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CEN Online Review Practice Post-test Already passed
Latest updated 2025 Expert Verified
CEN - Certified Emergency Nurse Specialization - Board
of Certification for Emergency Nursing (BCEN
CERTIFIED)
All questions with Answers and Rationales
- A male patient arrives following a motor vehicle collision. Emergency medical services report vital signs: HR 92 beats/min, RR 20 breaths/min, BP 128/74 mm Hg, SpO2 96% with a nonrebreather at 15 L/min. They state that the airbag malfunctioned and he hit the steering wheel. The nurse assesses the patient and finds bruising to the sternum, muffled heart tones, and the following vital signs: HR 102 beats/min, RR 18 breaths/min, BP 122/94 mm Hg, SpO2 92%. What pathophysiologic process does the nurse recognize? Low pulse pressure Decrease in afterload High pulse pressure Cushing triad Correct: The mechanism and clinical manifestations are indications of a probable pericardial tamponade. The other sign associated with pericardial tamponade is a low or narrowing pulse pressure. As the pericardium fills with blood, the heart loses its ability to pump.
- A patient presents with vaginal bleeding and cramping. She tells the emergency nurse, "I passed clots at home. I think I lost my baby." Pelvic examination reveals that the cervical os is open. Which type of spontaneous abortion most likely occurred? Missed abortion Septic abortion Inevitable abortion Threatened abortion Correct: An inevitable abortion occurs when the cervical os has opened and membranes have ruptured. The patient experiences vaginal bleeding and lower abdominal cramping.
- After exposure in a house fire, the patient presents to the emergency department with dyspnea and hoarse vocalization. Which condition does the nurse suspect? Angioedema Pneumonia Asthma exacerbation Respiratory distress syndrome
Correct: Thermal injuries, as in an exposure to a house fire, can cause an upper airway inhalation injury. The patient exhibits angioedema, the sudden development of swelling deep in the submucosal or subcutaneous tissue - the larynx and oropharynx in this case. Hoarse vocalization is an indication of vocal cord involvement and potential obstruction. Timely intubation is indicated for this condition.
- Which of the following clinical presentations is most consistent with a patient who has pancreatitis? Pain with palpation of the right subcostal area during inspiration Diffuse cramping abdominal pain Epigastric pain that radiates to the back Dull, constant umbilical pain Correct: Pancreatitis pain is located in the epigastrium and is described as dull and steady. Because of the pancreas' retroperitoneal location, pain may radiate through the abdomen to the back.
- The disease most commonly associated with the catarrhal, paroxysmal and convalescent stages is best treated with classification of medications? Immune globulin Steroids Antiretroviral therapy Macrolide antibiotics Correct: The disease most commonly associated with the catarrhal, paroxysmal and convalescent stages is pertussis. Pertussis is best treated with macrolide antibiotics.
- A patient presents to the ED stating he had been hit in the right eye with a glass bottle two days ago. On assessment, the eye is reddened, tearing, and there is an irregular pupil. Which ocular emergency is associated with these assessment findings? Retinal detachment Hyphema Foreign body Iritis Incorrect, The answer is Iritis: Foreign bodies in the eye are generally superficial and the patient will state that they feel something in the eye. Clinical manifestations include excessive pain, tearing, and photophobia. Iritis is inflammation of the middle portion of the eye. Clinical manifestations include pain, blurred vision, photophobia, redness around the outer ring of the iris, and an irregular pupil.
- Which eye condition requires bilateral patching of the eyes? Hyphema Ruptured globe Corneal ulcer Keratitis Correct: Interventions for a ruptured globe include patching both eyes to limit movement.
- Distributive shock is best characterized by which of the following patient presentations? Following a motor vehicle collision, a 20-year-old female has decreased sensation below the nipple line. Vital signs are BP 80/50 mm Hg, HR 54 beats/min, RR 10 breaths/min, T 36.7 C (98.2 F), SpO2 93% on 15 L/min via nonrebreather mask. Following a motor vehicle collision, a 45 - year-old male suffered massive blood loss from a partially amputated leg. Vital signs are BP 90/48 mm Hg, HR 120 beats/min, RR 24 breaths/min, T 36.7 C (98.2 F), SpO2 96% without supplemental oxygen. A 36 - year-old female with fatigue for two days presents with the following vital signs BP 89/45 mm Hg, HR 190 beats/min, RR 26 breaths/min, T 36. C (98.2 F), SpO2 88% with 15 L/min via nonrebreather mask.
