[Emergency Nursing] COMPLETE EXAM QUESTIONS AND
VERIFIED ANSWERS | 2026–2027 LATEST UPDATE |
GUARANTEED PASS | DETAILED RATIONALES | FULL STUDY
GUIDE | EXAM PREP | PRACTICE TEST | CERTIFICATION
PREPARATION
Section One: Questions 1–100
1. A patient is brought to the emergency department following a motor vehicle collision. They are
disoriented, with a blood pressure of 88/52 mmHg, heart rate of 122 bpm, and respirations of
28/min. Jugular veins are distended, and breath sounds are diminished on the left side. What is
the priority intervention?
A. Insertion of a nasogastric tube
B. Needle decompression of the left chest
C. Administration of a fluid bolus of 0.9% normal saline
D. Placement of a peripheral intravenous line
Correct Answer: B. Needle decompression of the left chest
Rationale: The patient is exhibiting signs of a tension pneumothorax: hypotension, tachycardia,
distended neck veins (indicating impaired venous return), and diminished breath sounds. This is a life-
threatening condition requiring immediate needle decompression to relieve intrapleural pressure.
While fluid resuscitation and IV access are important, they are secondary to addressing the
immediate airway, breathing, and circulation threat posed by the tension pneumothorax. A
nasogastric tube does not address this critical issue.
2. Which of the following findings is the most sensitive indicator of shock in a pediatric patient?
A. Hypotension
B. Tachycardia
C. Decreased urine output
D. Narrowed pulse pressure
Correct Answer: B. Tachycardia
Rationale: In pediatric patients, compensatory mechanisms are robust, and hypotension is a late and
ominous sign of shock. Tachycardia is the earliest and most sensitive indicator of hemodynamic
instability in children. While decreased urine output and narrowed pulse pressure are also signs of
shock, they are not as early or sensitive as an elevated heart rate.
3. A nurse is preparing to administer 50 mEq of sodium bicarbonate to a patient in cardiac arrest.
The medication is supplied in a 50 mEq/50 mL syringe. The patient's current IV is infusing lactated
Ringer's at 100 mL/hr. What is the nurse's best action?
A. Administer the sodium bicarbonate through the IV line after stopping the lactated Ringer's
B. Flush the IV line with 10 mL of 0.9% normal saline before administering the sodium bicarbonate
C. Administer the sodium bicarbonate via a separate IV site
D. Administer the sodium bicarbonate through the existing IV line without any further action
Correct Answer: A. Administer the sodium bicarbonate through the IV line after stopping the
lactated Ringer's
,Rationale: Sodium bicarbonate is incompatible with lactated Ringer's (LR) solution and can cause
precipitation. The nurse must stop the LR infusion, flush the line with a compatible solution (like
normal saline), administer the sodium bicarbonate, and then resume the LR if ordered. Giving it via a
separate site or through the same line without stopping the LR could lead to a precipitate formation
and a significant adverse event.
4. A patient presents with a severe headache, nausea, and photophobia. A lumbar puncture is
performed, and the cerebrospinal fluid (CSF) appears cloudy and is under elevated pressure. Which
of the following results would be most indicative of a bacterial, rather than viral, meningitis?
A. Elevated protein level
B. Normal glucose level
C. Predominance of lymphocytes
D. Positive Gram stain
Correct Answer: D. Positive Gram stain
Rationale: A positive Gram stain confirms the presence of bacteria in the CSF, which is diagnostic of
bacterial meningitis. While elevated protein and low glucose are classic findings, they are not as
definitive as visualizing the causative organism. Viral meningitis typically presents with a
predominance of lymphocytes, whereas bacterial meningitis usually shows a predominance of
neutrophils.
5. A trauma patient is being evaluated for a potential pelvic fracture. Which of the following
assessment findings would be a classic indicator of a severe pelvic ring injury?
