CEN Rapid-Fire Bonus Flashcards | 1,000+ Certified Emergency Nurse Exam Questions & Answers
What is the classic triad of an opioid toxidrome? Pinpoint pupils (miosis), respiratory depression, and depressed mental status
(coma).
What is the definitive antidote for an opioid overdose? Naloxone (Narcan).
Describe the classic presentation of an anticholinergic Mad as a hatter, blind as a bat, red as a beet, hot as a hare, dry as a bone
toxidrome. (delirium, mydriasis, flushed skin, hyperthermia, dry mucous membranes).
What is the specific antidote for severe, life-threatening Physostigmine.
anticholinergic toxicity?
What acronym describes the cholinergic toxidrome SLUDGE (Salivation, Lacrimation, Urination, Defecation, Gastrointestinal
(organophosphates)? distress, Emesis) or DUMBELS.
What are the two primary antidotes for organophosphate Atropine (for muscarinic effects like bronchorrhea) and Pralidoxime/2-PAM (for
(cholinergic) poisoning? nicotinic effects like fasciculations).
What is the definitive clinical endpoint for Atropine The drying of thick bronchial secretions (resolution of bronchorrhea).
administration in organophosphate poisoning?
What is the primary presentation of a sympathomimetic Tachycardia, hypertension, hyperthermia, mydriasis (dilated pupils), diaphoresis,
toxidrome (e.g., cocaine, meth)? and severe agitation.
Which class of medications is strictly contraindicated in Pure beta-blockers (e.g., propranolol) due to the risk of unopposed alpha-
cocaine-induced chest pain? adrenergic stimulation.
What is the first-line pharmacological treatment for Benzodiazepines (e.g., lorazepam, diazepam).
cocaine-induced agitation and tachycardia?
What is the antidote for a benzodiazepine overdose? Flumazenil (use with caution in chronic users due to seizure risk).
What is the hallmark ECG finding in a Tricyclic Widened QRS complex (>100 ms) and a prominent terminal R wave in lead aVR.
Antidepressant (TCA) overdose?
What is the definitive antidote for TCA-induced Intravenous Sodium Bicarbonate.
cardiotoxicity (widened QRS)?
What is the primary mechanism of Sodium Bicarbonate It increases the extracellular sodium load to overcome the fast sodium channel
in TCA toxicity? blockade and alkalizes the blood.
What are the early, phase 1 symptoms of acetaminophen Usually asymptomatic, or mild nausea, vomiting, and malaise.
toxicity?
What tool is used to determine the need for treatment in The Rumack-Matthew Nomogram (requires a serum level drawn at least 4 hours
an acute acetaminophen overdose? post-ingestion).
, CEN Rapid-Fire Bonus Flashcards | 1,000+ Certified Emergency Nurse Exam Questions & Answers
What is the definitive antidote for acetaminophen N-acetylcysteine (NAC).
toxicity?
What is the classic early symptom of salicylate (aspirin) Tinnitus (ringing in the ears).
toxicity?
What unique acid-base imbalance is caused by salicylate Combined primary respiratory alkalosis (medullary stimulation) and primary
toxicity? metabolic acidosis (uncoupled oxidative phosphorylation).
What is the targeted treatment for severe salicylate Urinary alkalinization with a continuous Sodium Bicarbonate infusion.
toxicity?
What is the most critical electrolyte abnormality seen in Hyperkalemia (serum potassium > 5.5 mEq/L is highly predictive of mortality).
acute digoxin toxicity?
What is the definitive antidote for severe digoxin toxicity? Digoxin Immune Fab (Digibind).
What is the primary treatment for a severe beta-blocker High-dose Glucagon (bypasses the blocked beta receptors to increase cAMP).
overdose refractory to fluids and atropine?
What is the definitive treatment for severe Calcium High-Dose Insulin Euglycemic Therapy (HIET).
Channel Blocker (CCB) toxicity?
