CERTIFIED EMERGENCY NURSE (CEN)
PRACTICE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
1. A 68-year-old patient presents to the emergency department with
crushing substernal chest pain radiating to the left arm and jaw. He
is diaphoretic and nauseated. BP is 88/54 mmHg, HR 112/min, and
SpO₂ 94% on room air. The ECG demonstrates ST-segment
elevation in leads II, III, and aVF. Which intervention should the
emergency nurse anticipate as the highest priority?
A. Administer sublingual nitroglycerin immediately
B. Prepare the patient for emergent reperfusion therapy
C. Administer an oral beta-blocker before further intervention
D. Obtain a routine chest radiograph before notifying the provider
Answer: B. Prepare the patient for emergent reperfusion therapy
Rationale: Inferior ST-segment elevation myocardial infarction with
hypotension represents an acute coronary occlusion requiring rapid
reperfusion. The nurse should activate the STEMI pathway and
prepare for emergent PCI when available. Nitroglycerin is potentially
dangerous in a hypotensive patient, particularly when right ventricular
involvement is possible. Delaying reperfusion for a routine chest
radiograph is inappropriate.
2. A patient arrives after a motor-vehicle collision with severe
respiratory distress, hypotension, distended neck veins, and absent
1
, breath sounds on the right. Tracheal deviation is developing toward
the left. Which intervention should the nurse anticipate
immediately?
A. Portable chest radiograph
B. Needle or finger thoracostomy followed by definitive chest drainage
C. Administration of IV furosemide
D. Endotracheal suctioning
Answer: B. Needle or finger thoracostomy followed by definitive
chest drainage
Rationale: The findings strongly indicate tension pneumothorax, a
life-threatening obstructive shock condition. Treatment must not be
delayed for imaging when the clinical presentation is compelling.
Immediate decompression followed by definitive tube thoracostomy is
required.
3. A patient with diabetic ketoacidosis has a serum potassium of 2.8
mEq/L. The provider writes prescriptions for IV regular insulin
and potassium replacement. Which order should the nurse
question?
A. Cardiac monitoring
B. IV potassium replacement according to protocol
C. Immediate initiation of the insulin infusion
D. Frequent electrolyte monitoring
Answer: C. Immediate initiation of the insulin infusion
Rationale: Insulin drives potassium intracellularly and can worsen an
already severe hypokalemia. In significant hypokalemia, potassium
replacement is prioritized and insulin is generally delayed until the
potassium has been corrected to a safer level. Continuous cardiac
monitoring and frequent laboratory reassessment are essential.
2
, 4. A 24-year-old patient is brought to the emergency department after
ingesting an unknown quantity of acetaminophen approximately 8
hours ago. The patient currently has minimal symptoms. Which
medication should the nurse anticipate?
A. Naloxone
B. N-acetylcysteine
C. Flumazenil
D. Sodium bicarbonate
Answer: B. N-acetylcysteine
Rationale: N-acetylcysteine is the antidote for acetaminophen toxicity
and is most effective when administered early, although benefit
remains possible even with delayed treatment. The absence of
symptoms does not exclude significant hepatic toxicity because early
acetaminophen poisoning can initially be clinically silent.
5. A patient with a suspected ischemic stroke arrives 45 minutes after
sudden onset of aphasia and right-sided weakness. Which nursing
action is most important initially?
A. Administer aspirin before brain imaging
B. Determine the exact last-known-well time and expedite stroke
evaluation
C. Lower the blood pressure immediately to below 120/80 mmHg
D. Give oral fluids to prevent dehydration
Answer: B. Determine the exact last-known-well time and expedite
stroke evaluation
Rationale: Time of symptom onset or last-known-well time is critical
for determining eligibility for reperfusion therapies. Rapid neurologic
assessment and brain imaging are required before thrombolytic
treatment, and oral intake should be avoided until swallowing safety is
3
, established. Routine aggressive blood-pressure reduction can also be
harmful in acute ischemic stroke.
6. A patient with an acute asthma exacerbation is initially wheezing
loudly. After several minutes, the nurse notes markedly diminished
breath sounds, increasing fatigue, and altered mental status. Which
finding is most concerning?
A. Persistent cough
B. Mild tachycardia
C. Silent chest with altered mental status
D. Expiratory wheezing
Answer: C. Silent chest with altered mental status
Rationale: A silent chest indicates critically reduced airflow and may
represent impending respiratory failure. Altered mental status further
suggests inadequate oxygenation, hypercapnia, or exhaustion. A
decrease in wheezing in this setting does not indicate improvement.
7. A patient develops urticaria, wheezing, facial swelling,
hypotension, and vomiting shortly after receiving an IV antibiotic.
Which medication should be administered first?
A. Diphenhydramine
B. Methylprednisolone
C. Epinephrine
D. Famotidine
Answer: C. Epinephrine
Rationale: This presentation is anaphylaxis involving airway,
respiratory, circulatory, and gastrointestinal manifestations.
Intramuscular epinephrine is the first-line treatment and should not
be delayed while waiting for antihistamines or corticosteroids.
