Facts checked against bcen.orgLast checked Nov 4, 2026
30 questions on the pattern of BCEN's published sample questions: a short ED scenario and one best answer. They cover every content area of the July 2026 outline, roughly in proportion to its item counts. Pick an option to open the explanation for all of them.
What went into these 30 items
Weighted by the outline. Cardiovascular Emergencies, the largest area at 18 items, gets the most questions; the four smallest areas get two each.
Current scope only. Topics the new outline dropped, such as procedural sedation and delegation, are left out.
Four or five options. About half of these items carry a fifth option; the live exam uses four. The extra distractor makes elimination harder here, not easier.
Ranking words in capitals. Some stems ask for the FIRST, BEST or HIGHEST-priority action, as BCEN's own sample questions do. Several options may be reasonable; one is the right next step.
The set: 30 CEN items
30 questions on this page · 0 answeredYour score: 0 of 0 correct
1/30 · Cardiovascular · 18 items
During resuscitation of a patient in ventricular fibrillation, the defibrillator displays "check electrodes" although the pads appear correctly placed. The nurse should
Use Check on the answer you favor. The verdict shows up with a short note on each choice.
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A 'check electrodes' alert points to poor pad contact; compressions continue while new pads go on so the next shock is not delayed.
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Ventricular fibrillation is already confirmed, so stopping CPR for a pulse check only adds hands-off time.
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Paddles without gel conduct poorly and can burn the skin; the fix is new pads, not dry paddles.
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Epinephrine follows the ACLS cycle and does nothing for an electrode fault.
2/30 · Cardiovascular · 18 items
A 68-year-old with advanced heart failure has worsening dyspnea, edema, a BNP of 1,800 pg/mL, and pulmonary edema on x-ray. Which finding MOST strongly indicates progression to cardiogenic shock?
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Cardiogenic shock is sustained hypotension with organ hypoperfusion; new confusion with a systolic of 75 shows both.
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Pitting edema reflects chronic fluid overload in heart failure and does not show failing perfusion.
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Rapid AF can worsen heart failure, but on its own it does not define shock.
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A respiratory rate of 32 with hypoxemia comes from pulmonary congestion, common in decompensated heart failure without shock.
3/30 · Cardiovascular · 18 items
A 76-year-old with suspected ruptured abdominal aortic aneurysm has blood pressure of 86/52 mm Hg and is awaiting transport to the operating room. The nurse should position the patient
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High Fowler position pools blood in the legs and lowers cerebral perfusion in a hypotensive patient.
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A contained rupture can bleed freely if disturbed, so the patient lies supine and still, with permissive hypotension, until surgery.
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Left lateral positioning relieves caval compression in late pregnancy and has no role in a ruptured aneurysm.
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Trendelenburg tilt gives little lasting rise in pressure and adds aspiration risk and abdominal pressure.
4/30 · Cardiovascular · 18 items
An esmolol infusion is started for a patient with acute aortic dissection. The nurse should titrate to an initial heart rate goal of
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A floor above 70 inverts the goal; the aim is to slow the heart, not keep it fast.
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A rate of 80–90 leaves too much shear stress on the aortic wall.
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Beta-blockade in aortic dissection aims for a rate under 60 to cut the force of each ejection on the torn wall, before vasodilators are added.
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A ceiling of 100 is far too lenient for dissection, which needs aggressive rate control.
5/30 · Respiratory · 17 items
A 58-year-old with known right upper lobe lung cancer is coughing up large amounts of bright red blood. SpO2 is 89% on oxygen, and the patient is alert. While bronchoscopy is being arranged, how should the nurse position the patient?
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Prone positioning does not keep blood away from the healthy lung and makes airway access hard.
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Lying with the bleeding right lung down keeps blood in that lung and protects gas exchange in the healthy left lung.
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Left side down puts the healthy lung underneath, so blood from the right would spill into it.
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Supine with legs elevated lets blood spread into both lungs.
6/30 · Respiratory · 17 items
A patient rescued from a burning apartment is confused, with a normal SpO2 on pulse oximetry and no visible burns. Which laboratory tests should the nurse anticipate to evaluate toxic smoke inhalation?
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Lipase and liver enzymes do not address the poisons that cause confusion after a fire.
