2024 Edition

Emergency Nurse Certification Test

Take this free Emergency Nurse Certification practice test to give you an idea of the types of questions and sections on your actual CEN exam.

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Cardiovascular Emergencies

1.	You have defibrillated the patient in ventricular fibrillation. The appropriate action to take next is:
		a. Do CPR for a 2-minute cycle.
		b. Obtain an ECG to determine the rhythm.
		c. Defibrillate again at a higher dose.
		d. Give IV Epinephrine.
The 2010 ACLS guidelines no longer recommend the stacked defibrillation. Instead, a 2-minute cycle of CPR should be done as the defibrillator is charging. While IV Epinephrine may be given every 3-5 minutes during CPR, the times that it is given do not necessarily correlate with the timing of defibrillation. Incorrect answer. Please choose another answer.

2.	When performing carotid massage, all of the following are true EXCEPT:
		a. The massage should be done on both sides of the neck at the same time.
		b. Carotid massage should not exceed 10 seconds.
		c. Emergency equipment should be available.
		d. Asystole may result from carotid massage.
Carotid massage should only be done on one side of the neck at a time. Before doing this procedure, the physician should auscultate both sides of the neck for bruits that might indicate atherosclerotic plaque in the artery. Incorrect answer. Please choose another answer.

3.	Common physiological findings with CHF include all of the following EXCEPT:
		a. Decreased stroke volume
		b. Decreased Cardiac output
		c. Increased venous congestion
		d. Decreased peripheral systemic pressure
In heart failure, it is typical to see venous congestion, decreased stroke volume and cardiac output and increased peripheral systemic pressure. Incorrect answer. Please choose another answer.

Respiratory Emergencies

4.	The laryngeal airway:
		a. Is more complicated to insert than an esophageal-tracheal tube.
		b. Is not an alternative to bag-mask ventilation.
		c. Can safely be used by any provider.
		d. Can be used for airway management in cardiac arrest.
The advantages of the laryngeal tube are similar to the ET tube, but the laryngeal tube is less complicated to insert. However, this advanced airway should only be inserted by a provider experienced in its insertion. Incorrect answer. Please choose another answer.

5.	You are caring for a 2-year-old child who was brought to the emergency department by his parents with reports of "trouble breathing". A sign of improved respiratory effort is:
		a. Nasal Flaring
		b. Chest Retractions
		c. Respiratory rate of 32
		d. Seesaw respirations
A respiratory rate of 24 to 40 is normal in a toddler as long as the respirations are normal and without any of the other signs of increased respiratory effort including nasal flaring, chest retractions and seesaw respirations. Incorrect answer. Please choose another answer.

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6.	A mother rushes her 6-year-old choking child into the emergency department. She states that he was playing with a small toy immediately before the choking incident began. The correct action for this patient is to perform:
		a. Vagal maneuvers
		b. CPR
		c. Back slaps and chest thrusts
		d. Abdominal thrusts
Abdominal thrusts are appropriate for choking patients over age 1. Under the age of one, alternating back slaps and chest thrusts are appropriate to relieve choking. In all cases, continue attempts to relieve choking until the patient becomes unresponsive; then begin the CPR sequence. Incorrect answer. Please choose another answer.

Shock Emergencies

7.	Which of the following is NOT a warning sign that compensatory mechanisms in a patient in shock are failing?
		a. Increasing heart rate above normal for the patient's age.
		b. Absent peripheral pulses.
		c. Decreasing level of consciousness.
		d. Increasing blood pressure.
As compensatory mechanisms begin to fail, systolic blood pressure will begin to decrease. Hypotension is a late and very ominous sign for the patient in shock. Incorrect answer. Please choose another answer.

8.	Which of the following is TRUE about shock?
		a. A patient with severe shock always has an abnormally low blood pressure
		b. Confusion and deteriorating mentation are indicative of hypotensive shock.
		c. Patients with compensated shock may be unable to maintain a normal blood pressure.
		d. A normal blood pressure implies that the patient is stable.
A patient with hypotensive shock will develop deteriorating mental status. Patients can be in severe shock without any change in blood pressure. Therefore, blood pressure is an unreliable indicator of shock status. Incorrect answer. Please choose another answer.

9.	For management of septic shock, vasopressors should be administered:
		a. If fluids have been administered properly and the shock is not resolved.
		b. When the patient shows signs of pulmonary edema
		c. As soon as IV or IO access is obtained.
		d. Never.
Vasopressors should be administered to the patient in septic shock when the shock is fluid refractory. Fluids are the first line treatment for septic shock; until the proper amount of fluids are given without having an effect on the shock, continue to push fluids. Incorrect answer. Please choose another answer.

