2026 Certified Emergency Nurse CEN
Exam by BCEN New Latest Version with
All 150 Questions from Actual Exam,
100% Correct Answers and Rationale
Cardiovascular Emergencies (Questions 1-12)
Q1. A 68-year-old male presents with crushing substernal chest pain radiating
to his left arm, diaphoresis, and nausea. ECG shows ST-segment elevation in
leads V1-V4. Which immediate intervention is most critical?
• A. Administer sublingual nitroglycerin
• B. Obtain cardiac enzymes
• C. Activate the catheterization lab for primary PCI
• D. Start an amiodarone drip
Correct Answer: C. Activate the catheterization lab for primary PCI
Rationale: ST-elevation in V1-V4 indicates an anterior STEMI . Time to
reperfusion is critical. Primary PCI within 90 minutes of arrival is the gold
standard. Nitroglycerin can be given but not before confirming right ventricular
involvement and ensuring adequate blood pressure. Cardiac enzymes should not
delay reperfusion .
,Q2. A 72-year-old female presents with sudden onset shortness of breath,
hypotension (88/52 mmHg), tachycardia, and distended neck veins. She is cool
and clammy. What is the priority intervention?
• A. Administer furosemide 40 mg IV
• B. Perform a focused cardiac ultrasound
• C. Start a dopamine drip
• D. Needle decompression of the chest
Correct Answer: B. Perform a focused cardiac ultrasound
Rationale: The triad of hypotension, distended neck veins, and clear lungs (Beck's
triad) suggests cardiac tamponade . Ultrasound (ECHO or bedside) is diagnostic to
confirm pericardial effusion with right ventricular collapse. Needle decompression
is for tension pneumothorax. Furosemide would worsen hypotension in
tamponade .
Q3. A 55-year-old presents with acute onset tearing chest pain radiating to the
back. Blood pressure is 160/90 in the right arm and 100/60 in the left arm.
What is the most appropriate next step?
• A. Administer tPA for suspected STEMI
• B. Obtain a stat chest X-ray
• C. STAT cardiology consult for possible pericarditis
• D. IV beta-blocker and emergency CT angiography
Correct Answer: D. IV beta-blocker and emergency CT angiography
Rationale: Unequal blood pressures and tearing pain are classic for aortic
dissection . First-line treatment is heart rate control (beta-blocker) to reduce aortic
wall stress, followed by emergency CT angiography for definitive diagnosis .
, Q4. A 45-year-old with epigastric pain, nausea, and diaphoresis. ECG shows
ST-depression in V2-V4. Troponin is elevated. What is the most likely
diagnosis?
• A. Acute pancreatitis
• B. Perforated ulcer
• C. Non-ST elevation MI (NSTEMI)
• D. Pulmonary embolism
Correct Answer: C. Non-ST elevation MI (NSTEMI)
Rationale: ST-depression with elevated troponin = NSTEMI . Epigastric pain can
be an atypical presentation of myocardial ischemia, especially in women and
diabetics .
Q5. A patient in the ED suddenly becomes unresponsive. Cardiac monitor
shows ventricular fibrillation. What is the priority action?
• A. Administer epinephrine 1 mg IV push
• B. Defibrillate at 200 J biphasic
• C. Start high-quality CPR
• D. Intubate the patient
Correct Answer: B. Defibrillate at 200 J biphasic
Rationale: For VF/pulseless VT, immediate defibrillation is the priority . CPR
should be performed while the defibrillator is charging. Epinephrine is given after
the second shock. Intubation should not delay defibrillation .
Exam by BCEN New Latest Version with
All 150 Questions from Actual Exam,
100% Correct Answers and Rationale
Cardiovascular Emergencies (Questions 1-12)
Q1. A 68-year-old male presents with crushing substernal chest pain radiating
to his left arm, diaphoresis, and nausea. ECG shows ST-segment elevation in
leads V1-V4. Which immediate intervention is most critical?
• A. Administer sublingual nitroglycerin
• B. Obtain cardiac enzymes
• C. Activate the catheterization lab for primary PCI
• D. Start an amiodarone drip
Correct Answer: C. Activate the catheterization lab for primary PCI
Rationale: ST-elevation in V1-V4 indicates an anterior STEMI . Time to
reperfusion is critical. Primary PCI within 90 minutes of arrival is the gold
standard. Nitroglycerin can be given but not before confirming right ventricular
involvement and ensuring adequate blood pressure. Cardiac enzymes should not
delay reperfusion .
,Q2. A 72-year-old female presents with sudden onset shortness of breath,
hypotension (88/52 mmHg), tachycardia, and distended neck veins. She is cool
and clammy. What is the priority intervention?
• A. Administer furosemide 40 mg IV
• B. Perform a focused cardiac ultrasound
• C. Start a dopamine drip
• D. Needle decompression of the chest
Correct Answer: B. Perform a focused cardiac ultrasound
Rationale: The triad of hypotension, distended neck veins, and clear lungs (Beck's
triad) suggests cardiac tamponade . Ultrasound (ECHO or bedside) is diagnostic to
confirm pericardial effusion with right ventricular collapse. Needle decompression
is for tension pneumothorax. Furosemide would worsen hypotension in
tamponade .
Q3. A 55-year-old presents with acute onset tearing chest pain radiating to the
back. Blood pressure is 160/90 in the right arm and 100/60 in the left arm.
What is the most appropriate next step?
• A. Administer tPA for suspected STEMI
• B. Obtain a stat chest X-ray
• C. STAT cardiology consult for possible pericarditis
• D. IV beta-blocker and emergency CT angiography
Correct Answer: D. IV beta-blocker and emergency CT angiography
Rationale: Unequal blood pressures and tearing pain are classic for aortic
dissection . First-line treatment is heart rate control (beta-blocker) to reduce aortic
wall stress, followed by emergency CT angiography for definitive diagnosis .
, Q4. A 45-year-old with epigastric pain, nausea, and diaphoresis. ECG shows
ST-depression in V2-V4. Troponin is elevated. What is the most likely
diagnosis?
• A. Acute pancreatitis
• B. Perforated ulcer
• C. Non-ST elevation MI (NSTEMI)
• D. Pulmonary embolism
Correct Answer: C. Non-ST elevation MI (NSTEMI)
Rationale: ST-depression with elevated troponin = NSTEMI . Epigastric pain can
be an atypical presentation of myocardial ischemia, especially in women and
diabetics .
Q5. A patient in the ED suddenly becomes unresponsive. Cardiac monitor
shows ventricular fibrillation. What is the priority action?
• A. Administer epinephrine 1 mg IV push
• B. Defibrillate at 200 J biphasic
• C. Start high-quality CPR
• D. Intubate the patient
Correct Answer: B. Defibrillate at 200 J biphasic
Rationale: For VF/pulseless VT, immediate defibrillation is the priority . CPR
should be performed while the defibrillator is charging. Epinephrine is given after
the second shock. Intubation should not delay defibrillation .
