200+ Free CEN Practice Questions

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Question 1

Score: 0/0

A patient arrives with crushing substernal chest pain and diaphoresis. What is the priority diagnostic action in the first 10 minutes?

Obtain a 12-lead ECG

Send troponin and wait for result

Administer fibrinolytic therapy

Order a CT angiogram

to track

2026 Statistics

Key Facts: CEN Exam

175

Total Items

BCEN CEN exam page

150 + 25

Scored + Unscored

BCEN CEN exam page

106/150

Passing Standard

BCEN CEN exam page

Exam Time

BCEN CEN exam page

$285/$380

Member / Nonmember Fee

BCEN CEN FAQ + CEN Exam Cost page

$195

Military Fee

BCEN CEN FAQ + CEN Exam Cost page

Jul 6, 2026

Current Content Outline Effective Date

BCEN CEN Exam Content Outline

4 years

Recertification Cycle

BCEN CEN FAQ

BCEN lists the CEN exam at 175 total items (150 scored + 25 unscored), 3-hour test time, and a passing standard of 106 scored items. BCEN's updated CEN Exam Content Outline became effective July 6, 2026 and defines 11 weighted domains across core emergency care and professional issues. BCEN's current posted CEN fees are $285 for professional-association members and $380 for non-members ($195 military). BCEN recommends two years of emergency nursing practice before testing.

Sample CEN Practice Questions

Try these sample questions to test your CEN exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A patient arrives with crushing substernal chest pain and diaphoresis. What is the priority diagnostic action in the first 10 minutes?

A.Obtain a 12-lead ECG

B.Send troponin and wait for result

C.Administer fibrinolytic therapy

D.Order a CT angiogram

Explanation: Early 12-lead ECG is the immediate priority for suspected ACS to identify STEMI and activate reperfusion pathways.

2Which rhythm in a pulseless adult is shockable?

A.Asystole

B.PEA

C.Ventricular fibrillation

D.Sinus bradycardia

Explanation: Ventricular fibrillation and pulseless VT are shockable rhythms. Asystole and PEA are not.

3An unstable tachycardic patient with hypotension and altered mentation should receive which immediate intervention?

A.Vagal maneuvers only

B.Synchronized cardioversion

C.Oral beta blocker

D.Observation for 30 minutes

Explanation: Unstable tachyarrhythmia requires immediate synchronized cardioversion per ACLS priorities.

4Which finding is MOST concerning for cardiogenic shock after acute MI?

A.Warm extremities and wide pulse pressure

B.Hypotension with cool clammy skin and low urine output

C.Mild hypertension with anxiety

D.Bradycardia with normal perfusion

Explanation: Cardiogenic shock presents with poor end-organ perfusion: hypotension, cool skin, oliguria, and altered mentation.

5A patient with tearing chest pain radiating to the back and pulse differential between arms should raise suspicion for:

A.Pericarditis

B.Aortic dissection

C.Stable angina

D.Pleurisy

Explanation: Sudden tearing pain and pulse/BP differential are classic red flags for acute aortic dissection.

6What is the first-line treatment priority for symptomatic bradycardia with poor perfusion?

A.Immediate unsynchronized defibrillation

B.Atropine while preparing transcutaneous pacing if needed

C.Oral calcium channel blocker

D.Observe and repeat ECG in 2 hours

Explanation: Symptomatic bradycardia is initially treated with atropine; pacing is prepared if unstable or unresponsive.

7A narrow-complex tachycardia at 180 bpm that is regular and stable is most consistent with:

A.Atrial fibrillation with RVR

B.Sinus tachycardia

C.SVT

D.Third-degree AV block

Explanation: Regular narrow-complex tachycardia at high rate is classic for supraventricular tachycardia (SVT).

8Which statement about high-sensitivity troponin in the ED is MOST accurate?

A.A single normal value always rules out ACS

B.Serial testing and clinical context are required

C.Troponin elevation is specific only to STEMI

D.Troponin is irrelevant if ECG is normal

Explanation: Troponin must be interpreted with timing, serial values, ECG, and clinical presentation.

