Pam Bartley CEN Review Questions: Emergency Nursing Certification Practice Test with
Answers & Rationales
A thin 16-year-old female complains of fatigue, dizziness, and feeling cold. You notice brittle
nails and she states she hasn't had a period in 6 months. The nurse suspects: - ANS ✔✔Anorexia
Which of the following statements is INCORRECT regarding the care of a patient who is a recent
victim of sexual assault? - ANS ✔✔Collect clean-catch urine as soon as possible for toxicology
testing.
Reasoning: Collect urine without clean-catch method to preserve potential evidence. Triage the
patient as ESI level-2, place evidence in separate paper bags (plastic molds degrading DNA) and
allow the patient to decline photo documentation if it will trigger traumatic memories.
A 70-year old female with a history of hypertension and atrial fibrillation presents to triage with
a sudden onset of right-side facial weakness, visual disturbance, and headache that began 30
minutes ago. Her symptoms resolved when the advanced practice provider examined her 15
minutes later. What is her likely diagnosis? - ANS ✔✔Transient ischemic attack.
A patient with a tingling sensation in his hands and feet and weakness in his lower extremities
after having COVID-19 is diagnosed with Guillain-Barre syndrome. What is the priority to
monitor? - ANS ✔✔Respiratory effort
A 16-year-old male swimming in the ocean was injured by a stingray on his forearm. Immerse
the forearm injured in hot water until: - ANS ✔✔Relief of pain
Assessment of a patient who received metoclopramide (Reglan) reveals facial spasms and
blepharospasms as well as tongue protrusion and lip-smacking. The patient is most likely
experiencing? - ANS ✔✔A dystonic reaction
,Parents bring in their 2-year-old child for respiratory distress and a "barking" cough after a viral
illness the last few days. Which of the following respiratory emergencies is the patient most
likely experiencing? - ANS ✔✔Croup
Sudden cardiac arrest after a blow to the chest is caused by which cardiac disorder? - ANS
✔✔Commotio cordis
A 20-year-old male is transported to the ED via EMS after a high-speed MVC complaining of
shortness of breath. Assessment reveals pain upon palpation, bony crepitus, and paradoxical
chest wall movement. The nurse suspects: - ANS ✔✔Flail chest
A patient with severe head trauma is diagnosed with syndrome of inappropriate antidiuretic
hormone (SIADH). The patient is most at risk for which of the following complications? - ANS
✔✔Seizures
A 16-year-old female complains of fever, nausea, and right lower quadrant abdominal pain.
Assessment reveals pain upon palpation at McBurney's point and rebound tenderness, so the
nurse suspects: - ANS ✔✔Appendicitis
A victim of violence was unresponsive at the scene, awake on arrival to the ED, but has a second
loss of consciousness in CT scan. Which of the following vessels is typically involved in an
epidural bleed? - ANS ✔✔Middle meningeal artery
Which injury will least likely occur in a 6-year-old front-seat passenger secured only with a lap
restraint? - ANS ✔✔Pelvic fracture
A 19-year-old male was ejected from the car in a high-speed crash. Which hemodynamic
changes are typically seen in neurogenic shock? - ANS ✔✔Bradycardia and hypotension
,A 19-year-old female who is gravida 2, para 1 at 38 weeks gestation has a magnesium sulfate
infusion for pregnancy-induced hypertension. What is the most important parameter to
monitor during a magnesium infusion? - ANS ✔✔Respiratory rate
A 19-year-old female with gestational hypertension is diagnosed with HEELP syndrome, a form
of disseminated intravascular coagulation (DIC). Laboratory results for a patient in DIC includes:
- ANS ✔✔Increased fibrin split products
A 68-year-old male complains of severe pain in his "big toe". The joint is red and swollen and
the uric acid level is elevated, so the nurse suspects: - ANS ✔✔Gouty arthritis
Which medication is the priority treatment in anaphylaxis? - ANS ✔✔Epinephrine
A patient with a lower leg injury returns to the emergency department 24 hours later with
severe throbbing pain not relieved by analgesia. The initial care includes: - ANS ✔✔Keeping the
injured leg in a neutral position
A patient with a crush injury to his lower leg has increased potassium, creatine kinase (CK), and
myoglobin levels. What is the hallmark sign of rhabdomyolysis. - ANS ✔✔Reddish-brown urine
A 20-year-old male strikes a wall with a closed fist fracturing his 5th metacarpal. This is referred
to as a: - ANS ✔✔Boxer's fracture
A 20-year-old male is transported to the ED via EMS after a rollover motor vehicle collision
(MVC). Vital signs: HR = 80 bpm, RR = 18 breaths, BP = 180/50. What is his pulse pressure? - ANS
✔✔(systolic - diastolic = pulse pressure) = (180-50 = 130 mmHg)
A 3-year-old female that weighs 15 kg has a history of vomiting and diarrhea for the past 24
hours. Her heart rate is 180 beats per minute, blood pressure is 74 systolic. Her capillary refill is
delayed, and peripheral pulses are weak. What is the initial bolus of intravenous isotonic fluid? -
ANS ✔✔15 kg * (20 ml/kg) = 300 ml in 5 to 10 minutes
, A 20-year-old male with a stab wound to the chest is tachycardic, tachypneic, and dyspneic. He
is diagnosed with cardiac tamponade utilizing fast assessment sonography for trauma (FAST).
