ESI Exam Questions With Complete
Solutions
4-year-old unresponsive
Pulled out of the family pool, mouth-to-mouth resuscitation administered.
Breathing spontaneously, continues to be unresponsive.
Vital signs: HR 126, RR 28, BP 80/64, SpO2 96% on NRB CORRECT ANSWERS ESI
1: Unresponsive.
Requires immediate lifesaving interventions for airway, breathing, and circulation
34-year-old female 10 days postpartum. "I suddenly started bleeding and passing clots
the size of oranges, I never did this with my other two pregnancies. Can I lie down
before I pass out?"
Vital signs: RR 22, HR 132, BP 86/40, SpO2 98%. CORRECT ANSWERS ESI 1:
Requires immediate lifesaving intervention.
Signs and symptoms of a post-partum hemorrhage.
Vital signs reflect fluid volume deficit. The patient needs immediate intravenous access
and fluid resuscitation.
19-year-old man reports "I was smoking a cigarette and had this coughing fit, and now I
feel short of breath,"
Vital signs: RR 36, HR 102, BP 128/76, SpO2 92%, T 36.6°C (98˚F), Pain 0/10.
CORRECT ANSWERS ESI 2: High-risk situation.
Elevated respiratory rate and a low oxygen saturation.
History and signs and symptoms are suggestive of a spontaneous pneumothorax.
He needs to be rapidly evaluated and closely monitored.
47-year-old female right leg is swollen with calf pain
Denies chest pain or shortness of breath
Admits to a history of type 2 diabetes and hypertension.
Vital signs: RR 24, HR 78, BP 158/82, SpO2 98%, T 36.6°C (98˚F), Pain 6/10.
CORRECT ANSWERS ESI 3: Two or more resources.
High risk for a deep vein thrombosis.
Two resources: labs and an ultrasound.
If this patient were short of breath or had chest pain, they would meet ESI -2 criteria.
A 27-year-old female low abdominal pain (6/10) for about 4 days.
This morning, she began spotting. Denies nausea, vomiting, diarrhea, or urinary
symptoms, last menstrual period 7 weeks ago.
Past medical history includes previous ectopic pregnancy.
Vital signs: RR 14, HR 66, BP 106/68 mm T 36.6°C (98˚F) CORRECT ANSWERS ESI
3: Two or more resources.
Require two or more resources - labs and an ultrasound.
,May be pregnant, ectopic pregnancy is a possibility, but this patient is currently
hemodynamically stable, and her pain is generalized across her lower abdomen.
17-year-old restrained driver high-speed motor vehicle crash.
Patient is immobilized on a backboard, complaining of abdominal pain, multiple
lacerations on left arm.
Vital Signs: RR 28, HR 86, BP 102/60, SpO2 96%. CORRECT ANSWERS ESI 2: High-
risk situation.
The mechanism of injury is significant, and patient has the potential for serious injuries
and should be considered high risk.
If he was hypotensive and tachycardic, he would be rated ESI 1, requiring immediate
lifesaving intervention.
20-year-old male rash in groin area.
Using over the counter spray, no known drug allergies.
Vital signs: RR 16, HR 58, BP 112/70, T 36.6°C (98˚F) CORRECT ANSWERS ESI level
5: No resources.
Patient will be sent home with prescriptions and appropriate discharge instructions
52-year-old female aching pain in left leg.
Patient has been sitting in a car for the last 2 days.
"We drove my daughter to college, and I thought it was the heat getting to me. The
whole ride home, it just ached and ached."
Denies any other complaints.
Vital signs: RR 16, HR 86, BP 148/98 T 36.6°C (98˚F) CORRECT ANSWERS ESI 3:
Two or more resources.
She will require labs and noninvasive vascular studies of her lower leg.
27-year-old female 7 weeks pregnant and vomiting.
"My doctor sent me to the emergency department because he thinks I am getting
dehydrated." Lips are dry and cracked.
Vital Signs: RR 18, HR 104, BP 104/68, SpO2 99%, T 36.1°C (97˚F), Pain 0/10.
CORRECT ANSWERS ESI 3: Two or more resources.
Showing signs of dehydration.
Lab studies, intravenous fluid, and an intravenous antiemetic
37-year-old female migraine starting this morning.
Can't get it under control, keeps vomiting.
Past medical history migraines, no allergies.
Vital Signs: RR 20, HR 102, BP 118/62, SpO2 98%,T 36.6°C (98˚F), Pain 6/10.
CORRECT ANSWERS ESI 3: Two or more resources.
Pain medication, an antiemetic, and fluid replacement.
The pain is not severe at 6/10 not high risk situation.
33-year-old female food poisoning.
Vomiting all night and now has diarrhea.
, Abdominal cramping rated at 5/10, denies fever or chills.
