CEN Practice Exam 1: Emergency Nursing Certification Questions with Answers & Rationales
(CEN Prep Test 1)
A patient is noted to have red, painless spots on the palms and soles, red, painful nodes in the
pad of the fingers and toes, and splinter hemorrhages under the nails, as well as an elevated
body temperature and elevated WBC count. The emergency nurse suspects the patient has:
A. Endocarditis
B. Pericarditis
C. Myocarditis
D. Leukemia - ANS ✔✔A. Endocarditis
A. Endocarditis. The patient's symptoms are classic for endocarditis. petechial lesions found on
the palms of the hands or soles of the feet are known as Janeway lesions. Painful fingertip
nodes or lesion are known as Osler's nodes. The patient may experience fevers along with an
elevated WBC count. Endocarditis is a bacterial infection: possible causes included damaged or
abnormal heart valve, parenteral drug addiction, and long-term IV access. The endocarditic
infection may also spread to valve str4uctures to the heart, resulting in permanent valvular
dysfunction.
B. Pericarditis, or inflammation of the pericardial sac, is characterized by an elevation in WBC
count, a pericardial friction rub, and ST changes throughout the electrocardiogram. Pericarditis
is not associated w/ elevated WBC count.
C. Myocarditis, or inflammation of the cardiac muscle, is characterized by CP, cardiac rhythm
abnormalities, poor nutrition, and fatigue. Myocarditis is typically a viral infection that present
w/ fever and elevate WBC count.
D. Leukemia, or cancer of the blood system, is dx by abnormalities in WBC counts. A rash may
also be present w/ certain types of leukemia
,A conscious pulseless pt w/ a continuous-flow left ventricular assist device and a hx of end-stage
HF presents to the ED because of a "low-flow" alarm. Which of the following interventions
would be appropriate in the scenario?
A. Obtain an automatic BP
B. Exchange the controller
C. Administer IV fluids
D. Begin chest compressions - ANS ✔✔C. Administer IV fluids
C. Administer IV fluids
Fluids should be initiated. The "low-flow" alarm may be due to decreased preload from
hypotension, dehydration, obstruction of the inflow or outflow (which would cause an increase
in afterload) cannula, or disconnections or percutaneous leads. In a stable patient, the provider
should focus efforts on identifying the potential causes of the alarm.
A. With no palpable pulse, obtaining a mechanical BP is usually not feasible. A mean arterial BP
(MAP) should be obtained by placing a Doppler over the brachial or radial artery and then
inflating the cuff until flow is no longer heard. Once the arterial flow is head again, this is the
MAP. Left ventricle assist device (LVAD) patients should have MAPs between 70 and 80 mm Hg.
In a conscious patient, determining the patient's BP will help guide therapy and
troubleshooting. The patient's LVAD coordinator should also be contacted as soon as possible.
B. The controller should be changed only in consultation with a trained professional from the
VAD team. patients are instructed to carry a backup controller in case of malfunction.
D. Chest compressions are not indicated in a conscious patient. Patients with continuous-flow
LVADs often do not have a palpable pulse because the device is pumping constantly throughout
the cardiac cycle; this causes aortic flow to be present during diastole, leading to reduced pulse
pressure. Chest compressions may be indicated fi a patient w/ an LVAD is unconscious,
,pulseless, and intubated with a PetCO2 < 20 mm Hg because this may indicate severely impaired
systemic perfusion.c
A nurse is preparing to assist w/ drug-assisted intubation (DAI) for a patient in severe respiratory
distress w/ a pulse ox reading of 91%. Which of the following is the priority intervention for
preoxygenating the patient?
A. Place the patient in reverse Trendelenburg
B. Administer an opiod
C. Use positive pressure ventilation
D. Provide high-flow oxygen - ANS ✔✔D. Provide high-flow oxygen
D. Providing high-flow oxygen at the highest concentration available will prepare the patient
tolerate the period of apnea and precent oxygen desaturation during intubation. This is the
priority intervention during the preoxygenation phase of DAI.
