CEN EXAM TEST BANK 2026/2027 –
CERTIFIED EMERGENCY NURSE
(BCEN) PRACTICE EXAM WITH 300
REAL QUESTIONS, CORRECT
VERIFIED ANSWERS & RATIONALES
| ALREADY GRADED A+ | INSTANT
PDF DOWNLOAD
Cardiovascular Emergencies
1. A 62-year-old male presents with crushing substernal chest pain radiating to
his left jaw, diaphoresis, and nausea. His ECG shows ST-segment elevation in
leads V1–V4. What is the priority intervention?
• A) Administer sublingual nitroglycerin
• B) Obtain cardiac enzymes
• C) Prepare for emergent percutaneous coronary intervention (PCI)
• D) Administer morphine sulfate for pain
• Answer: C
• Rationale: ST elevation in V1–V4 indicates an anterior ST-elevation myocardial
infarction (STEMI). The priority is reperfusion therapy, ideally PCI within 90
minutes of arrival. While nitroglycerin, morphine, and cardiac enzymes are
important, they should not delay activation of the cath lab.
2. A 55-year-old female with a history of hypertension and diabetes presents
with acute onset of severe, tearing chest pain radiating to her back. Her blood
pressure is 180/100 in the right arm and 110/70 in the left arm. What is the
most likely diagnosis?
• A) Acute myocardial infarction
• B) Aortic dissection
• C) Pericarditis
• D) Pulmonary embolism
• Answer: B
, • Rationale: Aortic dissection classically presents with severe, tearing chest pain
radiating to the back, often with a difference in blood pressure between arms.
Hypertension is a major risk factor. This is a medical emergency requiring
immediate surgical consultation.
3. A 45-year-old male presents with palpitations, dizziness, and a heart rate of
180 bpm. The ECG shows a narrow-complex tachycardia with a regular rhythm.
He is hypotensive with a BP of 85/50. What is the appropriate intervention?
• A) Administer adenosine 6 mg rapid IV push
• B) Perform synchronized cardioversion
• C) Administer amiodarone 150 mg IV
• D) Perform vagal maneuvers
• Answer: B
• Rationale: This patient has unstable tachycardia (hypotension with a narrow-
complex tachycardia). Synchronized cardioversion is the treatment of choice for
unstable tachyarrhythmias. Adenosine and vagal maneuvers are for stable
patients.
4. A 72-year-old female with a history of atrial fibrillation presents with sudden
onset of severe abdominal pain and blood in her stool. What is the most likely
diagnosis?
• A) Diverticulitis
• B) Mesenteric ischemia
• C) Peptic ulcer disease
• D) Gastroenteritis
• Answer: B
• Rationale: Atrial fibrillation is a major risk factor for embolic events. Acute
mesenteric ischemia presents with sudden, severe abdominal pain out of
proportion to physical exam findings. This is a surgical emergency requiring
immediate surgical consultation.
5. Which of the following is a classic sign of cardiac tamponade?
• A) Hypotension, muffled heart sounds, and JVD
• B) Hypertension, bounding pulses, and crackles
• C) Hypotension, clear lung sounds, and peripheral edema
• D) Tachycardia, fever, and pericardial friction rub
• Answer: A
• Rationale: Beck's triad (hypotension, muffled heart sounds, and jugular venous
distension) is the classic presentation of cardiac tamponade, which occurs when
fluid accumulates in the pericardial sac and impairs ventricular filling.
6. What is the initial treatment for a patient in ventricular fibrillation?
, • A) Administer amiodarone 300 mg IV
• B) Defibrillate at 200 joules (biphasic)
• C) Begin CPR with chest compressions
• D) Administer epinephrine 1 mg IV
• Answer: C
• Rationale: High-quality CPR is the foundation of cardiac arrest care. The
sequence is: confirm cardiac arrest, begin CPR, and then defibrillate as soon as a
defibrillator is available. Defibrillation is critical but should not delay chest
compressions.
7. A 48-year-old male presents with severe, tearing chest pain radiating to his
back. He has a history of Marfan syndrome. What is the most likely diagnosis?
• A) Acute myocardial infarction
• B) Aortic dissection
• C) Pericarditis
• D) Pulmonary embolism
• Answer: B
• Rationale: Marfan syndrome is a connective tissue disorder that predisposes
patients to aortic dissection. The classic presentation of severe, tearing chest
pain radiating to the back is a medical emergency requiring immediate surgical
consultation.
8. Which of the following is a sign of right-sided heart failure?
• A) Pulmonary edema
• B) Jugular venous distension
• C) Orthopnea
• D) Crackles in the lungs
• Answer: B
• Rationale: Right-sided heart failure leads to systemic venous congestion, which
manifests as jugular venous distension, peripheral edema, and hepatomegaly.
