PROPHECY EMERGENCY DEPARTMENT RN A EXAM 2026 |
Questions & Answers | Verified Answers | 75 Questions w/
Detailed Rationales | Comprehensive Practice | Pass
Guaranteed - A+ Graded
SECTION 1: TRIAGE AND PRIORITIZATION (Questions 1-8)
Q1: The charge nurse receives four patients simultaneously from EMS. Which patient
should be assigned to the resuscitation bay FIRST?
A. 45-year-old with chest pain, BP 140/90, HR 92, SpO2 96% on room air
B. 68-year-old with altered mental status, glucose 45 mg/dL, GCS 13
C. 22-year-old with ankle deformity after fall, pain 8/10, neurovascular intact
D. 72-year-old with respiratory distress, RR 32, SpO2 84% on room air, unable to speak in
full sentences
Correct Answer: D
Rationale: This patient meets ESI Level 1 criteria (requires immediate life-saving
intervention). Severe respiratory distress with hypoxemia (SpO2 <90%) and inability to
maintain adequate ventilation represents imminent respiratory failure requiring
immediate airway management. Option A is ESI Level 2 (high-risk chest pain). Option B
is ESI Level 2 (altered mental status with correctable cause, but glucose can be treated
quickly). Option C is ESI Level 3 or 4 (stable extremity trauma). The 72-year-old requires
immediate intervention to prevent respiratory arrest.
Q2: Select all that apply: A mass casualty incident occurs with 20 patients. Which
patients would receive a RED tag using the START triage system? (Select all that apply)
,A. Patient with respiratory rate 28, radial pulse absent, follows commands
B. Patient with respiratory rate 8, not breathing after airway positioning
C. Patient with respiratory rate 24, radial pulse present, follows commands
D. Patient with respiratory rate 35, radial pulse present, does not follow commands
E. Patient with respiratory rate 0, breathing after head tilt-chin lift
F. Patient with respiratory rate 18, radial pulse present, follows commands but has
severe leg amputation
Correct Answers: A, D, E
Rationale:
● A (RED): Respiratory rate >30 (or <10) = immediate; absent radial pulse indicates
shock; following commands indicates perfusion to brain but immediate
intervention needed.
● D (RED): Altered mental status (does not follow commands) indicates
inadequate perfusion despite palpable pulse—immediate.
● E (RED): Apneic but breathing after basic airway maneuver = immediate (would
be BLACK if no breathing after maneuver).
● B (BLACK): Apneic and not breathing after positioning = expectant/deceased in
mass casualty.
● C (YELLOW): Delayed—stable vitals, can wait.
● F (YELLOW): Delayed—hemorrhage controlled, stable vitals, can wait for definitive
care.
Q3: Four patients are waiting in the lobby. Which patient should be brought back to a
treatment area FIRST?
A. 25-year-old with sore throat and fever x 3 days, vitals stable
B. 34-year-old with abdominal pain, last meal 6 hours ago, pain 6/10
C. 56-year-old with intermittent chest pressure radiating to left arm, occurring with
exertion, currently pain-free
D. 19-year-old with wrist laceration from glass, bleeding controlled with pressure,
neurovascular intact
Correct Answer: C
,Rationale: This patient has unstable angina or NSTEMI equivalent—high-risk chest pain
with typical radiation pattern and exertional component. Even though currently pain-free,
this represents an ESI Level 2 (high-risk situation) requiring ECG within 10 minutes and
troponins. Option A is ESI Level 4-5 (minor illness). Option B is ESI Level 3 (possible
surgical abdomen but stable). Option D is ESI Level 4 (controlled bleeding, no
neurovascular compromise). Cardiac ischemia takes priority due to risk of progression
to STEMI or sudden death.
Q4: During triage, a patient reports "feeling funny" with mild chest discomfort. Vital
signs: BP 78/50, HR 120, RR 24, SpO2 94%. Skin is cool and diaphoretic. What is the ESI
level?
