CEN Exam 4 | Actual Questions and Answers Latest Updated
2026/2027 (Graded A+)
• Question
1. A pt presents who had experienced chest pain but is now pain free. EKG's have been
repeated twice,
and troponin levels repeated at 4 hour intervals are within normal limits. The pt has no
significant risk factor for heart disease. The nurse anticipates:
A. Admission to the ICU to rule out MI
B. Admission to the cardiac cath lab for eval of coronary anatomy
C. That the pt will be discharged home, with instructions for close follow up with their
PCP because the
risk of an adverse coronary event is low
D. Admission to the telemetry unit to rule out an MI
Correct Answer: C. That the pt will be discharged home, with instructions for close follow
up with their PCP because the risk of an adverse coronary event is low
In adult pts with chest pain who demonstrates two negative findings for serial
biomarkers, nonconcerning vital signs and nonischemic EKG findings, short term
clinically relevant adverse cardiac events are rare and commonly iatrogenic, inpatient
admission may not be beneficial
• Question
2. A pt who became unconscious during ascent while scuba diving arrives via EMS. The
pt is unconscious
and hypotensive. What is the most appropriate position in which to place this pt during
their examination by physician?:
A. Left lateral decubitus, head down
B. Right lateral decubitus, head down
C. Left lateral decubitus, head up
D. Supine
Correct Answer: A. Left lateral decubitus, head down
Head down position prevents air from traveling through the right side of the heart into
the pulmonary arteries, leading to a possible right ventricular outflow obstruction
• Question
3. In which pt would the nurse question on order for morphine sulfate?:
A. A pt with aortic dissection
B. A pt with a ST elevation MI
C. A pt with unstable angina
D. A pt with non-ST MI
Correct Answer: D. A pt with non-ST MI
,An increase of mortality has been associated with the use of morphine sulfate in pts with
non-ST segment elevation
• Question
4. Following the administration of 2L IV crystalloids, the ED nurse begins to administer IV
dobutamine
(Dobutrex) to a pt who has been diagnosed with a right ventricular infarction. The ED
nurse identifies that this medication has been effective when the pt demonstrates which
of the following?:
A. Bradycardia
B. Increase in blood pressure
C. Presence of distended neck veins
D. Onset of A-fib
Correct Answer: B. Increase in blood pressure
Pts who experience RVI as preload dependent and require additional fluids to increase
their blood pressure. If the pts BP does not respond to the additional fluid
administration, the administration of Dobutamine is indicated to increase the pts cardiac
output, thereby increasing the BP
• Question
5. The nurse has instituted applied O2 and is to reduce the pts heart rate and blood
pressure. Which of
the following findings would be expected after applying oxygen, initiating 2 large bore
IV's and administering IV beta blockers?:
A. Difference of >20 mmHg blood pressure when comparing in both arms
B. Chest pain radiating to left shoulder
C. Orthopnea and JVD
D. Petechial lesions on the pts palms or soles
Correct Answer: A. Difference of >20 mmHg blood pressure when comparing in both
arms
Difference of >20mmHg BP in both arms is suggestive of aortic dissection. Treatment
for aortic dissection incluides the insertion of 2 large caliber IV's, application of O2 and
administration of betablockers to reduce the pts HR and BP
,• Question
6. A 3 month old infant weighing 11lbs (5 kg) arrives to the ED in full cardiopulmonary
arrest. The
monitor shows V-fib. Good quality CPR is being preformed, and the infant has been
defibrilated once. Which medication should be administered next?:
A. Epi 0.05mg IV/IO
B. Atropine 0.1mg IV/IO
C. Amiodarone 25mg IV/IO
D. Sodium Bicarbonate 5mEq IV
Correct Answer: A. Epi 0.05mg IV/IO
Epi is the first line drug for an infant in cardiac arrest because of V-fib. The correct dose
is 0.01mg/kg (0.01x5= 0.05)
• Question
7. A pt in cardiopulmonary arrest remains in V-fib despite having been defibrillated 6
times, receieving
good quality CPR, and the administration of Epi and Amiodarone. ABG reveals a pH of
7.02, PO2 96mmHg, pCO2 40mmHg. What other medication order should the ED nurse
anticipate next for this pt?:
A. Adenosine 6mg
B. Calcium Chloride 1g
C. Vasopressin 40 units
D. Sodium Bicarb 1mEq/kg
