The patient is brought to the ED with an anterior ST-elevation myocardial

infarction (STEMI). You are assessing him for possible administration of

fibrinolytics. An absolute contraindication for this treatment is:
A. The patient's pain is not relieved by medications.
B. Symptoms began 36 hours before arrival.
C. The patient has received aspirin in the last 2 hours.
D. The patient had a previous MI 6 years ago.
ANSWER: B

Preload refers to:

A. a. The volume of blood entering the left side of the heart
B. The volume of blood entering the right side of the heart
C. The pressure in the venous system that the heart must overcome to pump the blood
D. The pressure in the arterial system that the heart must overcome to pump the
blood
ANSWER: B

The team is performing CPR on a patient. The rhythm that will respond to an
electrical shock is:
A. Asystole
B. PEA
C. Ventricular fibrillation
D. SVT
ANSWER: C

When suctioning during a cardiac arrest, suctioning should be limited to which of

the following?
A. Less than 5 seconds
B. Less than 10 seconds
C. Less than 20 seconds
D. Less than 30 seconds
ANSWER: B

Possible causes of cardiac arrest include all of the following EXCEPT:

A. Hypervolemia
B. Hypoxia
C. Hypokalemia
D. Tension Pneumothorax
ANSWER: A

You are providing ventilations using a Bag-mask device. Suddenly, you do not see
the patients chest rise with the ventilation. You reposition the patient to ensure
an open airway. When you attempt to ventilate, you do not see his chest rise. The
most likely cause of this is:
A. The bag-mask device is faulty
B. Airway obstruction
C. The patient has suffered an MI
D. Cardiac tamponade
ANSWER: B

According to American Heart Association ACLS guidelines, cricoid pressure during

intubation:
A. Should be done in all cases.
B. Is no longer recommended.
C. Should only be done on children.
D. None of the choices
ANSWER: B

You are providing positive pressure ventilation through an ET tube to a patient in

respiratory distress. Indications that you are ventilating too fast include all of
the following EXCEPT:
A. Increasing waveform capnography readings
B. Stomach insufflation
C. Tension pneumothorax
D. Aspiration
ANSWER: B

According to American Heart Association ACLS guidelines, when available, the best
way to confirm and maintain tracheal tube position is by:
A. Clinical examination only.
B. Quantitative waveform capnography.
C. Clinical examination and Pulse oximetry.
D. Clinical examination and quantitative waveform capnography.
ANSWER: D

Signs of respiratory failure include all of the following EXCEPT:

A. Bradypnea
B. Diminished air movement
C. Decreased level of consciousness
D. Nasal flaring and retractions
ANSWER: D

Emergency Medical Service has brought a 24-year-old man to the ED with gunshot
wounds to his abdomen and left groin area. His blood pressure is 84/52 and heart
rate is 120 per minute. His skin is diaphoretic, cool, and pale. The treatment the
nurse should prepare for is:
A. Chest compressions
B. Endotracheal intubation
C. Administration of verapamil
D. Rapid administration of a crystalloid solution
ANSWER: D

You are on the ED team caring for a 10-year-old child with a normal systolic blood
pressure, increased heart rate, slightly delayed capillary refill and cool, pale
skin. What severity of shock is the child likely in?
A. Decompensated shock
B. Hypotensive shock
C. Compensated shock
D. None of the above
ANSWER: C

You are caring for a patient in cardiogenic shock. You know that a probable cause
of this condition is:
A. Dehydration
B. Spinal cord injury
C. Congestive heart failure
D. Infection
ANSWER: C

You are caring for a 10-year-old child with normal blood pressure, increased heart
rate, and cool pale skin. The child is reported to have had vomiting and diarrhea
the past two days.�As you perform your primary assessment, you note that
respirations are clear and not labored. What is the probable first intervention for
this child?
A. Give 20 ml/kg bolus of saline or lactated Ringers
B. Start an Epinephrine infusion at 0.1mg/kg
C. Give Epinephrine bolus of 0.01 mg/kg
D. Give Amiodarone 5 mg/kg IV over 60 minutes
ANSWER: A

