CEN Certified Emergency Nurse 5 — Questions and Answers
Question 1: A patient arrives after a high-voltage electrical injury. Beyond cardiac monitoring, what other system requires priority assessment?
- Integumentary system only
- Musculoskeletal and renal systems for rhabdomyolysis (Correct answer)
- Neurological system for peripheral neuropathy only
- Gastrointestinal system for bowel perforation
Correct answer: Musculoskeletal and renal systems for rhabdomyolysis
High-voltage injuries cause massive muscle destruction (rhabdomyolysis), releasing myoglobin that can cause acute renal failure; aggressive IV fluids and urine output monitoring are essential.
Question 2: A 6-week-old infant presents with projectile, non-bilious vomiting after every feeding and a palpable olive-shaped mass in the epigastrium. This is most consistent with:
- Intussusception
- Pyloric stenosis (Correct answer)
- Hirschsprung's disease
- Malrotation with volvulus
Correct answer: Pyloric stenosis
Projectile non-bilious vomiting with an olive-shaped epigastric mass in a 4-8 week old infant is the classic presentation of hypertrophic pyloric stenosis.
Question 3: A patient on heparin infusion develops a sudden drop in platelet count from 280,000 to 80,000 on day 7. The nurse suspects heparin-induced thrombocytopenia (HIT). What is the priority action?
- Switch to low-molecular-weight heparin
- Discontinue heparin and begin an alternative anticoagulant (Correct answer)
- Administer a platelet transfusion
- Continue heparin and monitor platelet count daily
Correct answer: Discontinue heparin and begin an alternative anticoagulant
HIT is a prothrombotic condition; all heparin must be immediately discontinued and a direct thrombin inhibitor (e.g., argatroban) started to prevent thrombosis.
Question 4: A patient presents with chest pain and a widened mediastinum on CXR. BP in the right arm is 160/90 and in the left arm is 90/60. The nurse suspects aortic dissection. Which action is contraindicated?
- Administer IV labetalol for rate and pressure control
- Administer IV morphine for pain
- Administer thrombolytics (Correct answer)
- Obtain emergent CT angiography of the chest
Correct answer: Administer thrombolytics
Thrombolytics are absolutely contraindicated in aortic dissection as they would worsen hemorrhage and increase mortality.
Question 5: A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, blood glucose of 520 mg/dL, and a serum potassium of 3.8 mEq/L. When should insulin be initiated in DKA management?
- Immediately upon diagnosis
- Only after potassium is greater than 3.5 mEq/L and IV fluids are running (Correct answer)
- After sodium bicarbonate administration
- Only after blood glucose drops below 300 mg/dL
Correct answer: Only after potassium is greater than 3.5 mEq/L and IV fluids are running
Insulin drives potassium into cells; it must not be given until potassium is ≥3.5 mEq/L and IV fluid resuscitation is underway to prevent life-threatening hypokalemia.
Question 6: Which of the following is the most reliable early indicator of inadequate perfusion in a trauma patient?
- Decreased urine output
- Falling blood pressure
- Rising serum lactate (Correct answer)
- Altered mental status
Correct answer: Rising serum lactate
Elevated serum lactate reflects anaerobic metabolism and tissue hypoperfusion, often rising before overt hemodynamic changes become apparent.
Question 7: A patient presents with priapism following recreational drug use. Which drug class is most commonly associated with this condition?
- Opioids
- Cocaine and other stimulants (Correct answer)
- Benzodiazepines
- Cannabis
Correct answer: Cocaine and other stimulants
Cocaine and other stimulants cause priapism through alpha-adrenergic mechanisms that disrupt normal penile blood flow regulation.
CEN Certified Emergency Nurse 5
A patient arrives after a high-voltage electrical injury.
Beyond cardiac monitoring, what other system requires priority assessment?