Four adults arrive at the same time. Under the five-level Emergency Severity Index, which one is assigned level 1?
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This is a free 15-question sampler for the Certified Emergency Nurse (CEN) exam, written by the StudyPDF team. It covers triage and acuity, recognizing shock, trauma assessment, toxicology mechanisms, environmental emergencies and a few classic time-critical presentations, mixing multiple choice, select all that apply and fill in the blank. Answer all 15, then check your score and read the explanation for every question. It is exam practice, not medical guidance.
All 15 questions at a glance
Prefer to read before you play? Every question in the sampler is listed below. Answers and explanations stay collapsed until you open them.
1.Four adults arrive at the same time. Under the five-level Emergency Severity Index, which one is assigned level 1?
- A. A patient with new weakness on one side and slurred speech, with a stable airway
- B. An unresponsive patient with no pulse
- C. A patient with abdominal pain who will need blood tests, imaging and IV fluids
- D. A patient with a small cut that needs one simple procedure
Answer: B. An unresponsive patient with no pulse
ESI level 1 is for patients who need an immediate life-saving intervention, and a person with no pulse is the clearest example. The stroke presentation is high risk and fits level 2, because the patient is unstable in a time-critical way but not yet needing a rescue at the door. Abdominal pain that will use several resources is level 3, and a problem needing one resource is level 4. Level 5 needs none. Triage sorts by how sick the patient is and how many resources they will use, not by who arrived first.
2.A trauma patient answers your questions in a clear, full voice. What does this tell you during the primary survey?
- A. The airway is open for now, and it still has to be reassessed
- B. The airway can be ruled out as a problem for the whole visit
- C. Breathing and circulation are both normal
- D. Neurologic function is normal
Answer: A. The airway is open for now, and it still has to be reassessed
A patient who speaks clearly has a patent airway and enough air movement to talk, which is a good sign. It is only a snapshot, though, because swelling, bleeding and a falling level of consciousness can close an airway later, so the airway is checked again as the patient changes. Talking says nothing about the rate or depth of breathing, about circulation or about the whole neurologic exam, which each have their own step in the survey.
3.After a crushing chest injury, a patient has severe respiratory distress, absent breath sounds on the right, distended neck veins and a falling blood pressure. Which condition does this pattern fit best?
- A. Tension pneumothorax
- B. A small pleural effusion
- C. Pulmonary embolism
- D. Pericarditis
Answer: A. Tension pneumothorax
In a tension pneumothorax air enters the pleural space and cannot leave, so pressure builds, the lung collapses and the mediastinum is pushed against the great veins. Venous return falls, which explains the distended neck veins together with the low blood pressure. Absent breath sounds on the injured side with severe distress is the classic picture. Tracheal deviation away from the injury is real but late, so waiting for it can mean missing the diagnosis. A small effusion would not drop the pressure, and an embolus or pericarditis would not give one-sided absent breath sounds after trauma.
4.Complete the sentence.
By the rule of nines, the front of an adult's trunk is about _____ percent of the body surface and each entire arm is about _____ percent.
Options for blank 1: 9, 18, 36
Options for blank 2: 9, 18, 4.5
Answer: 18, 9
The rule of nines splits an adult's body surface into regions worth 9 percent or a multiple of it: the head 9, each arm 9, the front of the trunk 18, the back of the trunk 18, each leg 18 (front 9, back 9) and the groin 1. It gives a fast estimate of burn size that sets the triage level and the transfer decision. It is less accurate in children, whose heads are proportionally larger, so pediatric charts adjust the numbers. Only partial and full thickness burns are counted, not simple redness.
5.Why can a standard pulse oximeter show a reassuring saturation in a patient with carbon monoxide poisoning?
- A. Carbon monoxide raises the oxygen dissolved in the plasma
- B. The probe cannot detect hemoglobin at all in smoke exposure
- C. It reads carboxyhemoglobin much like oxyhemoglobin
- D. Carbon monoxide makes the fingers warmer, which skews the reading
Answer: C. It reads carboxyhemoglobin much like oxyhemoglobin
A standard pulse oximeter compares only two wavelengths of light, and carboxyhemoglobin absorbs light in a way the device cannot tell apart from oxyhemoglobin. The screen can therefore look fine while much of the hemoglobin is occupied by carbon monoxide and cannot carry oxygen. That is why symptoms, history and a co-oximetry blood gas matter more than the number on the finger probe in suspected exposure.