Left-sided heart failure typically causes pulmonary symptoms such as crackles
and orthopnea.
Respiratory Emergencies
9. A 50-year-old male with a history of heart failure presents with sudden onset
of shortness of breath and cough with frothy sputum. His SpO₂ is 84% on room
air. What is the priority intervention?
• A) Administer furosemide 80 mg IV
• B) Apply CPAP at 10 cm H₂O
• C) Administer nitroglycerin 0.4 mg SL
• D) Intubate and mechanically ventilate
, • Answer: B
• Rationale: The patient is in acute pulmonary edema with severe hypoxia (SpO₂
84%). CPAP is the priority as it improves oxygenation and reduces the work of
breathing. Intubation is indicated if CPAP fails or the patient cannot protect
their airway.
10. A patient with severe respiratory distress is unable to speak in complete
sentences. Which finding requires immediate intervention?
• A) Respiratory rate of 34/min
• B) Oxygen saturation of 89%
• C) Mild anxiety
• D) Respiratory rate of 20/min
• Answer: B
• Rationale: Hypoxemia in a patient with severe respiratory distress requires
immediate attention to oxygenation and ventilation. An SpO₂ of 89% indicates
significant hypoxemia that can lead to respiratory failure.
11. Which of the following indicates respiratory failure?
• A) RR 18
• B) O₂ sat 98%
• C) CO₂ retention
• D) Normal ABG
• Answer: C
• Rationale: CO₂ retention indicates hypoventilation and failure of the respiratory
system to adequately eliminate carbon dioxide. This is a hallmark of respiratory
failure, often seen in conditions like COPD exacerbation.
Trauma & Shock
12. A patient arrives in the emergency department after a motor-vehicle
collision. The patient is restless, pale, and diaphoretic with a blood pressure of
82/48 mm Hg. Which action should the nurse take first?
• A) Obtain a detailed medical history
• B) Establish airway and assess breathing
• C) Obtain a urine specimen
• D) Apply a warm blanket
• Answer: B
• Rationale: Airway and breathing are immediately life-threatening priorities. The
initial emergency assessment follows an ABC approach, with rapid identification
and treatment of threats to oxygenation and ventilation.
13. Which finding most strongly suggests inadequate tissue perfusion?
CERTIFIED EMERGENCY NURSE
(BCEN) PRACTICE EXAM WITH 300
REAL QUESTIONS, CORRECT
VERIFIED ANSWERS & RATIONALES
| ALREADY GRADED A+ | INSTANT
PDF DOWNLOAD
Cardiovascular Emergencies
1. A 62-year-old male presents with crushing substernal chest pain radiating to
his left jaw, diaphoresis, and nausea. His ECG shows ST-segment elevation in
leads V1–V4. What is the priority intervention?
• A) Administer sublingual nitroglycerin
• B) Obtain cardiac enzymes
• C) Prepare for emergent percutaneous coronary intervention (PCI)
• D) Administer morphine sulfate for pain
• Answer: C
• Rationale: ST elevation in V1–V4 indicates an anterior ST-elevation myocardial
infarction (STEMI). The priority is reperfusion therapy, ideally PCI within 90
minutes of arrival. While nitroglycerin, morphine, and cardiac enzymes are
important, they should not delay activation of the cath lab.
2. A 55-year-old female with a history of hypertension and diabetes presents
with acute onset of severe, tearing chest pain radiating to her back. Her blood
pressure is 180/100 in the right arm and 110/70 in the left arm. What is the
most likely diagnosis?
• A) Acute myocardial infarction
• B) Aortic dissection
• C) Pericarditis
• D) Pulmonary embolism
• Answer: B
, • Rationale: Aortic dissection classically presents with severe, tearing chest pain
radiating to the back, often with a difference in blood pressure between arms.
Hypertension is a major risk factor. This is a medical emergency requiring
immediate surgical consultation.
3. A 45-year-old male presents with palpitations, dizziness, and a heart rate of
180 bpm. The ECG shows a narrow-complex tachycardia with a regular rhythm.
He is hypotensive with a BP of 85/50. What is the appropriate intervention?
• A) Administer adenosine 6 mg rapid IV push
• B) Perform synchronized cardioversion
• C) Administer amiodarone 150 mg IV
• D) Perform vagal maneuvers
• Answer: B
• Rationale: This patient has unstable tachycardia (hypotension with a narrow-
complex tachycardia). Synchronized cardioversion is the treatment of choice for
unstable tachyarrhythmias. Adenosine and vagal maneuvers are for stable
patients.
