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CEN EXAM PRACTICE QUESTIONS AND ANSWERS
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CEN EXAM PRACTICE QUESTIONS AND ANSWERS
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CEN EXAM PRACTICE QUESTIONS AND ANSWERSAn indwelling urinary catheter is ordered for a patient who has sustained a straddle
injury to his external genitalia. Before catheter insertion, the nurse should assess the
patient for:
1. penile tenderness.
2. scrotal or penile swelling.
3. blood at the urinary meatus.
4. the ability to void spontaneously. - Answers-3. blood at the urinary meatus.
When assessing a trauma patient with blood at the urinary meatus, it is important to
know that this is a sign of a possible pelvic fracture and that a urinary drainage catheter
insertion is contraindicated. Penile tenderness and scrotal or penile swelling are
expected complaints after the described trauma, but alone they are not a
contraindication for a urinary drainage catheter insertion. The ability to void
spontaneously is not an indication or contraindication for the insertion of a urinary
drainage catheter.
Trauma Nursing Core Course, 8th ed. 2020, pg. 154
Emergency Nursing Core Curriculum, 7th ed. 2018, pg. 520
The MOST beneficial action of morphine in the treatment of pulmonary edema is to:
1. decrease preload.
2. decrease cardiac reserve.
3. increase systemic vascular resistance.
4. increase oxygen consumption. - Answers-Morphine sulfate has several beneficial
effects in the patient experiencing pulmonary edema, particularly pulmonary edema due
to heart failure. Morphine reduces pain and anxiety but, most importantly, by increasing
venous capacitance (through vasodilation), less blood is delivered to the lungs.
Emergency Nursing Core Curriculum, 7th ed. 2018, pg. 171
Sheehy's Emergency Nursing: Principles and Practice, 7th ed. 2020, pg. 223
An elderly woman presents with vague complaints of abdominal pain. The patient states
that the people she lives with are stealing from her. The nurse should:
1. call the family to discuss the situation.
2. arrange for protective custody of the patient.
3. assess the patient for signs of neglect and maltreatment.
4. obtain consent for evaluation by social services. - Answers-3. assess the patient for
signs of neglect and maltreatment.
,Maltreatment of the elderly cannot be assessed quickly or easily from a cluster of signs
and vague presenting symptoms. Keen awareness when performing the physical
examination is essential to identify elder abuse.
Emergency Nursing Core Curriculum, 7th ed. 2018, pg. 40-41
A patient who has a long-leg cast has pain out of proportion to the injury and decreased
sensation in the affected leg. Urinalysis reveals myoglobinemia. These findings MOST
likely indicate:
1. fat emboli.
2. nerve laceration.
3. compartment syndrome.
4. deep vein thrombosis. - Answers-3. compartment syndrome.
Characteristic signs of compartment syndrome are pain out of proportion of the extent of
the injury and decreased sensation. Muscle damage due to compression/damage of the
muscle releases myoglobin, which will be evident in the urinalysis.
Trauma Nursing Core Course, 8th ed. 2020, pg. 196-198
Chronic arterial insufficiency of the lower extremities is characterized by:
1. pitting edema.
2. bounding pedal pulses.
3.dilated tortuous veins.
4. intermittent claudication. - Answers-4. intermittent claudication.
Claudication is caused by poor tissue perfusion or ischemia due to gradual enlargement
of atheromatous plaques.
Emergency Nursing Core Curriculum, 7th ed. 2018, pg. 177-178
To assess pronator drift, the nurse should instruct the patient to:
1. "hold both arms straight out with your eyes closed."
2. "touch your finger to your nose, alternating your right and left hands."
3. "slide the left heel of your foot down your right shin."
4. "smile and show me your teeth." - Answers-1. "hold both arms straight out with your
eyes closed."
Pronator drift is an assessment parameter used to determine arm weakness potentially
caused by stroke. Both arms are held out straight while the nurse assesses for drift or
the patient's inability to hold one or both arms in place.
,AACN Core Curriculum for High Acuity, Progressive and Critical Care Nursing, 7th ed.
