CEN (Certified Emergency Nurse) Emergency
nursing certification validating expertise in rapid
assessment, trauma care, crisis intervention, and
emergency patient management.
1. A 45-year-old male presents to the emergency department (ED) with
sudden onset of severe chest pain radiating to the jaw, diaphoresis, and
shortness of breath. His vital signs: HR 110, BP 160/90, RR 24, SpO2 94%.
Using the Emergency Severity Index (ESI), which triage level is most
appropriate?
A. ESI 1 (requires immediate life-saving intervention)
B. ESI 2 (high risk: chest pain concerning for acute coronary syndrome)
C. ESI 3 (stable with multiple resources)
D. ESI 4 (stable with one resource)
Correct Answer: B
Rationale: ESI level 2 is assigned to patients at high risk for deterioration (e.g.,
chest pain suspicious for ACS). The patient is not in extremis (no airway
compromise, shock, or unconsciousness) so not ESI 1.
2. A 22-year-old is brought in after a motor vehicle crash (MVC) with altered
mental status, respiratory rate of 8, and blood pressure 80/50. Which of the
following should the nurse perform first?
A. Establish IV access
B. Apply a cervical collar
C. Jaw thrust and bag-valve-mask ventilation
D. Logroll to assess the back
Correct Answer: C
Rationale: Airway and breathing take priority in the primary survey (ABCDE).
The patient has a compromised airway (low RR, altered mental status) requiring
immediate airway support.
3. A patient arrives by ambulance following a seizure that lasted 4 minutes.
He is now postictal and confused. His blood glucose is 45 mg/dL. The nurse
should first:
A. Administer IV lorazepam
,B. Administer IV thiamine and D50 (or glucagon if no IV)
C. Perform a CT scan of the head
D. Obtain an EEG
Correct Answer: B
Rationale: Hypoglycemia is a reversible cause of seizure. Correcting glucose is
priority. Thiamine is given before glucose to prevent Wernicke encephalopathy in
malnourished patients.
4. A 5-year-old presents with stridor, drooling, and tripod positioning. The
child is anxious but has normal oxygen saturation. The most appropriate
nursing action is:
A. Attempt oral airway insertion
B. Prepare for immediate intubation
C. Keep the child calm, do not agitate, and notify the provider of suspected
epiglottitis
D. Obtain a lateral neck x-ray in the radiology department
Correct Answer: C
Rationale: Suspected epiglottitis requires maintaining a calm environment,
avoiding any airway manipulation, and immediate anesthesia/ENT consultation.
Agitation can cause complete airway obstruction.
5. A 65-year-old with a history of hypertension and diabetes presents with
sudden onset of right-sided weakness and aphasia. Time of symptom onset
was 90 minutes ago. What is the most time-sensitive intervention?
A. Aspirin 325 mg orally
B. Non-contrast head CT
C. ECG and cardiac monitoring
D. Blood glucose check
Correct Answer: B
Rationale: For acute ischemic stroke, non-contrast head CT must be obtained
immediately to rule out hemorrhage before thrombolytics. This should be done
within 25 minutes of arrival, read within 45 minutes.
6. A patient with a chief complaint of “weakness” has a temperature of
39.5°C, heart rate 130, blood pressure 85/50, and respiratory rate 24. The
patient is confused. Which triage priority is correct?
A. Sepsis alert (qSOFA positive) – immediate antibiotics and fluids
B. Observe in the waiting room
,C. Schedule for outpatient follow-up
D. Send for chest x-ray before provider evaluation
Correct Answer: A
Rationale: qSOFA: altered mental status, RR ≥22, SBP ≤100. This patient has 3/3,
indicating high risk of sepsis. Hour-1 bundle: measure lactate, blood cultures,
antibiotics, fluids.
7. A 30-year-old female presents with severe abdominal pain and vaginal
spotting. She is 8 weeks pregnant. Her blood pressure is 90/60, HR 120, and
she has a positive pregnancy test. The nurse should suspect:
A. Placenta previa
B. Ectopic pregnancy with possible rupture
C. Appendicitis
D. Ovarian cyst
Correct Answer: B
Rationale: First trimester bleeding and hypotension should prompt immediate
evaluation for ruptured ectopic pregnancy. Bedside ultrasound and surgical consult
are urgent.
8. Which of the following is an appropriate example of a “red tag” in a mass
casualty incident (MCI)?
