The Certified Emergency Nurse (CEN) exam measures the specialized knowledge and clinical judgment registered nurses need in emergency nursing practice. This guide covers the current eligibility requirements, exam format, 2026 content outline, fees, scoring, registration process, retake policy, and study resources.
Exam Background and Purpose
The Certified Emergency Nurse exam is offered by the Board of Certification for Emergency Nursing (BCEN). The certification is designed for registered nurses who want to demonstrate specialized knowledge in emergency nursing.
CEN certification does not expand a nurse’s legal scope of practice or replace state RN licensure. Instead, it demonstrates that the nurse has met BCEN’s eligibility requirements and passed an examination covering emergency nursing knowledge and clinical decision-making.
Major 2026 change: BCEN introduced a new CEN examination content outline on July 6, 2026. The number of scored questions remains 150, but the content is now divided among 11 areas and the passing requirement changed to 99 correct answers.
Who Is Eligible to Take the CEN Exam?
To take the CEN exam, you must hold a current, unencumbered Registered Nurse license in the United States, a U.S. territory, Canada, or Australia.
A nursing credential from another country may also qualify if it is equivalent to a U.S. RN license and is verified through BCEN’s international credential-evaluation process.
RN License: Your license must be current and unencumbered.
Emergency Nursing Experience: BCEN recommends at least two years of experience in the specialty area before taking the exam.
Experience Requirement: The two years of specialty experience are recommended, not required. You may qualify without two full years of emergency nursing experience as long as you meet the licensure requirements.
An active restriction, suspension, probation, or other order associated with a nursing license can make a candidate ineligible to sit for a BCEN examination.
CEN Exam Format
The exam contains 175 questions. Of these, 150 count toward your score and 25 are unscored pretest questions used to evaluate possible future exam items.
The pretest questions are mixed throughout the examination and are not identified. You should therefore treat every question as though it contributes to your score.
What Is on the CEN Exam?
The current CEN content outline became effective in July 2026 and contains 11 content areas. The number shown for each area represents the number of scored questions from that category.
| Content Area | Scored Questions |
|---|---|
| Cardiovascular Emergencies | 18 |
| Respiratory Emergencies | 17 |
| Neurological Emergencies | 17 |
| Gastrointestinal Emergencies | 14 |
| Genitourinary, Gynecology, and Obstetrical Emergencies | 10 |
| Mental Health Emergencies | 13 |
| Medical Emergencies | 15 |
| Musculoskeletal and Wound Emergencies | 11 |
| Head, Eye, Ear, Nose, and Throat Emergencies | 10 |
| Environment and Toxicology Emergencies, and Communicable Diseases | 13 |
| Professional Issues | 12 |
Cardiovascular Emergencies
This area covers emergency assessment and treatment of cardiovascular conditions such as acute coronary syndrome, aneurysm and dissection, cardiopulmonary arrest, dysrhythmias, heart failure, hypertension, thromboembolic disease, cardiovascular trauma, tamponade, and cardiogenic or obstructive shock.
Respiratory Emergencies
Respiratory questions address conditions such as asthma, COPD, pulmonary infections, aspiration, airway obstruction, pneumothorax, pulmonary embolism, pulmonary edema, respiratory distress syndrome, respiratory trauma, and pediatric conditions such as croup.
Neurological Emergencies
This section includes seizures, stroke, transient ischemic attack, meningitis, increased intracranial pressure, headaches, neurological disorders, traumatic brain injury, spinal cord trauma, and neurogenic shock.
Gastrointestinal Emergencies
Topics include appendicitis, gastrointestinal bleeding, bowel obstruction and perforation, pancreatitis, hepatitis, cirrhosis, cholecystitis, diverticulitis, esophageal varices, foreign bodies, intussusception, and gastrointestinal trauma.
Genitourinary, Gynecology, and Obstetrical Emergencies
This section covers renal and urinary conditions, reproductive emergencies, pregnancy complications, emergency delivery, neonatal resuscitation, hemorrhage, ectopic pregnancy, preeclampsia, eclampsia, HELLP syndrome, placental disorders, and obstetric trauma.
Mental Health Emergencies
Mental Health Emergencies include aggressive or violent behavior, anxiety, depressive disorders, suicidal and homicidal ideation, intentional overdose or ingestion, psychotic disorders, and bipolar disorders.
Medical Emergencies
This domain includes allergic reactions and anaphylaxis, hematologic disorders, electrolyte and fluid imbalances, endocrine emergencies, immunocompromise, sepsis, hypovolemic and distributive shock, substance use, and withdrawal syndromes.
Musculoskeletal and Wound Emergencies
Topics include fractures, dislocations, amputations, compartment syndrome, tendon and ligament injuries, osteomyelitis, avulsions, degloving injuries, lacerations, penetrating wounds, bleeding, wound infections, and injection injuries.
Head, Eye, Ear, Nose, and Throat Emergencies
This area covers maxillofacial infections and trauma, ocular emergencies, retinal conditions, foreign bodies, epistaxis, ear disorders, epiglottitis, peritonsillar abscess, and other urgent head and neck conditions.
Environment, Toxicology, and Communicable Diseases
Questions may cover burns, chemical exposures, electrical injuries, submersion injuries, temperature-related emergencies, animal bites, toxic exposures, carbon monoxide, cyanide, tuberculosis, respiratory viruses, multidrug-resistant organisms, vaccine-preventable diseases, and other communicable illnesses.
