2025 Certified Emergency Nurse CEN Exam by BCEN New
Latest Version with All 150 Questions from Actual Exam,
100% Correct Answers and Rationale
Question 1
A client arrives with chest pain, diaphoresis, and an ECG showing ST-elevation in leads V1-V4.
What is the nurse’s priority action?
A) Administer aspirin 325 mg
B) Obtain a second IV access
C) Prepare for thrombolytic therapy
D) Notify the cath lab team
Correct Answer: D) Notify the cath lab team
Rationale: ST-elevation in V1-V4 indicates an anterior wall STEMI, requiring urgent
percutaneous coronary intervention (PCI). Notifying the cath lab ensures the fastest reperfusion,
per AHA guidelines, over initial medications or additional access.
Question 2
A 5-year-old presents with stridor, drooling, and a fever of 102°F (38.9°C). What condition
should the nurse suspect?
A) Croup
B) Epiglottitis
C) Asthma
D) Foreign body aspiration
Correct Answer: B) Epiglottitis
Rationale: Stridor, drooling, and fever suggest epiglottitis, a medical emergency due to airway
obstruction. Croup typically presents with a barking cough, not drooling, while asthma and
foreign body lack this triad.
Question 3
A client with a history of COPD has a PaCO2 of 60 mmHg and is lethargic. What should the
nurse do first?
A) Increase oxygen to 4 L/min
B) Prepare for intubation
C) Administer a bronchodilator
D) Encourage pursed-lip breathing
Correct Answer: B) Prepare for intubation
Rationale: Hypercapnia (PaCO2 60 mmHg) and lethargy indicate respiratory failure in COPD.
Intubation is the priority to secure the airway and ventilate, as increasing oxygen alone may
worsen CO2 retention.
Question 4
A client receives IV morphine for pain and develops a respiratory rate of 8 breaths/min. What is
the nurse’s first action?
A) Administer naloxone
,B) Increase oxygen flow
C) Check oxygen saturation
D) Stimulate the client
Correct Answer: C) Check oxygen saturation
Rationale: Respiratory depression (cue) requires assessing oxygenation first to determine
severity. Naloxone is indicated if hypoxia or unresponsiveness is confirmed, but saturation
guides the next step.
Question 5
A trauma client has a Glasgow Coma Scale (GCS) score of 7. What should the nurse anticipate?
A) Immediate CT scan
B) Airway management
C) Cervical spine immobilization
D) IV fluid bolus
Correct Answer: B) Airway management
Rationale: A GCS of 7 indicates severe brain injury and compromised airway protection.
Intubation is the priority to prevent hypoxia, preceding imaging or fluids in the ABCs of trauma
care.
Question 6
A client with a bee sting develops wheezing and hypotension. Which medication should the
nurse administer first?
A) Diphenhydramine
B) Epinephrine
C) Methylprednisolone
D) Albuterol
Correct Answer: B) Epinephrine
Rationale: Wheezing and hypotension suggest anaphylaxis. Epinephrine (IM) is the first-line
treatment to reverse bronchospasm and shock, per emergency protocols, before adjuncts like
antihistamines.
Question 7
A 30-year-old with a gunshot wound to the abdomen has a BP of 80/50 mmHg. What is the
initial fluid choice?
A) 0.9% sodium chloride
B) Lactated Ringer’s
C) 5% dextrose in water
D) Packed red blood cells
Correct Answer: A) 0.9% sodium chloride
Rationale: Hypotension from hemorrhage requires immediate crystalloid resuscitation (0.9%
NaCl or LR). Normal saline is readily available and compatible with blood products if needed
later.
Question 8
A client with diabetic ketoacidosis (DKA) has a potassium of 3.2 mEq/L after insulin therapy.
What should the nurse do?
,A) Administer potassium chloride
B) Recheck glucose levels
C) Increase insulin drip rate
D) Stop insulin therapy
Correct Answer: A) Administer potassium chloride
Rationale: Insulin shifts potassium into cells, worsening hypokalemia (3.2 mEq/L). Potassium
replacement is critical to prevent arrhythmias, guided by lab monitoring in DKA protocols.
Question 9
A client presents with unilateral facial drooping and slurred speech starting 30 minutes ago.
What is the priority action?
A) Administer aspirin
B) Activate stroke team
C) Obtain a head CT
D) Start IV heparin
Correct Answer: B) Activate stroke team
Rationale: Symptoms and timing suggest acute stroke. Activating the stroke team ensures rapid
assessment and imaging within the thrombolytic window, per stroke guidelines.
Question 10
A 70-year-old with a history of atrial fibrillation is pulseless. The monitor shows ventricular
tachycardia. What should the nurse do first?
A) Begin CPR
B) Defibrillate at 200 J
C) Administer epinephrine
D) Check for a pulse again
Correct Answer: B) Defibrillate at 200 J
Rationale: Pulseless VT requires immediate defibrillation (biphasic 200 J) per ACLS. CPR
follows if unsuccessful, but shocking is the first action for this shockable rhythm.
