What Is the CEN Exam Content Outline? | 2025 Breakdown

The Certified Emergency Nurse (CEN) exam content outline is your roadmap to success. It shows exactly which domains you’ll be tested on, how many questions appear in each, and the high-yield topics to master.

Before we dive into the breakdown, prep with structured, blueprint-aligned resources:

👉 CEN Study Guide (Comprehensive Review Notes)
👉 CEN Practice Questions (Exam-Style Q&A with Rationales)

These align directly with the content outline so you study smarter—not harder.

CEN Exam Content Outline (2025)

Domain Number of Questions Key Topics Covered
Cardiovascular Emergencies 19 ACS, aneurysm/dissection, cardiopulmonary arrest, dysrhythmias, heart failure, hypertension, pericardial tamponade, thromboembolic disease, shock, cardiovascular trauma
Respiratory Emergencies 18 Asthma, COPD, pneumothorax, respiratory distress/failure, pulmonary embolus, inhalation injuries, noncardiac pulmonary edema
Neurological Emergencies 18 Seizures, stroke/TIA, intracranial pressure, meningitis, head & spinal trauma, Guillain-Barré, neurogenic shock
GI/GU/GYN/Obstetrical 18 Appendicitis, peritonitis, pancreatitis, testicular torsion, renal calculi, ovarian cysts, ectopic pregnancy, OB trauma, PPH, preterm labor, sexual assault, GYN infections
Mental Health Emergencies 11 Aggression, anxiety/PTSD, mood disorders (depression/bipolar), suicidal ideation, intentional overdose
Medical Emergencies 14 Anaphylaxis, sepsis, electrolyte imbalance, renal failure, substance use/withdrawal, endocrine disorders, hypovolemic shock
Musculoskeletal & Wound Emergencies 13 Amputation, compartment syndrome, fractures, dislocations, osteomyelitis, wound infections, lacerations, penetrating injuries
Maxillofacial & Ocular Emergencies 11 Epistaxis, facial nerve disorders, maxillofacial trauma, ocular injuries, ocular infections, retinal detachment
Environmental & Toxicology & Communicable Diseases 14 Burns, chemical exposure, electrical injuries, animal bites/rabies, influenza, TB, hemorrhagic fevers, vaccine-preventable diseases
Professional Issues 14 Ethics, evidence-based practice, workplace violence, cultural considerations, disaster management, patient safety

Key Domain Highlights (Full Detail—no condensing)

1) Cardiovascular Emergencies (19 Questions)

  • ACS/MI: Triage chest pain; 12-lead ECG acquisition/interpretation (STEMI vs NSTEMI); antiplatelets, anticoagulants, nitrates, beta-blocker caution; door-to-balloon/door-to-needle concepts; atypical presentations (older adults, women, diabetics).
  • Dysrhythmias: Recognition & immediate management (unstable vs stable); synchronized cardioversion vs defibrillation; pharmacologic algorithms (amiodarone, adenosine); bradycardia with poor perfusion (atropine, pacing).
  • Cardiac Arrest: High-quality CPR metrics, shockable vs non-shockable rhythms, reversible H’s & T’s, post-ROSC care (targeted temperature, ventilation goals).
  • Shock: Differentiate hypovolemic, cardiogenic, obstructive (PE, tamponade, tension pneumo), distributive (septic, anaphylactic, neurogenic); fluid responsiveness, pressor selection.
  • Heart Failure/Hypertensive Emergencies: Pulmonary edema management (NIV, diuretics, vasodilators); end-organ damage assessment.
  • Tamponade/Aortic Dissection: Beck’s triad, pulsus paradoxus, ultrasound cues; dissection red flags (tearing pain, pulse differential), BP control.
  • Thromboembolic Disease: PE risk stratification (Wells, PERC), D-dimer utility, CTA timing; anticoagulation & thrombolysis considerations.
  • Traumatic CV Injuries: Blunt cardiac injury, aortic injury suspicion, resuscitative priorities.

