FirstActionExam-level, case-based CEN questions that train what you'd do first.
On the CEN, several actions often look reasonable. Our questions give you two or three answers that look right, so you practice the priority call, not just fact recall.
Questions by ER physicians, reviewed by ER nurses.
Built around the first-action question
Many CEN items ask what you do first when more than one action is reasonable. That's the item type we write: realistic cases, plausible distractors, and one correct first move.
Written by ER physicians
Each item is drafted and clinically approved by emergency physicians.
Reviewed by ER nurses
Practicing ER nurses review each item for realism and nursing scope before it ships.
Every option explained
Each rationale names the strongest distractor, explains why it's tempting, and cites current guideline references.
What's planned
Organized around the BCEN CEN content-outline domains, from cardiovascular to professional issues.
Priority questions
"First action," "next step," and triage edge cases, written as full clinical scenarios.
Full rationales
Why the key is right, why each distractor is wrong, and the reference behind it.
Difficulty ratings
Each item is tagged moderate, hard, or very hard, so you can see where you stand.
Domain-based practice
Filter by content domain and focus on the areas you want to strengthen.
Full-length practice exam
A timed, exam-length practice test, planned for full launch.
Free sample questions
Waitlist members get occasional free questions with full rationales by email.
Try three questions
From our current draft set. Pick an answer, then open the explanation.
A 68-year-old man with an inferior STEMI (ST elevation in II, III, and aVF) is waiting for the cath lab, which is 20 minutes out. Six minutes ago he received aspirin 324 mg and one sublingual nitroglycerin 0.4 mg. A right-sided V4R shows 1.5 mm of ST elevation. He now feels lightheaded and rates his chest pain 6/10. BP 84/52 mm Hg (132/80 before nitroglycerin), HR 58/min sinus (62 before), SpO2 96%. Lungs are clear and neck veins are flat. Orders: NS 250 mL bolus for SBP <90; fentanyl 25 mcg IV PRN; atropine 0.5 mg IV PRN symptomatic bradycardia; pacing PRN. Which action should the nurse take first?
Show answer and explanation
Answer: C. ST elevation in V4R means right ventricular involvement. The RV is preload-dependent, so the nitrate dropped his SBP by 48 mm Hg. With clear lungs and flat neck veins, a cautious fluid bolus comes first.
Strongest distractor: B (atropine). Hypotension with a rate in the 50s looks like symptomatic bradycardia, but his rate barely changed while his BP fell. The problem is lost preload, not rate. Fentanyl (A) further reduces preload, and nothing calls for pacing (D) at a sinus rate of 58.
A 22-year-old with type 1 diabetes has had an insulin pump failure and has been vomiting for 2 days. HR 122/min, BP 100/62 mm Hg, RR 30/min and deep. She is alert. Glucose 512 mg/dL, pH 7.08, bicarbonate 7 mEq/L, anion gap 27, potassium 3.2 mEq/L. The first liter of 0.9% saline has been running for 30 minutes. The DKA order set includes regular insulin at 0.1 unit/kg/h and KCl 10 mEq/h IV. What should the nurse do next?
Show answer and explanation
Answer: B. The 2024 ADA/EASD hyperglycemic crisis consensus says to delay insulin until K⁺ is above 3.5 mEq/L and replace potassium first. Insulin drives potassium into cells and can trigger arrhythmias or respiratory muscle weakness.
Strongest distractor: C (start both). That's what most order sets do when K⁺ is normal. A reduced insulin rate (D) still shifts potassium into cells. The guidance says to delay insulin, not reduce it.
A 41-year-old house painter walks into triage 40 minutes after his airless paint sprayer discharged into the pad of his left index finger. There is a pinpoint wound with no active bleeding. Pain is 3/10, and the finger feels "a little numb and tight" and is mildly swollen. Vital signs are normal. His last tetanus booster was 3 years ago. Using ESI v5, what level should the nurse assign?
Show answer and explanation
Answer: A (ESI 2). A high-pressure injection injury is a limb-threatening surgical emergency despite a harmless-looking entry wound. Paint tracks along tendon sheaths, and delay is linked to amputation. Numbness and tightness are early neurovascular warning signs, which makes it a high-risk situation.
Strongest distractor: B (ESI 3). Counting resources correctly gives ESI 3, but the high-risk decision comes before resource counting.
Sample questions are for education only and are not taken from the actual CEN exam. Always follow your institution's protocols and current guidelines.
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FAQ
Who writes the questions?
Questions are drafted with help from software tools, fact-checked against current guidelines, and approved by emergency physicians. Practicing ER nurses then review them. No question ships without physician approval and nurse review.
Is this affiliated with BCEN?
No. FirstAction Prep is independent and is not affiliated with or endorsed by the Board of Certification for Emergency Nursing (BCEN). BCEN does not endorse any review course or product. Our questions are original and are not taken from the actual exam.
When does it launch, and what will it cost?
We're building the question bank now. Waitlist members will hear first about the launch date and pricing.
Do you guarantee I'll pass?
No. We don't make pass-rate promises or guarantees. FirstAction Prep is an educational practice resource, meant to sit alongside your own study plan.
How do I recertify my CEN?
CEN certification lasts 4 years. You can recertify by retaking the exam or by earning continuing-education hours that meet BCEN's requirements. Check bcen.org/recertify for current rules. FirstAction Prep does not currently offer CE credit.
Will you cover TCRN or CPEN?
They're planned after CEN. Join the waitlist to hear first.
What do you do with my email?
We use it only to send FirstAction Prep updates and sample questions. We never sell it, and you can unsubscribe anytime. Details are in our privacy policy.