ERNG420 Emergency Nursing Concepts Practice Exam Study Guide
Updated 2026 | Verified Questions and Answers with Detailed
Rationales | Triage and Emergency Assessment, Trauma and Injury
Management, Cardiac and Respiratory Emergencies, Shock and Sepsis,
Neurological Emergencies, Toxicology and Poisoning, Disaster
Preparedness, ACLS and BLS Protocols, Rapid Response and Critical Care
Interventions, NCLEX-Style Clinical Judgment Questions | Complete Exam
Prep Resource for Emergency Nursing Success
Question 1: A 45-year-old male presents to the emergency department with sudden
onset of crushing substernal chest pain radiating to the left arm, diaphoresis, and
nausea. His vital signs are BP 160/95 mmHg, HR 110 bpm, RR 22/min, SpO2 96% on
room air. Which intervention should the emergency nurse prioritize FIRST?
A. Obtain a 12-lead electrocardiogram
B. Administer sublingual nitroglycerin
C. Establish two large-bore intravenous lines
D. Apply supplemental oxygen via nasal cannula
CORRECT ANSWER: A. Obtain a 12-lead electrocardiogram
RATIONALE:In suspected acute coronary syndrome, obtaining a 12-lead ECG within 10
minutes of arrival is the highest priority per ACC/AHA guidelines. This allows for rapid
identification of ST-elevation myocardial infarction (STEMI) and activation of the cardiac
catheterization team. While oxygen, IV access, and nitroglycerin are important, they
should not delay ECG acquisition, which directly impacts time-sensitive reperfusion
therapy decisions.
Question 2: During the primary survey of a trauma patient, the emergency nurse
identifies absent breath sounds on the right side, tracheal deviation to the left, and
distended neck veins. Which immediate intervention is MOST critical?
A. Prepare for chest tube insertion
B. Administer high-flow oxygen
C. Perform needle decompression of the right chest
D. Obtain a stat chest X-ray
CORRECT ANSWER: C. Perform needle decompression of the right chest
RATIONALE:These findings indicate tension pneumothorax, a life-threatening
emergency requiring immediate needle decompression at the second intercostal
space, midclavicular line on the affected side. This intervention relieves intrathoracic
pressure and restores cardiac output. Delaying decompression for imaging or chest
tube placement can result in cardiovascular collapse and death.
Question 3: A patient with a known history of asthma presents with severe
respiratory distress, unable to speak in full sentences, with audible wheezing and
,use of accessory muscles. Peak expiratory flow is 40% of predicted. Which
medication should the emergency nurse anticipate administering FIRST?
A. Intravenous methylprednisolone
B. Inhaled ipratropium bromide
C. Nebulized albuterol
D. Subcutaneous epinephrine
CORRECT ANSWER: C. Nebulized albuterol
RATIONALE:Short-acting beta-2 agonists like albuterol are first-line therapy for acute
asthma exacerbations to rapidly reverse bronchospasm. Administered via nebulizer or
metered-dose inhaler with spacer, albuterol provides quick bronchodilation. Systemic
corticosteroids are essential but have delayed onset; ipratropium is an adjunct;
epinephrine is reserved for anaphylaxis or severe cases unresponsive to standard
therapy.
Question 4: Which finding in a patient with suspected sepsis would MOST strongly
indicate the need for immediate fluid resuscitation per Surviving Sepsis Campaign
guidelines?
A. Temperature of 38.5°C (101.3°F)
B. Serum lactate level of 3.2 mmol/L
C. White blood cell count of 15,000/mm³
D. Heart rate of 95 bpm
CORRECT ANSWER: B. Serum lactate level of 3.2 mmol/L
RATIONALE:A serum lactate ≥2 mmol/L in the context of suspected infection indicates
tissue hypoperfusion and is a key criterion for sepsis-induced hypoperfusion requiring
immediate fluid resuscitation with 30 mL/kg crystalloid within the first hour. Elevated
lactate correlates with mortality and guides early goal-directed therapy, whereas fever,
leukocytosis, or mild tachycardia alone do not mandate urgent fluid boluses.
Question 5: An unconscious patient is brought to the ED following a motor vehicle
collision. The emergency nurse notes irregular, gasping respirations with periods of
apnea. Which pattern of breathing is this MOST consistent with?