2) Respiratory Emergencies (18 Questions)

  • Asthma/COPD Exacerbations: Bronchodilators, anticholinergics, steroids, magnesium sulfate; NIV indications; red flags for impending failure.
  • Pneumothorax: Spontaneous vs tension; needle decompression vs chest tube; ultrasound (lung sliding).
  • Respiratory Distress/Failure: Recognize fatigue, accessory muscles, altered LOC; escalation from O₂ → NIV → intubation.
  • Pulmonary Embolus: Risk factors, DVT signs, imaging selection (CTA vs V/Q), anticoagulation/thrombolysis criteria.
  • Inhalation Injuries: Burns/smoke; airway edema anticipation, carbon monoxide/cyanide exposure management.
  • Noncardiac Pulmonary Edema: ARDS features, lung-protective ventilation principles.

3) Neurological Emergencies (18 Questions)

  • Stroke/TIA: FAST/BE-FAST recognition, last-known-well, CT non-contrast triage, thrombolysis/thrombectomy windows, BP parameters.
  • Seizures/Status Epilepticus: Benzodiazepines first-line, escalation (levetiracetam/valproate), postictal management; special cases (pregnancy/eclampsia, hypoglycemia).
  • Increased ICP/Head Trauma: Cushing triad recognition, head elevation, CO₂ targets; TBI imaging red flags; spinal precautions.
  • Spinal Cord Injury/Neurogenic Shock: Hypotension with bradycardia, warm dry skin; vasopressor and airway strategies.
  • Meningitis/Encephalitis: Fever/neck stiffness/AMS triad, droplet precautions, time-to-antibiotics.
  • GBS & Neuromuscular Weakness: Rapid respiratory decline recognition; NIF/Vital capacity monitoring.

4) Gastrointestinal, Genitourinary, Gynecology & Obstetrical (18 Questions)

  • Acute Abdomen: Appendicitis vs biliary vs pancreatitis vs SBO; peritonitis signs; early fluids, analgesia, antiemetics.
  • Pancreatitis: Gallstone vs alcohol etiologies; fluid resuscitation, electrolyte shifts (hypocalcemia).
  • GI Bleeding: Upper vs lower; resuscitation, PPI/octreotide indications; transfusion thresholds.
  • GU Emergencies: Testicular torsion (time-critical), pyelo vs cystitis, renal colic pain control and imaging.
  • OB Emergencies: Ectopic pregnancy (hemodynamic instability red flags), PPH management (uterotonics, TXA), preeclampsia/eclampsia (MgSO₄, BP control), trauma in pregnancy (Rhogam).
  • GYN/Sexual Assault: Trauma-informed care, evidence preservation, prophylaxis and chain of custody.

5) Mental Health Emergencies (11 Questions)

  • Suicidal Ideation/Homicide Risk: Screening, safety planning, means restriction, legal holds.
  • Aggression/De-escalation: Verbal techniques, environment control, indications for chemical/physical restraint with monitoring.
  • Anxiety/PTSD/Panic: Rule-out mimics (ACS, PE, thyrotoxicosis); targeted symptom control.
  • Mood Disorders & Psychosis: Mania vs depression; psychosis stabilization and medical clearance; substance-induced states.
  • Overdose/Intentional Ingestion: Toxidromes (anticholinergic, cholinergic, opioid, sympathomimetic, sedative-hypnotic), antidotes (naloxone, N-acetylcysteine).

6) Medical Emergencies (14 Questions)

  • Sepsis: Screening, lactate, cultures, early broad-spectrum antibiotics, 30 mL/kg crystalloid (contextual), MAP goals, vasopressors.
  • Anaphylaxis: IM epinephrine first, airway/oxygen/fluids, adjuncts (H₁/H₂ blockers, steroids).
  • Electrolytes/Metabolic: HyperK (stabilize membrane, shift, remove), hypoNa correction limits; DKA/HHS protocols.
  • Renal Failure: Hyperkalemia, volume status, dialysis indications (AEIOU).
  • Endocrine: Adrenal crisis (stress-dose steroids), thyroid storm vs myxedema coma.
  • Substance Use/Withdrawal: Opioids (naloxone), alcohol withdrawal (benzodiazepines, CIWA), stimulants, sedatives.
  • Hypovolemic Shock: Hemorrhage control, massive transfusion triggers.

