CEN Certification Emergency Nursing
Individually Scheduled Examination: Advanced
Practice Question Bank
Target Audience: Emergency nursing professionals preparing for the Certified Emergency Nurse (CEN)
examination
Difficulty Level: Advanced / Hard
Exam Format: 150 multiple-choice questions with detailed rationales
Reference Basis: Questions are modeled on the BCEN CEN Examination Content Outline (effective July
2026), Emergency Nursing Core Curriculum (8th Edition, ENA), Sheehy's Manual of Emergency Nursing,
and peer-reviewed emergency nursing literature.
Table of Contents
1. Cardiovascular Emergencies (Q1–Q27)
2. Respiratory Emergencies (Q28–Q48)
3. Neurological Emergencies (Q49–Q68)
4. Gastrointestinal Emergencies (Q69–Q82)
5. Genitourinary, Gynecological, and Obstetrical Emergencies (Q83–Q96)
6. Medical Emergencies (Q97–Q114)
7. Trauma Emergencies (Q115–Q132)
8. Environmental and Toxicology Emergencies (Q133–Q142)
9. Communicable Diseases (Q143–Q147)
10. Professional Issues (Q148–Q150)
Section 1: Cardiovascular Emergencies
🟢 Q1. A 58-year-old male presents with crushing substernal chest pain radiating to the left jaw. ECG
reveals ST elevation in leads II, III, and aVF. The nurse should anticipate which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
🔴 Correct Answer: C
,Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, which is
most commonly caused by occlusion of the right coronary artery (RCA). The RCA supplies the inferior
wall of the left ventricle in approximately 80% of individuals. Leads I and aVL would show reciprocal ST
depression. The LAD supplies the anterior wall (V1–V4), and the circumflex supplies the lateral wall (I,
aVL, V5–V6).
🟢 Q2. A patient with acute decompensated heart failure presents with severe dyspnea, bilateral crackles,
and pink frothy sputum. The patient is alert, hypertensive (BP 178/96), and hypoxic (SpO₂ 84% on room
air). Which intervention should the nurse anticipate implementing first?
A. IV furosemide 40 mg bolus
B. Upright positioning with high-flow oxygen and non-invasive positive pressure ventilation (NIPPV)
C. IV morphine 2 mg
D. Nitroglycerin sublingual 0.4 mg every 5 minutes
🔴 Correct Answer: B
Rationale: For acute pulmonary edema with hypertension and hypoxia, the immediate priorities are
oxygenation and preload reduction. Upright positioning, high-flow oxygen, and NIPPV (CPAP or BiPAP)
provide rapid improvement in oxygenation and reduce the work of breathing. While furosemide and
nitroglycerin are essential therapies, they are adjuncts to airway and breathing management. Morphine
is no longer routinely recommended due to increased mortality risk.
🟢 Q3. A patient with a permanent pacemaker presents with palpitations. The monitor shows a paced
rhythm at 60 bpm with intermittent spikes not followed by QRS complexes. What is the most likely
malfunction?
A. Failure to capture
B. Failure to sense
C. Pacemaker-mediated tachycardia
D. Battery depletion
🔴 Correct Answer: A
Rationale: Failure to capture occurs when the pacemaker fires (spike is visible) but does not depolarize
the myocardium (no QRS follows). This can result from lead displacement, fibrosis at the lead tip,
electrolyte abnormalities, or battery depletion. Failure to sense would show spikes occurring at
inappropriate times (e.g., on a T wave). Pacemaker-mediated tachycardia involves a rapid paced rhythm.
Battery depletion would show decreased rate or failure to fire.
🟢 Q4. A 62-year-old female presents with sudden-onset "tearing" chest pain radiating to the back. She is
diaphoretic and hypotensive (BP 88/54). Which diagnostic study is the priority?
A. 12-lead ECG
B. Chest X-ray
C. CT angiography of the chest
D. Transthoracic echocardiogram
🔴 Correct Answer: C
,Rationale: The clinical presentation is highly suspicious for aortic dissection. CT angiography is the
diagnostic study of choice with sensitivity and specificity approaching 100%. It can identify the location,
extent, and presence of pericardial effusion. While ECG and chest X-ray are initial screening tools, they
are nonspecific. Aortic dissection is a time-critical emergency requiring immediate surgical consultation.
