CEN EXAM 2: HIGH COMPREHENSIVE CERTIFIED EMERGENCY NURSE STUDY GUIDE 2026
130-Question Original Practice Exam
TABLE OF CONTENTS
Section Domain Questions
I Cardiovascular Emergencies 1–16
II Respiratory Emergencies 17–28
III Neurological Emergencies 29–41
IV Medical Emergencies 42–53
V Gastrointestinal Emergencies 54–64
VI Mental Health Emergencies 65–73
VII Environmental, Toxicology & Communicable Diseases 74–85
VIII Professional Issues 86–94
IX Musculoskeletal & Wound Emergencies 95–103
X Genitourinary, Gynecology & Obstetrical Emergencies 104–114
XI Head, Eye, Ear, Nose, Throat (HEENT) Emergencies 115–123
XII Shock & Trauma 124–130
SECTION I: CARDIOVASCULAR EMERGENCIES (Questions 1–16)
1. A 68-year-old male presents with substernal chest pressure radiating to his left jaw, diaphoresis, and nausea. His ECG shows 2-mm ST-segment
elevation in leads V1–V4. Which intervention should the emergency nurse prioritize?
A. Administer sublingual nitroglycerin 0.4 mg and obtain a 15-lead ECG
B. Notify the catheterization laboratory and prepare for primary PCI
C. Administer morphine sulfate 4 mg IV and monitor respiratory status
D. Obtain cardiac enzymes and administer a STAT chest X-ray
🔴 Correct Answer: B
Rationale: This patient is presenting with an acute ST-segment elevation myocardial infarction (STEMI) as evidenced by ST elevation in the anterior leads
(V1–V4). The priority intervention for STEMI is rapid reperfusion, and primary percutaneous coronary intervention (PCI) is the preferred strategy when
available, with a goal door-to-balloon time of ≤90 minutes. While nitroglycerin, morphine, and cardiac enzymes are all appropriate components of care,
they should not delay activation of the catheterization lab. The 15-lead ECG may be helpful for posterior involvement but should not precede the emergent
reperfusion decision. Initial management of ACS includes antiplatelet therapy (aspirin), anticoagulants, and pain control, but the priority is reperfusion.
2. A 55-year-old female with a history of hypertension and diabetes presents with "crushing" chest pain that began 30 minutes ago. Which of the
following findings is MOST concerning for a high-risk acute coronary syndrome presentation in this patient?
A. Pain relieved with rest
B. Pain described as sharp and pleuritic
C. Pain radiating to the right shoulder
D. Pain associated with nausea and diaphoresis
,🔴 Correct Answer: D
Rationale: Atypical presentations of acute coronary syndrome (ACS) are more common in women, older adults, and patients with diabetes. The presence of
associated symptoms such as nausea, diaphoresis, and dyspnea—along with chest discomfort—should raise suspicion for ACS even when pain is not
classic. Pain relieved with rest is more consistent with stable angina. Sharp, pleuritic pain suggests pericarditis or pulmonary etiology. Right shoulder
radiation is less specific for cardiac ischemia; left arm, jaw, or epigastric radiation is more typical.
3. The emergency nurse is caring for a patient with unstable angina. The provider orders a heparin infusion. What is the primary mechanism of action
for unfractionated heparin in this setting?
A. Inhibition of platelet aggregation
B. Activation of antithrombin III to inactivate thrombin and factor Xa
C. Direct inhibition of factor Xa
D. Fibrinolytic activity to dissolve existing clots
🔵 Correct Answer: B
Rationale: Unfractionated heparin (UFH) exerts its anticoagulant effect by binding to antithrombin III (ATIII), causing a conformational change that
accelerates ATIII's inactivation of thrombin (factor IIa) and factor Xa. This prevents the formation of new clots but does not dissolve existing ones. Option A
describes the mechanism of antiplatelet agents like aspirin and P2Y12 inhibitors. Option C describes the mechanism of direct factor Xa inhibitors like
fondaparinux. Option D describes the mechanism of fibrinolytic agents like alteplase (tPA).