A. Kussmaul respirations
B. Cheyne-Stokes respirations
C. Biot's respirations
D. Agonal respirations
CORRECT ANSWER: D. Agonal respirations
RATIONALE:Agonal respirations are irregular, gasping breaths often seen in cardiac
arrest or severe brainstem injury. They represent ineffective respiratory effort and
require immediate initiation of advanced cardiac life support, including bag-valve-mask
ventilation and chest compressions if pulseless. Kussmaul respirations are deep and
,rapid (metabolic acidosis); Cheyne-Stokes shows crescendo-decrescendo pattern with
apnea (heart failure, stroke); Biot's are irregular with abrupt pauses (meningitis, brain
injury).
Question 6: A 70-year-old female presents with sudden onset of right-sided facial
droop, arm weakness, and slurred speech that began 90 minutes ago. Her blood
glucose is 110 mg/dL. What is the MOST appropriate next step for the emergency
nurse?
A. Administer aspirin 325 mg orally
B. Prepare for immediate non-contrast head CT scan
C. Initiate thrombolytic therapy per protocol
D. Obtain a carotid Doppler ultrasound
CORRECT ANSWER: B. Prepare for immediate non-contrast head CT scan
RATIONALE:For acute ischemic stroke within the therapeutic window, a non-contrast
head CT must be performed immediately to rule out hemorrhage before considering
thrombolysis. Administering aspirin or thrombolytics without imaging could be
catastrophic if hemorrhagic stroke is present. Carotid Doppler is not emergent. Time to
CT is a critical quality metric in stroke care.
Question 7: Which assessment finding in a patient with a suspected opioid
overdose would MOST urgently require administration of naloxone?
A. Pinpoint pupils
B. Respiratory rate of 6 breaths per minute
C. Unresponsiveness to verbal stimuli
D. History of chronic pain management
CORRECT ANSWER: B. Respiratory rate of 6 breaths per minute
RATIONALE:Respiratory depression is the life-threatening manifestation of opioid
overdose requiring immediate naloxone administration to reverse respiratory arrest.
While pinpoint pupils and unresponsiveness support the diagnosis, inadequate
ventilation poses the most immediate risk of hypoxia and death. Naloxone should be
titrated to restore adequate respirations without precipitating acute withdrawal.
Question 8: During triage using the Emergency Severity Index (ESI), which patient
should be assigned ESI Level 1?
A. A 30-year-old with a simple forearm fracture and moderate pain
B. A 65-year-old with chest pain and diaphoresis
C. A 22-year-old with a laceration requiring sutures
D. A 40-year-old with a mild asthma exacerbation responsive to inhaler
CORRECT ANSWER: B. A 65-year-old with chest pain and diaphoresis
RATIONALE:ESI Level 1 is reserved for patients requiring immediate life-saving
intervention. Chest pain with diaphoresis suggests possible acute coronary syndrome,
, which can rapidly deteriorate to cardiac arrest. The other patients, while needing
prompt care, do not require immediate intervention to prevent death or disability.
Question 9: A patient with severe burns to the face and neck is exhibiting stridor
and hoarseness. Which intervention should the emergency nurse prioritize?
A. Apply silver sulfadiazine to burned areas
B. Administer intravenous morphine for pain
C. Prepare for endotracheal intubation
D. Initiate fluid resuscitation using the Parkland formula
CORRECT ANSWER: C. Prepare for endotracheal intubation
RATIONALE:Stridor and hoarseness in a burn patient indicate potential upper airway
edema from inhalation injury, which can progress rapidly to complete airway
obstruction. Securing the airway via early intubation is critical before edema makes
visualization impossible. Fluid resuscitation and pain management are important but
secondary to airway protection.
Question 10: Which electrocardiogram finding is MOST indicative of hyperkalemia
in a patient with end-stage renal disease?
A. Prolonged QT interval
B. Peaked T waves
C. ST-segment elevation
D. U waves
CORRECT ANSWER: B. Peaked T waves
RATIONALE:Hyperkalemia classically presents with tall, peaked T waves on ECG as the
earliest sign, progressing to PR prolongation, QRS widening, and sine wave pattern if
untreated. This is critical in renal failure patients who cannot excrete potassium.
Prolonged QT suggests hypocalcemia or medications; ST elevation indicates myocardial
injury; U waves are associated with hypokalemia.
Question 11: A trauma patient has a Glasgow Coma Scale score of 8. What is the
MOST appropriate airway management strategy?
A. Supplemental oxygen via non-rebreather mask
B. Nasopharyngeal airway placement
C. Rapid sequence intubation
D. Bag-valve-mask ventilation only
CORRECT ANSWER: C. Rapid sequence intubation
RATIONALE:A GCS ≤8 indicates severe traumatic brain injury with inability to protect
the airway, mandating definitive airway management via rapid sequence intubation to
prevent aspiration and ensure adequate ventilation. Less invasive methods are
insufficient for patients with depressed consciousness and compromised airway
reflexes.
