CEN (Certified Emergency Nurse) Advanced Practice Questions
with Rationales. Graded A+. 2024-2025
1. A patient presents with a gunshot wound to the abdomen and signs of shock. What is the nurse’s first priority in
the emergency department?
• Answer: Establish and maintain airway patency.
• Rationale: While controlling hemorrhage is vital in trauma cases, airway management always takes priority
as per the ABCs of trauma care (Airway, Breathing, Circulation). The next step would be fluid resuscitation
and immediate surgical intervention if needed.
2. A patient with a suspected cervical spine injury arrives in the ED following a motor vehicle accident. What is the
nurse’s initial action?
• Answer: Apply a cervical collar and maintain manual stabilization of the neck.
• Rationale: Cervical spine immobilization is critical to prevent further injury until diagnostic imaging confirms
the absence of spinal cord damage.
3. A 65-year-old patient with a history of COPD is brought to the ED with acute respiratory distress. The patient’s
oxygen saturation is 82%. What is the most appropriate initial intervention?
• Answer: Administer high-flow oxygen via non-rebreather mask.
• Rationale: COPD patients in distress require immediate oxygen therapy to improve oxygenation. Careful
monitoring of blood gases is essential to avoid hypercapnia, but correcting hypoxia takes precedence.
4. A patient presents with chest pain that radiates to the left arm and jaw. The ECG shows ST elevation in leads II,
III, and aVF. What is the most likely diagnosis?
• Answer: Inferior wall myocardial infarction.
• Rationale: ST elevation in leads II, III, and aVF indicates ischemia in the inferior portion of the heart, typically
supplied by the right coronary artery. Immediate interventions include administering aspirin, nitroglycerin,
and preparing for reperfusion therapy.
5. A patient arrives in the ED with altered mental status, dry mucous membranes, and a history of polyuria. Blood
glucose levels are 700 mg/dL. What condition does the nurse suspect, and what is the initial treatment?
• Answer: Diabetic ketoacidosis (DKA); initiate IV fluids and insulin infusion.
• Rationale: DKA is characterized by hyperglycemia, dehydration, and altered mental status. Fluid resuscitation
is critical to correct dehydration, followed by insulin therapy to reduce blood glucose levels.
6. In a mass casualty event, a patient with an open femur fracture and respiratory rate of 30 breaths per minute is
triaged. According to the START (Simple Triage and Rapid Treatment) system, what triage category should this
patient be assigned?
• Answer: Red (Immediate).
• Rationale: A patient with an open fracture and a high respiratory rate is categorized as “Immediate” because
they require urgent medical intervention to prevent further deterioration.
7. A patient experiencing a severe anaphylactic reaction is brought to the ED. After securing the airway, what is the
next priority action?
• Answer: Administer epinephrine intramuscularly.
, • Rationale: Epinephrine is the first-line treatment for anaphylaxis as it counteracts the life-threatening effects
of histamine release (e.g., bronchospasm, hypotension).
8. A trauma patient is receiving large amounts of blood products during resuscitation. The patient’s blood pressure
is stable, but they develop numbness and tingling in their extremities. What is the most likely cause?
• Answer: Hypocalcemia due to citrate toxicity.
• Rationale: Citrate is used as an anticoagulant in blood products and can bind calcium, leading to
hypocalcemia, which may present with symptoms like tingling and muscle spasms.
9. A patient presents with signs of sepsis, including hypotension, tachycardia, and altered mental status. Despite
aggressive fluid resuscitation, the patient remains hypotensive. What is the next appropriate treatment?
• Answer: Administer vasopressors (e.g., norepinephrine).
• Rationale: If hypotension persists after adequate fluid resuscitation, vasopressors are necessary to maintain
perfusion and prevent organ failure in septic shock.
10. A patient with a known history of atrial fibrillation presents with a rapid and irregular pulse. The ECG shows
atrial fibrillation with a ventricular rate of 150 bpm. What is the most appropriate initial treatment?
• Answer: Administer diltiazem IV.
• Rationale: In stable patients with rapid atrial fibrillation, rate control is the primary goal, and diltiazem (a
calcium channel blocker) is often used to reduce the ventricular response.
11. A 35-year-old patient is brought to the ED with multiple stab wounds. The patient’s blood pressure is 80/50
mmHg, heart rate is 130 bpm, and respiratory rate is 28 breaths per minute. What is the priority intervention?
• Answer: Initiate IV fluid resuscitation with crystalloids.
• Rationale: The patient is in hypovolemic shock, likely due to blood loss. The first priority is to restore
circulating volume using IV fluids (such as normal saline or lactated Ringer’s) to stabilize the patient.
12. A child presents to the emergency department with barking cough, stridor, and retractions. What is the most
likely diagnosis, and what is the appropriate intervention?
• Answer: Croup (laryngotracheobronchitis); administer nebulized epinephrine.
• Rationale: Croup typically presents with a barking cough and stridor. Nebulized epinephrine helps reduce
airway inflammation and improve breathing.
13. A patient is experiencing a hypertensive crisis with a blood pressure of 220/130 mmHg and symptoms of a
headache and blurred vision. What is the first-line medication to administer?
• Answer: Administer IV nitroprusside.
• Rationale: Nitroprusside is a vasodilator used in hypertensive emergencies to rapidly lower blood pressure
and prevent organ damage.
14. An elderly patient presents to the ED after falling at home. The patient is confused and has a heart rate of 40
bpm. The ECG shows a complete heart block. What is the priority intervention?
• Answer: Prepare for transcutaneous pacing.