4. A patient presents with a heart rate of 38 beats per minute, blood pressure 82/50 mmHg, and reports severe fatigue and dizziness. The cardiac
monitor shows a third-degree atrioventricular block with a junctional escape rhythm. Which intervention should the emergency nurse anticipate
FIRST?
A. Administration of atropine 0.5 mg IV push
B. Application of transcutaneous pacing
C. Administration of dopamine 5 mcg/kg/min
D. Administration of amiodarone 150 mg IV push
🔴 Correct Answer: B
Rationale: This patient has symptomatic bradycardia with unstable vital signs (hypotension and altered perfusion). For unstable bradycardia,
transcutaneous pacing is the definitive first-line intervention. While atropine may be attempted for symptomatic bradycardia, it is less effective in third-
degree heart block (particularly infranodal blocks) and should not delay pacing in the unstable patient. Dopamine or epinephrine may be used as a bridge
to pacing but are not first-line. Amiodarone is not indicated for bradycardia; it is used for tachyarrhythmias.
5. The emergency nurse is caring for a patient in cardiac arrest. High-quality CPR is being performed. Which of the following statements reflects
correct CPR technique? (Select all that apply)
🔵 A. Chest compression rate of 100–120 compressions per minute
🔵 B. Compression depth of at least 2 inches (5 cm) in adults
🔵 C. Complete chest recoil between compressions
🔵 D. Ventilation rate of 20 breaths per minute with advanced airway
Correct Answers: A, B, C
Rationale: High-quality CPR requires a compression rate of 100–120/min, a depth of at least 2 inches (5 cm) for adults, and complete chest recoil to allow
for cardiac refilling. With an advanced airway in place, ventilations should be delivered at 10 breaths per minute (not 20), with continuous compressions.
Excessive ventilation can increase intrathoracic pressure and decrease coronary perfusion pressure.
6. A 72-year-old male presents with acute-onset shortness of breath, hypotension, and jugular venous distention. His heart sounds are distant on
auscultation. A bedside ultrasound reveals a large pericardial effusion with right ventricular collapse. What is the priority nursing intervention?
A. Administer intravenous fluids rapidly
B. Prepare for emergent pericardiocentesis
C. Administer IV furosemide 40 mg
D. Obtain a STAT echocardiogram
🔴 Correct Answer: B
Rationale: This patient is displaying signs of cardiac tamponade: Beck's triad (hypotension, muffled heart sounds, and jugular venous distention) with
ultrasound findings of pericardial effusion and right ventricular collapse. Cardiac tamponade is a life-threatening emergency requiring immediate
,pericardiocentesis to remove fluid and relieve pressure on the heart. While IV fluids may provide temporary hemodynamic support, they do not address the
underlying cause. Furosemide is contraindicated in tamponade as it can worsen hypotension. An echocardiogram is useful for diagnosis but should not
delay emergent intervention.
7. A patient presents with sudden-onset, severe "tearing" chest pain radiating to the back. Blood pressure is 180/100 mmHg in the right arm and
140/80 mmHg in the left arm. Which of the following is the priority intervention?
A. Administration of IV morphine for pain control
B. Rapid blood pressure control with IV beta-blockers
C. Administration of IV heparin to prevent thrombus formation
D. Administration of IV thrombolytics
🔴 Correct Answer: B
Rationale: This patient's presentation—acute tearing chest pain radiating to the back with a pulse differential between arms—is classic for acute aortic
dissection. The priority is rapid blood pressure control to reduce aortic wall shear stress and prevent extension of the dissection. Beta-blockers (such as
esmolol or labetalol) are the agents of choice to lower heart rate and blood pressure. Morphine may be given for pain but does not address the underlying
pathophysiology. Heparin and thrombolytics are contraindicated in aortic dissection due to the risk of catastrophic hemorrhage.
