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2026 Edition

CEN Practice Exam

Try our free CEN Practice Test to study for your Certified Emergency Nurse certification exam. Our CEN test prep is written by certified instructors in emergecy nursing. For complete practice, use our 750 question CEN Practice Exam Kit.  See the below links for free CEN flash cards, a video of the practice exam and a free CEN study guide.

Cardiovascular Emergencies 

1 The patient is brought to the ED with an anterior ST-elevation myocardial infarction (STEMI). You are assessing him for possible administration of fibrinolytics. An absolute contraindication for this treatment is:
Incorrect. Please choose another answer.
Fibrinolytic therapy is generally NOT recommended for patients whose symptoms began more than 12 hours before arrival. Fibrinolytics should not be given if the onset of symptoms was more than 24 hours before arrival UNLESS a posterior MI is diagnosed. In this case, the MI was anterior.

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2 Preload refers to:
Incorrect. Please choose another answer.
Preload is the volume of blood that enters the right side of the heart. This volume stretches the fibers in the heart prior to contraction. Preload is commonly measured as atrial pressure.
3 The team is performing CPR on a patient. The rhythm that will respond to an electrical shock is:
Incorrect. Please choose another answer.
Ventricular fibrillation and pulseless ventricular tachycardia are the two rhythms that are considered to be "shockable" cardiac arrest rhythms. Although asystole and PEA are cardiac arrest rhythms, they will not respond to electrical shock.
4 When suctioning during a cardiac arrest, suctioning should be limited to which of the following?
Incorrect. Please choose another answer.
According to the 2010 BLS and ACLS guidelines, suctioning for longer than 10 seconds may result in pulling too much oxygen out of the airways resulting in hypoxemia.

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5 Possible causes of cardiac arrest include all of the following EXCEPT:
Incorrect. Please choose another answer.
Common causes of cardiac arrest are known as the H's and T's and include: hypovolemia (NOT hypervolemia), hypoxia, hydrogen ion excess (acidosis), hypo or hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, and thrombosis (pulmonary or coronary). Correction of these causes can often reverse a cardiac arrest.

Respiratory Emergencies 

6 You are providing ventilations using a Bag-mask device. Suddenly, you do not see the patient's chest rise with the ventilation. You reposition the patient to ensure an open airway. When you attempt to ventilate, you do not see his chest rise. The most likely cause of this is:
Incorrect. Please choose another answer.
The most likely cause of the failure of the chest to rise during ventilations is an airway obstruction. Although a faulty bag-mask device is a possibility, it is unlikely that it would fail in the middle of providing ventilations.
7 According to American Heart Association ACLS guidelines, cricoid pressure during intubation:
Incorrect. Please choose another answer.
According to the most current AHA guidelines, cricoid pressure may delay or prevent placement of an advanced airway so is no longer recommended.

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8 You are providing positive pressure ventilation through an ET tube to a patient in respiratory distress. Indications that you are ventilating too fast include all of the following EXCEPT:
Incorrect. Please choose another answer.
Latrogenic effects of hyperventilation through an ET tube include aspiration, stomach insufflation, and tension pneumothorax. Increasing waveform capnography readings are an indication of efficient CPR.
9 According to American Heart Association ACLS guidelines, when available, the best way to confirm and maintain tracheal tube position is by:
Incorrect. Please choose another answer.
The AHA recommends continuous waveform capnography and clinical examination to confirm and maintain ET tube position.
10 Signs of respiratory failure include all of the following EXCEPT:
Incorrect. Please choose another answer.
Nasal flaring and retractions are signs of respiratory distress, not respiratory failure. In respiratory failure, you will see decreased respiratory effort with late bradypnea, diminished air movement, peripheral and central cyanosis, and decreased level of consciousness.

