CEN (EMERGENCY NURSING) –QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Cardiovascular EmergenciesRespiratory EmergenciesNeurological EmergenciesGastrointestinal,
Genitourinary, and Gynecological EmergenciesOrthopedic and Wound EmergenciesMedical Emergencies and
ToxicologyProfessional Issues and Psychosocial EmergenciesShock and Multi-system Trauma
Introduction
The Certified Emergency Nurse (CEN) assessment is designed to evaluate the clinical proficiency, critical
thinking, and decision-making skills required for high-stakes emergency department environments. This
comprehensive examination covers a broad spectrum of clinical scenarios, ranging from foundational
pathophysiology to complex multi-system trauma management. By utilizing a rigorous multiple-choice format,
the assessment ensures that candidates possess the necessary knowledge to provide safe, evidence-based
care under pressure. The questions emphasize real-world application, regulatory compliance, and ethical
standards, reflecting the diverse and unpredictable nature of emergency nursing practice and ensuring
practitioners are prepared for the highest level of professional certification.
SECTION ONE: QUESTIONS 1–100
1. A 62-year-old male presents with sudden onset tearing chest pain radiating to the back and a blood
pressure discrepancy of 25 mmHg between arms. Which intervention is the highest priority?
A. Administration of high-dose aspirin
B. Initiation of a beta-blocker infusion
C. Preparation for immediate fibrinolytic therapy
D. Administration of a 1L normal saline bolus
🟢 Correct answer: B. Initiation of a beta-blocker infusion
🔴 RATIONALE: The clinical presentation is highly suggestive of an aortic dissection. The primary goal is to
,reduce heart rate and blood pressure (shear stress) to prevent further tearing, typically achieved with IV beta-
blockers like esmolol or labetalol.
2. A patient presents with a suspected opioid overdose. Which physical finding most specifically indicates the
need for naloxone administration?
A. Tachycardia and hypertension
B. Dilated, reactive pupils
C. Respiratory rate of 6 breaths per minute
D. Increased bowel sounds
🟢 Correct answer: C. Respiratory rate of 6 breaths per minute
🔴 RATIONALE: The primary indication for naloxone in the emergency setting is respiratory depression. While
miosis (pinpoint pupils) is a common sign of opioid use, the clinical priority is maintaining adequate ventilation.
3. During the primary survey of a trauma patient, the nurse notes paradoxical chest wall movement. This
finding is most indicative of:
A. Tension pneumothorax
B. Flail chest
C. Hemothorax
D. Pulmonary contusion
🟢 Correct answer: B. Flail chest
🔴 RATIONALE: Paradoxical chest wall movement (the injured area moving inward during inspiration and
outward during expiration) is the hallmark sign of a flail chest, occurring when two or more adjacent ribs are
fractured in two or more places.
4. A patient with a history of end-stage renal disease presents with peaked T-waves on the ECG. Which
medication is administered first to protect the myocardium?
, A. Sodium bicarbonate
B. Insulin and Dextrose 50%
C. Calcium gluconate
D. Sodium polystyrene sulfonate
🟢 Correct answer: C. Calcium gluconate
🔴 RATIONALE: In the setting of hyperkalemia with ECG changes, calcium gluconate or calcium chloride is
administered first to stabilize the myocardial cell membrane and prevent life-threatening arrhythmias.
5. Which of the following is a late sign of compartment syndrome?
A. Pain out of proportion to the injury
B. Paresthesia
C. Pulselessness
D. Pallor
🟢 Correct answer: C. Pulselessness
🔴 RATIONALE: Pulselessness and paralysis are late signs of compartment syndrome, indicating significant
ischemia. The "6 Ps" usually begin with pain and paresthesia.
6. A 4-year-old child presents with a high fever, muffled voice, and drooling. What is the most appropriate
nursing action?
A. Examine the throat using a tongue blade
B. Keep the child calm and prepare for intubation
C. Obtain a STAT throat culture
D. Place the child in a supine position for assessment
🟢 Correct answer: B. Keep the child calm and prepare for intubation
🔴 RATIONALE: These symptoms are classic for epiglottitis. Any agitation or invasive examination of the throat
(like using a tongue blade) can trigger a total airway obstruction.
