CEN Practice Exam 2026-2027 | Actual Complete Questions and
Correct Verified Answers
100 Questions | 2026-2027 | 100% VERIFIED
Introduction
This complete verified bank of 100 items evaluates the knowledge and clinical judgment required
to deliver certified emergency nursing care. Content follows the eight domains of the official Board
of Certification for Emergency Nursing blueprint: Cardiovascular Emergencies; Respiratory
Emergencies; Neurological Emergencies; Gastrointestinal and Genitourinary Emergencies; Trauma
and Shock Management; Medical, Toxicological, and Environmental Emergencies; Pediatric,
Obstetric, and Gynecological Emergencies; and Psychosocial, Triage, and Professional and Legal
Issues. Every item presents four options, the verified correct answer, and a concise rationale
explaining the reasoning and why the remaining options are incorrect. Mastery of this material is
essential for professional certification and for emergency nursing clinical execution, where rapid
identification, decisive intervention, and disciplined professional judgment determine survival for
clients whose conditions change within minutes.
1. A 58-year-old woman with diabetes reports epigastric discomfort, nausea, and fatigue without
chest pain. Which nursing action is most appropriate?
A. Reassure the client that epigastric discomfort excludes cardiac ischemia
B. Obtain an electrocardiogram and cardiac markers promptly because atypical presentations
of acute coronary syndrome are common in women and clients with diabetes
C. Provide an antacid and reassess after 30 minutes
D. Refer the client for an outpatient gastroenterology appointment
Answer: B. Obtain an electrocardiogram and cardiac markers promptly because atypical
presentations of acute coronary syndrome are common in women and clients with
diabetes
Rationale: Women, older adults, and clients with diabetes frequently present with atypical
symptoms such as nausea, fatigue, and epigastric pain, so ischemic evaluation begins
immediately. Reassurance, antacid trials, and outpatient referral delay treatment of a time-
critical condition.
2. A client with suspected acute coronary syndrome has no aspirin allergy and no active bleeding.
Which medication should the nurse administer first?
A. Oral nitroglycerin before any antiplatelet therapy
B. Intravenous morphine sulfate before aspirin administration
C. Subcutaneous heparin as the initial intervention
, D. Chewed aspirin 162 to 325 mg because antiplatelet therapy reduces mortality when given
early
Answer: D. Chewed aspirin 162 to 325 mg because antiplatelet therapy reduces
mortality when given early
Rationale: Chewable aspirin produces rapid platelet inhibition and is the earliest
pharmacologic priority in suspected acute coronary syndrome. Nitroglycerin, morphine, and
heparin are adjuncts that do not replace early antiplatelet therapy.
3. A client with substernal chest pain reports taking sildenafil within the past 12 hours. Which
prescribed medication should the nurse withhold?
A. Aspirin, because the combination increases bleeding risk
B. Heparin, because the combination causes thrombocytopenia
C. Metoprolol, because the combination precipitates bronchospasm
D. Nitroglycerin, because the combination can produce profound hypotension
Answer: D. Nitroglycerin, because the combination can produce profound hypotension
Rationale: PDE5 inhibitors potentiate nitrate-induced vasodilation and can cause refractory
hypotension, so nitrates are withheld for the recommended interval. Aspirin, heparin, and beta
blockade do not carry that specific interaction.
4. An electrocardiogram shows ST elevation in leads II, III, and aVF with hypotension and clear
lungs. Which intervention requires caution in this client?
A. Early aspirin administration, because it worsens right ventricular function
B. Continuous cardiac monitoring, because it delays reperfusion
C. Nitroglycerin administration, because right ventricular infarction is preload dependent
D. Intravenous fluid administration, because it causes pulmonary edema
Answer: C. Nitroglycerin administration, because right ventricular infarction is preload
dependent
Rationale: Inferior infarction with hypotension suggests right ventricular involvement, where
reducing preload can drop cardiac output further, so volume support is often required instead.
Aspirin and monitoring remain indicated, and cautious fluid administration supports rather
than harms this client.
5. A client diagnosed with ST elevation myocardial infarction arrives at a percutaneous coronary
intervention capable hospital. What is the target interval?
A. Six hours from arrival to balloon inflation
B. Twenty-four hours from symptom onset to intervention
C. Ninety minutes or less from first medical contact to device activation
D. Two hours from admission to cardiac catheterization
Answer: C. Ninety minutes or less from first medical contact to device activation
, Rationale: The reperfusion benchmark is 90 minutes or less from first medical contact to
device time for primary percutaneous intervention. Six hours, 24 hours, and two hours all fall
outside the recommended target for direct presentation.
