October 2003 29:5 JOURNAL OF EMERGENCY NURSING 451

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

Q U E S T I O N S

1. A patient arrives at the emergency department with a se-vere, pounding headache rated as an “8” on a scale of 0 to10 (with 10 being the most severe pain). His blood pressureis 200/100 mm Hg; pulse, 60 beats per minute; and respi-rations, 16 breaths per minute and regular. He had a spinalcord injury 6 months ago. After the initial workup is com-pleted, the physician suspects autonomic dysreflexia. Theprimary intervention for this patient is:

A. place the patient in a supine position.

B. administer a vasodilator.

C. remove the noxious stimulus.

D. initiate a stroke alert.

2. The most common treatment for methemoglobinemia is:

A. 100% oxygen.

B. hyperbaric oxygen.

C. intravenously administered ascorbic acid.

D. intravenously administered methylene blue.

3. Gastrointestinal upset, diaphoresis, fever, and tinnitus arecommon symptoms for which of the following conditions?

A. Gastroesophageal reflux disease

B. Acute salicylate toxicity

C. Appendicitis

D. Acute acetaminophen toxicity

Knowledge Assessment

and Preparation for the Certified Emergency

Nurses Examination

Kathleen Carlson, Tidewater Chapter, is Manager, Sentara CareplexEmergency Departments, Hampton, Va; E-mail: kkcarls@aol.com.

J Emerg Nurs 2003;29:451-2.

Copyright © 2003 by the Emergency Nurses Association.

0099-1767/2003 $30.00 + 0

doi:10.1067/men.2003.120

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

Section Editors: Kathleen Carlson, RN, MSN, CEN, and CarrieA. McCoy, PhD, MSPH, RN, CEN

With the current emphasis on credentialing in nursing, many nurseshave committed to taking the CEN examination. The followingquestions have been developed to assist in emergency nursing knowl-edge assessment and in preparation for the CEN examination.Questions, rationale for the correct answers, and references are pro-vided here for your self-evaluation. ENA has developed educationalmaterials that can be used as further resources for CEN preparation:Emergency Nursing Core Curriculum and CEN Review Manual. Forfurther information on educational review materials, please contactthe ENA Association Services Team at (800)243-8362.

REFERENCES1. Kim J. Clinical queries: how do I respond to autonomic dysre-

flexia? Nursing 2003;33(2):18.2. Carlson G, Negri E, McGrew A, Plaisier B. Two cases of methe-

moglobinemia from the use of topical anesthetics. J Emerg Nurs2003;29:106-8.

3. Muller A. Aspirin poisonings: challenges and clinical implicationsfor ED nurses. J Emerg Nurs 2003;29:177-9.

4. O’Donnell J, Bragg K, Sell S. Procedural sedation: safely navigat-ing the twilight zone. Nursing 2003;33(4):36-44.

5. Murray T, Kelly N, Jenkins S. Neurological examination: key toefficient, reliable and complete neurological exam is a systematic,organized approach. Advance for Nurses Maryland/DC/Virginia[online] 2003 Jan 6;17-21. Available from: URL: www.advanceweb.com.

452 JOURNAL OF EMERGENCY NURSING 29:5 October 2003

CEN REVIEW QUESTIONS/Carlson

4. According to the Joint Commission on Accreditation ofHealthcare Organizations, deep sedation is defined as:

A. normal response to verbal commands; cognitive func-tions and coordination may be impaired; patient canprotect his or her airway.

B. purposeful response to verbal commands or verbalcommands accompanied by light tactile stimulation;patient can protect his or her airway.

C. not easily aroused; purposeful response after repeatedor painful stimulation; patient may need help main-taining and protecting his or her airway; independentventilatory function may be impaired.

D. not arousable, even with painful stimulation; patientneeds help maintaining and protecting his or her air-way; positive-pressure ventilation may be needed; car-diovascular function may be impaired.

5. Assess the function of the cerebellum by:

A. asking the patient to swallow.

B. asking the patient to read a statement and do what itsays.

C. instructing the patient to close his or her eyes, hold hisor her arms out, and alternate touching his or her nosewith each index finger.

D. instructing the patient to close his or her eyes andextend his or her arms straight with palms up.

A N S W E R S

1. Correct answer: C

It is necessary to remove the noxious stimulus. Bladder distentionand constipation are the most likely triggers. The noxious stimu-lus produces an increased sympathetic response, causing vasocon-striction and, therefore, hypertension. Once the noxious stimulusis removed, a dramatic improvement in the patient’s symptomsusually occurs. The patient should be placed in a sitting position(A) to pool the blood in the legs in an attempt to reduce the bloodpressure. Administering rapid-onset, short-acting vasodilators,such as topical nitroglycerin, oral clonidine, or intravenoushydralazine (B) is indicated only if the noxious stimulus cannot beidentified and corrected. If it is untreated, autonomic dysreflexiacan lead to stroke (D), intracranial hemorrhage, seizures, anddeath. Kim,1 18.

2. Correct answer: D

In rare situations, topical agents such as benzocaine and lidocainemay cause methemoglobinemia. Normally, hemoglobin moleculesare bound to iron in the ferrous form. Agents such as benzocaineoxidize the ferrous molecule, converting ferrous Fe+2 to ferric Fe+3

and producing methemoglobin, a substance that is incapable ofbinding to oxygen (A, B). Methylene blue converts the Fe+3 backto Fe+2. Ascorbic acid (C) can be used to treat methemoglobine-mia, but it acts slowly. Carlson et al,2 108.

3. Correct answer: B

These symptoms are most commonly associated with acute salicy-late toxicity, a condition that affects the central nervous system.Salicylate poisoning causes an accumulation of pyruvic and lacticacids, which leads to hyperthermia and metabolic acidosis.Gastrointestinal irritation causes nausea, protracted vomiting, andhematemesis. Tinnitus is not a presenting symptom of gastro-esophageal reflux disease (A), appendicitis (C), or acetaminophentoxicity (D). Muller,3 178.

4. Correct answer: C

With deep sedation, the patient is not easily aroused. He or she hasa purposeful response after repeated or painful stimulation. Thepatient may need help maintaining and protecting his or her air-way. Independent ventilatory function may be impaired. Thismethod of procedural sedation poses a high risk of complications.Nurses must be aware of their facilities’ multidisciplinary protocolsas well as any state or regulatory requirements for treating sedatedpatients who lose their protective reflexes. (A) is the definition forminimal (anxiolysis) sedation. (B) is the definition for moderate(procedural) sedation. (D) is the definition for general anesthesia.O’Donnell et al,4 39.

5. Correct answer: C

The cerebellum organizes and controls movement. If there is nor-mal functioning, there would be smooth and coordinated move-ments of the arms. Swallowing without difficulty (A) shows intactfunctioning of cranial nerves IX and X. Reading a statement anddoing what it says (B) is part of a mini-mental status examination.Having a patient close his or her eyes and extend his or her armsstraight with palms up (D) assesses for arm drift, a sign of extrem-ity weakness. Murray et al,5 20.