No email required. Answer each question, then check your answer to see the rationale. Want the PDF version? Download the free sample PDF.
| 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. |
| Area | Weight |
|---|---|
| Cardiovascular Emergencies | 18 items (12%) |
| Respiratory Emergencies | 17 items (11.3%) |
| Neurological Emergencies | 17 items (11.3%) |
| Gastrointestinal Emergencies | 14 items (9.3%) |
| Genitourinary, Gynecology, and Obstetrical Emergencies | 10 items (6.7%) |
| Mental Health Emergencies | 13 items (8.7%) |
| Medical Emergencies | 15 items (10%) |
| Musculoskeletal and Wound Emergencies | 11 items (7.3%) |
| Head, Eye, Ear, Nose, Throat Emergencies | 10 items (6.7%) |
| Environment and Toxicology Emergencies, and Communicable Diseases | 13 items (8.7%) |
| Professional Issues | 12 items (8%) |
Source: BCEN – CEN exam FAQs. Always check the official site for updates.
A patient arrives with chest pain. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which finding should prompt the nurse to obtain right-sided leads before giving nitroglycerin?
Answer: C
Inferior STEMI may involve the right ventricle. RV infarction is preload dependent; nitrates can cause profound hypotension. Right-sided leads (V4R) help identify RV involvement.
A trauma patient has absent breath sounds on the right, tracheal deviation to the left, hypotension, and distended neck veins. What intervention is anticipated first?
Answer: A
These signs indicate tension pneumothorax, a clinical diagnosis requiring immediate decompression followed by chest tube placement. Imaging should not delay treatment.
A patient arrives 90 minutes after onset of left-sided weakness. Which finding is a contraindication to IV thrombolytic therapy?
Answer: D
Intracranial hemorrhage on imaging is an absolute contraindication to thrombolytics. Glucose should be checked to exclude hypoglycemia as a stroke mimic.
A patient with known cirrhosis is vomiting large amounts of bright red blood. Which medication should the nurse anticipate to reduce portal pressure?
Answer: B
Octreotide (a somatostatin analogue) reduces splanchnic blood flow and portal pressure in suspected variceal bleeding. Antibiotic prophylaxis and endoscopy are also standard.
A 16-year-old male reports sudden severe left scrotal pain that woke him from sleep, with nausea and vomiting. The cremasteric reflex is absent. What is the priority?
Answer: A
Testicular torsion is a time-sensitive emergency; testicular salvage rates decline significantly after about 6 hours. Absent cremasteric reflex supports the diagnosis.
A patient expressing suicidal ideation with a plan is in the ED. Which intervention is the priority?
Answer: D
High-risk patients require constant observation (1:1 or as policy dictates) and environmental safety measures, including removal of belongings that could be used for self-harm.
A patient with a bee sting has wheezing, hypotension, and urticaria. Which medication and route are first line?
Answer: B
IM epinephrine is first-line for anaphylaxis in adults (0.01 mg/kg up to 0.5 mg). IV push cardiac-arrest dosing is not used in a patient with a pulse due to dysrhythmia risk.
A patient with a tibial fracture in a splint reports pain that is unrelieved by opioids and worsens with passive toe movement. What should the nurse suspect?
Answer: C
Pain out of proportion and pain with passive stretch are early signs of compartment syndrome. Loosen constrictive dressings, keep the limb at heart level, and notify the provider for compartment pressure assessment/fasciotomy.
A patient sustained a chemical splash to both eyes from a cleaning product. What is the priority intervention?
Answer: B
Chemical eye exposures require immediate irrigation, continued until the pH normalizes (about 7.0–7.5). This is the one case where irrigation precedes visual acuity testing.
A family is brought in from a home with a faulty furnace. They report headache and nausea. The pulse oximeter reads 99%. Which intervention is the priority?
Answer: A
Standard pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin and may be falsely normal. High-flow oxygen shortens CO half-life; hyperbaric oxygen may be considered.