CEN Test Quiz Bank chapter 005 Practice Test Questions and
Answers 2023/2024 APPROVED
1. A pt presents to the ED experiencing an anterior ST segment elevation MI. The pts vital signs are
normal. The hospital is not equipped with a cardaic catheterization lab. The pt can be transferred to a
cardaic catheterization lab within 60 mins. Which of the following would you anticipate for this pt?:
A. A bolus of tissue plasminogen activator, followed by an infusion for fibrinolytic therapy
B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous coronary
intervention
C. A single bolus of tenecteplase (Tnkase) for fibrinolytic therapy
D. A bolus of reteplase (Retavase), followed by a second bolus of reteplase 30 mins later for fibrinolytic
therapy correct answers B. Immediate transfer to the hospital with a cardiac catheterization lab for
percutaneous coronary intervention
In adult pts presenting with a STEMI of a hospital that does not have PCI capability, it is recommended
that the pt be transferred immediately without fibrinolytics to a PCI center, instead of immediate
fibrinolysis at the intial hospital with transfer onlu for ischemia driven PCI
2. An anxious pt arrives by ambulance following an acute onset of difficulty breathing. The pt is
diaphoretic and denies chest pain. High-flow O2 by non-rebreather mask has been applied. Vitals: BP
210/140, HR 130, RR 32, SpO2 88%. In addition to initiating noninvasive ventilation to treat the pts
difficulty breathing, the nurse anticipates the administration of which medication to further treat the pts
symptoms?:
A. Morphine (Morphine sulfate)
B. Furosemide (Lasix)
C. Initation of a continuous nitroglycerin infusion
D. Acetylsalicylic acid (Aspirin) correct answers C. Initation of a continuous nitroglycerin infusion
Pts who present with acute pulmonary edema are typically markedly hypertensive and in acute
respiratory distress. Rapid initiation of appropriate treatment is vital to reversing the neurohormonal
surge and rescuing pts from respiratory and complete cardiac failure. Nitroglycerin is the most important
first line medication in treatment of acute pulmonary edema and respiratory distress. The initation of
continuous NTG infusion at low doses acts as a vasodilator, leading to decreased preload: at higher doses
( >100mcg/min) acts as a potent afterload reducer
3. An unrestrained driver is brought to the ED following a motor vehicle collision. The pt reports hitting
their chest on the steering wheel and is complaining of chest pain across the front of their chest. There
are no vital sign abnormalities and no other complaints of pain. The diagnosis of blunt cardiac injury is
considered. The nurse anticipates an order for which of the following?:
A. EKG
B. Cardiac marker evaluation (CK or Troponin)
C. Cardiac monitoring
D. Chest radiograph correct answers B. Cardiac marker evaluation (CK or Troponin)
Not all trauma pts with blunt cardiac injury will have acute alterations in cardiac markers, and other
organ injury may cause release of creatinine kinase and confound the diagnosis of blunt cardiac injury
,4. Which of the following is a form of distributive shock?:
A. Neurogenic
B. Metabolic
C. Respiratory
D. Obstructive correct answers A. Neurogenic
5. A pt presents following an acute onset of chest pain, dyspnea and severe diaphoresis, with near
syncope. Assessment shows a pt in severe distress, with HR 110, BP 60/40 and RR 36 with bilateral rales.