Neurological Emergencies

10.	Fibrinolytic therapy should be considered in hemorrhagic stroke.
		a. True
		b. False
Because of the bleeding risk, fibrinolytics and anticoagulants should not be used in hemorrhagic strokes, but should be the treatment considered first for ischemic stroke. Incorrect answer. Please choose another answer.

11.	You are caring for a 30-year-old patient who has been diagnosed with Guillain-Barre syndrome. Which of the following is NOT an appropriate intervention?
		a. Prepare for emergency intubation.
		b. Prepare to administer succinylcholine.
		c. Prepare for possible plasmapheresis.
		d. Prepare to administer immunoglobulin.
Administration of succinylcholine is absolutely contraindicated in a patient with Guillain-Barre syndrome. This drug can cause lethal hyperkalemia in these patients. Incorrect answer. Please choose another answer.

12.	Meningitis that is fatal in half of the infected patients is caused by a:
		a. Virus
		b. Bacteria
		c. Fungus
		d. Noninfectious agent
Bacterial meningitis is characterized by acute onset and is commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, Listeria monocytogenes and Neisseria meningitides. Bacterial meningitis commonly presents with the classic triad of symptoms: fever, stiff neck and diminished level of consciousness. Bacterial meningitis is fatal in approximately 50% of all cases. Incorrect answer. Please choose another answer.

Genitourinary, Gynecological and Obstetrical

13.	Priapism can result in impotence.
		a. True
		b. False
Priapism can lead to impotence. Fibrosis and scarring from repeated or long duration of priapism are typically the causes of the impotence. Repeated decompression efforts can also lead to scarring that can cause impotence. Incorrect answer. Please choose another answer.

14.	The term used to define uterine bleeding in which there is too much blood loss in a 24-year-old woman is:
		a. Oligomenorrhea
		b. Amenorrhea
		c. Menorrhagia
		d. Metrorrhagia
Menorrhagia is the term used to define too much blood loss during menstruation in a woman of child-bearing age. Incorrect answer. Please choose another answer.

15.	Placenta previa is common in early pregnancy; most of these early placenta previa cases resolve before delivery.
		a. True
		b. False
True. As the uterus grows during pregnancy, the placenta usually moves up and away from the cervical os. Placenta previa is typically described as complete (the placenta completely covers the os), partial (the placenta partially covers the os), or marginal (the placenta is beside the os but does not cover it). Incorrect answer. Please choose another answer.

Medical Emergencies

16.	The most common electrolyte in the extra-cellular fluid is:
		a. Potassium
		b. Sodium
		c. Chloride
		d. Bicarbonate
Sodium is the most common electrolyte in the extra-cellular fluid. Potassium is the most common electrolyte in intra-cellular fluid. The balance of electrolytes between the intra- and extra-cellular spaces is an ongoing process that controls osmotic pressure and the active transport system. Incorrect answer. Please choose another answer.

17.	A diabetic patient is brought to the emergency department in diabetic ketoacidosis (DKA). You would expect the patient to have:
		a. Hyperactivity
		b. Dehydration
		c. Elevated potassium level
		d. Metabolic alkalosis
As the name implies, DKA will present with metabolic acidosis. As the glucose increases (hyperglycemia), osmotic diuresis will result causing significant dehydration. This diuresis will also result in loss of potassium, sodium, magnesium, phosphorus, and calcium. Incorrect answer. Please choose another answer.

18.	Hepatitis C virus (HCV) can be spread through hugging, sneezing, coughing, sharing eating utensils and other forms of casual contact.
		a. True
		b. False
False. HCV is spread by direct contact with human blood through blood transfusions, improperly sterilized needles and syringes, needle sharing, or occasionally through sexual contact. Incorrect answer. Please choose another answer.

Gastrointestinal Emergencies

19.	Your patient in the ED has been diagnosed with gastroesophogeal reflux disease (GERD). The medication contraindicated for a patient with this disease is:
		a. Anticholinergics
		b. Reglan
		c. Urecholine
		d. Aciphex
Anticholinergics are contraindicated in GERD and a patient's medication list should be evaluated to determine if this drug class has been prescribed. These drugs reduce spasms in the intestine and are often prescribed for irritable bowel syndrome and COPD. This class of drugs includes medications such as atropine, belladonna, hyoscyamine and scopolamine. Incorrect answer. Please choose another answer.

20.	Diverticulosis is a condition that is found in almost all Americans over the age of 80 years.
		a. True
		b. False
True. Diverticulosis, or development of small pouches in the large intestine, is a condition that commonly develops in the aging population. Most of these individuals do not experience any pain with the condition. When the pouches become inflamed and diverticulitis develops, pain will become a primary symptom. Incorrect answer. Please choose another answer.

