CEN Study Questions: Emergency Nursing Practice Exam Questions with Answers & Rationales
(CEN Exam Prep)
The nurse is caring for a patient who sustained severe crush injuries after being trapped under a
car. Upon arrival to the trauma bay, the patient requires intubation. The nurse should seek
clarification with which of the following orders?
A) ketamine (Ketalar)
B) etomidate (Amidate)
C) succinylcholine (Quelicin)
D) rocuronium (Zemuron) - ANS ✔✔C
The treatment team should be cautious of hyperkalemia with crush injuries as the damaged
tissues and cells release potassium into the system. Succinylcholine is known to increase
hyperkalemia and in the presence of existing hyperkalemia can result in dysrhythmias.
Depending on the timeframe in which the original injury occurred, succinylcholine may still be
safe but it would be prudent of the nurse to clarify this with the provider prior to
administration.
A trauma patient complains of shoulder pain, but has no history or evidence of shoulder injury.
The patient should be examined for possible?
A) injury to the cervical spine.
B) visceral injury.
C) pneumothorax.
D) damage to the ulnar nerve. - ANS ✔✔B
Injury to the spleen can manifest itself with pain that is referred to the left shoulder (Kehr's
sign). A visceral injury may be the cause of the referred pain, secondary to stimulation of the
phrenic nerve due to abdominal distention or irritation of the diaphragm
,The nurse is caring for an unresponsive, intubated patient who was found floating on top of the
water in a pool. The event was unwitnessed. The ED nurse anticipates this is the highest
priority?
A) gastric tube insertion.
B) cervical spine stabilization.
C) fluid resuscitation.
D) re-warming protocols. - ANS ✔✔B
The unwitnessed injury and resulting patient status means c-spine stabilization is the highest
priority as traumatic injury cannot be ruled out. Protecting the c-spine from further injury is the
highest priority for this patient. Rewarming protocols, fluid resuscitation and gastric tube
insertion are appropriate for this patient's treatment, however they are not higher priority than
stabilizing the cervical spine.
A patient presents with a shoulder dislocation after a fall. The patient smells of alcohol, has
slightly slurred speech, and answers questions appropriately. The nurse should prepare to ?
A) obtain the patient's consent for a shoulder reduction.
B) collect a blood alcohol level.
C) monitor peripheral pulses until signs of intoxication are absent.
D) contact the patient's family. - ANS ✔✔A
Alcohol itself does not render a patient incompetent to give informed consent. The emergency
clinician should evaluate each situation individually to determine whether the patient is
incapacitated to the extent that they are unable to understand the proposed treatment, risks
and benefits, and rational alternatives. In a healthcare setting, measured blood alcohol
concentration does not necessarily indicate a person's ability to comprehend. Chronic alcoholics
can be entirely rational and competent with a high blood alcohol concentration. Monitoring
,circulation in the affected extremity should continue but is not definitive care. The patient is not
a minor, is able to answer questions appropriately, has no documented mental defects, and is
able to understand risks and benefits of the procedure, therefore a legal guardian is not
required for decisions to be made.
A patient would MOST likely require rabies prophylaxis if they?
A) handled raccoon stool.
B) came in contact with a person diagnosed with rabies.
C) were bitten by a neighbor's dog.
D) were bitten by a bat. - ANS ✔✔D
Bats commonly carry rabies, so prophylaxis treatment is recommended if bitten. Contact with a
person with rabies does not cause transmission of the disease. While raccoon's may carry the
rabies disease, it is not transmitted in their stool. A bite from a neighborhood dog may not
require initial rabies prophylaxis as the dog can be quarantined.
Which of the following symptoms is MOST characteristic of early left ventricular failure?
A) nocturnal dyspnea
B) peripheral edema
C) expiratory wheezing
D) jugular venous distention - ANS ✔✔A
Left ventricular failure causes blood to back up into the lungs. This can produce paroxysmal
nocturnal dyspnea. The other findings listed are symptoms of right sided heart failure. In LATE
left ventricular failure, the right heart will also fail and will then produce peripheral edema,
jugular vein distention, and expiratory wheezing (cardiac asthma).
, A patient presents with vision changes to the right eye, fever, fatigue and a rash on the nose and
forehead for two days. Extraocular movement is intact in the right eye. The nurse suspects?
A) orbital cellulitis.
B) ischemic stroke.
C) herpes zoster ophthalmicus.
D) conjunctivitis. - ANS ✔✔C
Herpes zoster ophthalmicus is an emergent condition involving a shingles infection to the
ophthalmic division of the trigeminal nerve. Hutchinson sign (involvement of the nose) is a likely
sign in the earlier stages of infection that the eye will be involved. Complications from this
condition include postherpetic neuralgia and vision loss. Conjunctivitis usually presents with
redness and swelling to the conjunctiva and drainage, none of which is reported or observed
with this patient's assessment. Unilateral vision changes could be a sign of an ischemic stroke;
however, fever, rash and fatigue make this less likely in this patient. Assessment of intact EOM
helps to rule out orbital cellulitis.
The nurse is caring for a patient who had a traumatic amputation of the foot. The BEST way to
care for the amputated part is to?
A) wrap the part in sterile gauze moistened with normal saline.
B) place the part in a container with sterile water.
C) wrap the part in dry sterile gauze.
D) place the part directly in chilled normal saline. - ANS ✔✔A
When caring for an amputated body part the part should be wrapped in sterile gauze and
moistened with normal saline or lactated ringers. An amputated body part should not be soaked
as it causes a fluid shift and further tissue damage.
