CEN Exam Flashcards

Q: What do these CEN flashcards cover?

These flashcards cover high-yield emergency nursing recall points across triage, shock, trauma, cardiovascular, respiratory, neurologic, medical, pediatric, obstetric, toxicologic, environmental, and professional practice topics.

Q: Are CEN flashcards enough by themselves?

Flashcards help build rapid recall, but CEN preparation should also include the BCEN content outline, applied study notes, and mixed practice questions that test emergency clinical judgment.

Q: How soon can a candidate retake the CEN after an unsuccessful attempt?

The local CEN summary states that candidates who do not pass may retest after a 90-day waiting period and must pay the applicable retest fee.

Question 1

Primary Survey

Accepted Answer

A rapid first pass for immediate threats: airway, breathing, circulation, disability, and exposure. Treat life threats as they are found instead of saving them for a later assessment.

Question 2

ESI Level 1

Accepted Answer

A patient needing immediate life-saving intervention belongs in the highest triage category. Examples include active arrest, severe respiratory failure, unresponsiveness with airway risk, or profound shock.

Question 3

Waiting Room Reassessment

Accepted Answer

Triage is not a one-time label. Reassessment looks for deterioration, new red flags, uncontrolled pain, worsening vital signs, and conditions that have become time-sensitive.

Question 4

Compensated Shock

Accepted Answer

Early shock may preserve blood pressure through tachycardia and vasoconstriction. Cool skin, anxiety, delayed capillary refill, weak pulses, and narrowing pulse pressure can appear before hypotension.

Question 5

Distributive Shock

Accepted Answer

Shock caused by abnormal vasodilation and maldistributed blood flow. Sepsis, anaphylaxis, and neurogenic shock are key ED patterns, but each has different first-line priorities.

Question 6

Septic Shock Pattern

Accepted Answer

Suspect infection plus poor perfusion: altered mental status, hypotension, rising lactate, oliguria, mottling, or escalating oxygen need. Early source control, cultures, antibiotics, fluids, and vasopressors may be needed.

Question 7

Hemorrhagic Shock Priority

Accepted Answer

Control bleeding and restore circulating volume. In trauma, look for external bleeding, chest, abdomen, pelvis, retroperitoneum, and long-bone sources while preparing blood products when indicated.

Question 8

C-Spine Precautions

Accepted Answer

Maintain spinal motion restriction when mechanism, neurologic deficit, intoxication, distracting injury, or altered mental status makes cervical injury possible. Airway care still takes priority if compromised.

Question 9

Tension Pneumothorax

Accepted Answer

Obstructive shock from trapped intrathoracic air. Severe dyspnea, unilateral breath-sound loss, hypotension, jugular venous distention, or tracheal shift should prompt immediate decompression per protocol.

Question 10

Cardiac Tamponade

Accepted Answer

Blood or fluid around the heart restricts filling. Think obstructive shock after chest trauma or procedure when hypotension, distended neck veins, muffled heart sounds, or pulsus paradoxus appear.

Question 11

Pelvic Fracture Bleeding

Accepted Answer

An unstable pelvic ring can hide major hemorrhage. Avoid repeated pelvic rocking, apply a binder when indicated, and anticipate blood resuscitation and rapid trauma-team coordination.

Question 12

Compartment Syndrome

Accepted Answer

Rising pressure in a closed muscle space threatens perfusion. Severe pain out of proportion, pain with passive stretch, tense swelling, paresthesia, or late pulse changes require urgent escalation.

Question 13

Crush Syndrome

Accepted Answer

Prolonged muscle compression can release potassium, acid, and myoglobin after extrication. Watch for dysrhythmias, renal injury, dark urine, and need for aggressive protocol-based resuscitation.

Question 14

STEMI Pathway Cue

Accepted Answer

Chest pressure, diaphoresis, dyspnea, syncope, or atypical ischemic symptoms should trigger rapid ECG review and reperfusion planning. Do not wait for biomarkers when the ECG is diagnostic.

Question 15

Pulseless Shockable Rhythms

Accepted Answer

Ventricular fibrillation and pulseless ventricular tachycardia require defibrillation with high-quality CPR. PEA and asystole require CPR, epinephrine, and a search for reversible causes.

