CEN Practice Exam Review

A certified emergency nurse commonly treats patients while they face a life-threatening crisis. They are most likely to be involved while an illness or injury is still in a critical stage.

They must be able to operate autonomously and reach important decisions quickly. Beyond the emergency room, they often play an important role in educating and supporting patients and their families during a critical medical situation.

The Board of Certification for Emergency Nursing (BCEN) sponsors the certification exam for emergency nurses. The BCEN reviews current practice every five years and incorporates any changes into future exams. The Certified Emergency Nurse exam is based entirely on practice within the United States.

According to the BCEN, the emergency nurse certification process helps patient care by:

  • Establishing a level of knowledge, competency, requirements, and achievements
  • Measuring the attainment of a defined body of knowledge needed to function at the current level of competence
  • Encouraging participation in continuing education
  • Promoting professional development and career advancement
  • Providing employers, patients, and peers a mechanism to recognize knowledgeable professionals
  • Promoting self confidence for emergency nursing practitioners

The actual Certified Emergency Nurse test is administered by Applied Measurement Professionals sites, and it must be scheduled at least five days in advance. The computer-based Certified Emergency Nurse exams are administered at 170 AMP Assessment Centers throughout the United States. Participants can take the exam on weekdays or on Saturdays.

Before taking the exam, participants must first become a registered nurse. This usually involves obtaining a bachelor's degree in nursing. In earning this degree, students will study several key areas of nursing, including many situations frequently faced by a certified emergency nurse.

The Board of Certification for Emergency Nursing (BCEN) accepts exam applications on line. Persons who meet the qualifications receive a handbook and a letter of authorization.

Participants are allowed three hours to complete the computer-based multiple-choice exam. The exam includes 175 items altogether, but 25 items are pretest questions which do not count on the current exam.

A passing score is about 75 percent, and the grade is available right after the exam has been completed.

Participants should allow four to six weeks to receive an ID card and certificate. The Certified Emergency Nurse certificate is good for four years. Tools that help the renewal process include the normal computer-based exams, continuing education, and Internet-based testing.

CEN test breakdown | CFRN Flight Nurse exam

1. An elderly female client presents to the ED with complaints of chest pain and a history of angina. After the initial triage, what would be the next appropriate interventions?

  1. cardiac monitor, oxygen, and sublingual nitroglycerin
  2. cardiac monitor, sublingual nitroglycerin, and Foley catheter
  3. cardiac monitor, IV, oxygen, and sublingual nitroglycerin
  4. oxygen, sublingual nitroglycerin, and Foley catheter

2. A 7-year-old child is brought to the emergency department after multiple bee stings about 30 minutes previously. He complains of itching, swollen lips, and difficulty breathing. Wheezing and stridor are heard. What is the most immediate treatment required?

  1. epinephrine 0.1 mg intramuscularly
  2. intravenous corticosteroid
  3. intravenous antihistamine
  4. broad-spectrum antibiotic

3. After an auto accident, x-rays of the patient's leg show a transverse fracture of the midfemur with several bone fragments surrounding the fracture site. The skin of the leg is intact. This type fracture is called:

  1. compression fracture
  2. comminuted fracture
  3. avulsion fracture
  4. open fracture

4. A cancer patient is seen in the emergency department with high fevers and malaise for 2 days. She received chemotherapy about 10 days ago. Her physical exam is not revealing but her temperature is 103°F. A CBC shows a hemoglobin of 10 g/dL, WBC 4000 with 10% polys, 5% bands, 70% lymphs, 10% monos, and 5% other white or unidentified cells. Platelets are 60,000/mm3. Which of the following is NOT immediately appropriate?

  1. blood cultures from different sites
  2. electrolytes, liver and renal function tests
  3. eask if she has been receiving granulocyte colony-stimulating factor (G-CSF)
  4. white blood cell transfusion

5. Which statement best describes acute respiratory distress syndrome (ARDS)?

  1. ARDS is caused by trauma only.
  2. ARDS is sudden, progressive, and severe.
  3. ARDS is caused by an illness only.
  4. ARDS never results in lung scarring.

Certified Emergency Nurse (CEN) Answer Key

1. Answer: C

A cardiac monitor, oxygen, and an IV should be in place for anyone complaining of chest pain and before administering nitroglycerin, especially in an elderly client, who may develop hypotension quickly. When a client does not respond to sublingual nitroglycerin, it indicates possible unstable angina and may require other interventions to relieve the pain.

2. Answer: A

The clinical picture of this patient is that of an anaphylactic reaction to bee stings which is potentially life-threatening. The onset of symptoms within 1 hour after exposure to the allergen is particularly worrisome as are the laryngeal and pulmonary signs. The airway must be established with intubation often necessary; high-flow oxygen, cardiac monitoring, and intravenous fluids are basics. Epinephrine given intramuscularly is the most rapidly acting agent and should be given as soon as possible after the diagnosis of anaphylaxis and every 5 to 15 minutes thereafter as needed. Steroids and antihistamines are slower acting than epinephrine but are often given to alleviate itching, angioedema, and hives. There is no indication for antibiotics in this clinical situation unless further signs and symptoms develop.

3. Answer: B

A fracture is a break or disruption in a bone, generally divided into closed (no break in the skin) and open (protrusion of the bone through the skin). Fractures may take different anatomic patterns, depending on the bone location, the nature of the trauma and the bone density (may be diminished with osteoporosis). Compression fractures are most common in the spine in which a fracture of one or more vertebral bodies leads to a collapse of the spine at that location. An avulsion fracture reflects a forceful contraction of muscle mass, which pulls a bone fragment to break away at the tendon's insertion site. This type of fracture is often seen with severe joint strains. This patient has a comminuted fracture in which the trauma causes more than two separated portions of the bone. Often, several small bony fragments are seen at the site of the break.

4. Answer: D

This patient has fever and neutropenia after chemotherapy. Neutropenia is defined as an absolute neutrophil count (ANC) under 1000/mm3, and a severe neutropenia less than 500/mm3 is particularly dangerous. These patients must be worked up quickly and antibiotic and possibly additional therapy started as soon as possible since the situation may be life-threatening. While myelosuppressive drugs differ in the length of time between administration and the nadir of the ANC, 10 to 14 days is typical. Multiple cultures from different possible sites of origin for sepsis must be done along with chest x-ray and other imaging as indicated by examination. Broad-spectrum antibiotics, such as ceftazidime or imipenem/cilastatin, should be started after cultures are obtained. She should be asked if she has been receiving G-CSF (Neupogen, Neulasta). WBC transfusions are rarely used today since they have a very short shelf life, do not last long in the circulation, and may cause allergic reactions.

5. Answer: B

ARDS is sudden, progressive, and severe, and can even lead to death.

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Last Updated: 03/01/2017


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