CEN Certified Emergency Nurse 5

Question 1

A patient arrives after a high-voltage electrical injury. Beyond cardiac monitoring, what other system requires priority assessment?

Accepted Answer

Musculoskeletal and renal systems for rhabdomyolysis

Answer

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:

Accepted Answer

Pyloric stenosis

Answer

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?

Accepted Answer

Discontinue heparin and begin an alternative anticoagulant

Answer

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?

Accepted Answer

Administer thrombolytics

Answer

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?

Accepted Answer

Only after potassium is greater than 3.5 mEq/L and IV fluids are running

Answer

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.

CEN - Certified Emergency Nurse Practice Test

CEN - Certified Emergency Nurse Practice Test

CEN Certified Emergency Nurse 5