What is the visual hallmark of methanol toxicity? "Snowstorm" vision or blurred vision, often progressing to blindness due to formic
acid.
What is the microscopic urine finding pathognomonic for Calcium oxalate crystals (envelope-shaped).
ethylene glycol (antifreeze) toxicity?
What is the antidote for both methanol and ethylene Fomepizole (or an ethanol infusion).
glycol poisoning?
What is the definitive antidote for severe iron toxicity? Deferoxamine.
How do you know the iron chelating agent The patient's urine turns a distinct reddish-pink "vin-rose" color.
(Deferoxamine) is working?
What is the treatment for carbon monoxide (CO) 100% high-flow oxygen via non-rebreather mask (or hyperbaric oxygen therapy
poisoning? for severe cases).
Why is a standard pulse oximeter (SpO2) unreliable in It cannot distinguish between oxyhemoglobin and carboxyhemoglobin, resulting
carbon monoxide poisoning? in a falsely normal 100% reading.
What is the definitive antidote for cyanide poisoning? Hydroxocobalamin (Cyanokit).
, CEN Rapid-Fire Bonus Flashcards | 1,000+ Certified Emergency Nurse Exam Questions & Answers
What is the distinguishing clinical feature of Serotonin Hyperreflexia and lower extremity clonus.
Syndrome compared to NMS?
What is the distinguishing clinical feature of Neuroleptic "Lead-pipe" severe muscle rigidity and bradyreflexia (decreased reflexes).
Malignant Syndrome (NMS) compared to Serotonin
Syndrome?
What is the first-line medication for a patient in Delirium High-dose benzodiazepines (symptom-triggered therapy).
Tremens (DTs)?
What is the only effective treatment for Ventricular Immediate unsynchronized defibrillation.
Fibrillation (V-Fib) or Pulseless Ventricular Tachycardia
(pVT)?
What is the treatment for Pulseless Electrical Activity High-quality CPR and Epinephrine 1 mg every 3-5 minutes (defibrillation is
(PEA) or Asystole? contraindicated).
What is the first-line medication for stable, symptomatic Atropine 1 mg IV push (up to a max of 3 mg).
bradycardia?
What is the definitive treatment for unstable, Transcutaneous pacing (TCP).
symptomatic bradycardia?
What is the first-line medication for stable, narrow- Adenosine 6 mg rapid IV push.
complex Supraventricular Tachycardia (SVT)?
What is the treatment for any unstable tachycardia (e.g., Immediate synchronized cardioversion.
SVT or V-Tach with a pulse and hypotension)?
Which medications are strictly contraindicated in Atrial AV nodal blocking agents (Adenosine, Diltiazem, Verapamil, Digoxin).
Fibrillation with Wolff-Parkinson-White (WPW)
syndrome?
What leads represent the inferior wall of the left ventricle Leads II, III, and aVF.
on a 12-lead ECG?
Which coronary artery is typically occluded in an inferior The Right Coronary Artery (RCA).
wall STEMI?
What leads represent the anterior wall of the left Leads V1, V2, V3, and V4 (LAD occlusion).
ventricle?
What leads represent the lateral wall of the left ventricle? Leads I, aVL, V5, and V6 (Circumflex artery occlusion).
What ECG findings suggest an acute posterior wall ST-segment depression in V1-V3 with tall R waves and upright T waves.
STEMI?
How do you definitively confirm a posterior wall STEMI? Obtain a posterior 12-lead ECG using leads V7, V8, and V9.
, CEN Rapid-Fire Bonus Flashcards | 1,000+ Certified Emergency Nurse Exam Questions & Answers
What medication is absolutely contraindicated in a right Nitroglycerin (due to profound preload dependence).
ventricular (RV) infarction?
How is hypotension treated in a right ventricular (RV) Aggressive intravenous fluid boluses to increase right-sided preload.
infarction?
