CEN Certified Emergency Nurse 4 — Questions and Answers
Question 1: A patient with suspected C5 spinal cord injury is hypotensive with bradycardia and warm, flushed skin. This hemodynamic picture is most consistent with:
- Hypovolemic shock
- Neurogenic shock (Correct answer)
- Septic shock
- Obstructive shock
Correct answer: Neurogenic shock
Loss of sympathetic tone in neurogenic shock causes vasodilation (warm skin) and bradycardia, distinguishing it from other shock types.
Question 2: A patient with a suspected overdose has a QRS duration of 140 ms on ECG, hypotension, and altered mental status. Which drug class is most likely responsible?
- Opioids
- Benzodiazepines
- Tricyclic antidepressants (Correct answer)
- Selective serotonin reuptake inhibitors
Correct answer: Tricyclic antidepressants
Tricyclic antidepressants cause sodium channel blockade, widening the QRS complex and producing the classic toxidrome of hypotension, dysrhythmia, and CNS depression.
Question 3: A patient presents with painless monocular vision loss described as a 'curtain coming down.' This symptom is most suggestive of:
- Central retinal artery occlusion
- Retinal detachment (Correct answer)
- Acute angle-closure glaucoma
- Optic neuritis
Correct answer: Retinal detachment
A 'curtain coming down' or 'veil' over vision is the classic description of retinal detachment due to progressive separation of the retina.
Question 4: During a mass casualty incident, a patient is found apneic. After repositioning the airway, the patient remains apneic. Under START triage, this patient is classified as:
- Immediate (Red)
- Delayed (Yellow)
- Minor (Green)
- Expectant (Black) (Correct answer)
Correct answer: Expectant (Black)
Under START triage, a patient who is apneic after airway repositioning is classified as Expectant (Black), indicating survival is unlikely with available resources.
Question 5: A patient presents with fever, hypotension, altered mental status, and a petechial rash spreading rapidly over the trunk. The nurse suspects:
- Rocky Mountain spotted fever
- Meningococcal septicemia (Correct answer)
- Immune thrombocytopenic purpura
- Allergic vasculitis
Correct answer: Meningococcal septicemia
Rapidly spreading petechiae with fever, hypotension, and altered mental status is the hallmark presentation of meningococcal septicemia, a life-threatening emergency.
Question 6: Which intervention is the HIGHEST priority for a patient presenting with status epilepticus lasting more than 5 minutes?
- Obtain a head CT
- Administer IV benzodiazepine immediately (Correct answer)
- Start a phenytoin infusion
- Draw blood cultures before starting antibiotics
Correct answer: Administer IV benzodiazepine immediately
Benzodiazepines (lorazepam or diazepam) are the first-line treatment for status epilepticus, given as soon as possible to terminate the seizure.
Question 7: A patient with a history of warfarin use presents with a traumatic intracerebral hemorrhage. Which reversal agent is most appropriate?
- Vitamin K alone
- Fresh frozen plasma alone
- 4-factor prothrombin complex concentrate (PCC) (Correct answer)
- Protamine sulfate
Correct answer: 4-factor prothrombin complex concentrate (PCC)
4-factor PCC provides the fastest and most complete reversal of warfarin anticoagulation in life-threatening hemorrhage compared to FFP or vitamin K alone.
CEN Certified Emergency Nurse 4
A patient with suspected C5 spinal cord injury is hypotensive with bradycardia and warm, flushed skin.
This hemodynamic picture is most consistent with: