CEN Practice Exam – 260 Questions with Rationales |
Certified Emergency Nurse | BCEN Certification |
Updated 2026 Blueprint
TABLE OF CONTENTS
1. Cardiovascular Emergencies (Questions 1–40)
2. Respiratory Emergencies (Questions 41–70)
3. Neurological Emergencies (Questions 71–95)
4. Gastrointestinal Emergencies (Questions 96–115)
5. Genitourinary and Renal Emergencies (Questions 116–130)
6. Obstetrical and Gynecological Emergencies (Questions 131–145)
7. Head, Eye, Ear, Nose, and Throat (HEENT) Emergencies (Questions 146–165)
8. Orthopedic and Musculoskeletal Emergencies (Questions 166–180)
9. Environmental and Toxicological Emergencies (Questions 181–200)
10.Shock and Multi-System Trauma (Questions 201–220)
11.Psychiatric and Behavioral Emergencies (Questions 221–235)
12.Infectious Disease and Immunologic Emergencies (Questions 236–250)
13.Endocrine and Metabolic Emergencies (Questions 251–260)
CARDIOVASCULAR EMERGENCIES (Questions 1–40)
Question 1 A 58-year-old male presents with chest pain described as pressure radiating to the jaw. He
is diaphoretic and nauseous. His ECG shows ST-segment elevation in leads V1-V4. What is the
priority intervention?
A. Administer aspirin 324 mg chewable B. Administer morphine IV C. Administer sublingual
nitroglycerin D. Prepare for immediate percutaneous coronary intervention (PCI)
Correct Answer: D Rationale: ST elevation in V1-V4 indicates an anterior ST-elevation myocardial
infarction (STEMI) caused by LAD occlusion. The priority is to minimize time to revascularization
,(PCI). Aspirin (A) should be given immediately, but PCI is the definitive treatment. Morphine (B) and
nitroglycerin (C) are adjunctive.
Question 2 (Select all that apply) Which of the following are contraindications to fibrinolytic therapy
in acute STEMI? (Select all that apply)
A. History of cerebral vascular disease/stroke B. Active internal bleeding C. Recent major surgery (<3
weeks) D. Uncontrolled hypertension (BP >180/110) E. Age >75
Correct Answers: A, B, C, D Rationale: History of stroke (A), active bleeding (B), recent surgery
(C), and severe hypertension (D) are absolute or relative contraindications. Age >75 (E) is not an
absolute contraindication.
Question 3 A patient with acute myocardial infarction develops a new systolic murmur at the apex.
Which complication should the nurse suspect?
A. Ventricular septal defect (VSD) B. Papillary muscle rupture (acute mitral regurgitation) C. Left
ventricular aneurysm D. Pericarditis
Correct Answer: B Rationale: A new systolic murmur at the apex suggests acute mitral regurgitation
from papillary muscle rupture. VSD (A) causes a harsh holosystolic murmur at the left sternal border.
Question 4 A patient presents with sudden onset of severe, tearing chest pain radiating to the back.
Blood pressure is 190/110 in the right arm and 120/70 in the left arm. What is the most likely
diagnosis?
A. Pulmonary embolism B. Acute aortic dissection C. Myocardial infarction D. Pericarditis
Correct Answer: B Rationale: Aortic dissection presents with tearing chest pain, pulse deficit (BP
difference between arms), and hypertension. This is a medical emergency requiring immediate
surgical consultation and blood pressure control.
Question 5 (Select all that apply) Which of the following are signs of cardiac tamponade? (Select all
that apply)
A. Muffled heart sounds B. Hypotension C. Jugular venous distension (JVD) D. Pulsus paradoxus E.
Widened pulse pressure
Correct Answers: A, B, C, D Rationale: Beck's triad: muffled heart sounds (A), hypotension (B),
JVD (C). Pulsus paradoxus (D) is also present. Widened pulse pressure (E) is seen in aortic
regurgitation.
,Question 6 A patient with pericarditis is placed on colchicine. What is the primary purpose of
colchicine?