21.	A 6-month-old child is brought to the emergency department with reported sudden onset projectile vomiting. It is a high probability that the diagnosis for this child is:
		a. Irritable bowel syndrome
		b. Intussusception
		c. Appendicitis
		d. Paralytic ileus
Intussusception is a mechanical bowel obstruction that occurs in children from 5 to 9 months of age. This disorder occurs when the bowel of the child telescopes within itself by peristalsis. This allows bowel contents to accumulate above the obstruction resulting in projectile vomiting. The other disorders are most common in older children and adults. Incorrect answer. Please choose another answer.

Maxillofacial and Ocular Emergencies

22.	A 12-year-old boy is brought to the ED with epistaxis after being hit in the nose by a baseball. There was no loss of consciousness and no other injury. All of the following are appropriate interventions for this patient EXCEPT:
		a. Pinch the nostrils tightly to stop the bleeding.
		b. Have him lie in a supine position to avoid postural hypotension.
		c. Apply pressure below the nares to stop the bleeding.
		d. Apply an ice pack to slow the bleeding.
The patient should be instructed to sit up leaning forward slightly to avoid swallowing any of the blood from his nose. If a large amount of blood is swallowed, it is not uncommon for the patient to vomit bright red blood. This should NOT be confused with a GI bleed. Incorrect answer. Please choose another answer.

23.	A 65-year-old man presents to the emergency department with complaint of painless visual disturbances including loss of central vision, photopsia, "floaters" and shadows in his vision. The most important intervention for this patient is to:
		a. Discharge to home with a referral to an ophthalmologist.
		b. Call an ophthalmologist for consult in the ED.
		c. Administer antibiotics and discharge to home.
		d. Administer steroids and discharge to home.
These symptoms are typical symptoms of a detached retina. This potential ophthalmological emergency should be evaluated in the ED. Incorrect answer. Please choose another answer.

24.	Your patient has been diagnosed with a hyphema. The medication class that is contraindicated for this patient is:
		a. NSAIDs
		b. Topical Steroids
		c. Systemic aminocaproic acid
		d. Anti-glaucoma topical medications
A hyphema is bleeding into the anterior chamber of the eye. It is usually caused by trauma. NSAIDs should be avoided in the case of a hyphema because of the anticoagulant effect of the NSAID class of drugs. Instead, Tylenol should be prescribed for pain management. Incorrect answer. Please choose another answer.

Musculoskeletal and Wound Emergencies

25.	A patient is brought to the ED with suspected shoulder dislocation after falling at home. His hand on that side is cooler than the other hand, but pulses are still palpable. He appears to be in severe pain. The most appropriate first intervention is to:
		a. Medicate with a narcotic for pain control.
		b. Immediate reduction of the shoulder
		c. X-ray of affected shoulder
		d. Tetanus prophylaxis
Since there is currently minimal neurovascular compromise, it is most appropriate to get an x-ray of the affected shoulder to verify the dislocation and to verify that there is not a fracture with the dislocation. Before administering a narcotic, the patient should sign a consent for the shoulder reduction. Unless the patient has also sustained a skin break, tetanus prophylaxis is not usually indicated. Incorrect answer. Please choose another answer.

26.	Your patient has been diagnosed with a left ankle sprain. On the discharge instructions, the physician has prescribed the RICE protocol. This acronym stands for:
		a. Rest, Ice, Compression, Elevation
		b. Radiology, Ice, Compression, Elevation
		c. Rest, Ice, Cast, Elevation
		d. Radiology, Ice, Cast, Elevation
Appropriate treatment for an ankle sprain is Rest, Ice (20 minutes on each hour while awake), Compression (usually with an elastic bandage), and Elevation of the foot above the level of the heart. Incorrect answer. Please choose another answer.

27.	A 22-year-old woman presents to the ED with complaint of pain, swelling, and purulent drainage around the site of a recently acquired piercing in her lower lip. Discharge instructions will include all of the following EXCEPT:
		a. Remove the jewelry until the infection heals.
		b. Take the antibiotic until gone.
		c. Cleanse the area twice a day with full strength hydrogen peroxide.
		d. Apply the topical antibiotic cream after cleansing.
Full strength hydrogen peroxide is no longer recommended for cleansing wounds due to the propensity to cause further tissue damage. Instead, a milder cleanser or soap and water may be recommended. Incorrect answer. Please choose another answer.

Environment and Toxicological Emergencies

28.	A patient is brought to the emergency department with multiple bee stings. Which of the following should NOT be done as part of treatment?
		a. Watch for signs of allergic reaction
		b. Carefully remove the stingers with tweezers
		c. Apply ice to stings
		d. Administer tetanus prophylaxis if needed
Tweezers should never be used to remove stingers since squeezing the stinger may inject more venom into the wound. Instead, use a scalpel or other instrument to scrape across the stinger. Incorrect answer. Please choose another answer.