What is Beck's Triad, and what does it indicate? Hypotension, jugular venous distention (JVD), and muffled heart sounds;
indicates Cardiac Tamponade.
What is pulsus paradoxus? An exaggerated drop in systolic blood pressure (>10 mmHg) during inspiration;
classic for cardiac tamponade.
What is the definitive emergent treatment for cardiac Pericardiocentesis.
tamponade?
What ECG finding is the hallmark of acute pericarditis? Diffuse, concave ST-segment elevation across most leads with PR-segment
depression.
What is the first-line treatment for acute pericarditis? High-dose NSAIDs (e.g., ibuprofen, indomethacin).
What is the primary pharmacological goal in an acute Immediate heart rate reduction (to 60-80 bpm) using beta-blockers (e.g.,
aortic dissection? esmolol) to reduce shear stress (dP/dt).
What is the defining clinical feature of a sudden A new, loud holosystolic murmur at the lower left sternal border accompanied by
ventricular septal rupture (VSR) post-MI? shock.
What is Commotio Cordis? Sudden cardiac arrest (V-fib) caused by a blunt strike to the chest during the
vulnerable period of the T-wave.
What is Brugada Syndrome? A genetic sodium channelopathy predisposing to V-fib during sleep,
characterized by a "coved" ST-elevation in V1-V2.
What is the primary target for blood pressure Systolic BP < 185 mmHg and Diastolic BP < 110 mmHg.
management prior to administering tPA for an ischemic
stroke?
What is the primary assessment component of the "A" in Airway maintenance with cervical spine protection.
the ATLS primary survey?
What is the clinical triad indicating a Tension Severe respiratory distress/hypoxia, absent breath sounds on the affected side,
Pneumothorax? and hemodynamic instability (shock).
What is a late sign of a tension pneumothorax? Tracheal deviation away from the affected side.
What is the immediate life-saving intervention for a Needle decompression (thoracostomy) in the 2nd intercostal space midclavicular
tension pneumothorax? line, or 5th intercostal space anterior axillary line.
What is the classic triad of an opioid toxidrome? Pinpoint pupils (miosis), respiratory depression, and depressed mental status
(coma).
What is the definitive antidote for an opioid overdose? Naloxone (Narcan).
Describe the classic presentation of an anticholinergic Mad as a hatter, blind as a bat, red as a beet, hot as a hare, dry as a bone
toxidrome. (delirium, mydriasis, flushed skin, hyperthermia, dry mucous membranes).
What is the specific antidote for severe, life-threatening Physostigmine.
anticholinergic toxicity?
What acronym describes the cholinergic toxidrome SLUDGE (Salivation, Lacrimation, Urination, Defecation, Gastrointestinal
(organophosphates)? distress, Emesis) or DUMBELS.
What are the two primary antidotes for organophosphate Atropine (for muscarinic effects like bronchorrhea) and Pralidoxime/2-PAM (for
(cholinergic) poisoning? nicotinic effects like fasciculations).
What is the definitive clinical endpoint for Atropine The drying of thick bronchial secretions (resolution of bronchorrhea).
administration in organophosphate poisoning?
What is the primary presentation of a sympathomimetic Tachycardia, hypertension, hyperthermia, mydriasis (dilated pupils), diaphoresis,
toxidrome (e.g., cocaine, meth)? and severe agitation.
Which class of medications is strictly contraindicated in Pure beta-blockers (e.g., propranolol) due to the risk of unopposed alpha-
cocaine-induced chest pain? adrenergic stimulation.
What is the first-line pharmacological treatment for Benzodiazepines (e.g., lorazepam, diazepam).
cocaine-induced agitation and tachycardia?
What is the antidote for a benzodiazepine overdose? Flumazenil (use with caution in chronic users due to seizure risk).
What is the hallmark ECG finding in a Tricyclic Widened QRS complex (>100 ms) and a prominent terminal R wave in lead aVR.