A. Pain relief B. Reduce inflammation and prevent recurrence C. Reduce fever D. Prevent
arrhythmias
Correct Answer: B Rationale: Colchicine is used in pericarditis to reduce inflammation and prevent
recurrence. NSAIDs (A) are first-line for pain.
Question 7 A patient with acute heart failure presents with crackles in both lungs, JVD, and 3+
pitting edema. Vital signs: BP 110/70, HR 102, RR 24, SpO2 90%. Which medication should the
nurse anticipate first?
A. IV furosemide (Lasix) B. IV dobutamine C. IV nitroglycerin D. Oral metoprolol
Correct Answer: A Rationale: IV furosemide is the first-line treatment for acute decompensated
heart failure with fluid overload. It reduces preload and pulmonary congestion.
Question 8 (Select all that apply) Which of the following are signs of cardiogenic shock? (Select all
that apply)
A. Hypotension (SBP <90) B. Tachycardia C. Cool, clammy skin D. Oliguria (<30 mL/hr) E. Altered
mental status
Correct Answers: A, B, C, D, E Rationale: Cardiogenic shock is caused by pump failure. Signs:
hypotension (A), tachycardia (B), cool, clammy skin (vasoconstriction), oliguria (D), and altered
mental status (E).
Question 9 A patient in cardiogenic shock is on dobutamine. What is the mechanism of action?
A. Beta-1 agonist (increases contractility, minimal vasoconstriction) B. Alpha-1 agonist
(vasoconstriction) C. Beta-2 agonist (vasodilation) D. Phosphodiesterase inhibitor (increases cAMP)
Correct Answer: A Rationale: Dobutamine is a beta-1 agonist that increases cardiac contractility
(inotropy) with mild chronotropy and mild vasodilation. It is used in cardiogenic shock with low
cardiac output.
Question 10 A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which treatment is
indicated?
A. Aspirin B. Warfarin or DOAC (direct oral anticoagulant) C. No anticoagulation D. Clopidogrel
Correct Answer: B Rationale: A score of ≥2 in men or ≥3 in women indicates high stroke risk, and
anticoagulation (warfarin or DOAC) is recommended. Aspirin (A) is not sufficient.
, Question 11 (Select all that apply) Which of the following are signs of digoxin toxicity? (Select all
that apply)
A. Nausea and vomiting B. Visual changes (yellow halos) C. Bradycardia D. Arrhythmias (ventricular
tachycardia) E. Hyperkalemia
Correct Answers: A, B, C, D, E Rationale: Digoxin toxicity causes GI symptoms (nausea, vomiting
– A), visual changes (yellow halos – B), bradycardia (C), arrhythmias (D), and hyperkalemia (E).
Monitor digoxin levels.
Question 12 A patient with acute coronary syndrome is on dual antiplatelet therapy (aspirin +
ticagrelor). Which side effect should the nurse monitor?
A. Bleeding B. Bradycardia C. Hyperkalemia D. Nephrotoxicity
Correct Answer: A Rationale: Dual antiplatelet therapy increases the risk of bleeding. Ticagrelor
can also cause dyspnea.
Question 13 A patient with an abdominal aortic aneurysm (AAA) is scheduled for repair. Which
finding indicates a rupturing AAA?
A. Sudden severe back pain B. Hypotension C. Pulsatile abdominal mass D. All of the above
Correct Answer: D Rationale: Rupturing AAA presents with sudden severe back pain (A),
hypotension (B), and a pulsatile abdominal mass (C). This is a surgical emergency.
Question 14 (Select all that apply) Which of the following are ECG changes seen in acute
pericarditis? (Select all that apply)
A. Diffuse ST-segment elevation B. PR-segment depression C. Reciprocal ST-segment depression D.
Q waves E. T-wave inversion (late)
Correct Answers: A, B, E Rationale: Pericarditis shows diffuse ST elevation (A), PR depression
(B), and late T-wave inversion (E). Reciprocal ST depression (C) is seen in MI. Q waves (D) indicate
infarction.
Question 15 A patient with ST-elevation MI is receiving thrombolytic therapy. Which finding
indicates successful reperfusion?