6.A farm worker was spraying a pesticide and now has heavy salivation, tearing, small pupils, a slow heart rate and muscle twitching. Which mechanism explains these findings?
- A. Blockage of acetylcholine receptors at the muscle
- B. Release of large amounts of norepinephrine
- C. Direct damage to the red blood cells
- D. Inhibition of the enzyme that breaks down acetylcholine
Answer: D. Inhibition of the enzyme that breaks down acetylcholine
Organophosphate pesticides block acetylcholinesterase, so acetylcholine keeps stimulating its targets. The result is a cholinergic picture: secretions from every gland, small pupils, a slow heart rate and twitching or weakness of muscle. Dry skin, wide pupils and a fast heart rate would point the other way, to an anticholinergic exposure. Exposure through skin counts too, which is why the history of what the person was handling matters.
7.Which finding most clearly separates heat stroke from heat exhaustion in a patient who has been working outdoors?
- A. Heavy sweating
- B. Painful muscle cramps
- C. Thirst and headache
- D. Confusion or a changed level of consciousness with a very high core temperature
Answer: D. Confusion or a changed level of consciousness with a very high core temperature
In heat exhaustion the body is still coping: the patient sweats, feels weak and thirsty and may have cramps, but thinking stays largely intact. Heat stroke means the cooling system has failed, the core temperature is usually above about 104 F (40 C), and the brain shows it through confusion, odd behavior, seizures or coma. Skin can be wet or dry in either condition, so skin alone is not the deciding sign. A changed mental status in the heat is treated as heat stroke until proven otherwise.
8.A previously healthy adult bleeding from a deep leg wound is anxious, with a heart rate of 118, a blood pressure of 112/92 and cool, clammy skin. Which statement is most accurate?
- A. The patient is compensating, and the narrow pulse pressure is an early warning
- B. The patient is not in shock because the blood pressure is normal
- C. The patient is in neurogenic shock because the skin is cool
- D. The patient is anxious, and the vital signs have no clinical meaning
Answer: A. The patient is compensating, and the narrow pulse pressure is an early warning
In early blood loss the body clamps down its vessels and speeds the heart to hold the pressure up, so the systolic pressure can stay normal while the patient is already in trouble. A rising heart rate, cool clammy skin, anxiety and a pulse pressure that narrows (here 20, because the diastolic pressure climbs) are the early clues. A drop in blood pressure comes late, after large losses. Neurogenic shock gives warm, dry skin and often a slow heart rate, not a fast one.
9.After a forearm fracture is set in a cast, which finding is the earliest and most reliable warning of compartment syndrome?
- A. Loss of the radial pulse
- B. Pain out of proportion to the injury that worsens with passive stretch of the muscles
- C. Pale skin
- D. Paralysis of the fingers
Answer: B. Pain out of proportion to the injury that worsens with passive stretch of the muscles
Swelling inside a closed muscle compartment raises the pressure until the small vessels and nerves are squeezed. Severe pain that does not match the injury, and that gets worse when the muscles are stretched, appears first. Pulse loss, pallor and paralysis are late, because the pressure has to exceed arterial pressure before the pulse goes. Waiting for a missing pulse means the tissue has already been without blood for some time, so the early pain finding is the one to catch.
10.A teenager wakes with sudden, severe pain in one testicle and nausea. The testis sits high and the cremasteric reflex is absent on that side. Which condition should come to mind first, and why is the timing so important?
- A. Epididymitis, because it can spread to the other side within an hour
- B. Testicular torsion, because the blood supply is cut off and tissue can be lost within hours
- C. A hydrocele, because it can burst without warning
- D. A urinary stone, because it always causes pain in the testis alone
Answer: B. Testicular torsion, because the blood supply is cut off and tissue can be lost within hours
Torsion twists the spermatic cord and cuts off the blood supply, so the testis is at risk of dying and the chance of saving it falls over a matter of hours. Sudden onset, nausea, a high-riding testis and a lost cremasteric reflex are the typical signs. Epididymitis tends to start more gradually, often with fever or urinary symptoms, and the pain may ease when the scrotum is lifted. A hydrocele is usually painless, and a stone causes flank pain that can spread but has a different pattern.