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Smoke carries carbon monoxide and cyanide, both hidden by a normal pulse oximeter; carboxyhemoglobin finds CO and a high lactate suggests cyanide.
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An alcohol level and drug screen can miss the real cause; confusion after smoke exposure is CO or cyanide until shown otherwise.
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Troponin and BNP look for ischemia or heart failure and do not identify the gases in smoke.
7/30 · Neuro · 17 items
A febrile patient with nuchal rigidity presents with new-onset right-sided hemiparesis. Which sequence of interventions is correct?
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Blood cultures first is right, but scanning before the antibiotics holds treatment for as long as the CT takes.
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Blood cultures are drawn, antibiotics start at once, and the head CT follows: the focal deficit requires CT before any lumbar puncture, but treatment cannot wait for the scan.
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A lumbar puncture before CT in a patient with hemiparesis risks herniation from a mass lesion.
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Tapping before imaging risks herniation with this focal deficit, and skipping blood cultures loses the chance to identify the organism.
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Putting the head CT before antibiotics delays treatment of bacterial meningitis, which raises mortality.
8/30 · Neuro · 17 items
For a patient with acute ischemic stroke who is eligible for IV thrombolysis, what is the standard benchmark for door-to-needle time?
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Door-to-needle is measured against a 60-minute benchmark for thrombolysis in ischemic stroke; many programs also track faster internal targets.
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25 minutes is the door-to-CT goal, an earlier step that must be done before the drug can be given.
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90 minutes is the door-to-balloon goal for STEMI, not a stroke measure.
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270 minutes (4.5 hours) is the extended onset-to-treatment window for selected patients, not an arrival-based goal.
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180 minutes is the original onset-to-treatment window for thrombolysis, counted from symptom onset rather than arrival.
9/30 · GI · 14 items
The family of a patient with alcohol-related cirrhosis asks why the patient developed bleeding esophageal varices. The nurse's BEST explanation is that varices form because
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Cirrhotic scarring blocks flow through the liver, so portal pressure rises and blood reroutes through thin esophageal veins that swell into varices.
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Acid erosion of the lining causes esophagitis or ulcers, not dilated veins.
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Tears from repeated vomiting are Mallory-Weiss lesions, a different source of bleeding.
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Low platelet counts worsen bleeding once a varix ruptures but do not create the varix.
10/30 · GI · 14 items
A patient with cirrhosis and ascites has a creatinine that rose from 1.0 to 2.6 mg/dL over 5 days. Urine sodium is very low, there is no shock or nephrotoxic exposure, and creatinine did not improve after 2 days of IV albumin. The nurse should suspect
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Acute tubular necrosis wastes sodium, so urine sodium is usually high, not very low.
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Obstructive uropathy shows hydronephrosis or retention, and nothing in the scenario points to it.
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Rising creatinine in cirrhosis with very low urine sodium, no shock or nephrotoxin, and no response to albumin fits hepatorenal syndrome.
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Contrast-induced injury needs a recent contrast dose, and the stem rules out nephrotoxic exposure.
11/30 · GI · 14 items
A 58-year-old patient with cirrhosis who takes furosemide and spironolactone presents with new confusion and asterixis. Which laboratory result is MOST likely to have precipitated the encephalopathy?
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Diuretic-induced hypokalemia raises renal ammonia production and causes alkalosis that helps ammonia enter the brain.
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A low platelet count reflects splenic sequestration in cirrhosis, not a trigger for encephalopathy.
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A sodium of 136 mEq/L is normal and does not explain new encephalopathy.
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Mildly low albumin is expected in cirrhosis and does not trigger encephalopathy.
12/30 · GU / GYN / OB · 10 items
Thirty minutes after a precipitous delivery in the emergency department, a patient has a steady trickle of bright red vaginal bleeding. The fundus is firm and midline, and the platelet count and fibrinogen are normal. Which of the 'Four Ts' is the MOST likely cause?
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Retained placental tissue keeps the uterus from clamping down, so it is usually soft or enlarged, not firm.
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A coagulation defect is unlikely with normal platelets and fibrinogen.
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A distended bladder pushes the fundus up and to one side and keeps it from contracting; this fundus is firm and midline.
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A firm, midline fundus shows the uterus is contracting, so a laceration of the cervix, vagina or perineum is the likely source, common after a fast delivery.