A. Resolution of ST-segment elevation by ≥50% B. Development of new Q waves C. Persistent chest
pain D. Decreased heart rate
Certified Emergency Nurse | BCEN Certification |
Updated 2026 Blueprint
TABLE OF CONTENTS
1. Cardiovascular Emergencies (Questions 1–40)
2. Respiratory Emergencies (Questions 41–70)
3. Neurological Emergencies (Questions 71–95)
4. Gastrointestinal Emergencies (Questions 96–115)
5. Genitourinary and Renal Emergencies (Questions 116–130)
6. Obstetrical and Gynecological Emergencies (Questions 131–145)
7. Head, Eye, Ear, Nose, and Throat (HEENT) Emergencies (Questions 146–165)
8. Orthopedic and Musculoskeletal Emergencies (Questions 166–180)
9. Environmental and Toxicological Emergencies (Questions 181–200)
10.Shock and Multi-System Trauma (Questions 201–220)
11.Psychiatric and Behavioral Emergencies (Questions 221–235)
12.Infectious Disease and Immunologic Emergencies (Questions 236–250)
13.Endocrine and Metabolic Emergencies (Questions 251–260)
CARDIOVASCULAR EMERGENCIES (Questions 1–40)
Question 1 A 58-year-old male presents with chest pain described as pressure radiating to the jaw. He
is diaphoretic and nauseous. His ECG shows ST-segment elevation in leads V1-V4. What is the
priority intervention?
A. Administer aspirin 324 mg chewable B. Administer morphine IV C. Administer sublingual
nitroglycerin D. Prepare for immediate percutaneous coronary intervention (PCI)
Correct Answer: D Rationale: ST elevation in V1-V4 indicates an anterior ST-elevation myocardial
infarction (STEMI) caused by LAD occlusion. The priority is to minimize time to revascularization
,(PCI). Aspirin (A) should be given immediately, but PCI is the definitive treatment. Morphine (B) and
nitroglycerin (C) are adjunctive.
Question 2 (Select all that apply) Which of the following are contraindications to fibrinolytic therapy
in acute STEMI? (Select all that apply)
A. History of cerebral vascular disease/stroke B. Active internal bleeding C. Recent major surgery (<3
weeks) D. Uncontrolled hypertension (BP >180/110) E. Age >75
Correct Answers: A, B, C, D Rationale: History of stroke (A), active bleeding (B), recent surgery
(C), and severe hypertension (D) are absolute or relative contraindications. Age >75 (E) is not an
absolute contraindication.
Question 3 A patient with acute myocardial infarction develops a new systolic murmur at the apex.
Which complication should the nurse suspect?
A. Ventricular septal defect (VSD) B. Papillary muscle rupture (acute mitral regurgitation) C. Left
ventricular aneurysm D. Pericarditis
Correct Answer: B Rationale: A new systolic murmur at the apex suggests acute mitral regurgitation
from papillary muscle rupture. VSD (A) causes a harsh holosystolic murmur at the left sternal border.
Question 4 A patient presents with sudden onset of severe, tearing chest pain radiating to the back.
Blood pressure is 190/110 in the right arm and 120/70 in the left arm. What is the most likely
diagnosis?
A. Pulmonary embolism B. Acute aortic dissection C. Myocardial infarction D. Pericarditis
Correct Answer: B Rationale: Aortic dissection presents with tearing chest pain, pulse deficit (BP
difference between arms), and hypertension. This is a medical emergency requiring immediate
surgical consultation and blood pressure control.
Question 5 (Select all that apply) Which of the following are signs of cardiac tamponade? (Select all
that apply)
A. Muffled heart sounds B. Hypotension C. Jugular venous distension (JVD) D. Pulsus paradoxus E.
Widened pulse pressure
Correct Answers: A, B, C, D Rationale: Beck's triad: muffled heart sounds (A), hypotension (B),
JVD (C). Pulsus paradoxus (D) is also present. Widened pulse pressure (E) is seen in aortic
regurgitation.
,Question 6 A patient with pericarditis is placed on colchicine. What is the primary purpose of
colchicine?
A. Pain relief B. Reduce inflammation and prevent recurrence C. Reduce fever D. Prevent
arrhythmias
Correct Answer: B Rationale: Colchicine is used in pericarditis to reduce inflammation and prevent
recurrence. NSAIDs (A) are first-line for pain.