Updated 2026 | Verified Questions and Answers with Detailed
Rationales | Triage and Emergency Assessment, Trauma and Injury
Management, Cardiac and Respiratory Emergencies, Shock and Sepsis,
Neurological Emergencies, Toxicology and Poisoning, Disaster
Preparedness, ACLS and BLS Protocols, Rapid Response and Critical Care
Interventions, NCLEX-Style Clinical Judgment Questions | Complete Exam
Prep Resource for Emergency Nursing Success
Question 1: A 45-year-old male presents to the emergency department with sudden
onset of crushing substernal chest pain radiating to the left arm, diaphoresis, and
nausea. His vital signs are BP 160/95 mmHg, HR 110 bpm, RR 22/min, SpO2 96% on
room air. Which intervention should the emergency nurse prioritize FIRST?
A. Obtain a 12-lead electrocardiogram
B. Administer sublingual nitroglycerin
C. Establish two large-bore intravenous lines
D. Apply supplemental oxygen via nasal cannula
CORRECT ANSWER: A. Obtain a 12-lead electrocardiogram
RATIONALE:In suspected acute coronary syndrome, obtaining a 12-lead ECG within 10
minutes of arrival is the highest priority per ACC/AHA guidelines. This allows for rapid
identification of ST-elevation myocardial infarction (STEMI) and activation of the cardiac
catheterization team. While oxygen, IV access, and nitroglycerin are important, they
should not delay ECG acquisition, which directly impacts time-sensitive reperfusion
therapy decisions.
Question 2: During the primary survey of a trauma patient, the emergency nurse
identifies absent breath sounds on the right side, tracheal deviation to the left, and
distended neck veins. Which immediate intervention is MOST critical?
A. Prepare for chest tube insertion
B. Administer high-flow oxygen
C. Perform needle decompression of the right chest
D. Obtain a stat chest X-ray
CORRECT ANSWER: C. Perform needle decompression of the right chest
RATIONALE:These findings indicate tension pneumothorax, a life-threatening
emergency requiring immediate needle decompression at the second intercostal
space, midclavicular line on the affected side. This intervention relieves intrathoracic
pressure and restores cardiac output. Delaying decompression for imaging or chest
tube placement can result in cardiovascular collapse and death.
Question 3: A patient with a known history of asthma presents with severe
respiratory distress, unable to speak in full sentences, with audible wheezing and
,use of accessory muscles. Peak expiratory flow is 40% of predicted. Which
medication should the emergency nurse anticipate administering FIRST?
A. Intravenous methylprednisolone
B. Inhaled ipratropium bromide
C. Nebulized albuterol
D. Subcutaneous epinephrine
CORRECT ANSWER: C. Nebulized albuterol
RATIONALE:Short-acting beta-2 agonists like albuterol are first-line therapy for acute
asthma exacerbations to rapidly reverse bronchospasm. Administered via nebulizer or
metered-dose inhaler with spacer, albuterol provides quick bronchodilation. Systemic
corticosteroids are essential but have delayed onset; ipratropium is an adjunct;
epinephrine is reserved for anaphylaxis or severe cases unresponsive to standard
therapy.
Question 4: Which finding in a patient with suspected sepsis would MOST strongly
indicate the need for immediate fluid resuscitation per Surviving Sepsis Campaign
guidelines?
A. Temperature of 38.5°C (101.3°F)
B. Serum lactate level of 3.2 mmol/L
C. White blood cell count of 15,000/mm³
D. Heart rate of 95 bpm
CORRECT ANSWER: B. Serum lactate level of 3.2 mmol/L
RATIONALE:A serum lactate ≥2 mmol/L in the context of suspected infection indicates
tissue hypoperfusion and is a key criterion for sepsis-induced hypoperfusion requiring
immediate fluid resuscitation with 30 mL/kg crystalloid within the first hour. Elevated
lactate correlates with mortality and guides early goal-directed therapy, whereas fever,
leukocytosis, or mild tachycardia alone do not mandate urgent fluid boluses.
Question 5: An unconscious patient is brought to the ED following a motor vehicle
collision. The emergency nurse notes irregular, gasping respirations with periods of
apnea. Which pattern of breathing is this MOST consistent with?
A. Kussmaul respirations
B. Cheyne-Stokes respirations
C. Biot's respirations
D. Agonal respirations
CORRECT ANSWER: D. Agonal respirations
RATIONALE:Agonal respirations are irregular, gasping breaths often seen in cardiac
arrest or severe brainstem injury. They represent ineffective respiratory effort and
require immediate initiation of advanced cardiac life support, including bag-valve-mask
ventilation and chest compressions if pulseless. Kussmaul respirations are deep and
,rapid (metabolic acidosis); Cheyne-Stokes shows crescendo-decrescendo pattern with
apnea (heart failure, stroke); Biot's are irregular with abrupt pauses (meningitis, brain
injury).
