CEN (CERTIFIED EMERGENCY
NURSE) CERTIFICATION EXAM:
COMPREHENSIVE REVIEW WITH
RATIONALES — 250 QUESTIONS
ACROSS 5 PARTS
PART 1 OF 5
SECTION 1: CARDIOVASCULAR EMERGENCIES — QUESTIONS 1–25
Q1. A 72-year-old male presents to the emergency department with sudden-onset "tearing" chest
pain that radiates to his back. He is diaphoretic and anxious. His blood pressure is 180/100 mm Hg,
and his heart rate is 110 beats/min. Which of the following actions should the nurse take first?
A. Administer intravenous morphine for pain
B. Obtain a 12-lead electrocardiogram
C. Establish two large-bore intravenous access sites
D. Prepare the patient for immediate surgery
Correct Answer: B. Obtain a 12-lead electrocardiogram
Rationale: The patient's presentation is highly concerning for aortic dissection, which is a
life-threatening emergency. The first priority is to obtain a 12-lead electrocardiogram to differentiate
between aortic dissection and acute myocardial infarction, as the treatment for these conditions
differs significantly. Option A is incorrect because morphine can mask symptoms and lower blood
pressure, which may be harmful if the patient is hypotensive, although this patient is hypertensive.
Option C is important but follows the initial diagnostic evaluation. Option D is premature without
confirmatory imaging. The nurse should also assess for pulses in all extremities, monitor blood
pressure in both arms, and prepare for a chest X-ray, CT angiography, or transesophageal
echocardiogram. Pain management with opioids and blood pressure control with beta-blockers are
essential components of care. The nurse should maintain a high index of suspicion for aortic
dissection in any patient presenting with sudden, severe, tearing chest or back pain.
,Q2. A 58-year-old woman with a history of diabetes presents to the emergency department with
epigastric discomfort, nausea, and fatigue without chest pain. Which of the following actions should
the nurse take first?
A. Administer an antacid for presumed indigestion
B. Obtain a 12-lead electrocardiogram and cardiac markers
C. Place the patient in a supine position
D. Administer intravenous fluids
Correct Answer: B. Obtain a 12-lead electrocardiogram and cardiac markers
Rationale: Women with diabetes often present with atypical symptoms of acute coronary
syndrome, including epigastric discomfort, nausea, and fatigue without classic chest pain. The nurse
must maintain a high index of suspicion and obtain a 12-lead electrocardiogram and cardiac markers
promptly. Option A is incorrect because antacids can delay diagnosis and treatment of a myocardial
infarction. Option C may be appropriate for comfort but does not address the underlying emergency.
Option D may be necessary but follows the initial diagnostic evaluation. The nurse should also assess
for other atypical symptoms, such as shortness of breath, diaphoresis, and jaw or back pain. Early
recognition and treatment of acute coronary syndrome in women and patients with diabetes can
significantly improve outcomes. The nurse should not dismiss atypical symptoms as non-cardiac in
origin.
Q3. A patient with a suspected ST-elevation myocardial infarction arrives in the emergency
department. Which of the following medications should the nurse anticipate administering first?
A. Aspirin 325 mg chewed
B. Nitroglycerin sublingual
C. Morphine intravenous
D. Heparin intravenous bolus
Correct Answer: A. Aspirin 325 mg chewed
Rationale: Aspirin is the first-line medication for suspected acute coronary syndrome and
should be administered as soon as possible, ideally by the patient or emergency medical services
,before arrival. Aspirin inhibits platelet aggregation and reduces mortality in myocardial infarction.
Option B, nitroglycerin, is contraindicated in patients with hypotension, right ventricular infarction, or
recent phosphodiesterase inhibitor use, and should be given after aspirin. Option C, morphine, is
used for pain relief but is not the first medication. Option D, heparin, is part of the treatment
regimen but is not the initial priority. The nurse should also obtain a 12-lead electrocardiogram
within 10 minutes of arrival, establish intravenous access, and prepare for reperfusion therapy, such
as percutaneous coronary intervention or fibrinolysis. The goal is to minimize time to reperfusion to
preserve myocardial function.
Q4. A patient presents with palpitations and a heart rate of 180 beats/min. The cardiac monitor
shows a narrow-complex tachycardia. The patient is alert and hemodynamically stable. Which of the
following actions should the nurse take first?
A. Administer adenosine 6 mg intravenous push
B. Perform synchronized cardioversion
C. Administer a bolus of normal saline
D. Perform vagal maneuvers
Correct Answer: D. Perform vagal maneuvers
Rationale: For a hemodynamically stable patient with a narrow-complex tachycardia, the
first intervention is to attempt vagal maneuvers, such as the Valsalva maneuver or carotid sinus
massage, to slow the heart rate and potentially convert the rhythm. Option A, adenosine, is the next
step if vagal maneuvers are unsuccessful. Option B, synchronized cardioversion, is indicated for
unstable patients or those who do not respond to pharmacological interventions. Option C,
intravenous fluids, may be helpful if the patient is dehydrated but is not the first action for a stable
tachycardia. The nurse should also assess the patient for signs of instability, such as hypotension,
altered mental status, chest pain, or heart failure. Continuous cardiac monitoring and documentation
of the rhythm before and after interventions are essential.
