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Board of Certification for Emergency Nursing (BCEN)

Certified Emergency Nurse (CEN®)

The specialty credential for registered nurses who work emergency care — triage to resuscitation, every age, every system.

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Questions175 multiple-choice (150 scored, 25 unscored pretest)
Time3 hours — about 1 minute per question
Blueprint11 domains — new outline effective July 2026
WhereAt home by Live Remote Proctoring, or at a PSI test center
Fee$285 association members · $380 non-members · $195 military · $200 retest
Who sits itRNs with a current, unrestricted license; about two years of emergency experience recommended, not required
RenewalEvery 4 years — 100 CE contact hours or retest

About the exam

The CEN is the emergency-nursing specialty certification awarded by the Board of Certification for Emergency Nursing (BCEN). It validates the breadth of knowledge an emergency nurse uses every shift: recognizing the life-threat in a crowded waiting room, prioritizing four patients at once, and knowing which intervention comes first.

The exam is built almost entirely from clinical scenarios across all ages and body systems, plus the professional side of emergency nursing — triage, disaster response, consent, forensic care and federal regulations such as EMTALA.

How we track your progress

Every blueprint domain moves through five levels as you study:

  1. Not startedNo questions answered in this domain yet.
  2. Getting startedFirst questions answered — not enough yet to judge.
  3. DevelopingAt least 5 answered and 50% or better on your recent questions.
  4. ProficientAt least 15 answered and 70% or better on your recent questions.
  5. Exam readyAt least 25 answered, 80% or better recently, and holding up on hard questions.

The exam blueprint

BCEN CEN Examination Content Outline, effective July 2026 — 150 scored items across 11 domains. Tap a domain to see its topics.

1 Cardiovascular Emergencies 18 items · 12%
Acute coronary syndromeAneurysm and dissectionCardiopulmonary arrestDysrhythmiasEndocarditis, myocarditis and pericarditisHeart failureHypertensionPericardial tamponadePeripheral vascular disease (venous and arterial)Thromboembolic diseaseCardiovascular traumaCardiogenic and obstructive shock

54 practice questions in this domain so far

2 Respiratory Emergencies 17 items · 11.3%
AspirationAsthmaCOPDInfectionsInhalation injuriesObstructionPleural effusionPneumothoraxNoncardiac pulmonary edemaPulmonary embolusRespiratory distress syndromeRespiratory traumaPulmonary hypertensionCroup

51 practice questions in this domain so far

3 Neurological Emergencies 17 items · 11.3%
Neurological disordersHeadacheIncreased intracranial pressureMeningitisSeizure disordersStrokeTransient ischemic attackHead and spinal cord traumaNeurogenic shock

51 practice questions in this domain so far

4 Gastrointestinal Emergencies 14 items · 9.3%
AppendicitisPeritonitisBowel perforationCyclic vomiting syndromeBleedingCholecystitisCirrhosisDiverticulitisEsophageal varicesForeign bodiesHepatitisIntussusceptionObstructionsPancreatitisGastrointestinal trauma

42 practice questions in this domain so far

5 Genitourinary, Gynecology and Obstetrical Emergencies 10 items · 6.7%
GU infections, priapism, renal calculiTesticular torsionUrinary retention and renal failureDysfunctional uterine bleeding and ovarian disordersSexual assaultEctopic pregnancyAbruptio placenta and placenta previaEmergent delivery and neonatal resuscitationPreeclampsia, eclampsia and HELLPPreterm labor, abortion, uterine rupture, obstetric trauma

30 practice questions in this domain so far

6 Mental Health Emergencies 13 items · 8.7%
Aggressive and violent behaviorAnxiety disordersDepressive disordersHomicidal and suicidal ideationIntentional overdose and ingestionsPsychotic disordersBipolar disorders

39 practice questions in this domain so far

7 Medical Emergencies 15 items · 10%
Allergic reactions and anaphylaxisHematologic disordersElectrolyte and fluid imbalanceEndocrine disordersImmunocompromiseSepsisHypovolemic and distributive shockSubstance use and abuseWithdrawal syndrome

45 practice questions in this domain so far

8 Musculoskeletal and Wound Emergencies 11 items · 7.3%
AmputationCompartment syndromeFractures and dislocationsLigament and tendon injuriesInflammatory conditions and osteomyelitisAvulsions and deglovingInjection injuriesLacerations and penetrating injuriesWound infections and bleeding

33 practice questions in this domain so far

9 Head, Eye, Ear, Nose and Throat Emergencies 10 items · 6.7%
Facial nerve disordersMaxillofacial infections and traumaOcular abrasions, burns and foreign bodiesIncreased intraocular pressureRetinal artery occlusion and retinal detachmentOcular infections, ulcerations and traumaVestibular dysfunction, ear infections and foreign bodiesEpistaxisEpiglottitis and peritonsillar abscess

30 practice questions in this domain so far

10 Environment, Toxicology and Communicable Diseases 13 items · 8.7%
Burns and electrical injuriesChemical exposureSubmersion injuryTemperature-related emergenciesAnimal bitesAcids and alkalisCarbon monoxideCyanideC. difficile and multi-drug resistant organismsVaccine-preventable diseasesRespiratory viruses and tuberculosisHemorrhagic fevers and STIs

39 practice questions in this domain so far

11 Professional Issues 12 items · 8%
TriageMass casualtyPatient throughputEnd-of-life and palliative careForensic evidence collectionFederal regulations (EMTALA)Consent for treatmentContinuity of careCultural humilityAbuse and neglectImpaired nurse and drug diversionWorkplace violence

36 practice questions in this domain so far

What you get when you access this exam

Free with your QuizMe account.