Question 7 A patient with acute heart failure presents with crackles in both lungs, JVD, and 3+
pitting edema. Vital signs: BP 110/70, HR 102, RR 24, SpO2 90%. Which medication should the
nurse anticipate first?
A. IV furosemide (Lasix) B. IV dobutamine C. IV nitroglycerin D. Oral metoprolol
Correct Answer: A Rationale: IV furosemide is the first-line treatment for acute decompensated
heart failure with fluid overload. It reduces preload and pulmonary congestion.
Question 8 (Select all that apply) Which of the following are signs of cardiogenic shock? (Select all
that apply)
A. Hypotension (SBP <90) B. Tachycardia C. Cool, clammy skin D. Oliguria (<30 mL/hr) E. Altered
mental status
Correct Answers: A, B, C, D, E Rationale: Cardiogenic shock is caused by pump failure. Signs:
hypotension (A), tachycardia (B), cool, clammy skin (vasoconstriction), oliguria (D), and altered
mental status (E).
Question 9 A patient in cardiogenic shock is on dobutamine. What is the mechanism of action?
A. Beta-1 agonist (increases contractility, minimal vasoconstriction) B. Alpha-1 agonist
(vasoconstriction) C. Beta-2 agonist (vasodilation) D. Phosphodiesterase inhibitor (increases cAMP)
Correct Answer: A Rationale: Dobutamine is a beta-1 agonist that increases cardiac contractility
(inotropy) with mild chronotropy and mild vasodilation. It is used in cardiogenic shock with low
cardiac output.
Question 10 A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which treatment is
indicated?
A. Aspirin B. Warfarin or DOAC (direct oral anticoagulant) C. No anticoagulation D. Clopidogrel
Correct Answer: B Rationale: A score of ≥2 in men or ≥3 in women indicates high stroke risk, and
anticoagulation (warfarin or DOAC) is recommended. Aspirin (A) is not sufficient.
, Question 11 (Select all that apply) Which of the following are signs of digoxin toxicity? (Select all
that apply)
A. Nausea and vomiting B. Visual changes (yellow halos) C. Bradycardia D. Arrhythmias (ventricular
tachycardia) E. Hyperkalemia
Correct Answers: A, B, C, D, E Rationale: Digoxin toxicity causes GI symptoms (nausea, vomiting
– A), visual changes (yellow halos – B), bradycardia (C), arrhythmias (D), and hyperkalemia (E).
Monitor digoxin levels.
Question 12 A patient with acute coronary syndrome is on dual antiplatelet therapy (aspirin +
ticagrelor). Which side effect should the nurse monitor?
A. Bleeding B. Bradycardia C. Hyperkalemia D. Nephrotoxicity
Correct Answer: A Rationale: Dual antiplatelet therapy increases the risk of bleeding. Ticagrelor
can also cause dyspnea.
Question 13 A patient with an abdominal aortic aneurysm (AAA) is scheduled for repair. Which
finding indicates a rupturing AAA?
A. Sudden severe back pain B. Hypotension C. Pulsatile abdominal mass D. All of the above
Correct Answer: D Rationale: Rupturing AAA presents with sudden severe back pain (A),
hypotension (B), and a pulsatile abdominal mass (C). This is a surgical emergency.
Question 14 (Select all that apply) Which of the following are ECG changes seen in acute
pericarditis? (Select all that apply)
A. Diffuse ST-segment elevation B. PR-segment depression C. Reciprocal ST-segment depression D.
Q waves E. T-wave inversion (late)
Correct Answers: A, B, E Rationale: Pericarditis shows diffuse ST elevation (A), PR depression
(B), and late T-wave inversion (E). Reciprocal ST depression (C) is seen in MI. Q waves (D) indicate
infarction.
Question 15 A patient with ST-elevation MI is receiving thrombolytic therapy. Which finding
indicates successful reperfusion?
A. Resolution of ST-segment elevation by ≥50% B. Development of new Q waves C. Persistent chest
pain D. Decreased heart rate