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Shock Emergencies 

11 Emergency Medical Service has brought a 24-year-old man to the ED with gunshot wounds to his abdomen and left groin area. His blood pressure is 84/52 and heart rate is 120 per minute. His skin is diaphoretic, cool, and pale. The treatment the nurse should prepare for is:
Incorrect. Please choose another answer.
The gunshot wounds and symptoms would indicate that the young man has lost a significant amount of blood that has resulted in hypovolemia. The treatment of hypovolemia is a rapid infusion of a crystalloid intravenous solution.
12 You are on the ED team caring for a 10-year-old child with a normal systolic blood pressure, increased heart rate, slightly delayed capillary refill and cool, pale skin. What severity of shock is the child likely in?
Incorrect. Please choose another answer.
Severity of shock is often characterized by its effect on the systolic blood pressure. When the compensatory mechanisms work and maintain the systolic blood pressure, the shock is defined as "compensated". When the mechanisms can no longer support the blood pressure, shock is classified as "hypotensive" (formally called "decompensated").
13 You are caring for a patient in cardiogenic shock. You know that a probable cause of this condition is:
Incorrect. Please choose another answer.
Congestive heart failure is a common cause of cardiogenic shock. Acute myocardial infarction and other heart conditions can also cause cardiogenic shock. Dehydration can be a cause of hypovolemic shock. Spinal cord injury can cause neurogenic shock. Infection can cause septic shock.

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14 You are caring for a 10-year-old child with normal blood pressure, increased heart rate, and cool pale skin. The child is reported to have had vomitting and diarrhea the past two days. As you perform your primary assessment, you note that respirations are clear and not labored. What is the probable first intervention for this child?
Incorrect. Please choose another answer.
By all indications, the child is in hypovolemic shock and the first interventions should be a fluid bolus at 20 ml/kg of saline or lactated Ringer's solution.

Neurological Emergencies 

15 You assume care for the patient in the ED. During the time she has been in the ED, she has consistently complained of photophobia, a stiff neck, increasing confusion, and nausea. Her history shows a motor vehicle accident several days ago. She states the pain is the worst headache she has ever had. You suspect she might have a:
Incorrect. Please choose another answer.
Given the history of the recent MVA and these classic symptoms, the prudent nurse should have a high degree of suspicion of a subarachnoid hemorrhage. Assessment will show neurologic deficits and decreased eye movements. The nurse should prepare the patient for a CT scan of the brain.
16 To quickly evaluate a child's neurological status, all of the following standard evaluations can be used EXCEPT:
Incorrect. Please choose another answer.
The Epworth Scale is a measure of sleepiness and is not part of the standard evaluation of a child's neurological exam. The AVPU and Glasgow Coma scales can be used to evaluate a child's neuro status. Pupillary size and response should also be checked.

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17 According to the American Heart Association stroke recommendations, the critical goal time from arrival to the Emergency Department to CT brain scan is:
Incorrect. Please choose another answer.
The goal for CT brain scan is 25 minutes after arrival to the Emergency Department. The assessment should occur within 10 minutes of arrival, diagnosis of ischemic stroke should be made within 45 minutes, and the administration of fibrinolytics should occur with 60 minutes.
18 The National Institute of Neurological Disorders and Stokes (NINDS) has set the goal for immediate general assessment by a stroke team or emergency physician as:
Incorrect. Please choose another answer.
The goal for general assessment by an ED or stroke team physician is within 10 minutes of arrival to the ED. Within the same 10 minutes, an urgent CT without contrast should also be ordered.

Genitourinary, Gynecological and Obstetrical Emergencies 

19 A 16-year-old boy is brought to the ED by his parents. They state that he awoke from sleep with nausea, vomiting, and pain in his scrotum. The nurse notes that the boy's scrotum is swollen and he has a low-grade fever. His urinalysis is normal. The physician suspects a testicular torsion. The definitive treatment for this boy is:
Incorrect. Please choose another answer.
The nurse should recognize that these signs and symptoms in a teenage boy may be indicative of testicular torsion. Although all of the treatments may be used, surgery is the definitive treatment for this condition.

