CEN CERTIFIED EMERGENCY NURSE
ACTUAL EXAM 2026/2027 | BCEN
Content Outline | Practice Test with Actual
Questions | Verified Q&A | Pass Guaranteed
- A+ Graded
DOMAIN 1: CARDIOVASCULAR EMERGENCIES (19
Questions)
Q1: A 62-year-old patient presents with substernal chest pain radiating to the left arm,
diaphoresis, and nausea. Vital signs: BP 98/62, HR 118, RR 24, O2 saturation 94% on room air.
ECG reveals ST-segment elevation in leads V2-V4. What is the nurse's priority action?
A. Administer nitroglycerin 0.4 mg sublingual
B. Obtain a stat chest x-ray
C. Prepare for immediate percutaneous coronary intervention (PCI) [CORRECT]
D. Start an IV bolus of normal saline at 500 mL/hour
Correct Answer: C
Rationale: This patient presents with signs of acute STEMI (chest pain, diaphoresis, ST
elevation in anterior leads) and is hemodynamically unstable (hypotension, tachycardia). The
priority is preparing for immediate reperfusion therapy, preferably PCI within 90 minutes of
arrival. Nitroglycerin (A) is contraindicated in hypotension (SBP <90). Chest x-ray (B) would
delay definitive care. IV fluids (D) may be needed but are not the priority over reperfusion.
BCEN Exam Note: "Priority" questions require identifying the intervention that directly
addresses the life-threatening condition—reperfusion in STEMI.
Q2: A 58-year-old patient with a history of atrial fibrillation presents with palpitations, chest
discomfort, and dizziness. Vital signs: BP 82/48, HR 156 irregularly irregular, RR 22, SpO2 95%.
The patient is diaphoretic and confused. What is the immediate nursing intervention?
,A. Administer diltiazem 15 mg IV push
B. Prepare for immediate synchronized cardioversion [CORRECT]
C. Give metoprolol 5 mg IV
D. Start heparin infusion per protocol
Correct Answer: B
Rationale: This patient has unstable atrial fibrillation with hypotension (SBP <90), altered
mental status, and signs of shock. Unstable tachycardia requires immediate synchronized
cardioversion (50-100 J biphasic). Diltiazem (A) and metoprolol (C) are contraindicated in
unstable patients as they may worsen hypotension. Heparin (D) is important but secondary to
immediate rhythm correction.
Clinical Pearl: Unstable = SBP <90, altered mental status, signs of shock, ischemic chest
pain, or acute heart failure. Cardiovert first, medicate later.
Q3: During resuscitation of a 45-year-old patient in ventricular fibrillation, the team has
delivered three shocks and administered epinephrine 1 mg IV. The rhythm persists as VF.
What is the next priority intervention?
A. Administer amiodarone 300 mg IV push [CORRECT]
B. Give atropine 1 mg IV
C. Perform immediate transcutaneous pacing
D. Administer calcium chloride 1 g IV
Correct Answer: A
Rationale: Per AHA ACLS guidelines, after three shocks and epinephrine for refractory
VF/pulseless VT, administer amiodarone 300 mg IV/IO (followed by 150 mg if needed).
Atropine (B) is for bradycardia, not VF. Pacing (C) is contraindicated in VF. Calcium (D) is
indicated for hyperkalemia, hypocalcemia, or calcium channel blocker overdose—not routine
cardiac arrest.
BCEN Exam Note: Remember the H's and T's (Hypovolemia, Hypoxia, Hydrogen ion/acidosis,
Hypo/Hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis
coronary/pulmonary) as reversible causes during arrest.
,Q4: A 70-year-old patient presents with acute onset tearing chest pain radiating to the back.
BP is 190/110 in the right arm and 160/90 in the left arm. The patient is diaphoretic and
anxious. What is the priority nursing action?
A. Administer IV heparin bolus
B. Obtain a stat CT angiography of the chest [CORRECT]
C. Give aspirin 325 mg chewable
D. Start nitroprusside infusion immediately
Correct Answer: B
Rationale: This presentation (tearing chest pain, blood pressure differential >20 mmHg
between arms) is classic for aortic dissection. Immediate CT angiography confirms
diagnosis and determines Stanford type (A = ascending, B = descending). Heparin (A) and
aspirin (C) are contraindicated until dissection is ruled out or if surgery is planned.
Nitroprusside (D) may be used after beta-blockade to prevent reflex tachycardia, but
diagnosis comes first.
Clinical Pearl: Always obtain beta-blockade (esmolol or labetalol) BEFORE vasodilators in
aortic dissection to prevent increased shear stress on the aortic wall.
Q5: A patient with suspected cardiac tamponade presents with Beck's triad. Which finding
requires immediate intervention?