A. Pain on palpation of the iliac crest
B. Leg-length discrepancy
C. A boggy mass on rectal examination
D. Macroscopic hematuria
Correct Answer: C. A boggy mass on rectal examination
Rationale: A boggy mass on rectal exam is a classic indicator of a retroperitoneal hematoma, which is
a serious complication of pelvic fractures. While the other options can be associated with pelvic
fractures, they are not as specific to the severity or the development of a significant retroperitoneal
bleed. This finding should alert the team to the need for rapid hemorrhage control and possible pelvic
binding.
6. A patient is experiencing a severe anaphylactic reaction after receiving IV contrast. The provider
orders epinephrine 0.3 mg of a 1:1000 solution IM. Which of the following needle lengths and
gauge would be most appropriate for this intramuscular injection?
A. 5/8 inch, 25-gauge
B. 1 inch, 22-gauge
C. 1 ½ inch, 18-gauge
D. 1 inch, 27-gauge
Correct Answer: B. 1 inch, 22-gauge
Rationale: For an IM epinephrine injection in an adult, a needle length of 1 to 1.5 inches is
recommended, with a gauge of 22 or 23. A 22-gauge 1-inch needle is suitable for most adults. A 5/8
inch is typically for subcutaneous injections, 18-gauge is too large, and 27-gauge is too small for a
reliable IM injection, especially in an emergency.
,7. A patient is admitted after a carbon monoxide (CO) poisoning incident. The nurse assesses the
patient for signs of CO toxicity. Which of the following clinical manifestations is most commonly
associated with this condition?
A. Cyanosis
B. Cherry-red skin
C. Tachycardia
D. Bradypnea
Correct Answer: C. Tachycardia
Rationale: Carbon monoxide poisoning causes tissue hypoxia. The body compensates by increasing
the heart rate in an attempt to deliver more oxygen to vital organs. While cherry-red skin is a classic
sign, it is not always present and is often a late finding. Cyanosis is not typically seen in CO poisoning
because the carboxyhemoglobin gives the blood a cherry-red color. Tachypnea, not bradypnea, is
more common.
8. An emergency nurse is caring for a patient with a suspected acute ischemic stroke. The patient's
symptoms began 2 hours ago. Which of the following is an absolute contraindication to the
administration of tissue plasminogen activator (tPA)?
A. Blood pressure of 175/95 mmHg
B. History of a seizure at the onset of symptoms
C. Current use of anticoagulant therapy with a therapeutic INR
D. A non-contrast head CT showing a small area of hypodensity
Correct Answer: C. Current use of anticoagulant therapy with a therapeutic INR
Rationale: The use of anticoagulants with a therapeutic INR (greater than 1.7) is an absolute
contraindication to tPA due to the significantly increased risk of intracerebral hemorrhage. A non-
contrast CT showing a hypodensity may indicate early ischemic changes, but it is a relative
contraindication in some cases. Elevated blood pressure (above 185/110) is a relative
contraindication that must be treated before administration. A seizure at onset can be a relative
contraindication, but it doesn't necessarily rule out tPA.
9. A patient arrives with a penetrating chest wound from a knife. The nurse observes a sucking
sound during inspiration and a wound that is open to the pleural space. What is the most
appropriate immediate intervention?
A. Apply an occlusive dressing taped on three sides
B. Pack the wound with sterile gauze
C. Apply an occlusive dressing taped on all four sides
D. Insert a 14-gauge IV catheter into the chest
Correct Answer: A. Apply an occlusive dressing taped on three sides
Rationale: This is a description of an open pneumothorax ("sucking chest wound"). The immediate
treatment is to apply an occlusive dressing taped on three sides. This acts as a flutter valve, allowing
air to escape during expiration (preventing tension pneumothorax) but preventing air from entering
during inspiration. Taping on all four sides creates a tension pneumothorax. Packing the wound or
inserting a catheter are not the correct first-line interventions.
10. The emergency department is implementing a disaster plan for a chemical spill. A patient
presents with a chemical burn from an acid. Which of the following is the priority action for the
nurse to take?