Correct Answer: D. Sodium Bicarb 1mEq/kg
Sodium bicarb is indicated for documented acidosis during cardiac arrest. Arterial gases
indicate a pH of 7.0, or acidosis. Sodium bicarb will act as an alkalinizer to raise the pH
to a value closer to a normal range (7.35-7.45)
• Question
8. A pt presents via EMS in cardiopulmonary arrest. Chest compressions and bag-mask
ventilation are
being preformed. The cardiac monitor shows V-tach. While the defibrilator is charging
for defibrillation, the nurse should ensure that:
A. No one is touching the pt
B. High-quality CPR is continued
C. Oxygen delivery via nasal cannula continues at 6L/min
D. The defibrilator pads have been plaed on the pt
Correct Answer: B. High-quality CPR is continued
, • Question
AHA suggests that high-quality CPR is continued while the defibrilator is charging
9. A teenaged pt presents to triage stating they have the sensation that their heart is
jumping out of
their chesrt for the past several hours. The pt denies routine drug use and states they
have been studying for end-of-the-semester final exams for the past 3 days and took a
pill to help him study. You palpate a radial pulse that is 170bpm and regular. Which of
the following dysrhythmias would be suspected?:
A. SVT
B. V-tach
C. A-fib
D. Sinus rhythm with PAC's
Correct Answer: A. SVT
SVT is common in young people with no history of organic heart disease and is
frequently associated with the use of stimulants
• Question
10. The ED nurse is participating in the treatment of a patient in cardiac arrest. CPR is
ongoing, an
advanced airway is present, and vascular access has been obtained. The monitor shows
an organized rhythm, but no palpable pulse is detected. In addition to evaluating the
"H's and T's" as cause of PEA, the nurse anticipates the use of what device or procedure
to better evaluate for potentially reversible causes of PEA?:
A. EKG
B. Point of care ultrasound
C. Bedside chest x-ray
D. Glucometer
Correct Answer: B. Point of care ultrasound
Point of care ultrasound can quickly aid in identification of mechanical causes of PEA. A
collapsed right ventricle suggests an inflow obstruction ( tampanode, pneumothorax or
hyperinflation). Dilated Right ventricle indicates outflow obstruction (Pulmonary
embolism)
2026/2027 (Graded A+)
• Question
1. A pt presents who had experienced chest pain but is now pain free. EKG's have been
repeated twice,
and troponin levels repeated at 4 hour intervals are within normal limits. The pt has no
significant risk factor for heart disease. The nurse anticipates:
A. Admission to the ICU to rule out MI
B. Admission to the cardiac cath lab for eval of coronary anatomy
C. That the pt will be discharged home, with instructions for close follow up with their
PCP because the
risk of an adverse coronary event is low
D. Admission to the telemetry unit to rule out an MI
Correct Answer: C. That the pt will be discharged home, with instructions for close follow
up with their PCP because the risk of an adverse coronary event is low
In adult pts with chest pain who demonstrates two negative findings for serial
biomarkers, nonconcerning vital signs and nonischemic EKG findings, short term
clinically relevant adverse cardiac events are rare and commonly iatrogenic, inpatient
admission may not be beneficial
• Question
2. A pt who became unconscious during ascent while scuba diving arrives via EMS. The
pt is unconscious
and hypotensive. What is the most appropriate position in which to place this pt during
their examination by physician?:
A. Left lateral decubitus, head down
B. Right lateral decubitus, head down
C. Left lateral decubitus, head up
D. Supine
Correct Answer: A. Left lateral decubitus, head down
Head down position prevents air from traveling through the right side of the heart into
the pulmonary arteries, leading to a possible right ventricular outflow obstruction
• Question
3. In which pt would the nurse question on order for morphine sulfate?:
A. A pt with aortic dissection
B. A pt with a ST elevation MI
C. A pt with unstable angina
D. A pt with non-ST MI
Correct Answer: D. A pt with non-ST MI
,An increase of mortality has been associated with the use of morphine sulfate in pts with
non-ST segment elevation
• Question
4. Following the administration of 2L IV crystalloids, the ED nurse begins to administer IV
dobutamine
(Dobutrex) to a pt who has been diagnosed with a right ventricular infarction. The ED
