ENA Emergency Nursing Orientation Final
Exam ACTUAL EXAM 2026/2027 | ENA
Emergency Nursing Certification | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: Triage & Initial Assessment
Q1: A 45-year-old male arrives by EMS after a motor vehicle crash at 65 mph. He is confused, has a
respiratory rate of 32, oxygen saturation of 88% on room air, and a thready radial pulse. Which action
should the emergency nurse take first?
A. Apply a non-rebreather mask at 15 L/min.
B. Logroll the patient to inspect the back.
C. Open the airway using jaw-thrust maneuver. [CORRECT]
D. Attach cardiac monitor and obtain vital signs.
Correct Answer: C
Rationale: The ABCDE framework prioritizes airway before breathing and circulation. In a trauma patient
with an altered level of consciousness and potential cervical spine injury, the jaw-thrust maneuver
without head tilt opens the airway while maintaining spinal precautions. Confusion and hypoxia are
downstream effects of an unprotected airway. Clinical Pearl: Always address the greatest immediate
threat to life; airway is always first in the primary survey.
Q2: [PRIORITIZATION / ESI] A 32-year-old female presents to triage with a 2-day history of lower
abdominal pain and a fever of 100.8°F (38.2°C). A 58-year-old male walks in complaining of a rash on his
arm for one week. A 70-year-old female arrives by car with sudden onset severe substernal chest
pressure radiating to the jaw, diaphoretic, and short of breath. Which patient should be seen first?
A. The 32-year-old female
B. The 58-year-old male
,C. The 70-year-old female [CORRECT]
D. The order of arrival should be maintained.
Correct Answer: C
Rationale: The 70-year-old female exhibits classic signs of an acute coronary syndrome (ACS), which is an
immediate life-threatening condition requiring ESI Level 1 or 2 resuscitation/intervention. The other
patients have urgent but not immediately life-threatening conditions. Clinical Pearl: ESI triage prioritizes
patients who require immediate life-saving interventions over those with stable vital signs and chronic
or non-acute complaints.
Q3: A patient is brought to the ED with a gunshot wound to the right chest. The emergency nurse notes
tracheal deviation to the left and absent breath sounds on the right. Which intervention is the priority?
A. Perform a needle decompression at the 5th intercostal space, midaxillary line.
B. Perform a needle decompression at the 2nd intercostal space, midclavicular line. [CORRECT]
C. Intubate the patient immediately.
D. Apply an occlusive dressing to the chest wound.
Correct Answer: B
Rationale: The patient presents with a tension pneumothorax, a clinical diagnosis requiring immediate
decompression. The standard ATLS/ENO intervention is needle decompression at the 2nd intercostal
space, midclavicular line (or 5th intercostal space, midaxillary line) to vent the pleural space. An
occlusive dressing is contraindicated until the tension is relieved, and intubation will not fix the
underlying thoracic pressure issue. Clinical Pearl: Tension pneumothorax is a clinical diagnosis; do not
delay decompression for an X-ray.
Q4: During the primary survey of a trauma patient, the nurse assesses capillary refill, skin color, and
pulse quality. Which component of the primary survey is the nurse evaluating?
A. Airway
B. Breathing
C. Circulation [CORRECT]
D. Disability
Correct Answer: C
,Rationale: Evaluating capillary refill, skin color, and pulse quality directly assesses tissue perfusion and
cardiac output, which are the core components of the "C" (Circulation) step in the ABCDE primary
survey. Clinical Pearl: Hemorrhage control is the critical intervention during the "C" phase of the primary
survey.
Q5: [PRIORITIZATION / ESI] A 25-year-old presents with a laceration to the forearm from a clean knife 2
hours ago, bleeding controlled, vital signs normal. A 45-year-old with a history of schizophrenia is
agitated, threatening staff, but currently contained in a room with security. A 60-year-old with a known
brain tumor presents with a sudden severe headache, vomiting, and a BP of 210/120 mmHg. Who is the
highest priority?
A. The 25-year-old with the laceration
B. The 45-year-old with agitation
C. The 60-year-old with the severe headache and hypertension [CORRECT]
D. The 45-year-old, as behavioral emergencies always take precedence.
Correct Answer: C
Rationale: The 60-year-old is exhibiting signs of hypertensive emergency with potential increased
intracranial pressure (ICP), which can lead to fatal hemorrhage or herniation, making this an ESI Level 2.
The laceration is ESI Level 4/5 (stable, non-urgent), and the behavioral patient, while requiring
resources, is currently safe and stable (ESI Level 3). Clinical Pearl: Hypertensive emergency with
neurological deficits is a true medical emergency requiring immediate BP reduction in a controlled
setting.
