CEN Exam
79. A patient presents with vaginal bleeding and cramping. She tells the emergency nurse, "I
passed clots at home. I think I lost my baby." Pelvic examination reveals that the cervical os is
open. Which type of spontaneous abortion most likely occurred?
Missed abortion
Septic abortion
Inevitable abortion
Threatened abortion - ANS-Inevitable abortion
A 12-year-old male is brought to the emergency department by his mother with complaints of
difficulty breathing, swollen eyes and lips, and hives. The mother states that the child had just
finished eating a peanut butter cookie. Epinephrine was administered. What is the next class of
medications to be administered to the patient?
Inhaled beta 2 agonist
Corticosteroid
Antihistamine
Anticholinergic - ANS-Inhaled beta 2 agonist
A 13-year-old presents to the emergency department. His parents state that he passed out at
home and had been vomiting and had diarrhea for the last few days. He answers questions
appropriately, although he complains of dizziness. His vital signs on arrival: BP 70/40 mm Hg,
HR 132 beats/min, RR 24 breaths/min, T 36.9 C (98.4 F), and SpO2 97% without supplemental
oxygen. A new graduate nurse inserted an intravenous line and is about to begin a fluid bolus of
D5W. What does the preceptor explain to the new graduate nurse regarding fluid resuscitation?
Because of the electrolyte disturbances from vomiting and diarrhea, use D5.45% sodium
chloride.
Because the patient is likely in septic shock, the fluid resuscitation is done slowly.
The appropriate fluid for hypotension is isotonic crystalloid, not D5W
As a pediatric patient, D5W fluid is given at a bolus rate of 20 mL/kg. - ANS-The appropriate
fluid for hypotension is isotonic crystalloid, not D5W
A 15-year-old female presents to the emergency department with crampy left lower quadrant
abdominal pain that lasted for 4 hours prior to arrival. She also is having frequent, severe,
bloody diarrhea. What gastrointestinal disorder is she most likely experiencing?
Ulcerative colitis
Diverticulitis
Crohn's disease
Appendicitis - ANS-Ulcerative colitis
A 16-year-old male is brought to the ED by his coach. The patient was playing football in
moderately cold weather one hour prior to arrival and felt severe pain in the left groin area. This
is suggestive of which genitourinary emergency?
Paraphimosis
Testicular torsion
, Priapism
Acute epididymitis - ANS-Testicular torsion
A 16-year-old presents with severe left upper quadrant abdominal pain after an
over-the-handlebars bicycle collision. Vital signs are BP 100/60 mm Hg, HR 100 beats/min, RR
30 breaths/min, T 37.0 C (98.6 F), SpO2 89% without supplemental oxygen. There is bruising
over the left upper quadrant of the abdomen. Auscultation reveals diminished breath sounds on
the left accompanied by gurgling. Based on this history and assessment, the nurse suspects
which injury?
Small bowel rupture
Ruptured diaphragm
Flail chest
Hepatic injury - ANS-Ruptured diaphragm
A 20-year-old male presents with a sudden onset of pleuritic chest pain, mild dyspnea, and a
cough. Assessment reveals a tall, thin patient with tachycardia and diminished breath sounds on
the right side. What thoracic condition is the most likely cause?
Spontaneous pneumothorax
Open pneumothorax
Tension pneumothorax
Hemothorax - ANS-Spontaneous pneumothorax
A 21-year-old female presents to the ED with complaints of pelvic pain. What possible cause of
the pain is assessed for first?
Urinary tract infection
Ectopic pregnancy
Ruptured ovarian cyst
Kidney stones - ANS-Ectopic pregnancy
A 22-year-old patient presents with upper respiratory symptoms, nausea and vomiting and a
low-grade fever. She has a history of leukemia and underwent chemotherapy 2 weeks ago.
What is the nurse's priority?
Protective isolation
Ondansetron oral dissolving tablet
Intravenous fluid bolus
Morphine intravenous - ANS-Protective isolation
A 23-year-old patient with a stable ectopic pregnancy is being cared for by an emergency nurse.
The emergency physician ordered methotrexate to be administered intramuscularly. Which
statement by the nurse indicates an understanding of the medication?
I'll instruct the patient to follow up in two weeks.
I can give this medication because there is only scant vaginal bleeding.
I'll give this medication because there is fetal cardiac activity.
I can't administer this medication. I'm pregnant. - ANS-I can't administer this medication. I'm
pregnant.
A 28-year-old female presents to the ED with complaints of dizziness, fear of dying, and hot
flashes that began 10 minutes prior to arrival. The patient is trembling and tachypneic. Which
anxiety disorder is the patient exhibiting?