11.Which findings point toward a stroke rather than a simple fainting episode?
Select all that apply.
- A. Sudden weakness of one arm
- B. A drooping face on one side
- C. A brief gray-out when standing up, gone within a minute of lying down
- D. Speech that is suddenly slurred or hard to find
- E. Dizziness after standing in a hot room for a long time
Answer: A. Sudden weakness of one arm, B. A drooping face on one side, D. Speech that is suddenly slurred or hard to find
Stroke strikes a part of the brain, so the signs are focal: one side of the body, one side of the face or speech. They do not clear in a minute. Fainting, in contrast, comes from a short drop in blood flow to the whole brain, usually when standing up or after heat or a long wait, and recovery is quick and complete once the person is lying flat. Whatever the cause, the time the patient was last known to be normal is the most important fact to establish, because treatment choices depend on it.
12.During a mass casualty incident using the START method, which findings put an adult in the immediate (red) category?
Select all that apply.
- A. A respiratory rate above 30 per minute
- B. Capillary refill longer than 2 seconds
- C. Unable to follow a simple command
- D. Able to walk to the designated area
- E. Not breathing even after the airway is opened
Answer: A. A respiratory rate above 30 per minute, B. Capillary refill longer than 2 seconds, C. Unable to follow a simple command
START (Simple Triage and Rapid Treatment) sorts patients in seconds by walking, breathing, perfusion and mental status. A fast respiratory rate, poor perfusion (slow capillary refill or no radial pulse) or an inability to follow commands each mark an immediate patient. Anyone who can walk goes to the minor group first. A patient who is not breathing after the airway is opened is tagged expectant or deceased in START, not immediate. Systems differ, and some regions use SALT, so know what your own jurisdiction and your exam materials teach.
13.Which statements about cyanide poisoning are correct?
Select all that apply.
- A. It stops cells from using oxygen at the mitochondria
- B. It works by stopping hemoglobin from carrying oxygen
- C. Smoke from an enclosed fire can be a source
- D. The lactate level usually rises
- E. It causes cholinergic excess, with heavy salivation and tearing
Answer: A. It stops cells from using oxygen at the mitochondria, C. Smoke from an enclosed fire can be a source, D. The lactate level usually rises
Cyanide blocks cytochrome oxidase, the last step of the energy chain in the mitochondria, so cells cannot use the oxygen that reaches them. They switch to anaerobic metabolism, which makes lactate, and the blood can stay oxygen-rich because the tissues are not taking it up. Burning plastics, wool and other materials in an enclosed space can release hydrogen cyanide, so it is considered in smoke inhalation. Carbon monoxide, not cyanide, interferes with hemoglobin, and cholinergic excess belongs to organophosphates.
14.Complete the sentence.
The shock index is the heart rate divided by the _____ blood pressure, and a value above about _____ raises concern for shock.
Options for blank 1: diastolic, systolic, mean arterial
Options for blank 2: 0.4, 1.0, 2.5
Answer: systolic, 1.0
A normal shock index is roughly 0.5 to 0.7. In early blood loss the heart rate climbs before the systolic pressure falls, so the ratio rises while the blood pressure alone still looks acceptable. A heart rate of 120 with a systolic pressure of 100 gives 1.2. Sources set the cutoff between about 0.9 and 1.0, and the index is a screening aid that supports clinical judgment, never a replacement for it.
15.Complete the sentence.
The Glasgow Coma Scale adds up eye, verbal and motor responses, so the lowest possible total is _____, and a total of _____ or less is generally treated as a severe head injury.
Options for blank 1: 0, 1, 3
Options for blank 2: 5, 8, 12
Answer: 3, 8
The eye score runs 1 to 4, the verbal score 1 to 5 and the motor score 1 to 6, so the lowest total is 3 and the highest is 15. A total of 8 or less is generally classed as severe, 9 to 12 as moderate and 13 to 15 as mild. The scale is the usual way to describe the disability step of the primary survey, and the three parts matter as much as the total, because the same total can come from quite different combinations.
What the CEN exam covers
The CEN is the specialty certification for emergency nurses, awarded by the Board of Certification for Emergency Nursing (BCEN). According to the BCEN FAQ, the exam has 175 items: 150 are scored and 25 are unscored pretest items that BCEN is trying out for future exams. You cannot tell which are which, so every question deserves a full answer.