2018, pg. 348
A patient who has been in a motorcycle crash is awake, alert, and oriented, but
complains of severe neck pain. Shortly after arrival, the patient experiences respiratory
arrest. Appropriate INITIAL management of the airway should consist of
1. endotracheal intubation.
2. administration of oxygen by a nasal cannula.
3. jaw-thrust maneuver and ventilation with a bag-mask device.
4. head-tilt maneuver and placement of an oropharyngeal airway. - Answers-3. jaw-
thrust maneuver and ventilation with a bag-mask device.
The jaw-thrust maneuver should be used as the basic airway management procedure in
any patient with a suspected cervical spine injury and the head should not be tilted.
Endotracheal intubation will be done, but it is not the first action to be taken.
Trauma Nursing Core Course, 8th ed. 2020, pg. 53
A 14-year-old patient whose airway is obstructed is conscious and unable to speak. The
nurse should FIRST:
1. remove the obstruction with Magill forceps.
2. administer back blows.
3. administer abdominal thrusts.
4. encourage the patient to cough. - Answers-3. administer abdominal thrusts.
The American Heart Association recommends performing abdominal thrusts for a
conscious choking patient; this should generate enough pressure to force the foreign
body out of the trachea. Back blows are reserved for infant choking victims, and, without
proper visualization, the Magill forceps are likely to force the blockage deeper. If the
patient is obstructed, there will not be an effective cough.
Pediatric Advanced Life Support (2015), pg. 135
The earliest indication of increased intracranial pressure is:
1. abnormal respirations.
2. decreased heart rate.
3. widened pulse pressure.
4. altered level of consciousness. - Answers-4. altered level of consciousness.
Early signs and symptoms of increased intracranial pressure are changes in the level of
consciousness and restlessness. Vital sign changes are a late sign of increased
intracranial pressure.
, Trauma Nursing Core Course, 8th ed. 2020, pg. 99
A patient with complete heart block is hypotensive and confused. The MOST
appropriate treatment is:
1. transcutaneous pacing.
2. lidocaine (Xylocaine).
3. defibrillation.
4. carotid massage. - Answers-1. transcutaneous pacing.
Transcutaneous pacing is the recommended immediate intervention for a severely
symptomatic patient in third-degree (complete) heart block. Other therapies (e.g.,
lidocaine, defibrillation, and carotid massage) would worsen this patient's condition.
Advanced Cardiac Life Support, 2015, pg. 120
Sheehy's Emergency Nursing: Principles and Practice, 7h ed. 2020, pg. 233
A patient has a regular, narrow complex tachycardia with a heart rate of 200 beats/min
and a blood pressure of 90/60 mm Hg. An IV of D5W has been initiated and adenosine
(Adenocard), 6 mg IV, is ordered. The nurse should
1. change the IV to normal saline solution and administer the adenosine.
2. reconstitute the adenosine with 5 mL of D5W and administer over 1 minute.
3. reconstitute the adenosine with 3 mL sterile water or saline and administer as rapidly
as possible.
4. administer the adenosine undiluted in the port closest to the insertion site. - Answers-
4. administer the adenosine undiluted in the port closest to the insertion site.
Adenosine (Adenocard) has a very short half-life. It must be given by IV administration
in a large vein over 1 second, followed by a 20 mL saline flush and immediate elevation
of the arm to enhance delivery to the heart.
Sheehy's Emergency Nursing: Principles and Practice, 7th ed. 2020, pg. 565
Which of the following medications should a nurse anticipate administering initially to an
adult patient in status epilepticus?
1. diazepam (Valium)
2. fosphenytoin (Cerebyx)
3. flumazenil (Romazicon)
4. phenobarbital - Answers-1. diazepam (Valium)
Diazepam (Valium) is a benzodiazepine used as a first-line drug in the treatment of
status epilepticus. Fosphenytoin (Cerebyx) is the second-line drug for seizure treatment
after a benzodiazepine. Flumazenil (Romazicon) is a reversal agent for benzodiazepine
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