1|Page
CEN Exam Version 1 (2025) — Certified Emergency
Nurse Study Guide, Practice Test Questions, and
BCEN Certification Review
Get ready for the CEN Exam Version 1 (2025) with a complete Certified Emergency Nurse
(BCEN) study guide, real practice test questions, and the latest exam review materials. Learn
critical concepts in emergency care, trauma, cardiovascular, and patient management to
pass your CEN certification exam successfully.
CEN exam version 1 2025
• Certified Emergency Nurse exam
• BCEN CEN version 1
• CEN study guide 2025
A patient with a history of hepatocellular carcinoma presents with jaundice, confusion and is combative.
The nurse suspects?
A) an elevated ammonia level.
B) an elevated glucose level.
C) elevated liver function levels.
D) an elevated bilirubin level. - ANSWER-A
Ammonia is a byproduct of protein metabolism, which is converted to urea by the liver and excreted by
the kidneys. At high levels, ammonia crosses the blood-brain barrier and can lead to cerebral edema.
Clinical features of hyperammonemia include sleep-wake cycle disturbances, irritability and confusion.
As ammonia rises, it can lead to seizures, coma and eventually death. Elevated bilirubin, liver enzymes
and hyperglycemia are significant findings but do not typically cause acute confusion.
,2|Page
A patient with a history of heart failure presents with shortness of breath and is unable to speak in
complete sentences. A chest x-ray shows a large collection of fluid in the pleural space. The PRIORITY
intervention is?
A) administration of antibiotics.
B) a paracentesis.
C) a thoracentesis.
D) insertion of urinary catheter. - ANSWER-C
The patient has a pleural effusion. Because the pleural effusion is large, and the patient is in respiratory
distress, a thoracentesis is indicated to remove the fluid and improve the patient's respiratory status.
Paracentesis is a procedure to remove fluid from the peritoneal cavity, not from the pleural space. The
patient may require antibiotics if there are signs of infection, but this is not the priority intervention
based on the x-ray findings. Due to the risk of infection, a urinary catheter should only be inserted if
indicated.
An adult patient sustains blunt trauma to the abdomen in a motor vehicle crash. The patient refuses to
allow any invasive treatments. Initial assessment reveals an ecchymotic area in the left upper quadrant.
The nurse should?
A) obtain consent from a relative for treatment.
B) assess the patient's neurological status
C) allow the patient to leave after signing a medical release form.
D) request an order to sedate the patient. - ANSWER-B
A rational, competent adult can refuse any treatment. The first step is to establish the patient's ability to
understand the consequences of refusing treatment. Due to the mechanism of injury, the patient should
be evaluated for the presence of a head injury.
The nurse is caring for a patient with an obvious femur fracture and bleeding from the urethra. The
nurse should question which of the following orders?
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A) viscoelastrometric testing
B) traction splint
C) ankle-brachial index
D) elevation of extremity - ANSWER-B
The nurse should be suspicious of a possible pelvic injury with urethral bleeding. Traction is
contraindicated in the presence of a pelvic injury. The other interventions are appropriate for this
patient's injuries.
The emergency nurse is treating a patient who was rescued from a burning building. The patient is
restless, intermittently confused, and nauseated. The nurse understands the MOST likely cause of this
presentation is?
A) decreased carbon dioxide.
B) increased carboxyhemoglobin.
C) increased carbon dioxide
D) decreased carboxyhemoglobin. - ANSWER-B
Carbon monoxide poisoning is the most immediate threat to life in survivors of inhalation injury. Because
carbon monoxide binds readily to hemoglobin, the most likely cause of the patient's symptoms is
increased carboxyhemoglobin. The other options do not account for the patient's presentation.
The nurse is caring for a patient who has sustained a femur fracture. The patient suddenly has alterations
in their mental status and a petechial rash is noted to the chest and axilla. The nurse immediately?
