CEN Exam 3 | Actual Questions and Answers Latest Updated
2026/2027 (Graded A+)
• Question
1. A pt present to the ED with complaints of chest pain. The 12-lead EKG reveals ST
segment elevation in
leads I and aVL. The initial BP is 112/69 and decreases to a systolic of 60 mmHg
following a dose of nitroglycerin 0.4mg SL. The next most appropriate intervention is to:
A. Complete a fibrinolytic check sheet
B. Initiate a dopamine drip for blood pressure control
C. Obtain a R sided EKG
D. Administer a 0.9% NS bolus IV
Correct Answer: D. Administer a 0.9% NS bolus IV
Pts can be sensitive to vasodilation effects of nitroglycerin. Initial intevention is the
administration of a fluid bolus for the hypotension that occurs secondary to nitroglycerin
• Question
2. A pt presents to the triage nurse complaining of a sudden onset of chest pressure that
has never been
experienced before. The 12 lead EKG shows ST segment elevation in leads V1-V6. This
ST segment pattern is consistent with an occlusion in which coronary artery?:
A. Left anterior descending artery
B. Circumflex descending artery
C. Posterior descending artery
D. Right coronary artery
Correct Answer: A. Left anterior descending artery
Occlusion of the LAD will show ST segment elevation in the septal (V1-V2), anterior
(V3-V4), and lateral (I, aVL, V5-V6) leads
• Question
3. A 68 y/o female presents to the ED with weakness, lightheadedness and nausea. She
has not felt well
for the past several hours but had to complete her workday before seeking medical
care. She denies the presence of chest pain or shortness of breath. The most
appropriate intervention during bedside triage is to:
A. Instruct the pt to chew 325mg of ASA
B. Complete the triage process, including obtaining past medical history, current
medications and family
history
C. Obtain vascular access and draw necessary lab studies specific to cardiac biomarkers
D. Preform a 12 lead EKG
Correct Answer: D. Preform a 12 lead EKG
,The pt is describing an atypical acute coronary syndrome (ACS) presentation. Women
have a unique presentation of signs and symptoms, and their care is at risk of being
delayed because of lack of early recognition. The 12 lead EKG should be completed
within 10 mins of arrival at the ED
• Question
4. Which symptom points toward a diagnosis of abdominal aortic aneurysm?:
A. Pulsatile mass
B. Distant heart sounds
C. Hypertension
D. Subcutaneous emphysema
Correct Answer: A. Pulsatile mass
Although the presence of a pulsatile mass in the abdomen may not always occur in a pt
with a AAA, when present, the nurse shoud be highly suspiscious of AAA and intervene
immediately. Bedside ultrasound can assist in a rapid diagnosis
• Question
5. A pt arrives to the ED and collapses in front of the triage desk. The pt does not have a
pulse and is not
breathing. CPR is initiated and the cardiac monitor displays ventricular tachycardia. The
immediate action by the ED nurse is to?:
A. Administer Amniodarone (Cordarone) 150mg IV
B. Synchronize cardioversion with 200 J
C. Defibrillate using biphasic defibrillator with 120-200J
D. Administer Sodium Bicarbonate 1 mEq/kg
Correct Answer: C. Defibrillate using biphasic defibrilator with 120- 200J
,• Question
Immediate defibrilation is the reccomended treatment for a pulseless V-tach, in
conjunction with adequate CPR. Medications are added after the first defibrilation
attempt. The defibrilation should be repeated every 2 mins if a palpable pulse and
palatable rhythm do not return. If using a monophasic defibrillator, 360J is reccomended
6. Which emergency pt would be an ideal candidate for targeted temperature
management or induced
hypothermia?:
A. A pt with an elevated temperature above 39.4 C (103 F) with a lactic acid level of 6.0
mmol/L
B. A responsive emergency pt who achieved a return of spontaneous circulation (ROSC)
following a
successful resuscitation by emergency medical services personnel
C. An unrepsonsive pt who arrives at the ED with ROSC following cardiopulmonary arrest
D. A pt remaining in ventricular fibrillation following a cardiopulmonary arrest event
Correct Answer: C. An unrepsonsive pt who arrives at the ED with ROSC following
cardiopulmonary arrest
The ideal candidate for targeted temperature management or induced hypothermia is
the pt with ROSC following CPR who remains unresponsive. According to the AHA
guidelines for postresusitative care, the described pt should be considered for targeted
temp management immediately on arrival at the ED with optimal reduced temperature
reached within 2-3 hours of CPR
• Question
7. Which of the following demonstrates that effective cardiopulmonary resuscitation is
being delivered
to the pt in cardiac arrest?:
A. Presence of waveform variation on the cardiac monitor
B. End-tital CO2 20mmHg
C. Arterial pH of 6.9
D. Decreased coronary perfusion pressure
Correct Answer: B. End-tital CO2 20mmHg
End-tital CO2 levels greater than 10mmHg during CPR efforts demonstrate adequate
chest compression depth and good quailty CPR. The higher the end-tital CO2 during
resuscitations, the greater the likelihood of ROSC
, • Question
8. Parents arrive to the ED with their infant, who has a pulse of 30. The infant is limo and
not breathing.