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Uterine atony gives a soft, boggy fundus, the opposite of the firm fundus found here.
13/30 · GU / GYN / OB · 10 items
A 34-week pregnant patient presents with severe preeclampsia, a blood pressure of 170/115 mmHg, and is currently receiving magnesium sulfate. Which medication is indicated for blood pressure management?
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Nitroprusside is a last-resort drug in pregnancy because of possible fetal cyanide toxicity.
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Lisinopril and other ACE inhibitors are contraindicated in pregnancy because they harm the fetal kidneys.
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A magnesium sulfate bolus prevents seizures but does not reliably lower blood pressure.
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Patients with preeclampsia are often volume depleted; IV furosemide does not treat severe hypertension and can reduce placental flow.
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A BP of 170/115 in severe preeclampsia needs treatment within an hour; IV hydralazine is a first-line agent, alongside IV labetalol and oral immediate-release nifedipine.
14/30 · Mental health · 13 items
A patient's violent behavior continues to escalate despite de-escalation and an offer of medication, and a restraint order is obtained. Which approach to applying restraints is SAFEST?
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Speed with only two staff raises injury risk; coordination and enough people matter more than speed.
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Handcuffs are not medical restraints and cannot carry out a clinical restraint order.
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Restraint is safest with a trained team and a designated leader: one person per limb while the leader guides the patient and protects the head and airway.
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One nurse alone cannot control four limbs safely, so injury to patient and staff becomes more likely.
15/30 · Mental health · 13 items
A 19-year-old is brought to the emergency department from a party. The patient is confused and hallucinating, with dilated pupils, heart rate of 138 beats/min, and hot, flushed, sweaty skin. Which action is the PRIORITY?
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Four-point restraints make a hyperthermic, agitated patient fight harder and generate more heat; sedation with a benzodiazepine is preferred.
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Hot, sweaty skin with tachycardia and confusion after a party suggests sympathomimetic toxicity, where hyperthermia is the main killer and must be measured and cooled fast.
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The hallucinations come from a toxic state that is treated medically first; a psychiatric consult comes later if needed.
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A urine drug screen misses many synthetic stimulants and does not change initial treatment.
16/30 · Medical · 15 items
A patient with dehydration from vomiting and diarrhea is ordered to receive 1,800 mL of Lactated Ringer's solution over the next 10 hours. The IV tubing has a drop factor of 20 gtts/mL. What is the correct flow rate?
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150 gtts/min would run 450 mL/hr, two and a half times the order.
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30 gtts/min corresponds to a 10 gtts/mL set, half the stated drop factor.
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90 gtts/min corresponds to a 30 gtts/mL set and would finish the bag in under 7 hours.
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120 gtts/min would empty the bag in 5 hours, twice the ordered rate.
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1,800 mL over 10 hours is 180 mL/hr, or 3 mL/min; 3 mL/min × 20 gtts/mL = 60 gtts/min.
17/30 · Medical · 15 items
A 143-lb patient with septic shock requires a fluid bolus of 30 mL/kg. The total volume to be infused is:
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1,300 mL is 20 mL/kg for 65 kg, less than the 30 mL/kg ordered.
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14,300 mL is 143 × 100, using pounds and a far larger volume per unit of weight.
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143 lb ÷ 2.2 = 65 kg, and 65 kg × 30 mL/kg = 1,950 mL.
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6,500 mL is 100 mL/kg for 65 kg, more than three times the order.
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4,290 mL multiplies 30 mL by the weight in pounds without converting to kilograms.
18/30 · MSK & wound · 11 items
A 24-year-old presents with a clean, 3 cm linear laceration to the cheek sustained 16 hours ago. The wound edges are well-approximated and there are no signs of infection. Which management plan is indicated?
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Healing by secondary intention leaves a worse facial scar and is kept for contaminated or infected wounds.
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Delayed primary closure is for heavily contaminated wounds, and this one is clean.
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Antibiotics alone do not close the wound, and a clean wound without signs of infection does not need them.
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Skin grafting covers tissue loss, and a linear, well-approximated laceration has none.
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Facial skin has a rich blood supply and resists infection, so a clean facial wound can still have primary closure well beyond the usual window, often up to 24 hours.
