CEN Review 8: Emergency Nursing Certification Exam Prep, High-Yield Topics & Practice
Questions
Which dysrhythmia would be identified on an ECG/EKG six-second strip by a heart rate of 76
and a PR interval of 0.24?
a.sinus tachycardia
b.first-degree atrioventricular block
c.sinus bradycardia
d.junctional escape rhythm - ANS ✔✔B: First-degree atrioventricular block is diagnosed partially
by an EKG showing a PR interval of greater than 0.20 seconds.
Which blood test may indicate infection or inflammation and would need to be used as part of
the clinical picture with diagnosing and treating abdominal pain?
a.white blood cell (WBC) count of 5.0
b.hematocrit (HCT) of 45
c.WBC count of 28.0
d.blood sugar (BS) of 74 - ANS ✔✔C: An elevated WBC count would be indicative of infection or
inflammation. The WBC count of 5.0 is normal. The HCT and BS levels listed would also be
considered within normal limits.
A 30-year-old man comes to the emergency department with the acute onset of left flank pain
radiating to the groin. Microscopic hematuria is present on urinalysis. What is the most likely
diagnosis?
a.ureteral calcium oxalate calculus
b.ureteral cystine calculus
c.testicular torsion
d.cystitis - ANS ✔✔A: Ureteral calculi are a quite common cause of acute emergency evaluation,
usually causing flank pain with radiation to the back and/or groin. About 75% of these are
,calcium oxalate or phosphate; less common are struvite, uric acid, or cystine calculi. While KUB
or ultrasound may show the stone, helical CT is now the preferred diagnostic method.
Additional workup includes CBC, chemistry panel, urinalysis, and straining of urine to catch a
passed stone for chemical analysis. Nursing attention should be directed to intravenous
hydration with input and output recording and narcotic or narcotic plus NSAID (e.g., ketorolac)
administration for pain. Some patients may be discharged with analgesics and instructions for
hydration and calculus capture. Testicular torsion is most common in adolescents and usually
presents with testicular and groin pain with abdominal radiation; increasing pain by lifting the
scrotum to the level of the pubic symphysis causes exacerbation of the pain (Prehn sign). Cystitis
may be infectious or drug-induced, but cystitis usually causes dysuria and pyuria and shows
positive urine cultures.
Which of the following is NOT appropriate for screening for domestic violence by the emergency
department nurse?
a.asking if the person has been hit, kicked, or otherwise hurt by someone in the past year; if so,
by whom
b.asking, "Do you feel safe in your present relationship?"
c.avoid asking about intimate person violence if the patient is in the emergency department for
a medical ailment, not trauma
d.asking if there is a partner from a previous relationship that makes the individual feel unsafe -
ANS ✔✔C: Domestic violence, nearly always perpetrated against women, is a major problem
confronted by the emergency nurse. Screening for possible cases should include answers A, B
and D. Interestingly, victims of intimate partner violence often present with a medical ailment,
not trauma. These include back, abdominal, or pelvic pain, headaches, urinary infections,
sexually transmitted disease, or symptoms consistent with posttraumatic stress disorder (PTSD).
Sometimes evidence of old trauma such as healing fractures or cosmetically concealed bruises
may point toward the presence of domestic violence. Many victims will deny it but sometimes
compassionate questioning in a private setting will elicit a positive response. The nurse may
then offer advice, refer to a social agency or shelter, or ask for a consultation by the hospital
social worker.
A patient is intubated and on mechanical ventilation. The ventilator alarm rings and the airway
pressure is found to be elevated. Possible causes include the following EXCEPT:
a.endotracheal tube obstruction with sputum
,b.pneumothorax
c.bronchospasm
d.cuff leak - ANS ✔✔D: Mechanical ventilation requires diligent observation of the patient and
ventilator by the emergency nurse. Modern ventilators usually come with alarms that indicate
high or low airway pressure. High pressure may be caused by endotracheal tube obstruction
with sputum or kinks or inadvertent endobronchial displacement. The airway should be
suctioned and tube placement checked. A chest x-ray is frequently helpful in determining the
cause. Lung collapse, worsening of the underlying disease, and bronchospasm are also causes of
elevated pressure. Leaks around the endotracheal tube cuffs will cause low airway pressure.
