CEN Certified Emergency Nurse - Rapid
Review 2026 - Complete Study Guide
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✔ Cardiovascular Emergencies ✔ Orthopedic & Wound Emergencies
✔ Respiratory Emergencies ✔ OB/GYN Emergencies
✔ Neurological Emergencies ✔ Psychosocial & Environmental
✔ GI & GU Emergencies ✔ Shock & Professional Issues
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CEN Certified Emergency Nurse — Rapid Review 2026 — 2026/2027 | Passing Score: 75% | Page 1 of 38
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Cardiovascular Emergencies Respiratory Emergencies Neurological Emergencies
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Psychosocial & Environmental Shock & Professional Issues
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CEN Certified Emergency Nurse — Rapid Review 2026 — 2026/2027 | Passing Score: 75% | Page 3 of 38
, SECTION 1 | Cardiovascular Emergencies | Q1-Q7 | CEN Certified Emergency Nurse - Rapid Review 2026 2026/2027
Q1 Question 1 of 50
A 62-year-old male presents to the emergency department with sudden-onset tearing chest pain
radiating to his back between the shoulder blades. His blood pressure is 180/110 mmHg in the right
arm and 140/85 mmHg in the left arm. A widened mediastinum is noted on chest X-ray. The nurse
anticipates which immediate intervention as the highest priority?
A. Initiate intravenous beta-blocker therapy to reduce the rate of rise in aortic pressure before
administering vasodilators
B. Obtain an immediate CT angiogram of the chest to confirm the diagnosis before initiating any treatment
C. Administer thrombolytic therapy given the high suspicion for acute myocardial infarction
D. Prepare the patient for immediate cardiac catheterization and possible stent placement
Correct Answer: A
Rationale:
This patient presents with classic signs of an acute aortic dissection, including tearing chest pain, blood
pressure differential between arms, and widened mediastinum. The priority is reducing shear force on
the aortic wall by first lowering heart rate with beta-blockers, then reducing blood pressure with
vasodilators. Thrombolytics are contraindicated in dissection and would worsen the condition, and
cardiac catheterization is for coronary artery disease, not dissection.
Q2 Question 2 of 50
A 55-year-old woman arrives in the ED complaining of substernal chest pressure that began 30
minutes ago while resting. Her ECG shows ST-segment elevation in leads II, III, and aVF. The
emergency nurse recognizes this pattern indicates an acute myocardial infarction in which area of
the heart?
A. Anterior wall, requiring immediate monitoring for left ventricular dysfunction and cardiogenic shock
B. Inferior wall, which is often associated with right ventricular involvement and may present with
hypotension
C. Lateral wall, typically caused by occlusion of the left circumflex coronary artery
D. Posterior wall, which is frequently missed on standard 12-lead ECG and requires additional leads
Correct Answer: B
Rationale:
ST elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, commonly caused by
right coronary artery occlusion. Inferior MI is frequently associated with right ventricular involvement, and
these patients may become hypotensive when administered nitrates. Anterior wall MI shows ST
elevation in V1-V4, lateral wall in I and aVL, and posterior wall requires posterior leads V7-V9 for
confirmation.
CEN Certified Emergency Nurse — Rapid Review 2026 — 2026/2027 | Passing Score: 75% | Page 4 of 38