A. ESI Level 2
B. ESI Level 1
C. ESI Level 3
D. ESI Level 4
Correct Answer: B
Rationale: This patient meets ESI Level 1 criteria: hemodynamic instability (systolic BP
<90 mmHg or MAP <65) with signs of shock (tachycardia, cool diaphoretic skin). The
"feeling funny" description with hypotension suggests cardiogenic shock, massive PE,
or abdominal aortic aneurysm rupture—all requiring immediate resuscitation. ESI Level
1 is assigned when vital signs meet high-risk criteria regardless of presenting
complaint. This patient needs two or more resources and immediate life-saving
interventions (fluids, pressors, ECG, labs).
Q5: Which patient assignment demonstrates appropriate delegation to an LPN/LVN
working in the emergency department?
A. Triage assessment of a patient with abdominal pain
, B. Administration of heparin bolus and drip per protocol for suspected PE
C. Wound cleansing and dressing change for a stable laceration repair
D. Discharge teaching for a patient with new diabetes diagnosis
Correct Answer: C
Rationale: LPN/LVN scope in the ED includes: stable wound care, vital signs, specimen
collection, and assistance with procedures. Triage (Option A) requires RN assessment
skills for acuity determination. Heparin administration (Option B) requires RN judgment
for dosing and monitoring. Discharge teaching (Option D) requires RN-level education
and assessment of understanding. Wound care for a stable, previously assessed
laceration is within LPN scope under RN supervision.
Q6: A disaster occurs and the ED implements surge capacity protocols. Which patient
should be transferred to an alternate care site or discharged first?
A. 28-year-old with closed ankle fracture, splinted, pain controlled, awaiting ortho
consult
B. 45-year-old with chest pain, negative troponins, normal ECG, awaiting stress test
C. 67-year-old with COPD exacerbation, improved on bronchodilators, stable on 2L O2
D. 34-year-old with renal colic, pain controlled, awaiting CT scan
Correct Answer: A
Rationale: Surge capacity requires disposition of non-acute patients to create capacity.
The ankle fracture (Option A) is stable, splinted, and can be safely discharged with
orthopedic follow-up within 24-48 hours. Option B requires cardiac clearance before
discharge (intermediate risk). Option C requires observation for stability off
bronchodilators. Option D requires imaging to rule out other pathology and ensure no
obstruction. Closed fractures without neurovascular compromise are lowest acuity and
appropriate for discharge during surge.
Q7: Three patients arrive simultaneously. In what order should they be seen?
Questions & Answers | Verified Answers | 75 Questions w/
Detailed Rationales | Comprehensive Practice | Pass
Guaranteed - A+ Graded
SECTION 1: TRIAGE AND PRIORITIZATION (Questions 1-8)
Q1: The charge nurse receives four patients simultaneously from EMS. Which patient
should be assigned to the resuscitation bay FIRST?
A. 45-year-old with chest pain, BP 140/90, HR 92, SpO2 96% on room air
B. 68-year-old with altered mental status, glucose 45 mg/dL, GCS 13
C. 22-year-old with ankle deformity after fall, pain 8/10, neurovascular intact
D. 72-year-old with respiratory distress, RR 32, SpO2 84% on room air, unable to speak in
full sentences
Correct Answer: D
Rationale: This patient meets ESI Level 1 criteria (requires immediate life-saving
intervention). Severe respiratory distress with hypoxemia (SpO2 <90%) and inability to
maintain adequate ventilation represents imminent respiratory failure requiring
immediate airway management. Option A is ESI Level 2 (high-risk chest pain). Option B
is ESI Level 2 (altered mental status with correctable cause, but glucose can be treated
quickly). Option C is ESI Level 3 or 4 (stable extremity trauma). The 72-year-old requires
immediate intervention to prevent respiratory arrest.
Q2: Select all that apply: A mass casualty incident occurs with 20 patients. Which
patients would receive a RED tag using the START triage system? (Select all that apply)
,A. Patient with respiratory rate 28, radial pulse absent, follows commands
B. Patient with respiratory rate 8, not breathing after airway positioning
C. Patient with respiratory rate 24, radial pulse present, follows commands
D. Patient with respiratory rate 35, radial pulse present, does not follow commands
E. Patient with respiratory rate 0, breathing after head tilt-chin lift
F. Patient with respiratory rate 18, radial pulse present, follows commands but has
severe leg amputation
Correct Answers: A, D, E
Rationale:
● A (RED): Respiratory rate >30 (or <10) = immediate; absent radial pulse indicates
shock; following commands indicates perfusion to brain but immediate
intervention needed.
