CEN Certified Emergency Nurse 2 — Questions and Answers
Question 1: A patient presents with chest pain radiating to the left arm, diaphoresis, and nausea. The 12-lead ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Right coronary artery (Correct answer)
- Left circumflex artery
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior STEMI, most commonly caused by right coronary artery occlusion.
Question 2: A 3-year-old is brought in after ingesting an unknown substance. The child has pinpoint pupils, bradycardia, excessive secretions, and bronchospasm. Which antidote is most appropriate?
- Naloxone
- Flumazenil
- Atropine (Correct answer)
- N-acetylcysteine
Correct answer: Atropine
The SLUDGE/DUMBELS toxidrome indicates organophosphate or cholinergic poisoning, treated with atropine to block muscarinic effects.
Question 3: A patient with a known history of COPD is in respiratory distress. SpO2 is 84%. Which oxygen delivery target is most appropriate for this patient?
- SpO2 100% via non-rebreather mask
- SpO2 88-92% via controlled oxygen delivery (Correct answer)
- SpO2 95-98% via simple face mask
- SpO2 >99% via mechanical ventilation
Correct answer: SpO2 88-92% via controlled oxygen delivery
COPD patients may rely on hypoxic drive; targeting SpO2 88-92% prevents CO2 retention while maintaining adequate oxygenation.
Question 4: During a rapid sequence intubation, succinylcholine is contraindicated in which of the following patients?
- Patient with a full stomach
- Patient with a crush injury 72 hours prior (Correct answer)
- Patient with hypertension
- Patient with a suspected cervical spine injury
Correct answer: Patient with a crush injury 72 hours prior
Succinylcholine is contraindicated in crush injuries (>24-48 hours), burns, and denervation injuries due to risk of life-threatening hyperkalemia from upregulated acetylcholine receptors.
Question 5: A patient presents with sudden severe headache described as 'the worst headache of my life,' neck stiffness, and photophobia. The CT scan is negative. What is the next priority intervention?
- Administer IV analgesics and discharge
- Perform lumbar puncture to assess for xanthochromia (Correct answer)
- Obtain an MRI of the brain
- Administer empiric antibiotics only
Correct answer: Perform lumbar puncture to assess for xanthochromia
A thunderclap headache with a negative CT warrants lumbar puncture to detect xanthochromia, indicating subarachnoid hemorrhage.
Question 6: A patient is brought in post-lightning strike and is pulseless. Which finding is unique to lightning injury compared to other cardiac arrest etiologies?
- V-fib is the most common arrest rhythm
- Asystole is the most common arrest rhythm (Correct answer)
- PEA is the most common arrest rhythm
- Torsades de pointes is the most common arrest rhythm
Correct answer: Asystole is the most common arrest rhythm
Unlike most cardiac arrests, lightning strike most commonly causes asystole due to massive depolarization of cardiac cells.
Question 7: A patient with suspected cardiac tamponade has Beck's triad. Which finding is NOT part of Beck's triad?
- Hypotension
- Muffled heart sounds
- Jugular venous distension
- Tracheal deviation (Correct answer)
Correct answer: Tracheal deviation
Beck's triad consists of hypotension, muffled heart sounds, and JVD; tracheal deviation is associated with tension pneumothorax.
CEN Certified Emergency Nurse 2
A patient presents with chest pain radiating to the left arm, diaphoresis, and nausea.
The 12-lead ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?