8. Which ECG finding is MOST consistent with acute pericarditis?
A. ST-segment depression in multiple leads
B. Diffuse ST-segment elevation with PR-segment depression
C. Pathologic Q waves in contiguous leads
D. T-wave inversion in leads V1–V4
🔴 Correct Answer: B
Rationale: Acute pericarditis classically presents with diffuse ST-segment elevation (concave upward) in multiple leads along with PR-segment depression.
PR depression is actually a more specific finding for pericarditis. ST depression is more consistent with ischemia or reciprocal changes. Pathologic Q waves
suggest prior myocardial infarction. T-wave inversions in V1–V4 can be seen in many conditions including Wellens' syndrome or normal variants.
9. The emergency nurse is assessing a patient with suspected pulmonary embolism. Which of the following are components of the Wells Criteria for
pulmonary embolism? (Select all that apply)
🔵 A. Clinical signs and symptoms of DVT
🔵 B. Heart rate > 100 beats per minute
🔵 C. Hemoptysis
🔵 D. Previous DVT or PE
🔵 E. Malignancy
Correct Answers: A, B, C, D, E
Rationale: The Wells Criteria for pulmonary embolism include: clinical signs and symptoms of DVT (leg swelling, pain with palpation), heart rate >100,
hemoptysis, previous DVT or PE, malignancy, surgery or immobilization within the past 4 weeks, and an alternative diagnosis less likely than PE. Each factor
is assigned a point value, and the total score helps determine the pretest probability of PE, guiding further diagnostic testing such as D-dimer or CT
angiography.
10. A 45-year-old male presents with acute substernal chest pain. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary
artery is MOST likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
🔴 Correct Answer: C
Rationale: ST elevation in the inferior leads (II, III, aVF) indicates an inferior wall MI, which is most commonly caused by occlusion of the right coronary
artery (RCA). The RCA supplies the inferior wall of the left ventricle and the posterior wall in most patients. The left anterior descending (LAD) artery
supplies the anterior wall and typically produces ST elevation in V1–V4. The left circumflex artery supplies the lateral wall and may produce ST elevation in
leads I, aVL, V5–V6. Left main occlusion is a catastrophic event usually presenting with widespread ST changes or cardiogenic shock.
, 11. A patient with acute heart failure presents with severe dyspnea, bilateral crackles, and pink frothy sputum. Which intervention should the
emergency nurse anticipate FIRST?
A. Administration of IV furosemide
B. Administration of IV morphine
C. Non-invasive positive pressure ventilation (NIV)
D. Administration of IV nitroglycerin
🔴 Correct Answer: C
Rationale: This patient is in acute cardiogenic pulmonary edema. While diuretics, nitrates, and morphine are all components of treatment, the priority
intervention for severe respiratory distress is non-invasive positive pressure ventilation (NIV) such as BiPAP or CPAP. NIV improves oxygenation, reduces
preload, decreases the work of breathing, and can prevent the need for intubation. In a patient with pink frothy sputum and severe distress, NIV should be
initiated emergently while other therapies are prepared.
12. Which of the following dysrhythmias requires immediate synchronized cardioversion in a stable patient?
A. Ventricular fibrillation
B. Unstable supraventricular tachycardia
C. Stable monomorphic ventricular tachycardia with a pulse
D. Atrial fibrillation with rapid ventricular response
🔴 Correct Answer: C
Rationale: In a stable patient with monomorphic ventricular tachycardia (VT) and a pulse, synchronized cardioversion is the treatment of choice. Ventricular
fibrillation requires immediate defibrillation (unsynchronized), not cardioversion. Unstable SVT requires immediate synchronized cardioversion but the
question specifies a stable patient. Atrial fibrillation with rapid ventricular response in a stable patient is typically managed with rate control medications
(calcium channel blockers or beta-blockers) rather than immediate cardioversion.