29.	A child presented to the ED with itchy scalp, irritation of the scalp, and infected areas on the child's head. Assessment reveals lice and nits in the child's hair. Discharge instructions will include:
		a. Permethrin 10% applied to hair and body after shower and shampoo
		b. Manual removal of nits must be done for several days to ensure they do not hatch
		c. Washing sheets and towels in hot water
		d. Child should not return to school until all lice and nits are gone
Sheets and towels should be washed in hot water to remove any lice. The CDC and American Association of Pediatrics both recommend that "no-nit" policies in schools should be discontinued. Although nits may persist after treatment with Permethrin 1% (not 10%), they are usually not viable and are unlikely to hatch into crawling lice. The child should be checked a week or 10 days after treatment to determine if all lice have been removed. Incorrect answer. Please choose another answer.

30.	The most common problem associated with a heat inhalation injury is:
		a. Obstruction due to increasing mucosal edema
		b. Lower airway damage
		c. Lung damage
		d. None of the above
The primary damage with heat inhalation injury is potential upper airway obstruction due to increasing mucosal edema. This can happen at any time during the first 48 hours after injury. For this reason, these patients must be closely monitored for several days following exposure. Incorrect answer. Please choose another answer.

Mental Health Emergencies

31.	A 35-year-old female patient is brought to the ED with complaint of depression as a result of a recent divorce. She must be evaluated for suicidal ideation.
		a. True
		b. False
Although depression associated with a situational crisis is usually time limited, the depression can be so deep as to cause the patient to consider suicide. Every patient who presents to the ED in a situational crisis should be assessed for suicidal ideation and appropriate referrals should be made. Incorrect answer. Please choose another answer.

32.	A patient is brought to the ED with complaint of inability to sleep for more than six hours during a 24-hour period. According to the CDC, workers in which industry are most likely to have this problem:
		a. Health care
		b. Food service
		c. Construction
		d. Retail sales
Over 50% of workers in health care, particularly those on the night shift, may have sleep disorders. The CDC recommends evidence based training programs for these workers to ensure they can get adequate sleep. It is recommended that an adult receive 7-8 hours of sleep per night. Incorrect answer. Please choose another answer.

33.	The factor most closely associated with a child's risk for autism and schizophrenia is which of the following?
		a. Father's age at conception
		b. Mother's age at conception
		c. Both were associated
		d. Neither were associated
Recent studies find that the father's age at conception seems to be closely associated with a child's risk for autism and schizophrenia. This seems to be due to the genetic mutations that may be passed to the child through the father's genetic material. Incorrect answer. Please choose another answer.

Professional Issues

34.	The term used to describe pain that is due to a stimulus that does not normally provoke pain is:
		a. Allodynia
		b. Analgesia
		c. Hyperalgesia
		d. Neuralgia
Allodynia is the perception of pain with a stimulus that does not normally cause pain. Analgesia is the absence of pain in response to a stimulus that would normally be considered painful. Hyperalgesia is an increased, or greater than expected, response to a stimulus that is painful. Neuralgia is pain in a nerve or nerves. Incorrect answer. Please choose another answer.

35.	A pregnant woman in active labor is brought to the emergency department by the pre-hospital providers. According to EMTALA:
		a. This patient must have a medical screening before being transferred to another hospital.
		b. Patients in active labor must be treated at the receiving hospital until the infant and placenta have been delivered.
		c. The hospital may refuse to treat this patient if she has not established obstetrical care there.
		d. None of the above
According to EMTALA, a woman in active labor must remain at the receiving hospital until the infant and placenta are both safely delivered. After delivery, the mother and child must both be stable before being transferred to another facility. Incorrect answer. Please choose another answer.

36.	Triage of patients in the ED should include PQRST components. This acronym includes:
		a. Provokes, Quality, Risk, Severity, Time
		b. Provokes, Quality, Radiation, Severity, Trauma
		c. Provokes, Quality, Risks, Severity, Trauma
		d. Provokes, Quality, Radiation, Severity, Time
The questions the triage nurse should ask include: what provokes the symptoms and makes them better? What does the pain feel like? Where is the discomfort and where does it go? How severe is it on a scale of 1 to 10? When did the symptoms start and how long did it last? The use of the Provokes, Quality, Radiation, Severity and Time acronym will help the ED nurse in triage obtain the initial information needed in the assessment. Incorrect answer. Please choose another answer.

Quality starts with who wrote the material.

Our practice exam writer

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

, a former CEN, 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.

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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