🟢 Q5. A patient is in pulseless ventricular tachycardia (pVT). After defibrillation at 200 J biphasic, the
rhythm remains pVT. The patient has received one dose of epinephrine and one dose of amiodarone.
Which is the correct next intervention?
A. Increase defibrillation energy to 360 J
B. Administer sodium bicarbonate 1 mEq/kg
C. Continue CPR for 2 minutes before next rhythm check
D. Administer magnesium sulfate 2 g IV push
🔴 Correct Answer: C
Rationale: Per ACLS guidelines, after each defibrillation attempt and medication administration, CPR
should be resumed immediately for 2 minutes before the next rhythm check. Interruptions in chest
compressions should be minimized. For refractory VF/pVT, escalating defibrillation energy may be
considered, but the priority is uninterrupted CPR. Sodium bicarbonate is not routinely recommended.
Magnesium is indicated for torsades de pointes, not standard pVT.
🟢 Q6. A patient presents with a heart rate of 36 bpm, BP 78/42, and altered mental status. The ECG
shows a third-degree heart block. Which intervention should the nurse anticipate first?
A. Atropine 1 mg IV push
B. Transcutaneous pacing
C. Dopamine infusion at 5 mcg/kg/min
D. Epinephrine infusion at 2 mcg/min
🔴 Correct Answer: B
Rationale: For symptomatic bradycardia with a high-degree block (third-degree), transcutaneous pacing
is the preferred immediate intervention because atropine is often ineffective in infranodal blocks.
Atropine may be tried first in some protocols, but in third-degree heart block, it is unlikely to work.
Transcutaneous pacing provides immediate rate support until transvenous pacing can be established.
🟢 Q7. A 45-year-old male presents with palpitations and a heart rate of 186 bpm. The ECG shows a
regular narrow-complex tachycardia. He is hemodynamically stable. Which intervention is most
appropriate?
A. Synchronized cardioversion at 50 J
B. Adenosine 6 mg IV rapid push
C. Amiodarone 150 mg IV over 10 minutes
D. Vagal maneuvers
🔴 Correct Answer: D
, Rationale: For stable narrow-complex tachycardia (likely SVT), vagal maneuvers are the first-line
intervention. They are non-invasive and can terminate the arrhythmia by increasing vagal tone at the AV
node. If vagal maneuvers fail, adenosine is the next step. Synchronized cardioversion is reserved for
unstable patients. Amiodarone is used for ventricular arrhythmias or atrial fibrillation.
🟢 Q8. A patient with a known history of heart failure presents with weight gain, peripheral edema, and
orthopnea. Which assessment finding is most concerning for acute decompensation?
A. Bibasilar crackles
B. 3+ pitting edema
C. Jugular venous distension (JVD) at 45 degrees
D. Oxygen saturation of 90% on room air
🔴 Correct Answer: D
Rationale: While all findings indicate heart failure exacerbation, an SpO₂ of 90% on room air indicates
significant hypoxia and impending respiratory failure, making it the most immediately concerning
finding. It requires urgent intervention with supplemental oxygen and likely NIPPV. The other findings
are chronic or subacute manifestations of volume overload.
🟢 Q9. A patient is receiving a dopamine infusion at 10 mcg/kg/min. Which assessment finding indicates
the desired therapeutic effect?
A. Increased urine output
B. Decreased heart rate
C. Increased blood pressure
D. Decreased respiratory rate
🔴 Correct Answer: C
Rationale: Dopamine at moderate doses (5–10 mcg/kg/min) primarily stimulates beta-1 receptors,
increasing cardiac contractility and heart rate, which leads to increased blood pressure. At low doses (1–
3 mcg/kg/min), it stimulates dopaminergic receptors, increasing renal blood flow and urine output. The
primary therapeutic goal in most emergency situations is hemodynamic stabilization, manifested as
increased blood pressure.
🟢 Q10. A patient with an acute MI develops a new holosystolic murmur at the apex, along with acute
pulmonary edema and hypotension. What complication should the nurse suspect?
