A patient with limited English proficiency arrives in the emergency department. What is the best action to ensure effective communication?

Use a certified medical interpreter

Use family members to interpret

Use hand gestures and visual cues only

Which of the following is the most reliable early sign of cardiogenic shock in a patient with acute MI?

Hypotension with cool, clammy skin

A diabetic patient becomes confused, diaphoretic, and shaky. Fingerstick glucose reads 42 mg/dL. What is the nurse’s first action?

Administer dextrose or oral glucose

A patient with dental trauma has a dislodged permanent tooth. It was kept in milk and brought to the ED within 30 minutes. What is the best next step?

Reimplant immediately and stabilize

Rinse with hydrogen peroxide and hold

Delay reimplantation until swelling resolves

A patient refuses a blood transfusion due to religious beliefs. What is the nurse’s best response?

Notify the provider and advocate for alternate treatments

Educate the patient until they change their mind

Document refusal but proceed with the transfusion

CEN

Free CEN Practice Questions

10 sample questions for the CEN, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Cardiovascular Emergencies, Respiratory Emergencies, Neurological Emergencies, Stroke, Seizures, Head Trauma , Spinal Cord Injuries, Gi, Gu, Ob/Gyn Emergencies, GI, GU, OB/GYN Emergencies, Mental Health Emergencies, Suicidal Ideation, Psychosis, Substance Abuse,, Medical Emergencies, Imbalances, Anaphylaxis, Musculoskeletal And Wound Emergencies, Wound Management, Maxillofacial And Ocular Emergencies, Maxillofacial and Ocular Emergencies, Environment And Toxicology Emergencies,, Heat/Cold Exposure, Poisoning, Overdose, Infections, Professional Issues – Nurse, Legal/Ethical Issues, Scope Of Practice, Documentation,, Professional Issues – Patient, Professional Issues: Patient, Professional Issues: Triage, Professional Issues: System, Professional Issues: Nurse, Professional Issues – System, Resource Management, Quality Improvement, Professional Issues – Triage, (Esi), Rapid Assessment, Shock, Pulmonary Disorders, Mechanical Ventilation, Airway, Injuries, Withdrawal, Management, Poisoning, Overdose, Heat/Cold Emergencies, Infectious, Rights, Improvement, Disaster Preparedness, Prioritization.

Question 1 · Cardiovascular Emergencies
Which of the following ECG findings is most characteristic of a myocardial infarction?
- A.Peaked T waves
- B.Prolonged QT interval
- C.ST-segment elevation
- D.Inverted P waves
Show answer and explanation
Answer: C. ST-segment elevation
ST-segment elevation on an ECG is a hallmark sign of acute myocardial infarction (STEMI). It indicates ongoing injury to the myocardial tissue. Peaked T waves are commonly seen in hyperkalemia, not MI.
Question 2 · Stroke, Seizures, Head Trauma , Spinal Cord Injuries
Which type of stroke typically presents with sudden onset of severe headache, nausea, vomiting, and photophobia?
- A.Hemorrhagic stroke
- B.Lacunar infarct
- C.Ischemic stroke
- D.Embolic stroke
Show answer and explanation
Answer: A. Hemorrhagic stroke
Hemorrhagic strokes often present with sudden severe headache, vomiting, and neurological deficits due to increased intracranial pressure.
Question 3 · Medical Emergencies
A diabetic patient presents with confusion, fruity breath odor, and Kussmaul respirations. Which laboratory value would you expect?
- A.Glucose 60 mg/dL
- B.Bicarbonate 28 mEq/L
- C.Glucose 450 mg/dL
- D.pH 7.45
Show answer and explanation
Answer: C. Glucose 450 mg/dL
These are signs of diabetic ketoacidosis (DKA), which is characterized by hyperglycemia, acidosis, and ketone production.
Question 4 · Maxillofacial and Ocular Emergencies
Which symptom is most concerning in a patient with an eye injury and hyphema (blood in the anterior chamber)?
- A.Photophobia
- B.Decreased blink reflex
- C.Eye redness
- D.Increased intraocular pressure
Show answer and explanation
Answer: D. Increased intraocular pressure
Hyphema can increase intraocular pressure and lead to vision loss. Immediate ophthalmologic evaluation is required.
Question 5 · Professional Issues – Patient
A patient with limited English proficiency arrives in the emergency department. What is the best action to ensure effective communication?
- A.Use a certified medical interpreter
- B.Use family members to interpret
- C.Use hand gestures and visual cues only
- D.Speak loudly and slowly
Show answer and explanation
Answer: A. Use a certified medical interpreter
Using a certified medical interpreter ensures accurate, unbiased, and confidential communication, protecting the patient’s rights.
Question 6 · Cardiovascular Emergencies
Which of the following is the most reliable early sign of cardiogenic shock in a patient with acute MI?
- A.Pulmonary edema
- B.Hypotension with cool, clammy skin
- C.Bounding peripheral pulses
- D.Bradycardia
Show answer and explanation
Answer: B. Hypotension with cool, clammy skin
Cardiogenic shock results from inadequate cardiac output. Cool, clammy skin and hypotension indicate poor perfusion early on.
Question 7 · Injuries
A 19-year-old male arrives via EMS after a diving accident. He is alert but has no motor or sensory function in his lower limbs. BP is 88/50 mmHg, HR 52 bpm. Skin is warm and dry. Which condition best explains this presentation?
- A.Spinal cord concussion
- B.Hypovolemic shock
- C.Neurogenic shock
- D.Septic shock
Show answer and explanation
Answer: C. Neurogenic shock
Bradycardia, hypotension, and warm skin after spinal trauma suggest neurogenic shock due to loss of sympathetic tone.
Question 8 · Medical Emergencies
A diabetic patient becomes confused, diaphoretic, and shaky. Fingerstick glucose reads 42 mg/dL. What is the nurse’s first action?
- A.Administer dextrose or oral glucose
- B.Recheck the glucose level
- C.Call the provider
- D.Start IV fluids
Show answer and explanation
Answer: A. Administer dextrose or oral glucose
These are classic signs of hypoglycemia. Rapid administration of glucose is the immediate priority to prevent seizure or coma.
Question 9 · Maxillofacial and Ocular Emergencies
A patient with dental trauma has a dislodged permanent tooth. It was kept in milk and brought to the ED within 30 minutes. What is the best next step?
- A.Rinse with hydrogen peroxide and hold
- B.Reimplant immediately and stabilize
- C.Delay reimplantation until swelling resolves
- D.Discard the tooth
Show answer and explanation
Answer: B. Reimplant immediately and stabilize
A permanent tooth avulsed within 30–60 minutes can often be successfully reimplanted. Milk is an acceptable transport medium.
Question 10 · Professional Issues – Patient
A patient refuses a blood transfusion due to religious beliefs. What is the nurse’s best response?
- A.Notify the provider and advocate for alternate treatments
- B.Educate the patient until they change their mind
- C.Document refusal but proceed with the transfusion
- D.Involve hospital security
Show answer and explanation
Answer: A. Notify the provider and advocate for alternate treatments
Respecting patient autonomy and beliefs is essential. The nurse should advocate for alternate therapies and notify the care team.

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