Cardiac tamponade is classified as which type of shock? - ANS ✔✔Obstructive shock
A 20-year-old male is transported to the ED via EMS after a rollover motor vehicle collision
(MVC). Vital signs: HR = 80 bpm, RR = 18 breaths, BP = 90/60. What is the patient's mean
arterial pressure (MAP)? - ANS ✔✔MAP = [(systolic) + 2* (diastolic)/3] = [(90 + 2 * (60)/3] = 70
A child has tachycardia, tachypnea, flash capillary refill, and bounding peripheral pulses. These
clinical findings are consistent with which type of shock? - ANS ✔✔Early hyperdynamic septic
shock
The ingestion of toxic alcohols such as ethylene glycol and methanol may produce which acid-
base imbalance? - ANS ✔✔Metabolic acidosis
A 30-year-old female with bulimia purges three times daily. Repeated frequent vomiting triggers
which acid-base imbalance? - ANS ✔✔Metabolic alkalosis
A patient 70-kg female with acute respiratory distress syndrome is orally intubated and
mechanically ventilated with a lung protective tidal volume of 350 mL. Which of the following
conditions would trigger a mechanical ventilator low pressure alarm? - ANS ✔✔Endotracheal
tube leak
A 60-year-old female with COPD dislocates her wrist after falling onto an outstretched hand. For
relocation, the nurse expects an order for which medication that is a dissociative anesthetic
with analgesic properties, yet sparing respiratory drive? - ANS ✔✔Ketamine
The following risk factors have been linked to an increased risk of sudden infant death syndrome
(SIDS) EXCEPT? - ANS ✔✔Babies who use pacifiers at naptime and bedtime.
Answers & Rationales
A thin 16-year-old female complains of fatigue, dizziness, and feeling cold. You notice brittle
nails and she states she hasn't had a period in 6 months. The nurse suspects: - ANS ✔✔Anorexia
Which of the following statements is INCORRECT regarding the care of a patient who is a recent
victim of sexual assault? - ANS ✔✔Collect clean-catch urine as soon as possible for toxicology
testing.
Reasoning: Collect urine without clean-catch method to preserve potential evidence. Triage the
patient as ESI level-2, place evidence in separate paper bags (plastic molds degrading DNA) and
allow the patient to decline photo documentation if it will trigger traumatic memories.
A 70-year old female with a history of hypertension and atrial fibrillation presents to triage with
a sudden onset of right-side facial weakness, visual disturbance, and headache that began 30
minutes ago. Her symptoms resolved when the advanced practice provider examined her 15
minutes later. What is her likely diagnosis? - ANS ✔✔Transient ischemic attack.
A patient with a tingling sensation in his hands and feet and weakness in his lower extremities
after having COVID-19 is diagnosed with Guillain-Barre syndrome. What is the priority to
monitor? - ANS ✔✔Respiratory effort
A 16-year-old male swimming in the ocean was injured by a stingray on his forearm. Immerse
the forearm injured in hot water until: - ANS ✔✔Relief of pain
Assessment of a patient who received metoclopramide (Reglan) reveals facial spasms and
blepharospasms as well as tongue protrusion and lip-smacking. The patient is most likely
experiencing? - ANS ✔✔A dystonic reaction
,Parents bring in their 2-year-old child for respiratory distress and a "barking" cough after a viral
illness the last few days. Which of the following respiratory emergencies is the patient most
likely experiencing? - ANS ✔✔Croup
Sudden cardiac arrest after a blow to the chest is caused by which cardiac disorder? - ANS
✔✔Commotio cordis
A 20-year-old male is transported to the ED via EMS after a high-speed MVC complaining of
shortness of breath. Assessment reveals pain upon palpation, bony crepitus, and paradoxical
chest wall movement. The nurse suspects: - ANS ✔✔Flail chest
A patient with severe head trauma is diagnosed with syndrome of inappropriate antidiuretic
hormone (SIADH). The patient is most at risk for which of the following complications? - ANS
✔✔Seizures
A 16-year-old female complains of fever, nausea, and right lower quadrant abdominal pain.
