ENA TRIAGE EXAM FINAL TEST PAPER
QUESTIONS AND CORRECT ANSWERS
◉ The triage nurse should be most concerned about which pediatric
patient?
A. An infant with a petechial rash
B. A toddler with a fever of 101° F (38.3° C) for the last 2 days
C. A preschooler who does not want to eat
D. A child, age 6, with a heart rate of 120 beats per minute Answer:
A. An infant with a petechial rash
◉ Which option for an interpreter meets The Joint Commission
requirements?
A. Contact a telephone language bank.
B. Ask a bilingual family member to assist.
C. Use a medical dictionary for the specific language.
D. Contact a housekeeper who speaks the patient's language.
Answer: A. Contact a telephone language bank.
◉ The Emergency Nurses Association and American College of
Emergency Physicians recommend which type of triage acuity
system for the best interrater reliability?
A. Three-level system
,B. Four-level system
C. Five-level system
D. Six-level system Answer: C. Five-level system
◉ The triage nurse should screen for which problem in an older
adult patient who presents with a new onset of confusion?
A. Congenital heart defect
B. Elder abuse or neglect
C. Urinary tract infection
D. Long-term use of opioids Answer: C. Urinary tract infection
◉ Which factor is an advantage of comprehensive triage over other
triage systems?
A. It is cost-effective because triage does not need to be staffed 24
hours a day.
B. It does not require competency validation.
C. It uses a nonclinical person to greet patients upon arrival.
D. It includes the initiation of patient teaching. Answer: D. It includes
the initiation of patient teaching.
◉ When performing an across-the-room assessment, the triage
nurse can use the sense of sight to detect which finding?
A. Stridor
, B. Ketones
C. Deformity
D. Poor hygiene Answer: C. Deformity
◉ What is the nurse's priority when triaging a patient with a
behavioral health concern?
A. Determine if the patient has recently taken mind-altering
medications.
B. Assess the patient for a psychiatric history.
C. Place the patient in a treatment room as soon as possible.
D. Ensure staff and patient safety. Answer: D. Ensure staff and
patient safety.
◉ Which of these is a goal of triage?
A. To identify patients who are safe to wait for care
B. To establish appropriate fees on a sliding scale
C. To initiate patient teaching
D. To perform a comprehensive history and physical Answer: A. To
identify patients who are safe to wait for care
◉ The Emergency Nurses Association recommends that emergency
departments use which triage system?
A. Spot-check triage
QUESTIONS AND CORRECT ANSWERS
◉ The triage nurse should be most concerned about which pediatric
patient?
A. An infant with a petechial rash
B. A toddler with a fever of 101° F (38.3° C) for the last 2 days
C. A preschooler who does not want to eat
D. A child, age 6, with a heart rate of 120 beats per minute Answer:
A. An infant with a petechial rash
◉ Which option for an interpreter meets The Joint Commission
requirements?
A. Contact a telephone language bank.
B. Ask a bilingual family member to assist.
C. Use a medical dictionary for the specific language.
D. Contact a housekeeper who speaks the patient's language.
Answer: A. Contact a telephone language bank.
◉ The Emergency Nurses Association and American College of
Emergency Physicians recommend which type of triage acuity
system for the best interrater reliability?
A. Three-level system
,B. Four-level system
C. Five-level system
D. Six-level system Answer: C. Five-level system
◉ The triage nurse should screen for which problem in an older
adult patient who presents with a new onset of confusion?
A. Congenital heart defect
B. Elder abuse or neglect
C. Urinary tract infection
D. Long-term use of opioids Answer: C. Urinary tract infection
◉ Which factor is an advantage of comprehensive triage over other
triage systems?
A. It is cost-effective because triage does not need to be staffed 24
hours a day.
B. It does not require competency validation.
C. It uses a nonclinical person to greet patients upon arrival.
D. It includes the initiation of patient teaching. Answer: D. It includes
the initiation of patient teaching.
◉ When performing an across-the-room assessment, the triage
nurse can use the sense of sight to detect which finding?
A. Stridor
, B. Ketones
C. Deformity
D. Poor hygiene Answer: C. Deformity
◉ What is the nurse's priority when triaging a patient with a
behavioral health concern?
A. Determine if the patient has recently taken mind-altering
medications.
B. Assess the patient for a psychiatric history.
C. Place the patient in a treatment room as soon as possible.
D. Ensure staff and patient safety. Answer: D. Ensure staff and
patient safety.
◉ Which of these is a goal of triage?
A. To identify patients who are safe to wait for care
B. To establish appropriate fees on a sliding scale
C. To initiate patient teaching
D. To perform a comprehensive history and physical Answer: A. To
identify patients who are safe to wait for care
◉ The Emergency Nurses Association recommends that emergency
departments use which triage system?
A. Spot-check triage
