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Free CEN Practice Questions

10 free, exam-style Certified Emergency Nurse (CEN) practice questions with answers and explanations. No signup required. Work through them below, then take the full free CEN practice test to study every exam domain.

Question 1

A trauma patient has absent breath sounds on the left, JVD, tracheal deviation to the right, and hypotension. The PRIORITY intervention is:

  1. Obtain a portable chest X-ray to confirm diagnosis
  2. Needle decompression of the left chest
  3. Start a second IV and bolus normal saline
  4. Prepare for emergent endotracheal intubation
Show answer & explanation

Correct answer: B - Needle decompression of the left chest

Question 2

A patient with an inferior wall STEMI develops hypotension, jugular venous distension, and clear lung sounds. The nurse suspects right ventricular infarction. Which medication should be AVOIDED?

  1. Normal saline 500 mL IV bolus
  2. Aspirin 325 mg chewed immediately
  3. Nitroglycerin sublingual or IV drip
  4. Unfractionated heparin IV infusion
Show answer & explanation

Correct answer: C - Nitroglycerin sublingual or IV drip

Question 3

A patient receiving tPA for ischemic stroke suddenly develops severe headache, vomiting, and worsening neurological deficits. The nurse should FIRST:

  1. Administer an IV antiemetic for comfort
  2. Stop the tPA infusion and obtain a STAT CT head
  3. Increase the tPA rate to improve reperfusion
  4. Administer IV labetalol for presumed hypertension
Show answer & explanation

Correct answer: B - Stop the tPA infusion and obtain a STAT CT head

Question 4

A patient presents to the ED stating, "I don't want to live anymore." The nurse's FIRST response should be:

  1. Contact psychiatry for an immediate consult
  2. Ask directly about suicidal thoughts and a plan
  3. Change the subject to help calm the patient
  4. Administer a PRN anxiolytic for acute distress
Show answer & explanation

Correct answer: B - Ask directly about suicidal thoughts and a plan

Question 5

A patient's ECG shows peaked T waves, widened QRS complexes, and a potassium level of 7.2 mEq/L. The FIRST medication to administer is:

  1. Regular insulin 10 units IV with D50W 25 g
  2. Calcium gluconate 10% to stabilize the myocardium
  3. Sodium polystyrene sulfonate (Kayexalate) orally
  4. Albuterol 10 mg via continuous nebulization
Show answer & explanation

Correct answer: B - Calcium gluconate 10% to stabilize the myocardium

Question 6

A pregnant patient at 35 weeks presents with sudden severe abdominal pain, dark red vaginal bleeding, and a rigid board-like uterus. The nurse suspects:

  1. Placenta previa with active hemorrhage
  2. Abruptio placentae with concealed bleeding
  3. Preterm labor with bloody show present
  4. Braxton Hicks contractions with spotting
Show answer & explanation

Correct answer: B - Abruptio placentae with concealed bleeding

Question 7

The EARLIEST and MOST reliable sign of compartment syndrome is:

  1. Pulselessness in the affected extremity
  2. Pallor and cool skin distal to the injury
  3. Pain out of proportion to injury, worsened by passive stretch
  4. Paralysis of muscles within the compartment
Show answer & explanation

Correct answer: C - Pain out of proportion to injury, worsened by passive stretch

Question 8

A patient presents after a splash of industrial alkaline cleaning solution into both eyes. The FIRST action the nurse should take is:

  1. Obtain a detailed history of the chemical exposure
  2. Check visual acuity to establish a baseline finding
  3. Begin immediate copious irrigation with normal saline
  4. Administer topical anesthetic drops before any exam
Show answer & explanation

Correct answer: C - Begin immediate copious irrigation with normal saline

Question 9

Using the Parkland formula, an 80 kg patient with 30% TBSA burns requires how much lactated Ringer's in the first 24 hours?

  1. 4,800 mL
  2. 7,200 mL
  3. 9,600 mL
  4. 12,000 mL
Show answer & explanation

Correct answer: C - 9,600 mL

Question 10

An elderly patient presents with vague complaints of fatigue and 'not feeling well.' Vital signs show HR 110, BP 88/60, RR 22, and SpO2 91%. The nurse should recognize:

  1. This is a low-acuity visit appropriate for ESI level 5
  2. Abnormal vitals are danger signs warranting ESI level 2
  3. The patient should wait since the complaint is non-specific
  4. Vital signs are unreliable in elderly patients over age 70
Show answer & explanation

Correct answer: B - Abnormal vitals are danger signs warranting ESI level 2

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