The CEN exam is a challenging assessment developed by the Board of Certification for Emergency Nursing for men and women who want to enter the field of emergency nursing. Registration for the examination is available online, over the telephone, and by mail.
The content of the CEN exam is divided into 13 categories: cardiovascular (21 items); gastrointestinal (9 items); genitourinary, gynecology, obstetrical (10 items); maxillofacial and ocular (6 items); neurological (15 items); orthopedic and wound (13 items); psychological and social (6 items); respiratory (18 items); patient care management (9 items); substance abuse, toxicological, and environmental (10 items); shock and multi-system (11 items); medical emergency (15 items); and professional issues (7 items).
The CEN exam consists of 175 multiple-choice questions with four possible answers. In some cases, several possible answers will be partially right; it is the test taker’s job to pick the best answer. The score is calculated according to the number of questions answered correctly and the relative difficulty of the test version.
Each CEN test contains 25 pretest items, which do not contribute to the final score but are used to develop future versions of the exam. It is impossible to identify these questions.
The CEN exam is administered by computer at special testing centers located around the United States.
CEN Exam Practice Test
1. A forty-year-old female presents to the emergency department (ED) complaining of chest pain. After triaging the client, obtaining vital signs including a blood pressure of 90/46, and establishing an adequate airway, what is the next most important intervention for this client?
a. registering the patient into the system
b. ordering serum blood laboratory tests
c. placing the client on a cardiac monitor, administering oxygen, and obtaining an electrocardiogram (EKG)
d. giving a sublingual nitroglycerin tablet for the immediate relief of pain
2. The purpose of the primary assessment in any emergency is to
a. perform a quick look-see to determine the illness or injury
b. assess for life-threatening problems that require an immediate intervention
c. make the client comfortable and remove wet clothing for the assessment
d. gain a medical and surgical history, including allergies and medication
3. The emergency medical services (EMS) team transports an adult male with chest pain to the ED. They have initiated a large-bore intravenous (IV) line, administered oxygen, and placed the client on the cardiac monitor. Upon arrival to the ED, the initial EKG shows ST deviation in two leads, and the client is pale, clammy, and restless. What is the next intervention the ED nurse should anticipate?
a. The nurse will give a report to the intensive care unit (ICU).
b. The nurse will give a large dose of heparin.
c. The nurse will prepare the client for the cardiac catheterization laboratory (cath lab).
d. The nurse will order a repeat EKG for 8 hours in the future.
4. Which factors about troponin levels are important to consider when caring for a client being evaluated for an acute myocardial infarction (MI)?
a. The troponin level is not the most important factor when caring for a client with an acute MI.
b. Troponin levels elevate 3 to 12 hours after MI onset.
c. Troponin levels are specific to MI clients only.
d. Troponin levels will elevate in unstable angina as well as in an MI.
5. Which factor is NOT a risk for heart disease but also should not be excluded when considering the diagnosis of MI when a client presents with chest pain?
a. age greater than 65
b. nonsmoking female
c. smoking any gender
1. C: A family member can register the patient into the system, blood tests must be done but can be done after the EKG, and, although nitroglycerin is an appropriate intervention for pain, the low blood pressure may need evaluation before choosing to give nitroglycerin. The appropriate intervention is to place the client on a cardiac monitor, give oxygen to decrease cardiac workload, and obtain an EKG to immediately evaluate the heart. The ED is a controlled setting where a physician should be readily available to look at the client, evaluate the cardiac monitor, and interpret the EKG to determine further interventions.
2. B: The primary assessment is done in a systematic way. Identifying a need and performing an intervention are essential before going on to the next step. Assess the airway and then intervene, assess the breathing and then intervene, and so on until you have performed a complete head-to-toe assessment to identify the immediate illness or injury and provided an immediate emergency intervention. Answer a is incorrect because it neglects the intervention aspect of the assessment. Answers c and d are incorrect because they are not aspects of the primary assessment.
3. C: The goal for any suspected acute coronary syndrome is a time frame of ED door to cath lab or to balloon those arteries to be 90 minutes or less. ST segment deviation in two or more leads usually indicates an acute ischemic event, which requires an angiogram or angioplasty. The nurse may give a report and may order labs and repeat EKGs, but the immediate intervention is to get the client ready for the cardiac cath lab. This may require calling in a cardiac team, undressing the patient completely, and removing jewelry. It may also include any other orders a cardiologist requires for the patient before the procedure. An ED nurse should be prepared for the possibility of this invasive procedure.
4. B: Troponin levels are elevated 3 to 12 hours after an acute onset of MI. Answer a is incorrect because troponin levels have taken the place of enzymes as cardiac biomarkers. However, troponin levels can also elevate in other disease states, including renal failure, making answer c incorrect. Answer d is incorrect because troponin levels actually help to distinguish between unstable angina (UA) and MI. Troponin levels do not elevate in UA.
5. B: A nonsmoking female may not have any risk factors, but a female complaining of chest pain should be evaluated for an acute cardiac problem, like any client with risk factors. Females present with different symptoms when having an MI and may not have classic symptoms, and they may also have an MI without having risk factors. The other answers are all risk factors for cardiac disease and acute cardiac syndromes.