CEN Review (ENA Ch.7 Practice Exam) Complete Solutions
A patient with chest pain has a 12-lead electrocardiogram that shows a new onset left bundle branch
block. There is > 1 mm concordant ST elevation in lead aVF. What is the priority intervention for this
patient?
A. Continuous ST-segment monitoring
B. Serial troponin measurements
C. Preparing the patient for transport to the cardiac catheterization lab
D. Admission to a telemetry unit for observation ✔️✔️C. Preparing the patient for transport to the
cardiac catheterization lab
During the completion of a 12-lead electrocardiogram, the nurse identifies excessive artifact in lead II
and lead III. To resolve this technical difficulty, the nurse should:
A. change the right arm electrode.
B. check for cable movement.
C. change the left leg electrode.
D. instruct the patient to momentarily hold their breath. ✔️✔️C. change the left leg electrode.
A patient with ST elevation in leads II, III, and aVF is likely to experience an infarct in which location of
the heart?
A. Inferior
B. Anterior
C. Lateral
D. Posterior ✔️✔️A. Inferior
,A patient states they awoke from sleep with midsternal chest pain approximately 4-5 hours ago. In the
presence of an acute myocardial infarction (AMI), the initial elevation of the troponin cardiac
biomarkers occurs within:
A. 1-2 hours of onset of an AMI.
B. 3-12 hours of onset of an AMI.
C. 24-30 hours of onset of an AMI.
D. 10-24 hours of onset of an AMI. ✔️✔️B. 3-12 hours of onset of an AMI.
The nurse suspects a patient may have an acute aortic dissection when, during the history-taking
process, the patient describes the pain as:
A. squeezing, burning epigastric pain that may radiate to the middle back area.
B. right upper quadrant pain referred to the right scapula and shoulder.
C. sudden, severe tearing or ripping chest, interscapular, or back pain.
D. sharp, stabbing chest pain radiating to the neck, arms, or left shoulder ✔️✔️C. sudden, severe
tearing or ripping chest, interscapular, or back pain.
You are assisting in the resuscitation of a patient in cardiac arrest. A waveform capnography is in place,
and high-quality cardiopulmonary resuscitation is being performed. A sudden increase in the level of the
end-tidal carbon dioxide indicates the:
A. need for deeper and faster chest compressions.
B. need for an additional dose of a vasopressor.
C. presence of an irreversible cardiac arrest.
D. return of spontaneous circulation. ✔️✔️D. return of spontaneous circulation.
The cardiac monitor of a patient in cardiac arrest displays sinus rhythm, but no palpable pulse can be
detected. The most likely cause of this pulseless electrical activity (PEA) is:
A. glucose level of 145 mg/dL.
,B. potassium value of 1.3 mmol/L (1.3 mEq/L).
C. arterial pH of 7.36.
D. magnesium level of 3.0 mg/dL. ✔️✔️B. potassium value of 1.3 mmol/L (1.3 mEq/L).
Which of the following physiological conditions would result in the loss of ventricular capture for a
patient with a transcutaneous pacemaker?
A. Lactic acidosis
B. Hypomagnesemia
C. Metabolic alkalosis
D. Hypokalemia ✔️✔️A. Lactic acidosis
A patient presents complaining of shortness of breath and chest pain. Electrocardiogram reveals a
ventricular rate of 210 with a regular rhythm. Which medication should the nurse anticipate
administering?
A. Adenosine
B. Amiodarone
C. Lidocaine
D. Moricizine ✔️✔️A. Adenosine
On examination of a febrile patient presenting to the emergency department with a chief complaint of
"flulike symptoms" and a history of intravenous drug use, the nurse notes a cardiac murmur, crackles in
bilateral lung bases, subungual hemorrhages, nontender erythematous macules on the palms of the
hands and soles of the feet, and painful erythematous nodules on the tips of the fingers and toes. Which
is the priority intervention for this patient?
A. Echocardiogram
B. Chest radiography
C. Surgery
D. Antibiotics ✔️✔️D. Antibiotics
, A patient presents to the emergency department complaining of a severe headache. Vital signs reveal a
BP of 270/170 mm Hg. The patient is alert and describes being recently diagnosed with high blood
pressure. What is the priority intervention for this patient?
A. Initiate intravenous medication to lower the patient's BP immediately
B. Obtain baseline laboratory data
C. Consider emergency cardioversion for BP control
D. Evaluate the BP cuff size for accuracy ✔️✔️D. Evaluate the BP cuff size for accuracy
Administration of nitroprusside (Nipride) to a patient in a hypertensive crisis without evidence of aortic
dissection is considered effective when the patient demonstrates which of the following?
A. The patient responds to verbal stimuli.
B. The systolic blood pressure reaches 160 mm Hg.
C. The systolic blood pressure reaches 120 mm Hg.
D. The patient reports relief of chest pain. ✔️✔️B. The systolic blood pressure reaches 160 mm Hg.
Which of the following is a symptom of pericardial tamponade?
A. Muffled heart tones
B. Widening pulse pressure
C. Jugular vein flattening
D. Tracheal deviation ✔️✔️A. Muffled heart tones
A child with a recent diagnosis of hand, foot, and mouth disease complains of chest pain that hurts more
while coughing and "when taking a deep breath." The nurse notes that the child is sitting upright on the
mother's lap and is leaning forward. Based on the patient's most recent illness history, the nurse knows
this patient is at risk for developing:
A. pneumonia.
A patient with chest pain has a 12-lead electrocardiogram that shows a new onset left bundle branch
block. There is > 1 mm concordant ST elevation in lead aVF. What is the priority intervention for this
patient?
