CEN Practice Test

CEN Neurological Emergencies Practice Questions

Neurological Emergencies makes up 6 of every 50 questions on a Tigertest CEN practice test. Here are 10 of the 24 questions on it, each with the answer and the reason.

Updated 2026-11-14 by the Tigertest team. Based on the BCEN CEN Examination Content Outline effective July 2026. Original questions; 50 per test, weighted like the real exam. Not affiliated with BCEN.

1. 1. A patient opens the eyes to voice, is confused and obeys commands. What is the Glasgow Coma Scale score?

   • A.14
   • B.13
   • C.11
   • D.12

   Answer: B. Eye opening to voice scores 3, confused speech 4 and obeying commands 6, for a total of 13.

2. 2. Which treatment lowers intracranial pressure by drawing water out of brain tissue?

   • A.D5W infusion
   • B.IV furosemide alone
   • C.Normal saline boluses
   • D.Mannitol or hypertonic saline

   Answer: D. Osmotic agents raise serum osmolality so water moves out of the brain. Hypotonic fluids such as D5W can worsen brain swelling.

3. 3. A ventilated patient with a severe head injury shows no signs of herniation. Which PaCO2 range is usually targeted?

   • A.35 to 45 mmHg
   • B.Above 60 mmHg
   • C.20 to 25 mmHg
   • D.50 to 60 mmHg

   Answer: A. Normal CO2 is targeted. Routine hyperventilation narrows cerebral vessels and can cause ischemia, so it is kept for brief use during signs of herniation.

4. 4. A patient was briefly unconscious after a head blow, then talked normally, then became drowsy with a dilating pupil. What injury is most likely?

   • A.Chronic subdural hematoma
   • B.Diffuse axonal injury
   • C.Epidural hematoma
   • D.Concussion only

   Answer: C. A lucid interval followed by rapid decline is classic for an epidural hematoma, usually arterial bleeding from the middle meningeal artery. It needs urgent surgery.

5. 5. An older adult on an anticoagulant had a minor fall two weeks ago and now has slowly worsening confusion. What should the nurse suspect?

   • A.Bacterial meningitis
   • B.Transient ischemic attack
   • C.Chronic subdural hematoma
   • D.Acute epidural hematoma

   Answer: C. Brain shrinkage stretches bridging veins in older adults, and anticoagulants add to bleeding. Slow venous bleeding can show up days to weeks after a minor fall.

6. 6. A patient describes 'the worst headache of my life' that began suddenly during exercise. What must be ruled out first?

   • A.Subarachnoid hemorrhage
   • B.Tension-type headache
   • C.Acute sinus infection
   • D.Migraine with aura

   Answer: A. A sudden, maximal thunderclap headache suggests a ruptured aneurysm. A noncontrast CT is done first, with a lumbar puncture if the CT is negative and suspicion stays high.

7. 7. Bacterial meningitis is suspected, but the lumbar puncture will be delayed for a CT scan. What should happen?

   • A.Give antipyretics only
   • B.Wait for the CT result
   • C.Wait for the CSF culture
   • D.Start antibiotics now

   Answer: D. Delaying antibiotics worsens outcomes. Blood cultures are drawn and antibiotics (often with dexamethasone) are started before the CT and lumbar puncture.

8. 8. A patient's leg is flexed at the hip, and extending the knee causes neck and back pain. Which sign is this?

   • A.Babinski's sign
   • B.Kernig's sign
   • C.Brudzinski's sign
   • D.Battle's sign

   Answer: B. Pain or resistance on extending the knee with the hip flexed is Kernig's sign of meningeal irritation. Brudzinski's sign is hip and knee flexion when the neck is bent.

9. 9. A patient has had a generalized tonic-clonic seizure for 6 minutes. What is the first-line drug class?

   • A.Antipsychotics
   • B.Benzodiazepines
   • C.Barbiturates
   • D.Beta blockers

   Answer: B. A seizure lasting 5 minutes or more is treated as status epilepticus. A benzodiazepine (lorazepam IV, or midazolam IM or intranasal) is given first.

10. 10. During a seizure, what is the nurse's priority?

    • A.Restrain the limbs
    • B.Give oral fluids
    • C.Insert a bite block
    • D.Protect from injury

    Answer: D. Turning the patient to the side, clearing the area and timing the seizure are key. Nothing goes in the mouth, and restraint can cause injury.