CEN Certified Emergency Nurse 3 — Questions and Answers
Question 1: A 28-year-old female presents with right lower quadrant pain, vaginal spotting, and a positive pregnancy test. Her BP is 80/50 and HR is 128. What is the priority intervention?
- Obtain a pelvic ultrasound before any treatment
- Administer methotrexate immediately
- Establish large-bore IV access and prepare for emergency surgery (Correct answer)
- Perform a pelvic exam and discharge with OB follow-up
Correct answer: Establish large-bore IV access and prepare for emergency surgery
This presentation is consistent with a ruptured ectopic pregnancy causing hemorrhagic shock; immediate IV access, fluid resuscitation, and surgical preparation are priorities.
Question 2: Which Glasgow Coma Scale (GCS) score indicates the need for definitive airway management?
- GCS 12
- GCS 10
- GCS 8 or less (Correct answer)
- GCS 6 or less
Correct answer: GCS 8 or less
A GCS of 8 or less indicates severe brain injury with inability to protect the airway, requiring endotracheal intubation.
Question 3: A patient with sickle cell disease presents with fever of 38.9°C, chest pain, and a new pulmonary infiltrate on CXR. This presentation is most consistent with:
- Vaso-occlusive crisis
- Acute chest syndrome (Correct answer)
- Pulmonary embolism
- Spontaneous pneumothorax
Correct answer: Acute chest syndrome
Acute chest syndrome is defined by a new pulmonary infiltrate with fever, chest pain, or respiratory symptoms in a sickle cell patient.
Question 4: A nurse is caring for a patient receiving tPA for acute ischemic stroke. The patient suddenly develops severe headache and BP rises to 185/105. What is the priority action?
- Increase the tPA infusion rate
- Stop the tPA infusion and notify the physician immediately (Correct answer)
- Administer a bolus of normal saline
- Continue monitoring and reassess in 30 minutes
Correct answer: Stop the tPA infusion and notify the physician immediately
Sudden severe headache and hypertension during tPA therapy are signs of hemorrhagic transformation; the infusion must be stopped immediately.
Question 5: Which finding in a pediatric patient is the EARLIEST indicator of decompensated shock?
- Hypotension
- Altered mental status
- Tachycardia (Correct answer)
- Mottled skin
Correct answer: Tachycardia
Children compensate effectively for shock; tachycardia is the earliest sign, while hypotension is a late and ominous finding.
Question 6: A patient is ordered IV potassium chloride 40 mEq to be given peripherally. What is the maximum infusion rate for peripheral IV potassium administration?
- 40 mEq/hr
- 20 mEq/hr
- 10 mEq/hr (Correct answer)
- 5 mEq/hr
Correct answer: 10 mEq/hr
Peripheral potassium infusion should not exceed 10 mEq/hr to prevent phlebitis, pain, and cardiac dysrhythmias.
Question 7: A patient presents with muscle weakness, peaked T-waves on ECG, and a serum potassium of 6.8 mEq/L. Which intervention is the FIRST priority to protect the heart?
- Administer sodium polystyrene sulfonate (Kayexalate)
- Administer IV calcium gluconate (Correct answer)
- Administer IV regular insulin with dextrose
- Initiate hemodialysis
Correct answer: Administer IV calcium gluconate
Calcium gluconate is given first to stabilize the cardiac membrane and protect against fatal dysrhythmias before potassium-lowering measures.
CEN Certified Emergency Nurse 3
A 28-year-old female presents with right lower quadrant pain, vaginal spotting, and a positive pregnancy test.
Her BP is 80/50 and HR is 128.
What is the priority intervention?