CEN Exam – Certified Emergency Nurse (Latest 2026/2027)

A comprehensive exam review for the Certified Emergency Nurse (CEN) certification featuring the newest actual exam questions with correct detailed answers. Covers all major emergency nursing content areas including cardiovascular emergencies (acute coronary syndromes, pericarditis with ST-segment elevation in diffuse leads improving when sitting forward, cardiac tamponade with Beck's triad, aortic dissection, dysrhythmias including WPW as supraventricular tachycardia, second-degree type I heart block with lengthening PR interval, ventricular tachycardia/pulseless VT treated with defibrillation, cardiogenic shock most commonly from myocardial infarction, Frank-Starling law relating to preload, early sign of increased ICP including nausea and vomiting), respiratory emergencies (asthma exacerbation severity with peak flow 48% of personal best as moderate, ARDS treated with PEEP, pleural effusion post-pneumonia, spontaneous pneumothorax in tall/thin patient, tension pneumothorax with absent breath sounds/JVD/cyanosis, pertussis treated with macrolide antibiotics, pulmonary embolism risk reduction with ambulation on long flights, chemical pneumonitis from gasoline aspiration), neurological emergencies (transient ischemic attack with resolving symptoms, Wernicke-Korsakoff syndrome with ataxia/confusion/ophthalmoplegia, Alzheimer's disease with gradual memory loss, multiple sclerosis with unsteady gait/weakness/vision changes, Bell's palsy treated with artificial tears, meningeal irritation with nuchal rigidity, Guillain-Barré with bilateral leg pain as significant finding, Brown-Séquard syndrome from knife wound with ipsilateral motor/contralateral sensory loss, subdural hematoma in elderly post-fall, epidural hematoma, diffuse axonal injury affecting reticular activating system, cluster headache with unilateral pain/red eye/flushing, tension headache, migraine), gastrointestinal emergencies (duodenal ulcer relieved with antacids and food, Mallory-Weiss syndrome from vomiting blood with history of alcohol abuse/bulimia, cholecystitis with RUQ pain radiating to right scapula, peritonitis with rigid abdomen/absent bowel sounds post-MVC, pancreatitis with epigastric pain radiating to back, ulcerative colitis with crampy LLQ pain/bloody diarrhea, intussusception late sign with currant jelly stools), genitourinary and reproductive emergencies (uterine fibroids with heavy bleeding, ectopic pregnancy as first consideration for pelvic pain, testicular torsion from football injury, inevitable abortion with open cervical os, pelvic inflammatory disease increasing ectopic pregnancy risk, methotrexate contraindicated in pregnant nurses, gonorrhea discharge teaching to notify partners), obstetrical and neonatal emergencies (neonate delivery priority to thoroughly dry, maternal resuscitation priority in pregnant arrest, magnesium toxicity with shortness of breath, quality neonatal CPR with minimal interruptions), endocrine and metabolic emergencies (diabetic ketoacidosis with ketonuria vs. HHS without ketones, diabetes insipidus treated with vasopressin, Cushing's syndrome from chronic prednisone with moon face/buffalo hump, Addison's disease, thyroid storm), renal and urological emergencies (renal calculi treated with antiemetics, postrenal injury from kidney stones causing minimal urine output, dark brown urine from prolonged immobilization), hematologic and oncologic emergencies (von Willebrand disease as most common inherited bleeding disorder, idiopathic thrombocytopenic purpura post-viral illness with low platelets, sickle cell pain crisis treated with morphine, immunocompromised post-chemotherapy requiring protective isolation, endocarditis treated with antibiotics pre-surgery), trauma and orthopedic emergencies (escharotomy for circumferential full-thickness burns impairing ventilation, ruptured diaphragm from handlebar injury with gurgling breath sounds, compartment syndrome from crush injury with pain out of proportion treated with extremity at heart level, Achilles tendon rupture with pop and inability to stand on ball of foot, orbital wall fracture with ocular entrapment, avulsion injury with skin peeled away, dislocation with complete joint disruption, gouty arthritis from elevated uric acid, puncture wounds most commonly complicated by abscess), ocular emergencies (iritis from blunt trauma with irregular pupil, acute angle-closure glaucoma with halos/peripheral vision loss, corneal abrasion with foreign body sensation, ruptured globe requiring bilateral patching, chemical splash priority irrigation, retinal detachment priority bilateral patching), environmental and toxicological emergencies (hydrofluoric acid burn treated with calcium gluconate gel, cyanide poisoning from burning plastics in confined space, rabies from bat bite, labyrinthitis with vertigo/nystagmus/tinnitus, frostbite rewarming with circulating warm water, jellyfish sting treated with acetic acid, permethrin for scabies from head-to-toe with second application one week later, cocaine-induced hypertension unopposed by beta blockers), infectious diseases (Lyme disease with bullseye rash treated with doxycycline, Ebola exposure from travel to Sierra Leone requiring infection prevention notification, PPD positive without symptoms requires standard precautions only, vancomycin-resistant Enterococcus transmitted by direct contact), shock states (septic shock in elderly with hypotension/bradycardia/hypothermia, uncompensated shock with unresponsiveness, compensated shock with RAAS increasing sodium, distributive shock with neurogenic presentation post-MVC, obstructive shock, hypovolemic shock), disaster management (hazard vulnerability analysis leading to mitigation phase upgrades, critical incident stress debriefing within 24 hours, key performance indicators for quality improvement), legal and ethical issues (nonmaleficence breached by administering known allergen, express consent with arm extension for blood draw, EMTALA violation with charge nurse as accepting professional, advance directive durable power of attorney for healthcare for sedated patient consent, chain of custody limiting evidence access, medical clearance for psychiatric patient with hallucinations/delusions), pharmacology (activated charcoal for carbamazepine overdose, hemodialysis for acute lithium toxicity, phenazopyridine causing orange urine, procalcitonin for sepsis, ipratropium bromide, albuterol, epinephrine, midazolam, lorazepam, fosphenytoin, phenobarbital, methotrexate, vasopressin, doxycycline), and medication-specific considerations (beta blockers masking cocaine-induced hypertension, SSRI discontinuation syndrome).