19/30 · MSK & wound · 11 items
Following reduction of a posterior knee dislocation, dorsalis pedis pulses are palpable. Which diagnostic assessment is required to rule out vascular injury?
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Plain films confirm the reduction but show nothing about the artery.
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Compartment pressure screens for compartment syndrome, a different problem that develops later.
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A D-dimer is a nonspecific clot marker and cannot rule out arterial injury.
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A venous Doppler scan looks for clots, not the arterial intimal injury that dislocation causes.
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Palpable pulses do not exclude popliteal artery injury after knee dislocation; an ankle-brachial index under 0.9 prompts CT angiography.
20/30 · HEENT · 10 items
A patient exposed to wet concrete has a persistently high ocular pH despite 4 liters of irrigation. What is the most likely cause?
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The tear film buffers toward neutral, so it would lower the pH, not hold it high.
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Irrigation pressure is not what brings pH down; volume and removing the source do.
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Saline and Ringer's both lower the pH once particles are removed, so the choice of fluid does not explain this.
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Cement particles trapped under the lids keep releasing alkali, so pH stays high until the fornices are swept and the lids everted.
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Alkali injury is local; systemic absorption does not keep the surface pH of the eye high.
21/30 · HEENT · 10 items
A patient returns to the ED 48 hours after being diagnosed with a corneal abrasion, reporting increased pain. Slit-lamp examination reveals a white fluid level layering in the inferior anterior chamber. Which intervention is indicated?
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A white layer in the anterior chamber is a hypopyon, a sign of infectious keratitis or endophthalmitis that threatens vision and needs an ophthalmologist now.
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Tetanus status is addressed at the first visit and does nothing for a corneal infection.
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Discharge with pain pills misses a vision-threatening infection.
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Worsening pain with a hypopyon means the current ointment is failing, so continuing it unchanged is unsafe.
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A pressure patch over an infected cornea creates a warm, closed space that favors bacterial growth.
22/30 · Tox & infection · 13 items
A patient with organophosphate poisoning received an initial 2 mg dose of atropine. Five minutes later, bronchorrhea persists. The next dose should be:
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A 6 mg jump triples the dose and skips the doubling sequence.
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Dropping to 1 mg while bronchorrhea continues leaves the airway flooded.
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When bronchorrhea persists, atropine is doubled every 5 minutes, so 2 mg is followed by 4 mg until secretions dry.
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A 0.5 mg test dose has no role once a cholinergic crisis is established.
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Repeating 2 mg is too slow for organophosphate poisoning, which often needs large cumulative doses.
23/30 · Tox & infection · 13 items
A 6-year-old was pulled from a backyard pool after about 2 minutes underwater and coughed repeatedly on the pool deck. In the emergency department the child is alert, with clear lungs, SpO2 97% on room air, and a respiratory rate of 24/min. Which disposition is MOST appropriate?
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Discharging immediately misses the delayed respiratory deterioration that can follow aspiration in a child who looks well on arrival.
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Aspirated water can cause pulmonary edema and hypoxemia that appear hours later, so a child who coughed after submersion is observed for 4 to 8 hours and sent home only if oximetry and the lung exam stay normal.
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Prophylactic IV antibiotics give no benefit after a pool submersion and are kept for signs of pneumonia.
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Corticosteroids do not prevent lung injury after drowning, and discharge without an observation period is unsafe.
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An alert child with clear lungs and normal oxygenation needs neither intubation nor intensive care.
24/30 · Respiratory · 17 items
A 6-year-old struck by a car has bruising over the right chest, tachypnea and an SpO2 of 92% on room air. The chest radiograph shows no rib fractures. The nurse should recognize that
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Intact ribs on the x-ray do not rule out lung injury in a child, because the flexible chest wall hides damage beneath it.
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Pain and anxiety speed breathing but do not explain an SpO2 of 92% after a blow to the chest.
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Chest bruising after being struck by a car marks a high-energy impact and a likely injury underneath, not a superficial one.
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A child's pliable ribs bend instead of breaking and pass the impact to the lung, so a pulmonary contusion is common without any fracture.
25/30 · Neuro · 17 items
A patient with a cerebral contusion has a GCS of 14. One hour later, the GCS is 13 and the patient is harder to rouse. A family member says the patient is just tired. What should the nurse do?