13. The emergency nurse is caring for a patient with a hypertensive emergency. Which of the following findings indicate end-organ damage requiring
emergent blood pressure reduction? (Select all that apply)
🔵 A. Acute kidney injury with rising creatinine
🔵 B. Hypertensive retinopathy with papilledema
🔵 C. Acute ischemic stroke
🔵 D. Acute pulmonary edema
🔵 E. Asymptomatic blood pressure of 220/120 mmHg
Correct Answers: A, B, C, D
Rationale: Hypertensive emergency is defined as severe hypertension with evidence of acute end-organ damage. End-organ manifestations include acute
kidney injury, hypertensive retinopathy with papilledema, acute ischemic stroke or intracranial hemorrhage, acute pulmonary edema, and acute myocardial
ischemia. Asymptomatic severe hypertension (even with markedly elevated readings) without end-organ damage is considered a hypertensive urgency, not
an emergency, and may be managed with oral agents rather than emergent IV therapy.
14. A 60-year-old patient presents with a 2-day history of progressive shortness of breath, orthopnea, and lower extremity edema. The patient has a
history of hypertension and diabetes. The nurse notes jugular venous distention and S3 gallop on cardiac auscultation. What is the most likely
diagnosis?
A. Acute myocardial infarction
B. Cardiogenic shock
C. Acute decompensated heart failure
D. Pericardial effusion
🔴 Correct Answer: C
Rationale: The combination of progressive dyspnea, orthopnea, lower extremity edema, JVD, and an S3 gallop is classic for acute decompensated heart
failure (ADHF). The S3 gallop indicates increased ventricular filling pressures and is a sensitive sign of heart failure. While cardiogenic shock represents the
most severe form of heart failure with hypotension and end-organ hypoperfusion, this patient's presentation is more consistent with ADHF without shock.
Myocardial infarction may be the precipitating cause but is not the primary diagnosis based on the described findings. Pericardial effusion would present
with muffled heart sounds and may have pulsus paradoxus.
15. The emergency nurse is caring for a patient with an automatic implantable cardioverter-defibrillator (AICD) who presents after receiving a shock.
Which of the following is the priority nursing action?
130-Question Original Practice Exam
TABLE OF CONTENTS
Section Domain Questions
I Cardiovascular Emergencies 1–16
II Respiratory Emergencies 17–28
III Neurological Emergencies 29–41
IV Medical Emergencies 42–53
V Gastrointestinal Emergencies 54–64
VI Mental Health Emergencies 65–73
VII Environmental, Toxicology & Communicable Diseases 74–85
VIII Professional Issues 86–94
IX Musculoskeletal & Wound Emergencies 95–103
X Genitourinary, Gynecology & Obstetrical Emergencies 104–114
XI Head, Eye, Ear, Nose, Throat (HEENT) Emergencies 115–123
XII Shock & Trauma 124–130
SECTION I: CARDIOVASCULAR EMERGENCIES (Questions 1–16)
1. A 68-year-old male presents with substernal chest pressure radiating to his left jaw, diaphoresis, and nausea. His ECG shows 2-mm ST-segment
elevation in leads V1–V4. Which intervention should the emergency nurse prioritize?
A. Administer sublingual nitroglycerin 0.4 mg and obtain a 15-lead ECG
B. Notify the catheterization laboratory and prepare for primary PCI
C. Administer morphine sulfate 4 mg IV and monitor respiratory status
D. Obtain cardiac enzymes and administer a STAT chest X-ray
🔴 Correct Answer: B
Rationale: This patient is presenting with an acute ST-segment elevation myocardial infarction (STEMI) as evidenced by ST elevation in the anterior leads
(V1–V4). The priority intervention for STEMI is rapid reperfusion, and primary percutaneous coronary intervention (PCI) is the preferred strategy when
available, with a goal door-to-balloon time of ≤90 minutes. While nitroglycerin, morphine, and cardiac enzymes are all appropriate components of care,
they should not delay activation of the catheterization lab. The 15-lead ECG may be helpful for posterior involvement but should not precede the emergent
reperfusion decision. Initial management of ACS includes antiplatelet therapy (aspirin), anticoagulants, and pain control, but the priority is reperfusion.