A. Ventricular septal defect
B. Papillary muscle rupture
C. Pericardial tamponade
D. Left ventricular free wall rupture
🔴 Correct Answer: B
Rationale: Papillary muscle rupture is a mechanical complication of MI (typically inferior wall) that
presents with acute mitral regurgitation, manifesting as a new holosystolic murmur, acute pulmonary
Individually Scheduled Examination: Advanced
Practice Question Bank
Target Audience: Emergency nursing professionals preparing for the Certified Emergency Nurse (CEN)
examination
Difficulty Level: Advanced / Hard
Exam Format: 150 multiple-choice questions with detailed rationales
Reference Basis: Questions are modeled on the BCEN CEN Examination Content Outline (effective July
2026), Emergency Nursing Core Curriculum (8th Edition, ENA), Sheehy's Manual of Emergency Nursing,
and peer-reviewed emergency nursing literature.
Table of Contents
1. Cardiovascular Emergencies (Q1–Q27)
2. Respiratory Emergencies (Q28–Q48)
3. Neurological Emergencies (Q49–Q68)
4. Gastrointestinal Emergencies (Q69–Q82)
5. Genitourinary, Gynecological, and Obstetrical Emergencies (Q83–Q96)
6. Medical Emergencies (Q97–Q114)
7. Trauma Emergencies (Q115–Q132)
8. Environmental and Toxicology Emergencies (Q133–Q142)
9. Communicable Diseases (Q143–Q147)
10. Professional Issues (Q148–Q150)
Section 1: Cardiovascular Emergencies
🟢 Q1. A 58-year-old male presents with crushing substernal chest pain radiating to the left jaw. ECG
reveals ST elevation in leads II, III, and aVF. The nurse should anticipate which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
🔴 Correct Answer: C
,Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, which is
most commonly caused by occlusion of the right coronary artery (RCA). The RCA supplies the inferior
wall of the left ventricle in approximately 80% of individuals. Leads I and aVL would show reciprocal ST
depression. The LAD supplies the anterior wall (V1–V4), and the circumflex supplies the lateral wall (I,
aVL, V5–V6).
🟢 Q2. A patient with acute decompensated heart failure presents with severe dyspnea, bilateral crackles,
and pink frothy sputum. The patient is alert, hypertensive (BP 178/96), and hypoxic (SpO₂ 84% on room
air). Which intervention should the nurse anticipate implementing first?
A. IV furosemide 40 mg bolus
B. Upright positioning with high-flow oxygen and non-invasive positive pressure ventilation (NIPPV)
C. IV morphine 2 mg
D. Nitroglycerin sublingual 0.4 mg every 5 minutes
🔴 Correct Answer: B
Rationale: For acute pulmonary edema with hypertension and hypoxia, the immediate priorities are
oxygenation and preload reduction. Upright positioning, high-flow oxygen, and NIPPV (CPAP or BiPAP)
provide rapid improvement in oxygenation and reduce the work of breathing. While furosemide and
nitroglycerin are essential therapies, they are adjuncts to airway and breathing management. Morphine
is no longer routinely recommended due to increased mortality risk.
🟢 Q3. A patient with a permanent pacemaker presents with palpitations. The monitor shows a paced
rhythm at 60 bpm with intermittent spikes not followed by QRS complexes. What is the most likely
malfunction?
A. Failure to capture
B. Failure to sense
C. Pacemaker-mediated tachycardia
D. Battery depletion
🔴 Correct Answer: A
Rationale: Failure to capture occurs when the pacemaker fires (spike is visible) but does not depolarize
the myocardium (no QRS follows). This can result from lead displacement, fibrosis at the lead tip,
electrolyte abnormalities, or battery depletion. Failure to sense would show spikes occurring at
inappropriate times (e.g., on a T wave). Pacemaker-mediated tachycardia involves a rapid paced rhythm.
Battery depletion would show decreased rate or failure to fire.
🟢 Q4. A 62-year-old female presents with sudden-onset "tearing" chest pain radiating to the back. She is
diaphoretic and hypotensive (BP 88/54). Which diagnostic study is the priority?
A. 12-lead ECG
B. Chest X-ray
C. CT angiography of the chest
D. Transthoracic echocardiogram
🔴 Correct Answer: C
,Rationale: The clinical presentation is highly suspicious for aortic dissection. CT angiography is the
diagnostic study of choice with sensitivity and specificity approaching 100%. It can identify the location,
extent, and presence of pericardial effusion. While ECG and chest X-ray are initial screening tools, they
are nonspecific. Aortic dissection is a time-critical emergency requiring immediate surgical consultation.