nurse identifies that this medication has been effective when the pt demonstrates which
of the following?:
A. Bradycardia
B. Increase in blood pressure
C. Presence of distended neck veins
D. Onset of A-fib
Correct Answer: B. Increase in blood pressure
Pts who experience RVI as preload dependent and require additional fluids to increase
their blood pressure. If the pts BP does not respond to the additional fluid
administration, the administration of Dobutamine is indicated to increase the pts cardiac
output, thereby increasing the BP
• Question
5. The nurse has instituted applied O2 and is to reduce the pts heart rate and blood
pressure. Which of
the following findings would be expected after applying oxygen, initiating 2 large bore
IV's and administering IV beta blockers?:
A. Difference of >20 mmHg blood pressure when comparing in both arms
B. Chest pain radiating to left shoulder
C. Orthopnea and JVD
D. Petechial lesions on the pts palms or soles
Correct Answer: A. Difference of >20 mmHg blood pressure when comparing in both
arms
Difference of >20mmHg BP in both arms is suggestive of aortic dissection. Treatment
for aortic dissection incluides the insertion of 2 large caliber IV's, application of O2 and
administration of betablockers to reduce the pts HR and BP
,• Question
6. A 3 month old infant weighing 11lbs (5 kg) arrives to the ED in full cardiopulmonary
arrest. The
monitor shows V-fib. Good quality CPR is being preformed, and the infant has been
defibrilated once. Which medication should be administered next?:
A. Epi 0.05mg IV/IO
B. Atropine 0.1mg IV/IO
C. Amiodarone 25mg IV/IO
D. Sodium Bicarbonate 5mEq IV
Correct Answer: A. Epi 0.05mg IV/IO
Epi is the first line drug for an infant in cardiac arrest because of V-fib. The correct dose
is 0.01mg/kg (0.01x5= 0.05)
• Question
7. A pt in cardiopulmonary arrest remains in V-fib despite having been defibrillated 6
times, receieving
good quality CPR, and the administration of Epi and Amiodarone. ABG reveals a pH of
7.02, PO2 96mmHg, pCO2 40mmHg. What other medication order should the ED nurse
anticipate next for this pt?:
A. Adenosine 6mg
B. Calcium Chloride 1g
C. Vasopressin 40 units
D. Sodium Bicarb 1mEq/kg
Correct Answer: D. Sodium Bicarb 1mEq/kg
Sodium bicarb is indicated for documented acidosis during cardiac arrest. Arterial gases
indicate a pH of 7.0, or acidosis. Sodium bicarb will act as an alkalinizer to raise the pH
to a value closer to a normal range (7.35-7.45)
• Question
8. A pt presents via EMS in cardiopulmonary arrest. Chest compressions and bag-mask
ventilation are
being preformed. The cardiac monitor shows V-tach. While the defibrilator is charging
for defibrillation, the nurse should ensure that:
A. No one is touching the pt
B. High-quality CPR is continued
C. Oxygen delivery via nasal cannula continues at 6L/min
D. The defibrilator pads have been plaed on the pt
Correct Answer: B. High-quality CPR is continued
, • Question
AHA suggests that high-quality CPR is continued while the defibrilator is charging
9. A teenaged pt presents to triage stating they have the sensation that their heart is
jumping out of
their chesrt for the past several hours. The pt denies routine drug use and states they
have been studying for end-of-the-semester final exams for the past 3 days and took a
pill to help him study. You palpate a radial pulse that is 170bpm and regular. Which of
the following dysrhythmias would be suspected?:
A. SVT
B. V-tach
C. A-fib
D. Sinus rhythm with PAC's
Correct Answer: A. SVT
SVT is common in young people with no history of organic heart disease and is
frequently associated with the use of stimulants
• Question
10. The ED nurse is participating in the treatment of a patient in cardiac arrest. CPR is
ongoing, an
advanced airway is present, and vascular access has been obtained. The monitor shows
an organized rhythm, but no palpable pulse is detected. In addition to evaluating the
"H's and T's" as cause of PEA, the nurse anticipates the use of what device or procedure
to better evaluate for potentially reversible causes of PEA?:
A. EKG
B. Point of care ultrasound
C. Bedside chest x-ray
D. Glucometer
Correct Answer: B. Point of care ultrasound
Point of care ultrasound can quickly aid in identification of mechanical causes of PEA. A
collapsed right ventricle suggests an inflow obstruction ( tampanode, pneumothorax or
hyperinflation). Dilated Right ventricle indicates outflow obstruction (Pulmonary
embolism)