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Cardiovascular EmergenciesRespiratory EmergenciesNeurological EmergenciesGastrointestinal,
Genitourinary, and Gynecological EmergenciesOrthopedic and Wound EmergenciesMedical Emergencies and
ToxicologyProfessional Issues and Psychosocial EmergenciesShock and Multi-system Trauma
Introduction
The Certified Emergency Nurse (CEN) assessment is designed to evaluate the clinical proficiency, critical
thinking, and decision-making skills required for high-stakes emergency department environments. This
comprehensive examination covers a broad spectrum of clinical scenarios, ranging from foundational
pathophysiology to complex multi-system trauma management. By utilizing a rigorous multiple-choice format,
the assessment ensures that candidates possess the necessary knowledge to provide safe, evidence-based
care under pressure. The questions emphasize real-world application, regulatory compliance, and ethical
standards, reflecting the diverse and unpredictable nature of emergency nursing practice and ensuring
practitioners are prepared for the highest level of professional certification.
SECTION ONE: QUESTIONS 1–100
1. A 62-year-old male presents with sudden onset tearing chest pain radiating to the back and a blood
pressure discrepancy of 25 mmHg between arms. Which intervention is the highest priority?
A. Administration of high-dose aspirin
B. Initiation of a beta-blocker infusion
C. Preparation for immediate fibrinolytic therapy
D. Administration of a 1L normal saline bolus
🟢 Correct answer: B. Initiation of a beta-blocker infusion
🔴 RATIONALE: The clinical presentation is highly suggestive of an aortic dissection. The primary goal is to
,reduce heart rate and blood pressure (shear stress) to prevent further tearing, typically achieved with IV beta-
blockers like esmolol or labetalol.
2. A patient presents with a suspected opioid overdose. Which physical finding most specifically indicates the
need for naloxone administration?
A. Tachycardia and hypertension
B. Dilated, reactive pupils
C. Respiratory rate of 6 breaths per minute
D. Increased bowel sounds
🟢 Correct answer: C. Respiratory rate of 6 breaths per minute
🔴 RATIONALE: The primary indication for naloxone in the emergency setting is respiratory depression. While
miosis (pinpoint pupils) is a common sign of opioid use, the clinical priority is maintaining adequate ventilation.
3. During the primary survey of a trauma patient, the nurse notes paradoxical chest wall movement. This
finding is most indicative of:
A. Tension pneumothorax
B. Flail chest
C. Hemothorax
D. Pulmonary contusion
🟢 Correct answer: B. Flail chest
🔴 RATIONALE: Paradoxical chest wall movement (the injured area moving inward during inspiration and
outward during expiration) is the hallmark sign of a flail chest, occurring when two or more adjacent ribs are
fractured in two or more places.
4. A patient with a history of end-stage renal disease presents with peaked T-waves on the ECG. Which
medication is administered first to protect the myocardium?
, A. Sodium bicarbonate
B. Insulin and Dextrose 50%
C. Calcium gluconate
D. Sodium polystyrene sulfonate
🟢 Correct answer: C. Calcium gluconate
🔴 RATIONALE: In the setting of hyperkalemia with ECG changes, calcium gluconate or calcium chloride is
administered first to stabilize the myocardial cell membrane and prevent life-threatening arrhythmias.
5. Which of the following is a late sign of compartment syndrome?
A. Pain out of proportion to the injury
B. Paresthesia
C. Pulselessness
D. Pallor
🟢 Correct answer: C. Pulselessness
🔴 RATIONALE: Pulselessness and paralysis are late signs of compartment syndrome, indicating significant
ischemia. The "6 Ps" usually begin with pain and paresthesia.
6. A 4-year-old child presents with a high fever, muffled voice, and drooling. What is the most appropriate
nursing action?
A. Examine the throat using a tongue blade
B. Keep the child calm and prepare for intubation
C. Obtain a STAT throat culture
D. Place the child in a supine position for assessment
🟢 Correct answer: B. Keep the child calm and prepare for intubation
🔴 RATIONALE: These symptoms are classic for epiglottitis. Any agitation or invasive examination of the throat
(like using a tongue blade) can trigger a total airway obstruction.