You assume care for the patient in the ED. During the time she has been in the ED,
she has consistently complained of photophobia, a stiff neck, increasing confusion,
and nausea. Her history shows a motor vehicle accident several days ago. She states
the pain is the worst headache she has ever had. You suspect she might have a:
A. Subarachnoid hemorrhage
B. Migraine headache
C. Whiplash injury
D. Sinus headache
ANSWER: A

To quickly evaluate a childs neurological status, all of the following standard

evaluations can be used EXCEPT:
A. The Epworth Scale.
B. The AVPU scale.
C. The Glasgow Coma Scale.
D. Pupillary responses to light.
ANSWER: A

According to the American Heart Association stroke recommendations, the critical

goal time from arrival to the Emergency Department to CT brain scan is:
A. 10 minutes
B. 25 minutes
C. 45 minutes
D. 60 minutes
ANSWER: B

The National Institute of Neurological Disorders and Stokes (NINDS) has set the
goal for immediate general assessment by a stroke team or emergency physician as:
A. Within 1 minute of arrival.
B. Within 10 minutes of arrival.
C. Within 30 minutes of arrival.
D. Within 60 minutes of arrival.
ANSWER: B

A 16-year-old boy is brought to the ED by his parents. They state that he awoke
from sleep with nausea, vomiting, and pain in his scrotum. The nurse notes that the
boys scrotum is swollen, and he has a low-grade fever. His urinalysis is normal.
The physician suspects a testicular torsion. The definitive treatment for this boy
is:
A. Antibiotics
B. Bed rest for several days
C. Anti-emetic and pain medication
D. Surgery
ANSWER: D

A 24-year-old woman is seen in the emergency department complaining of urinary

frequency, pain with urination and urgency. Vital signs are stable and within
normal limits. When you obtain a urine specimen, you note that it is cloudy and
foul smelling. You should prepare the patient for:
A. Admission for acute renal failure
B. Discharge with antibiotic therapy
C. Admission for lithotripsy
D. Discharge without medications
ANSWER: B

A woman is admitted to the ED with complaints of lower abdominal pain, smelly

vaginal discharge, pain with intercourse, and burning with urination. Her vital
signs are stable, and she has no other symptoms. Treatment for this patient will
likely include:
A. Hysterectomy
B. Inpatient treatment
C. Antibiotics
D. No treatment is needed
ANSWER: C

When evaluating a patient for Acute Renal Failure, it is helpful to use the RIFLE
criteria for classification. This acronym refers to:
A. Risk, Injury, Functional decrease, Loss, and End-Stage kidney disease
B. Risk, Iatrogenic factors, Failure, Labile diabetes, and End-Stage kidney disease
C. Risk, Iatrogenic factors, Failure, Loss, and End-Stage kidney disease
D. Risk, Injury, Failure, Loss, and End-Stage kidney disease
ANSWER: D

The nurse has assisted in an emergent delivery of an infant in the Emergency

Department. The infant was born 2 weeks before the due date and is small for
gestational age. The nurse documents a thin upper lip, small eye openings, and a
smooth philtrum above the upper lip. This child may be diagnosed with:
Vitamin B12 deficiency
Folic acid deficiency
Fetal alcohol syndrome
Diabetes
ANSWER: C

A young man is brought to the Emergency Department after receiving multiple fire
ant bites while working in his yard. Although initially alert and oriented, he
begins to develop wheezing and an itchy throat. He complains of nausea and severe
anxiety. The ED nurse should prepare to administer all of the following for initial
treatment EXCEPT:
A. Adrenaline
B. Antibiotic
C. Oxygen
D. Antihistamines
ANSWER: B

An eight-year-old child is brought to the emergency department by his parents after

receiving multiple fire ant bites at his home. His lips are swollen, and he is
complaining of itching. During your assessment, you note that he is wheezing. The
most appropriate immediate treatment for this child is:
A. Antibiotic
B. IV antihistamine
C. IV steroid
D. IM epinephrine
ANSWER: D