A. Muffled heart sounds
B. Elevated jugular venous pressure
C. Pulsus paradoxus >20 mmHg
D. Systolic BP 70 mmHg with altered mental status [CORRECT]
Correct Answer: D
Rationale: While all options are components of tamponade, hemodynamic instability (SBP
<90 or MAP <65) with altered mental status indicates obstructive shock requiring immediate
pericardiocentesis. Beck's triad (muffled heart sounds, JVD, hypotension) is present in only
10-40% of cases. Pulsus paradoxus >10 mmHg is suggestive but not as immediately
life-threatening as profound hypotension with AMS.
, BCEN Exam Note: Tamponade = fluid in pericardium → impaired ventricular filling →
equalization of pressures (RA = RV = PAOP) → obstructive shock.
Q6: A 55-year-old patient with acute decompensated heart failure presents with severe
dyspnea, orthopnea, and pink frothy sputum. Vital signs: BP 210/120, HR 128, RR 34, SpO2
88% on 2L NC. Which intervention should the nurse implement first?
A. Administer furosemide 80 mg IV push
B. Apply BiPAP at 10/5 cm H2O [CORRECT]
C. Give nitroglycerin 0.4 mg SL
D. Insert Foley catheter
Correct Answer: B
Rationale: This patient has acute cardiogenic pulmonary edema with respiratory failure.
Non-invasive positive pressure ventilation (BiPAP) is the priority to reduce preload/afterload,
decrease work of breathing, and improve oxygenation. While furosemide (A) and nitrates (C)
are important, addressing respiratory failure takes precedence. Foley (D) is appropriate but
not emergent.
Clinical Pearl: BiPAP in acute pulmonary edema: reduces venous return (preload), reduces
afterload, improves cardiac output, and decreases myocardial oxygen demand.
Q7: A patient with massive PE presents with syncope, hypotension (BP 78/50), and severe
hypoxemia. CT shows saddle embolus. What is the priority intervention?
A. Start heparin infusion
B. Administer systemic thrombolytics [CORRECT]
C. Obtain echocardiogram
D. Apply compression stockings
Correct Answer: B
Rationale: Massive PE (sustained hypotension, syncope, or shock) requires systemic
thrombolysis (alteplase 100 mg over 2 hours) unless contraindicated. Heparin (A) alone is
insufficient for massive PE. Echocardiogram (C) may show RV strain but delays definitive
therapy. Compression stockings (D) are for DVT prophylaxis, not acute massive PE.
ACTUAL EXAM 2026/2027 | BCEN
Content Outline | Practice Test with Actual
Questions | Verified Q&A | Pass Guaranteed
- A+ Graded
DOMAIN 1: CARDIOVASCULAR EMERGENCIES (19
Questions)
Q1: A 62-year-old patient presents with substernal chest pain radiating to the left arm,
diaphoresis, and nausea. Vital signs: BP 98/62, HR 118, RR 24, O2 saturation 94% on room air.
ECG reveals ST-segment elevation in leads V2-V4. What is the nurse's priority action?
A. Administer nitroglycerin 0.4 mg sublingual
B. Obtain a stat chest x-ray
C. Prepare for immediate percutaneous coronary intervention (PCI) [CORRECT]
D. Start an IV bolus of normal saline at 500 mL/hour
Correct Answer: C
Rationale: This patient presents with signs of acute STEMI (chest pain, diaphoresis, ST
elevation in anterior leads) and is hemodynamically unstable (hypotension, tachycardia). The
priority is preparing for immediate reperfusion therapy, preferably PCI within 90 minutes of
arrival. Nitroglycerin (A) is contraindicated in hypotension (SBP <90). Chest x-ray (B) would
delay definitive care. IV fluids (D) may be needed but are not the priority over reperfusion.
BCEN Exam Note: "Priority" questions require identifying the intervention that directly
addresses the life-threatening condition—reperfusion in STEMI.
Q2: A 58-year-old patient with a history of atrial fibrillation presents with palpitations, chest
discomfort, and dizziness. Vital signs: BP 82/48, HR 156 irregularly irregular, RR 22, SpO2 95%.
The patient is diaphoretic and confused. What is the immediate nursing intervention?
,A. Administer diltiazem 15 mg IV push
B. Prepare for immediate synchronized cardioversion [CORRECT]
C. Give metoprolol 5 mg IV
D. Start heparin infusion per protocol
Correct Answer: B
Rationale: This patient has unstable atrial fibrillation with hypotension (SBP <90), altered
mental status, and signs of shock. Unstable tachycardia requires immediate synchronized
cardioversion (50-100 J biphasic). Diltiazem (A) and metoprolol (C) are contraindicated in
unstable patients as they may worsen hypotension. Heparin (D) is important but secondary to
immediate rhythm correction.
