CEN Test Prep: Master Cardiovascular Emergencies – Essential Knowledge for Emergency Nursing Excellence
Why Cardiovascular Emergencies Knowledge is Crucial for CEN Success
Cardiovascular emergencies represent one of the most critical and frequently tested content areas on the CEN examination, comprising 13% of all scored questions with 19 items dedicated to this essential domain. This knowledge area encompasses the life-threatening conditions that emergency nurses encounter daily, including acute coronary syndromes, dysrhythmias, cardiogenic shock, aortic dissection, and cardiovascular trauma, all of which require immediate recognition and rapid intervention to prevent patient mortality and morbidity. The emphasis on cardiovascular emergencies in the CEN exam reflects the reality that heart disease remains the leading cause of death in the United States, with emergency departments serving as the first point of contact for many patients experiencing cardiac events. Emergency nurses must possess comprehensive understanding of electrocardiogram interpretation, advanced cardiac life support protocols, hemodynamic monitoring principles, and the pathophysiology underlying various cardiac conditions to provide optimal patient care. The time-sensitive nature of cardiovascular emergencies, particularly acute myocardial infarction where “time is muscle,” demands that emergency nurses can quickly differentiate between STEMI and NSTEMI presentations, understand reperfusion therapy indications and contraindications, and recognize when immediate cardiac catheterization is warranted. Beyond acute coronary syndromes, this domain tests knowledge of complex dysrhythmia management, including recognition of shockable versus non-shockable rhythms, appropriate use of antiarrhythmic medications, and indications for electrical cardioversion or defibrillation. The integration of cardiovascular trauma assessment, including recognition of cardiac tamponade, tension pneumothorax, and great vessel injuries, reflects the multisystem nature of emergency nursing practice. Success in this content area requires not only theoretical knowledge but also the ability to apply clinical reasoning skills to rapidly changing patient presentations, prioritize interventions based on acuity levels, and coordinate care with multidisciplinary teams including cardiologists, cardiac surgeons, and interventional specialists. Your mastery of cardiovascular emergency concepts will directly impact your ability to provide safe, competent care in high-stakes situations where split-second decisions can mean the difference between life and death for your patients.
Practice Questions: Cardiovascular Emergencies
Question 1
A patient presents with crushing chest pain radiating to the left arm, diaphoresis, and ST-elevation in leads II, III, and aVF. What is the most likely diagnosis?
A) Anterior wall STEMI
B) Inferior wall STEMI
C) Lateral wall STEMI
D) Unstable angina
Answer: B – ST-elevation in leads II, III, and aVF indicates an inferior wall STEMI involving the right coronary artery territory.
Question 2
What is the maximum time frame for fibrinolytic therapy administration in STEMI patients from symptom onset?
A) 6 hours
B) 12 hours
C) 18 hours
D) 24 hours
Answer: B – Fibrinolytic therapy should be administered within 12 hours of symptom onset for maximum benefit in STEMI patients.
Question 3
Which of the following is an absolute contraindication to fibrinolytic therapy?
A) Age over 75 years
B) Previous stroke within 3 months
C) Systolic BP > 180 mmHg
D) Recent dental work
Answer: B – Previous stroke within 3 months is an absolute contraindication due to high risk of hemorrhagic transformation.
Question 4
A patient in ventricular fibrillation should receive:
A) Synchronized cardioversion
B) Unsynchronized defibrillation
C) Pacing
D) Medication first
Answer: B – Ventricular fibrillation is a shockable rhythm requiring immediate unsynchronized defibrillation to restore organized rhythm.
Question 5
Beck’s triad, which includes elevated JVD, hypotension, and muffled heart sounds, is classically associated with:
A) Tension pneumothorax
B) Cardiac tamponade
C) Pulmonary embolism
D) Cardiogenic shock
Answer: B – Beck’s triad is the classic presentation of cardiac tamponade, where pericardial fluid compresses the heart.
Question 6
The initial drug of choice for stable supraventricular tachycardia is:
A) Amiodarone
B) Adenosine
C) Verapamil
D) Diltiazem
Answer: B – Adenosine is the first-line medication for stable SVT due to its ability to transiently block AV node conduction.
Question 7
What is the most appropriate initial fluid resuscitation for cardiogenic shock?
A) Aggressive fluid boluses
B) Cautious fluid challenge
C) No fluids
D) Hypertonic saline
Answer: B – Cardiogenic shock requires cautious fluid administration to avoid worsening pulmonary edema while assessing response.
Question 8
A patient with acute aortic dissection should have their blood pressure managed with:
A) ACE inhibitors alone
B) Beta-blockers first, then vasodilators
C) Calcium channel blockers
D) Diuretics
Answer: B – Beta-blockers should be given first to reduce shear stress, followed by vasodilators to control blood pressure.
Question 9
The classic triad of acute aortic dissection includes severe chest pain, pulse deficits, and:
A) Bradycardia
B) Hypertension
C) Fever
D) Cyanosis
Answer: B – The classic triad includes severe “tearing” chest pain, pulse deficits, and hypertension, though not all patients present with all three.
Question 10
In pulseless electrical activity (PEA), the priority intervention is:
A) Immediate defibrillation
B) High-quality CPR while searching for reversible causes
C) Synchronized cardioversion
D) Transcutaneous pacing
Answer: B – PEA is a non-shockable rhythm requiring high-quality CPR while identifying and treating reversible causes (H’s and T’s).
Question 11
A patient with acute heart failure and pulmonary edema would most benefit from:
A) IV fluid bolus
B) Nitroglycerin and furosemide
C) Beta-blockers
D) ACE inhibitors
Answer: B – Nitroglycerin reduces preload and furosemide promotes diuresis, both helping to reduce pulmonary congestion.
Question 12
The most common initial rhythm in sudden cardiac arrest is:
A) Asystole
B) Pulseless electrical activity
C) Ventricular fibrillation
D) Ventricular tachycardia
Answer: C – Ventricular fibrillation is the most common initial rhythm in witnessed sudden cardiac arrest, especially in adults.
Question 13
Cushing’s triad consists of hypertension, bradycardia, and:
A) Tachypnea
B) Irregular respirations
C) Apnea
D) Hyperventilation
Answer: B – Cushing’s triad indicates increased intracranial pressure and includes hypertension, bradycardia, and irregular (often Cheyne-Stokes) respirations.
Question 14
The preferred method for establishing vascular access during cardiac arrest is:
A) Central venous catheter
B) Peripheral IV
C) Intraosseous access
D) External jugular
Answer: C – Intraosseous access is preferred during cardiac arrest as it can be established quickly when peripheral IV access is difficult.
Question 15
A patient with chest trauma and decreased breath sounds on the left side with tracheal deviation to the right most likely has:
A) Hemothorax
B) Pneumothorax
C) Tension pneumothorax
D) Flail chest
Answer: C – Tension pneumothorax causes tracheal deviation away from the affected side and requires immediate needle decompression.