A. Ambulatory patient with minor abrasions
B. Patient with severe head injury, agonal breathing (immediate life threat)
C. Deceased victim
D. Patient with a simple femur fracture but stable vital signs
Correct Answer: B
Rationale: Red tag (immediate) for life-threatening injuries that can be treated
with reasonable resources. Agonal breathing indicates imminent airway
compromise.
9. A 4-year-old is found unresponsive, not breathing, and without a pulse. The
lone rescuer nurse should:
A. Leave the child to get the AED
B. Start CPR with 30:2 compressions-to-ventilation ratio (single rescuer child)
C. Give 2 rescue breaths before starting compressions
D. Perform abdominal thrusts
Correct Answer: B
Rationale: For pediatric cardiac arrest, single rescuer does 30:2 cycles. If two
, rescuers, 15:2. AED should be obtained if available, but do not leave child
unattended; start CPR first.
10. A 55-year-old with a history of opioid use disorder is found unresponsive
with pinpoint pupils and respiratory rate of 4. The nurse should first:
A. Administer naloxone 0.4-2 mg IV/IM
B. Intubate
C. Start an IV drip of dopamine
D. Obtain a urine drug screen
Correct Answer: A
Rationale: Suspected opioid overdose with respiratory depression is a naloxone
emergency. Administer naloxone while providing bag-mask ventilation.
Domain 2: Cardiovascular Emergencies (Questions 11-20)
11. A 62-year-old presents with chest pain described as “pressure” radiating
to the left arm, with diaphoresis and nausea. ECG shows ST-segment
elevation in leads V1-V4. The most appropriate immediate intervention is:
A. Morphine 4 mg IV
B. Aspirin 324 mg chewable and activate the cath lab for primary PCI
C. Nitroglycerin 0.4 mg sublingual
D. IV furosemide
Correct Answer: B
Rationale: STEMI (anterior wall) requires immediate reperfusion with primary
PCI (goal door-to-balloon <90 minutes). Aspirin is given immediately.
12. A patient with atrial fibrillation and rapid ventricular response (HR 150)
has a blood pressure of 85/50, chest pain, and altered mental status. The nurse
should prepare for:
A. IV metoprolol
B. Synchronized cardioversion
C. IV amiodarone
D. IV digoxin
Correct Answer: B
Rationale: Unstable tachycardia (hypotension, chest pain, altered mental status)
requires immediate synchronized cardioversion (starting at 50-100 J for atrial
fibrillation).
nursing certification validating expertise in rapid
assessment, trauma care, crisis intervention, and
emergency patient management.
1. A 45-year-old male presents to the emergency department (ED) with
sudden onset of severe chest pain radiating to the jaw, diaphoresis, and
shortness of breath. His vital signs: HR 110, BP 160/90, RR 24, SpO2 94%.
Using the Emergency Severity Index (ESI), which triage level is most
appropriate?
A. ESI 1 (requires immediate life-saving intervention)
B. ESI 2 (high risk: chest pain concerning for acute coronary syndrome)
C. ESI 3 (stable with multiple resources)
D. ESI 4 (stable with one resource)
Correct Answer: B
Rationale: ESI level 2 is assigned to patients at high risk for deterioration (e.g.,
chest pain suspicious for ACS). The patient is not in extremis (no airway
compromise, shock, or unconsciousness) so not ESI 1.
2. A 22-year-old is brought in after a motor vehicle crash (MVC) with altered
mental status, respiratory rate of 8, and blood pressure 80/50. Which of the
following should the nurse perform first?
A. Establish IV access
B. Apply a cervical collar
C. Jaw thrust and bag-valve-mask ventilation
D. Logroll to assess the back
Correct Answer: C
Rationale: Airway and breathing take priority in the primary survey (ABCDE).
The patient has a compromised airway (low RR, altered mental status) requiring
immediate airway support.
3. A patient arrives by ambulance following a seizure that lasted 4 minutes.
He is now postictal and confused. His blood glucose is 45 mg/dL. The nurse
should first:
A. Administer IV lorazepam
,B. Administer IV thiamine and D50 (or glucagon if no IV)
C. Perform a CT scan of the head
D. Obtain an EEG
Correct Answer: B
Rationale: Hypoglycemia is a reversible cause of seizure. Correcting glucose is
priority. Thiamine is given before glucose to prevent Wernicke encephalopathy in
malnourished patients.
4. A 5-year-old presents with stridor, drooling, and tripod positioning. The
child is anxious but has normal oxygen saturation. The most appropriate
nursing action is:
A. Attempt oral airway insertion
B. Prepare for immediate intubation
C. Keep the child calm, do not agitate, and notify the provider of suspected
epiglottitis
D. Obtain a lateral neck x-ray in the radiology department
Correct Answer: C
Rationale: Suspected epiglottitis requires maintaining a calm environment,
avoiding any airway manipulation, and immediate anesthesia/ENT consultation.
