CERTIFIED EMERGENCY NURSING
EXAM QUESTIONS AND ANSWERS
GRADED A+ 2025/2026
Shock - ANS State of impaired tissue perfusion resulting from circulatory failure.
Hypovolemic Shock - ANS Decreased cellular perfusion secondary to lack of circulating
volume or not ENOUGH GAS.
Cardiogenic Shock - ANS Decreased cellular perfusion secondary to maldistribution of oxygen
to the periphery. Its like adding a larger engine without increasing the size of the tank.
Obstructive shock - ANS Decreased cellular perfusion secondry to obstruction of blood into
or out of the ventricles (eg. pulmonary emboli, tamponade, tension pneumo. Like getting dirt or
blockage in the fuel line.
Prolonged lactic acidosis leads to microvascular thrombosis and disseminated intravascular
coagulation - ANS
Compensated Shock - ANS When patient is able to maintain blood pressure. Body attempting
to maintain homeostasis. Increases perfusion to brain, decreases blood flow to kidneys.
Uncompensated Shock - ANS Shock at cellular level. Intracellular fluid leaks into interstitium
causing third spacing and edema, bp decreases, hr increases, respiratory rate increases,
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Hypovolemic Shock - ANS Blood or fluid loss reduces circulating blood volume and cardiac
output.
Mean Arterial Pressure - ANS MAP = (Systolic pressure + 2(Diastolic) / 3
Want a MAP above 60
Hypovolemic shock interventions - ANS Airway control, control bleeing or fluid loss, restore
volume, NS 0.9%, Adult 1-2L bolus, Pedi 20ml/kg. Never use Dextrose
Cardiogenic Shock - ANS Inadequate tissue perfusion as a result of decreased cardiac output
despite adequate intravascular volume. Most common is MI. Pump Failure
Cardiogenic Shock Interventions - ANS Airway with PEEP will force pulmonary edema fluid
out of the lung interstitium. Decrease preload by position, nitro, diuretics, morphine. Cardiac
cath, angioplasty.
Distributive Shock - ANS Abnormal distribution of intravascular volume. Can me anaphylactic,
septic, neurogenic
Distributive Shock (Anaphylaxis) - ANS Acute life threatening allergic reaction to individuals
exposed to an antigen to which they have become hypersensitive.
Anaphylactic Shock Interventions - ANS IM epi 1:1000 repeat in 15-20 min as needed.
Albuterol, H1 abd H2 blockers, Corticosteroids.
Septic Shock - ANS Systemic Inflammatory response syndrome (SIRS). Sepsis with organ
dysfunction, cardio failure leading to hypotension, Resp failure leading to hypoxia, Renal failure
leading to oliguria and azotemia. MODS, multiple organ dysfumction syndrome.
Septic Shock Interventions - ANS Positive inotropes, vasopressors, fluid resuscitation,
antibiotics
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Neurogenic Shock - ANS Loss of the sympathetic nervous system "fight or flight" response is
lost and the rest of digest system is unopposed. Bradycardia, bradypnea, hypotension, priapism.
Neurogenic shock interventions - ANS abc's, fluids, vasopressors, atropine for bradycardia,
high dose corticosteroids not recommended.
Obstructive shock - ANS cardiac output and tissue perfusion are inadequate because of
resistance to ventricular filling. Causes pericardial tamponade, tension pneumo, pulmonary
embolism
Obstructive shock interventions - ANS correct underlying condition, pericardial tamponade,
pericardiocentesis and subsequent surgical repair, tension pneumo-immediate needle
thoracotomy, PE-thrombolytics
CVP - ANS 8-12mm Hg
Geriatric considerations - ANS tachycardia during shock may be masked by medications (beta
blockers), prone to dehydration, decreased thirst, avoid fluid overload
CO=SV X HR - ANS
SNS sympathetic nervous system - ANS heart rate is increased by stimulation of the sns,
which occurs from stress, anxiety, acute pain, release of catecholamines, hypotension and drugs
with positive chronotropic effects.
PNS parasympathetic nervous system - ANS heart rate decreases by stimulation of the pns,
which can occur with vagus nerve stimulation, cardiac conduction abnormalities and drugs with
negative chronotropic effects.