Q6: An unresponsive patient is brought to the ED. The nurse opens the airway with a jaw-thrust, looks in
the mouth, and sees a large piece of meat. What is the next immediate action?
A. Attempt to ventilate with a bag-valve-mask (BVM).
B. Perform finger sweeps to remove the meat.
C. Use Magill forceps to remove the foreign body. [CORRECT]
D. Suction the oropharynx.
Correct Answer: C
Rationale: A visible foreign body in the airway should be physically removed. Magill forceps are the
instrument of choice for extracting solid, visible objects from the upper airway. Blind finger sweeps are
, contraindicated as they can push the object further down, and BVM ventilation will force the object
deeper into the trachea. Clinical Pearl: Visualized foreign bodies require direct visualization and
instrumentation (Magill forceps) for removal.
Q7: The emergency nurse is assessing a patient who was struck in the abdomen. The patient is anxious,
tachycardic, and has a firm, rigid abdomen. Which assessment finding confirms the "E"
(Exposure/Environment) phase of the primary survey?
A. Assessing for jugular venous distension (JVD).
B. Logrolling the patient to palpate the spine.
C. Completely removing the patient's clothes to visually inspect for hidden injuries. [CORRECT]
D. Asking the patient about allergies.
Correct Answer: C
Rationale: The "E" in ABCDE stands for Exposure/Environment, which involves completely removing the
patient's clothing to perform a full head-to-toe visual inspection for injuries, rashes, or medical devices,
while simultaneously preventing hypothermia. Clinical Pearl: Remember to protect the patient's
modesty and prevent heat loss by using warm blankets and warm IV fluids after the exposure
assessment.
Q8: [PRIORITIZATION / ESI] A 4-year-old child is brought in by parents with a fever of 103°F (39.4°C) and
a barking cough at night (croup). A 22-year-old with no medical history presents with acute onset left-
sided weakness and slurred speech that started 30 minutes ago. A 40-year-old has a minor ankle sprain
from a fall. Which patient should be triaged as ESI Level 1?
A. The 4-year-old with croup
B. The 22-year-old with stroke symptoms [CORRECT]
C. The 40-year-old with the ankle sprain
D. None of them meet Level 1 criteria.
Correct Answer: B
Rationale: The 22-year-old is experiencing an acute ischemic stroke, which is a time-critical emergency
where the window for thrombolytics or thrombectomy is measured in minutes to hours, requiring
immediate team activation (ESI Level 1). Croup is distressing but typically manages with humidified
Exam ACTUAL EXAM 2026/2027 | ENA
Emergency Nursing Certification | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: Triage & Initial Assessment
Q1: A 45-year-old male arrives by EMS after a motor vehicle crash at 65 mph. He is confused, has a
respiratory rate of 32, oxygen saturation of 88% on room air, and a thready radial pulse. Which action
should the emergency nurse take first?
A. Apply a non-rebreather mask at 15 L/min.
B. Logroll the patient to inspect the back.
C. Open the airway using jaw-thrust maneuver. [CORRECT]
D. Attach cardiac monitor and obtain vital signs.
Correct Answer: C
Rationale: The ABCDE framework prioritizes airway before breathing and circulation. In a trauma patient
with an altered level of consciousness and potential cervical spine injury, the jaw-thrust maneuver
without head tilt opens the airway while maintaining spinal precautions. Confusion and hypoxia are
downstream effects of an unprotected airway. Clinical Pearl: Always address the greatest immediate
threat to life; airway is always first in the primary survey.
Q2: [PRIORITIZATION / ESI] A 32-year-old female presents to triage with a 2-day history of lower
abdominal pain and a fever of 100.8°F (38.2°C). A 58-year-old male walks in complaining of a rash on his
arm for one week. A 70-year-old female arrives by car with sudden onset severe substernal chest
pressure radiating to the jaw, diaphoretic, and short of breath. Which patient should be seen first?
A. The 32-year-old female
B. The 58-year-old male
,C. The 70-year-old female [CORRECT]
D. The order of arrival should be maintained.
Correct Answer: C
Rationale: The 70-year-old female exhibits classic signs of an acute coronary syndrome (ACS), which is an
immediate life-threatening condition requiring ESI Level 1 or 2 resuscitation/intervention. The other
patients have urgent but not immediately life-threatening conditions. Clinical Pearl: ESI triage prioritizes
patients who require immediate life-saving interventions over those with stable vital signs and chronic
or non-acute complaints.
Q3: A patient is brought to the ED with a gunshot wound to the right chest. The emergency nurse notes
tracheal deviation to the left and absent breath sounds on the right. Which intervention is the priority?