A. If a patient is on a spine board, placing in them in reverse Trendelenburg position may help
prevent oxygen desaturation during intubation. This is not a trauma patient, so this is not the
priority intervention.
B. Admin of meds to mitigate adverse effects occurs during the pretreatment phase of DAI.
Admin of opioid before intubation may reduce myocardial oxygen consumption and pulmonary
artery pressure that might increase from intubation; however, this practice is evaluated on a
case-by-case basis and not recommended routinely.
C. Assisted ventilation with a bag-mask device is not recommended because of the risk for
aspiration. Positive pressure ventilation may be indicated during the preoxygenation phase of
DAI for those patients unable to achieve an oxygen saturation at or above 94%. This is not the
priority intervention in this scenario.
, A patient presents complaining of lower abd px and the inability to void in the past 24 hrs.
Which of the following is the priority intervention for this pt?
A. Obtaining a full set of VS
B. Preparing the patient for an abd radiograph
C. Inserting a urinary catheter
D. Administering an IV fluid bolus of 500 mL - ANS ✔✔C. Inserting a urinary catheter
C. The priority intervention should be to relieve pressure within the bladder and prevent
bladder rupture. This accomplished by the insertion of an indwelling urinary catheter.
A. Although VS are important, relieving bladder pressure is the priority.
B. Computed tomography or abd XR may be needed to rule out bladder calculi, which is one of
several etiologies that may be responsible for urinary retention; however, the priority
intervention is to relieve the bladder pressure and prevent bladder rupture.
D. A lack of urinary output may be related to fluid volume status; however, the pt's absolute
inability to void along w/ lower abd discomfort, strongly suggests that urinary retention, not
hypovolemia, is the underlying problem to be addressed.
An ED patient has been diagnosed w/ a subarachnoid hemorrhage (SAH). Which med is the
priority for this pt?
A. Antiemetic
B. Antiepileptic
C. Antihypertensive
D. Calcium Channel Blocker - ANS ✔✔C. Antihypertensive
(CEN Prep Test 1)
A patient is noted to have red, painless spots on the palms and soles, red, painful nodes in the
pad of the fingers and toes, and splinter hemorrhages under the nails, as well as an elevated
body temperature and elevated WBC count. The emergency nurse suspects the patient has:
A. Endocarditis
B. Pericarditis
C. Myocarditis
D. Leukemia - ANS ✔✔A. Endocarditis
A. Endocarditis. The patient's symptoms are classic for endocarditis. petechial lesions found on
the palms of the hands or soles of the feet are known as Janeway lesions. Painful fingertip
nodes or lesion are known as Osler's nodes. The patient may experience fevers along with an
elevated WBC count. Endocarditis is a bacterial infection: possible causes included damaged or
abnormal heart valve, parenteral drug addiction, and long-term IV access. The endocarditic
infection may also spread to valve str4uctures to the heart, resulting in permanent valvular
dysfunction.
B. Pericarditis, or inflammation of the pericardial sac, is characterized by an elevation in WBC
count, a pericardial friction rub, and ST changes throughout the electrocardiogram. Pericarditis
is not associated w/ elevated WBC count.
C. Myocarditis, or inflammation of the cardiac muscle, is characterized by CP, cardiac rhythm
abnormalities, poor nutrition, and fatigue. Myocarditis is typically a viral infection that present
w/ fever and elevate WBC count.
D. Leukemia, or cancer of the blood system, is dx by abnormalities in WBC counts. A rash may
also be present w/ certain types of leukemia
,A conscious pulseless pt w/ a continuous-flow left ventricular assist device and a hx of end-stage
HF presents to the ED because of a "low-flow" alarm. Which of the following interventions
would be appropriate in the scenario?
