Certified Emergency Nurse (CEN) Practice
Exam 1 –Questions and Correct Answers
(Verified Answers) with Rationales 2025
1. A patient presents with chest pain radiating to the left arm. Which
diagnostic test is the priority?
• Chest X-ray
• Echocardiogram
• 12-lead ECG
• Cardiac enzyme panel
The 12-lead ECG is the fastest way to identify ST-elevation
myocardial infarction (STEMI), which requires immediate
intervention.
2. A trauma patient has distended neck veins, muffled heart sounds,
and hypotension. What condition is most likely?
• Tension pneumothorax
• Hemothorax
• Cardiac tamponade
• Pulmonary embolism
Beck's triad (distended neck veins, muffled heart sounds, and
hypotension) is classic for cardiac tamponade.
,3. A patient exposed to a house fire is coughing and has soot around
the nose. What is the priority intervention?
• Apply a cardiac monitor
• Prepare for intubation
• Administer IV fluids
• Administer pain medication
Airway management is critical due to possible inhalation injury.
Intubation should be considered early.
4. A patient with DKA presents with Kussmaul respirations. What acid-
base imbalance is expected?
• Metabolic alkalosis
• Respiratory alkalosis
• Respiratory acidosis
• Metabolic acidosis
Kussmaul respirations are compensatory for metabolic acidosis in
DKA.
5. Which of the following is the most reliable sign of basilar skull
fracture?
• Periorbital ecchymosis
• Battle sign
• Epistaxis
, • Scalp laceration
Battle sign (bruising over the mastoid process) is a hallmark of
basilar skull fracture.
6. A patient presents with sudden-onset shortness of breath after a
long flight. Which test is most appropriate?
• ECG
• Chest X-ray
• CT pulmonary angiogram
• D-dimer
CT pulmonary angiogram is the diagnostic test of choice for
suspected pulmonary embolism.
7. A patient has a potassium level of 2.8 mEq/L. Which finding is
expected?
• Tall, peaked T waves
• Muscle weakness
• Bradycardia
• Hyperreflexia
Hypokalemia commonly presents with muscle weakness due to
impaired neuromuscular function.
8. Which of the following is the initial management for a patient with
an open pneumothorax?
• Needle decompression
• Endotracheal intubation
Exam 1 –Questions and Correct Answers
(Verified Answers) with Rationales 2025
1. A patient presents with chest pain radiating to the left arm. Which
diagnostic test is the priority?
• Chest X-ray
• Echocardiogram
• 12-lead ECG
• Cardiac enzyme panel
The 12-lead ECG is the fastest way to identify ST-elevation
myocardial infarction (STEMI), which requires immediate
intervention.
2. A trauma patient has distended neck veins, muffled heart sounds,
and hypotension. What condition is most likely?
• Tension pneumothorax
• Hemothorax
• Cardiac tamponade
• Pulmonary embolism
Beck's triad (distended neck veins, muffled heart sounds, and
hypotension) is classic for cardiac tamponade.
,3. A patient exposed to a house fire is coughing and has soot around
the nose. What is the priority intervention?
• Apply a cardiac monitor
• Prepare for intubation
• Administer IV fluids
• Administer pain medication
Airway management is critical due to possible inhalation injury.
Intubation should be considered early.
4. A patient with DKA presents with Kussmaul respirations. What acid-
base imbalance is expected?
• Metabolic alkalosis
• Respiratory alkalosis
• Respiratory acidosis
• Metabolic acidosis
Kussmaul respirations are compensatory for metabolic acidosis in
DKA.
5. Which of the following is the most reliable sign of basilar skull
fracture?
• Periorbital ecchymosis
• Battle sign
• Epistaxis
, • Scalp laceration
Battle sign (bruising over the mastoid process) is a hallmark of
basilar skull fracture.
6. A patient presents with sudden-onset shortness of breath after a
long flight. Which test is most appropriate?
• ECG
• Chest X-ray
• CT pulmonary angiogram
• D-dimer
CT pulmonary angiogram is the diagnostic test of choice for
suspected pulmonary embolism.
7. A patient has a potassium level of 2.8 mEq/L. Which finding is
expected?
• Tall, peaked T waves
• Muscle weakness
• Bradycardia
• Hyperreflexia
Hypokalemia commonly presents with muscle weakness due to
impaired neuromuscular function.
8. Which of the following is the initial management for a patient with
an open pneumothorax?
• Needle decompression
• Endotracheal intubation
