CEN Exam 5 | Actual Questions and Answers Latest Updated
2026/2027 (Graded A+)
• Question
1. A pt presents to the ED experiencing an anterior ST segment elevation MI. The pts
vital signs are
normal. The hospital is not equipped with a cardaic catheterization lab. The pt can be
transferred to a cardaic catheterization lab within 60 mins. Which of the following would
you anticipate for this pt?:
A. A bolus of tissue plasminogen activator, followed by an infusion for fibrinolytic
therapy
B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous
coronary
intervention
C. A single bolus of tenecteplase (Tnkase) for fibrinolytic therapy
D. A bolus of reteplase (Retavase), followed by a second bolus of reteplase 30 mins later
for fibrinolytic
therapy
Correct Answer: B. Immediate transfer to the hospital with a cardiac catheterization lab
for percutaneous coronary intervention
In adult pts presenting with a STEMI of a hospital that does not have PCI capability, it is
recommended that the pt be transferred immediately without fibrinolytics to a PCI
center, instead of immediate fibrinolysis at the intial hospital with transfer onlu for
ischemia driven PCI
• Question
2. An anxious pt arrives by ambulance following an acute onset of difficulty breathing.
The pt is
diaphoretic and denies chest pain. High-flow O2 by non-rebreather mask has been
applied. Vitals: BP 210/140, HR 130, RR 32, SpO2 88%. In addition to initiating
noninvasive ventilation to treat the pts difficulty breathing, the nurse anticipates the
administration of which medication to further treat the pts symptoms?:
A. Morphine (Morphine sulfate)
B. Furosemide (Lasix)
C. Initation of a continuous nitroglycerin infusion
D. Acetylsalicylic acid (Aspirin)
Correct Answer: C. Initation of a continuous nitroglycerin infusion
,• Question
Pts who present with acute pulmonary edema are typically markedly hypertensive and
in acute respiratory distress. Rapid initiation of appropriate treatment is vital to
reversing the neurohormonal surge and rescuing pts from respiratory and complete
cardiac failure. Nitroglycerin is the most important first line medication in treatment of
acute pulmonary edema and respiratory distress. The initation of continuous NTG
infusion at low doses acts as a vasodilator, leading to decreased preload: at higher
doses ( >100mcg/min) acts as a potent afterload reducer
3. An unrestrained driver is brought to the ED following a motor vehicle collision. The pt
reports hitting
their chest on the steering wheel and is complaining of chest pain across the front of
their chest. There are no vital sign abnormalities and no other complaints of pain. The
diagnosis of blunt cardiac injury is considered. The nurse anticipates an order for which
of the following?:
A. EKG
B. Cardiac marker evaluation (CK or Troponin)
C. Cardiac monitoring
D. Chest radiograph
Correct Answer: B. Cardiac marker evaluation (CK or Troponin)
Not all trauma pts with blunt cardiac injury will have acute alterations in cardiac
markers, and other organ injury may cause release of creatinine kinase and confound
the diagnosis of blunt cardiac injury
• Question
4. Which of the following is a form of distributive shock?:
A. Neurogenic
B. Metabolic
C. Respiratory
D. Obstructive
Correct Answer: A. Neurogenic
,• Question
5. A pt presents following an acute onset of chest pain, dyspnea and severe diaphoresis,
with near
syncope. Assessment shows a pt in severe distress, with HR 110, BP 60/40 and RR 36
with bilateral rales. An EKG reveals ST segment elevation across the precordial leads. A
diagnosis of acute MI with cardiogenic shock is made, and the pt is being prepared for
transfer to the cardiac cath lab. The vasopressor of choice, based on this pts degree of
hypotension is:
A. Norepineprhine (Levophed)
B. Dopamine (Inotropin)
C. Dobutamine (Dobutrex)
D. Vasopressin (Pitressin)
Correct Answer: A. Norepineprhine (Levophed)
• Question
The intial use of norepinephrine for marked hypotension, <70mmHg systolic is the
current recommendation from the AHA
6. A pt presents with complaints of chest pain that radiates to the jaw, stating the pain is
a 6/10. Other
