CEN Certified Emergency Nurse MCQ 3 — Questions and Answers
Question 1: A patient presents with sudden onset severe headache described as 'the worst headache of my life.' What is the priority diagnosis to rule out?
- Migraine with aura
- Subarachnoid hemorrhage (Correct answer)
- Hypertensive urgency
- Cluster headache
Correct answer: Subarachnoid hemorrhage
A thunderclap headache (worst of life) is subarachnoid hemorrhage until proven otherwise, requiring immediate CT head without contrast.
Question 2: Which intervention is contraindicated in a patient with suspected increased intracranial pressure (ICP)?
- Elevating the head of bed to 30 degrees
- Administering hypertonic saline 3%
- Vigorous suctioning for more than 15 seconds (Correct answer)
- Maintaining PaCO2 between 35–45 mmHg
Correct answer: Vigorous suctioning for more than 15 seconds
Prolonged suctioning causes hypoxia and Valsalva responses that spike ICP; suction attempts should be brief and limited.
Question 3: A patient with known COPD presents in respiratory distress. ABG shows pH 7.28, PaCO2 72, PaO2 55. What is the correct interpretation?
- Metabolic acidosis with hypoxemia
- Respiratory acidosis with hypoxemia (Correct answer)
- Respiratory alkalosis with hypoxia
- Mixed metabolic and respiratory alkalosis
Correct answer: Respiratory acidosis with hypoxemia
Low pH with elevated PaCO2 indicates respiratory acidosis (CO2 retention), and PaO2 < 60 mmHg indicates hypoxemia.
Question 4: A 68-year-old is found unresponsive with a glucose of 22 mg/dL. After administering 50 mL of D50W IV, there is no improvement. What should the nurse consider next?
- Repeat the D50W bolus immediately
- Administer glucagon 1 mg IM
- Assess for concurrent causes such as alcohol use or adrenal insufficiency (Correct answer)
- Obtain a repeat glucose and wait 15 minutes
Correct answer: Assess for concurrent causes such as alcohol use or adrenal insufficiency
Failure to respond to dextrose suggests the hypoglycemia is refractory, possibly due to alcohol-induced hypoglycemia or adrenal insufficiency requiring additional treatment.
Question 5: Which of the following is the correct sequence for synchronized cardioversion in a hemodynamically unstable patient with atrial flutter?
- 200 J → 300 J → 360 J biphasic
- 50–100 J biphasic → increase if needed (Correct answer)
- 360 J monophasic only
- Adenosine 6 mg IV → cardioversion if no response
Correct answer: 50–100 J biphasic → increase if needed
Synchronized cardioversion for atrial flutter begins at 50–100 J biphasic and is increased stepwise if the initial attempt fails.
Question 6: A patient is brought in after a near-drowning in cold water. Despite 25 minutes of CPR with no ROSC, what principle should guide management?
- Terminate resuscitation after 20 minutes without ROSC
- Continue resuscitation until the patient is warm — 'not dead until warm and dead' (Correct answer)
- Administer high-dose epinephrine immediately
- Consult neurology before continuing resuscitation
Correct answer: Continue resuscitation until the patient is warm — 'not dead until warm and dead'
Hypothermia is protective to the brain; drowning victims in cold water may survive neurologically intact with prolonged resuscitation after rewarming.
Question 7: A trauma patient has absent breath sounds on the left, tracheal deviation to the right, and hypotension. What is the immediate intervention?
- Obtain portable chest X-ray before any intervention
- Perform needle decompression at the second intercostal space, midclavicular line on the left (Correct answer)
- Administer 2 L normal saline rapidly
- Insert a chest tube at the fifth intercostal space, midaxillary line on the right
Correct answer: Perform needle decompression at the second intercostal space, midclavicular line on the left
Absent breath sounds with tracheal deviation and hemodynamic instability indicate tension pneumothorax requiring immediate needle decompression on the affected side.
CEN Certified Emergency Nurse MCQ 3
A patient presents with sudden onset severe headache described as 'the worst headache of my life.' What is the priority diagnosis to rule out?