Auto-positive end-expiratory pressure (auto-PEEP) is caused by premature inspiratory delivery
before full expiration (as in asthma or COPD patients) and may lead to increased pressure and
lung damage.
A 2-year-old is brought to the emergency department with mild fever, persistent restlessness,
crying, and pulling his left ear. He has had a cold for about a week. Examination of the ear
reveals a distorted light reflex and slight bulging of the tympanic membrane. What is the proper
diagnosis and treatment?
a.otitis externa and antibiotics
b.otitis media and antibiotics
c.otitis media and myringotomy
d.acute labyrinthitis and antivertigo drug - ANS ✔✔B: Ear infections may cause severe and
persistent pain, especially in children in the 6-month to 3-year age group and are a frequent
cause of emergency department visits. Loss or distortion of the light reflex and bulging of the
tympanic membrane are cardinal signs of otitis media, usually caused by bacteria such as
Streptococcus Influenza or Haemophilus Influenza. Sinusitis and purulent rhinitis may
accompany the otitis. Antibiotics to cover these organisms, topical warmed otic analgesics, and
antipyretics are the usual treatment modalities. Otitis externa or swimmer's ear also causes
otalgia and frequently follows swimming in contaminated water or a foreign body in the ear.
Keeping the ear dry and using otic analgesics and antibiotics are indicated. Ear plugs while
swimming or ear drying agents after swimming or showering are the usual preventive measures.
Myringotomy is a surgical procedure to keep the middle ear draining in chronic otitis media and
hopefully prevent such complications as mastoiditis, meningitis, ruptured tympanic membrane,
or permanent hearing loss. Labyrinthitis is an infection of the inner ear and usually causes
severe vertigo, most commonly in adults.
, A 75-year-old man has a history of several episodes of transient right-sided arm and hand
weakness lasting an hour or two but with full recovery. He is diabetic and hypertensive and is
taking medication for both conditions. This time the episode does not resolve and he is taken to
the emergency department some 2 hours after the onset of symptoms. He is awake and able to
answer questions and give a medical history. His chest is clear and no bruits are heard over the
carotids. There is drift of the right arm on examination and his speech is slightly garbled. His
blood pressure is 160/95 mm Hg and his pulse is irregular at 80 beats per minute. A CT of the
brain reveals a small left-sided occlusion in a branch of the middle cerebral arterial circulation
without hemorrhage. What should be the next step in his management?
a.start nitroprusside to reduce his blood pressure to normal
b.begin fibrinolytic therapy with altep - ANS ✔✔B: This patient had several transient ischemic
attacks prior to his clear-cut signs of a stroke, shown to be nonhemorrhagic in nature. Such
strokes may be caused by local thrombosis, especially in arteriosclerotic vessels, or by emboli
arising in the carotid artery (usually at the bifurcation of the internal and external vessels) or the
heart, most often in atrial fibrillation patients with clots in the atrial appendage. Because this
patient arrived in the emergency department within 3 hours from the onset of symptoms, the
current recommendation is to begin fibrinolytic therapy with recombinant tissue plasminogen
activator (r-TPA). Some recent studies indicate benefit from this therapy may be achieved up to
4.5 hours after the onset of symptoms. Blood pressure management in stroke patients is tricky.
Most would agree with slow reduction if the value is greater than 220 systolic or 120 diastolic or
the stroke is hemorrhagic in nature. For patients treated with a fibrinolytic agent, significantly
elevated blood pressure should be lowered to prevent reperfusion problems. If noninvasive
carotid scanning shows marked stenosis, neurosurgical consultation for endarterectomy or
angioplasty with stent placement is reasonable. Subsequent warfarin treatment may be
appropriate if atrial fibrillation is present.