Clinical Pearl: Unstable = SBP <90, altered mental status, signs of shock, ischemic chest
pain, or acute heart failure. Cardiovert first, medicate later.
Q3: During resuscitation of a 45-year-old patient in ventricular fibrillation, the team has
delivered three shocks and administered epinephrine 1 mg IV. The rhythm persists as VF.
What is the next priority intervention?
A. Administer amiodarone 300 mg IV push [CORRECT]
B. Give atropine 1 mg IV
C. Perform immediate transcutaneous pacing
D. Administer calcium chloride 1 g IV
Correct Answer: A
Rationale: Per AHA ACLS guidelines, after three shocks and epinephrine for refractory
VF/pulseless VT, administer amiodarone 300 mg IV/IO (followed by 150 mg if needed).
Atropine (B) is for bradycardia, not VF. Pacing (C) is contraindicated in VF. Calcium (D) is
indicated for hyperkalemia, hypocalcemia, or calcium channel blocker overdose—not routine
cardiac arrest.
BCEN Exam Note: Remember the H's and T's (Hypovolemia, Hypoxia, Hydrogen ion/acidosis,
Hypo/Hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis
coronary/pulmonary) as reversible causes during arrest.
,Q4: A 70-year-old patient presents with acute onset tearing chest pain radiating to the back.
BP is 190/110 in the right arm and 160/90 in the left arm. The patient is diaphoretic and
anxious. What is the priority nursing action?
A. Administer IV heparin bolus
B. Obtain a stat CT angiography of the chest [CORRECT]
C. Give aspirin 325 mg chewable
D. Start nitroprusside infusion immediately
Correct Answer: B
Rationale: This presentation (tearing chest pain, blood pressure differential >20 mmHg
between arms) is classic for aortic dissection. Immediate CT angiography confirms
diagnosis and determines Stanford type (A = ascending, B = descending). Heparin (A) and
aspirin (C) are contraindicated until dissection is ruled out or if surgery is planned.
Nitroprusside (D) may be used after beta-blockade to prevent reflex tachycardia, but
diagnosis comes first.
Clinical Pearl: Always obtain beta-blockade (esmolol or labetalol) BEFORE vasodilators in
aortic dissection to prevent increased shear stress on the aortic wall.
Q5: A patient with suspected cardiac tamponade presents with Beck's triad. Which finding
requires immediate intervention?
A. Muffled heart sounds
B. Elevated jugular venous pressure
C. Pulsus paradoxus >20 mmHg
D. Systolic BP 70 mmHg with altered mental status [CORRECT]
Correct Answer: D
Rationale: While all options are components of tamponade, hemodynamic instability (SBP
<90 or MAP <65) with altered mental status indicates obstructive shock requiring immediate
pericardiocentesis. Beck's triad (muffled heart sounds, JVD, hypotension) is present in only
10-40% of cases. Pulsus paradoxus >10 mmHg is suggestive but not as immediately
life-threatening as profound hypotension with AMS.
, BCEN Exam Note: Tamponade = fluid in pericardium → impaired ventricular filling →
equalization of pressures (RA = RV = PAOP) → obstructive shock.
Q6: A 55-year-old patient with acute decompensated heart failure presents with severe
dyspnea, orthopnea, and pink frothy sputum. Vital signs: BP 210/120, HR 128, RR 34, SpO2
88% on 2L NC. Which intervention should the nurse implement first?
A. Administer furosemide 80 mg IV push
B. Apply BiPAP at 10/5 cm H2O [CORRECT]
C. Give nitroglycerin 0.4 mg SL
D. Insert Foley catheter
Correct Answer: B
Rationale: This patient has acute cardiogenic pulmonary edema with respiratory failure.
Non-invasive positive pressure ventilation (BiPAP) is the priority to reduce preload/afterload,
decrease work of breathing, and improve oxygenation. While furosemide (A) and nitrates (C)
are important, addressing respiratory failure takes precedence. Foley (D) is appropriate but
not emergent.
Clinical Pearl: BiPAP in acute pulmonary edema: reduces venous return (preload), reduces
afterload, improves cardiac output, and decreases myocardial oxygen demand.
Q7: A patient with massive PE presents with syncope, hypotension (BP 78/50), and severe
hypoxemia. CT shows saddle embolus. What is the priority intervention?
A. Start heparin infusion
B. Administer systemic thrombolytics [CORRECT]
C. Obtain echocardiogram
D. Apply compression stockings
Correct Answer: B
Rationale: Massive PE (sustained hypotension, syncope, or shock) requires systemic
thrombolysis (alteplase 100 mg over 2 hours) unless contraindicated. Heparin (A) alone is
insufficient for massive PE. Echocardiogram (C) may show RV strain but delays definitive
therapy. Compression stockings (D) are for DVT prophylaxis, not acute massive PE.