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Stopping neuro checks while the GCS is falling would miss further deterioration from an expanding lesion.
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Waiting two hours leaves a falling GCS unreported during the window when treating a bleed matters most.
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A one-point drop with growing drowsiness after a contusion can signal an expanding bleed or swelling, so the provider is notified at once for reassessment and imaging.
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Lying flat slows venous drainage from the head and can raise ICP; the head of the bed stays at about 30 degrees.
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Lethargy with a lower GCS after a contusion is deterioration, not expected fatigue, and charting alone delays treatment.
26/30 · Mental health · 13 items
A 25-year-old is brought to the emergency department with paranoid delusions and agitation. Which assessment finding MOST suggests a medical rather than a primary psychiatric cause?
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People with primary psychosis usually stay oriented; disorientation to time and place points to delirium from a medical or toxic cause that needs urgent workup.
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Paranoid delusions are common in primary psychotic disorders and do not separate them from a medical cause.
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Auditory hallucinations are typical of primary psychosis; visual hallucinations are the type that leans toward delirium.
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Pressured, tangential speech fits mania or primary psychosis and does not point to a medical cause.
27/30 · Medical · 15 items
A patient on warfarin presents with a subdural hematoma and INR of 6.2. Which medication is the priority for rapid reversal?
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Recombinant factor VIIa lowers the INR number without fully restoring clotting and raises thrombosis risk, so it is not used for warfarin reversal.
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Cryoprecipitate supplies fibrinogen and platelets help platelet problems; neither replaces the factors warfarin depletes.
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Fresh frozen plasma needs thawing, a large volume and hours to correct the INR, so it is the fallback when PCC is unavailable.
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Protamine sulfate reverses heparin, not warfarin.
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Four-factor prothrombin complex concentrate replaces vitamin K–dependent factors within minutes in a small volume; IV vitamin K is given with it to sustain the reversal.
28/30 · Tox & infection · 13 items
A nurse is the first responder after lightning strikes a crowd at an outdoor event. The storm has passed and the scene is safe, but several people are down and no other help has arrived. Which person should the nurse attend to FIRST?
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Confusion and ear injury are common after a strike and usually resolve; this adult is breathing and can wait.
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Fern-shaped red marks (Lichtenberg figures) fade within hours and need no treatment.
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Cold, mottled, weak legs after a strike (keraunoparalysis) usually clear within hours and are not the immediate threat.
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Lightning often stops the heart and breathing of people who are otherwise uninjured, and they respond well to prompt CPR, so the apparently dead are attended first.
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A crying teen is breathing and perfusing, so the burned hand can wait until the arrest is managed.
29/30 · Professional · 12 items
A 3-year-old has several round, uniform, 8-mm crusted burns on the palms and soles. The caregiver says the child "fell against the heater." Which interpretation is MOST accurate?
Check
Brief contact with a heater leaves a burn shaped like its grill or surface in one area, not several small round burns.
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An accidental scald from a spill leaves irregular splash or flow marks, not small round burns of equal size.
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One fall against a heater cannot produce multiple uniform burns on both palms and soles, so the history does not fit the pattern.
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Several round, uniform burns about 8 mm across on the palms and soles match inflicted cigarette burns, and the history does not explain them.
30/30 · Professional · 12 items
The family of an actively dying patient receiving comfort care is distressed by a loud gurgling sound when the patient breathes. What is the nurse's MOST appropriate action?
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Deep nasotracheal suctioning is distressing, provokes more secretions and rarely reaches them, so it is avoided at the end of life.
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A non-rebreather mask does not clear secretions and adds discomfort for a patient receiving comfort care.
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Extra IV fluid in the last hours of life adds to secretions and edema rather than thinning them.
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Terminal secretions rarely distress the dying patient; turning onto one side lets them drain, and explaining their cause eases the family's distress.
What your score tells you
The live exam passes at 99/150 scored questions. A short set like this one swings a lot with a single weak area, so read your result by area, not as one percentage. Two misses in one area point to a section of the study guide worth an evening.
On test day you get 3 hours (180 minutes) of seat time for 175 questions. Run this set once untimed to learn, then a second time against the clock.
Written by First Attempt
First Attempt wrote these questions; none come from BCEN's item bank. BCEN's own sample questions show the screen style.