Emergency Nursing Competency Exam
— Code: NUR-EMERG-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A patient arrives in the emergency department after a motor-vehicle
collision. The patient is hypotensive, tachycardic, pale, and has a rigid
abdomen. Which action should the nurse prioritize?
A. Obtain a detailed medication history
B. Insert a urinary catheter
C. Establish large-bore IV access and initiate resuscitation
D. Transport the patient for a routine abdominal CT
Answer: C. Establish large-bore IV access and initiate resuscitation
,Rationale: In a hemodynamically unstable trauma patient with suspected intra-
abdominal hemorrhage, rapid vascular access and resuscitation take priority.
Diagnostic procedures should not unnecessarily delay stabilization.
2. A patient with severe asthma becomes increasingly fatigued and develops a
markedly diminished wheeze despite worsening respiratory distress. What
does this finding indicate?
A. Resolution of bronchospasm
B. Improved airway clearance
C. Impending respiratory failure
D. Anxiety-related hyperventilation
Answer: C. Impending respiratory failure
Rationale: A suddenly quiet chest in a severely distressed asthmatic patient can
indicate critically reduced airflow. Fatigue, altered mental status, and a
diminishing wheeze are ominous signs requiring immediate escalation.
3. A patient presents with crushing substernal chest pain, diaphoresis, and
nausea. The ECG demonstrates ST-segment elevation in leads II, III, and
aVF. Which coronary territory is most likely affected?
A. Anterior wall
B. Inferior wall
C. Lateral wall
D. Septal wall
Answer: B. Inferior wall
Rationale: ST elevation in leads II, III, and aVF indicates an inferior myocardial
infarction, commonly involving the right coronary artery. Right ventricular
involvement should also be considered.
4. A patient with suspected opioid toxicity has respirations of 6/min and
pinpoint pupils. Which intervention is the priority?
,A. Administer oral fluids
B. Apply restraints
C. Support ventilation and administer naloxone as indicated
D. Obtain a complete psychiatric history
Answer: C. Support ventilation and administer naloxone as indicated
Rationale: Respiratory depression is the immediate life threat in opioid toxicity.
Airway and ventilatory support take priority while naloxone is administered
according to clinical circumstances.
5. A trauma patient has severe dyspnea, hypotension, distended neck veins,
and absent breath sounds on the right. Which condition should the nurse
suspect?
A. Pulmonary edema
B. Tension pneumothorax
C. Cardiac tamponade
D. Massive aspiration
Answer: B. Tension pneumothorax
Rationale: Severe respiratory compromise, hypotension, unilateral absent
breath sounds, and jugular venous distention strongly suggest tension
pneumothorax. This is an immediately life-threatening condition requiring
emergency decompression.
6. A patient with suspected sepsis has altered mental status, hypotension,
elevated lactate, and cool extremities. Which intervention should the nurse
anticipate?
A. Delaying treatment until all cultures are finalized
B. Rapid assessment, cultures as indicated, antimicrobial therapy, and fluid
resuscitation
C. Restricting all IV fluids
D. Administering a sedative first
, Answer: B. Rapid assessment, cultures as indicated, antimicrobial therapy, and
fluid resuscitation
Rationale: Sepsis management requires rapid recognition and treatment.
Appropriate cultures should be obtained without unnecessarily delaying
antimicrobial therapy, while perfusion is supported.
7. A patient with diabetic ketoacidosis has a serum potassium of 2.8 mEq/L.
Which prescription should the nurse question?
A. Cardiac monitoring
B. Potassium replacement
C. IV insulin infusion immediately
D. Frequent electrolyte monitoring
Answer: C. IV insulin infusion immediately
Rationale: Insulin shifts potassium intracellularly and can worsen significant
hypokalemia. Severe hypokalemia generally requires potassium correction
before insulin therapy proceeds, according to the treatment protocol.
8. A patient develops facial swelling, wheezing, hypotension, and generalized
urticaria minutes after receiving an antibiotic. Which medication is the
priority?
A. Diphenhydramine
B. Famotidine
C. Epinephrine
D. Acetaminophen
Answer: C. Epinephrine
Rationale: This presentation is consistent with anaphylaxis. Epinephrine is the
first-line treatment because it rapidly addresses airway edema, bronchospasm,
and cardiovascular collapse.
