Certified Emergency Nurse (CEN) Examination — Questions and Answers

Question 1: A COPD patient presents with worsening dyspnea and a PaCO2 of 65 mmHg. What ventilatory support should be initiated first?

Simple face mask at 15 L/min
Immediate intubation
Nasal cannula at 2 L/min only
Non-invasive positive pressure ventilation (NIPPV/BiPAP) (Correct answer)

Correct answer: Non-invasive positive pressure ventilation (NIPPV/BiPAP)

BiPAP is the preferred initial ventilatory support for hypercapnic COPD exacerbations, reducing the need for intubation.

Question 2: Which finding is most indicative of a tension pneumothorax in a trauma patient?

Bilateral crackles and SpO2 88%
Hemoptysis and tachycardia
Subcutaneous emphysema with equal breath sounds
Tracheal deviation away from the affected side with absent breath sounds (Correct answer)

Correct answer: Tracheal deviation away from the affected side with absent breath sounds

Tracheal deviation away from the affected side combined with absent breath sounds on that side is the classic presentation of tension pneumothorax.

Question 3: A patient presents with sudden onset of the 'worst headache of their life.' What condition should be suspected first?

Tension headache
Subarachnoid hemorrhage (Correct answer)
Cluster headache
Migraine with aura

Correct answer: Subarachnoid hemorrhage

Sudden severe 'thunderclap' headache is a classic hallmark of subarachnoid hemorrhage until proven otherwise.

Question 4: What should you do when encountering a difficult question?

Guess immediately without reading
Mark it, move on, and return to it later (Correct answer)
Stare at it until you figure it out
Skip it permanently

Correct answer: Mark it, move on, and return to it later

Mark difficult questions and move on to avoid wasting time. After completing easier questions, return with fresh perspective and remaining time.

Question 5: A patient arrives after ingesting an unknown substance with the following toxidrome: hyperthermia, diaphoresis, tachycardia, hypertension, and agitation. Which substance is LEAST likely responsible?

MDMA (ecstasy)
Heroin (Correct answer)
Methamphetamine
Cocaine

Correct answer: Heroin

Heroin (opioid) causes CNS and respiratory depression, miosis, and bradycardia — the opposite of the sympathomimetic toxidrome described.

Question 6: A patient with ischemic stroke arrives within 2 hours of symptom onset. What is the first-line pharmacological intervention if eligible?

IV alteplase (tPA) (Correct answer)
Aspirin 325 mg
Heparin infusion
Warfarin loading dose

Correct answer: IV alteplase (tPA)

IV alteplase (tPA) is the standard fibrinolytic therapy for eligible ischemic stroke patients within the 3–4.5 hour window.

Question 7: A patient presents with polymorphic ventricular tachycardia and a prolonged QTc interval of 560 ms. What is the first-line treatment?

Magnesium sulfate 1-2 g IV over 15 minutes (Correct answer)
Lidocaine 1.5 mg/kg IV bolus
Synchronized cardioversion at 100 J
Amiodarone 300 mg IV over 10 minutes

Correct answer: Magnesium sulfate 1-2 g IV over 15 minutes

Magnesium sulfate is first-line treatment for Torsades de pointes associated with prolonged QT interval, even if serum magnesium is normal.

Question 8: Which sign indicates impending respiratory arrest in a patient with severe asthma exacerbation?

Silent chest with markedly decreased air movement (Correct answer)
Moderate tachycardia
Mild accessory muscle use
Loud wheezing bilaterally

Correct answer: Silent chest with markedly decreased air movement

A 'silent chest' indicates near-complete airway obstruction with no air movement, a pre-arrest finding requiring immediate intervention.

Question 9: Which of the following is the most important reason to avoid applying carotid massage bilaterally for SVT conversion?

It may dislodge atherosclerotic plaque and cause stroke (Correct answer)
It can precipitate ventricular fibrillation
It causes excessive vagal bradycardia
It is ineffective for SVT conversion

Correct answer: It may dislodge atherosclerotic plaque and cause stroke

Bilateral carotid massage is contraindicated because it can dislodge atherosclerotic plaque from the carotid arteries, causing stroke; it must also be performed one side at a time.

Question 10: A patient with a known history of asthma presents with severe wheezing, accessory muscle use, and SpO2 of 88%. What is the priority intervention?

IV corticosteroids only
Nebulized albuterol and supplemental oxygen (Correct answer)
Intubate immediately
Chest X-ray

Correct answer: Nebulized albuterol and supplemental oxygen

Short-acting beta-2 agonists like albuterol combined with supplemental oxygen are the first-line treatment for acute asthma exacerbations.

Question 11: Which PPE level provides the highest level of protection against unknown chemical agents during hazmat decontamination?