Post-traumatic stress disorder
, Panic attack
Acute stress disorder
Generalized anxiety disorder - ANS-Panic attack
A 28-year-old female presents with shortness of breath, dizziness, and diaphoresis. Her vital
signs are BP 118/74 mm Hg, HR 122 beats/min, RR 26 breaths/min, T 37.7 C (99.9 F), SpO2
92% without supplemental oxygen. Her health history includes fractures of the left tibia and
fibula following an MVC 3 weeks ago. Surgical fixation was required. Her only current
medications are an oral contraceptive and intermittent ibuprofen for pain. Assessment of the
casted left leg reveals that the toes are swollen. With this information, which diagnostic testing
will the nurse expect as the highest priority?
Sputum cultures
Chest radiograph
Computed tomographic pulmonary angiography
Radiograph of the left leg - ANS-Computed tomographic pulmonary angiography
A 3-year-old boy is brought to the ED by his mother, who noticed bruises on the boy's left thigh,
back, and feet developing over the last week. Past medical history includes a mild respiratory
virus a month ago. The assessment reveals, he is awake and alert, with some bleeding noted
around the gums. Initial laboratory values include a low platelet count with a normal white blood
cell count. Hemoglobin and hematocrit are slightly low. Which disorder does the nurse suspect
is the cause of his signs and symptoms?
Leukemia
Thrombocytosis
Disseminated intravascular coagulopathy
Idiopathic thrombocytopenia purpura - ANS-Idiopathic thrombocytopenia purpura
A 30-year-old male presents to the emergency department with excruciating pain on the right
side of his head. It has been coming and going all day. His right eye is reddened and skin is
flushed. What type of headache is this patient experiencing?
Tension
Traumatic
Cluster
Migraine - ANS-Cluster
A 32-year-old female patient is brought to the emergency department via emergency medical
services with a complaint of coughing for the past two weeks. The patient is now complaining of
severe epigastric pain and is violently retching and vomiting blood. She has a history of alcohol
abuse and bulimia. Which type of gastrointestinal disorder is the most likely cause of these
symptoms?
Diverticulitis
Mallory-Weiss syndrome
Pancreatitis
Gastric ulcer - ANS-Mallory-Weiss syndrome
A 32-year-old female patient presents to the ED with complaints of abdominal pain that is 10 out
of 10 on a numeric rating scale. A pregnancy test is negative. A computed tomography (CT)
scan of the abdomen has been ordered. The physician wants to hold analgesia until the CT is
completed. As an advocate for the patient, what might the emergency nurse do in this situation?
79. A patient presents with vaginal bleeding and cramping. She tells the emergency nurse, "I
passed clots at home. I think I lost my baby." Pelvic examination reveals that the cervical os is
open. Which type of spontaneous abortion most likely occurred?
Missed abortion
Septic abortion
Inevitable abortion
Threatened abortion - ANS-Inevitable abortion
A 12-year-old male is brought to the emergency department by his mother with complaints of
difficulty breathing, swollen eyes and lips, and hives. The mother states that the child had just
finished eating a peanut butter cookie. Epinephrine was administered. What is the next class of
medications to be administered to the patient?
Inhaled beta 2 agonist
Corticosteroid
Antihistamine
Anticholinergic - ANS-Inhaled beta 2 agonist
A 13-year-old presents to the emergency department. His parents state that he passed out at
home and had been vomiting and had diarrhea for the last few days. He answers questions
appropriately, although he complains of dizziness. His vital signs on arrival: BP 70/40 mm Hg,
HR 132 beats/min, RR 24 breaths/min, T 36.9 C (98.4 F), and SpO2 97% without supplemental
oxygen. A new graduate nurse inserted an intravenous line and is about to begin a fluid bolus of
D5W. What does the preceptor explain to the new graduate nurse regarding fluid resuscitation?
Because of the electrolyte disturbances from vomiting and diarrhea, use D5.45% sodium
chloride.
Because the patient is likely in septic shock, the fluid resuscitation is done slowly.
The appropriate fluid for hypotension is isotonic crystalloid, not D5W
As a pediatric patient, D5W fluid is given at a bolus rate of 20 mL/kg. - ANS-The appropriate
fluid for hypotension is isotonic crystalloid, not D5W
A 15-year-old female presents to the emergency department with crampy left lower quadrant
abdominal pain that lasted for 4 hours prior to arrival. She also is having frequent, severe,
bloody diarrhea. What gastrointestinal disorder is she most likely experiencing?
Ulcerative colitis
Diverticulitis
Crohn's disease
Appendicitis - ANS-Ulcerative colitis
A 16-year-old male is brought to the ED by his coach. The patient was playing football in
moderately cold weather one hour prior to arrival and felt severe pain in the left groin area. This
is suggestive of which genitourinary emergency?
