Advanced CEN (Certified Emergency Nurse)
Multiple Choice Questions (MCQs) with
Answers and Explanations for Professional
Certification Exams
1. A 32-year-old patient involved in a motor vehicle collision presents with hypotension,
distended neck veins, muffled heart sounds, and pulsus paradoxus. Which condition
should the emergency nurse suspect?
A. Tension pneumothorax
B. Massive pulmonary embolism
C. Septic shock
D. Cardiac tamponade
Explanation: Beck's triad of hypotension, jugular venous distention, and muffled heart sounds is
characteristic of cardiac tamponade. Pulsus paradoxus further supports impaired ventricular
filling requiring emergent intervention.
2. A patient arrives with chest pain radiating to the jaw and diaphoresis. Which biomarker is
most specific for myocardial necrosis?
A. Myoglobin
B. Creatine kinase
C. Lactate dehydrogenase
D. Troponin I
Explanation: Troponin I is highly sensitive and specific for myocardial injury and is considered
the preferred biomarker in diagnosing acute myocardial infarction.
3. A patient with diabetic ketoacidosis has a serum potassium level of 2.9 mEq/L. What
should the nurse do before initiating insulin therapy?
A. Administer sodium bicarbonate
B. Start regular insulin infusion immediately
, C. Restrict intravenous fluids
D. Replace potassium before initiating insulin
Explanation: Insulin drives potassium intracellularly and may precipitate life-threatening
hypokalemia if potassium deficits are not corrected first.
4. A trauma patient develops absent breath sounds on the right side, tracheal deviation, and
severe respiratory distress. Which intervention should be anticipated immediately?
A. Chest radiography
B. Endotracheal suctioning
C. Pulmonary angiography
D. Needle decompression
Explanation: Tension pneumothorax is a life-threatening emergency that requires immediate
decompression without delaying for diagnostic imaging.
5. A patient with sepsis remains hypotensive after receiving adequate intravenous fluids.
Which medication is considered the first-line vasopressor?
A. Dopamine
B. Vasopressin
C. Dobutamine
D. Norepinephrine
Explanation: Norepinephrine is the recommended first-line vasopressor for septic shock because
of its potent vasoconstrictive properties and favorable safety profile.
6. Which electrocardiographic finding is most characteristic of hyperkalemia?
A. Prolonged PR interval only
B. ST-segment elevation
C. Atrial flutter
D. Peaked T waves
Multiple Choice Questions (MCQs) with
Answers and Explanations for Professional
Certification Exams
1. A 32-year-old patient involved in a motor vehicle collision presents with hypotension,
distended neck veins, muffled heart sounds, and pulsus paradoxus. Which condition
should the emergency nurse suspect?
A. Tension pneumothorax
B. Massive pulmonary embolism
C. Septic shock
D. Cardiac tamponade
Explanation: Beck's triad of hypotension, jugular venous distention, and muffled heart sounds is
characteristic of cardiac tamponade. Pulsus paradoxus further supports impaired ventricular
filling requiring emergent intervention.
2. A patient arrives with chest pain radiating to the jaw and diaphoresis. Which biomarker is
most specific for myocardial necrosis?
A. Myoglobin
B. Creatine kinase
C. Lactate dehydrogenase
D. Troponin I
Explanation: Troponin I is highly sensitive and specific for myocardial injury and is considered
the preferred biomarker in diagnosing acute myocardial infarction.
3. A patient with diabetic ketoacidosis has a serum potassium level of 2.9 mEq/L. What
should the nurse do before initiating insulin therapy?
A. Administer sodium bicarbonate
B. Start regular insulin infusion immediately
, C. Restrict intravenous fluids
D. Replace potassium before initiating insulin
Explanation: Insulin drives potassium intracellularly and may precipitate life-threatening
hypokalemia if potassium deficits are not corrected first.
4. A trauma patient develops absent breath sounds on the right side, tracheal deviation, and
severe respiratory distress. Which intervention should be anticipated immediately?
A. Chest radiography
B. Endotracheal suctioning
C. Pulmonary angiography
D. Needle decompression
Explanation: Tension pneumothorax is a life-threatening emergency that requires immediate
decompression without delaying for diagnostic imaging.
5. A patient with sepsis remains hypotensive after receiving adequate intravenous fluids.
Which medication is considered the first-line vasopressor?
A. Dopamine
B. Vasopressin
C. Dobutamine
D. Norepinephrine
Explanation: Norepinephrine is the recommended first-line vasopressor for septic shock because
of its potent vasoconstrictive properties and favorable safety profile.
6. Which electrocardiographic finding is most characteristic of hyperkalemia?
A. Prolonged PR interval only
B. ST-segment elevation
C. Atrial flutter
D. Peaked T waves