Agitation can cause complete airway obstruction.
5. A 65-year-old with a history of hypertension and diabetes presents with
sudden onset of right-sided weakness and aphasia. Time of symptom onset
was 90 minutes ago. What is the most time-sensitive intervention?
A. Aspirin 325 mg orally
B. Non-contrast head CT
C. ECG and cardiac monitoring
D. Blood glucose check
Correct Answer: B
Rationale: For acute ischemic stroke, non-contrast head CT must be obtained
immediately to rule out hemorrhage before thrombolytics. This should be done
within 25 minutes of arrival, read within 45 minutes.
6. A patient with a chief complaint of “weakness” has a temperature of
39.5°C, heart rate 130, blood pressure 85/50, and respiratory rate 24. The
patient is confused. Which triage priority is correct?
A. Sepsis alert (qSOFA positive) – immediate antibiotics and fluids
B. Observe in the waiting room
,C. Schedule for outpatient follow-up
D. Send for chest x-ray before provider evaluation
Correct Answer: A
Rationale: qSOFA: altered mental status, RR ≥22, SBP ≤100. This patient has 3/3,
indicating high risk of sepsis. Hour-1 bundle: measure lactate, blood cultures,
antibiotics, fluids.
7. A 30-year-old female presents with severe abdominal pain and vaginal
spotting. She is 8 weeks pregnant. Her blood pressure is 90/60, HR 120, and
she has a positive pregnancy test. The nurse should suspect:
A. Placenta previa
B. Ectopic pregnancy with possible rupture
C. Appendicitis
D. Ovarian cyst
Correct Answer: B
Rationale: First trimester bleeding and hypotension should prompt immediate
evaluation for ruptured ectopic pregnancy. Bedside ultrasound and surgical consult
are urgent.
8. Which of the following is an appropriate example of a “red tag” in a mass
casualty incident (MCI)?
A. Ambulatory patient with minor abrasions
B. Patient with severe head injury, agonal breathing (immediate life threat)
C. Deceased victim
D. Patient with a simple femur fracture but stable vital signs
Correct Answer: B
Rationale: Red tag (immediate) for life-threatening injuries that can be treated
with reasonable resources. Agonal breathing indicates imminent airway
compromise.
9. A 4-year-old is found unresponsive, not breathing, and without a pulse. The
lone rescuer nurse should:
A. Leave the child to get the AED
B. Start CPR with 30:2 compressions-to-ventilation ratio (single rescuer child)
C. Give 2 rescue breaths before starting compressions
D. Perform abdominal thrusts
Correct Answer: B
Rationale: For pediatric cardiac arrest, single rescuer does 30:2 cycles. If two
, rescuers, 15:2. AED should be obtained if available, but do not leave child
unattended; start CPR first.
10. A 55-year-old with a history of opioid use disorder is found unresponsive
with pinpoint pupils and respiratory rate of 4. The nurse should first:
A. Administer naloxone 0.4-2 mg IV/IM
B. Intubate
C. Start an IV drip of dopamine
D. Obtain a urine drug screen
Correct Answer: A
Rationale: Suspected opioid overdose with respiratory depression is a naloxone
emergency. Administer naloxone while providing bag-mask ventilation.
Domain 2: Cardiovascular Emergencies (Questions 11-20)
11. A 62-year-old presents with chest pain described as “pressure” radiating
to the left arm, with diaphoresis and nausea. ECG shows ST-segment
elevation in leads V1-V4. The most appropriate immediate intervention is:
A. Morphine 4 mg IV
B. Aspirin 324 mg chewable and activate the cath lab for primary PCI
C. Nitroglycerin 0.4 mg sublingual
D. IV furosemide
Correct Answer: B
Rationale: STEMI (anterior wall) requires immediate reperfusion with primary
PCI (goal door-to-balloon <90 minutes). Aspirin is given immediately.
12. A patient with atrial fibrillation and rapid ventricular response (HR 150)
has a blood pressure of 85/50, chest pain, and altered mental status. The nurse
should prepare for:
A. IV metoprolol
B. Synchronized cardioversion
C. IV amiodarone
D. IV digoxin
Correct Answer: B
Rationale: Unstable tachycardia (hypotension, chest pain, altered mental status)
requires immediate synchronized cardioversion (starting at 50-100 J for atrial
fibrillation).