Question 11
A client with a burn covering 18% of their body surface area is tachycardic. What is the fluid
resuscitation formula?
A) Parkland Formula
B) Rule of Nines
C) Lund-Browder Chart
D) Brooke Formula
Correct Answer: A) Parkland Formula
Rationale: The Parkland Formula (4 mL × kg × % TBSA) guides fluid resuscitation in burns. For
18% TBSA, it calculates the volume (e.g., 72 mL/kg) to correct tachycardia and hypovolemia.
Question 12
A client with a tension pneumothorax has absent breath sounds on the left. What is the definitive
treatment?
A) Chest tube insertion
B) Needle decompression
, C) Oxygen at 15 L/min
D) Thoracentesis
Correct Answer: A) Chest tube insertion
Rationale: Tension pneumothorax requires chest tube placement to evacuate air and restore lung
expansion. Needle decompression is temporary; a chest tube is definitive.
Question 13
A 25-year-old overdoses on acetaminophen. Which antidote should the nurse prepare?
A) Naloxone
B) Flumazenil
C) N-acetylcysteine
D) Sodium bicarbonate
Correct Answer: C) N-acetylcysteine
Rationale: N-acetylcysteine is the specific antidote for acetaminophen overdose, protecting the
liver from toxic metabolites. Timing is critical based on ingestion history.
Question 14
A client with a head injury has clear fluid leaking from the nose. What should the nurse suspect?
A) Sinus infection
B) Cerebrospinal fluid (CSF) leak
C) Allergic rhinitis
D) Epistaxis
Correct Answer: B) Cerebrospinal fluid (CSF) leak
Rationale: Clear nasal fluid post-head injury suggests a CSF leak from a basilar skull fracture,
confirmed by glucose testing or imaging, not sinus or allergy-related causes.
Question 15
A 40-year-old with a femur fracture reports shortness of breath. What should the nurse suspect?
A) Pneumonia
B) Fat embolism
C) Pulmonary edema
D) Tension pneumothorax
Correct Answer: B) Fat embolism
Rationale: Dyspnea after a long bone fracture suggests fat embolism syndrome, a triad with
petechiae and confusion. It’s more likely than pulmonary edema or pneumothorax here.
Question 16
A client with sepsis has a lactate level of 4 mmol/L. What does this indicate?
A) Adequate perfusion
B) Tissue hypoxia
C) Normal metabolism
D) Hyperventilation
Correct Answer: B) Tissue hypoxia
Rationale: Elevated lactate (>2 mmol/L) in sepsis reflects anaerobic metabolism from poor tissue
perfusion, guiding aggressive fluid and antibiotic therapy.
Latest Version with All 150 Questions from Actual Exam,
100% Correct Answers and Rationale
Question 1
A client arrives with chest pain, diaphoresis, and an ECG showing ST-elevation in leads V1-V4.
What is the nurse’s priority action?
A) Administer aspirin 325 mg
B) Obtain a second IV access
C) Prepare for thrombolytic therapy
D) Notify the cath lab team
Correct Answer: D) Notify the cath lab team
Rationale: ST-elevation in V1-V4 indicates an anterior wall STEMI, requiring urgent
percutaneous coronary intervention (PCI). Notifying the cath lab ensures the fastest reperfusion,
per AHA guidelines, over initial medications or additional access.
Question 2
A 5-year-old presents with stridor, drooling, and a fever of 102°F (38.9°C). What condition
should the nurse suspect?
A) Croup
B) Epiglottitis
C) Asthma
D) Foreign body aspiration
Correct Answer: B) Epiglottitis
Rationale: Stridor, drooling, and fever suggest epiglottitis, a medical emergency due to airway
obstruction. Croup typically presents with a barking cough, not drooling, while asthma and
foreign body lack this triad.
Question 3
A client with a history of COPD has a PaCO2 of 60 mmHg and is lethargic. What should the
nurse do first?
A) Increase oxygen to 4 L/min
B) Prepare for intubation
C) Administer a bronchodilator
D) Encourage pursed-lip breathing
Correct Answer: B) Prepare for intubation
Rationale: Hypercapnia (PaCO2 60 mmHg) and lethargy indicate respiratory failure in COPD.
Intubation is the priority to secure the airway and ventilate, as increasing oxygen alone may
worsen CO2 retention.
Question 4
A client receives IV morphine for pain and develops a respiratory rate of 8 breaths/min. What is
the nurse’s first action?
A) Administer naloxone
,B) Increase oxygen flow
C) Check oxygen saturation
D) Stimulate the client
Correct Answer: C) Check oxygen saturation
Rationale: Respiratory depression (cue) requires assessing oxygenation first to determine
severity. Naloxone is indicated if hypoxia or unresponsiveness is confirmed, but saturation
guides the next step.
Question 5
A trauma client has a Glasgow Coma Scale (GCS) score of 7. What should the nurse anticipate?
A) Immediate CT scan
B) Airway management
C) Cervical spine immobilization
D) IV fluid bolus
Correct Answer: B) Airway management
Rationale: A GCS of 7 indicates severe brain injury and compromised airway protection.