A 20 - year-old male with sudden onset of shortness of breath. His vital signs are BP 104/70 mm Hg, HR 96 beats/min, RR 22 breaths/min, T 36.7 C (98.2 F), and SpO2 97% with supplemental oxygen. Incorrect, The answer is Following a motor vehicle collision, a 20-year-old female has decreased sensation below the nipple line. Vital signs are BP 80/50 mm Hg, HR 54 beats/min, RR 10 breaths/min, T 36.7 C (98.2 F), SpO2 93% on 15 L/min via nonrebreather mask.: Types of distributive shock are neurogenic, anaphylactic, and septic. Neurogenic shock is caused by high thoracic or cervical spinal cord injury and characterized by bradycardia, bradypnea, and hypotension due to the loss of the effects of the sympathetic nervous system, leaving the parasympathetic nervous system unopposed. A patient presenting with fatigue for two day, with extreme tachycardia, tachypnea, normal temperature, but hypotensive, does not exhibit the abnormal temperature associated with septic shock, the bradycardia associated with neurogenic shock, and her history is more consistent with cardiogenic shock attributed to prolonged SVT.
- Bilevel positive airway pressure (BiPAP) can be an ideal therapy to use on a respiratory failure patient with which associated assessment finding? Absent gag reflex Nasal deformity Distended neck veins Excessive oral secretions
Correct: Crackles and distended neck veins are symptoms of cardiogenic pulmonary edema. Bilevel positive airway pressure (BiPAP) ventilation is an effective treatment modality for patients with respiratory failure related to chronic pulmonary disease, asthma, and cardiogenic pulmonary edema.
- The nurse is reviewing laboratory results in a patient who presents with hyperglycemia. Which of the following statements about the difference between diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome is true? The patient with hyperosmolar hyperglycemic syndrome presents with a more significant acidosis than the patient with diabetic ketoacidosis The patient with diabetic ketoacidosis presents with ketones in the urine and the patient with hyperosmolar hyperglycemic syndrome does not The patient with diabetic ketoacidosis presents with a higher blood glucose level than the patient with hyperosmolar hyperglycemic syndrome Diabetic ketoacidosis (DKA) is a more common presentation in patients with type 1 diabetes mellitus, while hyperosmolar hyperglycemic syndrome (HHS) is more common in patients with type 2 diabetes mellitus. Correct: Diabetic ketoacidosis (DKA) is a more common presentation in patients with type 1 diabetes mellitus, while hyperosmolar hyperglycemic syndrome (HHS) is more common in patients with type 2 diabetes mellitus. The hallmark of DKA is the presence of ketones in the urine and the development of
acidosis. Neither of these clinical manifestations occur in HHS. In DKA, the hyperglycemia is usually not as high as it is in HHS, which frequently presents with blood glucose levels greater than 600 mg/dL.
- Caregivers bring their 2-year-old son to the ED with suspected foreign body ingestion. He was found playing with a box of buttons. Vital signs are BP 92/54 mm Hg, HR 134 beats/min, RR 24 breaths/min, T 37.0 C (98.6 F), SpO2 99% without supplemental oxygen. There are no retractions or increased work of breathing, but he does cough with inspiration. He is able to talk. His breath sounds are diminished, with expiratory wheezing on the right. The left breath sounds are clear. Which intervention will the nurse prepare for? Endoscopic removal The Heimlich maneuver Manual removal Direct laryngoscopy with forceps Correct: Endoscopic removal or bronchoscopy is indicated for bronchial obstructions. These foreign objects are too far down for the Heimlich or direct visualization. With no increased work of breathing and adequate oxygenation, the obstruction is partial. With unilateral wheezing and diminished breath sounds on the affected side, the object is likely in the right mainstem bronchus.
- A patient presents to the ED with complaints of right arm weakness, and difficulty speaking. The symptoms started about 40 minutes ago and are now improving. She said this happened yesterday too, but went away. What is she experiencing? Hemorrhagic stroke Ischemic stroke Bell's palsy Transient ischemic attacks Correct: Transient ischemic attacks are characterized by neurologic dysfunction, similar to a stroke that is self-limiting in duration. They are not benign and may precede a stroke.