2. A 55-year-old female with a history of hypertension and diabetes presents with "crushing" chest pain that began 30 minutes ago. Which of the
following findings is MOST concerning for a high-risk acute coronary syndrome presentation in this patient?
A. Pain relieved with rest
B. Pain described as sharp and pleuritic
C. Pain radiating to the right shoulder
D. Pain associated with nausea and diaphoresis
,🔴 Correct Answer: D
Rationale: Atypical presentations of acute coronary syndrome (ACS) are more common in women, older adults, and patients with diabetes. The presence of
associated symptoms such as nausea, diaphoresis, and dyspnea—along with chest discomfort—should raise suspicion for ACS even when pain is not
classic. Pain relieved with rest is more consistent with stable angina. Sharp, pleuritic pain suggests pericarditis or pulmonary etiology. Right shoulder
radiation is less specific for cardiac ischemia; left arm, jaw, or epigastric radiation is more typical.
3. The emergency nurse is caring for a patient with unstable angina. The provider orders a heparin infusion. What is the primary mechanism of action
for unfractionated heparin in this setting?
A. Inhibition of platelet aggregation
B. Activation of antithrombin III to inactivate thrombin and factor Xa
C. Direct inhibition of factor Xa
D. Fibrinolytic activity to dissolve existing clots
🔵 Correct Answer: B
Rationale: Unfractionated heparin (UFH) exerts its anticoagulant effect by binding to antithrombin III (ATIII), causing a conformational change that
accelerates ATIII's inactivation of thrombin (factor IIa) and factor Xa. This prevents the formation of new clots but does not dissolve existing ones. Option A
describes the mechanism of antiplatelet agents like aspirin and P2Y12 inhibitors. Option C describes the mechanism of direct factor Xa inhibitors like
fondaparinux. Option D describes the mechanism of fibrinolytic agents like alteplase (tPA).
4. A patient presents with a heart rate of 38 beats per minute, blood pressure 82/50 mmHg, and reports severe fatigue and dizziness. The cardiac
monitor shows a third-degree atrioventricular block with a junctional escape rhythm. Which intervention should the emergency nurse anticipate
FIRST?
A. Administration of atropine 0.5 mg IV push
B. Application of transcutaneous pacing
C. Administration of dopamine 5 mcg/kg/min
D. Administration of amiodarone 150 mg IV push
🔴 Correct Answer: B
Rationale: This patient has symptomatic bradycardia with unstable vital signs (hypotension and altered perfusion). For unstable bradycardia,
transcutaneous pacing is the definitive first-line intervention. While atropine may be attempted for symptomatic bradycardia, it is less effective in third-
degree heart block (particularly infranodal blocks) and should not delay pacing in the unstable patient. Dopamine or epinephrine may be used as a bridge
to pacing but are not first-line. Amiodarone is not indicated for bradycardia; it is used for tachyarrhythmias.
5. The emergency nurse is caring for a patient in cardiac arrest. High-quality CPR is being performed. Which of the following statements reflects
correct CPR technique? (Select all that apply)
🔵 A. Chest compression rate of 100–120 compressions per minute
🔵 B. Compression depth of at least 2 inches (5 cm) in adults
🔵 C. Complete chest recoil between compressions
🔵 D. Ventilation rate of 20 breaths per minute with advanced airway
Correct Answers: A, B, C
Rationale: High-quality CPR requires a compression rate of 100–120/min, a depth of at least 2 inches (5 cm) for adults, and complete chest recoil to allow
for cardiac refilling. With an advanced airway in place, ventilations should be delivered at 10 breaths per minute (not 20), with continuous compressions.
Excessive ventilation can increase intrathoracic pressure and decrease coronary perfusion pressure.
