CEN Basics Flashcards: 20 Practice Questions & Answers

EMTALA mandates that any individual who comes to the emergency department must receive a Medical Screening Exam (MSE) to determine if an EMC exists, regardless of ability to pay. Crucially, the MSE and stabilizing treatment must NOT be delayed to inquire about the patient's insurance or payment status. While a hospital may follow standard registration processes, they cannot interfere with the prompt delivery of the MSE. Exam Strategy: BCEN often tests the distinction between triage and MSE. Triage is a prioritization tool; the MSE is a diagnostic process performed by Qualified Medical Personnel (QMP) to rule out an EMC.

1. Duty: A nurse-patient relationship existed (the nurse had a duty to provide care). 2. Breach of Duty: The nurse failed to meet the standard of care (e.g., failing to perform/document neuro checks). 3. Causation (Proximate Cause): The breach of duty directly caused the injury (the but-for test). 4. Damages: The patient suffered an actual physical or financial injury. Exam Tip: BCEN focus is often on Standard of Care, which is defined by what a reasonably prudent nurse with similar training would do in the same situation.

1. Order: A face-to-face evaluation by a provider (MD/PA/NP) must occur within 1 hour of application. Orders must be renewed every 4 hours for adults (2 hours for ages 9-17). 2. Monitoring: Continuous 1-on-1 observation is required for violent/self-destructive behavior. 3. Assessment: Document circulation, skin integrity, and the continued need for restraints every 15 minutes. Legal Risk: Failure to follow these strictly can lead to charges of battery or false imprisonment. Always use the least restrictive environment first. Chemical restraints (medications) follow similar strict guidelines.

The nurse must honor the DNR status and withhold CPR, defibrillation, and intubation. Limited Interventions allows for IV fluids, oxygen, and medications to treat reversible causes (e.g., antibiotics, comfort meds) but specifically excludes resuscitation in the event of cardiac or respiratory arrest. CEN Tip: A POLST is a medical order that translates patient preferences into actionable directions, carrying more weight in the ED than a standard living will. If the patient has a pulse but is in respiratory distress, you provide the limited interventions specified; if they are pulseless, you stop.

Under the UAGA (adopted in most states), a person's documented decision to be a donor (e.g., driver's license or registry) is legally binding and constitutes First Person Consent. Legally, family consent is not required to proceed. CEN Tip: While legally binding, hospitals and OPOs work extensively with families to reach consensus to avoid trauma and litigation. For the CEN exam, remember that the patient's prior documented wish (Autonomy) legally supersedes the family's wishes after death.