2025 Certified Emergency Nurse CEN Exam by BCEN New
Latest Version with All 150 Questions from Actual Exam,
100% Correct Answers and Rationale
1. A 62-year-old has crushing substernal chest pain, diaphoresis, and nausea. Which action
should the nurse take first?
Obtain a 12-lead ECG as soon as possible
Administer oral fluids
Ambulate the patient
Apply a warm compress
Rationale: A rapid 12-lead ECG helps identify acute coronary occlusion and guides time-sensitive reperfusion decisions.
2. A patient with suspected STEMI has no contraindication to aspirin. Which intervention is most
appropriate?
Give chewable aspirin
Give IM morphine first
Place the patient prone
Delay treatment until troponin returns
Rationale: Early aspirin reduces platelet aggregation and is a core early intervention in suspected ACS.
3. A patient with inferior STEMI becomes hypotensive after nitroglycerin. Which finding most
strongly suggests right ventricular involvement?
Clear lungs with elevated jugular venous pressure
Diffuse crackles
Pink frothy sputum
Severe unilateral wheezing
Rationale: Right ventricular infarction can cause preload-dependent hypotension with JVD and relatively clear lungs.
4. A patient has sudden tearing chest pain radiating to the back with unequal arm blood
pressures. Which diagnosis is most concerning?
Aortic dissection
Original CEN-style practice item bank — not actual or leaked BCEN exam questions. Page 1
, Stable angina
Pericarditis
Deep-vein thrombosis
Rationale: Abrupt tearing pain with pulse or pressure asymmetry is classic for aortic dissection.
5. Which finding is most consistent with cardiac tamponade?
Hypotension, JVD, and muffled heart sounds
Hypertension, bradycardia, and crackles
Fever, wheezing, and urticaria
Bounding pulses and wide pulse pressure
Rationale: The classic Beck triad is hypotension, JVD, and muffled heart sounds.
6. A patient in ventricular fibrillation has no pulse. What is the priority intervention?
Immediate unsynchronized defibrillation with CPR
Synchronized cardioversion
Atropine IV push
Vagal maneuvers
Rationale: VF is a shockable cardiac arrest rhythm; high-quality CPR and prompt defibrillation are priorities.
7. A patient has pulseless electrical activity. Which intervention is appropriate?
High-quality CPR and search for reversible causes
Immediate defibrillation
Synchronized cardioversion
Carotid sinus massage
Rationale: PEA is not treated with a shock; CPR and correction of reversible causes are required.
Original CEN-style practice item bank — not actual or leaked BCEN exam questions. Page 2
, 8. Which rhythm is characterized by an irregularly irregular ventricular response and no
consistent P waves?
Atrial fibrillation
Atrial flutter
Sinus tachycardia
First-degree AV block
Rationale: Atrial fibrillation produces chaotic atrial activity and an irregularly irregular ventricular response.
9. A patient has polymorphic ventricular tachycardia associated with a prolonged QT interval.
Which medication is typically indicated?
Magnesium sulfate
Adenosine
Calcium chloride for all cases
Digoxin
Rationale: Torsades de pointes is associated with prolonged QT and is treated acutely with IV magnesium.
10. A stable patient has regular narrow-complex tachycardia at 190/min. Vagal maneuvers fail.
Which medication is commonly used next?
Adenosine
Amiodarone for every case
Lidocaine IM
Atropine
Rationale: For stable regular narrow-complex SVT, adenosine is commonly used after vagal maneuvers.
11. A patient with acute decompensated heart failure develops severe dyspnea and pink frothy
sputum. What is the priority?
Support oxygenation/ventilation and treat pulmonary edema
Original CEN-style practice item bank — not actual or leaked BCEN exam questions. Page 3
, Give a large rapid fluid bolus
Place the patient flat
Encourage oral fluids
Rationale: Acute pulmonary edema threatens oxygenation; respiratory support and appropriate afterload/preload
management are priorities.
12. Which assessment finding is most suggestive of left-sided heart failure?
Bibasilar crackles and orthopnea
Unilateral calf tenderness only
Warm flushed skin
Isolated suprapubic pain
Rationale: Left-sided failure causes pulmonary congestion, commonly producing crackles and orthopnea.
13. A patient with cardiogenic shock is hypotensive, cool, and clammy. Which pathophysiology is
most likely?
Pump failure causing inadequate cardiac output
Excessive systemic vasodilation only
Primary airway obstruction
Isolated renal failure
Rationale: Cardiogenic shock results from inadequate cardiac pump function and therefore reduced tissue perfusion.
14. Which finding favors cardiogenic shock over hypovolemic shock?
Pulmonary crackles with elevated filling pressures
Flat neck veins
History of major hemorrhage
Marked thirst after fluid loss
Rationale: Pulmonary congestion and elevated filling pressures point toward pump failure rather than volume depletion.