, A. Apply a neutralization agent to the burned area
B. Cover the burn with a clean, dry dressing
C. Initiate a large-bore IV and fluid resuscitation
D. Remove contaminated clothing and irrigate the skin with copious amounts of water
Correct Answer: D. Remove contaminated clothing and irrigate the skin with copious amounts of
water
Rationale: For a chemical injury, the priority is to remove the offending agent. This is achieved by
immediately removing all contaminated clothing and jewelry and then flushing the affected area with
large volumes of tepid water for at least 15-20 minutes. Neutralization agents should be avoided as
they can generate exothermic reactions that cause further thermal injury. Fluid resuscitation is
important but secondary to decontamination.
11. A 45-year-old male presents with sudden onset of severe chest pain radiating to his back,
described as a "tearing" sensation. His blood pressure is 110/60 mmHg in the right arm and 90/50
mmHg in the left arm. These findings are most consistent with which of the following?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C. Aortic dissection
Rationale: Aortic dissection classically presents with abrupt, severe "tearing" chest pain that may
radiate to the back. A significant finding is a difference in blood pressure between arms (often >20
mmHg systolic). This suggests a dissection involving the aortic arch and compromise of the subclavian
artery. AMI pain is typically crushing or pressure-like, PE pain is often pleuritic, and pericarditis pain is
usually positional.
12. Which of the following electrocardiogram (ECG) findings is most characteristic of pericarditis?
A. ST-segment elevation in all leads except aVR
B. Deep Q waves in leads II, III, and aVF
C. ST-segment depression with tall T waves
D. Narrow, peaked T waves
Correct Answer: A. ST-segment elevation in all leads except aVR
Rationale: Acute pericarditis is characterized by diffuse ST-segment elevation (concave upward) in
most leads, with reciprocal ST depression in lead aVR and sometimes V1. Deep Q waves are indicative
of a prior myocardial infarction. ST depression and tall T waves can be seen in hyperkalemia, and
narrow peaked T waves are not a classic pericarditis finding.
13. A triage nurse is assessing an adult patient. The patient has a respiratory rate of 28 breaths per
minute, heart rate of 110 bpm, and is confused. Which triage color would the nurse assign to this
patient based on these findings?
A. Green (Minor)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Deceased/Expectant)
Correct Answer: C. Red (Immediate)
VERIFIED ANSWERS | 2026–2027 LATEST UPDATE |
GUARANTEED PASS | DETAILED RATIONALES | FULL STUDY
GUIDE | EXAM PREP | PRACTICE TEST | CERTIFICATION
PREPARATION
Section One: Questions 1–100
1. A patient is brought to the emergency department following a motor vehicle collision. They are
disoriented, with a blood pressure of 88/52 mmHg, heart rate of 122 bpm, and respirations of
28/min. Jugular veins are distended, and breath sounds are diminished on the left side. What is
the priority intervention?
A. Insertion of a nasogastric tube
B. Needle decompression of the left chest
C. Administration of a fluid bolus of 0.9% normal saline
D. Placement of a peripheral intravenous line
Correct Answer: B. Needle decompression of the left chest
Rationale: The patient is exhibiting signs of a tension pneumothorax: hypotension, tachycardia,
distended neck veins (indicating impaired venous return), and diminished breath sounds. This is a life-
threatening condition requiring immediate needle decompression to relieve intrapleural pressure.
While fluid resuscitation and IV access are important, they are secondary to addressing the
immediate airway, breathing, and circulation threat posed by the tension pneumothorax. A
nasogastric tube does not address this critical issue.
2. Which of the following findings is the most sensitive indicator of shock in a pediatric patient?
A. Hypotension
B. Tachycardia
C. Decreased urine output
D. Narrowed pulse pressure
Correct Answer: B. Tachycardia
Rationale: In pediatric patients, compensatory mechanisms are robust, and hypotension is a late and
ominous sign of shock. Tachycardia is the earliest and most sensitive indicator of hemodynamic
instability in children. While decreased urine output and narrowed pulse pressure are also signs of
shock, they are not as early or sensitive as an elevated heart rate.
3. A nurse is preparing to administer 50 mEq of sodium bicarbonate to a patient in cardiac arrest.
The medication is supplied in a 50 mEq/50 mL syringe. The patient's current IV is infusing lactated
Ringer's at 100 mL/hr. What is the nurse's best action?