A. Perform a needle decompression at the 5th intercostal space, midaxillary line.
B. Perform a needle decompression at the 2nd intercostal space, midclavicular line. [CORRECT]
C. Intubate the patient immediately.
D. Apply an occlusive dressing to the chest wound.
Correct Answer: B
Rationale: The patient presents with a tension pneumothorax, a clinical diagnosis requiring immediate
decompression. The standard ATLS/ENO intervention is needle decompression at the 2nd intercostal
space, midclavicular line (or 5th intercostal space, midaxillary line) to vent the pleural space. An
occlusive dressing is contraindicated until the tension is relieved, and intubation will not fix the
underlying thoracic pressure issue. Clinical Pearl: Tension pneumothorax is a clinical diagnosis; do not
delay decompression for an X-ray.
Q4: During the primary survey of a trauma patient, the nurse assesses capillary refill, skin color, and
pulse quality. Which component of the primary survey is the nurse evaluating?
A. Airway
B. Breathing
C. Circulation [CORRECT]
D. Disability
Correct Answer: C
,Rationale: Evaluating capillary refill, skin color, and pulse quality directly assesses tissue perfusion and
cardiac output, which are the core components of the "C" (Circulation) step in the ABCDE primary
survey. Clinical Pearl: Hemorrhage control is the critical intervention during the "C" phase of the primary
survey.
Q5: [PRIORITIZATION / ESI] A 25-year-old presents with a laceration to the forearm from a clean knife 2
hours ago, bleeding controlled, vital signs normal. A 45-year-old with a history of schizophrenia is
agitated, threatening staff, but currently contained in a room with security. A 60-year-old with a known
brain tumor presents with a sudden severe headache, vomiting, and a BP of 210/120 mmHg. Who is the
highest priority?
A. The 25-year-old with the laceration
B. The 45-year-old with agitation
C. The 60-year-old with the severe headache and hypertension [CORRECT]
D. The 45-year-old, as behavioral emergencies always take precedence.
Correct Answer: C
Rationale: The 60-year-old is exhibiting signs of hypertensive emergency with potential increased
intracranial pressure (ICP), which can lead to fatal hemorrhage or herniation, making this an ESI Level 2.
The laceration is ESI Level 4/5 (stable, non-urgent), and the behavioral patient, while requiring
resources, is currently safe and stable (ESI Level 3). Clinical Pearl: Hypertensive emergency with
neurological deficits is a true medical emergency requiring immediate BP reduction in a controlled
setting.
Q6: An unresponsive patient is brought to the ED. The nurse opens the airway with a jaw-thrust, looks in
the mouth, and sees a large piece of meat. What is the next immediate action?
A. Attempt to ventilate with a bag-valve-mask (BVM).
B. Perform finger sweeps to remove the meat.
C. Use Magill forceps to remove the foreign body. [CORRECT]
D. Suction the oropharynx.
Correct Answer: C
Rationale: A visible foreign body in the airway should be physically removed. Magill forceps are the
instrument of choice for extracting solid, visible objects from the upper airway. Blind finger sweeps are
, contraindicated as they can push the object further down, and BVM ventilation will force the object
deeper into the trachea. Clinical Pearl: Visualized foreign bodies require direct visualization and
instrumentation (Magill forceps) for removal.
Q7: The emergency nurse is assessing a patient who was struck in the abdomen. The patient is anxious,
tachycardic, and has a firm, rigid abdomen. Which assessment finding confirms the "E"
(Exposure/Environment) phase of the primary survey?
A. Assessing for jugular venous distension (JVD).
B. Logrolling the patient to palpate the spine.
C. Completely removing the patient's clothes to visually inspect for hidden injuries. [CORRECT]
D. Asking the patient about allergies.
Correct Answer: C
Rationale: The "E" in ABCDE stands for Exposure/Environment, which involves completely removing the
patient's clothing to perform a full head-to-toe visual inspection for injuries, rashes, or medical devices,
while simultaneously preventing hypothermia. Clinical Pearl: Remember to protect the patient's
modesty and prevent heat loss by using warm blankets and warm IV fluids after the exposure
assessment.
Q8: [PRIORITIZATION / ESI] A 4-year-old child is brought in by parents with a fever of 103°F (39.4°C) and
a barking cough at night (croup). A 22-year-old with no medical history presents with acute onset left-
sided weakness and slurred speech that started 30 minutes ago. A 40-year-old has a minor ankle sprain
from a fall. Which patient should be triaged as ESI Level 1?
A. The 4-year-old with croup
B. The 22-year-old with stroke symptoms [CORRECT]
C. The 40-year-old with the ankle sprain
D. None of them meet Level 1 criteria.
Correct Answer: B
Rationale: The 22-year-old is experiencing an acute ischemic stroke, which is a time-critical emergency
where the window for thrombolytics or thrombectomy is measured in minutes to hours, requiring
immediate team activation (ESI Level 1). Croup is distressing but typically manages with humidified