The Emergency Department nurse knows that the best way to prevent transmission of
nosocomial infections is:
A. Using sterile supplies
B. Isolating patients
C. Wearing appropriate personal protective equipment
D. Hand hygiene
ANSWER: D

Patient placement in the emergency department should be based on:

A. Route of transmission of the suspected infectious agent
B. Risk factors in other patients in the ED
C. Availability of single-patient rooms
D. All the choices
ANSWER: D

You are caring for a patient who has just been diagnosed with hepatitis A. The
discharge instructions for this patient will likely include all of the following
EXCEPT:
A. Medication for nausea
B. Advising eating several small meals rather than 3 large meals
C. Scheduled medicines for pain
D. Resting frequently
ANSWER: C

A 12-year-old patient is brought to the emergency department by his parents after

accidentally swallowing a disk battery while changing the battery in his watch. A
chest x-ray reveals that the battery is in the patient's esophagus. He is able to
swallow and breathe without difficulty. The most appropriate intervention for this
patient is to:
A. Prepare the patient and his family for emergent endoscopy to remove the battery.
B. Allow the patient clear liquids until repeat x-rays show that the battery has
moved into the stomach.
C. Discharge the patient to home with instructions to check his stools until the
battery passes.
D. Prepare to administer polyethylene glycol.
ANSWER: A

A nurse is caring for a patient with pancreatitis. Which of the following symptoms
would indicate a possible life-threatening complication?
A. Abnormal bowel sounds
B. Abdominal pain
C. Nausea and vomiting
D. Increased respiratory rate
ANSWER: D

A patient has been admitted to the Emergency Department with persistent epistaxis.
Vital signs are stable. The correct position for this patient is:
A. Sitting with head leaning forward
B. Supine with the head facing to the side
C. Left lateral recumbent
D. Prone with the head facing to the side
ANSWER: A

A patient presents to the ED with complaint of ear and jaw pain. Upon assessment,
you note that his tympanic membranes are non-bulging, pearly gray. You look in his
mouth and see this. The primary diagnosis for this patient will be:
A. Acute otitis media
B. Acute otitis externa
C. Dental caries
D. None of the choices
ANSWER: C

A young woman is brought to the ED by her roommates. The nurse notes that a
knitting needle is sticking out of her right eye. All of the following are
appropriate initial interventions EXCEPT:
A. Consult an ophthalmologist
B. Apply gauze around the knitting needle to stabilize it
C. Remove the knitting needle and patch the eye
D. Patch the other eye
ANSWER: C
A baseball coach calls the emergency department after a 15-year-old boy had a tooth
knocked out during a baseball game. The baseball coach found the intact tooth on
the ground and has rinsed off the dirt. What should the coach be advised to do?
A. The tooth and boy should go to the dentist in the morning.
B. You cannot give any advice over the telephone.
C. If the child is alert and oriented, put the tooth under his tongue and bring him
to the ED.
D. Wrap the tooth in a clean shirt and bring the boy and tooth to the ED.
ANSWER: C

The child pictured on the right is seen in the ED for a left forearm fracture. The
orthopedic surgeon reduces the fracture in the ED and applies the cast. The
discharge instructions have not been understood because:
A. The sling is too long
B. The child's hand is lower than the elbow.
C. The child is cradling her fractured limb in her other hand.
D. The child's clothes will not be easily removable.
ANSWER: B

A seventeen-year-old is brought to the emergency department complaining of leg pain

after a motor vehicle crash. X-rays show a fracture of the femur with several bone
fragments at the fracture site. You note that the skin above the fracture site is
intact but bruised. This type of fracture is called:
A. Open
B. Avulsion
C. Compression
D. Comminuted
ANSWER: D