A. Administer the sodium bicarbonate through the IV line after stopping the lactated Ringer's
B. Flush the IV line with 10 mL of 0.9% normal saline before administering the sodium bicarbonate
C. Administer the sodium bicarbonate via a separate IV site
D. Administer the sodium bicarbonate through the existing IV line without any further action
Correct Answer: A. Administer the sodium bicarbonate through the IV line after stopping the
lactated Ringer's
,Rationale: Sodium bicarbonate is incompatible with lactated Ringer's (LR) solution and can cause
precipitation. The nurse must stop the LR infusion, flush the line with a compatible solution (like
normal saline), administer the sodium bicarbonate, and then resume the LR if ordered. Giving it via a
separate site or through the same line without stopping the LR could lead to a precipitate formation
and a significant adverse event.
4. A patient presents with a severe headache, nausea, and photophobia. A lumbar puncture is
performed, and the cerebrospinal fluid (CSF) appears cloudy and is under elevated pressure. Which
of the following results would be most indicative of a bacterial, rather than viral, meningitis?
A. Elevated protein level
B. Normal glucose level
C. Predominance of lymphocytes
D. Positive Gram stain
Correct Answer: D. Positive Gram stain
Rationale: A positive Gram stain confirms the presence of bacteria in the CSF, which is diagnostic of
bacterial meningitis. While elevated protein and low glucose are classic findings, they are not as
definitive as visualizing the causative organism. Viral meningitis typically presents with a
predominance of lymphocytes, whereas bacterial meningitis usually shows a predominance of
neutrophils.
5. A trauma patient is being evaluated for a potential pelvic fracture. Which of the following
assessment findings would be a classic indicator of a severe pelvic ring injury?
A. Pain on palpation of the iliac crest
B. Leg-length discrepancy
C. A boggy mass on rectal examination
D. Macroscopic hematuria
Correct Answer: C. A boggy mass on rectal examination
Rationale: A boggy mass on rectal exam is a classic indicator of a retroperitoneal hematoma, which is
a serious complication of pelvic fractures. While the other options can be associated with pelvic
fractures, they are not as specific to the severity or the development of a significant retroperitoneal
bleed. This finding should alert the team to the need for rapid hemorrhage control and possible pelvic
binding.
6. A patient is experiencing a severe anaphylactic reaction after receiving IV contrast. The provider
orders epinephrine 0.3 mg of a 1:1000 solution IM. Which of the following needle lengths and
gauge would be most appropriate for this intramuscular injection?
A. 5/8 inch, 25-gauge
B. 1 inch, 22-gauge
C. 1 ½ inch, 18-gauge
D. 1 inch, 27-gauge
Correct Answer: B. 1 inch, 22-gauge
Rationale: For an IM epinephrine injection in an adult, a needle length of 1 to 1.5 inches is
recommended, with a gauge of 22 or 23. A 22-gauge 1-inch needle is suitable for most adults. A 5/8
inch is typically for subcutaneous injections, 18-gauge is too large, and 27-gauge is too small for a
reliable IM injection, especially in an emergency.
,7. A patient is admitted after a carbon monoxide (CO) poisoning incident. The nurse assesses the
patient for signs of CO toxicity. Which of the following clinical manifestations is most commonly
associated with this condition?
A. Cyanosis
B. Cherry-red skin
C. Tachycardia
D. Bradypnea
Correct Answer: C. Tachycardia
Rationale: Carbon monoxide poisoning causes tissue hypoxia. The body compensates by increasing
the heart rate in an attempt to deliver more oxygen to vital organs. While cherry-red skin is a classic
sign, it is not always present and is often a late finding. Cyanosis is not typically seen in CO poisoning
because the carboxyhemoglobin gives the blood a cherry-red color. Tachypnea, not bradypnea, is
more common.
8. An emergency nurse is caring for a patient with a suspected acute ischemic stroke. The patient's
symptoms began 2 hours ago. Which of the following is an absolute contraindication to the
administration of tissue plasminogen activator (tPA)?