— Code: NUR-EMERG-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A patient arrives in the emergency department after a motor-vehicle
collision. The patient is hypotensive, tachycardic, pale, and has a rigid
abdomen. Which action should the nurse prioritize?
A. Obtain a detailed medication history
B. Insert a urinary catheter
C. Establish large-bore IV access and initiate resuscitation
D. Transport the patient for a routine abdominal CT
Answer: C. Establish large-bore IV access and initiate resuscitation
,Rationale: In a hemodynamically unstable trauma patient with suspected intra-
abdominal hemorrhage, rapid vascular access and resuscitation take priority.
Diagnostic procedures should not unnecessarily delay stabilization.
2. A patient with severe asthma becomes increasingly fatigued and develops a
markedly diminished wheeze despite worsening respiratory distress. What
does this finding indicate?
A. Resolution of bronchospasm
B. Improved airway clearance
C. Impending respiratory failure
D. Anxiety-related hyperventilation
Answer: C. Impending respiratory failure
Rationale: A suddenly quiet chest in a severely distressed asthmatic patient can
indicate critically reduced airflow. Fatigue, altered mental status, and a
diminishing wheeze are ominous signs requiring immediate escalation.
3. A patient presents with crushing substernal chest pain, diaphoresis, and
nausea. The ECG demonstrates ST-segment elevation in leads II, III, and
aVF. Which coronary territory is most likely affected?
A. Anterior wall
B. Inferior wall
C. Lateral wall
D. Septal wall
Answer: B. Inferior wall
Rationale: ST elevation in leads II, III, and aVF indicates an inferior myocardial
infarction, commonly involving the right coronary artery. Right ventricular
involvement should also be considered.
4. A patient with suspected opioid toxicity has respirations of 6/min and
pinpoint pupils. Which intervention is the priority?
,A. Administer oral fluids
B. Apply restraints
C. Support ventilation and administer naloxone as indicated
D. Obtain a complete psychiatric history
Answer: C. Support ventilation and administer naloxone as indicated
Rationale: Respiratory depression is the immediate life threat in opioid toxicity.
Airway and ventilatory support take priority while naloxone is administered
according to clinical circumstances.
5. A trauma patient has severe dyspnea, hypotension, distended neck veins,
and absent breath sounds on the right. Which condition should the nurse
suspect?
A. Pulmonary edema
B. Tension pneumothorax
C. Cardiac tamponade
D. Massive aspiration
Answer: B. Tension pneumothorax
Rationale: Severe respiratory compromise, hypotension, unilateral absent
breath sounds, and jugular venous distention strongly suggest tension
pneumothorax. This is an immediately life-threatening condition requiring
emergency decompression.
6. A patient with suspected sepsis has altered mental status, hypotension,
elevated lactate, and cool extremities. Which intervention should the nurse
anticipate?
A. Delaying treatment until all cultures are finalized
B. Rapid assessment, cultures as indicated, antimicrobial therapy, and fluid
resuscitation
C. Restricting all IV fluids
D. Administering a sedative first
, Answer: B. Rapid assessment, cultures as indicated, antimicrobial therapy, and
fluid resuscitation
Rationale: Sepsis management requires rapid recognition and treatment.
Appropriate cultures should be obtained without unnecessarily delaying
antimicrobial therapy, while perfusion is supported.
7. A patient with diabetic ketoacidosis has a serum potassium of 2.8 mEq/L.
Which prescription should the nurse question?
A. Cardiac monitoring
B. Potassium replacement
C. IV insulin infusion immediately
D. Frequent electrolyte monitoring
Answer: C. IV insulin infusion immediately
Rationale: Insulin shifts potassium intracellularly and can worsen significant
hypokalemia. Severe hypokalemia generally requires potassium correction
before insulin therapy proceeds, according to the treatment protocol.
8. A patient develops facial swelling, wheezing, hypotension, and generalized
urticaria minutes after receiving an antibiotic. Which medication is the
priority?
A. Diphenhydramine
B. Famotidine
C. Epinephrine
D. Acetaminophen
Answer: C. Epinephrine
Rationale: This presentation is consistent with anaphylaxis. Epinephrine is the
first-line treatment because it rapidly addresses airway edema, bronchospasm,
and cardiovascular collapse.