- An older adult patient arrives in the emergency department after she fell on her bathroom floor and was unable to get up. Knowing the patient was on the floor for a prolonged period of time, what clinical manifestation will the emergency nurse assess for? Blood in the urine
Dysuria Dark brown urine Anuria Correct: Prolonged immobilization is a common cause of rhabdomyolysis. The characteristic sign of rhabdomyolysis is dark brown urine.
- A 42-year-old female patient presents to the emergency department with complaints of having right upper quadrant cramping pain that radiates to the right scapula and shoulder areas. She also complains of being "bloated and passing gas." With her history, which gastrointestinal disorder is she at risk for? Cholecystitis Hepatitis Pancreatitis Diverticulitis Correct: Presenting signs for cholecystitis include right upper quadrant pain that radiates to the right scapula or shoulder, guarding or rigidity of the abdomen on palpation, bloating, fever, chills, jaundice or dark urine.
- A patient presents with a positive purified protein derivative (PPD) test that was administered 2 days ago. She has no other symptoms. Which isolation precautions will the nurse initiate? Contact Standard Airborne Droplet
Correct: Asymptomatic tuberculosis (TB) or latent TB is not contagious and therefore only requires standard precautions.
- A 28-year-old female presents with shortness of breath, dizziness, and diaphoresis. Her vital signs are BP 118/74 mm Hg, HR 122 beats/min, RR 26 breaths/min, T 37.7 C (99.9 F), SpO2 92% without supplemental oxygen. Her health history includes fractures of the left tibia and fibula following an MVC 3 weeks ago. Surgical fixation was required. Her only current medications are an oral contraceptive and intermittent ibuprofen for pain. Assessment of the casted left leg reveals that the toes are swollen. With this information, which diagnostic testing will the nurse expect as the highest priority? Sputum cultures Chest radiograph Computed tomographic pulmonary angiography Radiograph of the left leg Correct: Her history and clinical manifestations indicate she is at risk for a pulmonary embolism (PE). The risk factors include recent surgery and estrogen use. Clinical manifestations include tachycardia, tachypnea, sudden onset shortness of breath, syncope, diaphoresis, fever, unilateral lower extremity swelling, and decreased oxygen saturation. Assessments or diagnostics for patients with a suspected PE may include a D-dimer test, which is useful if the suspicion is low. If the suspicion is high, as in this case, a computed tomographic pulmonary angiography (CTPA) scan will provide definitive diagnosis of a PE. A ventilation/perfusion (VQ) scan would also be diagnostic for a PE. Other diagnostics would be a chest radiograph to rule out pneumonia or other pulmonary condition, and an ECG and cardiac enzymes to rule out coronary artery pathology.
- The emergency nurse is caring for an 11-month-old child found unresponsive and apneic, face down in a bucket of water. The child received rescue breaths and had rapid return of respirations and is now awake, with normal vital signs. The nurse should anticipate which of the following? Early endotracheal intubation for preservation of airway Prophylactic anticonvulsant medication
Close observation for a minimum of 24 hours Radiographic imaging of the patient's spine Correct: Virtually all patients who have experienced a submersion event significant enough to lead to a cessation of breathing should be observed for worsening clinical status for a minimum of 24 hours. Aspiration pneumonia will not initially show up on chest radiographs.
- Elevation of the head of the bed, but not the affected extremity, ambulation as tolerated, and thrombolytic therapy are interventions for which type of peripheral vascular disease? Lymphedema Peripheral artery disease Deep vein thrombosis Peripheral venous disease Correct: In peripheral artery disease, arterial blood flow is decreased, and elevation of the extremity can worsen perfusion.
- A 74-year-old presents to the ED with a history of chronic bronchitis and complaints of dyspnea and shortness of breath. He is cyanotic and the nurse applies oxygen. Which of the following assessment findings will be most concerning to the nurse? A respiratory rate of 10 breaths/min An elevated hemoglobin Generalized edema Productive cough Correct: The addition of oxygen for the patient with chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis, can affect the respiratory drive, which, because of chronically high PaCO2 levels in these patients, becomes governed by oxygenation. High PaO2 levels in a patient with COPD can lead to an impaired drive to breathe.