Professional Issues
This section focuses on prioritization, triage, mass-casualty situations, patient throughput, legal and ethical issues, end-of-life care, forensic evidence, federal regulations, consent, continuity of care, cultural humility, abuse and neglect, impaired nurses, drug diversion, and workplace violence.
How Much Does the CEN Exam Cost?
The current self-pay examination fee depends on whether you qualify for an Emergency Nurses Association membership discount or a military discount.
*BCEN offers the discounted $200 retest price for eligible retest applications submitted within one year of the initial examination date.
BCEN also offers an optional Test Assurance program that includes a second attempt if the first exam is unsuccessful. That option costs more than the standard initial exam fee.
How Do I Apply for the CEN Exam?
The CEN application is completed through your BCEN account.
1. Confirm your eligibility.
Make sure your RN license is current and unencumbered.
2. Complete the online application.
Create or sign in to your BCEN account and submit the CEN exam application.
3. Pay the examination fee.
Online credit-card or voucher payments are processed immediately. BCEN also accepts qualifying mailed payments, although processing takes longer.
4. Receive your eligibility email.
Once the application is processed, BCEN sends information about your testing eligibility period.
5. Schedule with PSI.
Select a PSI testing-center appointment or an available Live Remote Proctoring appointment.
How Long Is the CEN Testing Window?
After your application is processed, you receive a 90-day testing window. You must schedule and complete the CEN exam during that period.
Appointments are available on a first-come, first-served basis, so it is better to schedule early instead of waiting until the end of your eligibility period.
Cancellation rule: BCEN allows candidates to cancel and reschedule without a fee when the change is made more than 24 hours before the appointment and the new date remains within the original 90-day eligibility window. Missing an appointment can result in forfeiting the full exam fee.
Where Can I Take the CEN Exam?
The CEN is administered by BCEN’s testing provider, PSI Exams.
Take the computer-based CEN exam in person at an available PSI testing location.
Take the exam remotely while being monitored by a live proctor if your computer and testing environment meet PSI’s requirements.
What to Know Before Test Day
Make sure the first and last name used for your exam registration match your identification.
Review PSI’s current identification and security requirements before your appointment.
Expect 175 questions even though only 150 contribute to your score.
Treat every question as scored because the 25 pretest questions are not identified.
Remember that the three-hour testing clock continues if you take an unscheduled break.
If testing remotely, complete the PSI system check and prepare a private, compliant testing space before your appointment.
How Is the CEN Exam Scored?
Your CEN result is based on the number of scored questions you answer correctly. There is no penalty for guessing.
For exams administered under the content outline effective July 6, 2026, you must answer at least 99 of the 150 scored questions correctly to pass.
Current passing standard: 99 out of 150 scored questions. The previous passing requirement of 106 correct answers no longer applies to the current CEN exam.
The passing standard is criterion-referenced rather than curved against other candidates. BCEN periodically conducts job-analysis and passing-point studies to make sure the examination continues to reflect current emergency nursing practice.
When Will I Get My CEN Result?
After you finish the examination, your result is reported as pass or fail. Your score report also provides information about your performance across the exam’s major content areas.
That diagnostic information can be especially useful if you need to prepare for another attempt.
What If I Don’t Pass?
BCEN allows candidates who do not pass the CEN exam to test again after a waiting period.
You must wait 90 days after an unsuccessful attempt before retesting.
BCEN does not impose a lifetime limit on the number of CEN attempts.
Once the 90-day waiting period has passed, you may submit another exam application through your BCEN account. BCEN currently offers a discounted retest fee for eligible candidates applying within one year of their initial exam date.
How Long Does CEN Certification Last?
The CEN credential operates on a four-year certification cycle.
You may recertify either by completing the required continuing education or by retaking and passing the current CEN examination.
Recertification by Continuing Education
For CE recertification, BCEN requires 100 contact hours earned during your four-year certification period.
100 total contact hours during the four-year certification period
At least 75 hours must be clinical content relevant to the specialty
For recertification applications submitted on or after January 1, 2027, at least 75 hours must come from accredited sources
How Can I Prepare for the CEN Exam?
Make sure your study materials follow the July 2026 CEN content outline. Older resources that divide the exam into eight broad content categories are no longer aligned with the current blueprint.
Your preparation should also focus on application rather than simple memorization. Emergency nursing questions often require you to identify the most urgent problem, prioritize interventions, recognize a deteriorating patient, interpret clinical findings, or determine the safest next nursing action.
CEN Study Checklist
Use the current 11-area CEN content outline instead of the older eight-area blueprint.
Review high-priority cardiovascular, respiratory, neurological, and shock emergencies.
Practice recognizing unstable patients and deciding which intervention or assessment should happen first.
Review emergency medications, treatments, laboratory findings, and diagnostic patterns.
Study mental health, toxicology, environmental emergencies, communicable diseases, and professional issues instead of concentrating only on major body systems.
Practice triage, prioritization, mass-casualty decisions, consent, legal issues, and emergency-department patient flow.
Complete full-length timed practice so you are comfortable working through 175 questions within three hours.
CEN Study Resources
Use these resources to review the current CEN content and practice before your examination.
CEN® and Certified Emergency Nurse® are registered trademarks of the Board of Certification for Emergency Nursing (BCEN). BCEN is not affiliated with StudyGuideZone or Mometrix Test Preparation and does not endorse these products or services.