An EKG reveals ST segment elevation across the precordial leads. A diagnosis of acute MI with
cardiogenic shock is made, and the pt is being prepared for transfer to the cardiac cath lab. The
vasopressor of choice, based on this pts degree of hypotension is:
A. Norepineprhine (Levophed)
B. Dopamine (Inotropin)
C. Dobutamine (Dobutrex)
D. Vasopressin (Pitressin) correct answers A. Norepineprhine (Levophed)
The intial use of norepinephrine for marked hypotension, <70mmHg systolic is the current
recommendation from the AHA
6. A pt presents with complaints of chest pain that radiates to the jaw, stating the pain is a 6/10. Other
symptoms include nausea, dizziness, shortness of breath with clear lung sounds, and a sense of
impending doom. The pain started 40 mins before arrival. Vitals: BP 116/58, HR 98, RR 20, SpO2 94%, T
98.6F. The 12 lead EKG shows inferior wall myocardial injury pattern. Which clinical presentations
indicate the need to complete a right sided 12 lead EKG?:
A. Shortness of breath with clear lung sounds
B. Nausea and dizziness
C. Chest pain with radiation to the jaw
D. Sense of impending doom correct answers A. Shortness of breath with clear lung sounds
Classic right ventricular infarcts are associated with the absence of pulmonary congestion
Think: RIGHT to my foot
7. Following the successful resuscitation of a pt in a cardiac arrest, which of the following findings is the
best indicator high-quality CPR?:
A. A compression depth of 1 1/2 inches
B. Palpable pulses with the preformance of chest compressions during CPR
C. A decrease of skin and mucus membrane cyanosis
D. An increasing end tital Co2 level correct answers D. An increasing end tital Co2 level
An increasing end-tidal carbon dioxide level indicates increasing cellular perfusion with effective CPR or
ROSC
8. During transcutaneous pacing for a pt in third-degree heart block, there is a loss of ventricular
capture. Which is a significant physiological reason for loss of a pacemaker capture?:
A. Metabolic alkalosis
B. Hypomagnesemia
,C. Lactic acidosis
D. Hypokalemia correct answers C. Lactic acidosis
Lactic acidosis alters the contractility of the myocardium, leading to decreased abilty to gain ventricular
capture, this results in lack of tissue perfusion
9. A pt presents with complaints of lightheadedness, weakness and near syncope. The pts 12 lead EKG
reveals the presence of 2:1 arterial flutter. The most appropriate intervention for this presentation with
arterial flutter rhythm is to preform:
A. Synchronized cardioversion at 50 joules
B. Unsynchronized cardioversion at 120 joules
C. Unsynchronized cardioversion at 50 joules
D. Synchronized cardioversion at 120 joules correct answers A. Synchronized cardioversion at 50 joules
Synchronized cardioversion is reccomended for rhythms with a normal width QRS complex. A pt with
new onset atrial flutter, who is experiencing chest pain, shortness of breath or other symptoms of
instability should be considered for cardioversion. A-flutter requires less energy to cardiovert than other
dysrhythmias
10. In preparing to discharge a pt who has been given a prescription for nitroglycerin tablets 0.4mg SL
PRN, the ED nurse acknowledges that the pt teaching has been effective when the pt states:
A. " I am to take the tablets at least every 2-3 mins when I experience chest pain"
B. " I will call my doctor every time I need to take a tablet for my chest pain"
C. " I should keep the tablets on my window sill in the kitchen so I can find them easily"
D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the hospital" correct
answers D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the hospital"
Nitro should result in vasodilation of the coronary arteries, leading to improved blood flow and a
decrease in the pts chest discomfort. Pts are instructed to seek medical care if their chest pain has not
subsided after taking 2-3 NTG 5 mins apart
11. Which of the following findings would the ED nurse to anticipate in a pt experiencing signs and
symptoms of cardiac tamponade following successful aspiration of fluid from the pericardial sac?:
A. Presence of electrical alternans
B. Increase in the pts heart rate
C. Decrease in the pts BP
D. Increase in the pts BP correct answers D. Increase in the pts BP
Following removal of fluid from the pericardial sac, the pts central venous pressure should decrease,
allowing for increased preload and an increase in the pts blood pressure
12. Initial interventions for a pt diagnosed with acute aortic dissection include 2 large caliber IV's, O2 and
aortic wall pressure control with beta blocker administration. Maintaining which assessment finding is a
priority for determining end organ perfusion?:
A. HR below 60
B. Systolic BP above 120mmHg
C. Normal mental status
D. Urinary output above 30ml/hr correct answers C. Normal mental status
, Determining the pts mental status is an important finding in determining adequate end organ perfusion.
