CEN certification for emergency nurses, on the 2026 outline

During CPR on an adult in the ED lobby, the AED is attached and announces that it is analyzing the rhythm. The nurse should

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1. pause compressions and keep everyone clear.
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   Rhythm analysis needs a still chest, so hands come off and nobody touches the patient; compressions restart right after the shock or no-shock prompt.
2. check for a carotid pulse during analysis.
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   A carotid pulse check is not part of the analysis step; the device decides from the rhythm, and the check only lengthens the hands-off pause.
3. give two rescue breaths while it is analyzing.
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   Rescue breaths during analysis move the chest just as compressions do, so ventilation waits until CPR resumes after the prompt.
4. continue compressions during the analysis.
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   Compressing during analysis adds motion artifact, and the AED can misread the rhythm and give or withhold a shock wrongly.

Four infants with RSV bronchiolitis are in the emergency department. Which infant is at HIGHEST risk for apnea?

1. A 9-month-old with mild retractions
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   Mild retractions show some work of breathing, but a term-age 9-month-old is past the age when RSV apnea is common.
2. A 7-month-old with nasal congestion
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   Nasal congestion is the expected upper-airway part of bronchiolitis and, at 7 months, does not mark apnea risk.
3. A 5-week-old born at 32 weeks' gestation
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   Apnea in RSV clusters in infants under about 2 months and in those born preterm; this 5-week-old ex-preemie is both and needs continuous cardiorespiratory monitoring.
4. A 10-month-old born at term with a fever
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   Fever is common with RSV and does not predict apnea; a term infant of 10 months is outside the high-risk group.

A trauma patient presents with warm, dry skin. Vital signs are BP 78/42 mmHg, HR 54 bpm, and RR 16/min. These findings are most consistent with:

1. Hypovolemic shock
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   Hypovolemic shock from blood loss gives a fast pulse with cool, pale, clammy skin; warm skin and a rate of 54 point away from it.
2. Cushing triad
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   Cushing triad pairs bradycardia with a rising blood pressure and irregular breathing; this pressure is low, not high.
3. Septic shock
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   Warm skin fits early septic shock, but sepsis drives the heart rate up, and a fresh trauma patient has no infection to explain it.
4. Obstructive shock
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   Obstructive shock from tamponade or tension pneumothorax brings tachycardia and distended neck veins, not a rate of 54.
5. Neurogenic shock
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   Loss of sympathetic tone after spinal cord injury gives hypotension with a slow heart rate and warm, dry skin from vasodilation.

The triage nurse is evaluating four patients with mental health concerns. Which patient should be seen FIRST?

1. A patient with anxiety since losing a job last week
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   Anxiety after a job loss warrants a suicide screen, but with no other risk signs it ranks below an active threat to others.
2. A patient with insomnia for three nights in a row
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   Three nights of insomnia is distressing yet poses no immediate danger to the patient or anyone else.
3. A patient with chronic depression that has worsened
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   Worsening chronic depression needs prompt suicide screening, but as described there is no plan or threat, so it ranks below command hallucinations.
4. A patient hearing voices telling him to hurt others
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   Command hallucinations to harm others carry a risk of sudden violence, so this patient needs immediate safe placement and evaluation.