Certified Emergency Nurse (CEN) Examination — Questions and Answers

Question 1: What is the immediate treatment for a tension pneumothorax?

Needle decompression at 2nd ICS midclavicular line (Correct answer)
Chest X-ray then chest tube
High-flow O2 and observation
Intubation and mechanical ventilation

Correct answer: Needle decompression at 2nd ICS midclavicular line

Tension pneumothorax is a clinical emergency requiring immediate needle decompression without waiting for imaging.

Question 2: A nurse is asked to float to a unit where they have limited experience. What is the BEST response?

Ask a coworker to sign off on their care without supervision
Accept and independently manage all patients without disclosing inexperience
Accept while communicating limitations and requesting appropriate support (Correct answer)
Refuse the assignment entirely

Correct answer: Accept while communicating limitations and requesting appropriate support

Nurses must communicate competency limitations when floated to unfamiliar units to ensure safe patient care and appropriate supervision.

Question 3: What is the primary purpose of professional certification in Toxicology?

To replace practical experience
To meet legal requirements only
To validate competency and knowledge in the field (Correct answer)
To increase salary automatically

Correct answer: To validate competency and knowledge in the field

Certification validates that a professional has met established standards of knowledge and competency in Toxicology.

Question 4: A burn patient has circumferential full-thickness burns to both lower extremities with absent distal pulses. The priority intervention is:

Perform escharotomy (Correct answer)
Administer vasopressors
Increase IV fluid rate immediately
Apply compression dressings

Correct answer: Perform escharotomy

Circumferential full-thickness burns cause compartment syndrome requiring escharotomy to restore distal perfusion.

Question 5: When assessing a trauma patient using the primary survey, which action is performed FIRST?

Assess circulation
Establish airway with C-spine precautions (Correct answer)
Control hemorrhage
Expose and examine the patient

Correct answer: Establish airway with C-spine precautions

The primary survey follows the ABCDE sequence, starting with airway management while maintaining cervical spine protection.

Question 6: A patient presents with a sudden onset of the 'worst headache of my life.' Which condition must be ruled out FIRST?

Meningitis
Migraine
Subarachnoid hemorrhage (SAH) (Correct answer)
Hypertensive urgency

Correct answer: Subarachnoid hemorrhage (SAH)

A thunderclap headache described as the worst ever is the classic presentation of subarachnoid hemorrhage until proven otherwise.

Question 7: What does informed consent require?

Explaining the procedure, risks, benefits, and alternatives to the patient (Correct answer)
Family approval only
Verbal agreement only
Getting any signature on a form

Correct answer: Explaining the procedure, risks, benefits, and alternatives to the patient

Informed consent requires that patients understand the proposed procedure, its risks and benefits, alternatives, and have the opportunity to ask questions before agreeing.

Question 8: What role does ethics play in Toxicology practice?

It only matters for legal compliance
It only applies to managers
Ethics is optional in professional settings
It guides professional conduct and protects stakeholders (Correct answer)

Correct answer: It guides professional conduct and protects stakeholders

Professional ethics provide frameworks for responsible decision-making, ensuring practitioners act in the best interest of those they serve.

Question 9: A patient on warfarin presents with a headache and vomiting after a fall. CT scan shows a hyperdense crescent-shaped lesion crossing suture lines. This is MOST consistent with:

Epidural hematoma
Subarachnoid hemorrhage
Intracerebral hemorrhage
Subdural hematoma (Correct answer)

Correct answer: Subdural hematoma

A crescent-shaped hyperdensity that crosses suture lines on CT is characteristic of an acute subdural hematoma from bridging vein rupture.

Question 10: A patient presents with sudden onset of the 'worst headache of their life.' What condition should be suspected first?

Subarachnoid hemorrhage (Correct answer)
Migraine with aura
Tension headache
Cluster headache

Correct answer: Subarachnoid hemorrhage

Sudden severe 'thunderclap' headache is a classic hallmark of subarachnoid hemorrhage until proven otherwise.

Question 11: A patient with a foreign body airway obstruction is unconscious after failed back blows. What is the next step?

Continue back blows indefinitely
Perform abdominal thrusts in supine position and visualize airway (Correct answer)
Immediate cricothyrotomy
Begin CPR with chest compressions only

Correct answer: Perform abdominal thrusts in supine position and visualize airway

In an unconscious patient with FBAO, perform CPR with each breath attempt preceded by looking in the mouth for a visible foreign body.

