CEN (CErtifiEd EmErgENCy NursE)
Exam NursE aCtuaL Exam 2026/2027
| BCEN CoNtENt outLiNE | PraCtiCE
tEst with aCtuaL QuEstioNs |
VErifiEd Q&a | Pass guaraNtEEd - a+
gradEd
Cardiovascular Emergencies (13%)
Question 1
A 68-year-old male presents with crushing substernal chest pain radiating to his left jaw,
diaphoresis, and nausea. His initial 12-lead ECG shows ST-segment elevation in leads V1-V4.
Which intervention is the HIGHEST priority after obtaining IV access and administering
oxygen?
A) Administer sublingual nitroglycerin
B) Obtain a portable chest X-ray
C) Activate the STEMI protocol for emergent percutaneous coronary intervention (PCI)
D) Administer intravenous morphine sulfate for pain relief
Answer: C) Activate the STEMI protocol for emergent percutaneous coronary intervention
(PCI)
Rationale: ST-segment elevation in leads V1-V4 indicates an acute anterior wall myocardial
infarction. For STEMI patients, the priority is rapid reperfusion. PCI is the preferred method if it
can be performed within 90 minutes of first medical contact. While nitroglycerin and morphine
are important for pain and preload reduction, they should not delay activation of the STEMI
protocol. A chest X-ray is not the priority in the acute phase.
1
, Question 2
A 55-year-old female with a history of hypertension presents with acute onset of severe
"tearing" chest pain that radiates to her back. Her blood pressure is 160/94 mmHg in the right
arm and 142/86 mmHg in the left arm. Which diagnosis should the nurse suspect?
A) Acute myocardial infarction
B) Acute pericarditis
C) Aortic dissection
D) Pulmonary embolism
Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe tearing or ripping chest
pain that may radiate to the back. A key finding is blood pressure differential between arms
(often >20 mmHg difference). This is a life-threatening emergency requiring immediate surgical
consultation and blood pressure control.
Question 3
A patient in the ED with new-onset atrial fibrillation has a heart rate of 150 bpm and is
hemodynamically stable. Which medication is most appropriate for rate control?
A) Amiodarone
B) Diltiazem
C) Lidocaine
D) Adenosine
Answer: B) Diltiazem
Rationale: For hemodynamically stable patients with atrial fibrillation, rate control is achieved
with either a calcium channel blocker (diltiazem or verapamil) or a beta-blocker. Diltiazem is
commonly used due to its rapid onset and effectiveness. Amiodarone is used for rhythm control
in unstable patients. Lidocaine is for ventricular arrhythmias. Adenosine is for supraventricular
tachycardias.
Question 4
2
, A patient with suspected cardiac tamponade has Beck's triad. Which findings are included in
this triad?
A) Hypotension, muffled heart sounds, and jugular venous distension
B) Hypertension, muffled heart sounds, and diminished pulses
C) Hypotension, pericardial friction rub, and pulsus paradoxus
D) Hypertension, tachycardia, and diminished pulses
Answer: A) Hypotension, muffled heart sounds, and jugular venous distension
Rationale: Beck's triad is the classic presentation of cardiac tamponade and includes
hypotension (from decreased cardiac output), muffled heart sounds (from fluid accumulation in
the pericardial sac), and jugular venous distension (from impaired right ventricular filling).
Question 5
A 72-year-old with a history of CHF presents with acute shortness of breath, pink frothy
sputum, and crackles throughout all lung fields. The nurse should anticipate which initial
intervention?
A) IV furosemide and high-flow oxygen
B) IV epinephrine and albuterol nebulizer
C) Chest tube insertion
D) Cardiac catheterization
Answer: A) IV furosemide and high-flow oxygen
Rationale: The patient is in acute cardiogenic pulmonary edema. Initial management includes
high-flow oxygen and IV loop diuretics (furosemide) to reduce preload and pulmonary
congestion. Nitroglycerin and morphine may also be used. Albuterol is for bronchospasm. Chest
tube is for pneumothorax/hemothorax.
Question 6
Which rhythm is characterized by a chaotic, irregular baseline with no discernible P waves and
an irregularly irregular ventricular response?
A) Ventricular tachycardia
B) Atrial flutter
C) Atrial fibrillation
D) Supraventricular tachycardia
3
, Answer: C) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an absence of P waves, replaced by a chaotic,
irregular baseline (fibrillatory waves), and an irregularly irregular ventricular response. This is
the most common sustained dysrhythmia in emergency settings.
Question 7
A patient in ventricular tachycardia without a pulse requires immediate:
A) Defibrillation
B) Synchronized cardioversion
C) IV amiodarone
D) Vagal maneuvers
Answer: A) Defibrillation
Rationale: Pulseless ventricular tachycardia is a shockable rhythm. Immediate defibrillation is
indicated at 200J biphasic. This is a cardiac arrest situation following the ACLS pulseless arrest
algorithm. Synchronized cardioversion is used for unstable, perfusing rhythms. Amiodarone is
given after defibrillation attempts.
Question 8
A patient presents with chest pain and ECG showing widespread ST-segment elevation with
PR-segment depression. The nurse should suspect:
A) STEMI
B) Pericarditis
C) Pulmonary embolism
D) Hyperkalemia
Answer: B) Pericarditis
Rationale: Acute pericarditis presents with widespread ST-segment elevation (typically concave
upward) and PR-segment depression. This differs from STEMI, which shows regional ST
elevation with reciprocal changes. Pericarditis pain is often positional, worsened by lying flat.