A) administers oxygen
B) prepares for chest tube insertion
C) releases the traction splint
D) prepares an intra-compartmental pressure monitor - ANSWER-A
, 4|Page
Petechial rash on the chest and axilla are associated with fatty embolism, which the patient would be at
a higher risk for after sustaining a long bone fracture. The hallmark sign of fatty embolism is hypoxemia
and altered mental status. Initial treatment is focused on symptom management and correcting hypoxia
and hypotension. There is no indication to release traction or prepare for chest tube insertion at this
time. An intra-compartmental pressure monitor is indicated for the detection of compartment
syndrome, of which there are no symptoms indicated with the information provided.
A patient with pancreatic cancer presents to the emergency department in acute distress with sudden
shortness of breath, palpitations, anxiety and chest pain exacerbated with deep breaths. The patient has
a history of recurrent bilateral deep vein thrombosis. The patient's vital signs are:
BP 101/57 mm HgHR 117 beats/minRR 24 breaths/minT (oral) : 98.8˚F (37.1˚C)O2 sat 92% on room air
The nurse suspects?
A) a myocardial infarction.
B) pericardial tamponade.
C) a pulmonary embolism.
D) a spontaneous pneumothorax. - ANSWER-C
Cancer cells are prothrombic as malignant cells release procoagulants and cytokines, both factors
frequently leading to thrombosis. Of all cancers, pancreatic and gastric cancer have the highest risk for
thromboembolic disease. Based on the patient's medical history and presenting signs and symptoms,
this patient is likely experiencing a pulmonary embolism. The other diagnoses are incongruent with the
patient's medical history, signs and symptoms.
A patient presents to the emergency room with complaints of a bull's-eye shaped rash after removing a
tick. The patient also reports headaches, fatigue, malaise, and left-sided facial weakness. What diagnosis
would the nurse expect?
A) Cellulitis
B) Lyme Disease
C) Rocky Mountain spotted fever
D) Tularemia - ANSWER-B
CEN Exam Version 1 (2025) — Certified Emergency
Nurse Study Guide, Practice Test Questions, and
BCEN Certification Review
Get ready for the CEN Exam Version 1 (2025) with a complete Certified Emergency Nurse
(BCEN) study guide, real practice test questions, and the latest exam review materials. Learn
critical concepts in emergency care, trauma, cardiovascular, and patient management to
pass your CEN certification exam successfully.
CEN exam version 1 2025
• Certified Emergency Nurse exam
• BCEN CEN version 1
• CEN study guide 2025
A patient with a history of hepatocellular carcinoma presents with jaundice, confusion and is combative.
The nurse suspects?
A) an elevated ammonia level.
B) an elevated glucose level.
C) elevated liver function levels.
D) an elevated bilirubin level. - ANSWER-A
Ammonia is a byproduct of protein metabolism, which is converted to urea by the liver and excreted by
the kidneys. At high levels, ammonia crosses the blood-brain barrier and can lead to cerebral edema.
Clinical features of hyperammonemia include sleep-wake cycle disturbances, irritability and confusion.
As ammonia rises, it can lead to seizures, coma and eventually death. Elevated bilirubin, liver enzymes
and hyperglycemia are significant findings but do not typically cause acute confusion.
,2|Page
A patient with a history of heart failure presents with shortness of breath and is unable to speak in
complete sentences. A chest x-ray shows a large collection of fluid in the pleural space. The PRIORITY
intervention is?
A) administration of antibiotics.
B) a paracentesis.
C) a thoracentesis.
D) insertion of urinary catheter. - ANSWER-C
The patient has a pleural effusion. Because the pleural effusion is large, and the patient is in respiratory
distress, a thoracentesis is indicated to remove the fluid and improve the patient's respiratory status.
Paracentesis is a procedure to remove fluid from the peritoneal cavity, not from the pleural space. The
patient may require antibiotics if there are signs of infection, but this is not the priority intervention
based on the x-ray findings. Due to the risk of infection, a urinary catheter should only be inserted if
indicated.