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20 A 24-year-old woman is seen in the emergency department complaining of urinary frequency, pain with urination and urgency. Vital signs are stable and within normal limits. When you obtain a urine specimen, you note that it is cloudy and foul smelling. You should prepare the patient for:
Incorrect. Please choose another answer.
The symptoms of dysuria, urgency and frequency are classic indicators of a urinary tract infection. Urinary tract infections are very common in women and can almost always be treated on an outpatient basis with a course of antibiotics.
21 A woman is admitted to the ED with complaints of lower abdominal pain, smelly vaginal discharge, pain with intercourse, and burning with urination. Her vital signs are stable, and she has no other symptoms. Treatment for this patient will likely include:
Incorrect. Please choose another answer.
Given the patient symptoms, the nurse should suspect that the patient has pelvic inflammatory disease (PID). With early antibiotic treatment, this infection can be treated on an outpatient basis. Without treatment, the infection can continue and cause scar tissue that may lead to infertility and ectopic pregnancies.
22 When evaluating a patient for Acute Renal Failure, it is helpful to use the RIFLE criteria for classification. This acronym refers to:
Incorrect. Please choose another answer.
ARF can be classified by using Risk, Injury, Failure, Loss and End-stage kidney disease. Risk is defined as an increased serum creatinine level at 1.5 times normal or decrease of glomerular filtration rate (GFR) by 25% or decrease in urine output less than 0.5 cc/kg/hr for more than 6 hours. AFR is defined as Injury when the serum creatinine level is increased more than 2 times, GFR is decreased by 50% or urine output is less than 0.5 cc/kg/hr for 12 hours. AFR is defined as Failure when the serum creatinine level is increased more than 3 times, GFR is decreased by 75% or urine output is less than 0.3 cc/kg/hr for 24 hours or anuria for 12 hours. AFR is classified as Loss if there is persistent ARF or if there is a complete loss of kidney function for more than 4 weeks. End-stage kidney disease is defined as a loss of kidney function for more than 3 months.

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23 The nurse has assisted in an emergent delivery of an infant in the Emergency Department. The infant was born 2 weeks before the due date and is small for gestational age. The nurse documents a thin upper lip, small eye openings, and a smooth philtrum above the upper lip. This child may be diagnosed with:
Incorrect. Please choose another answer.
The symptoms described in the scenario are classic signs of fetal alcohol syndrome caused by maternal consumption of alcohol during pregnancy. The other vitamin deficiencies can result in defects and delays in growth and development, but the particular facial deformities in this scenario are unique to FAS.

Medical and Infectious Disease Emergencies 

24 A young man is brought to the Emergency Department after receiving multiple fire ant bites while working in his yard. Although initially alert and oriented, he begins to develop wheezing and an itchy throat. He complains of nausea and severe anxiety. The ED nurse should prepare to administer all of the following for initial treatment EXCEPT:
Incorrect. Please choose another answer.
The nurse should recognize that these signs and symptoms indicate possible anaphylaxis following the fire ant bites. Antibiotics are not indicated for the initial treatment of anaphylaxis. They may be necessary at a future time if the ant bites become infected. Adrenaline, oxygen, and antihistamines will help reduce some of the symptoms the patient is experiencing. The nurse should also be prepared for emergency intubation if the respiratory problems increase and result in respiratory distress.
25 An eight-year-old child is brought to the emergency department by his parents after receiving multiple fire ant bites at his home. His lips are swollen, and he is complaining of itching. During your assessment, you note that he is wheezing. The most appropriate immediate treatment for this child is:
Incorrect. Please choose another answer.
The mechanism of injury and symptoms would indicate an anaphylactic reaction to the fire ant bites. Since the child has respiratory symptoms, immediate treatment must be instituted with attention to airway maintenance. Epinephrine will act rapidly and should be given as soon as possible and every 10 to 15 minutes as needed. Steroids and antihistamines may be given, but act much more slowly than epinephrine.

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26 The Emergency Department nurse knows that the best way to prevent transmission of nosocomial infections is:
Incorrect. Please choose another answer.
According to the CDC and infection control personnel, hand hygiene is the single most important precaution to take to prevent hospital-acquired infections. The other interventions may be necessary for specific circumstances. However, hand hygiene is the most important intervention to prevent nosocomial infections.
27 Patient placement in the emergency department should be based on:
Incorrect. Please choose another answer.
Isolation precautions should be based on all of these factors. In addition, ED personnel must consider risk factors for transmission of the agent in the infected patient. Room-sharing should only be considered if the patients have the same infection. Terminal clean should be instituted for any room that has been occupied by a potentially infectious patient.

Gastrointestinal Emergencies 

28 You are caring for a patient who has just been diagnosed with hepatitis A. The discharge instructions for this patient will likely include all of the following EXCEPT:
Incorrect. Please choose another answer.
Patients with hepatitis A rarely have pain so having scheduled pain medication would not be necessary. However, these patients do have nausea and fatigue necessitating medication and small meals for nausea and frequent rests for the fatigue.

