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 furtherinformation on educational review materials, please contact the ENAAssociation Services Team at (800) 243-8362.

REFERENCES1. Fitch S, Gossage J. Optimal management of septic shock: rapid

recognition and institution of therapy are crucial. Postgrad Med2002;111:1-14. Available from: URL: http://www.postgradmed.com/issues/2002/03_02/fitch2.htm

2. Cheek D, McGehee-Smith H, Cunneen J, Cartwright M. Sepsis:taking a deeper look. Nursing 2005;35(1):38-43.

3. Sentinel events: 10 most common sentinel events. Nursing 2004;34(11):35.

4. Lee NG. Legal and regulatory constructs. In: Newberry L,editor. Sheehy’s emergency nursing principles and practice.5th ed. St. Louis: Mosby; 2003. p. 13-21.

5. Walker BW. Combating infection: locking down tetanus. Nurs-ing 2004;34(9):70.

6. Ayers DM. Patient education series: heart failure. Nursing2004;34(11):46-7.

7. Berlinger JS. Taking an intimate look at domestic violence.Nursing 2004;34(10):42-6.

Kathleen Carlson is Member, Tidewater Chapter, and Staff Nurse,Emergency Department, Sentara Virginia Beach General Hospital,Virginia Beach, Va.

J Emerg Nurs 2005;31:460-1.

0099-1767/$30.00

Copyright n 2005 by the Emergency Nurses Association.

doi: 10.1016/j.jen.2005.05.005

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QUESTIONS

1. Along with antimicrobial therapy, another first-line treat-ment for sepsis is to administer

A. a crystalloid bolus.

B. a diuretic.

C. a vasoactive agent.

D. high-dose steroids.

2. ‘‘An unexpected occurrence involving death or serious phys-ical or psychological injury, or the risk of death or seriousinjury’’ is the definition of

A. the Emergency Medical Treatment and Active LaborAct.

B. breach of duty.

C. an Occupational Safety and Health Administrationregulation.

D. a sentinel event.

3. Endotoxins from Clostridium tetani, the causative agentin tetanus, are produced in which of the followingenvironments?

A. Hyperbaric

B. Aerobic

C. Antimicrobial

D. Anaerobic

4. At the time of discharge, you give your patient a pre-scription for an angiotensin-converting enzyme inhibitor,such as enalapril (Vasotec). You should inform the patientthat the drug will:

A. ‘‘remove excess water from your system.’’

B. ‘‘open your blood vessels, thereby lowering your bloodpressure and helping your kidneys to work moreefficiently.’’

C. ‘‘block substances that increase your heart rate’’ (ie,catecholamines).

D. ‘‘help your heart to pump more efficiently.’’

JOURNAL OF EMERGENCY NURSING 31:5 October 2005

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 most appropriate way to screen a patient for domesticviolence is to:

A. phone the patient at home any time after the ED visitis complete.

B. interview the entire family.

C. provide written material for the patient to review.

D. interview the patient alone.

October 2005 31:5

ANSWERS

1. Correct answer: A

Sepsis is a systemic response to infection. Venous dilation in sepsiscreates relative hypovolemia and hypotension, requiring aggressivefluid resuscitation. Endothelial damage allows fluids to escape intoextravascular spaces, causing edema and further hypovolemia.Diuresis (B) would cause more fluid loss, hypovolemia, and hypo-tension and is not a treatment for sepsis. Patients who do not respondto fluid therapy should receive a vasoactive drug with the goal ofrapidly normalizing tissue perfusion pressure (C). Low-dose steroidreplacement therapy may be necessary to treat relative adrenalinsufficiency (D). Fitch and Gossage,1 4-10; Cheek et al,2 40-1.

2. Correct answer: D

This is the Joint Commission on Accreditation of Healthcare Or-ganizations’ definition of a sentinel event. The Emergency MedicalTreatment and Active Labor Act (A) is a federal statute that addresses‘‘patient dumping’’—the transfer of unstable patients for financialreasons. Breach of duty (B) is 1 of 4 elements of medical negligence.The other elements are duty, proximate cause, and damage. Throughactions such as inspections and fines, the Occupational Safety andHealth Administration (C) enforces regulations that affect employeesafety, such as the regulation on the occupational exposure to blood-borne pathogens. Sentinel events,3 35; Lee,4 13-20.

3. Correct answer: D

Clostridium tetani spores germinate and produce the endotoxin,tetanospasmin, in an anaerobic environment. All other responses(A, B, C) would not support growth of this organism, because gram-positive bacilli, such as C tetani spores, can only grow in anaerobicenvironments. Walker,5 70.

4. Correct answer: B

Opening blood vessels, thereby lowering blood pressure and helpingthe kidneys work more efficiently, is the action of an angiotensin-converting enzyme inhibitor. Removing excess water (A) is the ac-tion of a diuretic. Blocking substances that increase the heart rate(C) is the action of a h-blocker. Helping the heart pump moreefficiently (D) is the action of a digitalis glycoside. Ayers,6 46-7.

5. Correct answer: D.

The best way to identify a victim of domestic violence is to screen allpatients 14 years or older in total privacy; a victim of domesticviolence may be afraid to reveal the truth if he or she does not feelsafe and supported. If the partner will not leave the patient alone andyou are unable to distract the partner by referring him or her to aregistrar for billing questions, etc, it is best not to press the issuebecause it could increase the patient’s risk for violence. If you can-not interview the patient privately, consider calling the patient atwork or at home when the partner is not likely to be there (A). Thepatient should be interviewed alone, no matter how compassionatethe partner appears to be (B). Written materials (C) that includephases and progression of abuse, reasons why victims stay, and howto devise a safety plan can be helpful, but it may be unsafe for thepatient to take the material if he or she believes that the abuser mayfind it. Berlinger,7 44-5.

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