Vital signs: RR 16, HR 96 , BP 116/74. T 36°C (96.8˚F) CORRECT ANSWERS ESI 3:
Two or more resources.
Lab studies, intravenous fluid, and an intravenous antiemetic
The patient is not high risk or in severe pain or distress.
45-year-old woman with asthma .
Has had a cold for week, started wheezing a few days ago and then developed a cough
and a fever of 103.
Vital signs: RR 24, HR 92, BP 148/86, SpO2 97%.T 38.6°C (101.6˚F) CORRECT
ANSWERS ESI 3: Two or more resources.
Labs, a chest x-ray, and perhaps intravenous antibiotics
Because the patient is not in acute respiratory distress, he or she does not meet ESI-2
criteria.
2-week-old male fever
Uncomplicated, vaginal delivery, acting appropriately.
Vital signs: RR 42, HR 154, SpO2 100%, T 38.3°C (101˚F) CORRECT ANSWERS ESI
level 2: High-risk situation.
A temp higher than 38˚C (100.4˚F ) in an infant less than 28 days old is a high-risk
situation no matter how good the infant looks.
Infants in this age range are at a high risk for bacteremia(sepsis).
34-year-old female sore breast, cracked nipples, and a fever.
Three months postpartum and has recently returned to work.
No past medical history, taking vitamins, and is allergic to penicillin.
Vital signs: RR 18 , HR 90, BP 108/60, T 39.3°C (102.8˚F), Pain 5/10. CORRECT
ANSWERS ESI 3: Two or more resources.
At a minimum, she will require labs and intravenous antibiotics.
16-year-old unrestrained driver hit a tree while traveling at 45 mph.
Pt was moaning but moving all extremities when help arrived. Passenger side of the car
had significant damage.
Vital signs: RR 36, HR 132, BP 74/50, SpO2 99%, T 37°C (98.6˚F). CORRECT
ANSWERS ESI 1: Requires immediate lifesaving intervention.
Signs of shock - hypotension, tachycardia, and tachypnea.
Based on the mechanism of injury and presenting vital signs, this patient requires
immediate lifesaving interventions, including immediate fluid resuscitation.
60-year-old man right foot hurts.
Great toe and foot skin is red, warm, swollen, and tender to touch.
He denies injury.
Vital signs: RR 18, HR 82, BP 146/70, SpO2 99%, T 37.4°C (99.4˚F) CORRECT
ANSWERS ESI 3: Two or more resources.
Labs and intravenous antibiotics.
Solutions
4-year-old unresponsive
Pulled out of the family pool, mouth-to-mouth resuscitation administered.
Breathing spontaneously, continues to be unresponsive.
Vital signs: HR 126, RR 28, BP 80/64, SpO2 96% on NRB CORRECT ANSWERS ESI
1: Unresponsive.
Requires immediate lifesaving interventions for airway, breathing, and circulation
34-year-old female 10 days postpartum. "I suddenly started bleeding and passing clots
the size of oranges, I never did this with my other two pregnancies. Can I lie down
before I pass out?"
Vital signs: RR 22, HR 132, BP 86/40, SpO2 98%. CORRECT ANSWERS ESI 1:
Requires immediate lifesaving intervention.
Signs and symptoms of a post-partum hemorrhage.
Vital signs reflect fluid volume deficit. The patient needs immediate intravenous access
and fluid resuscitation.
19-year-old man reports "I was smoking a cigarette and had this coughing fit, and now I
feel short of breath,"
Vital signs: RR 36, HR 102, BP 128/76, SpO2 92%, T 36.6°C (98˚F), Pain 0/10.
CORRECT ANSWERS ESI 2: High-risk situation.
Elevated respiratory rate and a low oxygen saturation.
History and signs and symptoms are suggestive of a spontaneous pneumothorax.
He needs to be rapidly evaluated and closely monitored.
47-year-old female right leg is swollen with calf pain
Denies chest pain or shortness of breath
Admits to a history of type 2 diabetes and hypertension.
Vital signs: RR 24, HR 78, BP 158/82, SpO2 98%, T 36.6°C (98˚F), Pain 6/10.
CORRECT ANSWERS ESI 3: Two or more resources.
High risk for a deep vein thrombosis.
Two resources: labs and an ultrasound.
If this patient were short of breath or had chest pain, they would meet ESI -2 criteria.
A 27-year-old female low abdominal pain (6/10) for about 4 days.
This morning, she began spotting. Denies nausea, vomiting, diarrhea, or urinary
symptoms, last menstrual period 7 weeks ago.
Past medical history includes previous ectopic pregnancy.
Vital signs: RR 14, HR 66, BP 106/68 mm T 36.6°C (98˚F) CORRECT ANSWERS ESI
3: Two or more resources.
Require two or more resources - labs and an ultrasound.