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29 A 12-year-old patient is brought to the emergency department by his parents after accidentally swallowing a disk battery while changing the battery in his watch. A chest x-ray reveals that the battery is in the patient's esophagus. He is able to swallow and breathe without difficulty. The most appropriate intervention for this patient is to:
Incorrect. Please choose another answer.
Emergent endoscopy is indicated for any obstruction: when a patient is unable to manage secretions, when a patient swallows a sharp-pointed object, or when a patient swallows a disk battery. Any of these ingestions may constitute an emergency and the patient and family should be prepared for possible emergent endoscopy.
30 A nurse is caring for a patient with pancreatitis. Which of the following symptoms would indicate a possible life-threatening complication?
Incorrect. Please choose another answer.
Respiratory distress as evidenced by increased respiratory rate is a potentially life-threatening complication of pancreatitis. The other symptoms are all common findings in the patient with pancreatitis. If the symptoms have not changed significantly, they should be noted but are not life-threatening.
31 An alcoholic patient well known to the emergency department staff presents to the department with complaints of generalized weakness, low-grade fever off and on for the last month, new onset ankle edema, anorexia, right upper quadrant abdominal pain and vomiting. He denies any bloody or coffee ground emesis. This patient should be evaluated for esophageal varices.
Incorrect. Please choose another answer.
Given the history of alcoholism and the presenting symptoms, this patient should be considered at very high risk for esophageal varices. As the disease progresses, one would expect to see bleeding from the varices. Ruptured esophageal varices should be considered a medical/surgical emergency.

Maxillofacial and Ocular Emergencies 

32 A patient has been admitted to the Emergency Department with persistent epistaxis. Vital signs are stable. The correct position for this patient is:
Incorrect. Please choose another answer.
The patient should be sitting up with his head leaning forward. This position helps to prevent blood from being swallowed by the patient. Swallowing blood can cause vomiting. Pinching the nose below the bridge of the nose may help stop bleeding.

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33 A patient presents to the ED with complaint of ear and jaw pain. Upon assessment, you note that his tympanic membranes are non-bulging, pearly gray. You look in his mouth and see this: The primary diagnosis for this patient will be:
Incorrect. Please choose another answer.
The normal eardrum is pearly gray in color so this would rule out any of the ear infections. This patient has an extensive dental caries that should be referred to a dentist. The ED provider may prescribe antibiotics and/or pain medications for this patient to clear any infection that may be causing the ear pain.
34 A young woman is brought to the ED by her roommates. The nurse notes that a knitting needle is sticking out of her right eye. All of the following are appropriate initial interventions EXCEPT:
Incorrect. Please choose another answer.
A penetrating object should never be removed by the nurse since doing so can cause more injury to the eye. Instead, attempt to stabilize the object, patch the other eye to prevent eye movement, and call for an ophthalmology consult.
35 A baseball coach calls the emergency department after a 15-year-old boy had a tooth knocked out during a baseball game. The baseball coach found the intact tooth on the ground and has rinsed off the dirt. What should the coach be advised to do?
Incorrect. Please choose another answer.
Many times, an avulsed tooth can be reimplanted if the tooth is out of the socket for less than 60 minutes. After that time, the periodontal ligaments begin to die. An avulsed tooth is best transported in the patient's own mouth if he is not at risk for swallowing the tooth and if there are no other injuries. Generally, the rule of thumb is that children under the age of six should not transport the tooth in their mouth.

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Orthopedic and Wound Emergencies 

36 The child pictured on the right is seen in the ED for a left forearm fracture. The orthopedic surgeon reduces the fracture in the ED and applies the cast. The discharge instructions have not been understood because:
Incorrect. Please choose another answer.
The child and parent should understand that the hand must be elevated above the level of the heart (on a pillow, for example) when the child is sitting. When the child is up, the sling should be adjusted to keep the hand elevated as much as possible. Hanging the hand down will cause blood to collect in the hand causing swelling. The swelling under the cast may cause decreased venous return. The parents should be taught to check capillary refill, movement, and sensation of the hand as long as the cast is in place.
37 A seventeen-year-old is brought to the emergency department complaining of leg pain after a motor vehicle crash. X-rays show a fracture of the femur with several bone fragments at the fracture site. You note that the skin above the fracture site is intact but bruised. This type of fracture is called:
Incorrect. Please choose another answer.
A comminuted fracture is one in which there are more than two portions of the fractured bone. In a comminuted fracture, you may see bone fragments at the site of the fracture. An open fracture is one in which the skin is broken. Since the skin is intact, this fracture is a closed, comminuted fracture of the femur.

