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CEN Exam Version 2 (2025) — Updated Certified
Emergency Nurse Study Guide, Practice Test Questions, and
BCEN Certification Review
Prepare for the CEN Exam Version 2 (2025) with the newest Certified Emergency Nurse
(BCEN) study guide, updated practice test questions, and expert review materials. Learn
emergency care concepts, trauma management, and patient safety to pass your CEN
certification exam on the first attempt.
• CEN exam version 2 2025
• Certified Emergency Nurse exam
• CEN study guide updated version 2
What medications do you give for a patient with extrapyramidal symptoms? - ANSWER-Benadryl,
propranolol, Antiparkinsonian drugs
Lithium toxicity is associated with which electrolyte imbalance? - ANSWER-Hyponatremia
What shape bruising indicates pinching? - ANSWER-Crescent shaped
What medication class do you give to increase preload and afterload? Decrease? - ANSWER-Increase:
Vasoconstrictor - Decrease: Vasodilator
What are the two settings you set when performing transcutaneous pacing? - ANSWER-Rate and output.
When transcutaneously pacing, what should you initially set the rate to? - ANSWER-70 bpm
,2|Page
When transcutaneously pacing, what should you initially set the output to? - ANSWER-Unitl you get
Capture (puts the pacing spikes on the R waves) then turn it up 10% above capture
What is Brudzinski's sign and why would you test this? - ANSWER-If you lay a patient flat and bend their
neck forward, their legs will automatically bend up if they have meningitis
What precautions do you need to place a patient if they have bacterial meningitis? - ANSWER-Droplet
How do you treat viral meningitis? - ANSWER-Supportive care: fluids, rest, pain and fever control
What is the difference between a focal seizure and a generalized seizure? - ANSWER-Focal: a specific part
of the brain; Generalized: the whole brain
What is Todd's paralysis? - ANSWER-Where s/p a sz the patient has one area that is non-responsive,
numb, or stiff and can last for up to 24 hours
What are the 3 side effects of giving dilantin too fast? - ANSWER-Hypotension, bradycardia and heart
block
What neurotransmitter is disrupted when a patient has myesthenia gravis? - ANSWER-Acetylcholine
What is the key issue with myesthenia gravis? - ANSWER-Muscle Weakness that gets worse as the day
goes on
What is a myesthenia crisis? - ANSWER-When the patients respiratory muscles are so weak they go into
respiratory distress or arrest
If a patient has an anterior fossa fracture, where would bleeding/CSF leak? - ANSWER-Through the nose
If a patient has a middle fossa fracture, where would bleeding/CSF leak? - ANSWER-Through the ear
,3|Page
What kind of fracture do you want to avoid giving someone NC O2? - ANSWER-Basilar skull fracture b/c it
can blow air embolisms into the brain (pneumocephalus)
What is the treatment for Lithium toxicity? - ANSWER-Dialysis
What two medications do you give for Mania? - ANSWER-Lithium and Carbamazepine
What two classes of drugs do you give a patient with schizophrenia? - ANSWER-Antipsychotics and
benzodiazepines
What is Blepharospasm? - ANSWER-Eyelid spasm causing forced eyelid closure
What is Torticollis? - ANSWER-Neck muscle spasms causing the head to twist to one side
How far away should you place a transcutaneous pad away from an ICD? - ANSWER-10 cm
What is the lowest dose of atropine? Why? - ANSWER-0.5mg/dose because it will cause paradoxical
bradycardia (or just bradycardia)
What does the EKG wave look like in super late hyperkalemia? - ANSWER-Sine wave
What does the EKG wave look like in the very earliest of hyperkalemia? - ANSWER-Peaked T-wave
What symptoms will you see for early vs late hyperkalemia? - ANSWER-Early: so excited I'm going to
puke, Late: so weak I can't breath
What EKG changes will you see with hypokalemia? - ANSWER-ST depression (below isoelectric line) and a
U wave (looks like a camel hump)
, 4|Page
If a patient is hypokalemic, what other electrolyte abnormality accompanies this? - ANSWER-
Hypomagnesemia
What does a positive Chvostek and Trousseau's sign indicate? - ANSWER-Hypomagnesemia
What is the treatment for hypermagnesemia? - ANSWER-If no EKG changes: loop diuretics and fluids, if
EKG changes then dialysis
Calcium and phosphate have what kind of relationship? - ANSWER-INVERSE, opposite
After transfusing 10 units of blood, what electrolyte imbalance are you worried about? - ANSWER-
Hypocalcemia and hyperphosphatemia (inverse relationship!)
If a patient is hypoalbuminemic what electrolyte are you worried about? - ANSWER-Hypocalcemia bc
albumin carries calcium (also hyperphosphatemia=inverse relationship!)
What oral medication do you give someone with hyperphosphatemia? - ANSWER-Antacids (aluminum
hydroxid) it absorbs phosphate
What happens if you give IV hypertonic saline solution too fast? - ANSWER-Central Pontine Myelinolysis
(Flaccid paralysis, dysarthria, dysphasia, hypotension)
What is Central Pontine Myelinolysis and how do you get it? - ANSWER-Flaccid paralysis, dysarthria,
dysphasia, hypotension from administering hypertonic saline solutions too fast
How slowly should you administer IV hypertonic saline solution? - ANSWER-over 48-72 hours
What are the two types of renal failure? - ANSWER-oliguric and non-oliguric
What two electrolytes do you expect to be increased in renal failure? Decreased? - ANSWER-Increased:
potassium & phosphate; Decreased: sodium & magnesium
CEN Exam Version 2 (2025) — Updated Certified
Emergency Nurse Study Guide, Practice Test Questions, and
BCEN Certification Review
Prepare for the CEN Exam Version 2 (2025) with the newest Certified Emergency Nurse
(BCEN) study guide, updated practice test questions, and expert review materials. Learn
emergency care concepts, trauma management, and patient safety to pass your CEN
certification exam on the first attempt.
