Certified Emergency Nurse WITH CORRECT ACTUAL
QUESTIONS AND CORRECTLY WELL DEFINED
ANSWERS LATEST ALREADY GRADED A+
(2025/2026)
Cardiovascular Emergencies (1–15)
1. A 68-year-old man presents to the emergency department with crushing
substernal chest pain radiating to the left arm, diaphoresis, and nausea. An ECG
shows ST-segment elevation in leads V1–V4. Which intervention should the nurse
perform first?
A) Draw blood for cardiac enzymes
B) Administer morphine 4 mg IV
C) Administer aspirin 324 mg chewed
D) Obtain a chest X-ray
Answer: C
*Rationale: Aspirin reduces mortality in acute myocardial infarction and should be
given immediately (chewed for rapid absorption). Oxygen, nitroglycerin, and
morphine are also important but aspirin is the priority. Door-to-aspirin time
should be <10 minutes.*
2. A patient with acute chest pain has an ECG that shows ST-segment depression
and T-wave inversion in leads II, III, and aVF. Cardiac troponin is elevated. What is
the most likely diagnosis?
A) Unstable angina
B) Non-ST-elevation myocardial infarction (NSTEMI)
,C) ST-elevation myocardial infarction (STEMI)
D) Pericarditis
Answer: B
Rationale: NSTEMI is diagnosed by elevated cardiac biomarkers (troponin) and
ECG changes that do not include ST elevation (ST depression, T-wave inversion).
Unstable angina has normal biomarkers. Pericarditis has diffuse ST elevation and
PR depression.
3. A 55-year-old man with a history of hypertension and diabetes presents with
sudden onset of severe tearing chest pain radiating to the back. Blood pressure is
180/100 mmHg in the right arm and 100/60 mmHg in the left arm. Which
condition is most likely?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Esophageal rupture
Answer: B
Rationale: Aortic dissection classically presents with sudden, severe tearing or
ripping chest pain that radiates to the back, with differential blood pressures in the
arms. It is a surgical emergency. A CT angiogram is diagnostic.
4. A patient with acute decompensated heart failure has crackles in all lung fields
and an oxygen saturation of 88% on room air. Which intervention should the nurse
initiate first?
A) Administer furosemide 40 mg IV push
B) Place the patient on high-flow oxygen (non-rebreather mask)
C) Position the patient in a supine position
D) Start a dopamine infusion
Answer: B
*Rationale: Hypoxemia requires immediate oxygen therapy. A non-rebreather
,mask at 15 L/min is appropriate. After oxygen, the patient should be positioned in
high Fowler's to reduce preload. Furosemide is given but not before oxygenation.*
5. A patient is in atrial fibrillation with a rapid ventricular response of 150 bpm.
The patient is confused, hypotensive (BP 80/50 mmHg), and has chest pain. What
is the most appropriate immediate intervention?
A) Administer diltiazem 0.25 mg/kg IV push
B) Administer amiodarone 150 mg IV over 10 minutes
C) Perform synchronized cardioversion
D) Administer adenosine 6 mg IV push
Answer: C
Rationale: Unstable atrial fibrillation (hypotension, altered mental status, chest
pain, pulmonary edema) requires immediate synchronized cardioversion (starting
at 100–200 J). Adenosine is for supraventricular tachycardia. Diltiazem and
amiodarone are for stable patients.
6. A patient with a history of hypertension presents with a blood pressure of
220/120 mmHg, headache, and altered mental status. The nurse should prepare
to administer which medication?
A) Nitroglycerin 0.4 mg sublingual
B) Furosemide 40 mg IV
C) Labetalol 20 mg IV push
D) Aspirin 324 mg chewed
Answer: C
*Rationale: This is hypertensive emergency with end-organ damage
(encephalopathy). IV labetalol (or nicardipine, clevidipine, nitroglycerin,
nitroprusside) is used to lower blood pressure gradually. The goal is to reduce
MAP by 20–25% over the first hour.*
, 7. A patient is brought to the emergency department after a cardiac arrest. Return
of spontaneous circulation (ROSC) has been achieved. The patient is comatose.
Which intervention is most likely to improve neurological outcomes?
A) Induced hypothermia (targeted temperature management at 32–36°C)
B) High-dose epinephrine
C) 100% oxygen for 24 hours
D) Immediate cardiac catheterization
Answer: A
Rationale: Targeted temperature management (TTM) for 24 hours at 32–36°C
reduces neurological injury after cardiac arrest. Oxygen should be titrated to
maintain SpO₂ 94–99% (avoid hyperoxia). Immediate catheterization is indicated
for STEMI patients.
8. A patient with a suspected acute myocardial infarction has a heart rate of 45
bpm with a blood pressure of 80/50 mmHg. The ECG shows third-degree heart
block with a wide QRS complex. Which medication should the nurse prepare to
administer?
A) Atropine 0.5 mg IV push
B) Dopamine infusion
C) Transcutaneous pacing
D) Amiodarone 150 mg IV
Answer: C
Rationale: Third-degree heart block with hemodynamic instability (hypotension)
and wide QRS requires immediate transcutaneous pacing. Atropine is often
ineffective for infranodal block. Pacing is the definitive treatment while preparing
for transvenous pacing.
9. A patient presents with a regular narrow-complex tachycardia at a rate of 180
bpm. The patient is stable (alert, blood pressure 110/70 mmHg, no chest pain).