Clinically, the pt must be assessed frequently for hemodynamic compromise, mental status change,
neurologic or peripheral vascular changes and developement or progression of carotid, brachial and
femoral bruits to establish the presence of continued adequate organ perfusion
13. A 5 y/o weighing 33lbs (15kg) presents to the ED in cardiac arrest. The child remains in Ventricular
tachycardia despite having been defibrilated 3 times, having recieved epinephrine 0.15mg IO and
recieved good quality CPR. Which drug should be administered next?:
A. Amiodarone (Cordarone) 75 mg IO
B. Atropine 0.3mg IO
C. Calcium chloride 1.0mL IV
D. Lidocaine (Xylocaine) 50mg IV correct answers A. Amiodarone (Cordarone) 75 mg IO
Amio is the next drug used in a pt with pulseless V-tach. The pt should also recieve good quality CPR, be
re-evaluated every 2 mins and be defibrilated as indicated
14. The ED nurse is caring for a pt with a permanent pacemaker and observes that the pt has a paced
rhythm with an occasional normal beat (pts own intrinsic beat) without the presence of a pacemaker
spike. The ED nurse would interpret this rhythm as:
A. Paced rhythm with capture
B. Paced rhythm with failure to sense
C. Paced rhythm with sensing
D. Malfunctioning pacemaker correct answers C. Paced rhythm with sensing
A pacemaker can have the capability of sensing an intrinsic beat or intrinsic rhythm and cease to fire.
This is a safety feature to prevent a demand pacemaker from firing during a cardiac cycle, possibly
causing a lethal dyshrhythmia
15. A female pt presents to the ED complaining of numb fingers and throbbing pain. The fingertips of
both hands are noted to be light blue in color and pale to the touch. The pt denies both trauma and
recent exposure to the cold. The pt is a 2 pack per day smoker and has a history of hypertension. Based
on the assessment findings, the ED nurse should suspect the pt has which condition?:
A. Raynauds disease
B. Buergers disease
C. Thrombocytopenia
D. Inflammatory arthritis correct answers A. Raynauds disease
Raynauds disease is a blood vessel disease affecting the skin. Symptoms include numbness and pallor to
the fingertips, nose and ears. Light bluish color discoloration can also be present. Smoking, being female
and having hypertension are noted to be predisposing factors
16. Which condition places the pt ar the highest risk for infective endocarditis due to a dental
procedure?:
A. Prosthetic cardiac valve
B. Diabetes
C. Congestive heart failure
D. Rheumatoid arthritis correct answers A. Prosthetic cardiac valve
Answers 2023/2024 APPROVED
1. A pt presents to the ED experiencing an anterior ST segment elevation MI. The pts vital signs are
normal. The hospital is not equipped with a cardaic catheterization lab. The pt can be transferred to a
cardaic catheterization lab within 60 mins. Which of the following would you anticipate for this pt?:
A. A bolus of tissue plasminogen activator, followed by an infusion for fibrinolytic therapy
B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous coronary
intervention
C. A single bolus of tenecteplase (Tnkase) for fibrinolytic therapy
D. A bolus of reteplase (Retavase), followed by a second bolus of reteplase 30 mins later for fibrinolytic
therapy correct answers B. Immediate transfer to the hospital with a cardiac catheterization lab for
percutaneous coronary intervention
In adult pts presenting with a STEMI of a hospital that does not have PCI capability, it is recommended
that the pt be transferred immediately without fibrinolytics to a PCI center, instead of immediate
fibrinolysis at the intial hospital with transfer onlu for ischemia driven PCI
2. An anxious pt arrives by ambulance following an acute onset of difficulty breathing. The pt is
diaphoretic and denies chest pain. High-flow O2 by non-rebreather mask has been applied. Vitals: BP
210/140, HR 130, RR 32, SpO2 88%. In addition to initiating noninvasive ventilation to treat the pts
difficulty breathing, the nurse anticipates the administration of which medication to further treat the pts
symptoms?:
A. Morphine (Morphine sulfate)
B. Furosemide (Lasix)
C. Initation of a continuous nitroglycerin infusion
D. Acetylsalicylic acid (Aspirin) correct answers C. Initation of a continuous nitroglycerin infusion
Pts who present with acute pulmonary edema are typically markedly hypertensive and in acute
respiratory distress. Rapid initiation of appropriate treatment is vital to reversing the neurohormonal
surge and rescuing pts from respiratory and complete cardiac failure. Nitroglycerin is the most important
first line medication in treatment of acute pulmonary edema and respiratory distress. The initation of
continuous NTG infusion at low doses acts as a vasodilator, leading to decreased preload: at higher doses
( >100mcg/min) acts as a potent afterload reducer
3. An unrestrained driver is brought to the ED following a motor vehicle collision. The pt reports hitting
their chest on the steering wheel and is complaining of chest pain across the front of their chest. There
are no vital sign abnormalities and no other complaints of pain. The diagnosis of blunt cardiac injury is
considered. The nurse anticipates an order for which of the following?:
A. EKG
B. Cardiac marker evaluation (CK or Troponin)
C. Cardiac monitoring
D. Chest radiograph correct answers B. Cardiac marker evaluation (CK or Troponin)
Not all trauma pts with blunt cardiac injury will have acute alterations in cardiac markers, and other
organ injury may cause release of creatinine kinase and confound the diagnosis of blunt cardiac injury
,4. Which of the following is a form of distributive shock?:
A. Neurogenic
B. Metabolic
C. Respiratory
D. Obstructive correct answers A. Neurogenic
5. A pt presents following an acute onset of chest pain, dyspnea and severe diaphoresis, with near
syncope. Assessment shows a pt in severe distress, with HR 110, BP 60/40 and RR 36 with bilateral rales.