The immediate action by the nurse would be to:
A. Begin rescue breathing at a rate of 20 breaths per min
B. Initiate chest compressions at a rate of 110 breaths per min
C. Defibrillate with 100J
D. Administer epinephrine 0.01mg/kg
Correct Answer: B. Initiate chest compressions at a rate of 110 breaths per min
Chest compressions should be started immediately because of the pulse rate less than
60 beats per min, followed by rescue breathing for a child or infant with a pulse rate of
less than 60 with poor perfusion
• Question
9. A pt presents to the ED with complaints of a rapid heartbeat, which is identified as an
accelerated
junctional rhythm. This dysrhythmia is most commonly associated with:
A. The use of marijuana
B. COPD
C. Use of digoxin
D. History of diabetes
Correct Answer: C. Use of digoxin
Digitalis toxicity leads to the development of atrioventricular dysrhythmias, commonly
resulting in an accelerated rhythm
• Question
10. A pt presents to the ED stating that their heart beat feels irregular. The ED nurse
assesses an
irregular radial pulse. The cardiac monitor displays a cyclic irregular rhythm with an
inconsistent PR segment, which becomes progressively longer until dropping a QRS
complex. The cyclic pattern repeats each 4 complexes. You determine the cardiac
rhythm to be:
A. Second degree Mobitz I
B. Second degree Mobitz II
C. Third degree heart block
D. First degree heart block
Correct Answer: A. Second degree Mobitz I
Second degree Mobitz I or Wenkebach rhythm, is described as the progressive
lengthening of the PR segment ending in a dropped QRS complex usually occuring after
3-5 beats. One of the P waves fails to be conducted to the ventricles, resulting in a
"dropped beat" and then repeating
2026/2027 (Graded A+)
• Question
1. A pt present to the ED with complaints of chest pain. The 12-lead EKG reveals ST
segment elevation in
leads I and aVL. The initial BP is 112/69 and decreases to a systolic of 60 mmHg
following a dose of nitroglycerin 0.4mg SL. The next most appropriate intervention is to:
A. Complete a fibrinolytic check sheet
B. Initiate a dopamine drip for blood pressure control
C. Obtain a R sided EKG
D. Administer a 0.9% NS bolus IV
Correct Answer: D. Administer a 0.9% NS bolus IV
Pts can be sensitive to vasodilation effects of nitroglycerin. Initial intevention is the
administration of a fluid bolus for the hypotension that occurs secondary to nitroglycerin
• Question
2. A pt presents to the triage nurse complaining of a sudden onset of chest pressure that
has never been
experienced before. The 12 lead EKG shows ST segment elevation in leads V1-V6. This
ST segment pattern is consistent with an occlusion in which coronary artery?:
A. Left anterior descending artery
B. Circumflex descending artery
C. Posterior descending artery
D. Right coronary artery
Correct Answer: A. Left anterior descending artery
Occlusion of the LAD will show ST segment elevation in the septal (V1-V2), anterior
(V3-V4), and lateral (I, aVL, V5-V6) leads
• Question
3. A 68 y/o female presents to the ED with weakness, lightheadedness and nausea. She
has not felt well
for the past several hours but had to complete her workday before seeking medical
care. She denies the presence of chest pain or shortness of breath. The most
appropriate intervention during bedside triage is to:
A. Instruct the pt to chew 325mg of ASA
B. Complete the triage process, including obtaining past medical history, current
medications and family
history
C. Obtain vascular access and draw necessary lab studies specific to cardiac biomarkers
D. Preform a 12 lead EKG
Correct Answer: D. Preform a 12 lead EKG
,The pt is describing an atypical acute coronary syndrome (ACS) presentation. Women
have a unique presentation of signs and symptoms, and their care is at risk of being
delayed because of lack of early recognition. The 12 lead EKG should be completed
within 10 mins of arrival at the ED
• Question
4. Which symptom points toward a diagnosis of abdominal aortic aneurysm?:
A. Pulsatile mass
B. Distant heart sounds
C. Hypertension
D. Subcutaneous emphysema
Correct Answer: A. Pulsatile mass
Although the presence of a pulsatile mass in the abdomen may not always occur in a pt
with a AAA, when present, the nurse shoud be highly suspiscious of AAA and intervene