9A patient in cardiac arrest has PEA on monitor. What is the MOST important immediate strategy?

A.Defibrillate at maximum joules

B.Perform high-quality CPR and search for reversible causes

C.Give antiarrhythmic first

D.Pause CPR for central line placement

Explanation: PEA management centers on high-quality CPR, epinephrine, and rapid identification of Hs and Ts.

10Which finding best differentiates pericarditis from STEMI on ECG?

A.Diffuse ST elevation with PR depression

B.Isolated inferior ST elevation only

C.Pathologic Q waves in contiguous leads

D.New left bundle branch block only

Explanation: Pericarditis commonly shows diffuse ST elevation and PR depression rather than territorial ischemic changes.

About the CEN Exam

CEN is BCEN's board certification for emergency nurses. The exam tests emergency clinical judgment across cardiovascular, respiratory, neurologic, GI/GU/OB, trauma, toxicology, communicable disease, and professional emergency-practice domains.

Questions

175 scored questions

Time Limit

3 hours

Passing Score

106 out of 150 scored items

Exam Fee

$285 professional-association members / $380 non-members (BCEN / PSI)

CEN Exam Content Outline

12.0%

Cardiovascular Emergencies

ACS recognition, dysrhythmias, shock patterns, resuscitation priorities, and time-critical cardiac pathways

11.3%

Respiratory Emergencies

Airway compromise, respiratory failure, PE/pneumothorax red flags, and escalation of oxygenation support

11.3%

Neurologic Emergencies

Stroke pathway activation, seizure emergencies, altered mentation differentials, and ICP/herniation concerns

16.0%

GI/GU/GYN/OB Emergencies

Abdominal catastrophes, GU emergencies, pregnancy-related instability, and hemorrhage recognition

18.7%

Mental Health + Medical Emergencies

Behavioral crisis safety, suicide risk, sepsis, endocrine crises, and metabolic/electrolyte emergencies

22.7%

Trauma/HEENT/Environmental/Toxicology

Trauma priorities, wound and limb threats, eye/ENT emergencies, poisoning, heat/cold illness, and communicable threats

8.0%

Professional Issues

Triage systems, legal/ethical emergency care, disaster operations, communication, and quality/safety practice

How to Pass the CEN Exam

What You Need to Know

Passing score: 106 out of 150 scored items
Exam length: 175 questions
Time limit: 3 hours
Exam fee: $285 professional-association members / $380 non-members

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CEN Study Tips from Top Performers

1Study by the 2026 BCEN domain weighting, not by random topic order; prioritize cardiovascular, respiratory, neurologic, and medical domains first

2Use first-action drills for unstable scenarios (airway compromise, shock, seizure, severe bleeding) because CEN questions heavily test priority decisions

3Practice mixed, timed 50-question blocks to match exam pacing and transition quickly between systems

4For each missed question, write one escalation trigger and one contraindicated action to strengthen clinical judgment under pressure

5Add a weekly professional-issues review block (triage, legal/ethical, disaster) to protect points in the non-clinical domain

Frequently Asked Questions

How many questions are on the CEN exam?

BCEN lists 175 total items: 150 scored items and 25 unscored pretest items.

What score do I need to pass CEN?

BCEN lists the CEN passing standard as 106 correct out of 150 scored items.

How long is the CEN exam?

BCEN lists a 3-hour testing appointment for CEN.

What changed for CEN in 2026?

BCEN released an updated CEN Exam Content Outline effective July 6, 2026 with 11 weighted domains, including cardiovascular (18 items), respiratory (17), neurologic (17), and professional issues (12).

How much does CEN cost?

BCEN's current CEN FAQ/cost pages list $285 for professional-association members, $380 for non-members, and $195 for military candidates.

Who can take the CEN exam?

BCEN lists active unrestricted RN licensure as required. Two years of emergency nursing practice is recommended before testing.

How often do I renew CEN?

BCEN certifications follow a 4-year recertification cycle.