6. A 72-year-old male presents with acute-onset shortness of breath, hypotension, and jugular venous distention. His heart sounds are distant on
auscultation. A bedside ultrasound reveals a large pericardial effusion with right ventricular collapse. What is the priority nursing intervention?
A. Administer intravenous fluids rapidly
B. Prepare for emergent pericardiocentesis
C. Administer IV furosemide 40 mg
D. Obtain a STAT echocardiogram
🔴 Correct Answer: B
Rationale: This patient is displaying signs of cardiac tamponade: Beck's triad (hypotension, muffled heart sounds, and jugular venous distention) with
ultrasound findings of pericardial effusion and right ventricular collapse. Cardiac tamponade is a life-threatening emergency requiring immediate
,pericardiocentesis to remove fluid and relieve pressure on the heart. While IV fluids may provide temporary hemodynamic support, they do not address the
underlying cause. Furosemide is contraindicated in tamponade as it can worsen hypotension. An echocardiogram is useful for diagnosis but should not
delay emergent intervention.
7. A patient presents with sudden-onset, severe "tearing" chest pain radiating to the back. Blood pressure is 180/100 mmHg in the right arm and
140/80 mmHg in the left arm. Which of the following is the priority intervention?
A. Administration of IV morphine for pain control
B. Rapid blood pressure control with IV beta-blockers
C. Administration of IV heparin to prevent thrombus formation
D. Administration of IV thrombolytics
🔴 Correct Answer: B
Rationale: This patient's presentation—acute tearing chest pain radiating to the back with a pulse differential between arms—is classic for acute aortic
dissection. The priority is rapid blood pressure control to reduce aortic wall shear stress and prevent extension of the dissection. Beta-blockers (such as
esmolol or labetalol) are the agents of choice to lower heart rate and blood pressure. Morphine may be given for pain but does not address the underlying
pathophysiology. Heparin and thrombolytics are contraindicated in aortic dissection due to the risk of catastrophic hemorrhage.
8. Which ECG finding is MOST consistent with acute pericarditis?
A. ST-segment depression in multiple leads
B. Diffuse ST-segment elevation with PR-segment depression
C. Pathologic Q waves in contiguous leads
D. T-wave inversion in leads V1–V4
🔴 Correct Answer: B
Rationale: Acute pericarditis classically presents with diffuse ST-segment elevation (concave upward) in multiple leads along with PR-segment depression.
PR depression is actually a more specific finding for pericarditis. ST depression is more consistent with ischemia or reciprocal changes. Pathologic Q waves
suggest prior myocardial infarction. T-wave inversions in V1–V4 can be seen in many conditions including Wellens' syndrome or normal variants.
9. The emergency nurse is assessing a patient with suspected pulmonary embolism. Which of the following are components of the Wells Criteria for
pulmonary embolism? (Select all that apply)
🔵 A. Clinical signs and symptoms of DVT
🔵 B. Heart rate > 100 beats per minute
🔵 C. Hemoptysis
🔵 D. Previous DVT or PE
🔵 E. Malignancy
Correct Answers: A, B, C, D, E
Rationale: The Wells Criteria for pulmonary embolism include: clinical signs and symptoms of DVT (leg swelling, pain with palpation), heart rate >100,
hemoptysis, previous DVT or PE, malignancy, surgery or immobilization within the past 4 weeks, and an alternative diagnosis less likely than PE. Each factor
is assigned a point value, and the total score helps determine the pretest probability of PE, guiding further diagnostic testing such as D-dimer or CT
angiography.
10. A 45-year-old male presents with acute substernal chest pain. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary
artery is MOST likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
🔴 Correct Answer: C
Rationale: ST elevation in the inferior leads (II, III, aVF) indicates an inferior wall MI, which is most commonly caused by occlusion of the right coronary
artery (RCA). The RCA supplies the inferior wall of the left ventricle and the posterior wall in most patients. The left anterior descending (LAD) artery
supplies the anterior wall and typically produces ST elevation in V1–V4. The left circumflex artery supplies the lateral wall and may produce ST elevation in
leads I, aVL, V5–V6. Left main occlusion is a catastrophic event usually presenting with widespread ST changes or cardiogenic shock.