Which initial intervention should the nurse perform?
QUESTIONS AND CORRECTLY WELL DEFINED
ANSWERS LATEST ALREADY GRADED A+
(2025/2026)
Cardiovascular Emergencies (1–15)
1. A 68-year-old man presents to the emergency department with crushing
substernal chest pain radiating to the left arm, diaphoresis, and nausea. An ECG
shows ST-segment elevation in leads V1–V4. Which intervention should the nurse
perform first?
A) Draw blood for cardiac enzymes
B) Administer morphine 4 mg IV
C) Administer aspirin 324 mg chewed
D) Obtain a chest X-ray
Answer: C
*Rationale: Aspirin reduces mortality in acute myocardial infarction and should be
given immediately (chewed for rapid absorption). Oxygen, nitroglycerin, and
morphine are also important but aspirin is the priority. Door-to-aspirin time
should be <10 minutes.*
2. A patient with acute chest pain has an ECG that shows ST-segment depression
and T-wave inversion in leads II, III, and aVF. Cardiac troponin is elevated. What is
the most likely diagnosis?
A) Unstable angina
B) Non-ST-elevation myocardial infarction (NSTEMI)
,C) ST-elevation myocardial infarction (STEMI)
D) Pericarditis
Answer: B
Rationale: NSTEMI is diagnosed by elevated cardiac biomarkers (troponin) and
ECG changes that do not include ST elevation (ST depression, T-wave inversion).
Unstable angina has normal biomarkers. Pericarditis has diffuse ST elevation and
PR depression.
3. A 55-year-old man with a history of hypertension and diabetes presents with
sudden onset of severe tearing chest pain radiating to the back. Blood pressure is
180/100 mmHg in the right arm and 100/60 mmHg in the left arm. Which
condition is most likely?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Esophageal rupture
Answer: B
Rationale: Aortic dissection classically presents with sudden, severe tearing or
ripping chest pain that radiates to the back, with differential blood pressures in the
arms. It is a surgical emergency. A CT angiogram is diagnostic.
4. A patient with acute decompensated heart failure has crackles in all lung fields
and an oxygen saturation of 88% on room air. Which intervention should the nurse
initiate first?
A) Administer furosemide 40 mg IV push
B) Place the patient on high-flow oxygen (non-rebreather mask)
C) Position the patient in a supine position
D) Start a dopamine infusion
Answer: B
*Rationale: Hypoxemia requires immediate oxygen therapy. A non-rebreather
,mask at 15 L/min is appropriate. After oxygen, the patient should be positioned in
high Fowler's to reduce preload. Furosemide is given but not before oxygenation.*
5. A patient is in atrial fibrillation with a rapid ventricular response of 150 bpm.
The patient is confused, hypotensive (BP 80/50 mmHg), and has chest pain. What
is the most appropriate immediate intervention?
A) Administer diltiazem 0.25 mg/kg IV push
B) Administer amiodarone 150 mg IV over 10 minutes
C) Perform synchronized cardioversion
D) Administer adenosine 6 mg IV push
Answer: C
Rationale: Unstable atrial fibrillation (hypotension, altered mental status, chest
pain, pulmonary edema) requires immediate synchronized cardioversion (starting
at 100–200 J). Adenosine is for supraventricular tachycardia. Diltiazem and
amiodarone are for stable patients.
6. A patient with a history of hypertension presents with a blood pressure of
220/120 mmHg, headache, and altered mental status. The nurse should prepare
to administer which medication?
A) Nitroglycerin 0.4 mg sublingual
B) Furosemide 40 mg IV
C) Labetalol 20 mg IV push
D) Aspirin 324 mg chewed
Answer: C
*Rationale: This is hypertensive emergency with end-organ damage
(encephalopathy). IV labetalol (or nicardipine, clevidipine, nitroglycerin,
nitroprusside) is used to lower blood pressure gradually. The goal is to reduce
MAP by 20–25% over the first hour.*
, 7. A patient is brought to the emergency department after a cardiac arrest. Return
of spontaneous circulation (ROSC) has been achieved. The patient is comatose.
Which intervention is most likely to improve neurological outcomes?
A) Induced hypothermia (targeted temperature management at 32–36°C)
B) High-dose epinephrine
C) 100% oxygen for 24 hours
D) Immediate cardiac catheterization
Answer: A
Rationale: Targeted temperature management (TTM) for 24 hours at 32–36°C
reduces neurological injury after cardiac arrest. Oxygen should be titrated to
maintain SpO₂ 94–99% (avoid hyperoxia). Immediate catheterization is indicated
for STEMI patients.
8. A patient with a suspected acute myocardial infarction has a heart rate of 45
bpm with a blood pressure of 80/50 mmHg. The ECG shows third-degree heart
block with a wide QRS complex. Which medication should the nurse prepare to
administer?
A) Atropine 0.5 mg IV push
B) Dopamine infusion
C) Transcutaneous pacing
D) Amiodarone 150 mg IV
Answer: C
Rationale: Third-degree heart block with hemodynamic instability (hypotension)
and wide QRS requires immediate transcutaneous pacing. Atropine is often
ineffective for infranodal block. Pacing is the definitive treatment while preparing
for transvenous pacing.
9. A patient presents with a regular narrow-complex tachycardia at a rate of 180
bpm. The patient is stable (alert, blood pressure 110/70 mmHg, no chest pain).
Which initial intervention should the nurse perform?