4. A 72-year-old female with a history of atrial fibrillation presents with sudden
onset of severe abdominal pain and blood in her stool. What is the most likely
diagnosis?
• A) Diverticulitis
• B) Mesenteric ischemia
• C) Peptic ulcer disease
• D) Gastroenteritis
• Answer: B
• Rationale: Atrial fibrillation is a major risk factor for embolic events. Acute
mesenteric ischemia presents with sudden, severe abdominal pain out of
proportion to physical exam findings. This is a surgical emergency requiring
immediate surgical consultation.
5. Which of the following is a classic sign of cardiac tamponade?
• A) Hypotension, muffled heart sounds, and JVD
• B) Hypertension, bounding pulses, and crackles
• C) Hypotension, clear lung sounds, and peripheral edema
• D) Tachycardia, fever, and pericardial friction rub
• Answer: A
• Rationale: Beck's triad (hypotension, muffled heart sounds, and jugular venous
distension) is the classic presentation of cardiac tamponade, which occurs when
fluid accumulates in the pericardial sac and impairs ventricular filling.
6. What is the initial treatment for a patient in ventricular fibrillation?
, • A) Administer amiodarone 300 mg IV
• B) Defibrillate at 200 joules (biphasic)
• C) Begin CPR with chest compressions
• D) Administer epinephrine 1 mg IV
• Answer: C
• Rationale: High-quality CPR is the foundation of cardiac arrest care. The
sequence is: confirm cardiac arrest, begin CPR, and then defibrillate as soon as a
defibrillator is available. Defibrillation is critical but should not delay chest
compressions.
7. A 48-year-old male presents with severe, tearing chest pain radiating to his
back. He has a history of Marfan syndrome. What is the most likely diagnosis?
• A) Acute myocardial infarction
• B) Aortic dissection
• C) Pericarditis
• D) Pulmonary embolism
• Answer: B
• Rationale: Marfan syndrome is a connective tissue disorder that predisposes
patients to aortic dissection. The classic presentation of severe, tearing chest
pain radiating to the back is a medical emergency requiring immediate surgical
consultation.
8. Which of the following is a sign of right-sided heart failure?
• A) Pulmonary edema
• B) Jugular venous distension
• C) Orthopnea
• D) Crackles in the lungs
• Answer: B
• Rationale: Right-sided heart failure leads to systemic venous congestion, which
manifests as jugular venous distension, peripheral edema, and hepatomegaly.
Left-sided heart failure typically causes pulmonary symptoms such as crackles
and orthopnea.
Respiratory Emergencies
9. A 50-year-old male with a history of heart failure presents with sudden onset
of shortness of breath and cough with frothy sputum. His SpO₂ is 84% on room
air. What is the priority intervention?
• A) Administer furosemide 80 mg IV
• B) Apply CPAP at 10 cm H₂O
• C) Administer nitroglycerin 0.4 mg SL
• D) Intubate and mechanically ventilate
, • Answer: B
• Rationale: The patient is in acute pulmonary edema with severe hypoxia (SpO₂
84%). CPAP is the priority as it improves oxygenation and reduces the work of
breathing. Intubation is indicated if CPAP fails or the patient cannot protect
their airway.
10. A patient with severe respiratory distress is unable to speak in complete
sentences. Which finding requires immediate intervention?
• A) Respiratory rate of 34/min
• B) Oxygen saturation of 89%
• C) Mild anxiety
• D) Respiratory rate of 20/min
• Answer: B
• Rationale: Hypoxemia in a patient with severe respiratory distress requires
immediate attention to oxygenation and ventilation. An SpO₂ of 89% indicates
significant hypoxemia that can lead to respiratory failure.
11. Which of the following indicates respiratory failure?
• A) RR 18
• B) O₂ sat 98%
• C) CO₂ retention
• D) Normal ABG
• Answer: C
• Rationale: CO₂ retention indicates hypoventilation and failure of the respiratory
system to adequately eliminate carbon dioxide. This is a hallmark of respiratory
failure, often seen in conditions like COPD exacerbation.
Trauma & Shock
12. A patient arrives in the emergency department after a motor-vehicle
collision. The patient is restless, pale, and diaphoretic with a blood pressure of
82/48 mm Hg. Which action should the nurse take first?
• A) Obtain a detailed medical history
• B) Establish airway and assess breathing
• C) Obtain a urine specimen
• D) Apply a warm blanket
• Answer: B
• Rationale: Airway and breathing are immediately life-threatening priorities. The
initial emergency assessment follows an ABC approach, with rapid identification
and treatment of threats to oxygenation and ventilation.
13. Which finding most strongly suggests inadequate tissue perfusion?