🟢 Q5. A patient is in pulseless ventricular tachycardia (pVT). After defibrillation at 200 J biphasic, the
rhythm remains pVT. The patient has received one dose of epinephrine and one dose of amiodarone.
Which is the correct next intervention?
A. Increase defibrillation energy to 360 J
B. Administer sodium bicarbonate 1 mEq/kg
C. Continue CPR for 2 minutes before next rhythm check
D. Administer magnesium sulfate 2 g IV push
🔴 Correct Answer: C
Rationale: Per ACLS guidelines, after each defibrillation attempt and medication administration, CPR
should be resumed immediately for 2 minutes before the next rhythm check. Interruptions in chest
compressions should be minimized. For refractory VF/pVT, escalating defibrillation energy may be
considered, but the priority is uninterrupted CPR. Sodium bicarbonate is not routinely recommended.
Magnesium is indicated for torsades de pointes, not standard pVT.
🟢 Q6. A patient presents with a heart rate of 36 bpm, BP 78/42, and altered mental status. The ECG
shows a third-degree heart block. Which intervention should the nurse anticipate first?
A. Atropine 1 mg IV push
B. Transcutaneous pacing
C. Dopamine infusion at 5 mcg/kg/min
D. Epinephrine infusion at 2 mcg/min
🔴 Correct Answer: B
Rationale: For symptomatic bradycardia with a high-degree block (third-degree), transcutaneous pacing
is the preferred immediate intervention because atropine is often ineffective in infranodal blocks.
Atropine may be tried first in some protocols, but in third-degree heart block, it is unlikely to work.
Transcutaneous pacing provides immediate rate support until transvenous pacing can be established.
🟢 Q7. A 45-year-old male presents with palpitations and a heart rate of 186 bpm. The ECG shows a
regular narrow-complex tachycardia. He is hemodynamically stable. Which intervention is most
appropriate?
A. Synchronized cardioversion at 50 J
B. Adenosine 6 mg IV rapid push
C. Amiodarone 150 mg IV over 10 minutes
D. Vagal maneuvers
🔴 Correct Answer: D
, Rationale: For stable narrow-complex tachycardia (likely SVT), vagal maneuvers are the first-line
intervention. They are non-invasive and can terminate the arrhythmia by increasing vagal tone at the AV
node. If vagal maneuvers fail, adenosine is the next step. Synchronized cardioversion is reserved for
unstable patients. Amiodarone is used for ventricular arrhythmias or atrial fibrillation.
🟢 Q8. A patient with a known history of heart failure presents with weight gain, peripheral edema, and
orthopnea. Which assessment finding is most concerning for acute decompensation?
A. Bibasilar crackles
B. 3+ pitting edema
C. Jugular venous distension (JVD) at 45 degrees
D. Oxygen saturation of 90% on room air
🔴 Correct Answer: D
Rationale: While all findings indicate heart failure exacerbation, an SpO₂ of 90% on room air indicates
significant hypoxia and impending respiratory failure, making it the most immediately concerning
finding. It requires urgent intervention with supplemental oxygen and likely NIPPV. The other findings
are chronic or subacute manifestations of volume overload.
🟢 Q9. A patient is receiving a dopamine infusion at 10 mcg/kg/min. Which assessment finding indicates
the desired therapeutic effect?
A. Increased urine output
B. Decreased heart rate
C. Increased blood pressure
D. Decreased respiratory rate
🔴 Correct Answer: C
Rationale: Dopamine at moderate doses (5–10 mcg/kg/min) primarily stimulates beta-1 receptors,
increasing cardiac contractility and heart rate, which leads to increased blood pressure. At low doses (1–
3 mcg/kg/min), it stimulates dopaminergic receptors, increasing renal blood flow and urine output. The
primary therapeutic goal in most emergency situations is hemodynamic stabilization, manifested as
increased blood pressure.
🟢 Q10. A patient with an acute MI develops a new holosystolic murmur at the apex, along with acute
pulmonary edema and hypotension. What complication should the nurse suspect?
A. Ventricular septal defect
B. Papillary muscle rupture
C. Pericardial tamponade
D. Left ventricular free wall rupture
🔴 Correct Answer: B
Rationale: Papillary muscle rupture is a mechanical complication of MI (typically inferior wall) that
presents with acute mitral regurgitation, manifesting as a new holosystolic murmur, acute pulmonary