Adjunctive medications do not replace epinephrine.
4
PRACTICE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
1. A 68-year-old patient presents to the emergency department with
crushing substernal chest pain radiating to the left arm and jaw. He
is diaphoretic and nauseated. BP is 88/54 mmHg, HR 112/min, and
SpO₂ 94% on room air. The ECG demonstrates ST-segment
elevation in leads II, III, and aVF. Which intervention should the
emergency nurse anticipate as the highest priority?
A. Administer sublingual nitroglycerin immediately
B. Prepare the patient for emergent reperfusion therapy
C. Administer an oral beta-blocker before further intervention
D. Obtain a routine chest radiograph before notifying the provider
Answer: B. Prepare the patient for emergent reperfusion therapy
Rationale: Inferior ST-segment elevation myocardial infarction with
hypotension represents an acute coronary occlusion requiring rapid
reperfusion. The nurse should activate the STEMI pathway and
prepare for emergent PCI when available. Nitroglycerin is potentially
dangerous in a hypotensive patient, particularly when right ventricular
involvement is possible. Delaying reperfusion for a routine chest
radiograph is inappropriate.
2. A patient arrives after a motor-vehicle collision with severe
respiratory distress, hypotension, distended neck veins, and absent
1
, breath sounds on the right. Tracheal deviation is developing toward
the left. Which intervention should the nurse anticipate
immediately?
A. Portable chest radiograph
B. Needle or finger thoracostomy followed by definitive chest drainage
C. Administration of IV furosemide
D. Endotracheal suctioning
Answer: B. Needle or finger thoracostomy followed by definitive
chest drainage
Rationale: The findings strongly indicate tension pneumothorax, a
life-threatening obstructive shock condition. Treatment must not be
delayed for imaging when the clinical presentation is compelling.
Immediate decompression followed by definitive tube thoracostomy is
required.
3. A patient with diabetic ketoacidosis has a serum potassium of 2.8
mEq/L. The provider writes prescriptions for IV regular insulin
and potassium replacement. Which order should the nurse
question?
A. Cardiac monitoring
B. IV potassium replacement according to protocol
C. Immediate initiation of the insulin infusion
D. Frequent electrolyte monitoring
Answer: C. Immediate initiation of the insulin infusion
Rationale: Insulin drives potassium intracellularly and can worsen an
already severe hypokalemia. In significant hypokalemia, potassium
replacement is prioritized and insulin is generally delayed until the
potassium has been corrected to a safer level. Continuous cardiac
monitoring and frequent laboratory reassessment are essential.
2
, 4. A 24-year-old patient is brought to the emergency department after
ingesting an unknown quantity of acetaminophen approximately 8
hours ago. The patient currently has minimal symptoms. Which
medication should the nurse anticipate?
A. Naloxone
B. N-acetylcysteine
C. Flumazenil
D. Sodium bicarbonate
Answer: B. N-acetylcysteine
Rationale: N-acetylcysteine is the antidote for acetaminophen toxicity
and is most effective when administered early, although benefit
remains possible even with delayed treatment. The absence of
symptoms does not exclude significant hepatic toxicity because early
acetaminophen poisoning can initially be clinically silent.
5. A patient with a suspected ischemic stroke arrives 45 minutes after
sudden onset of aphasia and right-sided weakness. Which nursing
action is most important initially?
A. Administer aspirin before brain imaging
B. Determine the exact last-known-well time and expedite stroke
evaluation
C. Lower the blood pressure immediately to below 120/80 mmHg
D. Give oral fluids to prevent dehydration
Answer: B. Determine the exact last-known-well time and expedite
stroke evaluation
Rationale: Time of symptom onset or last-known-well time is critical
for determining eligibility for reperfusion therapies. Rapid neurologic
assessment and brain imaging are required before thrombolytic
treatment, and oral intake should be avoided until swallowing safety is
3
, established. Routine aggressive blood-pressure reduction can also be
harmful in acute ischemic stroke.
6. A patient with an acute asthma exacerbation is initially wheezing
loudly. After several minutes, the nurse notes markedly diminished
breath sounds, increasing fatigue, and altered mental status. Which
finding is most concerning?
A. Persistent cough
B. Mild tachycardia
C. Silent chest with altered mental status
D. Expiratory wheezing
Answer: C. Silent chest with altered mental status
Rationale: A silent chest indicates critically reduced airflow and may
represent impending respiratory failure. Altered mental status further
suggests inadequate oxygenation, hypercapnia, or exhaustion. A
decrease in wheezing in this setting does not indicate improvement.
7. A patient develops urticaria, wheezing, facial swelling,
hypotension, and vomiting shortly after receiving an IV antibiotic.
Which medication should be administered first?
A. Diphenhydramine
B. Methylprednisolone
C. Epinephrine
D. Famotidine
Answer: C. Epinephrine
Rationale: This presentation is anaphylaxis involving airway,
respiratory, circulatory, and gastrointestinal manifestations.
Intramuscular epinephrine is the first-line treatment and should not
be delayed while waiting for antihistamines or corticosteroids.
Adjunctive medications do not replace epinephrine.
4