Question 16

Unstable Tachycardia

Accepted Answer

Tachycardia with hypotension, shock, ischemic chest discomfort, acute heart failure, or altered mental status needs immediate synchronized cardioversion while airway and IV access are supported.

Question 17

Symptomatic Bradycardia

Accepted Answer

Bradycardia with poor perfusion requires rapid intervention. Atropine may be used while preparing transcutaneous pacing and vasoactive support if instability persists.

Question 18

Aortic Dissection Red Flags

Accepted Answer

Abrupt severe chest, back, or abdominal pain with neurologic deficits, pulse differences, syncope, or shock suggests dissection. Anticoagulation or fibrinolytics can be dangerous if misapplied.

Question 19

Acute Pulmonary Edema

Accepted Answer

Severe dyspnea with crackles, frothy sputum, hypertension or ischemia, and hypoxia suggests cardiogenic pulmonary edema. Upright positioning, oxygen support, noninvasive ventilation, and ordered preload reduction may help.

Question 20

Airway Failure Warning

Accepted Answer

Worsening mental status, exhaustion, inability to speak, poor chest rise, cyanosis, or rising carbon dioxide are signs that oxygen alone may not be enough.

Question 21

Upper Airway Obstruction

Accepted Answer

Inspiratory stridor, drooling, tripod posture, hoarseness, or facial and tongue swelling point to upper airway danger. Keep the patient calm and prepare advanced airway support early.

Question 22

Severe Asthma Silent Chest

Accepted Answer

Minimal wheezing can mean critically low airflow, not improvement. A silent chest, fatigue, altered mentation, or poor response to bronchodilators signals impending respiratory failure.

Question 23

COPD Exacerbation Oxygen

Accepted Answer

Give oxygen for hypoxemia but titrate and reassess ventilation, mental status, and blood gases when hypercapnia is a concern. Withhold oxygen only if ordered care would be unsafe, not because COPD is present.

Question 24

Pulmonary Embolism Clues

Accepted Answer

Sudden dyspnea, pleuritic chest pain, syncope, tachycardia, hypoxemia, hemoptysis, or unilateral leg swelling should raise concern for PE, especially with recent immobility, surgery, pregnancy, or cancer.

Question 25

Noninvasive Ventilation

Accepted Answer

NIPPV can reduce work of breathing in selected COPD exacerbation or cardiogenic pulmonary edema patients. Avoid or escalate quickly if the patient cannot protect the airway, is vomiting, or is deteriorating.

Question 26

Stroke Mimics

Accepted Answer

Hypoglycemia, seizure, migraine, intoxication, infection, and electrolyte problems can mimic stroke. Check glucose early while still activating time-sensitive stroke evaluation when deficits are acute.

Question 27

Large Vessel Occlusion Signs

Accepted Answer

Severe unilateral weakness, gaze deviation, aphasia, neglect, or dense visual field loss suggests a high-risk stroke pattern that needs rapid imaging and stroke-team coordination.

Question 28

Increased Intracranial Pressure

Accepted Answer

Worsening headache, vomiting, declining level of consciousness, unequal pupils, posturing, hypertension with bradycardia, or abnormal respirations can signal dangerous intracranial pressure.

Question 29

Status Epilepticus Priority

Accepted Answer

Ongoing or recurrent seizure without recovery threatens oxygenation and brain function. Protect from injury, support airway and glucose assessment, give ordered benzodiazepine therapy, and prepare second-line treatment.

Question 30

Meningitis Safety

Accepted Answer

Fever, neck stiffness, petechial rash, photophobia, or altered mental status requires rapid isolation precautions as indicated, sepsis assessment, cultures when feasible, and prompt antimicrobial therapy.

Question 31

DKA Pattern

Accepted Answer

Hyperglycemia with dehydration, ketones, metabolic acidosis, abdominal pain, vomiting, or Kussmaul respirations suggests diabetic ketoacidosis. Treatment depends on fluids, insulin, potassium monitoring, and cause correction.

Question 32

Hypoglycemia First

Accepted Answer

Altered mental status, diaphoresis, seizure, focal deficit, or collapse can be caused by low glucose. Confirm rapidly and treat according to airway status and available access.