symptoms include nausea, dizziness, shortness of breath with clear lung sounds, and a
sense of impending doom. The pain started 40 mins before arrival. Vitals: BP 116/58, HR
98, RR 20, SpO2 94%, T 98.6F. The 12 lead EKG shows inferior wall myocardial injury
pattern. Which clinical presentations indicate the need to complete a right sided 12 lead
EKG?:
A. Shortness of breath with clear lung sounds
B. Nausea and dizziness
C. Chest pain with radiation to the jaw
D. Sense of impending doom
Correct Answer: A. Shortness of breath with clear lung sounds
Classic right ventricular infarcts are associated with the absence of pulmonary
congestion
Think: RIGHT to my foot
• Question
7. Following the successful resuscitation of a pt in a cardiac arrest, which of the
following findings is the
best indicator high-quality CPR?:
A. A compression depth of 1 1/2 inches
B. Palpable pulses with the preformance of chest compressions during CPR
C. A decrease of skin and mucus membrane cyanosis
D. An increasing end tital Co2 level
Correct Answer: D. An increasing end tital Co2 level
, An increasing end-tidal carbon dioxide level indicates increasing cellular perfusion with
effective CPR or ROSC
• Question
8. During transcutaneous pacing for a pt in third-degree heart block, there is a loss of
ventricular
capture. Which is a significant physiological reason for loss of a pacemaker capture?:
A. Metabolic alkalosis
B. Hypomagnesemia
C. Lactic acidosis
D. Hypokalemia
Correct Answer: C. Lactic acidosis
Lactic acidosis alters the contractility of the myocardium, leading to decreased abilty to
gain ventricular capture, this results in lack of tissue perfusion
• Question
9. A pt presents with complaints of lightheadedness, weakness and near syncope. The
pts 12 lead EKG
reveals the presence of 2:1 arterial flutter. The most appropriate intervention for this
presentation with arterial flutter rhythm is to preform:
A. Synchronized cardioversion at 50 joules
B. Unsynchronized cardioversion at 120 joules
C. Unsynchronized cardioversion at 50 joules
D. Synchronized cardioversion at 120 joules
Correct Answer: A. Synchronized cardioversion at 50 joules
Synchronized cardioversion is reccomended for rhythms with a normal width QRS
complex. A pt with new onset atrial flutter, who is experiencing chest pain, shortness of
breath or other symptoms of instability should be considered for cardioversion. A-flutter
requires less energy to cardiovert than other dysrhythmias
• Question
10. In preparing to discharge a pt who has been given a prescription for nitroglycerin
tablets 0.4mg SL
PRN, the ED nurse acknowledges that the pt teaching has been effective when the pt
states:
A. " I am to take the tablets at least every 2-3 mins when I experience chest pain"
B. " I will call my doctor every time I need to take a tablet for my chest pain"
C. " I should keep the tablets on my window sill in the kitchen so I can find them easily"
D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the
hospital"
Correct Answer: D. " If my chest pain has not gone away after I have taken 2 tablets, I
will come to the hospital"
2026/2027 (Graded A+)
• Question
1. A pt presents to the ED experiencing an anterior ST segment elevation MI. The pts
vital signs are
normal. The hospital is not equipped with a cardaic catheterization lab. The pt can be
transferred to a cardaic catheterization lab within 60 mins. Which of the following would
you anticipate for this pt?:
A. A bolus of tissue plasminogen activator, followed by an infusion for fibrinolytic
therapy
B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous
coronary
intervention
C. A single bolus of tenecteplase (Tnkase) for fibrinolytic therapy
D. A bolus of reteplase (Retavase), followed by a second bolus of reteplase 30 mins later
for fibrinolytic
therapy
Correct Answer: B. Immediate transfer to the hospital with a cardiac catheterization lab
for percutaneous coronary intervention
In adult pts presenting with a STEMI of a hospital that does not have PCI capability, it is
recommended that the pt be transferred immediately without fibrinolytics to a PCI
center, instead of immediate fibrinolysis at the intial hospital with transfer onlu for