Assessment reveals pain upon palpation at McBurney's point and rebound tenderness, so the
nurse suspects: - ANS ✔✔Appendicitis
A victim of violence was unresponsive at the scene, awake on arrival to the ED, but has a second
loss of consciousness in CT scan. Which of the following vessels is typically involved in an
epidural bleed? - ANS ✔✔Middle meningeal artery
Which injury will least likely occur in a 6-year-old front-seat passenger secured only with a lap
restraint? - ANS ✔✔Pelvic fracture
A 19-year-old male was ejected from the car in a high-speed crash. Which hemodynamic
changes are typically seen in neurogenic shock? - ANS ✔✔Bradycardia and hypotension
,A 19-year-old female who is gravida 2, para 1 at 38 weeks gestation has a magnesium sulfate
infusion for pregnancy-induced hypertension. What is the most important parameter to
monitor during a magnesium infusion? - ANS ✔✔Respiratory rate
A 19-year-old female with gestational hypertension is diagnosed with HEELP syndrome, a form
of disseminated intravascular coagulation (DIC). Laboratory results for a patient in DIC includes:
- ANS ✔✔Increased fibrin split products
A 68-year-old male complains of severe pain in his "big toe". The joint is red and swollen and
the uric acid level is elevated, so the nurse suspects: - ANS ✔✔Gouty arthritis
Which medication is the priority treatment in anaphylaxis? - ANS ✔✔Epinephrine
A patient with a lower leg injury returns to the emergency department 24 hours later with
severe throbbing pain not relieved by analgesia. The initial care includes: - ANS ✔✔Keeping the
injured leg in a neutral position
A patient with a crush injury to his lower leg has increased potassium, creatine kinase (CK), and
myoglobin levels. What is the hallmark sign of rhabdomyolysis. - ANS ✔✔Reddish-brown urine
A 20-year-old male strikes a wall with a closed fist fracturing his 5th metacarpal. This is referred
to as a: - ANS ✔✔Boxer's fracture
A 20-year-old male is transported to the ED via EMS after a rollover motor vehicle collision
(MVC). Vital signs: HR = 80 bpm, RR = 18 breaths, BP = 180/50. What is his pulse pressure? - ANS
✔✔(systolic - diastolic = pulse pressure) = (180-50 = 130 mmHg)
A 3-year-old female that weighs 15 kg has a history of vomiting and diarrhea for the past 24
hours. Her heart rate is 180 beats per minute, blood pressure is 74 systolic. Her capillary refill is
delayed, and peripheral pulses are weak. What is the initial bolus of intravenous isotonic fluid? -
ANS ✔✔15 kg * (20 ml/kg) = 300 ml in 5 to 10 minutes
, A 20-year-old male with a stab wound to the chest is tachycardic, tachypneic, and dyspneic. He
is diagnosed with cardiac tamponade utilizing fast assessment sonography for trauma (FAST).
Cardiac tamponade is classified as which type of shock? - ANS ✔✔Obstructive shock
A 20-year-old male is transported to the ED via EMS after a rollover motor vehicle collision
(MVC). Vital signs: HR = 80 bpm, RR = 18 breaths, BP = 90/60. What is the patient's mean
arterial pressure (MAP)? - ANS ✔✔MAP = [(systolic) + 2* (diastolic)/3] = [(90 + 2 * (60)/3] = 70
A child has tachycardia, tachypnea, flash capillary refill, and bounding peripheral pulses. These
clinical findings are consistent with which type of shock? - ANS ✔✔Early hyperdynamic septic
shock
The ingestion of toxic alcohols such as ethylene glycol and methanol may produce which acid-
base imbalance? - ANS ✔✔Metabolic acidosis
A 30-year-old female with bulimia purges three times daily. Repeated frequent vomiting triggers
which acid-base imbalance? - ANS ✔✔Metabolic alkalosis
A patient 70-kg female with acute respiratory distress syndrome is orally intubated and
mechanically ventilated with a lung protective tidal volume of 350 mL. Which of the following
conditions would trigger a mechanical ventilator low pressure alarm? - ANS ✔✔Endotracheal
tube leak
A 60-year-old female with COPD dislocates her wrist after falling onto an outstretched hand. For
relocation, the nurse expects an order for which medication that is a dissociative anesthetic
with analgesic properties, yet sparing respiratory drive? - ANS ✔✔Ketamine
The following risk factors have been linked to an increased risk of sudden infant death syndrome
(SIDS) EXCEPT? - ANS ✔✔Babies who use pacifiers at naptime and bedtime.