A. Continuous ST-segment monitoring
B. Serial troponin measurements
C. Preparing the patient for transport to the cardiac catheterization lab
D. Admission to a telemetry unit for observation ✔️✔️C. Preparing the patient for transport to the
cardiac catheterization lab
During the completion of a 12-lead electrocardiogram, the nurse identifies excessive artifact in lead II
and lead III. To resolve this technical difficulty, the nurse should:
A. change the right arm electrode.
B. check for cable movement.
C. change the left leg electrode.
D. instruct the patient to momentarily hold their breath. ✔️✔️C. change the left leg electrode.
A patient with ST elevation in leads II, III, and aVF is likely to experience an infarct in which location of
the heart?
A. Inferior
B. Anterior
C. Lateral
D. Posterior ✔️✔️A. Inferior
,A patient states they awoke from sleep with midsternal chest pain approximately 4-5 hours ago. In the
presence of an acute myocardial infarction (AMI), the initial elevation of the troponin cardiac
biomarkers occurs within:
A. 1-2 hours of onset of an AMI.
B. 3-12 hours of onset of an AMI.
C. 24-30 hours of onset of an AMI.
D. 10-24 hours of onset of an AMI. ✔️✔️B. 3-12 hours of onset of an AMI.
The nurse suspects a patient may have an acute aortic dissection when, during the history-taking
process, the patient describes the pain as:
A. squeezing, burning epigastric pain that may radiate to the middle back area.
B. right upper quadrant pain referred to the right scapula and shoulder.
C. sudden, severe tearing or ripping chest, interscapular, or back pain.
D. sharp, stabbing chest pain radiating to the neck, arms, or left shoulder ✔️✔️C. sudden, severe
tearing or ripping chest, interscapular, or back pain.
You are assisting in the resuscitation of a patient in cardiac arrest. A waveform capnography is in place,
and high-quality cardiopulmonary resuscitation is being performed. A sudden increase in the level of the
end-tidal carbon dioxide indicates the:
A. need for deeper and faster chest compressions.
B. need for an additional dose of a vasopressor.
C. presence of an irreversible cardiac arrest.
D. return of spontaneous circulation. ✔️✔️D. return of spontaneous circulation.
The cardiac monitor of a patient in cardiac arrest displays sinus rhythm, but no palpable pulse can be
detected. The most likely cause of this pulseless electrical activity (PEA) is:
A. glucose level of 145 mg/dL.
,B. potassium value of 1.3 mmol/L (1.3 mEq/L).
C. arterial pH of 7.36.
D. magnesium level of 3.0 mg/dL. ✔️✔️B. potassium value of 1.3 mmol/L (1.3 mEq/L).
Which of the following physiological conditions would result in the loss of ventricular capture for a
patient with a transcutaneous pacemaker?
A. Lactic acidosis
B. Hypomagnesemia
C. Metabolic alkalosis
D. Hypokalemia ✔️✔️A. Lactic acidosis
A patient presents complaining of shortness of breath and chest pain. Electrocardiogram reveals a
ventricular rate of 210 with a regular rhythm. Which medication should the nurse anticipate
administering?
A. Adenosine
B. Amiodarone
C. Lidocaine
D. Moricizine ✔️✔️A. Adenosine
On examination of a febrile patient presenting to the emergency department with a chief complaint of
"flulike symptoms" and a history of intravenous drug use, the nurse notes a cardiac murmur, crackles in
bilateral lung bases, subungual hemorrhages, nontender erythematous macules on the palms of the
hands and soles of the feet, and painful erythematous nodules on the tips of the fingers and toes. Which
is the priority intervention for this patient?
A. Echocardiogram
B. Chest radiography
C. Surgery
D. Antibiotics ✔️✔️D. Antibiotics
, A patient presents to the emergency department complaining of a severe headache. Vital signs reveal a
BP of 270/170 mm Hg. The patient is alert and describes being recently diagnosed with high blood
pressure. What is the priority intervention for this patient?
A. Initiate intravenous medication to lower the patient's BP immediately
B. Obtain baseline laboratory data
C. Consider emergency cardioversion for BP control
D. Evaluate the BP cuff size for accuracy ✔️✔️D. Evaluate the BP cuff size for accuracy
Administration of nitroprusside (Nipride) to a patient in a hypertensive crisis without evidence of aortic
dissection is considered effective when the patient demonstrates which of the following?
A. The patient responds to verbal stimuli.
B. The systolic blood pressure reaches 160 mm Hg.
C. The systolic blood pressure reaches 120 mm Hg.
D. The patient reports relief of chest pain. ✔️✔️B. The systolic blood pressure reaches 160 mm Hg.
Which of the following is a symptom of pericardial tamponade?
A. Muffled heart tones
B. Widening pulse pressure
C. Jugular vein flattening
D. Tracheal deviation ✔️✔️A. Muffled heart tones
A child with a recent diagnosis of hand, foot, and mouth disease complains of chest pain that hurts more
while coughing and "when taking a deep breath." The nurse notes that the child is sitting upright on the
mother's lap and is leaning forward. Based on the patient's most recent illness history, the nurse knows
this patient is at risk for developing:
A. pneumonia.