6. A client with ST elevation myocardial infarction presents to a hospital without catheterization
capability, and symptom onset was 2 hours ago. Which reperfusion strategy should the nurse
anticipate?
A. Fibrinolytic therapy administered within 30 minutes of arrival when transfer time exceeds
the recommended window
B. Immediate transfer without any reperfusion therapy started locally
C. Delayed fibrinolytic therapy after 6 hours of monitoring
D. Coronary bypass surgery as the initial reperfusion strategy
Answer: A. Fibrinolytic therapy administered within 30 minutes of arrival when transfer
time exceeds the recommended window
Rationale: When primary intervention cannot be delivered within the recommended time,
fibrinolytics are given promptly, generally with a door-to-needle goal of 30 minutes. Transfer
without treatment, delayed lysis, and immediate bypass do not reflect the reperfusion
algorithm.
7. During fibrinolytic infusion for myocardial infarction, a client develops frequent premature
ventricular contractions. How should the nurse interpret this finding?
A. A reperfusion dysrhythmia that is often self-limited and requires monitoring rather than
reflex antiarrhythmic therapy
B. Evidence of failed reperfusion requiring a second fibrinolytic dose
C. A sign of cardiac rupture requiring immediate pericardiocentesis
D. An allergic reaction requiring discontinuation of the infusion
Answer: A. A reperfusion dysrhythmia that is often self-limited and requires monitoring
rather than reflex antiarrhythmic therapy
Rationale: A brief burst of ventricular ectopy commonly accompanies restored coronary flow
and is generally monitored rather than aggressively treated. Failed lysis, rupture, and allergy
present with different findings and require different interventions.
8. A client with acute decompensated heart failure has crackles, orthopnea, and an oxygen
saturation of 86 percent. Which intervention should the nurse anticipate first?
A. Rapid infusion of 1 L of normal saline for preload support
B. Noninvasive positive pressure ventilation with nitroglycerin and diuretic therapy as
prescribed
C. Immediate intubation before any noninvasive support is attempted
D. Administration of intravenous beta blockers to reduce heart rate
Answer: B. Noninvasive positive pressure ventilation with nitroglycerin and diuretic
therapy as prescribed
, Rationale: Noninvasive ventilation plus preload and afterload reduction corrects hypoxemia
and pulmonary congestion rapidly. Fluid loading worsens pulmonary edema, intubation is not
the first step when noninvasive support is available, and beta blockade is contraindicated in
acute decompensation.
9. A client in atrial fibrillation has a ventricular rate of 168/min with hypotension and altered
mentation. Which action should the nurse anticipate?
A. Synchronized cardioversion with sedation because the client is hemodynamically unstable
B. Oral anticoagulation followed by discharge planning
C. Adenosine administration to convert the rhythm
D. Vagal maneuvers followed by observation for 1 hour
Answer: A. Synchronized cardioversion with sedation because the client is
hemodynamically unstable
Rationale: Unstable tachyarrhythmia with hypoperfusion requires immediate synchronized
cardioversion. Oral anticoagulation, adenosine, and vagal maneuvers are appropriate for stable
or specific rhythms rather than hemodynamically compromising atrial fibrillation.
10. A client has a regular narrow-complex tachycardia at 186/min with a blood pressure of 118/70
mm Hg. Which intervention should the nurse prepare for after vagal maneuvers fail?
A. Adenosine 12 mg slow intravenous push over 2 minutes
B. Amiodarone 300 mg rapid push as the first-line agent
C. Unsynchronized defibrillation at 200 joules
D. Adenosine 6 mg rapid intravenous push followed by a flush, with a second dose of 12 mg if
needed
Answer: D. Adenosine 6 mg rapid intravenous push followed by a flush, with a second
dose of 12 mg if needed
Rationale: Adenosine is given as a rapid bolus with an immediate flush because of its very
short half-life, starting at 6 mg and escalating to 12 mg. Slow administration, amiodarone as
first-line, and unsynchronized shock are inappropriate for stable supraventricular tachycardia.
11. A client with a wide-complex tachycardia and a palpable pulse becomes unconscious during
assessment. Which action is the priority?
A. Prepare for synchronized cardioversion at 100 joules
B. Administer adenosine by rapid intravenous push
C. Begin cardiopulmonary resuscitation and defibrillate immediately
D. Obtain a 12-lead electrocardiogram before any intervention
Answer: C. Begin cardiopulmonary resuscitation and defibrillate immediately
Rationale: Loss of consciousness converts the rhythm to a pulseless arrest requiring
immediate CPR and defibrillation. Synchronized cardioversion, adenosine, and diagnostic
testing delay treatment of pulseless ventricular tachycardia.