A chronically anemic patient is receiving a packed red blood cell (PRBC) transfusion. He
suddenly develops fever and chills, tachypnea and dyspnea, and tightness in the chest. His urine
flow is diminished and dark in color. What is the probable diagnosis and appropriate measures
to take?
a.air embolus; stop infusion, administer oxygen, and turn patient on left side
b.hemolytic transfusion reaction; stop transfusion, send the untransfused blood and a patient
blood sample to the blood bank, monitor urine flow and collect sample for the lab
Questions
Which dysrhythmia would be identified on an ECG/EKG six-second strip by a heart rate of 76
and a PR interval of 0.24?
a.sinus tachycardia
b.first-degree atrioventricular block
c.sinus bradycardia
d.junctional escape rhythm - ANS ✔✔B: First-degree atrioventricular block is diagnosed partially
by an EKG showing a PR interval of greater than 0.20 seconds.
Which blood test may indicate infection or inflammation and would need to be used as part of
the clinical picture with diagnosing and treating abdominal pain?
a.white blood cell (WBC) count of 5.0
b.hematocrit (HCT) of 45
c.WBC count of 28.0
d.blood sugar (BS) of 74 - ANS ✔✔C: An elevated WBC count would be indicative of infection or
inflammation. The WBC count of 5.0 is normal. The HCT and BS levels listed would also be
considered within normal limits.
A 30-year-old man comes to the emergency department with the acute onset of left flank pain
radiating to the groin. Microscopic hematuria is present on urinalysis. What is the most likely
diagnosis?
a.ureteral calcium oxalate calculus
b.ureteral cystine calculus
c.testicular torsion
d.cystitis - ANS ✔✔A: Ureteral calculi are a quite common cause of acute emergency evaluation,
usually causing flank pain with radiation to the back and/or groin. About 75% of these are
,calcium oxalate or phosphate; less common are struvite, uric acid, or cystine calculi. While KUB
or ultrasound may show the stone, helical CT is now the preferred diagnostic method.
Additional workup includes CBC, chemistry panel, urinalysis, and straining of urine to catch a
passed stone for chemical analysis. Nursing attention should be directed to intravenous
hydration with input and output recording and narcotic or narcotic plus NSAID (e.g., ketorolac)
administration for pain. Some patients may be discharged with analgesics and instructions for
hydration and calculus capture. Testicular torsion is most common in adolescents and usually
presents with testicular and groin pain with abdominal radiation; increasing pain by lifting the
scrotum to the level of the pubic symphysis causes exacerbation of the pain (Prehn sign). Cystitis
may be infectious or drug-induced, but cystitis usually causes dysuria and pyuria and shows
positive urine cultures.
Which of the following is NOT appropriate for screening for domestic violence by the emergency
department nurse?
a.asking if the person has been hit, kicked, or otherwise hurt by someone in the past year; if so,
by whom
b.asking, "Do you feel safe in your present relationship?"
c.avoid asking about intimate person violence if the patient is in the emergency department for
a medical ailment, not trauma
d.asking if there is a partner from a previous relationship that makes the individual feel unsafe -
ANS ✔✔C: Domestic violence, nearly always perpetrated against women, is a major problem
confronted by the emergency nurse. Screening for possible cases should include answers A, B
and D. Interestingly, victims of intimate partner violence often present with a medical ailment,
not trauma. These include back, abdominal, or pelvic pain, headaches, urinary infections,
sexually transmitted disease, or symptoms consistent with posttraumatic stress disorder (PTSD).
Sometimes evidence of old trauma such as healing fractures or cosmetically concealed bruises
may point toward the presence of domestic violence. Many victims will deny it but sometimes
compassionate questioning in a private setting will elicit a positive response. The nurse may
then offer advice, refer to a social agency or shelter, or ask for a consultation by the hospital
social worker.
A patient is intubated and on mechanical ventilation. The ventilator alarm rings and the airway
pressure is found to be elevated. Possible causes include the following EXCEPT:
a.endotracheal tube obstruction with sputum
,b.pneumothorax
c.bronchospasm
d.cuff leak - ANS ✔✔D: Mechanical ventilation requires diligent observation of the patient and
ventilator by the emergency nurse. Modern ventilators usually come with alarms that indicate
high or low airway pressure. High pressure may be caused by endotracheal tube obstruction
with sputum or kinks or inadvertent endobronchial displacement. The airway should be
suctioned and tube placement checked. A chest x-ray is frequently helpful in determining the
cause. Lung collapse, worsening of the underlying disease, and bronchospasm are also causes of
elevated pressure. Leaks around the endotracheal tube cuffs will cause low airway pressure.