Environment and Toxicological Emergencies 

38 A nurse is caring for a farmer who was bitten by a rattlesnake while working in his field. He killed the snake and brought it to the ED for positive identification. The triage nurse notes two puncture marks on his right hand. The proper interventions for this patient may include all of the following EXCEPT:
Incorrect. Please choose another answer.
The optimal position of the affected extremity is below the level of the heart to slow venom movement into central circulation. Tetanus vaccination and antivenom administration should be given as medically indicated. Cleaning the puncture wounds should be done gently.

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39 A 36-year-old African American man presented to the emergency department with burns to his hands that were suffered when his car radiator boiled over onto his hands. He has run cool water over his hands but he is still experiencing what he describes as "horrible" pain. He does not have burns on any other area of his body. How should this burn be classified according to the American Burn Association's guidelines?
Incorrect. Please choose another answer.
Minor shallow or deep partial thickness burns on less than 15% of an adult's body less than 40 years of age can be treated on an outpatient basis. Because the burns are on his hands, the patient may be admitted as an observation patient since there is a functional risk to his hands.

The American Burn Association's guidelines are as follows:
  • First Degree (partial thickness) - superficial, red, sometimes painful
  • Second Degree (partial thickness) - red, blistered, swollen, very painful
  • Third Degree (full thickness) - whitish, charred or translucent, no pin prick sensation
40 A patient in the ED is diagnosed with West Nile virus. Which of the following is the mode of transmission for this disease?
Incorrect. Please choose another answer.
West Nile virus is caused by the bite of a mosquito. First discovered in the US in 1999, it is believed that the virus is actually carried by infected birds. The mosquito bites the bird and then bites a person. Mosquitoes carry the highest amount of virus in the early fall; typically, rates of the reported disease increases in late August and early September. As mosquitoes die off in the cold weather, the incidence of disease decreases.

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Mental Health Emergencies 

41 One of the tools ED nurses can use to recognize aggressive behavior before it increases in patients in the ED is called STAMP, which stands for:
Incorrect. Please choose another answer.
Stamp stands for: Staring, Tone and volume of voice, Anxiety, Mumbling, and Pacing. Originally, a health researcher who spent 300 hours observing aggressive, violent behavior in the ED developed this framework. STAMP is a screening tool that triage nurses can use to identify potentially violent individuals in emergency rooms. 
42 The nurse in the Emergency Department is discharging a patient who has been evaluated by the psychiatric team for suicidal ideations. Discharge instructions should include all of the following EXCEPT:
Incorrect. Please choose another answer.
Recommending that the family know where the patient is at all times may be counterproductive since this action can cause the patient to feel untrusted, trapped, and spied on. The other options should all be considered by the nurse.
43 The medication indicated for a suspected opioid overdose is:
Incorrect. Please choose another answer.
Naloxone (Narcan) is the medication that is indicated for the treatment of an opioid overdose. If the patient's condition is due to opioids, the nurse should be prepared for rapid reversal of the narcotic effects of the drug.

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Professional Issues 

44 You are the nurse in the Emergency Department caring for a patient with a known history of alcoholism. He is loud, verbally abusive and argumentative to the staff, and uncooperative with requests from the staff. His blood pressure is 158/84. Heart rate is 104, respiratory rate 22, and a blood alcohol level of 0.30%. The first action by the staff should be to:
Incorrect. Please choose another answer.
The first action is to move the patient to a quiet room where the activity in the Emergency Department will not escalate the patient's abusive behavior. Locking the room is a form of restraint so rounds should be made every 15 minutes or more frequently as defined by hospital policy. Lorazepam is an appropriate medication to calm the patient and help prevent seizures. A magnesium level is appropriate since the risk of seizures increases if the magnesium level is low.
45 The pediatric Emergency Department nurse is required to report:
Incorrect. Please choose another answer.
Regardless of the patient's age or gender, the Emergency Department nurse is required to report any suspected abuse or injury that might have resulted from abuse or neglect. The reporter is protected by statute from retaliatory actions as a result of their report to protective services or local law enforcement.
46 Emergency nurses are encouraged to use evidence based practices (EBP) in the practice of emergency nursing. Which of the following practices is not recommended by the Emergency Nurse's Association?
Incorrect. Please choose another answer.
Although verbal and telephone orders are not ideal, the practice of emergency nursing often requires taking verbal orders. In those cases, the nurse must employ the practice of reading back the order to ensure that it was received and recorded accurately.

