CEN Final Exam 2026 Question Bank – All
Versions Covered (Verified Answers &
Rationales Included)
Question 1
A 45-year-old male presents to the emergency department after a high-speed
motor vehicle collision. He exhibits severe respiratory distress, cyanosis, and
chest asymmetry. Physical examination reveals absent breath sounds on the left
side, hyperresonance to percussion, and jugular venous distention. His blood
,pressure is 78/42 mmHg. Which of the following is the immediate priority
intervention?
A. Perform endotracheal intubation.
B. Obtain an urgent chest X-ray.
C. Perform needle thoracostomy.
D. Insert a large-bore chest tube.
VERIFIED ANSWER: C
EXPLANATION: This clinical presentation is highly indicative of a left-sided
tension pneumothorax, characterized by the classic triad of absent breath
sounds, hyperresonance, and obstructive shock (hypotension and jugular
venous distention). In an unstable patient, tension pneumothorax is a clinical
diagnosis requiring immediate decompression via needle thoracostomy before
acquiring diagnostic imaging or attempting intubation. Delaying treatment to
obtain a chest X-ray can lead to rapid cardiovascular collapse due to
decreased venous return to the heart. Endotracheal intubation with positive
pressure ventilation can worsen a tension pneumothorax if performed prior to
decompression. While a formal chest tube (tube thoracostomy) is the
definitive treatment, needle decompression is the fastest life-saving bridge
intervention.
Question 2
A 68-year-old female presents with a sudden onset of severe, crushing
substernal chest pain radiating to her left jaw and back. The initial 12-lead ECG
demonstrates ST-segment depression of 2 mm in leads V1 through V3, along
with prominent R waves. Which of the following coronary events is most likely
occurring?
,A. Acute anterior wall myocardial infarction
B. Acute posterior wall myocardial infarction
C. Non-ST-elevation myocardial infarction (NSTEMI)
D. Acute inferior wall myocardial infarction
VERIFIED ANSWER: B
EXPLANATION: ST-segment depression in the septal and anterior
precordial leads (V1–V3), when accompanied by tall, prominent R waves and
upright T waves, is the mirror image of an acute posterior wall ST-elevation
myocardial infarction (STEMI). To confirm this, a posterior ECG should be
performed by placing leads V7, V8, and V9 on the patient's back, which would
demonstrate ST-segment elevation. Misinterpreting this pattern as simple
anterior ischemia or an NSTEMI delays critical reperfusion therapy. Inferior
wall infarctions present with ST elevation in leads II, III, and aVF.
Question 3
An 18-month-old child is brought to the emergency department by their
caregiver due to a sudden onset of a harsh, barking cough and inspiratory stridor
at rest. The child is alert but exhibits mild intercostal retractions. Vital signs
reveal a temperature of 38.2°C (100.8°F), a heart rate of 132 bpm, a respiratory
rate of 28 breaths/minute, and an SpO2 of 95% on room air. According to the
Emergency Severity Index (ESI), which triage level should this patient be
assigned?
A. ESI Level 1
B. ESI Level 2
C. ESI Level 3
D. ESI Level 4
, VERIFIED ANSWER: B
EXPLANATION: This pediatric patient presents with signs of moderate to
severe croup, highlighted by the presence of inspiratory stridor at rest and
intercostal retractions. Stridor at rest indicates a high-risk situation with
potential for rapid, unpredictable airway compromise. According to the ESI
triage algorithm, high-risk situations that require immediate, resource-
intensive evaluation to prevent further deterioration are designated as ESI
Level 2. ESI Level 1 is reserved for patients requiring immediate life-saving
interventions (such as severe respiratory failure or cardiac arrest). ESI Level
3 would be inappropriate because the patient cannot safely wait the extended
periods often associated with that tier.
Question 4
A 29-year-old male is brought to the emergency department following an
industrial blast injury. He is awake but confused, complaining of a severe
headache and abdominal pain. He is noted to have petechiae across his chest
and back, and chest auscultation reveals diminished breath sounds bilaterally
with scattered crackles. Which primary blast injury mechanism is most likely
responsible for his pulmonary presentation?
