CEN Certified Emergency Nurse MCQ 2 — Questions and Answers
Question 1: A patient presents with ST-elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending
- Right coronary artery (Correct answer)
- Left circumflex
- 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 (RCA) occlusion.
Question 2: Which finding on a 12-lead ECG most urgently requires immediate defibrillation?
- Atrial fibrillation with rapid ventricular response
- Ventricular fibrillation (Correct answer)
- Third-degree heart block
- Torsades de pointes with stable pulse
Correct answer: Ventricular fibrillation
Ventricular fibrillation produces no effective cardiac output and requires immediate unsynchronized defibrillation.
Question 3: A child presents with inspiratory stridor, a barking cough, and low-grade fever. What is the priority intervention?
- Administer nebulized racemic epinephrine immediately
- Place the child supine for airway assessment
- Administer dexamethasone and allow the child to remain with caregiver (Correct answer)
- Perform nasopharyngeal suctioning
Correct answer: Administer dexamethasone and allow the child to remain with caregiver
Croup is managed with corticosteroids (dexamethasone) and keeping the child calm; separating the child from the caregiver increases agitation and worsens stridor.
Question 4: Which lab value is most indicative of rhabdomyolysis requiring aggressive IV fluid resuscitation?
- Elevated troponin
- Elevated creatine kinase (CK) (Correct answer)
- Elevated BNP
- Elevated D-dimer
Correct answer: Elevated creatine kinase (CK)
Markedly elevated CK indicates extensive muscle breakdown characteristic of rhabdomyolysis, and IV fluids protect the kidneys from myoglobin-induced injury.
Question 5: A patient in anaphylaxis has received epinephrine 1:1,000 IM but symptoms persist. What is the next priority action?
- Administer diphenhydramine 50 mg IV
- Repeat epinephrine 1:1,000 IM in 5–15 minutes (Correct answer)
- Administer methylprednisolone 125 mg IV
- Place the patient in Trendelenburg position
Correct answer: Repeat epinephrine 1:1,000 IM in 5–15 minutes
A second dose of epinephrine IM can be given 5–15 minutes after the first if the patient does not improve, as epinephrine is the first-line treatment for anaphylaxis.
Question 6: Which assessment finding in a burn patient indicates the need for immediate endotracheal intubation?
- Burns covering 30% TBSA on the extremities
- Singed nasal hairs with hoarse voice and stridor (Correct answer)
- Carbon monoxide level of 15%
- Full-thickness burn to the right hand
Correct answer: Singed nasal hairs with hoarse voice and stridor
Singed nasal hairs, hoarseness, and stridor signal impending upper airway obstruction from inhalation injury requiring immediate intubation before edema worsens.
Question 7: When calculating the Parkland formula for burn resuscitation, what fluid is used in the first 24 hours?
- 5% dextrose in water (D5W)
- Lactated Ringer's solution (Correct answer)
- Normal saline with albumin
- Hypertonic saline 3%
Correct answer: Lactated Ringer's solution
The Parkland formula calls for 4 mL/kg/% TBSA burned of Lactated Ringer's solution over 24 hours.
CEN Certified Emergency Nurse MCQ 2
A patient presents with ST-elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?