• CEN exam version 2 2025
• Certified Emergency Nurse exam
• CEN study guide updated version 2
What medications do you give for a patient with extrapyramidal symptoms? - ANSWER-Benadryl,
propranolol, Antiparkinsonian drugs
Lithium toxicity is associated with which electrolyte imbalance? - ANSWER-Hyponatremia
What shape bruising indicates pinching? - ANSWER-Crescent shaped
What medication class do you give to increase preload and afterload? Decrease? - ANSWER-Increase:
Vasoconstrictor - Decrease: Vasodilator
What are the two settings you set when performing transcutaneous pacing? - ANSWER-Rate and output.
When transcutaneously pacing, what should you initially set the rate to? - ANSWER-70 bpm
,2|Page
When transcutaneously pacing, what should you initially set the output to? - ANSWER-Unitl you get
Capture (puts the pacing spikes on the R waves) then turn it up 10% above capture
What is Brudzinski's sign and why would you test this? - ANSWER-If you lay a patient flat and bend their
neck forward, their legs will automatically bend up if they have meningitis
What precautions do you need to place a patient if they have bacterial meningitis? - ANSWER-Droplet
How do you treat viral meningitis? - ANSWER-Supportive care: fluids, rest, pain and fever control
What is the difference between a focal seizure and a generalized seizure? - ANSWER-Focal: a specific part
of the brain; Generalized: the whole brain
What is Todd's paralysis? - ANSWER-Where s/p a sz the patient has one area that is non-responsive,
numb, or stiff and can last for up to 24 hours
What are the 3 side effects of giving dilantin too fast? - ANSWER-Hypotension, bradycardia and heart
block
What neurotransmitter is disrupted when a patient has myesthenia gravis? - ANSWER-Acetylcholine
What is the key issue with myesthenia gravis? - ANSWER-Muscle Weakness that gets worse as the day
goes on
What is a myesthenia crisis? - ANSWER-When the patients respiratory muscles are so weak they go into
respiratory distress or arrest
If a patient has an anterior fossa fracture, where would bleeding/CSF leak? - ANSWER-Through the nose
If a patient has a middle fossa fracture, where would bleeding/CSF leak? - ANSWER-Through the ear
,3|Page
What kind of fracture do you want to avoid giving someone NC O2? - ANSWER-Basilar skull fracture b/c it
can blow air embolisms into the brain (pneumocephalus)
What is the treatment for Lithium toxicity? - ANSWER-Dialysis
What two medications do you give for Mania? - ANSWER-Lithium and Carbamazepine
What two classes of drugs do you give a patient with schizophrenia? - ANSWER-Antipsychotics and
benzodiazepines
What is Blepharospasm? - ANSWER-Eyelid spasm causing forced eyelid closure
What is Torticollis? - ANSWER-Neck muscle spasms causing the head to twist to one side
How far away should you place a transcutaneous pad away from an ICD? - ANSWER-10 cm
What is the lowest dose of atropine? Why? - ANSWER-0.5mg/dose because it will cause paradoxical
bradycardia (or just bradycardia)
What does the EKG wave look like in super late hyperkalemia? - ANSWER-Sine wave
What does the EKG wave look like in the very earliest of hyperkalemia? - ANSWER-Peaked T-wave
What symptoms will you see for early vs late hyperkalemia? - ANSWER-Early: so excited I'm going to
puke, Late: so weak I can't breath
What EKG changes will you see with hypokalemia? - ANSWER-ST depression (below isoelectric line) and a
U wave (looks like a camel hump)
, 4|Page
If a patient is hypokalemic, what other electrolyte abnormality accompanies this? - ANSWER-
Hypomagnesemia
What does a positive Chvostek and Trousseau's sign indicate? - ANSWER-Hypomagnesemia
What is the treatment for hypermagnesemia? - ANSWER-If no EKG changes: loop diuretics and fluids, if
EKG changes then dialysis
Calcium and phosphate have what kind of relationship? - ANSWER-INVERSE, opposite
After transfusing 10 units of blood, what electrolyte imbalance are you worried about? - ANSWER-
Hypocalcemia and hyperphosphatemia (inverse relationship!)
If a patient is hypoalbuminemic what electrolyte are you worried about? - ANSWER-Hypocalcemia bc
albumin carries calcium (also hyperphosphatemia=inverse relationship!)
What oral medication do you give someone with hyperphosphatemia? - ANSWER-Antacids (aluminum
hydroxid) it absorbs phosphate
What happens if you give IV hypertonic saline solution too fast? - ANSWER-Central Pontine Myelinolysis
(Flaccid paralysis, dysarthria, dysphasia, hypotension)
What is Central Pontine Myelinolysis and how do you get it? - ANSWER-Flaccid paralysis, dysarthria,
dysphasia, hypotension from administering hypertonic saline solutions too fast
How slowly should you administer IV hypertonic saline solution? - ANSWER-over 48-72 hours
What are the two types of renal failure? - ANSWER-oliguric and non-oliguric
What two electrolytes do you expect to be increased in renal failure? Decreased? - ANSWER-Increased:
potassium & phosphate; Decreased: sodium & magnesium