- A 12 - year-old male is brought to the emergency department by his mother with complaints of difficulty breathing, swollen eyes and lips, and hives. The mother states that the child had just finished eating a peanut butter cookie. Epinephrine was administered. What is the next class of medications to be administered to the patient? Inhaled beta 2 agonist Corticosteroid Antihistamine
Anticholinergic Correct: First line treatment for anaphylactic shock is administration of epinephrine, 0.1 to 0.5 ml of 1:10,000 concentration. Nebulized albuterol may be used for bronchospasm not responding to epinephrine. This would be the next class of medications to administer to prevent airway compromise. Primary attention is directed at the stabilization of the patient's airway, breathing, and circulation.
- A patient has just been diagnosed with endocarditis. While preparing for surgery for valvular repair, which intervention will the nurse perform? Insert a urinary catheter Insert a gastric tube Begin an infusion of nitroprusside Administer antibiotics Correct: Endocarditis is a bacterial infection of the cardiac muscle. Antibiotics are a priority.
- A 23-year-old patient with a stable ectopic pregnancy is being cared for by an emergency nurse. The emergency physician ordered methotrexate to be administered intramuscularly. Which statement by the nurse indicates an understanding of the medication?
I'll instruct the patient to follow up in two weeks. I can give this medication because there is only scant vaginal bleeding. I'll give this medication because there is fetal cardiac activity. I can't administer this medication. I'm pregnant. Correct: Methotrexate should not be handled by pregnant nurses or those of child-bearing age; it is a chemotherapeutic agent that is cytotoxic. Special handling of chemotherapeutic agents must be practiced to prevent exposure.
- An adult presents to the emergency department complaining of a low-grade fever, malaise, pain in the joints, and headache for the past week. The patient reports hiking in wooded areas during a recent vacation in the Northeast United States. Upon physical assessment, a circular, flat, red rash with central clearing is noted to the left scapular area, and local tenderness upon palpation to the left axillary lymph node. After confirmatory diagnosis, the emergency nurse anticipates which course of pharmacologic treatment? Levofloxacin Doxycycline Ceftriaxone Praziquantel
Correct: This presentation is consistent with Lyme disease, which is treated with oral doxycycline in the early stages of the disease.
- A 40-year-old man presents to the emergency department with minimal urine output for the past two days. His history includes recent kidney stones. Which type of renal injury does this represent? Intrarenal Intrinsic Prerenal Postrenal Correct: Postrenal kidney injury is caused by obstruction of the urinary tract. Kidney stones are one example of obstruction that can lead to kidney injury.
- The nurse is giving discharge instructions to a patient with chronic obstructive pulmonary disease - emphysema. Which response indicates the patient understands the instructions? I need to limit my fluids to prevent fluid overload. I need to sleep with my feet elevated to prevent swelling.
I need to get the pneumococcal vaccine. I need to avoid snacking between meals. Correct: Pneumonia in a patient with emphysema can be devastating. Immunizations, especially to prevent pneumonia, are recommended for all patients with chronic obstructive pulmonary disease.
- To make certain that chain of custody has been followed appropriately, what is the most responsible task performed by the emergency nurse? Keep the evidence at their work station until released to law enforcement
Sign and date the tamper resistant tape in front of law enforcement Limit the number of people with access to the evidence Carry the evidence with them until released to law enforcement Correct: Keeping the number of people involved with chain of custody to a minimum limits the risk of contamination of the evidence. At some institutions, the charge nurse is the person designated to secure the evidence and then to release it to law enforcement.
- A patient presents to the emergency department complaining of flu-like symptoms, malaise, and fever for three days after being bitten by a bat. The emergency nurse suspects which condition? Tularemia West Nile virus Rabies Rocky Mountain spotted fever
Correct: Rabies is transmitted to humans primarily through bites by infected bats, raccoons, skunks and foxes, and presents with mild and non-specific complaints during the prodromal period (the first two to ten days).
- Which of the following statements is most significant when assessing a patient for Guillain-Barré syndrome? My mother says I have been forgetful. Both of my legs really hurt at night. I've lost control of my bladder a few times. My eye twitches a lot lately. Correct: In Guillain-Barré syndrome, neuropathy usually begins in lower extremities and ascends in a symmetrical pattern. Pain is usually worse at night.