Correct Verified Answers
100 Questions | 2026-2027 | 100% VERIFIED
Introduction
This complete verified bank of 100 items evaluates the knowledge and clinical judgment required
to deliver certified emergency nursing care. Content follows the eight domains of the official Board
of Certification for Emergency Nursing blueprint: Cardiovascular Emergencies; Respiratory
Emergencies; Neurological Emergencies; Gastrointestinal and Genitourinary Emergencies; Trauma
and Shock Management; Medical, Toxicological, and Environmental Emergencies; Pediatric,
Obstetric, and Gynecological Emergencies; and Psychosocial, Triage, and Professional and Legal
Issues. Every item presents four options, the verified correct answer, and a concise rationale
explaining the reasoning and why the remaining options are incorrect. Mastery of this material is
essential for professional certification and for emergency nursing clinical execution, where rapid
identification, decisive intervention, and disciplined professional judgment determine survival for
clients whose conditions change within minutes.
1. A 58-year-old woman with diabetes reports epigastric discomfort, nausea, and fatigue without
chest pain. Which nursing action is most appropriate?
A. Reassure the client that epigastric discomfort excludes cardiac ischemia
B. Obtain an electrocardiogram and cardiac markers promptly because atypical presentations
of acute coronary syndrome are common in women and clients with diabetes
C. Provide an antacid and reassess after 30 minutes
D. Refer the client for an outpatient gastroenterology appointment
Answer: B. Obtain an electrocardiogram and cardiac markers promptly because atypical
presentations of acute coronary syndrome are common in women and clients with
diabetes
Rationale: Women, older adults, and clients with diabetes frequently present with atypical
symptoms such as nausea, fatigue, and epigastric pain, so ischemic evaluation begins
immediately. Reassurance, antacid trials, and outpatient referral delay treatment of a time-
critical condition.
2. A client with suspected acute coronary syndrome has no aspirin allergy and no active bleeding.
Which medication should the nurse administer first?
A. Oral nitroglycerin before any antiplatelet therapy
B. Intravenous morphine sulfate before aspirin administration
C. Subcutaneous heparin as the initial intervention
, D. Chewed aspirin 162 to 325 mg because antiplatelet therapy reduces mortality when given
early
Answer: D. Chewed aspirin 162 to 325 mg because antiplatelet therapy reduces
mortality when given early
Rationale: Chewable aspirin produces rapid platelet inhibition and is the earliest
pharmacologic priority in suspected acute coronary syndrome. Nitroglycerin, morphine, and
heparin are adjuncts that do not replace early antiplatelet therapy.
3. A client with substernal chest pain reports taking sildenafil within the past 12 hours. Which
prescribed medication should the nurse withhold?
A. Aspirin, because the combination increases bleeding risk
B. Heparin, because the combination causes thrombocytopenia
C. Metoprolol, because the combination precipitates bronchospasm
D. Nitroglycerin, because the combination can produce profound hypotension
Answer: D. Nitroglycerin, because the combination can produce profound hypotension
Rationale: PDE5 inhibitors potentiate nitrate-induced vasodilation and can cause refractory
hypotension, so nitrates are withheld for the recommended interval. Aspirin, heparin, and beta
blockade do not carry that specific interaction.
4. An electrocardiogram shows ST elevation in leads II, III, and aVF with hypotension and clear
lungs. Which intervention requires caution in this client?
A. Early aspirin administration, because it worsens right ventricular function
B. Continuous cardiac monitoring, because it delays reperfusion
C. Nitroglycerin administration, because right ventricular infarction is preload dependent
D. Intravenous fluid administration, because it causes pulmonary edema
Answer: C. Nitroglycerin administration, because right ventricular infarction is preload
dependent
Rationale: Inferior infarction with hypotension suggests right ventricular involvement, where
reducing preload can drop cardiac output further, so volume support is often required instead.
Aspirin and monitoring remain indicated, and cautious fluid administration supports rather
than harms this client.
5. A client diagnosed with ST elevation myocardial infarction arrives at a percutaneous coronary
intervention capable hospital. What is the target interval?
A. Six hours from arrival to balloon inflation
B. Twenty-four hours from symptom onset to intervention
C. Ninety minutes or less from first medical contact to device activation
D. Two hours from admission to cardiac catheterization
Answer: C. Ninety minutes or less from first medical contact to device activation
, Rationale: The reperfusion benchmark is 90 minutes or less from first medical contact to
device time for primary percutaneous intervention. Six hours, 24 hours, and two hours all fall
outside the recommended target for direct presentation.
