CEN Exam 2026 2027 Questions and Correct Detailed Answers |
Graded A+ | Exams of Nursing Comprehensive Assessment
Updated Questions and Verified Answers | 100 Questions | 100% VERIFIED
Introduction
The Certified Emergency Nurse examination assesses the knowledge, clinical reasoning, and
priority setting judgment required to care for patients across the lifespan in the emergency
care environment. This comprehensive assessment spans eight core domains:
Cardiovascular Emergencies; Respiratory Emergencies; Neurological Emergencies;
Gastrointestinal and Abdominal Emergencies; Genitourinary, Gynecological, and Obstetrical
Emergencies; Musculoskeletal and Wound Emergencies; Psychosocial and Medical
Emergencies; and Patient Care Management, Triage, and Emergency Operations. Each
question that follows targets a distinct sub-topic within this blueprint, from acute coronary
syndromes, dysrhythmia management, and post arrest care, through asthma, chronic
obstructive pulmonary disease, pneumothorax, and chest tube management, stroke, seizure,
meningitis, and spinal cord emergencies, gastrointestinal hemorrhage, obstruction, and
abdominal trauma, ectopic pregnancy, torsion, preeclampsia, and postpartum hemorrhage,
compartment syndrome, fractures, wound care, and soft tissue infection, behavioral
emergencies, substance withdrawal and toxicity, abuse recognition, and family support, and
triage acuity, mass casualty response, sepsis bundles, transfusion reactions, high alert
medications, restraint requirements, and handoff communication. Mastery of these domains
supports professional board certification and strengthens emergency nursing clinical
execution, patient safety, and quality outcomes in the emergency care setting.
1. A patient arriving with chest pain and possible acute coronary syndrome should
have a twelve lead electrocardiogram obtained:
A. After the troponin result is reported and confirmed
B. Within ten minutes of arrival while aspirin and monitoring are initiated
C. Only if the chest pain radiates to the left arm
D. After a cardiology consultation has been completed
Correct Answer: B. Within ten minutes of arrival while aspirin and monitoring are
initiated
Rationale: Early acquisition allows identification of ST elevation so that reperfusion can
begin promptly, which is why it is tied to an arrival time benchmark. Waiting for
laboratory results, restricting testing to a specific symptom pattern, and waiting for
consultation delay treatment and worsen outcomes.
2. Which electrocardiographic finding requires immediate activation of the
reperfusion pathway?
A. Sinus tachycardia at one hundred twelve beats per minute
, B. New ST segment elevation in two or more contiguous leads
C. Nonspecific ST segment depression occurring with fever
D. Premature atrial contractions occurring every third beat
Correct Answer: B. New ST segment elevation in two or more contiguous leads
Rationale: Contiguous ST elevation indicates an occluded coronary artery and triggers
reperfusion therapy. Rate elevation, nonspecific changes, and isolated atrial ectopy do
not by themselves indicate an acute occlusion requiring reperfusion.
3. A patient reports sudden severe tearing chest pain radiating to the back with
unequal blood pressures between arms. The priority action is to:
A. Administer a thrombolytic agent for presumed myocardial infarction
B. Administer aspirin and heparin and continue the standard chest pain pathway
C. Maintain the patient at rest, avoid anticoagulants, obtain blood pressure in both arms,
and arrange urgent imaging for a suspected aortic dissection
D. Perform a deep breathing and ambulation assessment to reproduce the pain
Correct Answer: C. Maintain the patient at rest, avoid anticoagulants, obtain blood
pressure in both arms, and arrange urgent imaging for a suspected aortic
dissection
Rationale: Aortic dissection requires imaging and avoidance of anticoagulation, since
antithrombotic therapy can be catastrophic. Thrombolytics and standard antiplatelet
and anticoagulant therapy may be lethal, and activity may accelerate the dissection.
4. A patient with acute pulmonary edema who is alert, hypertensive, and hypoxemic
should initially receive:
A. Large volume fluid boluses to improve cardiac output
B. Rapid bolus diuretic therapy before any ventilatory support
C. Immediate endotracheal intubation for all such patients
D. Upright positioning, positive pressure ventilation such as bilevel support,
nitroglycerin, and diuresis as indicated
Correct Answer: D. Upright positioning, positive pressure ventilation such as
bilevel support, nitroglycerin, and diuresis as indicated
Rationale: Preload reduction with positive pressure support and vasodilators improves
oxygenation quickly in hypertensive pulmonary edema. Fluid loading worsens
congestion, isolated diuresis delays ventilatory support, and routine intubation is
reserved for failure of less invasive measures.