(CEN Exam Prep)
The nurse is caring for a patient who sustained severe crush injuries after being trapped under a
car. Upon arrival to the trauma bay, the patient requires intubation. The nurse should seek
clarification with which of the following orders?
A) ketamine (Ketalar)
B) etomidate (Amidate)
C) succinylcholine (Quelicin)
D) rocuronium (Zemuron) - ANS ✔✔C
The treatment team should be cautious of hyperkalemia with crush injuries as the damaged
tissues and cells release potassium into the system. Succinylcholine is known to increase
hyperkalemia and in the presence of existing hyperkalemia can result in dysrhythmias.
Depending on the timeframe in which the original injury occurred, succinylcholine may still be
safe but it would be prudent of the nurse to clarify this with the provider prior to
administration.
A trauma patient complains of shoulder pain, but has no history or evidence of shoulder injury.
The patient should be examined for possible?
A) injury to the cervical spine.
B) visceral injury.
C) pneumothorax.
D) damage to the ulnar nerve. - ANS ✔✔B
Injury to the spleen can manifest itself with pain that is referred to the left shoulder (Kehr's
sign). A visceral injury may be the cause of the referred pain, secondary to stimulation of the
phrenic nerve due to abdominal distention or irritation of the diaphragm
,The nurse is caring for an unresponsive, intubated patient who was found floating on top of the
water in a pool. The event was unwitnessed. The ED nurse anticipates this is the highest
priority?
A) gastric tube insertion.
B) cervical spine stabilization.
C) fluid resuscitation.
D) re-warming protocols. - ANS ✔✔B
The unwitnessed injury and resulting patient status means c-spine stabilization is the highest
priority as traumatic injury cannot be ruled out. Protecting the c-spine from further injury is the
highest priority for this patient. Rewarming protocols, fluid resuscitation and gastric tube
insertion are appropriate for this patient's treatment, however they are not higher priority than
stabilizing the cervical spine.
A patient presents with a shoulder dislocation after a fall. The patient smells of alcohol, has
slightly slurred speech, and answers questions appropriately. The nurse should prepare to ?
A) obtain the patient's consent for a shoulder reduction.
B) collect a blood alcohol level.
C) monitor peripheral pulses until signs of intoxication are absent.
D) contact the patient's family. - ANS ✔✔A
Alcohol itself does not render a patient incompetent to give informed consent. The emergency
clinician should evaluate each situation individually to determine whether the patient is
incapacitated to the extent that they are unable to understand the proposed treatment, risks
and benefits, and rational alternatives. In a healthcare setting, measured blood alcohol
concentration does not necessarily indicate a person's ability to comprehend. Chronic alcoholics
can be entirely rational and competent with a high blood alcohol concentration. Monitoring
,circulation in the affected extremity should continue but is not definitive care. The patient is not
a minor, is able to answer questions appropriately, has no documented mental defects, and is
able to understand risks and benefits of the procedure, therefore a legal guardian is not
required for decisions to be made.
A patient would MOST likely require rabies prophylaxis if they?
A) handled raccoon stool.
B) came in contact with a person diagnosed with rabies.
C) were bitten by a neighbor's dog.
D) were bitten by a bat. - ANS ✔✔D
Bats commonly carry rabies, so prophylaxis treatment is recommended if bitten. Contact with a
person with rabies does not cause transmission of the disease. While raccoon's may carry the
rabies disease, it is not transmitted in their stool. A bite from a neighborhood dog may not
require initial rabies prophylaxis as the dog can be quarantined.
Which of the following symptoms is MOST characteristic of early left ventricular failure?
A) nocturnal dyspnea
B) peripheral edema
C) expiratory wheezing
D) jugular venous distention - ANS ✔✔A
Left ventricular failure causes blood to back up into the lungs. This can produce paroxysmal
nocturnal dyspnea. The other findings listed are symptoms of right sided heart failure. In LATE
left ventricular failure, the right heart will also fail and will then produce peripheral edema,
jugular vein distention, and expiratory wheezing (cardiac asthma).
, A patient presents with vision changes to the right eye, fever, fatigue and a rash on the nose and
forehead for two days. Extraocular movement is intact in the right eye. The nurse suspects?
A) orbital cellulitis.
B) ischemic stroke.
C) herpes zoster ophthalmicus.
D) conjunctivitis. - ANS ✔✔C
Herpes zoster ophthalmicus is an emergent condition involving a shingles infection to the
ophthalmic division of the trigeminal nerve. Hutchinson sign (involvement of the nose) is a likely
sign in the earlier stages of infection that the eye will be involved. Complications from this
condition include postherpetic neuralgia and vision loss. Conjunctivitis usually presents with
redness and swelling to the conjunctiva and drainage, none of which is reported or observed
with this patient's assessment. Unilateral vision changes could be a sign of an ischemic stroke;
however, fever, rash and fatigue make this less likely in this patient. Assessment of intact EOM
helps to rule out orbital cellulitis.
The nurse is caring for a patient who had a traumatic amputation of the foot. The BEST way to
care for the amputated part is to?
A) wrap the part in sterile gauze moistened with normal saline.
B) place the part in a container with sterile water.
C) wrap the part in dry sterile gauze.
D) place the part directly in chilled normal saline. - ANS ✔✔A
When caring for an amputated body part the part should be wrapped in sterile gauze and
moistened with normal saline or lactated ringers. An amputated body part should not be soaked
as it causes a fluid shift and further tissue damage.