Question 9
4
Exam NursE aCtuaL Exam 2026/2027
| BCEN CoNtENt outLiNE | PraCtiCE
tEst with aCtuaL QuEstioNs |
VErifiEd Q&a | Pass guaraNtEEd - a+
gradEd
Cardiovascular Emergencies (13%)
Question 1
A 68-year-old male presents with crushing substernal chest pain radiating to his left jaw,
diaphoresis, and nausea. His initial 12-lead ECG shows ST-segment elevation in leads V1-V4.
Which intervention is the HIGHEST priority after obtaining IV access and administering
oxygen?
A) Administer sublingual nitroglycerin
B) Obtain a portable chest X-ray
C) Activate the STEMI protocol for emergent percutaneous coronary intervention (PCI)
D) Administer intravenous morphine sulfate for pain relief
Answer: C) Activate the STEMI protocol for emergent percutaneous coronary intervention
(PCI)
Rationale: ST-segment elevation in leads V1-V4 indicates an acute anterior wall myocardial
infarction. For STEMI patients, the priority is rapid reperfusion. PCI is the preferred method if it
can be performed within 90 minutes of first medical contact. While nitroglycerin and morphine
are important for pain and preload reduction, they should not delay activation of the STEMI
protocol. A chest X-ray is not the priority in the acute phase.
1
, Question 2
A 55-year-old female with a history of hypertension presents with acute onset of severe
"tearing" chest pain that radiates to her back. Her blood pressure is 160/94 mmHg in the right
arm and 142/86 mmHg in the left arm. Which diagnosis should the nurse suspect?
A) Acute myocardial infarction
B) Acute pericarditis
C) Aortic dissection
D) Pulmonary embolism
Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe tearing or ripping chest
pain that may radiate to the back. A key finding is blood pressure differential between arms
(often >20 mmHg difference). This is a life-threatening emergency requiring immediate surgical
consultation and blood pressure control.
Question 3
A patient in the ED with new-onset atrial fibrillation has a heart rate of 150 bpm and is
hemodynamically stable. Which medication is most appropriate for rate control?
A) Amiodarone
B) Diltiazem
C) Lidocaine
D) Adenosine
Answer: B) Diltiazem
Rationale: For hemodynamically stable patients with atrial fibrillation, rate control is achieved
with either a calcium channel blocker (diltiazem or verapamil) or a beta-blocker. Diltiazem is
commonly used due to its rapid onset and effectiveness. Amiodarone is used for rhythm control
in unstable patients. Lidocaine is for ventricular arrhythmias. Adenosine is for supraventricular
tachycardias.
Question 4
2
, A patient with suspected cardiac tamponade has Beck's triad. Which findings are included in
this triad?
A) Hypotension, muffled heart sounds, and jugular venous distension
B) Hypertension, muffled heart sounds, and diminished pulses
C) Hypotension, pericardial friction rub, and pulsus paradoxus
D) Hypertension, tachycardia, and diminished pulses
Answer: A) Hypotension, muffled heart sounds, and jugular venous distension
Rationale: Beck's triad is the classic presentation of cardiac tamponade and includes
hypotension (from decreased cardiac output), muffled heart sounds (from fluid accumulation in
the pericardial sac), and jugular venous distension (from impaired right ventricular filling).
Question 5
A 72-year-old with a history of CHF presents with acute shortness of breath, pink frothy
sputum, and crackles throughout all lung fields. The nurse should anticipate which initial
intervention?
A) IV furosemide and high-flow oxygen
B) IV epinephrine and albuterol nebulizer
C) Chest tube insertion
D) Cardiac catheterization
Answer: A) IV furosemide and high-flow oxygen
Rationale: The patient is in acute cardiogenic pulmonary edema. Initial management includes
high-flow oxygen and IV loop diuretics (furosemide) to reduce preload and pulmonary
congestion. Nitroglycerin and morphine may also be used. Albuterol is for bronchospasm. Chest
tube is for pneumothorax/hemothorax.
Question 6
Which rhythm is characterized by a chaotic, irregular baseline with no discernible P waves and
an irregularly irregular ventricular response?
A) Ventricular tachycardia
B) Atrial flutter
C) Atrial fibrillation
D) Supraventricular tachycardia
3
, Answer: C) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an absence of P waves, replaced by a chaotic,
irregular baseline (fibrillatory waves), and an irregularly irregular ventricular response. This is
the most common sustained dysrhythmia in emergency settings.
Question 7
A patient in ventricular tachycardia without a pulse requires immediate:
A) Defibrillation
B) Synchronized cardioversion
C) IV amiodarone
D) Vagal maneuvers
Answer: A) Defibrillation
Rationale: Pulseless ventricular tachycardia is a shockable rhythm. Immediate defibrillation is
indicated at 200J biphasic. This is a cardiac arrest situation following the ACLS pulseless arrest
algorithm. Synchronized cardioversion is used for unstable, perfusing rhythms. Amiodarone is
given after defibrillation attempts.
Question 8
A patient presents with chest pain and ECG showing widespread ST-segment elevation with
PR-segment depression. The nurse should suspect:
A) STEMI
B) Pericarditis
C) Pulmonary embolism
D) Hyperkalemia
Answer: B) Pericarditis
Rationale: Acute pericarditis presents with widespread ST-segment elevation (typically concave
upward) and PR-segment depression. This differs from STEMI, which shows regional ST
elevation with reciprocal changes. Pericarditis pain is often positional, worsened by lying flat.
Question 9
4