Level A — fully encapsulating suit with SCBA (Correct answer)
Level C — air-purifying respirator with chemical-resistant clothing
Level B — chemical-resistant suit with SCBA
Level D — standard work uniform with gloves

Correct answer: Level A — fully encapsulating suit with SCBA

Level A provides maximum protection with a vapor-tight suit and self-contained breathing apparatus for the highest-risk chemical environments.

Question 12: During surge capacity triage, 'reverse triage' refers to:

Prioritizing the most critically ill patients for all available resources
Assigning the least experienced nurses to the highest-acuity patients
Triaging patients in the order they arrived regardless of acuity
Rapidly discharging stable inpatients to free capacity for incoming casualties (Correct answer)

Correct answer: Rapidly discharging stable inpatients to free capacity for incoming casualties

Reverse triage involves quickly identifying and discharging current stable inpatients to create bed capacity for incoming mass casualty victims.

Question 13: A patient on warfarin presents with supratherapeutic INR of 9.5 and active major bleeding. What is the MOST appropriate treatment?

Administer fresh frozen plasma alone
Hold warfarin and recheck INR in 24 hours
Administer 4-factor prothrombin complex concentrate and vitamin K (Correct answer)
Administer vitamin K 10 mg IV only

Correct answer: Administer 4-factor prothrombin complex concentrate and vitamin K

4-factor PCC provides immediate reversal of warfarin effect for life-threatening bleeding, while IV vitamin K ensures sustained reversal.

Question 14: During assessment of an abdominal aortic aneurysm (AAA), the nurse palpates a pulsatile midline mass. Which associated finding would suggest rupture?

Mild periumbilical tenderness
Hematuria
Intermittent claudication
Sudden severe pain radiating to the back with hypotension (Correct answer)

Correct answer: Sudden severe pain radiating to the back with hypotension

Sudden severe abdominal or back pain with hemodynamic instability in a patient with a known AAA strongly suggests rupture.

Question 15: A patient with a crush injury to the lower extremities develops tea-colored urine. Which complication should the nurse anticipate?

Hepatic failure from systemic fat embolism
Hemorrhagic cystitis from pelvic hematoma
Acute tubular necrosis from myoglobinuria (Correct answer)
Urinary tract infection from catheter placement

Correct answer: Acute tubular necrosis from myoglobinuria

Myoglobin released from crush-injured muscle precipitates in renal tubules, causing acute tubular necrosis; aggressive fluid resuscitation is required.

Question 16: A 35-year-old male presents with fever, chills, and confusion. His blood pressure is 88/50, and he has a rapid heart rate. His laboratory results show a white blood cell count of 16,000/mm³. What is the most likely diagnosis?

Pyelonephritis
Acute pancreatitis
Sepsis (Correct answer)
Meningitis

Correct answer: Sepsis

The patient's presentation with fever, chills, confusion, hypotension (88/50), tachycardia, and an elevated white blood cell count (16,000/mm³) are classic signs of sepsis. Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, often leading to septic shock. The combination of infection signs and organ dysfunction (confusion, hypotension) is highly indicative of sepsis, requiring urgent intervention.

Question 17: Which study approach is most effective for Disaster Preparedness material?

Highlighting all text
Active recall with practice questions (Correct answer)
Passive re-reading of notes
Studying for very long sessions without breaks

Correct answer: Active recall with practice questions

Active recall through practice questions is the most effective study method, as it strengthens memory retrieval pathways.

Question 18: A patient presents with unilateral absence of breath sounds after a central line placement. The nurse should first assess for:

Pulmonary embolism
Hemothorax
Pleural effusion
Pneumothorax (Correct answer)

Correct answer: Pneumothorax

Absent unilateral breath sounds following central line insertion is a classic presentation of iatrogenic pneumothorax.

Question 19: What is the most appropriate head position for a patient with suspected elevated ICP?

Head of bed elevated 30° (Correct answer)
Trendelenburg (head down 15°)
Right lateral decubitus
Supine with head flat

Correct answer: Head of bed elevated 30°

Elevating the head of bed to 30° promotes venous drainage from the cranium, helping to reduce ICP.

Question 20: A patient with hemoptysis, night sweats, and weight loss from a country with high TB prevalence. What is the priority infection control measure?

Airborne isolation in a negative-pressure room (Correct answer)
Droplet precautions with surgical mask
Standard precautions only
Contact precautions only

Correct answer: Airborne isolation in a negative-pressure room

Suspected pulmonary tuberculosis requires airborne precautions in a negative-pressure room to prevent spread of aerosolized mycobacteria.

Question 21: A patient is found unconscious with needle track marks and has pinpoint pupils and respiratory rate of 6 breaths/min. The INITIAL nursing priority is:

Establish IV access and draw toxicology labs
Obtain a 12-lead ECG
Administer naloxone 2 mg IV immediately
Open the airway and support ventilation (Correct answer)

Correct answer: Open the airway and support ventilation

Airway management and ventilatory support take priority over antidote administration in opioid toxicity with respiratory depression.