BCEN built its content outline around the common knowledge every emergency nurse needs, whatever the size of the department. The outline in force since July 6, 2026 groups the exam into eleven areas: cardiovascular, respiratory, neurological, gastrointestinal, genitourinary with gynecology and obstetrical, mental health, medical emergencies, musculoskeletal and wound, head, eye, ear, nose and throat, environment and toxicology with communicable diseases, and professional issues.
The outline before it, effective January 2022, had ten areas. It combined gastrointestinal with genitourinary, gynecology and obstetrical, called the head area maxillofacial and ocular, and listed triage under professional issues. The July 2026 update splits gastrointestinal out and reorganizes professional issues into prioritization, which includes triage, mass casualty and patient throughput, and legal and ethical issues. It also came with a new passing score: according to the BCEN FAQ, you must answer 99 of the 150 scored questions correctly. Many prep books still describe the 2022 outline, so read the current outline and the eligibility rules on bcen.org before you plan your study time, and treat any number you find elsewhere, including on this page, as something to confirm there.
How to use this sampler
Real emergency nursing questions often ask what to do next. This sampler deliberately does not. Interventions, drug choices and doses depend on your department's protocols, the provider's orders and current references, so they do not belong on a free practice page. Every question here tests the reasoning underneath those decisions: what a set of findings points to, what a poison does at the cellular level, which sign is early and which is late, who needs to be seen first. This is exam practice, not medical guidance.
That recognition skill is worth drilling on its own, because it is what lets you eliminate wrong answers on the real test. If you know that a rising heart rate and a narrowing pulse pressure come before a falling blood pressure, a question about early hemorrhage turns into reading the clues. If you know why carbon monoxide fools a pulse oximeter, you can answer the next question about it without memorizing a fact.
Take the 15 questions in one sitting without notes, then read every explanation, including the ones you got right. Treat each miss as a topic rather than a single question. The ICU side of the picture, such as hemodynamic calculations and ventilated patients, is a different exam, and the CCRN sampler on this site covers it.
Every question on this page was written by the StudyPDF team from the topics BCEN publishes in its content outline. None of them comes from BCEN, from its sample questions or from any commercial question bank, and StudyPDF is not affiliated with BCEN.
How to build more practice tests from your own materials
Fifteen questions can show you which areas need work. They cannot get you ready for a certification exam on their own, and a generic question bank does not know what your review course stressed or which topics you keep missing.
StudyPDF works from your material instead. Upload your emergency nursing review book, the slides from your CEN course, your department's education packets or your own notes. Then press New material, pick a practice exam or a quiz, choose those files as the sources and set the length and the difficulty. Every question is written from those exact pages and every explanation cites where the answer comes from, so you can open the source the moment something looks off. You can narrow a test to one area such as toxicology or trauma, and your answers build a per-concept picture of what keeps costing you points.
Bo is the tutor for the rest. Ask him why an answer is right and he explains it from your own pages, with a hint first if you want one.
You do not have to upload anything to start. Name a topic instead, for example triage acuity, carbon monoxide poisoning or compartment syndrome, and Bo sets it up with its key concepts so you can build a practice test on it. Starting is free.
Written by the StudyPDF team. Last updated August 19, 2026.
Good to know
Are these CEN practice questions free?
Yes. All 15 questions, the score screen and every explanation are free to play, and the test runs fully in your browser. You need a free StudyPDF account to download the PDF or to build more practice tests from your own study materials.
Who wrote these questions?
The StudyPDF team wrote every question and explanation from the topics in the published CEN content outline. They are not real exam questions, and StudyPDF is not affiliated with BCEN or any test maker. This page is exam practice, not medical guidance.
Does this match the current CEN exam?
The questions cover topics from the BCEN content outline, including triage, shock, trauma, toxicology and environmental emergencies. BCEN's updated outline and passing score took effect on July 6, 2026, and fifteen questions cannot cover every area, so always check the current outline and exam rules on bcen.org.
Can I get more questions like these from my own materials?
Yes. Upload your emergency nursing review book, course slides or notes to StudyPDF and build full practice exams from your exact material, with explanations tied to your pages. If you have nothing to upload, you can just name a topic instead.