Question 12: Which diagnostic test is the gold standard for confirming pulmonary embolism?

D-dimer blood test
Chest X-ray
VQ scan
CT pulmonary angiography (CTPA) (Correct answer)

Correct answer: CT pulmonary angiography (CTPA)

CT pulmonary angiography is the gold standard for diagnosing PE due to its high sensitivity, specificity, and wide availability.

Question 13: A nurse receives an order that they believe is inappropriate for the patient. What is the FIRST action?

Clarify the order with the prescribing provider directly (Correct answer)
Refuse the order and document it without notifying the provider
Carry out the order to maintain chain of command
Ask a colleague to carry out the order instead

Correct answer: Clarify the order with the prescribing provider directly

Nurses must clarify unclear or potentially harmful orders with the prescribing provider before administering, to ensure patient safety.

Question 14: How does documentation support quality in Toxicology?

It creates records, ensures consistency, and enables improvement (Correct answer)
It only serves administrative purposes
Documentation is unnecessary overhead
It is only for billing

Correct answer: It creates records, ensures consistency, and enables improvement

Proper documentation creates accountability, ensures consistency, supports quality improvement, and provides legal protection.

Question 15: Why is continuing education important in Pediatric Emergencies?

It is not important after certification
Only for re-certification requirements
To network only
To stay current with evolving standards and practices (Correct answer)

Correct answer: To stay current with evolving standards and practices

Continuing education keeps professionals updated with the latest developments, standards, and best practices in their field.

Question 16: A patient with inferior STEMI and RV infarction develops hypotension. Which intervention is contraindicated?

Normal saline 500 mL IV bolus
Dopamine infusion
Nitroglycerin administration (Correct answer)
Norepinephrine infusion

Correct answer: Nitroglycerin administration

Nitroglycerin is contraindicated in RV infarction because the RV is preload-dependent, and reducing venous return can precipitate severe hypotension.

Question 17: What does the CURB-65 score assess in pneumonia patients?

Severity and need for hospitalization (Correct answer)
Risk of pleural effusion
Likelihood of bacterial vs. viral etiology
Response to antibiotic therapy

Correct answer: Severity and need for hospitalization

CURB-65 evaluates confusion, urea, respiratory rate, blood pressure, and age ≥65 to determine pneumonia severity and disposition.

Question 18: A 3-year-old presents with drooling, muffled voice, high fever, and refusal to move the neck. The nurse should FIRST:

Attempt to visualize the oropharynx with a tongue blade
Prepare for immediate airway management and notify the physician (Correct answer)
Obtain a throat swab for culture
Administer antipyretics and observe

Correct answer: Prepare for immediate airway management and notify the physician

These signs suggest epiglottitis — a life-threatening airway emergency; the airway must be secured immediately without agitating the child.

Question 19: A patient seizing for more than 5 minutes is considered to have status epilepticus. What is the first-line IV treatment?

Phenytoin
Levetiracetam
Phenobarbital
Lorazepam (Correct answer)

Correct answer: Lorazepam

Benzodiazepines such as lorazepam are first-line treatment for status epilepticus due to rapid onset and CNS inhibitory action.

Question 20: Which ethical principle is applied when a nurse advocates for a patient who is unable to speak for themselves?

Justice
Nonmaleficence
Veracity
Advocacy (patient autonomy surrogate) (Correct answer)

Correct answer: Advocacy (patient autonomy surrogate)

Advocacy involves speaking on behalf of patients who cannot represent their own interests, upholding their rights and preferences.

Question 21: Which capnography waveform finding indicates esophageal intubation?

Waveform with a plateau phase (ETCO2 35-45 mmHg)
Elevated ETCO2 above 50 mmHg
Shark fin waveform
Absence of waveform with ETCO2 near zero (Correct answer)

Correct answer: Absence of waveform with ETCO2 near zero

Absence of a capnography waveform and ETCO2 near zero confirms esophageal intubation, as the stomach does not produce sustained CO2.

Question 22: A patient with ischemic stroke arrives within 2 hours of symptom onset. What is the first-line pharmacological intervention if eligible?