Question 22: A patient arrives with a gunshot wound to the abdomen and is showing signs of shock. Which of the following assessments is most important for prioritizing immediate interventions?

Perform a full head-to-toe trauma assessment
Check for signs of spinal injury
Assess the Glasgow Coma Scale (GCS)
Establish two large-bore IV access for fluid resuscitation (Correct answer)

Correct answer: Establish two large-bore IV access for fluid resuscitation

A patient with a gunshot wound to the abdomen showing signs of shock (e.g., hypotension, tachycardia) is likely experiencing significant internal hemorrhage. Rapid fluid resuscitation is critical to restore circulating volume and maintain organ perfusion. Establishing two large-bore IVs allows for quick and efficient administration of fluids or blood products, which is a life-saving priority in managing hemorrhagic shock.

Question 23: A patient post-seizure is confused and lethargic. What is this period called?

Focal onset seizure
Postictal state (Correct answer)
Absence episode
Todd's paralysis

Correct answer: Postictal state

The postictal state is a transient period of confusion and fatigue that follows a seizure as the brain recovers.

Question 24: A patient presents with unequal pupils after head trauma. The left pupil is 6mm and non-reactive; the right is 3mm and reactive. What does this finding suggest?

Opioid toxicity
Pontine hemorrhage
Ipsilateral uncal herniation on the left side (Correct answer)
Bilateral brainstem herniation

Correct answer: Ipsilateral uncal herniation on the left side

A unilaterally dilated, non-reactive pupil after head trauma indicates uncal herniation with compression of cranial nerve III on the same side.

Question 25: What is the relationship between theory and practice in Toxicology?

They are completely separate
Theory provides the foundation; practice applies it to real situations (Correct answer)
Theory is unnecessary
Practice is unnecessary if you know theory

Correct answer: Theory provides the foundation; practice applies it to real situations

Theory provides the conceptual foundation and principles, while practice involves applying those concepts to real-world situations. Both are essential for competence.

Question 26: Which statement about activated charcoal is CORRECT?

It is effective for all toxic ingestions including metals and alcohols
It should be given within 1 hour of ingestion for maximum benefit (Correct answer)
It is contraindicated in acetaminophen overdose
It is the treatment of choice for caustic ingestions

Correct answer: It should be given within 1 hour of ingestion for maximum benefit

Activated charcoal is most effective when given within 1 hour of ingestion before significant absorption occurs.

Question 27: Which study approach is most effective for Toxicology material?

Active recall with practice questions (Correct answer)
Studying for very long sessions without breaks
Highlighting all text
Passive re-reading of notes

Correct answer: Active recall with practice questions

Active recall through practice questions is the most effective study method, as it strengthens memory retrieval pathways.

Question 28: When should you change an answer on a test?

Change every answer you doubt
Always change your first answer
Only when you have a clear reason the new answer is better (Correct answer)
Never change answers

Correct answer: Only when you have a clear reason the new answer is better

Research shows changing answers is beneficial only when you have a specific reason, such as recalling new information or catching a misread question.

Question 29: Under mandatory reporting laws, which situation requires an emergency nurse to report to authorities without the patient's consent?

A patient with a mental health condition expressing abstract fears
A patient refusing discharge against medical advice
An adult patient requesting privacy about their diagnosis
A child presenting with injuries suspicious for non-accidental trauma (Correct answer)

Correct answer: A child presenting with injuries suspicious for non-accidental trauma

Suspected child abuse is a mandatory reporting situation in all US states; nurses are legally required to report to child protective services regardless of patient or family consent.

Question 30: When assessing a trauma patient using the primary survey, which action is performed FIRST?

Control hemorrhage
Establish airway with C-spine precautions (Correct answer)
Expose and examine the patient
Assess circulation

Correct answer: Establish airway with C-spine precautions

The primary survey follows the ABCDE sequence, starting with airway management while maintaining cervical spine protection.

Question 31: Which ECG finding is most consistent with right ventricular infarction complicating an inferior STEMI?

ST depression in leads I and aVL
ST elevation in right-sided lead V4R (Correct answer)
ST elevation in V1-V4
New left bundle branch block

Correct answer: ST elevation in right-sided lead V4R

ST elevation in right-sided lead V4R is the most sensitive and specific indicator of right ventricular infarction.

Certified Emergency Nurse (CEN) Examination

The CEN exam, administered by the Board of Certification for Emergency Nursing (BCEN), validates specialized knowledge and clinical skills across 10 emergency nursing domains including cardiovascular, respiratory, neurological, and other emergency care competencies.

175

Questions

180 min

Time Limit

71%

To Pass

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