Question 6: A 70-year-old female presents with sudden onset of right-sided facial
droop, arm weakness, and slurred speech that began 90 minutes ago. Her blood
glucose is 110 mg/dL. What is the MOST appropriate next step for the emergency
nurse?
A. Administer aspirin 325 mg orally
B. Prepare for immediate non-contrast head CT scan
C. Initiate thrombolytic therapy per protocol
D. Obtain a carotid Doppler ultrasound
CORRECT ANSWER: B. Prepare for immediate non-contrast head CT scan
RATIONALE:For acute ischemic stroke within the therapeutic window, a non-contrast
head CT must be performed immediately to rule out hemorrhage before considering
thrombolysis. Administering aspirin or thrombolytics without imaging could be
catastrophic if hemorrhagic stroke is present. Carotid Doppler is not emergent. Time to
CT is a critical quality metric in stroke care.
Question 7: Which assessment finding in a patient with a suspected opioid
overdose would MOST urgently require administration of naloxone?
A. Pinpoint pupils
B. Respiratory rate of 6 breaths per minute
C. Unresponsiveness to verbal stimuli
D. History of chronic pain management
CORRECT ANSWER: B. Respiratory rate of 6 breaths per minute
RATIONALE:Respiratory depression is the life-threatening manifestation of opioid
overdose requiring immediate naloxone administration to reverse respiratory arrest.
While pinpoint pupils and unresponsiveness support the diagnosis, inadequate
ventilation poses the most immediate risk of hypoxia and death. Naloxone should be
titrated to restore adequate respirations without precipitating acute withdrawal.
Question 8: During triage using the Emergency Severity Index (ESI), which patient
should be assigned ESI Level 1?
A. A 30-year-old with a simple forearm fracture and moderate pain
B. A 65-year-old with chest pain and diaphoresis
C. A 22-year-old with a laceration requiring sutures
D. A 40-year-old with a mild asthma exacerbation responsive to inhaler
CORRECT ANSWER: B. A 65-year-old with chest pain and diaphoresis
RATIONALE:ESI Level 1 is reserved for patients requiring immediate life-saving
intervention. Chest pain with diaphoresis suggests possible acute coronary syndrome,
, which can rapidly deteriorate to cardiac arrest. The other patients, while needing
prompt care, do not require immediate intervention to prevent death or disability.
Question 9: A patient with severe burns to the face and neck is exhibiting stridor
and hoarseness. Which intervention should the emergency nurse prioritize?
A. Apply silver sulfadiazine to burned areas
B. Administer intravenous morphine for pain
C. Prepare for endotracheal intubation
D. Initiate fluid resuscitation using the Parkland formula
CORRECT ANSWER: C. Prepare for endotracheal intubation
RATIONALE:Stridor and hoarseness in a burn patient indicate potential upper airway
edema from inhalation injury, which can progress rapidly to complete airway
obstruction. Securing the airway via early intubation is critical before edema makes
visualization impossible. Fluid resuscitation and pain management are important but
secondary to airway protection.
Question 10: Which electrocardiogram finding is MOST indicative of hyperkalemia
in a patient with end-stage renal disease?
A. Prolonged QT interval
B. Peaked T waves
C. ST-segment elevation
D. U waves
CORRECT ANSWER: B. Peaked T waves
RATIONALE:Hyperkalemia classically presents with tall, peaked T waves on ECG as the
earliest sign, progressing to PR prolongation, QRS widening, and sine wave pattern if
untreated. This is critical in renal failure patients who cannot excrete potassium.
Prolonged QT suggests hypocalcemia or medications; ST elevation indicates myocardial
injury; U waves are associated with hypokalemia.
Question 11: A trauma patient has a Glasgow Coma Scale score of 8. What is the
MOST appropriate airway management strategy?
A. Supplemental oxygen via non-rebreather mask
B. Nasopharyngeal airway placement
C. Rapid sequence intubation
D. Bag-valve-mask ventilation only
CORRECT ANSWER: C. Rapid sequence intubation
RATIONALE:A GCS ≤8 indicates severe traumatic brain injury with inability to protect
the airway, mandating definitive airway management via rapid sequence intubation to
prevent aspiration and ensure adequate ventilation. Less invasive methods are
insufficient for patients with depressed consciousness and compromised airway
reflexes.
