CEN Certified Emergency Nurse MCQ 5 — Questions and Answers
Question 1: A patient with a suspected ectopic pregnancy has a positive beta-hCG of 2,800 mIU/mL with no intrauterine pregnancy seen on transvaginal ultrasound. She is hemodynamically stable. What is the expected management?
- Immediate surgical intervention
- Methotrexate administration after OB/GYN evaluation if criteria are met (Correct answer)
- Repeat beta-hCG in 48 hours and discharge to home
- Administer RhoGAM only and discharge
Correct answer: Methotrexate administration after OB/GYN evaluation if criteria are met
Hemodynamically stable ectopic pregnancy may be managed with methotrexate if the patient meets criteria (no cardiac activity, tube < 3.5 cm, compliant); OB/GYN must evaluate.
Question 2: During a mass casualty incident, which triage category is assigned to patients with survivable injuries requiring immediate intervention?
- Green (minor)
- Yellow (delayed)
- Red (immediate) (Correct answer)
- Black (expectant)
Correct answer: Red (immediate)
Red tag (immediate) is assigned to patients with life-threatening but survivable injuries who need urgent treatment within 60 minutes.
Question 3: A patient with end-stage renal disease on hemodialysis presents with peaked T-waves on ECG, muscle weakness, and potassium of 6.8 mEq/L. What is the FIRST intervention?
- Administer sodium polystyrene sulfonate (Kayexalate) orally
- Administer calcium gluconate IV to stabilize the cardiac membrane (Correct answer)
- Begin emergency hemodialysis immediately
- Give insulin 10 units IV with D50W
Correct answer: Administer calcium gluconate IV to stabilize the cardiac membrane
Calcium gluconate is the first-line intervention because it immediately stabilizes the cardiac membrane and protects against life-threatening arrhythmias while other potassium-lowering measures take effect.
Question 4: Which assessment is most important before administering thrombolytics (tPA) to a patient with ischemic stroke?
- 12-lead ECG to rule out MI
- CT scan of the head without contrast to exclude hemorrhage (Correct answer)
- Serum troponin to rule out cardiac embolism
- MRI brain to confirm ischemic territory size
Correct answer: CT scan of the head without contrast to exclude hemorrhage
Non-contrast CT of the head must be performed before tPA to rule out hemorrhagic stroke, which is an absolute contraindication to thrombolytic therapy.
Question 5: A nurse is caring for a patient restrained due to violent behavior. Which action is a priority to prevent positional asphyxia?
- Apply four-point restraints in the prone position for optimal control
- Ensure the patient is never placed prone and monitor breathing continuously (Correct answer)
- Apply wrist restraints only and allow the patient to self-position
- Sedate the patient heavily to reduce movement
Correct answer: Ensure the patient is never placed prone and monitor breathing continuously
Positional asphyxia occurs when a restrained person cannot breathe effectively, most commonly in the prone position; continuous monitoring and supine/lateral positioning are essential.
Question 6: Which of the following best describes distributive shock?
- Decreased cardiac output due to myocardial failure
- Decreased preload due to hemorrhage
- Massive vasodilation causing maldistribution of blood flow (Correct answer)
- Obstruction of cardiac output by pulmonary embolism
Correct answer: Massive vasodilation causing maldistribution of blood flow
Distributive shock (e.g., septic, anaphylactic, neurogenic) is characterized by widespread vasodilation leading to inadequate tissue perfusion despite normal or elevated cardiac output.
Question 7: A patient with sickle cell disease presents in vaso-occlusive crisis with severe pain rated 10/10. What is the priority nursing intervention?
- Encourage ambulation to improve circulation
- Administer IV opioids promptly per protocol and ensure adequate hydration (Correct answer)
- Apply ice packs to affected areas for vasoconstriction
- Obtain hemoglobin electrophoresis before pain management
Correct answer: Administer IV opioids promptly per protocol and ensure adequate hydration
Prompt IV opioid administration and IV hydration are the priority in vaso-occlusive crisis to relieve pain and improve microvascular flow; delays in pain management worsen outcomes.
CEN Certified Emergency Nurse MCQ 5
A patient with a suspected ectopic pregnancy has a positive beta-hCG of 2,800 mIU/mL with no intrauterine pregnancy seen on transvaginal ultrasound.
She is hemodynamically stable.
What is the expected management?