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. 1. Emergency nursing environment includes unplanned situations that require immediate intervention, allocation of limited resources, need for immediate care perceived by the patient, geographic variables,unpredictable number of patients, unknown patient severity, urgency, and diagnosis, cultural diversity. 2. Over time, the certification examination has evolved into a more sophisticated measure of emergency nursing knowledge. Before inclusion into the test bank, all question-and-answer are now pretested on actual examinations for accuracy, clarity, and reliability. This process tests the validity and reliability of the proposed certification examination questions. Items being pretested are not included in scoring of the examination. At present examination contains 25 pretest items and 150 scored items.