A nurse is caring for a farmer who was bitten by a rattlesnake while working in his
field. He killed the snake and brought it to the ED for positive identification.
The triage nurse notes two puncture marks on his right hand. The proper
interventions for this patient may include all of the following EXCEPT:
A. Tetanus vaccination
B. Antivenom administration
C. Positioning the patient's hand above the heart
D. Cleansing of the bite
ANSWER: C

A 36-year-old African American man presented to the emergency department with burns
to his hands that were suffered when his car radiator boiled over onto his hands.
He has run cool water over his hands but he is still experiencing what he describes
as horrible pain. He does not have burns on any other area of his body. How should
this burn be classified according to the American Burn Associations guidelines?
A. First degree
B. Second degree
C. Third degree
D. Fourth degree
ANSWER: B

A patient in the ED is diagnosed with West Nile virus. Which of the following is
the mode of transmission for this disease?
A. Bite of infected tick
B. Bite of infected flea
C. Bite of infected mosquito
D. Bite of infected spider
ANSWER: C

One of the tools ED nurses can use to recognize aggressive behavior before it
increases in patients in the ED is called STAMP, which stands for:
A. Staring, Tone and volume of voice, Anxiety, Mumbling, and Pushing
B. Standing, Tone and volume of voice, Anxiety, Moving, and Pushing
C. Searching, Tone and volume of voice, Anxiety, Moving, and Pacing
D. Staring, Tone and volume of voice, Anxiety, Mumbling, and Pacing
ANSWER: D

The nurse in the Emergency Department is discharging a patient who has been
evaluated by the psychiatric team for suicidal ideations. Discharge instructions
should include all of the following EXCEPT:
A. Encourage the patient to sign a suicide prevention agreement.
B. Give the patient the telephone number for the crisis hotline.
C. Recommend that the family know where the patient is at all times.
D. Educate the family members about what they can do to prevent suicide.
ANSWER: C

The medication indicated for a suspected opioid overdose is:

A. Atropine
B. Epinephrine
C. Lidocaine
D. Naloxone
ANSWER: D

You are the nurse in the Emergency Department caring for a patient with a known
history of alcoholism. He is loud, verbally abusive and argumentative to the staff,
and uncooperative with requests from the staff. His blood pressure is 158/84. Heart
rate is 104, respiratory rate 22, and a blood alcohol level of 0.30%. The first
action by the staff should be to:
A. Administer lorazepam
B. Move the patient to a quiet, secluded room
C. Take vital signs every 15 minutes
D. Order a magnesium level
ANSWER: B

The pediatric Emergency Department nurse is required to report:

A. Sexual abuse
B. Serious physical injury
C. A suspicious death
D. All of the choices
ANSWER: A

Emergency nurses are encouraged to use evidence-based practices (EBP) in the

practice of emergency nursing. Which of the following practices is not recommended
by the Emergency Nurses Association?
A. Use of two or more patient identifiers when providing care.
B. Not taking verbal or telephone orders.
C. Comply with hand hygiene guidelines
D. Assure central lines are inserted under sterile conditions.
ANSWER: B

The nurse in a small rural hospital is caring for a pregnant woman who is at 34-
weeks gestation in her first pregnancy. She is complaining of intermittent lower
abdominal pain. The hospital does not have a labor and delivery unit, but the on-
call physician has determined that her cervix is dilated to 3 cm. The fetal heart
sounds are strong at a rate of 150 beats per minute. The woman is accompanied by
her husband. The nearest hospital with a labor and delivery unit is 30 minutes
away. The correct action in this situation is to:
A. Admit the woman for observation.
B. Keep the woman in the ED for monitoring.
C. Transfer the woman via ambulance to the hospital with obstetrical care.
D. Instruct the husband to transport the patient to the hospital with obstetrical
care.
ANSWER: D

The ENA Code of Ethics expects the emergency nurse to do all of the following
EXCEPT:
Maintain accountability for individual practice
Act to protect the patient from incompetent or illegal practice
Work to improve access to health care for all
Complete all required tasks for every patient
ANSWER: D