Q5. A patient with a permanent pacemaker presents to the emergency department with dizziness
and palpitations. The cardiac monitor shows a heart rate of 40 beats/min. Which of the following
actions should the nurse take first?
A. Administer atropine 1 mg intravenous push
B. Apply a transcutaneous pacing device
C. Assess the patient's pacemaker function with a magnet
, D. Obtain a 12-lead electrocardiogram
Correct Answer: D. Obtain a 12-lead electrocardiogram
Rationale: The patient's symptoms and bradycardia may indicate pacemaker malfunction or
failure to capture. The first action is to obtain a 12-lead electrocardiogram to assess the pacemaker's
function, including whether the pacemaker is firing and capturing the myocardium. Option A,
atropine, may be used for symptomatic bradycardia but is not the first action when a pacemaker is
present. Option B, transcutaneous pacing, is indicated if the patient is unstable and the pacemaker is
not functioning. Option C, applying a magnet, is done by a provider to assess pacemaker function.
The nurse should also assess the patient's vital signs, level of consciousness, and signs of poor
perfusion. A chest X-ray may be obtained to verify lead placement, and a pacemaker representative
may be consulted. The nurse should document all findings and interventions.
SECTION 2: RESPIRATORY EMERGENCIES — QUESTIONS 26–50
Q26. A patient with a suspected tension pneumothorax becomes hypotensive, severely dyspneic,
and develops unilateral absent breath sounds with tracheal deviation. What is the priority
intervention?
A. Perform immediate needle decompression
B. Obtain a chest X-ray
C. Administer high-flow oxygen
D. Prepare for chest tube insertion
Correct Answer: A. Perform immediate needle decompression
Rationale: Tension pneumothorax is a life-threatening emergency that requires immediate
decompression without waiting for imaging confirmation. The classic signs include hypotension,
severe dyspnea, unilateral absent breath sounds, tracheal deviation away from the affected side, and
distended neck veins. Option B is incorrect because obtaining a chest X-ray delays life-saving
treatment. Option C is important but does not address the underlying pressure that is compromising
cardiac output. Option D, chest tube insertion, is the definitive treatment but follows needle
decompression in an unstable patient. The nurse should insert a large-bore needle or perform a
finger thoracostomy in the second intercostal space, midclavicular line, on the affected side. This
converts the tension pneumothorax to an open pneumothorax, allowing air to escape and relieving
NURSE) CERTIFICATION EXAM:
COMPREHENSIVE REVIEW WITH
RATIONALES — 250 QUESTIONS
ACROSS 5 PARTS
PART 1 OF 5
SECTION 1: CARDIOVASCULAR EMERGENCIES — QUESTIONS 1–25
Q1. A 72-year-old male presents to the emergency department with sudden-onset "tearing" chest
pain that radiates to his back. He is diaphoretic and anxious. His blood pressure is 180/100 mm Hg,
and his heart rate is 110 beats/min. Which of the following actions should the nurse take first?
A. Administer intravenous morphine for pain
B. Obtain a 12-lead electrocardiogram
C. Establish two large-bore intravenous access sites
D. Prepare the patient for immediate surgery
Correct Answer: B. Obtain a 12-lead electrocardiogram
Rationale: The patient's presentation is highly concerning for aortic dissection, which is a
life-threatening emergency. The first priority is to obtain a 12-lead electrocardiogram to differentiate
between aortic dissection and acute myocardial infarction, as the treatment for these conditions
differs significantly. Option A is incorrect because morphine can mask symptoms and lower blood
pressure, which may be harmful if the patient is hypotensive, although this patient is hypertensive.
Option C is important but follows the initial diagnostic evaluation. Option D is premature without
confirmatory imaging. The nurse should also assess for pulses in all extremities, monitor blood
pressure in both arms, and prepare for a chest X-ray, CT angiography, or transesophageal
echocardiogram. Pain management with opioids and blood pressure control with beta-blockers are
essential components of care. The nurse should maintain a high index of suspicion for aortic
dissection in any patient presenting with sudden, severe, tearing chest or back pain.
,Q2. A 58-year-old woman with a history of diabetes presents to the emergency department with
epigastric discomfort, nausea, and fatigue without chest pain. Which of the following actions should
the nurse take first?
A. Administer an antacid for presumed indigestion
B. Obtain a 12-lead electrocardiogram and cardiac markers
C. Place the patient in a supine position
D. Administer intravenous fluids
Correct Answer: B. Obtain a 12-lead electrocardiogram and cardiac markers
Rationale: Women with diabetes often present with atypical symptoms of acute coronary
syndrome, including epigastric discomfort, nausea, and fatigue without classic chest pain. The nurse
must maintain a high index of suspicion and obtain a 12-lead electrocardiogram and cardiac markers
promptly. Option A is incorrect because antacids can delay diagnosis and treatment of a myocardial
infarction. Option C may be appropriate for comfort but does not address the underlying emergency.