Antidepressant (TCA) overdose?
What is the definitive antidote for TCA-induced Intravenous Sodium Bicarbonate.
cardiotoxicity (widened QRS)?
What is the primary mechanism of Sodium Bicarbonate It increases the extracellular sodium load to overcome the fast sodium channel
in TCA toxicity? blockade and alkalizes the blood.
What are the early, phase 1 symptoms of acetaminophen Usually asymptomatic, or mild nausea, vomiting, and malaise.
toxicity?
What tool is used to determine the need for treatment in The Rumack-Matthew Nomogram (requires a serum level drawn at least 4 hours
an acute acetaminophen overdose? post-ingestion).
, CEN Rapid-Fire Bonus Flashcards | 1,000+ Certified Emergency Nurse Exam Questions & Answers
What is the definitive antidote for acetaminophen N-acetylcysteine (NAC).
toxicity?
What is the classic early symptom of salicylate (aspirin) Tinnitus (ringing in the ears).
toxicity?
What unique acid-base imbalance is caused by salicylate Combined primary respiratory alkalosis (medullary stimulation) and primary
toxicity? metabolic acidosis (uncoupled oxidative phosphorylation).
What is the targeted treatment for severe salicylate Urinary alkalinization with a continuous Sodium Bicarbonate infusion.
toxicity?
What is the most critical electrolyte abnormality seen in Hyperkalemia (serum potassium > 5.5 mEq/L is highly predictive of mortality).
acute digoxin toxicity?
What is the definitive antidote for severe digoxin toxicity? Digoxin Immune Fab (Digibind).
What is the primary treatment for a severe beta-blocker High-dose Glucagon (bypasses the blocked beta receptors to increase cAMP).
overdose refractory to fluids and atropine?
What is the definitive treatment for severe Calcium High-Dose Insulin Euglycemic Therapy (HIET).
Channel Blocker (CCB) toxicity?
What is the visual hallmark of methanol toxicity? "Snowstorm" vision or blurred vision, often progressing to blindness due to formic
acid.
What is the microscopic urine finding pathognomonic for Calcium oxalate crystals (envelope-shaped).
ethylene glycol (antifreeze) toxicity?
What is the antidote for both methanol and ethylene Fomepizole (or an ethanol infusion).
glycol poisoning?
What is the definitive antidote for severe iron toxicity? Deferoxamine.
How do you know the iron chelating agent The patient's urine turns a distinct reddish-pink "vin-rose" color.
(Deferoxamine) is working?
What is the treatment for carbon monoxide (CO) 100% high-flow oxygen via non-rebreather mask (or hyperbaric oxygen therapy
poisoning? for severe cases).
Why is a standard pulse oximeter (SpO2) unreliable in It cannot distinguish between oxyhemoglobin and carboxyhemoglobin, resulting
carbon monoxide poisoning? in a falsely normal 100% reading.
What is the definitive antidote for cyanide poisoning? Hydroxocobalamin (Cyanokit).
, CEN Rapid-Fire Bonus Flashcards | 1,000+ Certified Emergency Nurse Exam Questions & Answers
What is the distinguishing clinical feature of Serotonin Hyperreflexia and lower extremity clonus.
Syndrome compared to NMS?
What is the distinguishing clinical feature of Neuroleptic "Lead-pipe" severe muscle rigidity and bradyreflexia (decreased reflexes).
Malignant Syndrome (NMS) compared to Serotonin
Syndrome?
What is the first-line medication for a patient in Delirium High-dose benzodiazepines (symptom-triggered therapy).
Tremens (DTs)?
What is the only effective treatment for Ventricular Immediate unsynchronized defibrillation.
Fibrillation (V-Fib) or Pulseless Ventricular Tachycardia
(pVT)?
What is the treatment for Pulseless Electrical Activity High-quality CPR and Epinephrine 1 mg every 3-5 minutes (defibrillation is
(PEA) or Asystole? contraindicated).