• Rationale: Complete heart block (third-degree AV block) often requires immediate intervention with
transcutaneous pacing to restore adequate cardiac output.
with Rationales. Graded A+. 2024-2025
1. A patient presents with a gunshot wound to the abdomen and signs of shock. What is the nurse’s first priority in
the emergency department?
• Answer: Establish and maintain airway patency.
• Rationale: While controlling hemorrhage is vital in trauma cases, airway management always takes priority
as per the ABCs of trauma care (Airway, Breathing, Circulation). The next step would be fluid resuscitation
and immediate surgical intervention if needed.
2. A patient with a suspected cervical spine injury arrives in the ED following a motor vehicle accident. What is the
nurse’s initial action?
• Answer: Apply a cervical collar and maintain manual stabilization of the neck.
• Rationale: Cervical spine immobilization is critical to prevent further injury until diagnostic imaging confirms
the absence of spinal cord damage.
3. A 65-year-old patient with a history of COPD is brought to the ED with acute respiratory distress. The patient’s
oxygen saturation is 82%. What is the most appropriate initial intervention?
• Answer: Administer high-flow oxygen via non-rebreather mask.
• Rationale: COPD patients in distress require immediate oxygen therapy to improve oxygenation. Careful
monitoring of blood gases is essential to avoid hypercapnia, but correcting hypoxia takes precedence.
4. A patient presents with chest pain that radiates to the left arm and jaw. The ECG shows ST elevation in leads II,
III, and aVF. What is the most likely diagnosis?
• Answer: Inferior wall myocardial infarction.
• Rationale: ST elevation in leads II, III, and aVF indicates ischemia in the inferior portion of the heart, typically
supplied by the right coronary artery. Immediate interventions include administering aspirin, nitroglycerin,
and preparing for reperfusion therapy.
5. A patient arrives in the ED with altered mental status, dry mucous membranes, and a history of polyuria. Blood
glucose levels are 700 mg/dL. What condition does the nurse suspect, and what is the initial treatment?
• Answer: Diabetic ketoacidosis (DKA); initiate IV fluids and insulin infusion.
• Rationale: DKA is characterized by hyperglycemia, dehydration, and altered mental status. Fluid resuscitation
is critical to correct dehydration, followed by insulin therapy to reduce blood glucose levels.
6. In a mass casualty event, a patient with an open femur fracture and respiratory rate of 30 breaths per minute is
triaged. According to the START (Simple Triage and Rapid Treatment) system, what triage category should this
patient be assigned?
• Answer: Red (Immediate).
• Rationale: A patient with an open fracture and a high respiratory rate is categorized as “Immediate” because
they require urgent medical intervention to prevent further deterioration.
7. A patient experiencing a severe anaphylactic reaction is brought to the ED. After securing the airway, what is the
next priority action?
• Answer: Administer epinephrine intramuscularly.
, • Rationale: Epinephrine is the first-line treatment for anaphylaxis as it counteracts the life-threatening effects
of histamine release (e.g., bronchospasm, hypotension).
8. A trauma patient is receiving large amounts of blood products during resuscitation. The patient’s blood pressure
is stable, but they develop numbness and tingling in their extremities. What is the most likely cause?
• Answer: Hypocalcemia due to citrate toxicity.
• Rationale: Citrate is used as an anticoagulant in blood products and can bind calcium, leading to
hypocalcemia, which may present with symptoms like tingling and muscle spasms.
9. A patient presents with signs of sepsis, including hypotension, tachycardia, and altered mental status. Despite
aggressive fluid resuscitation, the patient remains hypotensive. What is the next appropriate treatment?
• Answer: Administer vasopressors (e.g., norepinephrine).
• Rationale: If hypotension persists after adequate fluid resuscitation, vasopressors are necessary to maintain
perfusion and prevent organ failure in septic shock.
10. A patient with a known history of atrial fibrillation presents with a rapid and irregular pulse. The ECG shows
atrial fibrillation with a ventricular rate of 150 bpm. What is the most appropriate initial treatment?
• Answer: Administer diltiazem IV.
• Rationale: In stable patients with rapid atrial fibrillation, rate control is the primary goal, and diltiazem (a
calcium channel blocker) is often used to reduce the ventricular response.
11. A 35-year-old patient is brought to the ED with multiple stab wounds. The patient’s blood pressure is 80/50
mmHg, heart rate is 130 bpm, and respiratory rate is 28 breaths per minute. What is the priority intervention?
• Answer: Initiate IV fluid resuscitation with crystalloids.
• Rationale: The patient is in hypovolemic shock, likely due to blood loss. The first priority is to restore
circulating volume using IV fluids (such as normal saline or lactated Ringer’s) to stabilize the patient.
12. A child presents to the emergency department with barking cough, stridor, and retractions. What is the most
likely diagnosis, and what is the appropriate intervention?
• Answer: Croup (laryngotracheobronchitis); administer nebulized epinephrine.
• Rationale: Croup typically presents with a barking cough and stridor. Nebulized epinephrine helps reduce
airway inflammation and improve breathing.
13. A patient is experiencing a hypertensive crisis with a blood pressure of 220/130 mmHg and symptoms of a
headache and blurred vision. What is the first-line medication to administer?
• Answer: Administer IV nitroprusside.
• Rationale: Nitroprusside is a vasodilator used in hypertensive emergencies to rapidly lower blood pressure
and prevent organ damage.
14. An elderly patient presents to the ED after falling at home. The patient is confused and has a heart rate of 40
bpm. The ECG shows a complete heart block. What is the priority intervention?
• Answer: Prepare for transcutaneous pacing.
• Rationale: Complete heart block (third-degree AV block) often requires immediate intervention with
transcutaneous pacing to restore adequate cardiac output.