Paraphimosis
Testicular torsion
, Priapism
Acute epididymitis - ANS-Testicular torsion
A 16-year-old presents with severe left upper quadrant abdominal pain after an
over-the-handlebars bicycle collision. Vital signs are BP 100/60 mm Hg, HR 100 beats/min, RR
30 breaths/min, T 37.0 C (98.6 F), SpO2 89% without supplemental oxygen. There is bruising
over the left upper quadrant of the abdomen. Auscultation reveals diminished breath sounds on
the left accompanied by gurgling. Based on this history and assessment, the nurse suspects
which injury?
Small bowel rupture
Ruptured diaphragm
Flail chest
Hepatic injury - ANS-Ruptured diaphragm
A 20-year-old male presents with a sudden onset of pleuritic chest pain, mild dyspnea, and a
cough. Assessment reveals a tall, thin patient with tachycardia and diminished breath sounds on
the right side. What thoracic condition is the most likely cause?
Spontaneous pneumothorax
Open pneumothorax
Tension pneumothorax
Hemothorax - ANS-Spontaneous pneumothorax
A 21-year-old female presents to the ED with complaints of pelvic pain. What possible cause of
the pain is assessed for first?
Urinary tract infection
Ectopic pregnancy
Ruptured ovarian cyst
Kidney stones - ANS-Ectopic pregnancy
A 22-year-old patient presents with upper respiratory symptoms, nausea and vomiting and a
low-grade fever. She has a history of leukemia and underwent chemotherapy 2 weeks ago.
What is the nurse's priority?
Protective isolation
Ondansetron oral dissolving tablet
Intravenous fluid bolus
Morphine intravenous - ANS-Protective isolation
A 23-year-old patient with a stable ectopic pregnancy is being cared for by an emergency nurse.
The emergency physician ordered methotrexate to be administered intramuscularly. Which
statement by the nurse indicates an understanding of the medication?
I'll instruct the patient to follow up in two weeks.
I can give this medication because there is only scant vaginal bleeding.
I'll give this medication because there is fetal cardiac activity.
I can't administer this medication. I'm pregnant. - ANS-I can't administer this medication. I'm
pregnant.
A 28-year-old female presents to the ED with complaints of dizziness, fear of dying, and hot
flashes that began 10 minutes prior to arrival. The patient is trembling and tachypneic. Which
anxiety disorder is the patient exhibiting?
Post-traumatic stress disorder
, Panic attack
Acute stress disorder
Generalized anxiety disorder - ANS-Panic attack
A 28-year-old female presents with shortness of breath, dizziness, and diaphoresis. Her vital
signs are BP 118/74 mm Hg, HR 122 beats/min, RR 26 breaths/min, T 37.7 C (99.9 F), SpO2
92% without supplemental oxygen. Her health history includes fractures of the left tibia and
fibula following an MVC 3 weeks ago. Surgical fixation was required. Her only current
medications are an oral contraceptive and intermittent ibuprofen for pain. Assessment of the
casted left leg reveals that the toes are swollen. With this information, which diagnostic testing
will the nurse expect as the highest priority?
Sputum cultures
Chest radiograph
Computed tomographic pulmonary angiography
Radiograph of the left leg - ANS-Computed tomographic pulmonary angiography
A 3-year-old boy is brought to the ED by his mother, who noticed bruises on the boy's left thigh,
back, and feet developing over the last week. Past medical history includes a mild respiratory
virus a month ago. The assessment reveals, he is awake and alert, with some bleeding noted
around the gums. Initial laboratory values include a low platelet count with a normal white blood
cell count. Hemoglobin and hematocrit are slightly low. Which disorder does the nurse suspect
is the cause of his signs and symptoms?
Leukemia
Thrombocytosis
Disseminated intravascular coagulopathy
Idiopathic thrombocytopenia purpura - ANS-Idiopathic thrombocytopenia purpura
A 30-year-old male presents to the emergency department with excruciating pain on the right
side of his head. It has been coming and going all day. His right eye is reddened and skin is
flushed. What type of headache is this patient experiencing?
Tension
Traumatic
Cluster
Migraine - ANS-Cluster
A 32-year-old female patient is brought to the emergency department via emergency medical
services with a complaint of coughing for the past two weeks. The patient is now complaining of
severe epigastric pain and is violently retching and vomiting blood. She has a history of alcohol
abuse and bulimia. Which type of gastrointestinal disorder is the most likely cause of these
symptoms?
Diverticulitis
Mallory-Weiss syndrome
Pancreatitis
Gastric ulcer - ANS-Mallory-Weiss syndrome
A 32-year-old female patient presents to the ED with complaints of abdominal pain that is 10 out
of 10 on a numeric rating scale. A pregnancy test is negative. A computed tomography (CT)
scan of the abdomen has been ordered. The physician wants to hold analgesia until the CT is
completed. As an advocate for the patient, what might the emergency nurse do in this situation?