An adult patient sustains blunt trauma to the abdomen in a motor vehicle crash. The patient refuses to
allow any invasive treatments. Initial assessment reveals an ecchymotic area in the left upper quadrant.
The nurse should?
A) obtain consent from a relative for treatment.
B) assess the patient's neurological status
C) allow the patient to leave after signing a medical release form.
D) request an order to sedate the patient. - ANSWER-B
A rational, competent adult can refuse any treatment. The first step is to establish the patient's ability to
understand the consequences of refusing treatment. Due to the mechanism of injury, the patient should
be evaluated for the presence of a head injury.
The nurse is caring for a patient with an obvious femur fracture and bleeding from the urethra. The
nurse should question which of the following orders?
,3|Page
A) viscoelastrometric testing
B) traction splint
C) ankle-brachial index
D) elevation of extremity - ANSWER-B
The nurse should be suspicious of a possible pelvic injury with urethral bleeding. Traction is
contraindicated in the presence of a pelvic injury. The other interventions are appropriate for this
patient's injuries.
The emergency nurse is treating a patient who was rescued from a burning building. The patient is
restless, intermittently confused, and nauseated. The nurse understands the MOST likely cause of this
presentation is?
A) decreased carbon dioxide.
B) increased carboxyhemoglobin.
C) increased carbon dioxide
D) decreased carboxyhemoglobin. - ANSWER-B
Carbon monoxide poisoning is the most immediate threat to life in survivors of inhalation injury. Because
carbon monoxide binds readily to hemoglobin, the most likely cause of the patient's symptoms is
increased carboxyhemoglobin. The other options do not account for the patient's presentation.
The nurse is caring for a patient who has sustained a femur fracture. The patient suddenly has alterations
in their mental status and a petechial rash is noted to the chest and axilla. The nurse immediately?
A) administers oxygen
B) prepares for chest tube insertion
C) releases the traction splint
D) prepares an intra-compartmental pressure monitor - ANSWER-A
, 4|Page
Petechial rash on the chest and axilla are associated with fatty embolism, which the patient would be at
a higher risk for after sustaining a long bone fracture. The hallmark sign of fatty embolism is hypoxemia
and altered mental status. Initial treatment is focused on symptom management and correcting hypoxia
and hypotension. There is no indication to release traction or prepare for chest tube insertion at this
time. An intra-compartmental pressure monitor is indicated for the detection of compartment
syndrome, of which there are no symptoms indicated with the information provided.
A patient with pancreatic cancer presents to the emergency department in acute distress with sudden
shortness of breath, palpitations, anxiety and chest pain exacerbated with deep breaths. The patient has
a history of recurrent bilateral deep vein thrombosis. The patient's vital signs are:
BP 101/57 mm HgHR 117 beats/minRR 24 breaths/minT (oral) : 98.8˚F (37.1˚C)O2 sat 92% on room air
The nurse suspects?
A) a myocardial infarction.
B) pericardial tamponade.
C) a pulmonary embolism.
D) a spontaneous pneumothorax. - ANSWER-C
Cancer cells are prothrombic as malignant cells release procoagulants and cytokines, both factors
frequently leading to thrombosis. Of all cancers, pancreatic and gastric cancer have the highest risk for
thromboembolic disease. Based on the patient's medical history and presenting signs and symptoms,
this patient is likely experiencing a pulmonary embolism. The other diagnoses are incongruent with the
patient's medical history, signs and symptoms.
A patient presents to the emergency room with complaints of a bull's-eye shaped rash after removing a
tick. The patient also reports headaches, fatigue, malaise, and left-sided facial weakness. What diagnosis
would the nurse expect?
A) Cellulitis
B) Lyme Disease
C) Rocky Mountain spotted fever
D) Tularemia - ANSWER-B