A. Obtain an automatic BP
B. Exchange the controller
C. Administer IV fluids
D. Begin chest compressions - ANS ✔✔C. Administer IV fluids
C. Administer IV fluids
Fluids should be initiated. The "low-flow" alarm may be due to decreased preload from
hypotension, dehydration, obstruction of the inflow or outflow (which would cause an increase
in afterload) cannula, or disconnections or percutaneous leads. In a stable patient, the provider
should focus efforts on identifying the potential causes of the alarm.
A. With no palpable pulse, obtaining a mechanical BP is usually not feasible. A mean arterial BP
(MAP) should be obtained by placing a Doppler over the brachial or radial artery and then
inflating the cuff until flow is no longer heard. Once the arterial flow is head again, this is the
MAP. Left ventricle assist device (LVAD) patients should have MAPs between 70 and 80 mm Hg.
In a conscious patient, determining the patient's BP will help guide therapy and
troubleshooting. The patient's LVAD coordinator should also be contacted as soon as possible.
B. The controller should be changed only in consultation with a trained professional from the
VAD team. patients are instructed to carry a backup controller in case of malfunction.
D. Chest compressions are not indicated in a conscious patient. Patients with continuous-flow
LVADs often do not have a palpable pulse because the device is pumping constantly throughout
the cardiac cycle; this causes aortic flow to be present during diastole, leading to reduced pulse
pressure. Chest compressions may be indicated fi a patient w/ an LVAD is unconscious,
,pulseless, and intubated with a PetCO2 < 20 mm Hg because this may indicate severely impaired
systemic perfusion.c
A nurse is preparing to assist w/ drug-assisted intubation (DAI) for a patient in severe respiratory
distress w/ a pulse ox reading of 91%. Which of the following is the priority intervention for
preoxygenating the patient?
A. Place the patient in reverse Trendelenburg
B. Administer an opiod
C. Use positive pressure ventilation
D. Provide high-flow oxygen - ANS ✔✔D. Provide high-flow oxygen
D. Providing high-flow oxygen at the highest concentration available will prepare the patient
tolerate the period of apnea and precent oxygen desaturation during intubation. This is the
priority intervention during the preoxygenation phase of DAI.
A. If a patient is on a spine board, placing in them in reverse Trendelenburg position may help
prevent oxygen desaturation during intubation. This is not a trauma patient, so this is not the
priority intervention.
B. Admin of meds to mitigate adverse effects occurs during the pretreatment phase of DAI.
Admin of opioid before intubation may reduce myocardial oxygen consumption and pulmonary
artery pressure that might increase from intubation; however, this practice is evaluated on a
case-by-case basis and not recommended routinely.
C. Assisted ventilation with a bag-mask device is not recommended because of the risk for
aspiration. Positive pressure ventilation may be indicated during the preoxygenation phase of
DAI for those patients unable to achieve an oxygen saturation at or above 94%. This is not the
priority intervention in this scenario.
, A patient presents complaining of lower abd px and the inability to void in the past 24 hrs.
Which of the following is the priority intervention for this pt?
A. Obtaining a full set of VS
B. Preparing the patient for an abd radiograph
C. Inserting a urinary catheter
D. Administering an IV fluid bolus of 500 mL - ANS ✔✔C. Inserting a urinary catheter
C. The priority intervention should be to relieve pressure within the bladder and prevent
bladder rupture. This accomplished by the insertion of an indwelling urinary catheter.
A. Although VS are important, relieving bladder pressure is the priority.
B. Computed tomography or abd XR may be needed to rule out bladder calculi, which is one of
several etiologies that may be responsible for urinary retention; however, the priority
intervention is to relieve the bladder pressure and prevent bladder rupture.
D. A lack of urinary output may be related to fluid volume status; however, the pt's absolute
inability to void along w/ lower abd discomfort, strongly suggests that urinary retention, not
hypovolemia, is the underlying problem to be addressed.
An ED patient has been diagnosed w/ a subarachnoid hemorrhage (SAH). Which med is the
priority for this pt?
A. Antiemetic
B. Antiepileptic
C. Antihypertensive
D. Calcium Channel Blocker - ANS ✔✔C. Antihypertensive