6. A client with ST elevation myocardial infarction presents to a hospital without catheterization
capability, and symptom onset was 2 hours ago. Which reperfusion strategy should the nurse
anticipate?
A. Fibrinolytic therapy administered within 30 minutes of arrival when transfer time exceeds
the recommended window
B. Immediate transfer without any reperfusion therapy started locally
C. Delayed fibrinolytic therapy after 6 hours of monitoring
D. Coronary bypass surgery as the initial reperfusion strategy
Answer: A. Fibrinolytic therapy administered within 30 minutes of arrival when transfer
time exceeds the recommended window
Rationale: When primary intervention cannot be delivered within the recommended time,
fibrinolytics are given promptly, generally with a door-to-needle goal of 30 minutes. Transfer
without treatment, delayed lysis, and immediate bypass do not reflect the reperfusion
algorithm.
7. During fibrinolytic infusion for myocardial infarction, a client develops frequent premature
ventricular contractions. How should the nurse interpret this finding?
A. A reperfusion dysrhythmia that is often self-limited and requires monitoring rather than
reflex antiarrhythmic therapy
B. Evidence of failed reperfusion requiring a second fibrinolytic dose
C. A sign of cardiac rupture requiring immediate pericardiocentesis
D. An allergic reaction requiring discontinuation of the infusion
Answer: A. A reperfusion dysrhythmia that is often self-limited and requires monitoring
rather than reflex antiarrhythmic therapy
Rationale: A brief burst of ventricular ectopy commonly accompanies restored coronary flow
and is generally monitored rather than aggressively treated. Failed lysis, rupture, and allergy
present with different findings and require different interventions.
8. A client with acute decompensated heart failure has crackles, orthopnea, and an oxygen
saturation of 86 percent. Which intervention should the nurse anticipate first?
A. Rapid infusion of 1 L of normal saline for preload support
B. Noninvasive positive pressure ventilation with nitroglycerin and diuretic therapy as
prescribed
C. Immediate intubation before any noninvasive support is attempted
D. Administration of intravenous beta blockers to reduce heart rate
Answer: B. Noninvasive positive pressure ventilation with nitroglycerin and diuretic
therapy as prescribed
, Rationale: Noninvasive ventilation plus preload and afterload reduction corrects hypoxemia
and pulmonary congestion rapidly. Fluid loading worsens pulmonary edema, intubation is not
the first step when noninvasive support is available, and beta blockade is contraindicated in
acute decompensation.
9. A client in atrial fibrillation has a ventricular rate of 168/min with hypotension and altered
mentation. Which action should the nurse anticipate?
A. Synchronized cardioversion with sedation because the client is hemodynamically unstable
B. Oral anticoagulation followed by discharge planning
C. Adenosine administration to convert the rhythm
D. Vagal maneuvers followed by observation for 1 hour
Answer: A. Synchronized cardioversion with sedation because the client is
hemodynamically unstable
Rationale: Unstable tachyarrhythmia with hypoperfusion requires immediate synchronized
cardioversion. Oral anticoagulation, adenosine, and vagal maneuvers are appropriate for stable
or specific rhythms rather than hemodynamically compromising atrial fibrillation.
10. A client has a regular narrow-complex tachycardia at 186/min with a blood pressure of 118/70
mm Hg. Which intervention should the nurse prepare for after vagal maneuvers fail?
A. Adenosine 12 mg slow intravenous push over 2 minutes
B. Amiodarone 300 mg rapid push as the first-line agent
C. Unsynchronized defibrillation at 200 joules
D. Adenosine 6 mg rapid intravenous push followed by a flush, with a second dose of 12 mg if
needed
Answer: D. Adenosine 6 mg rapid intravenous push followed by a flush, with a second
dose of 12 mg if needed
Rationale: Adenosine is given as a rapid bolus with an immediate flush because of its very
short half-life, starting at 6 mg and escalating to 12 mg. Slow administration, amiodarone as
first-line, and unsynchronized shock are inappropriate for stable supraventricular tachycardia.
11. A client with a wide-complex tachycardia and a palpable pulse becomes unconscious during
assessment. Which action is the priority?
A. Prepare for synchronized cardioversion at 100 joules
B. Administer adenosine by rapid intravenous push
C. Begin cardiopulmonary resuscitation and defibrillate immediately
D. Obtain a 12-lead electrocardiogram before any intervention
Answer: C. Begin cardiopulmonary resuscitation and defibrillate immediately
Rationale: Loss of consciousness converts the rhythm to a pulseless arrest requiring
immediate CPR and defibrillation. Synchronized cardioversion, adenosine, and diagnostic
testing delay treatment of pulseless ventricular tachycardia.