An EKG reveals ST segment elevation across the precordial leads. A diagnosis of acute MI with
cardiogenic shock is made, and the pt is being prepared for transfer to the cardiac cath lab. The
vasopressor of choice, based on this pts degree of hypotension is:
A. Norepineprhine (Levophed)
B. Dopamine (Inotropin)
C. Dobutamine (Dobutrex)
D. Vasopressin (Pitressin) correct answers A. Norepineprhine (Levophed)
The intial use of norepinephrine for marked hypotension, <70mmHg systolic is the current
recommendation from the AHA
6. A pt presents with complaints of chest pain that radiates to the jaw, stating the pain is a 6/10. Other
symptoms include nausea, dizziness, shortness of breath with clear lung sounds, and a sense of
impending doom. The pain started 40 mins before arrival. Vitals: BP 116/58, HR 98, RR 20, SpO2 94%, T
98.6F. The 12 lead EKG shows inferior wall myocardial injury pattern. Which clinical presentations
indicate the need to complete a right sided 12 lead EKG?:
A. Shortness of breath with clear lung sounds
B. Nausea and dizziness
C. Chest pain with radiation to the jaw
D. Sense of impending doom correct answers A. Shortness of breath with clear lung sounds
Classic right ventricular infarcts are associated with the absence of pulmonary congestion
Think: RIGHT to my foot
7. Following the successful resuscitation of a pt in a cardiac arrest, which of the following findings is the
best indicator high-quality CPR?:
A. A compression depth of 1 1/2 inches
B. Palpable pulses with the preformance of chest compressions during CPR
C. A decrease of skin and mucus membrane cyanosis
D. An increasing end tital Co2 level correct answers D. An increasing end tital Co2 level
An increasing end-tidal carbon dioxide level indicates increasing cellular perfusion with effective CPR or
ROSC
8. During transcutaneous pacing for a pt in third-degree heart block, there is a loss of ventricular
capture. Which is a significant physiological reason for loss of a pacemaker capture?:
A. Metabolic alkalosis
B. Hypomagnesemia
,C. Lactic acidosis
D. Hypokalemia correct answers C. Lactic acidosis
Lactic acidosis alters the contractility of the myocardium, leading to decreased abilty to gain ventricular
capture, this results in lack of tissue perfusion
9. A pt presents with complaints of lightheadedness, weakness and near syncope. The pts 12 lead EKG
reveals the presence of 2:1 arterial flutter. The most appropriate intervention for this presentation with
arterial flutter rhythm is to preform:
A. Synchronized cardioversion at 50 joules
B. Unsynchronized cardioversion at 120 joules
C. Unsynchronized cardioversion at 50 joules
D. Synchronized cardioversion at 120 joules correct answers A. Synchronized cardioversion at 50 joules
Synchronized cardioversion is reccomended for rhythms with a normal width QRS complex. A pt with
new onset atrial flutter, who is experiencing chest pain, shortness of breath or other symptoms of
instability should be considered for cardioversion. A-flutter requires less energy to cardiovert than other
dysrhythmias
10. In preparing to discharge a pt who has been given a prescription for nitroglycerin tablets 0.4mg SL
PRN, the ED nurse acknowledges that the pt teaching has been effective when the pt states:
A. " I am to take the tablets at least every 2-3 mins when I experience chest pain"
B. " I will call my doctor every time I need to take a tablet for my chest pain"
C. " I should keep the tablets on my window sill in the kitchen so I can find them easily"
D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the hospital" correct
answers D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the hospital"
Nitro should result in vasodilation of the coronary arteries, leading to improved blood flow and a