A. Secondary blast injury
B. Tertiary blast injury
C. Primary blast injury
D. Quaternary blast injury
VERIFIED ANSWER: C
EXPLANATION: Primary blast injuries are caused directly by the supersonic
overpressure wave generated by an explosion. This blast wave selectively
Versions Covered (Verified Answers &
Rationales Included)
Question 1
A 45-year-old male presents to the emergency department after a high-speed
motor vehicle collision. He exhibits severe respiratory distress, cyanosis, and
chest asymmetry. Physical examination reveals absent breath sounds on the left
side, hyperresonance to percussion, and jugular venous distention. His blood
,pressure is 78/42 mmHg. Which of the following is the immediate priority
intervention?
A. Perform endotracheal intubation.
B. Obtain an urgent chest X-ray.
C. Perform needle thoracostomy.
D. Insert a large-bore chest tube.
VERIFIED ANSWER: C
EXPLANATION: This clinical presentation is highly indicative of a left-sided
tension pneumothorax, characterized by the classic triad of absent breath
sounds, hyperresonance, and obstructive shock (hypotension and jugular
venous distention). In an unstable patient, tension pneumothorax is a clinical
diagnosis requiring immediate decompression via needle thoracostomy before
acquiring diagnostic imaging or attempting intubation. Delaying treatment to
obtain a chest X-ray can lead to rapid cardiovascular collapse due to
decreased venous return to the heart. Endotracheal intubation with positive
pressure ventilation can worsen a tension pneumothorax if performed prior to
decompression. While a formal chest tube (tube thoracostomy) is the
definitive treatment, needle decompression is the fastest life-saving bridge
intervention.
Question 2
A 68-year-old female presents with a sudden onset of severe, crushing
substernal chest pain radiating to her left jaw and back. The initial 12-lead ECG
demonstrates ST-segment depression of 2 mm in leads V1 through V3, along
with prominent R waves. Which of the following coronary events is most likely
occurring?
,A. Acute anterior wall myocardial infarction
B. Acute posterior wall myocardial infarction
C. Non-ST-elevation myocardial infarction (NSTEMI)
D. Acute inferior wall myocardial infarction
VERIFIED ANSWER: B
EXPLANATION: ST-segment depression in the septal and anterior
precordial leads (V1–V3), when accompanied by tall, prominent R waves and
upright T waves, is the mirror image of an acute posterior wall ST-elevation
myocardial infarction (STEMI). To confirm this, a posterior ECG should be
performed by placing leads V7, V8, and V9 on the patient's back, which would
demonstrate ST-segment elevation. Misinterpreting this pattern as simple
anterior ischemia or an NSTEMI delays critical reperfusion therapy. Inferior
wall infarctions present with ST elevation in leads II, III, and aVF.
Question 3
An 18-month-old child is brought to the emergency department by their
caregiver due to a sudden onset of a harsh, barking cough and inspiratory stridor
at rest. The child is alert but exhibits mild intercostal retractions. Vital signs
reveal a temperature of 38.2°C (100.8°F), a heart rate of 132 bpm, a respiratory
rate of 28 breaths/minute, and an SpO2 of 95% on room air. According to the
Emergency Severity Index (ESI), which triage level should this patient be
assigned?
A. ESI Level 1
B. ESI Level 2
C. ESI Level 3
D. ESI Level 4
, VERIFIED ANSWER: B
EXPLANATION: This pediatric patient presents with signs of moderate to
severe croup, highlighted by the presence of inspiratory stridor at rest and
intercostal retractions. Stridor at rest indicates a high-risk situation with
potential for rapid, unpredictable airway compromise. According to the ESI
triage algorithm, high-risk situations that require immediate, resource-
intensive evaluation to prevent further deterioration are designated as ESI
Level 2. ESI Level 1 is reserved for patients requiring immediate life-saving
interventions (such as severe respiratory failure or cardiac arrest). ESI Level
3 would be inappropriate because the patient cannot safely wait the extended
periods often associated with that tier.
Question 4
A 29-year-old male is brought to the emergency department following an
industrial blast injury. He is awake but confused, complaining of a severe
headache and abdominal pain. He is noted to have petechiae across his chest
and back, and chest auscultation reveals diminished breath sounds bilaterally
with scattered crackles. Which primary blast injury mechanism is most likely
responsible for his pulmonary presentation?
A. Secondary blast injury
B. Tertiary blast injury
C. Primary blast injury
D. Quaternary blast injury
VERIFIED ANSWER: C
EXPLANATION: Primary blast injuries are caused directly by the supersonic
overpressure wave generated by an explosion. This blast wave selectively