Intubation is the priority to prevent hypoxia, preceding imaging or fluids in the ABCs of trauma
care.
Question 6
A client with a bee sting develops wheezing and hypotension. Which medication should the
nurse administer first?
A) Diphenhydramine
B) Epinephrine
C) Methylprednisolone
D) Albuterol
Correct Answer: B) Epinephrine
Rationale: Wheezing and hypotension suggest anaphylaxis. Epinephrine (IM) is the first-line
treatment to reverse bronchospasm and shock, per emergency protocols, before adjuncts like
antihistamines.
Question 7
A 30-year-old with a gunshot wound to the abdomen has a BP of 80/50 mmHg. What is the
initial fluid choice?
A) 0.9% sodium chloride
B) Lactated Ringer’s
C) 5% dextrose in water
D) Packed red blood cells
Correct Answer: A) 0.9% sodium chloride
Rationale: Hypotension from hemorrhage requires immediate crystalloid resuscitation (0.9%
NaCl or LR). Normal saline is readily available and compatible with blood products if needed
later.
Question 8
A client with diabetic ketoacidosis (DKA) has a potassium of 3.2 mEq/L after insulin therapy.
What should the nurse do?
,A) Administer potassium chloride
B) Recheck glucose levels
C) Increase insulin drip rate
D) Stop insulin therapy
Correct Answer: A) Administer potassium chloride
Rationale: Insulin shifts potassium into cells, worsening hypokalemia (3.2 mEq/L). Potassium
replacement is critical to prevent arrhythmias, guided by lab monitoring in DKA protocols.
Question 9
A client presents with unilateral facial drooping and slurred speech starting 30 minutes ago.
What is the priority action?
A) Administer aspirin
B) Activate stroke team
C) Obtain a head CT
D) Start IV heparin
Correct Answer: B) Activate stroke team
Rationale: Symptoms and timing suggest acute stroke. Activating the stroke team ensures rapid
assessment and imaging within the thrombolytic window, per stroke guidelines.
Question 10
A 70-year-old with a history of atrial fibrillation is pulseless. The monitor shows ventricular
tachycardia. What should the nurse do first?
A) Begin CPR
B) Defibrillate at 200 J
C) Administer epinephrine
D) Check for a pulse again
Correct Answer: B) Defibrillate at 200 J
Rationale: Pulseless VT requires immediate defibrillation (biphasic 200 J) per ACLS. CPR
follows if unsuccessful, but shocking is the first action for this shockable rhythm.
Question 11
A client with a burn covering 18% of their body surface area is tachycardic. What is the fluid
resuscitation formula?
A) Parkland Formula
B) Rule of Nines
C) Lund-Browder Chart
D) Brooke Formula
Correct Answer: A) Parkland Formula
Rationale: The Parkland Formula (4 mL × kg × % TBSA) guides fluid resuscitation in burns. For
18% TBSA, it calculates the volume (e.g., 72 mL/kg) to correct tachycardia and hypovolemia.
Question 12
A client with a tension pneumothorax has absent breath sounds on the left. What is the definitive
treatment?
A) Chest tube insertion
B) Needle decompression
, C) Oxygen at 15 L/min
D) Thoracentesis
Correct Answer: A) Chest tube insertion
Rationale: Tension pneumothorax requires chest tube placement to evacuate air and restore lung
expansion. Needle decompression is temporary; a chest tube is definitive.
Question 13
A 25-year-old overdoses on acetaminophen. Which antidote should the nurse prepare?
A) Naloxone
B) Flumazenil
C) N-acetylcysteine
D) Sodium bicarbonate
Correct Answer: C) N-acetylcysteine
Rationale: N-acetylcysteine is the specific antidote for acetaminophen overdose, protecting the
liver from toxic metabolites. Timing is critical based on ingestion history.
Question 14
A client with a head injury has clear fluid leaking from the nose. What should the nurse suspect?
A) Sinus infection
B) Cerebrospinal fluid (CSF) leak
C) Allergic rhinitis
D) Epistaxis
Correct Answer: B) Cerebrospinal fluid (CSF) leak
Rationale: Clear nasal fluid post-head injury suggests a CSF leak from a basilar skull fracture,
confirmed by glucose testing or imaging, not sinus or allergy-related causes.
Question 15
A 40-year-old with a femur fracture reports shortness of breath. What should the nurse suspect?
A) Pneumonia
B) Fat embolism
C) Pulmonary edema
D) Tension pneumothorax
Correct Answer: B) Fat embolism
Rationale: Dyspnea after a long bone fracture suggests fat embolism syndrome, a triad with
petechiae and confusion. It’s more likely than pulmonary edema or pneumothorax here.
Question 16
A client with sepsis has a lactate level of 4 mmol/L. What does this indicate?
A) Adequate perfusion
B) Tissue hypoxia
C) Normal metabolism
D) Hyperventilation
Correct Answer: B) Tissue hypoxia
Rationale: Elevated lactate (>2 mmol/L) in sepsis reflects anaerobic metabolism from poor tissue
perfusion, guiding aggressive fluid and antibiotic therapy.