decrease in the pts chest discomfort. Pts are instructed to seek medical care if their chest pain has not
subsided after taking 2-3 NTG 5 mins apart
11. Which of the following findings would the ED nurse to anticipate in a pt experiencing signs and
symptoms of cardiac tamponade following successful aspiration of fluid from the pericardial sac?:
A. Presence of electrical alternans
B. Increase in the pts heart rate
C. Decrease in the pts BP
D. Increase in the pts BP correct answers D. Increase in the pts BP
Following removal of fluid from the pericardial sac, the pts central venous pressure should decrease,
allowing for increased preload and an increase in the pts blood pressure
12. Initial interventions for a pt diagnosed with acute aortic dissection include 2 large caliber IV's, O2 and
aortic wall pressure control with beta blocker administration. Maintaining which assessment finding is a
priority for determining end organ perfusion?:
A. HR below 60
B. Systolic BP above 120mmHg
C. Normal mental status
D. Urinary output above 30ml/hr correct answers C. Normal mental status
, Determining the pts mental status is an important finding in determining adequate end organ perfusion.
Clinically, the pt must be assessed frequently for hemodynamic compromise, mental status change,
neurologic or peripheral vascular changes and developement or progression of carotid, brachial and
femoral bruits to establish the presence of continued adequate organ perfusion
13. A 5 y/o weighing 33lbs (15kg) presents to the ED in cardiac arrest. The child remains in Ventricular
tachycardia despite having been defibrilated 3 times, having recieved epinephrine 0.15mg IO and
recieved good quality CPR. Which drug should be administered next?:
A. Amiodarone (Cordarone) 75 mg IO
B. Atropine 0.3mg IO
C. Calcium chloride 1.0mL IV
D. Lidocaine (Xylocaine) 50mg IV correct answers A. Amiodarone (Cordarone) 75 mg IO
Amio is the next drug used in a pt with pulseless V-tach. The pt should also recieve good quality CPR, be
re-evaluated every 2 mins and be defibrilated as indicated
14. The ED nurse is caring for a pt with a permanent pacemaker and observes that the pt has a paced
rhythm with an occasional normal beat (pts own intrinsic beat) without the presence of a pacemaker
spike. The ED nurse would interpret this rhythm as:
A. Paced rhythm with capture
B. Paced rhythm with failure to sense
C. Paced rhythm with sensing
D. Malfunctioning pacemaker correct answers C. Paced rhythm with sensing
A pacemaker can have the capability of sensing an intrinsic beat or intrinsic rhythm and cease to fire.
This is a safety feature to prevent a demand pacemaker from firing during a cardiac cycle, possibly
causing a lethal dyshrhythmia
15. A female pt presents to the ED complaining of numb fingers and throbbing pain. The fingertips of
both hands are noted to be light blue in color and pale to the touch. The pt denies both trauma and
recent exposure to the cold. The pt is a 2 pack per day smoker and has a history of hypertension. Based
on the assessment findings, the ED nurse should suspect the pt has which condition?:
A. Raynauds disease
B. Buergers disease
C. Thrombocytopenia
D. Inflammatory arthritis correct answers A. Raynauds disease
Raynauds disease is a blood vessel disease affecting the skin. Symptoms include numbness and pallor to
the fingertips, nose and ears. Light bluish color discoloration can also be present. Smoking, being female
and having hypertension are noted to be predisposing factors
16. Which condition places the pt ar the highest risk for infective endocarditis due to a dental
procedure?:
A. Prosthetic cardiac valve
B. Diabetes
C. Congestive heart failure
D. Rheumatoid arthritis correct answers A. Prosthetic cardiac valve