Aspirin 325 mg
Heparin infusion
Warfarin loading dose
IV alteplase (tPA) (Correct answer)

Correct answer: IV alteplase (tPA)

IV alteplase (tPA) is the standard fibrinolytic therapy for eligible ischemic stroke patients within the 3–4.5 hour window.

Question 23: Which principle underlies the concept of informed consent in emergency nursing?

Beneficence — acting in the patient's best interest without input
Patient autonomy — the right to make informed decisions about their care (Correct answer)
Fidelity — maintaining loyalty to the institution's policies
Justice — ensuring equal distribution of medical resources

Correct answer: Patient autonomy — the right to make informed decisions about their care

Informed consent is rooted in patient autonomy, requiring that competent patients receive adequate information to make voluntary decisions about their care.

Question 24: Which of the following is the priority intervention for a patient with a suspected spinal cord injury?

Immediate MRI
Lumbar puncture
Spinal immobilization (Correct answer)
IV methylprednisolone bolus

Correct answer: Spinal immobilization

Spinal immobilization is the immediate priority to prevent secondary injury from movement before definitive imaging and diagnosis.

Question 25: A patient with diabetes presents with Kussmaul respirations, fruity breath odor, and altered mental status. The nurse should anticipate which diagnosis?

Hyperosmolar hyperglycemic state (HHS)
Hypoglycemia
Diabetic ketoacidosis (DKA) (Correct answer)
Lactic acidosis

Correct answer: Diabetic ketoacidosis (DKA)

Kussmaul respirations (deep, rapid) and fruity breath from acetone are compensatory signs of metabolic acidosis in DKA.

Question 26: What role does ethics play in Cardiac Emergencies practice?

Ethics is optional in professional settings
It only applies to managers
It guides professional conduct and protects stakeholders (Correct answer)
It only matters for legal compliance

Correct answer: It guides professional conduct and protects stakeholders

Professional ethics provide frameworks for responsible decision-making, ensuring practitioners act in the best interest of those they serve.

Question 27: A patient with hemoptysis, night sweats, and weight loss from a country with high TB prevalence. What is the priority infection control measure?

Contact precautions only
Droplet precautions with surgical mask
Standard precautions only
Airborne isolation in a negative-pressure room (Correct answer)

Correct answer: Airborne isolation in a negative-pressure room

Suspected pulmonary tuberculosis requires airborne precautions in a negative-pressure room to prevent spread of aerosolized mycobacteria.

Question 28: What are standard precautions in healthcare?

Hand washing after patient contact only
Only wearing gloves for known infections
Using masks during surgery only
Treating all blood and body fluids as potentially infectious (Correct answer)

Correct answer: Treating all blood and body fluids as potentially infectious

Standard precautions assume all blood and body fluids are potentially infectious, requiring consistent use of barriers (gloves, gowns, masks) and hand hygiene for all patient interactions.

Question 29: What is the primary purpose of professional certification in Disaster Preparedness?

To replace practical experience
To meet legal requirements only
To increase salary automatically
To validate competency and knowledge in the field (Correct answer)

Correct answer: To validate competency and knowledge in the field

Certification validates that a professional has met established standards of knowledge and competency in Disaster Preparedness.

Question 30: When using the OPQRST mnemonic, 'T' stands for:

Tolerance
Temperature
Timing/time course (Correct answer)
Treatment tried

Correct answer: Timing/time course

In OPQRST, 'T' stands for Timing — when the symptom started, whether it is constant or intermittent, and what makes it better or worse over time.

Question 31: Which organization publishes the core curriculum used as the primary reference for BCEN certification preparation?

American Nurses Association (ANA)
Joint Commission on Accreditation (TJC)
National Council of State Boards of Nursing (NCSBN)
Emergency Nurses Association (ENA) (Correct answer)

Correct answer: Emergency Nurses Association (ENA)

The Emergency Nurses Association publishes the Sheehy's Emergency Nursing core curriculum, the primary reference for BCEN exam preparation.

Certified Emergency Nurse (CEN) Examination

The CEN exam, administered by the Board of Certification for Emergency Nursing (BCEN), validates specialized knowledge and clinical skills across 10 emergency nursing domains including cardiovascular, respiratory, neurological, and other emergency care competencies.

175

Questions

180 min

Time Limit

71%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

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