Original CEN-style practice item bank — not actual or leaked BCEN exam questions. Page 4
Latest Version with All 150 Questions from Actual Exam,
100% Correct Answers and Rationale
1. A 62-year-old has crushing substernal chest pain, diaphoresis, and nausea. Which action
should the nurse take first?
Obtain a 12-lead ECG as soon as possible
Administer oral fluids
Ambulate the patient
Apply a warm compress
Rationale: A rapid 12-lead ECG helps identify acute coronary occlusion and guides time-sensitive reperfusion decisions.
2. A patient with suspected STEMI has no contraindication to aspirin. Which intervention is most
appropriate?
Give chewable aspirin
Give IM morphine first
Place the patient prone
Delay treatment until troponin returns
Rationale: Early aspirin reduces platelet aggregation and is a core early intervention in suspected ACS.
3. A patient with inferior STEMI becomes hypotensive after nitroglycerin. Which finding most
strongly suggests right ventricular involvement?
Clear lungs with elevated jugular venous pressure
Diffuse crackles
Pink frothy sputum
Severe unilateral wheezing
Rationale: Right ventricular infarction can cause preload-dependent hypotension with JVD and relatively clear lungs.
4. A patient has sudden tearing chest pain radiating to the back with unequal arm blood
pressures. Which diagnosis is most concerning?
Aortic dissection
Original CEN-style practice item bank — not actual or leaked BCEN exam questions. Page 1
, Stable angina
Pericarditis
Deep-vein thrombosis
Rationale: Abrupt tearing pain with pulse or pressure asymmetry is classic for aortic dissection.
5. Which finding is most consistent with cardiac tamponade?
Hypotension, JVD, and muffled heart sounds
Hypertension, bradycardia, and crackles
Fever, wheezing, and urticaria
Bounding pulses and wide pulse pressure
Rationale: The classic Beck triad is hypotension, JVD, and muffled heart sounds.
6. A patient in ventricular fibrillation has no pulse. What is the priority intervention?
Immediate unsynchronized defibrillation with CPR
Synchronized cardioversion
Atropine IV push
Vagal maneuvers
Rationale: VF is a shockable cardiac arrest rhythm; high-quality CPR and prompt defibrillation are priorities.
7. A patient has pulseless electrical activity. Which intervention is appropriate?
High-quality CPR and search for reversible causes
Immediate defibrillation
Synchronized cardioversion
Carotid sinus massage
Rationale: PEA is not treated with a shock; CPR and correction of reversible causes are required.
Original CEN-style practice item bank — not actual or leaked BCEN exam questions. Page 2
, 8. Which rhythm is characterized by an irregularly irregular ventricular response and no
consistent P waves?
Atrial fibrillation
Atrial flutter
Sinus tachycardia
First-degree AV block
Rationale: Atrial fibrillation produces chaotic atrial activity and an irregularly irregular ventricular response.
9. A patient has polymorphic ventricular tachycardia associated with a prolonged QT interval.
Which medication is typically indicated?
Magnesium sulfate
Adenosine
Calcium chloride for all cases
Digoxin
Rationale: Torsades de pointes is associated with prolonged QT and is treated acutely with IV magnesium.
10. A stable patient has regular narrow-complex tachycardia at 190/min. Vagal maneuvers fail.
Which medication is commonly used next?
Adenosine
Amiodarone for every case
Lidocaine IM
Atropine
Rationale: For stable regular narrow-complex SVT, adenosine is commonly used after vagal maneuvers.
11. A patient with acute decompensated heart failure develops severe dyspnea and pink frothy
sputum. What is the priority?
Support oxygenation/ventilation and treat pulmonary edema
Original CEN-style practice item bank — not actual or leaked BCEN exam questions. Page 3
, Give a large rapid fluid bolus
Place the patient flat
Encourage oral fluids
Rationale: Acute pulmonary edema threatens oxygenation; respiratory support and appropriate afterload/preload
management are priorities.
12. Which assessment finding is most suggestive of left-sided heart failure?
Bibasilar crackles and orthopnea
Unilateral calf tenderness only
Warm flushed skin
Isolated suprapubic pain
Rationale: Left-sided failure causes pulmonary congestion, commonly producing crackles and orthopnea.
13. A patient with cardiogenic shock is hypotensive, cool, and clammy. Which pathophysiology is
most likely?
Pump failure causing inadequate cardiac output
Excessive systemic vasodilation only
Primary airway obstruction
Isolated renal failure
Rationale: Cardiogenic shock results from inadequate cardiac pump function and therefore reduced tissue perfusion.
14. Which finding favors cardiogenic shock over hypovolemic shock?
Pulmonary crackles with elevated filling pressures
Flat neck veins
History of major hemorrhage
Marked thirst after fluid loss
Rationale: Pulmonary congestion and elevated filling pressures point toward pump failure rather than volume depletion.
Original CEN-style practice item bank — not actual or leaked BCEN exam questions. Page 4