Stroke volume - ANS amount of blood ejected from each ventricle per contraction, strength
of myocardial contraction
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
EXAM QUESTIONS AND ANSWERS
GRADED A+ 2025/2026
Shock - ANS State of impaired tissue perfusion resulting from circulatory failure.
Hypovolemic Shock - ANS Decreased cellular perfusion secondary to lack of circulating
volume or not ENOUGH GAS.
Cardiogenic Shock - ANS Decreased cellular perfusion secondary to maldistribution of oxygen
to the periphery. Its like adding a larger engine without increasing the size of the tank.
Obstructive shock - ANS Decreased cellular perfusion secondry to obstruction of blood into
or out of the ventricles (eg. pulmonary emboli, tamponade, tension pneumo. Like getting dirt or
blockage in the fuel line.
Prolonged lactic acidosis leads to microvascular thrombosis and disseminated intravascular
coagulation - ANS
Compensated Shock - ANS When patient is able to maintain blood pressure. Body attempting
to maintain homeostasis. Increases perfusion to brain, decreases blood flow to kidneys.
Uncompensated Shock - ANS Shock at cellular level. Intracellular fluid leaks into interstitium
causing third spacing and edema, bp decreases, hr increases, respiratory rate increases,
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Hypovolemic Shock - ANS Blood or fluid loss reduces circulating blood volume and cardiac
output.
Mean Arterial Pressure - ANS MAP = (Systolic pressure + 2(Diastolic) / 3
Want a MAP above 60
Hypovolemic shock interventions - ANS Airway control, control bleeing or fluid loss, restore
volume, NS 0.9%, Adult 1-2L bolus, Pedi 20ml/kg. Never use Dextrose
Cardiogenic Shock - ANS Inadequate tissue perfusion as a result of decreased cardiac output
despite adequate intravascular volume. Most common is MI. Pump Failure
Cardiogenic Shock Interventions - ANS Airway with PEEP will force pulmonary edema fluid
out of the lung interstitium. Decrease preload by position, nitro, diuretics, morphine. Cardiac
cath, angioplasty.
Distributive Shock - ANS Abnormal distribution of intravascular volume. Can me anaphylactic,
septic, neurogenic
Distributive Shock (Anaphylaxis) - ANS Acute life threatening allergic reaction to individuals
exposed to an antigen to which they have become hypersensitive.
Anaphylactic Shock Interventions - ANS IM epi 1:1000 repeat in 15-20 min as needed.
Albuterol, H1 abd H2 blockers, Corticosteroids.
Septic Shock - ANS Systemic Inflammatory response syndrome (SIRS). Sepsis with organ
dysfunction, cardio failure leading to hypotension, Resp failure leading to hypoxia, Renal failure
leading to oliguria and azotemia. MODS, multiple organ dysfumction syndrome.
Septic Shock Interventions - ANS Positive inotropes, vasopressors, fluid resuscitation,
antibiotics
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Neurogenic Shock - ANS Loss of the sympathetic nervous system "fight or flight" response is
lost and the rest of digest system is unopposed. Bradycardia, bradypnea, hypotension, priapism.
Neurogenic shock interventions - ANS abc's, fluids, vasopressors, atropine for bradycardia,
high dose corticosteroids not recommended.
Obstructive shock - ANS cardiac output and tissue perfusion are inadequate because of
resistance to ventricular filling. Causes pericardial tamponade, tension pneumo, pulmonary
embolism
Obstructive shock interventions - ANS correct underlying condition, pericardial tamponade,
pericardiocentesis and subsequent surgical repair, tension pneumo-immediate needle
thoracotomy, PE-thrombolytics
CVP - ANS 8-12mm Hg
Geriatric considerations - ANS tachycardia during shock may be masked by medications (beta
blockers), prone to dehydration, decreased thirst, avoid fluid overload
CO=SV X HR - ANS
SNS sympathetic nervous system - ANS heart rate is increased by stimulation of the sns,
which occurs from stress, anxiety, acute pain, release of catecholamines, hypotension and drugs
with positive chronotropic effects.
PNS parasympathetic nervous system - ANS heart rate decreases by stimulation of the pns,
which can occur with vagus nerve stimulation, cardiac conduction abnormalities and drugs with
negative chronotropic effects.
Stroke volume - ANS amount of blood ejected from each ventricle per contraction, strength
of myocardial contraction
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
