Knowledge Assessment

and Preparation for the Certified Emergency

Nurses Examination

C E N R E V I E W Q U E S T I O N S

Author: Kathleen Carlson, RN, MSN, CEN, Hampton, Va

Section Editors: Kathleen Carlson, RN, MSN, CEN, andCarrie A. McCoy, PhD, MSPH, RN, CEN

With the current emphasis on credentialing in nursing, many nurseshave committed to taking the CEN examination. The following ques-tions have been developed to assist in emergency nursing knowledgeassessment and in preparation for the CEN examination. Questions,rationale for the correct answers, and references are provided here foryour self-evaluation. ENA has developed educational materials thatcan be used as further resources for CEN preparation: EmergencyNursing Core Curriculum and CEN Review Manual. For further in-formation on educational review materials, please contact the ENAAssociation Services Team at (800) 243-8362.

REFERENCES

1. Tefera L. Toxicity, Beta-blocker (online, 2006, sections 1-10).Available from: URL: http://www.emedicine.com/emerg/topic59.htm.

2. ENA. Children with special health care needs. In: Hawkins H,editor. Emergency nursing pediatric course. 3rd ed. Des Plaines(IL): ENA; 2004. p. 209-22.

3. King J. What is gastroparesis? Nursing 2006;36(9):18.

4. Cummings S, Cummings P. Abdominal emergencies in Emer-gency Nursing Core Curriculum. 5th ed. Philadelphia: W.B.Saunders; 2000. p. 27-56.

5. Goldich G. Understanding the 12-lead ECG part I. Nursing2006;36(11):36-41.

6. Jordan KS. Obstetrical and gynecological emergencies inEmergency Nursing Core Curriculum. 5th ed. Philadelphia:W.B. Saunders; 2000. p. 431-65.

Kathleen Carlson is Staff Nurse, Sentara Virginia Beach GeneralHospital, Emergency Department, Virginia Beach, Va.

For correspondence, e-mail: Kathleen Carlson, RN, MSN, CEN,kkcarls@aol.com.

J Emerg Nurs 2007;33:245-6.

0099-1767/$32.00

Copyright n 2007 by the Emergency Nurses Association.

doi: 10.1016/j.jen.2007.01.005

June 2007 33:3

QUESTIONS

1. When treating a patient who took an overdose of pro-pranolol, a frequently used h-blocker, you would be alertfor which of the following complications?

A. Tachycardia

B. Hyperglycemia

C. Metabolic alkalosis

D. Seizures

2. The priority intervention for a child with special healthcare needs presenting with copious secretions from histracheostomy and fever would be:

A. assisting ventilations with a bag-valve-mask (BVM)device.

B. administering acetaminophen rectally.

C. inserting a gastric tube.

D. suctioning the tracheostomy.

3. Which of the following discharge instructions would youprovide for a patient diagnosed with gastroparesis?

A. Maintain a low-fat diet

B. Maintain a high-fiber diet

C. Increase your intake of nuts and popcorn

D. Avoid foods containing sorbitol

4. Which of the following limb leads serves as the groundelectrode in an EKG?

A. Right arm

B. Right leg

C. Left arm

D. Left leg

JOURNAL OF EMERGENCY NURSING 245

C E N R E V I E W Q U E S T I O N S / C a r l s o n

5. The proper position for a pregnant woman for whom bedrest is ordered is:

A. supine.

B. Trendelenburg.

C. left lateral decubitus.

D. right lateral decubitus.

246 J

ANSWERS

1. Correct answer: D

Seizures are a common side effect of a propranolol overdose as aresult of cellular hypoxia from poor cardiac output and hypogly-cemia. Propranolol is lipid soluble and has a marked quinidine-likeeffect. Patients become bradycardic (A), hypotensive, hypoglyce-mic (B), and acidotic (C) from poor cardiac perfusion manifestedby low serum bicarbonate. Propranolol overdoses are treated withcrystalloids, atropine, vasopressors with catecholamine action, glu-cagon, and phosphodiesterase inhibitors. Tefera,1 sections 2, 3, and 7.

2. Correct answer: D

Establishing a patent airway is the priority for this child. Suc-tioning the respiratory secretions and positioning the child tooptimize breathing would accomplish this goal. Not enough in-formation is provided to determine the need for BVM assist (A).An assessment of breathing effectiveness to include rate and depthof respirations, symmetric chest rise and fall, skin color, andpresence and quality of bilateral breath sounds is necessary todetermine this need. Acetaminophen (B) would be given after theprimary survey and appropriate interventions have been accom-plished. There is no information to indicate the need for a gastrictube (C). ENA,2 214-5.

3. Correct answer: A

Patients diagnosed with gastroparesis, or delayed emptying of thestomach caused by diabetic neuropathy, gastric surgery, a vagotomy,or hypothyroidism, need to alter their eating habits to avoid nausea,vomiting, or bloating. They should be instructed to avoid fatty andhigh-fiber foods (B) and eat 6 small meals daily to enhance di-gestion. Patients diagnosed with diverticulitis would be instructed todecrease their intake of nuts and popcorn (C) because these foodsmay become trapped in diverticula. Patients diagnosed with irritablebowel syndrome would be instructed to avoid sorbitol-containingfoods. King,3 18; Cummings & Cummings,4 44-6.

4. Correct answer: B

The right leg electrode is the ground electrode. In lead I, the leftarm is the positive electrode looking toward the right arm that isthe negative electrode. In lead II, the left leg is the positive elec-trode looking toward the right arm that is the negative electrode.In lead III, the left leg is the positive electrode looking toward theleft arm that is the negative electrode. Goldich,5 38-9.

5. Correct answer: C

The pregnant patient should be placed in the left lateral decubitusposition so that the uterus is not pressing on the inferior vena cavaand aorta, thus preventing supine hypotensive syndrome. All otherpositions would not achieve this objective. Jordan,6 451.

OURNAL OF EMERGENCY NURSING 33:3 June 2007