5. A patient with a blood pressure of two hundred twenty over one hundred twenty
who has chest pain and neurologic symptoms should be treated by:
A. Rapid reduction to a normal range within thirty minutes using oral agents
B. Withholding all antihypertensive therapy until the patient is admitted
C. Controlled blood pressure reduction with titratable intravenous agents while
monitoring for end organ injury
, D. Administering a single large sublingual dose of a short acting nitrate and reassessing
in one hour
Correct Answer: C. Controlled blood pressure reduction with titratable
intravenous agents while monitoring for end organ injury
Rationale: Hypertensive emergency with organ injury requires monitored, gradual
reduction to preserve perfusion to the brain, heart, and kidneys. Abrupt normalization,
no treatment, and unattended dosing risk ischemia or rebound.
6. A patient with atrial fibrillation, a rapid ventricular rate, and hypotension with
altered mental status should be managed with:
A. Adenosine administration as the first intervention
B. Rate controlling medication given orally and observation for one hour
C. Synchronized cardioversion while sedation planning and continuous rhythm
monitoring proceed
D. Expectant management while awaiting a cardiology appointment
Correct Answer: C. Synchronized cardioversion while sedation planning and
continuous rhythm monitoring proceed
Rationale: Unstable rapid dysrhythmias require immediate synchronized cardioversion
because the patient cannot tolerate the rate. Adenosine is used for regular narrow
complex tachycardia, and oral agents and referral do not address hemodynamic
instability.
7. A stable patient with supraventricular tachycardia who does not respond to vagal
maneuvers should be considered for:
A. Adenosine administered by rapid intravenous push with a flush, along with
continuous cardiac monitoring and defibrillation capability at the bedside
B. A beta blocker given by mouth and discharge if the rhythm converts
C. Synchronized cardioversion before any medication is attempted
D. Immediate initiation of a lidocaine infusion
Correct Answer: A. Adenosine administered by rapid intravenous push with a
flush, along with continuous cardiac monitoring and defibrillation capability at
the bedside
Rationale: Adenosine transiently blocks conduction and often terminates the rhythm,
and equipment must be available if the rhythm destabilizes. Oral therapy and discharge,
immediate cardioversion, and agents used for ventricular arrhythmias do not reflect the
accepted sequence.
8. A patient found pulseless with a rhythm of polymorphic ventricular tachycardia
should be treated with:
A. Synchronized cardioversion at a lower energy setting
B. Immediate high quality cardiopulmonary resuscitation and defibrillation without
delay
C. Adenosine given intravenously while compressions continue
, D. Epinephrine alone, since electricity is reserved for other rhythms
Correct Answer: B. Immediate high quality cardiopulmonary resuscitation and
defibrillation without delay
Rationale: Pulseless polymorphic ventricular tachycardia is treated as a shockable
rhythm with defibrillation and immediate resuscitation. Synchronization cannot be
achieved in a pulseless patient, adenosine has no role, and medication alone will not
terminate the rhythm.
9. When a patient is in asystole, the nurse should ensure that:
A. Defibrillation is attempted at maximal energy immediately
B. Chest compressions are paused while the team discusses reversible causes
C. Sodium bicarbonate is given as the first medication
D. Cardiopulmonary resuscitation is in progress, the rhythm is confirmed in more than
one lead, and reversible causes are being evaluated while epinephrine is administered
Correct Answer: D. Cardiopulmonary resuscitation is in progress, the rhythm is
confirmed in more than one lead, and reversible causes are being evaluated while
epinephrine is administered
Rationale: Asystole is not shockable, so high quality compressions, rhythm
confirmation, epinephrine, and a search for causes are the priorities. Defibrillation is
inappropriate, prolonged pauses harm the patient, and bicarbonate is not a first line
agent.
10. A patient with symptomatic bradycardia who does not respond to atropine should
be managed with:
A. Transcutaneous pacing with sedation and analgesia as tolerated, and preparation for
transvenous pacing
B. Carotid sinus massage to increase the rate
C. Adenosine to reset the conduction system
D. A lidocaine bolus to reduce ventricular irritability
Correct Answer: A. Transcutaneous pacing with sedation and analgesia as
tolerated, and preparation for transvenous pacing
Rationale: Pacing provides the rate needed for adequate perfusion when medication
fails. Massage slows the heart further, adenosine is used for tachyarrhythmias, and
lidocaine does not increase heart rate.
