I'm reviewing to take the CEN for the first time, and bought "CEN Examination Review" put out by JB test prep. I've found several questions that I think are wrong and was wondering if anybody else had used their book? The last question I disagreed with was- A possible cause of Thrombocytopenia? I chose Alcoholism, they said Portal Hypertension. I've found several different sites that ID ETOH as a causative factor, but none that include their answer.
Another involved an uncompensated shock pt.sent from a tertiary care center. They are getting TPN/Lipids and Dopamine together in a peripheral IV. You get an order for IV Bicarb and AMpicillin, should you shut off the TPN/Lipids and run the other meds together? ask the MD for a central line for additional access? Insert another peripheral line to run the other meds, or push the bicarb in another peripheral IV while waiting for the pharmacy to send the Ampicillin? I chose MD placed central line, if they are in uncompensated shock peripheral IVs might be difficult and time consuming. They said start an additional line, push the bicarb while waiting for pharmacy to send the Ampicillin. What do you all think?
Lastly, what type/brand of prep books/sites did you all use to prepare that most resembled the actual test? I've found some review sites that have very easy questions, and others that are naming off obscure questions about disease processes I've never even heard of in the 26 years I've been a nurse.
Last I checked, TPN cannot be given with anything and ONLY in a central line. You can give pressors in a peripheral line, but you should be expected to get a central line started if they are going to need it for an extended period of time (uncompensated = start central line).
Question number two that you provided aims at making sure the nurse will take action. Asking MD to insert central is right, but the main point is to see the initiative from the RN and start the line. I found ENA lectures to be the best resource for CEN (took the test twice).