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CEN Cheat Sheet

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Cardiovascular Emergencies

  • 12% of exam
  • ACS Dysrhythmias Shock Dissection Tamponade

Respiratory Emergencies

  • 11% of exam
  • Airway Asthma COPD Pneumothorax PE

Neurological Emergencies

  • 11% of exam
  • Stroke Seizures ICP Meningitis Spinal Trauma

Gastrointestinal Emergencies

  • 9% of exam
  • Bleeding Obstruction Pancreatitis Peritonitis Varices

GU/GYN/OB Emergencies

  • 7% of exam
  • Ectopic Torsion Preeclampsia Delivery Renal

Mental Health Emergencies

  • 9% of exam
  • Suicide Violence Psychosis Overdose De-escalation

Medical Emergencies

  • 10% of exam
  • Sepsis Anaphylaxis Endocrine Electrolytes Withdrawal

MSK + Wound Emergencies

  • 7% of exam
  • Fractures Dislocations Compartment Amputation Lacerations

HEENT Emergencies

  • 7% of exam
  • Eye Trauma Epistaxis Epiglottitis Foreign Bodies Retina

Environment + Toxicology

  • 9% of exam
  • Burns CO Cyanide Temperature Communicable

Professional Issues

  • 8% of exam
  • Triage MCI Consent Forensics Throughput

Quick Facts

  • Exam CEN
  • Owner BCEN
  • Items 175 total
  • Scored 150 scored
  • Pretest 25 unscored
  • Time 3 hours
  • Pass 106/150 scored
  • Delivery PSI or LRP
  • Eligibility Unrestricted RN license
  • Validity 4 years
  • Blueprint Effective Jul 6 2026
  • Fee $380 standard

Hs and Ts CA

  • Hypoxia hypovolemia hydrogen hyperkalemia toxins tamponade tension thrombosis
  • Hs: metabolic Ts: obstructive Search causes Treat reversible

STEMI vs Pericarditis CA

STEMI

  • Territorial ST
  • Reciprocal changes
  • Reperfusion clock

Pericarditis

  • Diffuse ST
  • PR depression
  • Position pain
  • Territory vs diffuse

Cardiac Red Flags CA

  • ACS Early ECG
  • STEMI Reperfusion clock
  • Dissection Tearing back pain
  • Tamponade Obstructive shock
  • Cardiogenic Cold low output
  • Hypertensive Crisis End-organ injury
  • PE RV strain
  • Aneurysm Pulsatile mass

VF/pVT vs PEA/asystole CA

VF/pVT

  • Shockable
  • Defibrillate
  • CPR continues

PEA/asystole

  • Not shockable
  • CPR/epi
  • Find causes
  • Shock vs search

Rhythms + Shock CA

  • VF Defibrillate fast
  • Pulseless VT Shockable arrest
  • PEA CPR plus causes
  • Asystole CPR plus epi
  • Unstable SVT Synchronized cardioversion
  • Symptomatic Brady Atropine/pacing
  • 12-lead Locate ischemia
  • IO Access Crash access

LEMON RE

  • Look Evaluate Mallampati Obstruction Neck
  • Look Evaluate Mallampati Obstruction Neck

Asthma vs COPD RE

Asthma

  • Bronchospasm
  • Silent chest danger
  • Peak flow

COPD

  • Hypercapnia risk
  • Titrate oxygen
  • NIPPV often
  • Airflow vs retention

Airway Picker RE

  • Cannot protect airway → Intubation prep ( RSI support )
  • CHF distress → NIPPV ( Reduce work )
  • COPD exacerbation → Titrated oxygen ( 88-92% )
  • Upper obstruction → Airway expert ( Stridor threat )
  • Tension signs → Needle decompression ( Before imaging )
  • Intubated patient → Capnography ( Confirm ventilation )

Airway + Breathing RE

  • Stridor Upper airway
  • Silent Chest Impending failure
  • Tension Pneumo Decompress now
  • COPD Target 88-92%
  • Capnography Ventilation trend
  • NIPPV CHF/COPD support
  • Chest Tube Seal below chest
  • RSI Airway sequence