11. A patient with pericardial tamponade is likely to demonstrate:
A. Hypotension, distended neck veins, muffled heart sounds, and pulsus paradoxus with
deterioration when supine
B. Hypertension with a widened pulse pressure and a loud systolic murmur
C. Bradycardia with warm extremities and clear lung fields in every case
D. Elevated oxygen saturation with pleuritic pain relieved by leaning forward
Correct Answer: A. Hypotension, distended neck veins, muffled heart sounds, and
pulsus paradoxus with deterioration when supine
Graded A+ | Exams of Nursing Comprehensive Assessment
Updated Questions and Verified Answers | 100 Questions | 100% VERIFIED
Introduction
The Certified Emergency Nurse examination assesses the knowledge, clinical reasoning, and
priority setting judgment required to care for patients across the lifespan in the emergency
care environment. This comprehensive assessment spans eight core domains:
Cardiovascular Emergencies; Respiratory Emergencies; Neurological Emergencies;
Gastrointestinal and Abdominal Emergencies; Genitourinary, Gynecological, and Obstetrical
Emergencies; Musculoskeletal and Wound Emergencies; Psychosocial and Medical
Emergencies; and Patient Care Management, Triage, and Emergency Operations. Each
question that follows targets a distinct sub-topic within this blueprint, from acute coronary
syndromes, dysrhythmia management, and post arrest care, through asthma, chronic
obstructive pulmonary disease, pneumothorax, and chest tube management, stroke, seizure,
meningitis, and spinal cord emergencies, gastrointestinal hemorrhage, obstruction, and
abdominal trauma, ectopic pregnancy, torsion, preeclampsia, and postpartum hemorrhage,
compartment syndrome, fractures, wound care, and soft tissue infection, behavioral
emergencies, substance withdrawal and toxicity, abuse recognition, and family support, and
triage acuity, mass casualty response, sepsis bundles, transfusion reactions, high alert
medications, restraint requirements, and handoff communication. Mastery of these domains
supports professional board certification and strengthens emergency nursing clinical
execution, patient safety, and quality outcomes in the emergency care setting.
1. A patient arriving with chest pain and possible acute coronary syndrome should
have a twelve lead electrocardiogram obtained:
A. After the troponin result is reported and confirmed
B. Within ten minutes of arrival while aspirin and monitoring are initiated
C. Only if the chest pain radiates to the left arm
D. After a cardiology consultation has been completed
Correct Answer: B. Within ten minutes of arrival while aspirin and monitoring are
initiated
Rationale: Early acquisition allows identification of ST elevation so that reperfusion can
begin promptly, which is why it is tied to an arrival time benchmark. Waiting for
laboratory results, restricting testing to a specific symptom pattern, and waiting for
consultation delay treatment and worsen outcomes.
2. Which electrocardiographic finding requires immediate activation of the
reperfusion pathway?
A. Sinus tachycardia at one hundred twelve beats per minute
, B. New ST segment elevation in two or more contiguous leads
C. Nonspecific ST segment depression occurring with fever
D. Premature atrial contractions occurring every third beat
Correct Answer: B. New ST segment elevation in two or more contiguous leads
Rationale: Contiguous ST elevation indicates an occluded coronary artery and triggers
reperfusion therapy. Rate elevation, nonspecific changes, and isolated atrial ectopy do
not by themselves indicate an acute occlusion requiring reperfusion.
3. A patient reports sudden severe tearing chest pain radiating to the back with
unequal blood pressures between arms. The priority action is to:
A. Administer a thrombolytic agent for presumed myocardial infarction
B. Administer aspirin and heparin and continue the standard chest pain pathway
C. Maintain the patient at rest, avoid anticoagulants, obtain blood pressure in both arms,
and arrange urgent imaging for a suspected aortic dissection
D. Perform a deep breathing and ambulation assessment to reproduce the pain
Correct Answer: C. Maintain the patient at rest, avoid anticoagulants, obtain blood
pressure in both arms, and arrange urgent imaging for a suspected aortic
dissection
Rationale: Aortic dissection requires imaging and avoidance of anticoagulation, since
antithrombotic therapy can be catastrophic. Thrombolytics and standard antiplatelet
and anticoagulant therapy may be lethal, and activity may accelerate the dissection.
4. A patient with acute pulmonary edema who is alert, hypertensive, and hypoxemic
should initially receive:
A. Large volume fluid boluses to improve cardiac output
B. Rapid bolus diuretic therapy before any ventilatory support
C. Immediate endotracheal intubation for all such patients
D. Upright positioning, positive pressure ventilation such as bilevel support,
nitroglycerin, and diuresis as indicated
Correct Answer: D. Upright positioning, positive pressure ventilation such as
bilevel support, nitroglycerin, and diuresis as indicated
Rationale: Preload reduction with positive pressure support and vasodilators improves
oxygenation quickly in hypertensive pulmonary edema. Fluid loading worsens
congestion, isolated diuresis delays ventilatory support, and routine intubation is
reserved for failure of less invasive measures.
