Certified Emergency Nurse (CEN)–Screenshot
Questions & 100% Verified Answers
,Cardiovascular Emergencies
1. A 65-year-old patient presents with chest pain radiating to the back, a blood pressure of 180/40 mmHg in the
right arm and 90/60 mmHg in the left arm. What is the priority intervention?
A. Administer nitroglycerin sublingual
B. Initiate two large-bore IVs and prepare for surgery
C. Obtain a stat CT scan of the chest
D. Administer beta-blocker to reduce heart rate
Answer: B. Initiate two large-bore IVs and prepare for surgery
Rationale: The blood pressure differential and chest pain radiating to the back are classic signs of an aortic
dissection. The priority is aggressive blood pressure and heart rate control (often with beta-blockers first, then
vasodilators) and immediate surgical consultation. Nitroglycerin is contraindicated in suspected right ventricular
infarction and is not the priority here. While a CT scan is diagnostic, stabilizing the patient and preparing for
definitive management takes priority.
2. A patient with atrial fibrillation has a heart rate of 145 bpm, BP 88/50, and is diaphoretic. What is the
immediate treatment of choice?
,A. Diltiazem IV push
B. Synchronized cardioversion
C. Amiodarone 150 mg IV over 10 minutes
D. Digoxin 0.5 mg IV
Answer: B. Synchronized cardioversion
Rationale: The patient is unstable (hypotensive, diaphoretic) with a tachyarrhythmia. Per ACLS guidelines,
unstable tachycardic patients require immediate synchronized cardioversion. Pharmacological agents like
diltiazem, amiodarone, or digoxin are reserved for stable patients or as adjuncts post-cardioversion.
3. What is the most reliable sign of cardiac tamponade?
A. Muffled heart sounds
B. Hypotension
C. Pulsus paradoxus
D. Jugular venous distension (JVD)
Answer: C. Pulsus paradoxus
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) suggests tamponade, but pulsus paradoxus (a
drop in systolic BP >10 mmHg during inspiration) is the most consistent and specific clinical finding. It is not
, exclusive to tamponade (also seen in severe asthma, COPD) but in the context of trauma or chest pain, it is a
key indicator.
4. A patient’s ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left Anterior Descending (LAD)
B. Circumflex
C. Right Coronary Artery (RCA)
D. Left Main
Answer: C. Right Coronary Artery (RCA)
Rationale: Leads II, III, and aVF represent the inferior wall of the heart, which is typically supplied by the RCA.
Inferior MIs are frequently associated with right ventricular infarction, so a right-sided ECG (V4R) should be
obtained.
5. Which thrombolytic agent has the shortest infusion time for acute myocardial infarction?
A. Streptokinase
B. Alteplase (tPA)
C. Tenecteplase (TNK)
Questions & 100% Verified Answers
,Cardiovascular Emergencies
1. A 65-year-old patient presents with chest pain radiating to the back, a blood pressure of 180/40 mmHg in the
right arm and 90/60 mmHg in the left arm. What is the priority intervention?
A. Administer nitroglycerin sublingual
B. Initiate two large-bore IVs and prepare for surgery
C. Obtain a stat CT scan of the chest
D. Administer beta-blocker to reduce heart rate
Answer: B. Initiate two large-bore IVs and prepare for surgery
Rationale: The blood pressure differential and chest pain radiating to the back are classic signs of an aortic
dissection. The priority is aggressive blood pressure and heart rate control (often with beta-blockers first, then
vasodilators) and immediate surgical consultation. Nitroglycerin is contraindicated in suspected right ventricular
infarction and is not the priority here. While a CT scan is diagnostic, stabilizing the patient and preparing for
definitive management takes priority.
2. A patient with atrial fibrillation has a heart rate of 145 bpm, BP 88/50, and is diaphoretic. What is the
immediate treatment of choice?
,A. Diltiazem IV push
B. Synchronized cardioversion
C. Amiodarone 150 mg IV over 10 minutes
D. Digoxin 0.5 mg IV
Answer: B. Synchronized cardioversion
Rationale: The patient is unstable (hypotensive, diaphoretic) with a tachyarrhythmia. Per ACLS guidelines,
unstable tachycardic patients require immediate synchronized cardioversion. Pharmacological agents like
diltiazem, amiodarone, or digoxin are reserved for stable patients or as adjuncts post-cardioversion.
3. What is the most reliable sign of cardiac tamponade?
A. Muffled heart sounds
B. Hypotension
C. Pulsus paradoxus
D. Jugular venous distension (JVD)
Answer: C. Pulsus paradoxus
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) suggests tamponade, but pulsus paradoxus (a
drop in systolic BP >10 mmHg during inspiration) is the most consistent and specific clinical finding. It is not
, exclusive to tamponade (also seen in severe asthma, COPD) but in the context of trauma or chest pain, it is a
key indicator.
4. A patient’s ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left Anterior Descending (LAD)
B. Circumflex
C. Right Coronary Artery (RCA)
D. Left Main
Answer: C. Right Coronary Artery (RCA)
Rationale: Leads II, III, and aVF represent the inferior wall of the heart, which is typically supplied by the RCA.
Inferior MIs are frequently associated with right ventricular infarction, so a right-sided ECG (V4R) should be
obtained.
5. Which thrombolytic agent has the shortest infusion time for acute myocardial infarction?
A. Streptokinase
B. Alteplase (tPA)
C. Tenecteplase (TNK)