● D (RED): Altered mental status (does not follow commands) indicates
inadequate perfusion despite palpable pulse—immediate.
● E (RED): Apneic but breathing after basic airway maneuver = immediate (would
be BLACK if no breathing after maneuver).
● B (BLACK): Apneic and not breathing after positioning = expectant/deceased in
mass casualty.
● C (YELLOW): Delayed—stable vitals, can wait.
● F (YELLOW): Delayed—hemorrhage controlled, stable vitals, can wait for definitive
care.
Q3: Four patients are waiting in the lobby. Which patient should be brought back to a
treatment area FIRST?
A. 25-year-old with sore throat and fever x 3 days, vitals stable
B. 34-year-old with abdominal pain, last meal 6 hours ago, pain 6/10
C. 56-year-old with intermittent chest pressure radiating to left arm, occurring with
exertion, currently pain-free
D. 19-year-old with wrist laceration from glass, bleeding controlled with pressure,
neurovascular intact
Correct Answer: C
,Rationale: This patient has unstable angina or NSTEMI equivalent—high-risk chest pain
with typical radiation pattern and exertional component. Even though currently pain-free,
this represents an ESI Level 2 (high-risk situation) requiring ECG within 10 minutes and
troponins. Option A is ESI Level 4-5 (minor illness). Option B is ESI Level 3 (possible
surgical abdomen but stable). Option D is ESI Level 4 (controlled bleeding, no
neurovascular compromise). Cardiac ischemia takes priority due to risk of progression
to STEMI or sudden death.
Q4: During triage, a patient reports "feeling funny" with mild chest discomfort. Vital
signs: BP 78/50, HR 120, RR 24, SpO2 94%. Skin is cool and diaphoretic. What is the ESI
level?
A. ESI Level 2
B. ESI Level 1
C. ESI Level 3
D. ESI Level 4
Correct Answer: B
Rationale: This patient meets ESI Level 1 criteria: hemodynamic instability (systolic BP
<90 mmHg or MAP <65) with signs of shock (tachycardia, cool diaphoretic skin). The
"feeling funny" description with hypotension suggests cardiogenic shock, massive PE,
or abdominal aortic aneurysm rupture—all requiring immediate resuscitation. ESI Level
1 is assigned when vital signs meet high-risk criteria regardless of presenting
complaint. This patient needs two or more resources and immediate life-saving
interventions (fluids, pressors, ECG, labs).
Q5: Which patient assignment demonstrates appropriate delegation to an LPN/LVN
working in the emergency department?
A. Triage assessment of a patient with abdominal pain
, B. Administration of heparin bolus and drip per protocol for suspected PE
C. Wound cleansing and dressing change for a stable laceration repair
D. Discharge teaching for a patient with new diabetes diagnosis
Correct Answer: C
Rationale: LPN/LVN scope in the ED includes: stable wound care, vital signs, specimen
collection, and assistance with procedures. Triage (Option A) requires RN assessment
skills for acuity determination. Heparin administration (Option B) requires RN judgment
for dosing and monitoring. Discharge teaching (Option D) requires RN-level education
and assessment of understanding. Wound care for a stable, previously assessed
laceration is within LPN scope under RN supervision.
Q6: A disaster occurs and the ED implements surge capacity protocols. Which patient
should be transferred to an alternate care site or discharged first?
A. 28-year-old with closed ankle fracture, splinted, pain controlled, awaiting ortho
consult
B. 45-year-old with chest pain, negative troponins, normal ECG, awaiting stress test
C. 67-year-old with COPD exacerbation, improved on bronchodilators, stable on 2L O2
D. 34-year-old with renal colic, pain controlled, awaiting CT scan
Correct Answer: A
Rationale: Surge capacity requires disposition of non-acute patients to create capacity.
The ankle fracture (Option A) is stable, splinted, and can be safely discharged with
orthopedic follow-up within 24-48 hours. Option B requires cardiac clearance before
discharge (intermediate risk). Option C requires observation for stability off
bronchodilators. Option D requires imaging to rule out other pathology and ensure no
obstruction. Closed fractures without neurovascular compromise are lowest acuity and
appropriate for discharge during surge.
Q7: Three patients arrive simultaneously. In what order should they be seen?