Questions and scenarios aligned to the blueprint

Every question is tagged to one of the 11 CEN domains and topics, written the way BCEN writes them — the patient in front of you, and what you do first.

EMS radio report drills

Listen to paramedic radio reports coming into your ED, then set the triage level, pick the room, activate the right team and plan your first actions when the patient arrives. It's a separate drill from the question bank.

Exam-critical hints

Stuck? Reveal the clinical pearl that unlocks the question — the same rule you'll lean on in the testing room. Every answer comes with the full rationale.

Adaptive testing

Questions steer toward your weakest domains, weighted by how heavily each domain counts on the real exam, and get harder as you get stronger.

Timed practice exams

Blueprint-weighted exams at the real pace — about a minute a question — with no feedback until you finish, then a full review.

Flashcards, case simulations and guides

120 flashcards, 8 unfolding emergency cases where the chart updates with every decision, and interactive illustrated guides you explore hotspot by hotspot.

Progress for every blueprint domain

Each domain moves from Not started to Getting started, Developing, Proficient and Exam ready — so you know exactly what to study next.

Test at home or at a center

BCEN offers the CEN two ways, both delivered by PSI. You pick when you schedule, and you have a 90-day window from approval to sit the exam.

At home — Live Remote Proctoring

  • A live PSI proctor watches through your webcam for the whole exam.
  • Use your own Windows PC or Mac — not an iPad, Chromebook or a locked-down work computer.
  • You need a webcam you can move for a 360° room scan, a working microphone and speakers, and a steady broadband connection.
  • PSI's secure browser is downloaded after you schedule. Run PSI's compatibility check well before exam day — and again on the same network the day before.
  • Test in a private, quiet room with a clear desk: no phone, notes, second monitor, smartwatch or other people.
  • If your equipment, internet or room doesn't meet PSI's requirements, BCEN can treat it as a missed appointment and the fee can be forfeited.

At a PSI test center

  • Arrive about 30 minutes early for check-in.
  • Bring valid, unexpired government-issued photo ID whose name matches your registration exactly — check your PSI confirmation for the full ID rules.
  • Phones, bags, watches, food and notes go in a locker; nothing comes into the testing room.
  • Fewer moving parts: no home tech check, no room scan, no worries about your Wi-Fi.

Exam-day game plan

How to walk in ready — and how to pace 175 questions in 3 hours.

Pacing checkpoints

Hit these and you finish with time to revisit your flagged questions. Our timed practice exams run at this same pace.

44questions0:45
88questions1:30
131questions2:15
175questions3:00

The week before

  • Take one full-length, timed practice exam 3–5 days out — then rest, don't cram.
  • Spend your last study sessions on the heaviest domains (Cardiovascular, Respiratory, Neurological, Medical) and on any domain still below Proficient.
  • Review high-risk meds and antidotes: epinephrine, adenosine, amiodarone, magnesium, calcium, naloxone, hydroxocobalamin.
  • At home? Run PSI's system check again and set up your testing room.

Exam morning

  • Eat a real breakfast with protein a couple of hours before; go easy on caffeine.
  • Have your ID ready. Test center: arrive 30 minutes early. Home: log in early, restart your computer and close every other program.
  • Use the restroom right before you start.

During the exam

  • Read the whole stem and circle the cue in your head: first, priority, initial, most concerning, contraindicated.
  • When patients compete, apply airway → breathing → circulation → disability, then safety, then comfort.
  • Eliminate two answers, then choose between the last two on what helps the patient most right now.
  • Don't fight a question — pick your best answer, flag it and move on. Revisit flags at the end.
  • Answer every question: there's no penalty for a wrong answer.
  • 25 questions are unscored pretest items you can't identify — a question that seems strange may not even count.

Keep your head

  • A few nerves sharpen focus. If you freeze, take three slow breaths and reread the stem.
  • Your score is criterion-referenced — you're measured against the standard, not against other test-takers.
  • Change an answer only when you find a real reason in the stem, not a feeling.

Keeping your CEN

  • Certification lasts 4 years.
  • Renew with 100 CE contact hours earned in your cycle — at least 75 clinical; up to 25 can be non-clinical.
  • At least 50 hours must come from an accredited provider (such as BCEN Learn, ENA, ANCC or AACN); this rises to 75 hours starting January 1, 2027.
  • Or renew by retaking the exam, at home or at a test center.

Official sources and further reading

Ready to start?

450 questions and scenarios across the blueprint — and growing.

Enroll free

CEN® is a registered trademark of the Board of Certification for Emergency Nursing (BCEN). QuizMe and thinQtank Learning are not affiliated with or endorsed by BCEN or PSI. Exam details are summarized from BCEN's published materials and the linked guides; fees, ID and technology rules change — always confirm current requirements at bcen.org before you schedule. BCEN does not publish a fixed passing score on these pages, so we don't state one; our Exam ready level asks for 80% or better.