Auto-positive end-expiratory pressure (auto-PEEP) is caused by premature inspiratory delivery
before full expiration (as in asthma or COPD patients) and may lead to increased pressure and
lung damage.
A 2-year-old is brought to the emergency department with mild fever, persistent restlessness,
crying, and pulling his left ear. He has had a cold for about a week. Examination of the ear
reveals a distorted light reflex and slight bulging of the tympanic membrane. What is the proper
diagnosis and treatment?
a.otitis externa and antibiotics
b.otitis media and antibiotics
c.otitis media and myringotomy
d.acute labyrinthitis and antivertigo drug - ANS ✔✔B: Ear infections may cause severe and
persistent pain, especially in children in the 6-month to 3-year age group and are a frequent
cause of emergency department visits. Loss or distortion of the light reflex and bulging of the
tympanic membrane are cardinal signs of otitis media, usually caused by bacteria such as
Streptococcus Influenza or Haemophilus Influenza. Sinusitis and purulent rhinitis may
accompany the otitis. Antibiotics to cover these organisms, topical warmed otic analgesics, and
antipyretics are the usual treatment modalities. Otitis externa or swimmer's ear also causes
otalgia and frequently follows swimming in contaminated water or a foreign body in the ear.
Keeping the ear dry and using otic analgesics and antibiotics are indicated. Ear plugs while
swimming or ear drying agents after swimming or showering are the usual preventive measures.
Myringotomy is a surgical procedure to keep the middle ear draining in chronic otitis media and
hopefully prevent such complications as mastoiditis, meningitis, ruptured tympanic membrane,
or permanent hearing loss. Labyrinthitis is an infection of the inner ear and usually causes
severe vertigo, most commonly in adults.
, A 75-year-old man has a history of several episodes of transient right-sided arm and hand
weakness lasting an hour or two but with full recovery. He is diabetic and hypertensive and is
taking medication for both conditions. This time the episode does not resolve and he is taken to
the emergency department some 2 hours after the onset of symptoms. He is awake and able to
answer questions and give a medical history. His chest is clear and no bruits are heard over the
carotids. There is drift of the right arm on examination and his speech is slightly garbled. His
blood pressure is 160/95 mm Hg and his pulse is irregular at 80 beats per minute. A CT of the
brain reveals a small left-sided occlusion in a branch of the middle cerebral arterial circulation
without hemorrhage. What should be the next step in his management?
a.start nitroprusside to reduce his blood pressure to normal
b.begin fibrinolytic therapy with altep - ANS ✔✔B: This patient had several transient ischemic
attacks prior to his clear-cut signs of a stroke, shown to be nonhemorrhagic in nature. Such
strokes may be caused by local thrombosis, especially in arteriosclerotic vessels, or by emboli
arising in the carotid artery (usually at the bifurcation of the internal and external vessels) or the
heart, most often in atrial fibrillation patients with clots in the atrial appendage. Because this
patient arrived in the emergency department within 3 hours from the onset of symptoms, the
current recommendation is to begin fibrinolytic therapy with recombinant tissue plasminogen
activator (r-TPA). Some recent studies indicate benefit from this therapy may be achieved up to
4.5 hours after the onset of symptoms. Blood pressure management in stroke patients is tricky.
Most would agree with slow reduction if the value is greater than 220 systolic or 120 diastolic or
the stroke is hemorrhagic in nature. For patients treated with a fibrinolytic agent, significantly
elevated blood pressure should be lowered to prevent reperfusion problems. If noninvasive
carotid scanning shows marked stenosis, neurosurgical consultation for endarterectomy or
angioplasty with stent placement is reasonable. Subsequent warfarin treatment may be
appropriate if atrial fibrillation is present.
A chronically anemic patient is receiving a packed red blood cell (PRBC) transfusion. He
suddenly develops fever and chills, tachypnea and dyspnea, and tightness in the chest. His urine
flow is diminished and dark in color. What is the probable diagnosis and appropriate measures
to take?
a.air embolus; stop infusion, administer oxygen, and turn patient on left side
b.hemolytic transfusion reaction; stop transfusion, send the untransfused blood and a patient
blood sample to the blood bank, monitor urine flow and collect sample for the lab
