CEN · verified October 2026
Certified Emergency Nurse (CEN) Exam Prep
Built around the 2026 BCEN content outline. Registered nurses practicing in emergency care who want to earn the CEN credential. BCEN recommends (but does not require) about two years of emergency experience.
Disclaimer: Independent product, not affiliated with or endorsed by NCSBN, BCEN, AACN, or the Florida Board of Nursing. CEN and related names are registered trademarks of their respective owners. Original practice content for educational use only.
Exam at a glance
| Credentialing body | BCEN (Board of Certification for Emergency Nursing) |
|---|---|
| Length | 175 multiple-choice items: 150 scored + 25 unscored pretest items |
| Time | 180 minutes (3 hours) of seat time |
| Passing score | 99 of 150 scored items (per BCEN, effective July 6, 2026) |
| Content outline | Updated outline effective July 6, 2026 (from BCEN's 2025 job analysis), with 11 categories |
| Eligibility | Current, unrestricted RN license (U.S. or territories, or equivalent); see BCEN for details |
| Fees | Set by BCEN with a member discount. Check bcen.org for current pricing. |
Fees and policies change. Confirm with the official sources below.
Blueprint coverage
Questions mapped to the official test plan
| Blueprint area | Official weight | Review Qs | Practice-test Qs |
|---|---|---|---|
| Cardiovascular Emergencies | 18 items (12%) | 6 | 9 |
| Respiratory Emergencies | 17 items (11.3%) | 6 | 8 |
| Neurological Emergencies | 17 items (11.3%) | 6 | 8 |
| Gastrointestinal Emergencies | 14 items (9.3%) | 5 | 7 |
| Genitourinary, Gynecology, and Obstetrical Emergencies | 10 items (6.7%) | 3 | 5 |
| Mental Health Emergencies | 13 items (8.7%) | 4 | 6 |
| Medical Emergencies | 15 items (10%) | 5 | 8 |
| Musculoskeletal and Wound Emergencies | 11 items (7.3%) | 4 | 5 |
| Head, Eye, Ear, Nose, Throat Emergencies | 10 items (6.7%) | 3 | 6 |
| Environment and Toxicology Emergencies, and Communicable Diseases | 13 items (8.7%) | 4 | 7 |
| Professional Issues | 12 items (8%) | 4 | 6 |
Item counts are for the 150 scored items in the BCEN CEN Examination Content Outline effective July 6, 2026. Gastrointestinal is now its own category; Head/Eye/Ear/Nose/Throat replaces Maxillofacial and Ocular; Professional Issues is split into Prioritization and Legal/Ethical.
Preview
A taste of the key points
Two sample points per area. The full package has several more for each area.
Cardiovascular Emergencies
- Suspected ACS: 12-lead ECG within 10 minutes. Primary PCI target: 90 minutes or less from first medical contact/door.
- Inferior STEMI: get right-sided leads (V4R). RV infarction is preload dependent, so avoid nitrates and give fluids.
Respiratory Emergencies
- Tension pneumothorax is a clinical diagnosis. Decompress immediately, then place a chest tube.
- Silent chest in asthma = impending respiratory failure. Give systemic steroids, ipratropium, and consider IV magnesium.
Neurological Emergencies
- Stroke: get noncontrast CT fast and check glucose. BP must be below 185/110 before thrombolysis and kept below 180/105 after.
- Status epilepticus: benzodiazepine first, then levetiracetam, fosphenytoin, or valproate.
Gastrointestinal Emergencies
- Variceal bleeding: octreotide, antibiotic prophylaxis, endoscopy, and restrictive transfusion strategy per protocol.
- Signs: Murphy's (cholecystitis), McBurney/Rovsing (appendicitis), Kehr's (spleen), Cullen/Grey Turner (retroperitoneal bleeding).
Genitourinary, Gynecology, and Obstetrical Emergencies
- Testicular torsion: sudden pain and absent cremasteric reflex. Salvage is time-sensitive (about 6 h).
- Ectopic pregnancy: any female of childbearing age with abdominal pain gets a pregnancy test. Rupture means hemorrhagic shock.
Mental Health Emergencies
- Suicidal ideation with a plan: 1:1 observation, a ligature-resistant environment, and removal of belongings.
- Agitation: verbal de-escalation first. Restraints require orders, monitoring, and documentation.
Medical Emergencies
- Anaphylaxis: IM epinephrine (1 mg/mL) in the anterolateral thigh first. Refractory cases need IV fluids and an epinephrine infusion; consider glucagon if the patient is on beta-blockers.
- DKA: fluids, then insulin. Hold insulin if K+ is below 3.3 until it is repleted. Add dextrose when glucose falls to about 200–250.
Musculoskeletal and Wound Emergencies
- Compartment syndrome: pain out of proportion and pain with passive stretch are early signs. Keep the limb at heart level.
- Amputated part: wrap in moist gauze, seal in a bag, and place the bag on ice water. Never put the part directly on ice.
Head, Eye, Ear, Nose, Throat Emergencies
- Chemical eye exposure: irrigate first, before testing visual acuity, until pH is about 7.0–7.5.
- Sudden painless vision loss: CRAO (cherry-red spot) or retinal detachment (curtain).
Environment and Toxicology Emergencies, and Communicable Diseases
- Rule of Nines (adult): each leg 18%, each arm 9%, anterior and posterior trunk 18% each, head 9%, perineum 1%.
- Parkland: 4 mL × kg × %TBSA (partial- and full-thickness) over 24 h, half in the first 8 h from the time of the burn. Titrate to urine output (current ABA guidance starts at 2 mL/kg/%TBSA for adults).
Professional Issues
- ESI: level 1 needs immediate lifesaving intervention. Level 2 is high-risk, confused/lethargic, or in severe pain/distress. Levels 3–5 are based on expected resources.
- Mass casualty (START): RR over 30, no radial pulse/capillary refill over 2 s, or unable to follow commands → immediate.
Questions
What format is the package?
One PDF (letter size) with the overview, key points, 50 review questions, and a 75-question practice test. Answers and rationales for the practice test are in a separate answer key at the end, so you can test yourself first.
How should I use the practice test?
Take it in one sitting with a timer (about 1–1.2 minutes per question), then review every rationale, including the ones you got right.
Is this enough to pass on its own?
It is a focused review and self-assessment tool. Use it alongside your coursework or a comprehensive review, and the official resources linked above. We cannot guarantee a passing result.
Who wrote the questions?
All items are original and written against the official blueprint and current clinical guidelines. See the About page for our review process.
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