ischemia driven PCI
• Question
2. An anxious pt arrives by ambulance following an acute onset of difficulty breathing.
The pt is
diaphoretic and denies chest pain. High-flow O2 by non-rebreather mask has been
applied. Vitals: BP 210/140, HR 130, RR 32, SpO2 88%. In addition to initiating
noninvasive ventilation to treat the pts difficulty breathing, the nurse anticipates the
administration of which medication to further treat the pts symptoms?:
A. Morphine (Morphine sulfate)
B. Furosemide (Lasix)
C. Initation of a continuous nitroglycerin infusion
D. Acetylsalicylic acid (Aspirin)
Correct Answer: C. Initation of a continuous nitroglycerin infusion
,• Question
Pts who present with acute pulmonary edema are typically markedly hypertensive and
in acute respiratory distress. Rapid initiation of appropriate treatment is vital to
reversing the neurohormonal surge and rescuing pts from respiratory and complete
cardiac failure. Nitroglycerin is the most important first line medication in treatment of
acute pulmonary edema and respiratory distress. The initation of continuous NTG
infusion at low doses acts as a vasodilator, leading to decreased preload: at higher
doses ( >100mcg/min) acts as a potent afterload reducer
3. An unrestrained driver is brought to the ED following a motor vehicle collision. The pt
reports hitting
their chest on the steering wheel and is complaining of chest pain across the front of
their chest. There are no vital sign abnormalities and no other complaints of pain. The
diagnosis of blunt cardiac injury is considered. The nurse anticipates an order for which
of the following?:
A. EKG
B. Cardiac marker evaluation (CK or Troponin)
C. Cardiac monitoring
D. Chest radiograph
Correct Answer: B. Cardiac marker evaluation (CK or Troponin)
Not all trauma pts with blunt cardiac injury will have acute alterations in cardiac
markers, and other organ injury may cause release of creatinine kinase and confound
the diagnosis of blunt cardiac injury
• Question
4. Which of the following is a form of distributive shock?:
A. Neurogenic
B. Metabolic
C. Respiratory
D. Obstructive
Correct Answer: A. Neurogenic
,• Question
5. A pt presents following an acute onset of chest pain, dyspnea and severe diaphoresis,
with near
syncope. Assessment shows a pt in severe distress, with HR 110, BP 60/40 and RR 36
with bilateral rales. An EKG reveals ST segment elevation across the precordial leads. A
diagnosis of acute MI with cardiogenic shock is made, and the pt is being prepared for
transfer to the cardiac cath lab. The vasopressor of choice, based on this pts degree of
hypotension is:
A. Norepineprhine (Levophed)
B. Dopamine (Inotropin)
C. Dobutamine (Dobutrex)
D. Vasopressin (Pitressin)
Correct Answer: A. Norepineprhine (Levophed)
• Question
The intial use of norepinephrine for marked hypotension, <70mmHg systolic is the
current recommendation from the AHA
6. A pt presents with complaints of chest pain that radiates to the jaw, stating the pain is
a 6/10. Other
symptoms include nausea, dizziness, shortness of breath with clear lung sounds, and a
sense of impending doom. The pain started 40 mins before arrival. Vitals: BP 116/58, HR
98, RR 20, SpO2 94%, T 98.6F. The 12 lead EKG shows inferior wall myocardial injury
pattern. Which clinical presentations indicate the need to complete a right sided 12 lead
EKG?:
A. Shortness of breath with clear lung sounds
B. Nausea and dizziness
C. Chest pain with radiation to the jaw
D. Sense of impending doom
Correct Answer: A. Shortness of breath with clear lung sounds
Classic right ventricular infarcts are associated with the absence of pulmonary
congestion
Think: RIGHT to my foot
• Question
7. Following the successful resuscitation of a pt in a cardiac arrest, which of the
following findings is the
best indicator high-quality CPR?:
A. A compression depth of 1 1/2 inches
B. Palpable pulses with the preformance of chest compressions during CPR
C. A decrease of skin and mucus membrane cyanosis
D. An increasing end tital Co2 level
Correct Answer: D. An increasing end tital Co2 level
, An increasing end-tidal carbon dioxide level indicates increasing cellular perfusion with
effective CPR or ROSC
• Question
8. During transcutaneous pacing for a pt in third-degree heart block, there is a loss of
ventricular
capture. Which is a significant physiological reason for loss of a pacemaker capture?:
A. Metabolic alkalosis
B. Hypomagnesemia
C. Lactic acidosis
D. Hypokalemia
Correct Answer: C. Lactic acidosis
Lactic acidosis alters the contractility of the myocardium, leading to decreased abilty to
gain ventricular capture, this results in lack of tissue perfusion
• Question
9. A pt presents with complaints of lightheadedness, weakness and near syncope. The
pts 12 lead EKG
reveals the presence of 2:1 arterial flutter. The most appropriate intervention for this
presentation with arterial flutter rhythm is to preform:
A. Synchronized cardioversion at 50 joules
B. Unsynchronized cardioversion at 120 joules
C. Unsynchronized cardioversion at 50 joules
D. Synchronized cardioversion at 120 joules
Correct Answer: A. Synchronized cardioversion at 50 joules
Synchronized cardioversion is reccomended for rhythms with a normal width QRS
complex. A pt with new onset atrial flutter, who is experiencing chest pain, shortness of
breath or other symptoms of instability should be considered for cardioversion. A-flutter
requires less energy to cardiovert than other dysrhythmias
• Question
10. In preparing to discharge a pt who has been given a prescription for nitroglycerin
tablets 0.4mg SL
PRN, the ED nurse acknowledges that the pt teaching has been effective when the pt
states:
A. " I am to take the tablets at least every 2-3 mins when I experience chest pain"
B. " I will call my doctor every time I need to take a tablet for my chest pain"
C. " I should keep the tablets on my window sill in the kitchen so I can find them easily"
D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the
hospital"
Correct Answer: D. " If my chest pain has not gone away after I have taken 2 tablets, I
will come to the hospital"