A nurse has inserted a nasogastric (NG) tube for the relief of nausea and vomiting.
The technician working with the nurse does not have any special training or
certification. The nurse asks the technician to "take care of the patient while I
go to lunch". While the nurse is out of the department, the technician working with
the patient can:
A. Do oral care
B. Irrigate the NG tube
C. Administer meds through the NG
D. All the choices
ANSWER: A

Which of the following is a way to reduce gender bias when triaging patients who
come to the ED?
A. Asking open-ended questions.
B. Have a training coach meet with the staff to discuss gender equity.
C. Imagine asking the same question to a patient of the opposite sex.
D. All of the choices.
ANSWER: D

Cardo Dalisay arrived at the emergency department suffering from multiple injuries
from a head-on car collision. Which of the following assessment should take the
highest priority to take?
A. Unequal Pupils
B. Irregular Pulse
C. Ecchymosis in the flank area
D. A Deviated trachea
ANSWER: D

The Davao Central 911 has transported a client with severe chest pain. As the
client is being transferred to the emergency stretcher, you note unresponsiveness,
cessation of breathing, and unpalpable pulse. Which of the following task is
appropriate to delegate to the nursing assistant?
A. Assisting with the intubation
B. Placing the defibrillator pads
C. Doing chest compressions
D. Initiating bag valve mask ventilation
ANSWER: C

Mang Canor arrived in the emergency unit and reports that a concentrated household
cleaner was splashed in both eyes. Which of the following nursing actions is a
priority?
A. Examine the client's visual acuity
B. Patch the eye
C. Use Restasis (Allergan) drops in the eye
D. Flush the eye repeatedly using sterile normal saline
ANSWER: D
Aling Nena was brought to the emergency department after suffering a closed head
injury and lacerations around the face due to a hit-run accident. She is
unconscious and has a minimal response to noxious stimuli. Which of the following
assessment findings if observed after few hours, should be reported to the
physician immediately?
A. Drainage of a clear fluid from the client's nose
B. Withdrawal of the client in response to painful stimuli
C. Bruises and minimal edema of the eyelids
D. Bleeding around the lacerations
ANSWER: A

Karen, an anxious female client complains of chest tightness, tingling sensations,

and palpitations. Deep, rapid breathing, and carpal spasms are noted. Which of the
following priority action should the nurse do first?
A. Provide oxygen therapy
B. Notify the physician immediately
C. Administer anxiolytic medication as ordered
D. Have the client breathe into a brown paper bag
ANSWER: D

Jake, an intoxicated client came into the emergency unit with uncooperative
behavior, mild confusion, and slurred speech. The client is unable to provide a
good history but he verbalizes that he has been drinking a lot. Which of the
following is a priority action of the nurse?
A. Administer IV fluid incorporated with Vitamin B1 as ordered
B. Administer Naloxone (Narcan) 4 mg as ordered
C. Contact the family to get information about the client
D. Obtain an order for the determination of blood alcohol level
ANSWER: A

Nurse Duke is attending to a client with a head and neck trauma following a
vehicular accident, what should be his initial action?
A. Provide oxygen therapy
B. Initiate intravenous access
C. Immobilize the cervical area
D. Do oral and nasal suctioning
ANSWER: C

Subdiaphragmatic abdominal thrust performed to clear airway obstruction in the

awake patient without ventilation is termed as:
A. Leopolds maneuvers
B. Pallachs maneuver
C. Heimlich maneuver
D. Valsalva maneuver
ANSWER: C

Four victims of a vehicular accident are brought by ambulance to the emergency

department. The triage nurse determines that the victim who has the highest
priority for treatment is the one with
A. severe bleeding of facial and head lacerations
B. an open femur fracture with profuse bleeding
C. a sucking chest wound
D. absence of peripheral pulses
ANSWER: C

During the primary assessment of a trauma victim, the nurse determines that the
patient has a patent airway. The next assessment by the nurse should be to
A. check the patient's level of consciousness.
B. examine the patient for any external bleeding.
C. observe the patient's respiratory effort.
D. palpate for the presence of peripheral pulses.
ANSWER: C