,May be pregnant, ectopic pregnancy is a possibility, but this patient is currently
hemodynamically stable, and her pain is generalized across her lower abdomen.
17-year-old restrained driver high-speed motor vehicle crash.
Patient is immobilized on a backboard, complaining of abdominal pain, multiple
lacerations on left arm.
Vital Signs: RR 28, HR 86, BP 102/60, SpO2 96%. CORRECT ANSWERS ESI 2: High-
risk situation.
The mechanism of injury is significant, and patient has the potential for serious injuries
and should be considered high risk.
If he was hypotensive and tachycardic, he would be rated ESI 1, requiring immediate
lifesaving intervention.
20-year-old male rash in groin area.
Using over the counter spray, no known drug allergies.
Vital signs: RR 16, HR 58, BP 112/70, T 36.6°C (98˚F) CORRECT ANSWERS ESI level
5: No resources.
Patient will be sent home with prescriptions and appropriate discharge instructions
52-year-old female aching pain in left leg.
Patient has been sitting in a car for the last 2 days.
"We drove my daughter to college, and I thought it was the heat getting to me. The
whole ride home, it just ached and ached."
Denies any other complaints.
Vital signs: RR 16, HR 86, BP 148/98 T 36.6°C (98˚F) CORRECT ANSWERS ESI 3:
Two or more resources.
She will require labs and noninvasive vascular studies of her lower leg.
27-year-old female 7 weeks pregnant and vomiting.
"My doctor sent me to the emergency department because he thinks I am getting
dehydrated." Lips are dry and cracked.
Vital Signs: RR 18, HR 104, BP 104/68, SpO2 99%, T 36.1°C (97˚F), Pain 0/10.
CORRECT ANSWERS ESI 3: Two or more resources.
Showing signs of dehydration.
Lab studies, intravenous fluid, and an intravenous antiemetic
37-year-old female migraine starting this morning.
Can't get it under control, keeps vomiting.
Past medical history migraines, no allergies.
Vital Signs: RR 20, HR 102, BP 118/62, SpO2 98%,T 36.6°C (98˚F), Pain 6/10.
CORRECT ANSWERS ESI 3: Two or more resources.
Pain medication, an antiemetic, and fluid replacement.
The pain is not severe at 6/10 not high risk situation.
33-year-old female food poisoning.
Vomiting all night and now has diarrhea.
, Abdominal cramping rated at 5/10, denies fever or chills.
Vital signs: RR 16, HR 96 , BP 116/74. T 36°C (96.8˚F) CORRECT ANSWERS ESI 3:
Two or more resources.
Lab studies, intravenous fluid, and an intravenous antiemetic
The patient is not high risk or in severe pain or distress.
45-year-old woman with asthma .
Has had a cold for week, started wheezing a few days ago and then developed a cough
and a fever of 103.
Vital signs: RR 24, HR 92, BP 148/86, SpO2 97%.T 38.6°C (101.6˚F) CORRECT
ANSWERS ESI 3: Two or more resources.
Labs, a chest x-ray, and perhaps intravenous antibiotics
Because the patient is not in acute respiratory distress, he or she does not meet ESI-2
criteria.
2-week-old male fever
Uncomplicated, vaginal delivery, acting appropriately.
Vital signs: RR 42, HR 154, SpO2 100%, T 38.3°C (101˚F) CORRECT ANSWERS ESI
level 2: High-risk situation.
A temp higher than 38˚C (100.4˚F ) in an infant less than 28 days old is a high-risk
situation no matter how good the infant looks.
Infants in this age range are at a high risk for bacteremia(sepsis).
34-year-old female sore breast, cracked nipples, and a fever.
Three months postpartum and has recently returned to work.
No past medical history, taking vitamins, and is allergic to penicillin.
Vital signs: RR 18 , HR 90, BP 108/60, T 39.3°C (102.8˚F), Pain 5/10. CORRECT
ANSWERS ESI 3: Two or more resources.
At a minimum, she will require labs and intravenous antibiotics.
16-year-old unrestrained driver hit a tree while traveling at 45 mph.
Pt was moaning but moving all extremities when help arrived. Passenger side of the car
had significant damage.
Vital signs: RR 36, HR 132, BP 74/50, SpO2 99%, T 37°C (98.6˚F). CORRECT
ANSWERS ESI 1: Requires immediate lifesaving intervention.
Signs of shock - hypotension, tachycardia, and tachypnea.
Based on the mechanism of injury and presenting vital signs, this patient requires
immediate lifesaving interventions, including immediate fluid resuscitation.
60-year-old man right foot hurts.
Great toe and foot skin is red, warm, swollen, and tender to touch.
He denies injury.
Vital signs: RR 18, HR 82, BP 146/70, SpO2 99%, T 37.4°C (99.4˚F) CORRECT
ANSWERS ESI 3: Two or more resources.
Labs and intravenous antibiotics.