- A patient presents to the emergency department with right-sided facial drooping, right arm weakness and slurred speech. Which of the following
assessments indicates exclusion criteria for receiving tissue plasminogen activator (tPA)? Blood glucose of 180 mg/dL BP 190/110 mm Hg NIH stroke scale of 6 Headache Correct: Elevated blood pressure is an absolute contraindication for tissue plasminogen activator (tPA) administration. If administered to a patient with an elevated blood pressure, it may increase the likelihood of intracerebral hemorrhage. Blood pressure must be less than 185 mm Hg (systolic) and 110 mm Hg (diastolic).
- Which of the following techniques is the most effective way to determine homicidal ideation? Inquire about the patient's interaction with family members and friends Ask the patient about plans to carry out violence and any prohibiting factors
Observe the patient for threatening statements, movements, or actions Be aware of any threatening feelings experienced while interacting with the patient Correct: An open, direct approach allows the discussion to occur in a reassuring, nonthreatening manner. This may make the patient more likely to be honest about thoughts and feelings.
- A patient, who has suffered deep, full-thickness (third degree) thermal burns to the circumferential chest and abdomen, as well as burns of varying depth to the upper extremities, has been transferred to your emergency department from a small, rural community hospital. Ventilating the intubated patient via bag-mask device is becoming increasingly difficult and chest rise with ventilation is poor. The emergency nurse anticipates which procedure? Tracheostomy Cricothyroidotomy Escharotomy Fasciotomy
Correct: Circumferential (or near-circumferential) deep burns to the thorax can decrease chest wall compliance which be manifested while ventilating the patient. These burns are treated with a chest-wall escharotomy in the anterior axillary line bilaterally, with possible escharotomy incisions extending to the abdomen and connected by a transverse incision along the costal margin.
- A 58-year-old male arrives to the ED following a motor vehicle collision. Assessment reveals bony crepitus and bruising over the left chest with paradoxical chest wall movement. He complains that it is difficult to breathe and his chest hurts. His vital signs are BP 118/60 mm Hg, HR 110 beats/min, RR 32 breaths/min and shallow, T 37.0 C (98.6 F) SpO2 95% with 15 L/min via nonrebreather mask. The nurse will prepare for which priority intervention? Portable chest radiograph 12 - lead electrocardiogram Chest tube insertion Intubation with positive end-expiratory pressure Incorrect, The answer is Intubation with positive end-expiratory pressure: This patient has signs of a flail chest. Because of the pain and paradoxical chest wall movement, adequate ventilation is difficult. Intubation and mechanical ventilation with positive end-expiratory pressure will limit the risk of hypoventilation and development of pneumonia. He may also have a pneumothorax from the thoracic trauma, but further assessment is needed to determine that.
- A patient arrives in the emergency department with severe, sudden-onset chest pain. He states he used cocaine earlier that day and is taking a beta blocker for hypertension. Which abnormal assessment finding will the nurse expect? Metabolic alkalosis Hypoglycemia BP 196/110 mm Hg HR 48 beats/min Correct: Cocaine use can result in unopposed alpha activity in patients taking beta blockers, which can result in hypertension
- A mass casualty incident occurred near a level one trauma center. There were several deaths ranging from ages 3 months to 42 years old. The nurses working that night were emotionally drained and physically stressed. A critical incident process was arranged within 24 hours. Which component of the critical incident stress management process took place?
Debriefing Defusing Crisis intervention Follow-up Incorrect, The answer is Debriefing: Defusing is a brief interview that is conducted in a short time-frame following the event. It occurs within 12 hours of the event. Debriefing is a 7-step process that takes place 1-3 days after an event. It includes an introduction; gathering details of the event; detailing emotional responses, personal reactions, and actions; identifying symptoms; an instruction phase; and determining whether the person involved is ready to return to work.
- Which of the following is an early sign of increasing intracranial pressure in a patient with a head injury? Bradycardia Widening pulse pressure Extension of upper extremities with stimuli
Nausea and vomiting Correct: Headache, nausea, vomiting, altered mental status, and amnesia of the event are examples of early signs of increasing intracranial pressure.
- The emergency nurse knows that a patient who has experienced a severe electrical injury is at risk for which of the following? Arrhythmias Carboxyhemoglobinemia Tissue liquefaction Hypocalcemia Correct: Severe electrical injuries may result in severe or fatal arrhythmias.