What is the first-line medication for stable, symptomatic Atropine 1 mg IV push (up to a max of 3 mg).
bradycardia?
What is the definitive treatment for unstable, Transcutaneous pacing (TCP).
symptomatic bradycardia?
What is the first-line medication for stable, narrow- Adenosine 6 mg rapid IV push.
complex Supraventricular Tachycardia (SVT)?
What is the treatment for any unstable tachycardia (e.g., Immediate synchronized cardioversion.
SVT or V-Tach with a pulse and hypotension)?
Which medications are strictly contraindicated in Atrial AV nodal blocking agents (Adenosine, Diltiazem, Verapamil, Digoxin).
Fibrillation with Wolff-Parkinson-White (WPW)
syndrome?
What leads represent the inferior wall of the left ventricle Leads II, III, and aVF.
on a 12-lead ECG?
Which coronary artery is typically occluded in an inferior The Right Coronary Artery (RCA).
wall STEMI?
What leads represent the anterior wall of the left Leads V1, V2, V3, and V4 (LAD occlusion).
ventricle?
What leads represent the lateral wall of the left ventricle? Leads I, aVL, V5, and V6 (Circumflex artery occlusion).
What ECG findings suggest an acute posterior wall ST-segment depression in V1-V3 with tall R waves and upright T waves.
STEMI?
How do you definitively confirm a posterior wall STEMI? Obtain a posterior 12-lead ECG using leads V7, V8, and V9.
, CEN Rapid-Fire Bonus Flashcards | 1,000+ Certified Emergency Nurse Exam Questions & Answers
What medication is absolutely contraindicated in a right Nitroglycerin (due to profound preload dependence).
ventricular (RV) infarction?
How is hypotension treated in a right ventricular (RV) Aggressive intravenous fluid boluses to increase right-sided preload.
infarction?
What is Beck's Triad, and what does it indicate? Hypotension, jugular venous distention (JVD), and muffled heart sounds;
indicates Cardiac Tamponade.
What is pulsus paradoxus? An exaggerated drop in systolic blood pressure (>10 mmHg) during inspiration;
classic for cardiac tamponade.
What is the definitive emergent treatment for cardiac Pericardiocentesis.
tamponade?
What ECG finding is the hallmark of acute pericarditis? Diffuse, concave ST-segment elevation across most leads with PR-segment
depression.
What is the first-line treatment for acute pericarditis? High-dose NSAIDs (e.g., ibuprofen, indomethacin).
What is the primary pharmacological goal in an acute Immediate heart rate reduction (to 60-80 bpm) using beta-blockers (e.g.,
aortic dissection? esmolol) to reduce shear stress (dP/dt).
What is the defining clinical feature of a sudden A new, loud holosystolic murmur at the lower left sternal border accompanied by
ventricular septal rupture (VSR) post-MI? shock.
What is Commotio Cordis? Sudden cardiac arrest (V-fib) caused by a blunt strike to the chest during the
vulnerable period of the T-wave.
What is Brugada Syndrome? A genetic sodium channelopathy predisposing to V-fib during sleep,
characterized by a "coved" ST-elevation in V1-V2.
What is the primary target for blood pressure Systolic BP < 185 mmHg and Diastolic BP < 110 mmHg.
management prior to administering tPA for an ischemic
stroke?
What is the primary assessment component of the "A" in Airway maintenance with cervical spine protection.
the ATLS primary survey?
What is the clinical triad indicating a Tension Severe respiratory distress/hypoxia, absent breath sounds on the affected side,
Pneumothorax? and hemodynamic instability (shock).
What is a late sign of a tension pneumothorax? Tracheal deviation away from the affected side.
What is the immediate life-saving intervention for a Needle decompression (thoracostomy) in the 2nd intercostal space midclavicular
tension pneumothorax? line, or 5th intercostal space anterior axillary line.