immediately. Bedside ultrasound can assist in a rapid diagnosis
• Question
5. A pt arrives to the ED and collapses in front of the triage desk. The pt does not have a
pulse and is not
breathing. CPR is initiated and the cardiac monitor displays ventricular tachycardia. The
immediate action by the ED nurse is to?:
A. Administer Amniodarone (Cordarone) 150mg IV
B. Synchronize cardioversion with 200 J
C. Defibrillate using biphasic defibrillator with 120-200J
D. Administer Sodium Bicarbonate 1 mEq/kg
Correct Answer: C. Defibrillate using biphasic defibrilator with 120- 200J
,• Question
Immediate defibrilation is the reccomended treatment for a pulseless V-tach, in
conjunction with adequate CPR. Medications are added after the first defibrilation
attempt. The defibrilation should be repeated every 2 mins if a palpable pulse and
palatable rhythm do not return. If using a monophasic defibrillator, 360J is reccomended
6. Which emergency pt would be an ideal candidate for targeted temperature
management or induced
hypothermia?:
A. A pt with an elevated temperature above 39.4 C (103 F) with a lactic acid level of 6.0
mmol/L
B. A responsive emergency pt who achieved a return of spontaneous circulation (ROSC)
following a
successful resuscitation by emergency medical services personnel
C. An unrepsonsive pt who arrives at the ED with ROSC following cardiopulmonary arrest
D. A pt remaining in ventricular fibrillation following a cardiopulmonary arrest event
Correct Answer: C. An unrepsonsive pt who arrives at the ED with ROSC following
cardiopulmonary arrest
The ideal candidate for targeted temperature management or induced hypothermia is
the pt with ROSC following CPR who remains unresponsive. According to the AHA
guidelines for postresusitative care, the described pt should be considered for targeted
temp management immediately on arrival at the ED with optimal reduced temperature
reached within 2-3 hours of CPR
• Question
7. Which of the following demonstrates that effective cardiopulmonary resuscitation is
being delivered
to the pt in cardiac arrest?:
A. Presence of waveform variation on the cardiac monitor
B. End-tital CO2 20mmHg
C. Arterial pH of 6.9
D. Decreased coronary perfusion pressure
Correct Answer: B. End-tital CO2 20mmHg
End-tital CO2 levels greater than 10mmHg during CPR efforts demonstrate adequate
chest compression depth and good quailty CPR. The higher the end-tital CO2 during
resuscitations, the greater the likelihood of ROSC
, • Question
8. Parents arrive to the ED with their infant, who has a pulse of 30. The infant is limo and
not breathing.
The immediate action by the nurse would be to:
A. Begin rescue breathing at a rate of 20 breaths per min
B. Initiate chest compressions at a rate of 110 breaths per min
C. Defibrillate with 100J
D. Administer epinephrine 0.01mg/kg
Correct Answer: B. Initiate chest compressions at a rate of 110 breaths per min
Chest compressions should be started immediately because of the pulse rate less than
60 beats per min, followed by rescue breathing for a child or infant with a pulse rate of
less than 60 with poor perfusion
• Question
9. A pt presents to the ED with complaints of a rapid heartbeat, which is identified as an
accelerated
junctional rhythm. This dysrhythmia is most commonly associated with:
A. The use of marijuana
B. COPD
C. Use of digoxin
D. History of diabetes
Correct Answer: C. Use of digoxin
Digitalis toxicity leads to the development of atrioventricular dysrhythmias, commonly
resulting in an accelerated rhythm
• Question
10. A pt presents to the ED stating that their heart beat feels irregular. The ED nurse
assesses an
irregular radial pulse. The cardiac monitor displays a cyclic irregular rhythm with an
inconsistent PR segment, which becomes progressively longer until dropping a QRS
complex. The cyclic pattern repeats each 4 complexes. You determine the cardiac
rhythm to be:
A. Second degree Mobitz I
B. Second degree Mobitz II
C. Third degree heart block
D. First degree heart block
Correct Answer: A. Second degree Mobitz I
Second degree Mobitz I or Wenkebach rhythm, is described as the progressive
lengthening of the PR segment ending in a dropped QRS complex usually occuring after
3-5 beats. One of the P waves fails to be conducted to the ventricles, resulting in a
"dropped beat" and then repeating