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47 The nurse in a small rural hospital is caring for a pregnant woman who is at 34-weeks gestation in her first pregnancy. She is complaining of intermittent lower abdominal pain. The hospital does not have a labor and delivery unit, but the on-call physician has determined that her cervix is dilated to 3 cm. The fetal heart sounds are strong at a rate of 150 beats per minute. The woman is accompanied by her husband. The nearest hospital with a labor and delivery unit is 30 minutes away. The correct action in this situation is to:
Incorrect. Please choose another answer.
According to EMTALA, a pregnant woman cannot be transferred if delivery is imminent. However, in this scenario, the patient is stable, the fetus does not seem to be in distress, and the woman is not in active labor. Therefore, the discharge of the patient is not restricted by the EMTALA statute. The husband should transport the patient to the nearest hospital with a labor and delivery unit for further monitoring.
48 The ENA Code of Ethics expects the emergency nurse to do all of the following EXCEPT:
Incorrect. Please choose another answer.
An integral part of being an effective ED nurse is knowing what tasks can or should be delegated to other roles. The ED nurse should not expect to perform all tasks for every patient but should know what tasks can be delegated.

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49 A nurse has inserted a nasogastric (NG) tube for the relief of nausea and vomiting. The technician working with the nurse does not have any special training or certification. The nurse asks the technician to "take care of the patient while I go to lunch". While the nurse is out of the department, the technician working with the patient can:
Incorrect. Please choose another answer.
The only task that the nurse should delegate to the unlicensed technician is the provision of oral care.
50 Which of the following is a way to reduce gender bias when triaging patients who come to the ED?
Incorrect. Please choose another answer.
To reduce gender bias, nurses of both sexes need to ask all patients gender-neutral questions, not just those of the opposite sex. Ways to minimize gender bias overall include asking open-ended questions, imagining asking the same question to a patient of the opposite sex, and having a training coach work with staff to assist in identifying situations of gender bias.
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Related Links

Quality starts with who wrote the material. Our writers:

Macie Roetting, MSN, APRN, CEN, has worked in the emergency room for over 10 years. She has mentored many new nurses and is the trauma liaison in the emergency room.

Jennifer Hulsebus, RN, CEN, has been a CEN for five years and a registered nurse for over fifteen years. She has worked in the emergency department in four hospitals.

Eileen Johnson, RN, MSN, is a master's prepared RN and medical writer. She had over 15 years of experience as a Certified Emergency Nurse and is a former item writer for the CEN exam.

How should I study for the emergency nurse exam?

Practice tests and flash cards are an effective way to study for the CEN exam.  They help you learn the subject matter and practice your test taking skills.  The CEN exam is taken on a computer, so practicing with online practice tests can boost your chance of success.

What is on the certified emergency nusre exam?

A nurse who wishes to obtain the Certified Emergency Nurse (CEN) credential must take and pass the CEN exam which is administered by the Board of Certification of Emergency Nursing (BCEN).

The CEN exam tests your ability to use the Nursing Process within the context of Emergency Nursing. Throughout the test, you can expect to see questions that will test your assessment, analysis, intervention and evaluation knowledge. The CEN exam is composed of 175 multiple choice questions and covers the following twelve areas:

  • Cardiovascular
  • Respiratory
  • Medical Emergencies and Infections
  • Neurological
  • Orthopedics and Wounds
  • Gastrointestinal
  • Genitourinary, Gynecological and Obstetrical
  • Environment and Toxicology
  • Professional issues
  • Shock
  • Maxillofacial and Ocular
  • Psychosocial

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