BE FAST NE

  • Balance Eyes Face Arm Speech Time
  • Balance Eyes Face Arm Speech Time

Stroke vs Hypoglycemia NE

Stroke

  • Focal deficit
  • LKW matters
  • CT first

Hypoglycemia

  • Mimics stroke
  • Check glucose
  • Correct immediately
  • Image plus glucose

Neuro + Stroke NE

  • FAST Stroke screen
  • Last Known Well Reperfusion clock
  • Glucose Mimic check
  • Noncontrast CT Bleed screen
  • Thunderclap SAH concern
  • Status >5 min seizure
  • Cushing Triad High ICP
  • Spinal Shock Neurogenic hypotension

Ectopic vs Miscarriage GU

Ectopic

  • Unilateral pain
  • Shoulder pain
  • Shock risk

Miscarriage

  • Cramping bleeding
  • Cervical findings
  • Rh status
  • Shock changes priority

Abdomen + OB GU

  • Appendicitis Migrates RLQ
  • Pancreatitis Lipase pain
  • GI Bleed Two large IVs
  • Varices Portal bleeding
  • Ectopic Pregnant shock
  • Torsion Sudden pelvic pain
  • Preeclampsia HTN plus symptoms
  • Prolapsed Cord Relieve pressure

Previa vs Abruption GU

Previa

  • Painless bleeding
  • Avoid vaginal exam
  • Placenta low

Abruption

  • Painful bleeding
  • Rigid uterus
  • Fetal distress
  • Painless vs painful

Mental Health ME

  • Suicide Risk Ask directly
  • Violence Safety first
  • Psychosis Reality impaired
  • Overdose Toxidrome clues
  • Withdrawal Seizure risk
  • Restraints Least restrictive
  • De-escalation Calm choices
  • Therapeutic Low stimulus

SAMPLE ME

  • Signs Allergies Meds Past Last Events
  • Signs Allergies Meds Past Last Events

DKA vs HHS ME

DKA

  • Ketones
  • Acidosis
  • Kussmaul

HHS

  • Severe hyperosmolarity
  • Minimal ketones
  • Older adults
  • Acid vs osmoles

Shock Picker ME

  • Fever hypotension → Septic shock ( Cultures/antibiotics )
  • Hives wheeze shock → Anaphylaxis ( IM epi )
  • Bleeding trauma → Hemorrhagic shock ( Control loss )
  • MI cold clammy → Cardiogenic shock ( Pump failure )
  • JVD muffled tones → Tamponade ( Obstructive )
  • Absent breath sounds → Tension pneumo ( Decompress )
  • Spinal cord injury → Neurogenic shock ( Brady hypotension )
  • Vomiting dehydration → Hypovolemic shock ( Volume loss )

Shock + Sepsis ME

  • Sepsis Infection plus dysfunction
  • Septic Shock Vasopressor need
  • Anaphylaxis IM epinephrine
  • Hypovolemic Volume loss
  • Distributive Vasodilation
  • DKA Ketones/acidosis
  • HHS Hyperosmolar dehydration
  • Hyperkalemia ECG danger

Ortho + Wounds MS

  • Compartment Pain outsize
  • Open Fracture Cover sterile
  • Dislocation Check pulses
  • Amputation Cool dry part
  • Injection Injury Surgical emergency
  • Degloving Major soft tissue
  • Osteomyelitis Deep infection
  • Hemorrhage Direct pressure

HEENT Threats HE

  • Globe Rupture Shield only
  • Hyphema Eye rest
  • Retinal Detach Curtain vision
  • Acute Glaucoma Painful pressure
  • Epiglottitis Airway danger
  • Peritonsillar Muffled voice
  • Epistaxis Lean forward
  • Foreign Body Avoid blind sweep