Question 33

Anaphylaxis

Accepted Answer

Multisystem allergic reaction with airway symptoms, bronchospasm, hypotension, vomiting, or widespread hives is an epinephrine emergency. Antihistamines and steroids are adjuncts, not substitutes.

Question 34

Hyperkalemia ECG Concern

Accepted Answer

Peaked T waves, widening QRS, bradyarrhythmias, or sine-wave patterns indicate electrical instability. Prepare ordered calcium for membrane stabilization plus potassium-shifting and elimination therapies.

Question 35

Sickle Cell Vaso-Occlusive Crisis

Accepted Answer

Severe pain requires timely analgesia, hydration assessment, oxygen only when hypoxic, and evaluation for complications such as acute chest syndrome, stroke, infection, or splenic sequestration.

Question 36

GI Bleed Instability

Accepted Answer

Hematemesis, melena, syncope, hypotension, tachycardia, or orthostasis suggests significant blood loss. Priorities include airway readiness, large-bore access, labs, transfusion preparation, and escalation.

Question 37

Ectopic Pregnancy Concern

Accepted Answer

Reproductive-age patient with abdominal or pelvic pain, vaginal bleeding, shoulder pain, syncope, or shock needs pregnancy testing and rapid evaluation for ectopic rupture.

Question 38

Severe Preeclampsia Clues

Accepted Answer

Pregnancy or postpartum hypertension with severe headache, visual changes, right upper quadrant pain, pulmonary edema, seizure, or abnormal labs requires urgent maternal stabilization and OB involvement.

Question 39

Pregnant Trauma Positioning

Accepted Answer

After early pregnancy, a left uterine displacement or tilt can reduce aortocaval compression. Maternal stabilization is the best immediate fetal resuscitation.

Question 40

Pediatric Respiratory Distress

Accepted Answer

Nasal flaring, grunting, retractions, head bobbing, poor feeding, cyanosis, or decreasing effort are serious signs. Children may compensate until they decompensate quickly.

Question 41

Pediatric Dehydration

Accepted Answer

Dry mucosa, absent tears, sunken eyes, delayed capillary refill, tachycardia, lethargy, and decreased urine output indicate escalating dehydration risk.

Question 42

Nonaccidental Trauma Clues

Accepted Answer

Injuries inconsistent with history, patterned bruises, multiple healing stages, delay in seeking care, or concerning caregiver behavior should trigger protection, documentation, and mandatory reporting procedures.

Question 43

Acetaminophen Overdose

Accepted Answer

Early symptoms may be mild despite later liver injury. Obtain accurate timing and amount, check levels and liver tests per protocol, and anticipate N-acetylcysteine when indicated.

Question 44

Opioid Toxicity

Accepted Answer

Respiratory depression with pinpoint pupils and decreased mental status suggests opioid poisoning. Ventilation support is the priority; naloxone reverses respiratory depression but may precipitate withdrawal.

Question 45

Carbon Monoxide Poisoning

Accepted Answer

Headache, dizziness, nausea, confusion, syncope, or multiple symptomatic people from the same setting should prompt high-flow oxygen and carboxyhemoglobin evaluation. Pulse oximetry may look falsely reassuring.

Question 46

Heat Stroke

Accepted Answer

Hyperthermia with central nervous system dysfunction is a cooling emergency. Rapid cooling and supportive care take priority over antipyretics, which do not correct environmental heat injury.

Question 47

Hypothermia Handling

Accepted Answer

A severely hypothermic patient can develop dysrhythmias with rough movement. Handle gently, remove wet clothing, rewarm according to severity, and continue resuscitation decisions with temperature in mind.

Question 48

HazMat Arrival

Accepted Answer

Protect the ED before treatment begins. Control entry, use appropriate PPE, separate contaminated patients, and perform decontamination so staff, patients, and the facility are not secondarily exposed.

Question 49

EMTALA Screening Duty

Accepted Answer

A patient requesting emergency care needs an appropriate medical screening exam to determine whether an emergency medical condition exists, regardless of insurance status or ability to pay.

Question 50

Closed-Loop Communication

Accepted Answer

The receiver repeats the message or critical value, the sender confirms accuracy, and the team acts on the plan. It reduces errors during resuscitation, transfer, and mass-casualty operations.

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