Option D may be necessary but follows the initial diagnostic evaluation. The nurse should also assess
for other atypical symptoms, such as shortness of breath, diaphoresis, and jaw or back pain. Early
recognition and treatment of acute coronary syndrome in women and patients with diabetes can
significantly improve outcomes. The nurse should not dismiss atypical symptoms as non-cardiac in
origin.
Q3. A patient with a suspected ST-elevation myocardial infarction arrives in the emergency
department. Which of the following medications should the nurse anticipate administering first?
A. Aspirin 325 mg chewed
B. Nitroglycerin sublingual
C. Morphine intravenous
D. Heparin intravenous bolus
Correct Answer: A. Aspirin 325 mg chewed
Rationale: Aspirin is the first-line medication for suspected acute coronary syndrome and
should be administered as soon as possible, ideally by the patient or emergency medical services
,before arrival. Aspirin inhibits platelet aggregation and reduces mortality in myocardial infarction.
Option B, nitroglycerin, is contraindicated in patients with hypotension, right ventricular infarction, or
recent phosphodiesterase inhibitor use, and should be given after aspirin. Option C, morphine, is
used for pain relief but is not the first medication. Option D, heparin, is part of the treatment
regimen but is not the initial priority. The nurse should also obtain a 12-lead electrocardiogram
within 10 minutes of arrival, establish intravenous access, and prepare for reperfusion therapy, such
as percutaneous coronary intervention or fibrinolysis. The goal is to minimize time to reperfusion to
preserve myocardial function.
Q4. A patient presents with palpitations and a heart rate of 180 beats/min. The cardiac monitor
shows a narrow-complex tachycardia. The patient is alert and hemodynamically stable. Which of the
following actions should the nurse take first?
A. Administer adenosine 6 mg intravenous push
B. Perform synchronized cardioversion
C. Administer a bolus of normal saline
D. Perform vagal maneuvers
Correct Answer: D. Perform vagal maneuvers
Rationale: For a hemodynamically stable patient with a narrow-complex tachycardia, the
first intervention is to attempt vagal maneuvers, such as the Valsalva maneuver or carotid sinus
massage, to slow the heart rate and potentially convert the rhythm. Option A, adenosine, is the next
step if vagal maneuvers are unsuccessful. Option B, synchronized cardioversion, is indicated for
unstable patients or those who do not respond to pharmacological interventions. Option C,
intravenous fluids, may be helpful if the patient is dehydrated but is not the first action for a stable
tachycardia. The nurse should also assess the patient for signs of instability, such as hypotension,
altered mental status, chest pain, or heart failure. Continuous cardiac monitoring and documentation
of the rhythm before and after interventions are essential.
Q5. A patient with a permanent pacemaker presents to the emergency department with dizziness
and palpitations. The cardiac monitor shows a heart rate of 40 beats/min. Which of the following
actions should the nurse take first?
A. Administer atropine 1 mg intravenous push
B. Apply a transcutaneous pacing device
C. Assess the patient's pacemaker function with a magnet
, D. Obtain a 12-lead electrocardiogram
Correct Answer: D. Obtain a 12-lead electrocardiogram
Rationale: The patient's symptoms and bradycardia may indicate pacemaker malfunction or
failure to capture. The first action is to obtain a 12-lead electrocardiogram to assess the pacemaker's
function, including whether the pacemaker is firing and capturing the myocardium. Option A,
atropine, may be used for symptomatic bradycardia but is not the first action when a pacemaker is
present. Option B, transcutaneous pacing, is indicated if the patient is unstable and the pacemaker is
not functioning. Option C, applying a magnet, is done by a provider to assess pacemaker function.
The nurse should also assess the patient's vital signs, level of consciousness, and signs of poor
perfusion. A chest X-ray may be obtained to verify lead placement, and a pacemaker representative
may be consulted. The nurse should document all findings and interventions.
SECTION 2: RESPIRATORY EMERGENCIES — QUESTIONS 26–50
Q26. A patient with a suspected tension pneumothorax becomes hypotensive, severely dyspneic,
and develops unilateral absent breath sounds with tracheal deviation. What is the priority
intervention?
A. Perform immediate needle decompression
B. Obtain a chest X-ray
C. Administer high-flow oxygen
D. Prepare for chest tube insertion
Correct Answer: A. Perform immediate needle decompression
Rationale: Tension pneumothorax is a life-threatening emergency that requires immediate
decompression without waiting for imaging confirmation. The classic signs include hypotension,
severe dyspnea, unilateral absent breath sounds, tracheal deviation away from the affected side, and
distended neck veins. Option B is incorrect because obtaining a chest X-ray delays life-saving
treatment. Option C is important but does not address the underlying pressure that is compromising
cardiac output. Option D, chest tube insertion, is the definitive treatment but follows needle
decompression in an unstable patient. The nurse should insert a large-bore needle or perform a
finger thoracostomy in the second intercostal space, midclavicular line, on the affected side. This
converts the tension pneumothorax to an open pneumothorax, allowing air to escape and relieving
