CEN Certified Emergency Nurse MCQ 4 — Questions and Answers
Question 1: Which toxidrome is characterized by miosis, bradycardia, bronchospasm, excessive secretions, and diaphoresis?
- Sympathomimetic
- Anticholinergic
- Cholinergic (organophosphate) (Correct answer)
- Opioid
Correct answer: Cholinergic (organophosphate)
The SLUDGE/DUMBELS mnemonic describes cholinergic toxidrome caused by organophosphate poisoning, which overstimulates muscarinic receptors.
Question 2: What is the antidote for acetaminophen toxicity, and within what timeframe is it most effective?
- Flumazenil, within 1 hour of ingestion
- N-acetylcysteine (NAC), within 8–10 hours of ingestion (Correct answer)
- Activated charcoal, within 24 hours of ingestion
- Fomepizole, within 12 hours of ingestion
Correct answer: N-acetylcysteine (NAC), within 8–10 hours of ingestion
NAC is most effective when given within 8 hours of acetaminophen ingestion but can still provide benefit if given later; it replenishes glutathione to prevent hepatotoxicity.
Question 3: A patient presents with altered mental status, fever, muscle rigidity, and clonus after starting a new antidepressant. What condition should be suspected?
- Neuroleptic malignant syndrome
- Serotonin syndrome (Correct answer)
- Anticholinergic toxicity
- Malignant hyperthermia
Correct answer: Serotonin syndrome
Serotonin syndrome presents with the triad of mental status changes, autonomic instability, and neuromuscular abnormalities (especially clonus) following serotonergic medication use.
Question 4: A patient on warfarin presents with an INR of 9.5 and active GI bleeding. What is the most appropriate reversal agent?
- Vitamin K 10 mg IV only
- Fresh frozen plasma (FFP) only
- 4-factor prothrombin complex concentrate (4F-PCC) plus Vitamin K IV (Correct answer)
- Protamine sulfate IV
Correct answer: 4-factor prothrombin complex concentrate (4F-PCC) plus Vitamin K IV
4F-PCC provides rapid reversal of warfarin-induced coagulopathy in life-threatening bleeding, and Vitamin K ensures sustained reversal; this combination is preferred over FFP alone.
Question 5: Which sign is most specific for cardiac tamponade on physical examination?
- Jugular venous distension alone
- Beck's triad: hypotension, muffled heart sounds, and JVD (Correct answer)
- Pulsus alternans greater than 20 mmHg
- Bilateral crackles with S3 gallop
Correct answer: Beck's triad: hypotension, muffled heart sounds, and JVD
Beck's triad (hypotension, muffled heart sounds, JVD) is the classic physical examination finding of cardiac tamponade, though it is not always present.
Question 6: A 5-year-old ingests an unknown pill from a grandparent's medication bottle. The child is bradycardic with a BP of 70/40, and ECG shows widened QRS. What drug class is most likely?
- Benzodiazepines
- Calcium channel blockers or beta-blockers (Correct answer)
- SSRIs
- Antihistamines
Correct answer: Calcium channel blockers or beta-blockers
Cardiovascular drug ingestions, particularly calcium channel blockers and beta-blockers, commonly cause bradycardia, hypotension, and conduction abnormalities in pediatric patients.
Question 7: Which Glasgow Coma Scale (GCS) score indicates severe traumatic brain injury requiring airway management consideration?
- GCS 13–15
- GCS 9–12
- GCS 8 or below (Correct answer)
- GCS 6–8 with stable vitals
Correct answer: GCS 8 or below
A GCS score of 8 or below indicates severe TBI, and the inability to protect the airway is the standard threshold for endotracheal intubation.
CEN Certified Emergency Nurse MCQ 4
Which toxidrome is characterized by miosis, bradycardia, bronchospasm, excessive secretions, and diaphoresis?