, 11. A patient with acute heart failure presents with severe dyspnea, bilateral crackles, and pink frothy sputum. Which intervention should the
emergency nurse anticipate FIRST?
A. Administration of IV furosemide
B. Administration of IV morphine
C. Non-invasive positive pressure ventilation (NIV)
D. Administration of IV nitroglycerin
🔴 Correct Answer: C
Rationale: This patient is in acute cardiogenic pulmonary edema. While diuretics, nitrates, and morphine are all components of treatment, the priority
intervention for severe respiratory distress is non-invasive positive pressure ventilation (NIV) such as BiPAP or CPAP. NIV improves oxygenation, reduces
preload, decreases the work of breathing, and can prevent the need for intubation. In a patient with pink frothy sputum and severe distress, NIV should be
initiated emergently while other therapies are prepared.
12. Which of the following dysrhythmias requires immediate synchronized cardioversion in a stable patient?
A. Ventricular fibrillation
B. Unstable supraventricular tachycardia
C. Stable monomorphic ventricular tachycardia with a pulse
D. Atrial fibrillation with rapid ventricular response
🔴 Correct Answer: C
Rationale: In a stable patient with monomorphic ventricular tachycardia (VT) and a pulse, synchronized cardioversion is the treatment of choice. Ventricular
fibrillation requires immediate defibrillation (unsynchronized), not cardioversion. Unstable SVT requires immediate synchronized cardioversion but the
question specifies a stable patient. Atrial fibrillation with rapid ventricular response in a stable patient is typically managed with rate control medications
(calcium channel blockers or beta-blockers) rather than immediate cardioversion.
13. The emergency nurse is caring for a patient with a hypertensive emergency. Which of the following findings indicate end-organ damage requiring
emergent blood pressure reduction? (Select all that apply)
🔵 A. Acute kidney injury with rising creatinine
🔵 B. Hypertensive retinopathy with papilledema
🔵 C. Acute ischemic stroke
🔵 D. Acute pulmonary edema
🔵 E. Asymptomatic blood pressure of 220/120 mmHg
Correct Answers: A, B, C, D
Rationale: Hypertensive emergency is defined as severe hypertension with evidence of acute end-organ damage. End-organ manifestations include acute
kidney injury, hypertensive retinopathy with papilledema, acute ischemic stroke or intracranial hemorrhage, acute pulmonary edema, and acute myocardial
ischemia. Asymptomatic severe hypertension (even with markedly elevated readings) without end-organ damage is considered a hypertensive urgency, not
an emergency, and may be managed with oral agents rather than emergent IV therapy.
14. A 60-year-old patient presents with a 2-day history of progressive shortness of breath, orthopnea, and lower extremity edema. The patient has a
history of hypertension and diabetes. The nurse notes jugular venous distention and S3 gallop on cardiac auscultation. What is the most likely
diagnosis?
A. Acute myocardial infarction
B. Cardiogenic shock
C. Acute decompensated heart failure
D. Pericardial effusion
🔴 Correct Answer: C
Rationale: The combination of progressive dyspnea, orthopnea, lower extremity edema, JVD, and an S3 gallop is classic for acute decompensated heart
failure (ADHF). The S3 gallop indicates increased ventricular filling pressures and is a sensitive sign of heart failure. While cardiogenic shock represents the
most severe form of heart failure with hypotension and end-organ hypoperfusion, this patient's presentation is more consistent with ADHF without shock.
Myocardial infarction may be the precipitating cause but is not the primary diagnosis based on the described findings. Pericardial effusion would present
with muffled heart sounds and may have pulsus paradoxus.
15. The emergency nurse is caring for a patient with an automatic implantable cardioverter-defibrillator (AICD) who presents after receiving a shock.
Which of the following is the priority nursing action?