A. Blood pressure of 175/95 mmHg
B. History of a seizure at the onset of symptoms
C. Current use of anticoagulant therapy with a therapeutic INR
D. A non-contrast head CT showing a small area of hypodensity
Correct Answer: C. Current use of anticoagulant therapy with a therapeutic INR
Rationale: The use of anticoagulants with a therapeutic INR (greater than 1.7) is an absolute
contraindication to tPA due to the significantly increased risk of intracerebral hemorrhage. A non-
contrast CT showing a hypodensity may indicate early ischemic changes, but it is a relative
contraindication in some cases. Elevated blood pressure (above 185/110) is a relative
contraindication that must be treated before administration. A seizure at onset can be a relative
contraindication, but it doesn't necessarily rule out tPA.
9. A patient arrives with a penetrating chest wound from a knife. The nurse observes a sucking
sound during inspiration and a wound that is open to the pleural space. What is the most
appropriate immediate intervention?
A. Apply an occlusive dressing taped on three sides
B. Pack the wound with sterile gauze
C. Apply an occlusive dressing taped on all four sides
D. Insert a 14-gauge IV catheter into the chest
Correct Answer: A. Apply an occlusive dressing taped on three sides
Rationale: This is a description of an open pneumothorax ("sucking chest wound"). The immediate
treatment is to apply an occlusive dressing taped on three sides. This acts as a flutter valve, allowing
air to escape during expiration (preventing tension pneumothorax) but preventing air from entering
during inspiration. Taping on all four sides creates a tension pneumothorax. Packing the wound or
inserting a catheter are not the correct first-line interventions.
10. The emergency department is implementing a disaster plan for a chemical spill. A patient
presents with a chemical burn from an acid. Which of the following is the priority action for the
nurse to take?
, A. Apply a neutralization agent to the burned area
B. Cover the burn with a clean, dry dressing
C. Initiate a large-bore IV and fluid resuscitation
D. Remove contaminated clothing and irrigate the skin with copious amounts of water
Correct Answer: D. Remove contaminated clothing and irrigate the skin with copious amounts of
water
Rationale: For a chemical injury, the priority is to remove the offending agent. This is achieved by
immediately removing all contaminated clothing and jewelry and then flushing the affected area with
large volumes of tepid water for at least 15-20 minutes. Neutralization agents should be avoided as
they can generate exothermic reactions that cause further thermal injury. Fluid resuscitation is
important but secondary to decontamination.
11. A 45-year-old male presents with sudden onset of severe chest pain radiating to his back,
described as a "tearing" sensation. His blood pressure is 110/60 mmHg in the right arm and 90/50
mmHg in the left arm. These findings are most consistent with which of the following?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C. Aortic dissection
Rationale: Aortic dissection classically presents with abrupt, severe "tearing" chest pain that may
radiate to the back. A significant finding is a difference in blood pressure between arms (often >20
mmHg systolic). This suggests a dissection involving the aortic arch and compromise of the subclavian
artery. AMI pain is typically crushing or pressure-like, PE pain is often pleuritic, and pericarditis pain is
usually positional.
12. Which of the following electrocardiogram (ECG) findings is most characteristic of pericarditis?
A. ST-segment elevation in all leads except aVR
B. Deep Q waves in leads II, III, and aVF
C. ST-segment depression with tall T waves
D. Narrow, peaked T waves
Correct Answer: A. ST-segment elevation in all leads except aVR
Rationale: Acute pericarditis is characterized by diffuse ST-segment elevation (concave upward) in
most leads, with reciprocal ST depression in lead aVR and sometimes V1. Deep Q waves are indicative
of a prior myocardial infarction. ST depression and tall T waves can be seen in hyperkalemia, and
narrow peaked T waves are not a classic pericarditis finding.
13. A triage nurse is assessing an adult patient. The patient has a respiratory rate of 28 breaths per
minute, heart rate of 110 bpm, and is confused. Which triage color would the nurse assign to this
patient based on these findings?
A. Green (Minor)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Deceased/Expectant)
Correct Answer: C. Red (Immediate)
