can precipitate profound hypotension, syncope, or cardiovascular collapse. The
provider must be notified.
, Q7: A patient with hypertensive emergency (BP 220/130) has altered mental status and papilledema on
exam. Which medication is most appropriate for initial management?
A. Nitroprusside IV infusion
B. Nicardipine IV infusion
C. Labetalol IV bolus followed by infusion
D. Any of the above with careful titration to reduce MAP by 10-20% in the first hour. [CORRECT]
Correct Answer: D
Rationale: In hypertensive emergency with end-organ damage, the goal is controlled reduction of mean
arterial pressure by 10-20% in the first hour using IV agents (nitroprusside, nicardipine, or labetalol).
Rapid, uncontrolled drops can cause cerebral, coronary, or renal ischemia.
Q8: A patient presents with chest pain and the following ECG findings: ST elevation in V1-V3 with a tall,
peaked T wave in V2. Which electrolyte imbalance should the nurse suspect?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Correct Answer: B
Rationale: Tall, peaked ("tented") T waves are the earliest ECG manifestation of hyperkalemia. The
pattern described (pseudoinfarction pattern in V1-V3) can mimic Brugada syndrome or ACS, making
electrolyte assessment critical in chest pain evaluation.
Q9: A patient with acute pulmonary edema is receiving high-flow oxygen via non-rebreather at 15
L/min. SpO2 remains 84%. What is the next priority intervention?
A. Increase oxygen flow to 20 L/min
B. Initiate bilevel positive airway pressure (BiPAP). [CORRECT]
C. Prepare for emergent intubation immediately
D. Administer furosemide 80 mg IV push
Correct Answer: B
Rationale: BiPAP provides positive pressure support that reduces preload and afterload while improving
oxygenation in acute cardiogenic pulmonary edema. It is the next step after high-flow oxygen fails,
before proceeding to intubation.