Contact vs Airborne EN

Contact

  • Gown/gloves
  • C diff
  • MDRO

Airborne

  • N95
  • Negative pressure
  • TB/measles
  • Touch vs aerosol

Tox + Environment EN

  • CO High-flow oxygen
  • Cyanide Smoke collapse
  • Caustics Do not neutralize
  • Burns Stop burning
  • Electrical Cardiac monitoring
  • Hypothermia Handle gently
  • Heat Stroke Rapid cooling
  • Submersion Hypoxia first

Communicable EN

  • C diff Soap/water
  • TB Airborne room
  • Measles Airborne risk
  • Pertussis Droplet risk
  • MDRO Contact precautions
  • Resp Viruses Mask early
  • Hemorrhagic Fever Isolation escalate
  • STI Confidential care

ABCDE PR

  • Airway Breathing Circulation Disability Exposure
  • A: airway B: breathing C: circulation D: neuro E: expose

Consent vs Implied PR

Consent

  • Capacity
  • Risks/benefits
  • Voluntary choice

Implied

  • Emergency
  • No capacity
  • Delay unsafe
  • Permission vs emergency

Triage Picker PR

  • Airway threatened → Resuscitation ( Immediate bed )
  • Chest pain unstable → Rapid ECG ( STEMI screen )
  • Stroke symptoms → Stroke alert ( LKW rules )
  • Sepsis cues → Sepsis pathway ( Early bundle )
  • Psych danger → Safety room ( Ligature risk )
  • Contaminated arrival → Decon zone ( Protect ED )
  • MCI surge → Incident command ( Shared priorities )
  • Boarded patient → Reassess cadence ( Detect decline )

Exam Frame PR

  • Total Items 175 questions
  • Scored Items 150 count
  • Pretest Items 25 hidden
  • Seat Time 180 minutes
  • Pass Mark 106 scored correct
  • Pacing 62 sec/item
  • Window 90 days
  • Retest 90-day wait

Triage Priority PR

  • ABCD Immediate life threats
  • Unstable Resuscitation pathway
  • Time Critical STEMI/stroke/sepsis
  • MCI Greatest good
  • Throughput Reassess boarded patients
  • EMTALA Screen and stabilize
  • Consent Capacity plus disclosure
  • Forensics Preserve chain

Professional Practice PR

  • MCI Triage Resource-based priority
  • Throughput Flow plus safety
  • Capacity Decision ability
  • Implied Consent Emergency exception
  • Abuse Mandatory report
  • Diversion Report impairment
  • Workplace Violence Activate safety
  • Cultural Humility Ask preferences

Common Traps

Pretest still matters

  • Pretest is hidden ≠ Answer every item

Current vs July outline

  • Before July uses 2022 ≠ After July uses 2026

Stable vs unstable

  • Stable can wait ≠ Unstable gets bed

PEA vs VF

  • PEA needs causes ≠ VF needs shock

COPD oxygen trap

  • Titrate oxygen ≠ Do not withhold

Stroke mimic trap

  • Check glucose ≠ Do not delay alert

Previa exam trap

  • Avoid vaginal exam ≠ Ultrasound first

C diff sanitizer trap

  • Soap/water needed ≠ Alcohol insufficient

Consent shortcut trap

  • Capacity matters ≠ Emergency exception narrow

Forensic evidence trap

  • Minimize handling ≠ Document transfers

MCI fairness trap

  • Use objective criteria ≠ Avoid favoritism

Boarding trap

  • Room status irrelevant ≠ Reassessment continues

Last Minute

  • 1. Jul 6 blueprint changes domains
  • 2. 175 items; 150 scored
  • 3. Pass = 106/150 scored
  • 4. Pace near 62 seconds
  • 5. ABCD before diagnosis
  • 6. Unstable beats chronic
  • 7. STEMI gets rapid ECG
  • 8. Stroke: glucose plus CT
  • 9. Sepsis: recognize shock early
  • 10. Anaphylaxis = IM epi
  • 11. COPD target 88-92%
  • 12. PEA: CPR plus causes
  • 13. Previa: no vaginal exam
  • 14. C diff: soap/water
  • 15. MCI: greatest good
  • 16. Retest wait: 90 days

CEN Certified Emergency Nurse

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