ENA ESI 2.0 Exam /ENA Triage ESI 2.0 2026/2027
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"My pain medications are not working anymore. Last night
I couldn't sleep because the pain was so bad," reports a
47-year-old female with metastatic ovarian cancer. "My
husband called my oncologist, and he told me to come to
the emergency department." The patient rates her pain as
9/10. Vital signs are within normal limits. - Answer-ESI
level 2: Severe pain or distress. This patient needs
aggressive pain management with IV medications. There
is nothing the triage nurse can do to decrease the patient's
pain level. The answer to "Would you give your last open
bed to this patient?" should be yes.
A 48-year-old male tells you that he has a history of kidney
stones and thinks he has another one. He has right
costovertebral angle pain that radiates around to the front
and into his groin. He is nauseous but tells you he took a
pain pill, and right now he has minimal pain. He denies
vomiting. T 98°F, RR 16, HR 80, BP 136/74, SpO2 100%.
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Pain 3/10. - Answer-ESI level 3: Two or more resources.
The patient is presenting with signs and symptoms of
another kidney stone. At a minimum, he will need a
urinalysis and CT scan. If his pain increases, he may need
IV pain medication. At a minimum, two resources are
required. If the pain level was 7/10 or greater and the
triage nurse could not manage the pain at triage, the
patient could meet level-2 criteria.
"After my pediatrician saw my son's rash, he said I had to
bring him to the emergency department immediately. He
has this rash on his face and chest that started today. He
has little pinpoint purplish spots he called petechiae. My
son is a healthy kid who has had a cold for a couple of
days and a cough. My pediatrician said he had to be sure
nothing bad is going on. What do you think?" - Answer-ESI
level 2: High risk. Rashes are difficult to triage, but the
presence of petechiae is always a high-risk situation. Even
if the patient looks good, it is important to recognize that
petechia can be a symptom of a life-threatening infection,
meningococcemia.
"I think I picked up a bug overseas," reports a 34-year-old
male who presented in the emergency department
complaining of frequent watery stools and abdominal
cramping. "I think I am getting dehydrated." T 98°F, RR 22,
HR 112, BP 120/80, SpO2 100%. Pain 6/10. - Answer-ESI
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level 3: Two or more resources. From the patient's history,
he will require labs and IV fluid replacement—two
resources.
When asked why she came to the emergency department,
the 18-year-old college student begins to cry. She tells the
triage nurse that she was sexually assaulted last night at
an off-campus party. - Answer-ESI level 3: Two or more
resources. It looks as though this patient has a displaced
fracture and will need a closed reduction prior to casting or
splinting. At a minimum, he needs x-rays and an
orthopedic consult. This patient may also require
procedural sedation. However, there are already two or
more resources, so it is not necessary to be overly
concerned about counting resources beyond two.
"I don't know what's wrong with my baby girl," cries a
young mother. She reports that her 2-week-old baby is not
acting right and is not interested in eating. As you begin to
undress the baby, you notice that she is listless and her
skin is mottled. - Answer-ESI level 1: Requires immediate
lifesaving intervention; possible aggressive fluid
resuscitation.