5. A patient with a blood pressure of two hundred twenty over one hundred twenty
who has chest pain and neurologic symptoms should be treated by:
A. Rapid reduction to a normal range within thirty minutes using oral agents
B. Withholding all antihypertensive therapy until the patient is admitted
C. Controlled blood pressure reduction with titratable intravenous agents while
monitoring for end organ injury
, D. Administering a single large sublingual dose of a short acting nitrate and reassessing
in one hour
Correct Answer: C. Controlled blood pressure reduction with titratable
intravenous agents while monitoring for end organ injury
Rationale: Hypertensive emergency with organ injury requires monitored, gradual
reduction to preserve perfusion to the brain, heart, and kidneys. Abrupt normalization,
no treatment, and unattended dosing risk ischemia or rebound.
6. A patient with atrial fibrillation, a rapid ventricular rate, and hypotension with
altered mental status should be managed with:
A. Adenosine administration as the first intervention
B. Rate controlling medication given orally and observation for one hour
C. Synchronized cardioversion while sedation planning and continuous rhythm
monitoring proceed
D. Expectant management while awaiting a cardiology appointment
Correct Answer: C. Synchronized cardioversion while sedation planning and
continuous rhythm monitoring proceed
Rationale: Unstable rapid dysrhythmias require immediate synchronized cardioversion
because the patient cannot tolerate the rate. Adenosine is used for regular narrow
complex tachycardia, and oral agents and referral do not address hemodynamic
instability.
7. A stable patient with supraventricular tachycardia who does not respond to vagal
maneuvers should be considered for:
A. Adenosine administered by rapid intravenous push with a flush, along with
continuous cardiac monitoring and defibrillation capability at the bedside
B. A beta blocker given by mouth and discharge if the rhythm converts
C. Synchronized cardioversion before any medication is attempted
D. Immediate initiation of a lidocaine infusion
Correct Answer: A. Adenosine administered by rapid intravenous push with a
flush, along with continuous cardiac monitoring and defibrillation capability at
the bedside
Rationale: Adenosine transiently blocks conduction and often terminates the rhythm,
and equipment must be available if the rhythm destabilizes. Oral therapy and discharge,
immediate cardioversion, and agents used for ventricular arrhythmias do not reflect the
accepted sequence.
8. A patient found pulseless with a rhythm of polymorphic ventricular tachycardia
should be treated with:
A. Synchronized cardioversion at a lower energy setting
B. Immediate high quality cardiopulmonary resuscitation and defibrillation without
delay
C. Adenosine given intravenously while compressions continue
, D. Epinephrine alone, since electricity is reserved for other rhythms
Correct Answer: B. Immediate high quality cardiopulmonary resuscitation and
defibrillation without delay
Rationale: Pulseless polymorphic ventricular tachycardia is treated as a shockable
rhythm with defibrillation and immediate resuscitation. Synchronization cannot be
achieved in a pulseless patient, adenosine has no role, and medication alone will not
terminate the rhythm.
9. When a patient is in asystole, the nurse should ensure that:
A. Defibrillation is attempted at maximal energy immediately
B. Chest compressions are paused while the team discusses reversible causes
C. Sodium bicarbonate is given as the first medication
D. Cardiopulmonary resuscitation is in progress, the rhythm is confirmed in more than
one lead, and reversible causes are being evaluated while epinephrine is administered
Correct Answer: D. Cardiopulmonary resuscitation is in progress, the rhythm is
confirmed in more than one lead, and reversible causes are being evaluated while
epinephrine is administered
Rationale: Asystole is not shockable, so high quality compressions, rhythm
confirmation, epinephrine, and a search for causes are the priorities. Defibrillation is
inappropriate, prolonged pauses harm the patient, and bicarbonate is not a first line
agent.
10. A patient with symptomatic bradycardia who does not respond to atropine should
be managed with:
A. Transcutaneous pacing with sedation and analgesia as tolerated, and preparation for
transvenous pacing
B. Carotid sinus massage to increase the rate
C. Adenosine to reset the conduction system
D. A lidocaine bolus to reduce ventricular irritability
Correct Answer: A. Transcutaneous pacing with sedation and analgesia as
tolerated, and preparation for transvenous pacing
Rationale: Pacing provides the rate needed for adequate perfusion when medication
fails. Massage slows the heart further, adenosine is used for tachyarrhythmias, and
lidocaine does not increase heart rate.
11. A patient with pericardial tamponade is likely to demonstrate:
A. Hypotension, distended neck veins, muffled heart sounds, and pulsus paradoxus with
deterioration when supine
B. Hypertension with a widened pulse pressure and a loud systolic murmur
C. Bradycardia with warm extremities and clear lung fields in every case
D. Elevated oxygen saturation with pleuritic pain relieved by leaning forward
Correct Answer: A. Hypotension, distended neck veins, muffled heart sounds, and
pulsus paradoxus with deterioration when supine