7) Musculoskeletal & Wound Emergencies (13 Questions)

  • Fractures/Dislocations: NV checks pre/post reduction, open fracture antibiotics/tetanus, sedation/analgesia.
  • Compartment Syndrome: 6 P’s, pain out of proportion, emergent fasciotomy referral.
  • Amputation/Crush: Limb preservation, reimplant considerations, rhabdomyolysis (fluids, urine alkalinization).
  • Wound Care: Irrigation/debridement, closure timing, infection risk stratification; bite injuries (human/animal).
  • Ortho Red Flags: Septic joint (fever, single joint, inability to bear weight).

8) Maxillofacial & Ocular Emergencies (11 Questions)

  • Airway First: Midface instability, bleeding control, dental/mandible injuries.
  • Epistaxis: Anterior vs posterior management, packing and monitoring.
  • Facial Nerve Disorders: Bell’s palsy differentiation from stroke; steroid/antiviral windows.
  • Ocular Trauma: Globe rupture precautions (shield, no pressure), chemical burns (irrigation until pH neutral), corneal abrasion/foreign body.
  • Vision Threats: Acute angle-closure glaucoma, central retinal artery occlusion, retinal detachment recognition.

9) Environmental & Toxicology & Communicable Diseases (14 Questions)

  • Burns: %TBSA estimation, Parkland formula principles, airway/CO exposure; transfer criteria.
  • Electrical/Lightning: Hidden internal injury, rhabdomyolysis, cardiac monitoring.
  • Hypo/Hyperthermia: Rewarming/active cooling strategies; heat stroke vs exhaustion.
  • Chemical/Tox Exposure: Decontamination, antidotes where applicable, HAZMAT basics.
  • Animal/Human Bites & Rabies: Wound care, antibiotics, PEP indications.
  • Communicable Diseases: Isolation (droplet/airborne/contact), TB evaluation, influenza, vaccine-preventables, hemorrhagic fevers—PPE and escalation pathways.

10) Professional Issues (14 Questions)

  • Ethics & Legal: Consent, capacity, AMA, minors, end-of-life decisions; documentation standards.
  • Evidence-Based Practice/Quality: Protocol adherence (sepsis, stroke, ACS), audit and improvement cycles.
  • Cultural & Communication: Language access, bias mitigation, trauma-informed approaches.
  • Disaster/Incident Command: Triage systems (START/SALT), surge, decon, crisis standards.
  • Workplace Safety/Violence: Risk recognition, reporting, de-escalation training, restraint policy compliance.

How to Use the Content Outline for Study Planning

  • Prioritize high-weight domains: Cardiovascular, Respiratory, Neurological (but don’t neglect mid-weight areas like Medical and Environmental/Tox).
  • Target weaknesses: Build micro-sprints for your bottom 2–3 domains; require ≥80% in timed blocks before moving on.
  • Use practice exams: Mirror the blueprint with mixed sets and full-length mocks; measure pacing (~1 min/question).
  • Review rationales deeply: Learn why answers are correct—and why distractors are wrong.

Your CEN Study Resources

To master the entire content outline:

✅ CEN Study Guide (Comprehensive Review Notes) 
✅ CEN Practice Questions (Exam-Style Q&A with Rationales) 

Both are instant digital downloads, so you can start today.

Final Thoughts

The CEN content outline is the blueprint—study to it, practice against it, and track your progress by domain. With a targeted plan and the right resources, you’ll walk into the exam with clarity, control, and confidence.

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