NUR 208 EMERGENCY NURSING COMPREHENSIVE GUIDE
Q&A 2026 EDITION
1. A 45-year-old male arrives at the emergency department (ED)
with severe chest pain, diaphoresis, and shortness of breath. His
ECG shows ST-segment elevation in leads II, III, and aVF. Which
intervention should the emergency nurse prioritize?
A. Administer sublingual nitroglycerin
B. Establish IV access and prepare for reperfusion therapy
C. Administer aspirin 325 mg chewed
D. Obtain a 12-lead ECG confirmation
Correct Answer: B
Explanation: ST elevation in inferior leads (II, III, aVF) indicates an
inferior STEMI requiring immediate reperfusion (PCI or
thrombolytics). While aspirin and nitroglycerin are important,
establishing IV access and preparing for reperfusion is the highest
priority. ECG is already done.
2. A 28-year-old female presents with anaphylaxis after eating
peanuts. She has stridor, hypotension (BP 80/50), and urticaria.
What is the FIRST medication the nurse should administer?
A. Diphenhydramine 50 mg IV
B. Epinephrine 0.3 mg IM in the lateral thigh
C. Albuterol nebulizer treatment
D. Methylprednisolone 125 mg IV
Correct Answer: B
Explanation: Epinephrine IM is the first-line treatment for
anaphylaxis and should be given immediately. Antihistamines and
, steroids are adjunctive but do not reverse airway obstruction or
hypotension. Delaying epinephrine increases mortality risk.
3. During trauma resuscitation of a 35-year-old male with blunt
abdominal trauma, the patient becomes hypotensive with a
distended abdomen. FAST exam is positive. What is the most
appropriate next step?
A. Administer 2L crystalloid bolus
B. Prepare for emergent laparotomy
C. Obtain CT scan of the abdomen
D. Insert Foley catheter
Correct Answer: B
Explanation: Positive FAST with hemodynamic instability indicates
intra-abdominal hemorrhage requiring emergent surgical
intervention. Fluid resuscitation should be limited per damage
control resuscitation principles. CT is contraindicated in unstable
patients.
4. A 67-year-old with COPD presents with severe respiratory distress.
ABG shows pH 7.25, PaCO2 68 mmHg, PaO2 52 mmHg, HCO3 29
mEq/L. What type of acid-base disturbance is present?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Acute respiratory acidosis with partial compensation
D. Metabolic alkalosis
Correct Answer: C
Explanation: Low pH + elevated PaCO2 indicates respiratory
, acidosis. Elevated HCO3 suggests some renal compensation
(chronic COPD), but pH remains acidic indicating acute-on-chronic
process. This is acute respiratory acidosis with partial
compensation.
5. A 22-year-old male sustains a gunshot wound to the chest. He has
tracheal deviation to the left, absent breath sounds on the right,
and hypotension. What is the priority intervention?
A. Administer 100% oxygen
B. Perform immediate needle decompression on the right side
C. Insert chest tube on the left side
D. Obtain chest X-ray
Correct Answer: B
Explanation: Classic signs of tension pneumothorax (tracheal
deviation, absent breath sounds, hypotension) require immediate
needle decompression before chest tube placement. This is a life-
saving intervention that cannot wait for imaging.
6. A patient presents with a serum potassium level of 6.8 mEq/L and
peaked T-waves on ECG. Which medication should the nurse
administer FIRST to stabilize the cardiac membrane?
A. Insulin 10 units IV with dextrose
B. Sodium bicarbonate 50 mEq IV
C. Calcium gluconate 10 mL of 10% solution IV
D. Albuterol nebulizer
Correct Answer: C
Explanation: Calcium gluconate stabilizes cardiac membranes
, within minutes and is the first priority in severe hyperkalemia with
ECG changes. Insulin/dextrose, bicarbonate, and albuterol shift
potassium intracellularly but take longer to work.
7. A 55-year-old female presents with sudden onset severe headache
described as "the worst headache of my life." CT head is negative.
What is the next diagnostic test the nurse should anticipate?
A. MRI brain
B. Lumbar puncture
C. EEG
D. CT venogram
Correct Answer: B
Explanation: Classic presentation of subarachnoid hemorrhage
with negative CT requires lumbar puncture to detect
xanthochromia or RBCs. This is the standard diagnostic algorithm
for suspected SAH when CT is negative.
8. A burn victim with 40% total body surface area (TBSA) burns
arrives at the ED. Using the Parkland formula (4 mL × kg × %TBSA),
how much fluid should be administered in the first 8 hours for a
70 kg patient?
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 8,400 mL
Correct Answer: A
Explanation: Parkland formula: 4 mL × 70 kg × 40% = 11,200 mL
Q&A 2026 EDITION
1. A 45-year-old male arrives at the emergency department (ED)
with severe chest pain, diaphoresis, and shortness of breath. His
ECG shows ST-segment elevation in leads II, III, and aVF. Which
intervention should the emergency nurse prioritize?
A. Administer sublingual nitroglycerin
B. Establish IV access and prepare for reperfusion therapy
C. Administer aspirin 325 mg chewed
D. Obtain a 12-lead ECG confirmation
Correct Answer: B
Explanation: ST elevation in inferior leads (II, III, aVF) indicates an
inferior STEMI requiring immediate reperfusion (PCI or
thrombolytics). While aspirin and nitroglycerin are important,
establishing IV access and preparing for reperfusion is the highest
priority. ECG is already done.
2. A 28-year-old female presents with anaphylaxis after eating
peanuts. She has stridor, hypotension (BP 80/50), and urticaria.
What is the FIRST medication the nurse should administer?
A. Diphenhydramine 50 mg IV
B. Epinephrine 0.3 mg IM in the lateral thigh
C. Albuterol nebulizer treatment
D. Methylprednisolone 125 mg IV
Correct Answer: B
Explanation: Epinephrine IM is the first-line treatment for
anaphylaxis and should be given immediately. Antihistamines and
, steroids are adjunctive but do not reverse airway obstruction or
hypotension. Delaying epinephrine increases mortality risk.
3. During trauma resuscitation of a 35-year-old male with blunt
abdominal trauma, the patient becomes hypotensive with a
distended abdomen. FAST exam is positive. What is the most
appropriate next step?
A. Administer 2L crystalloid bolus
B. Prepare for emergent laparotomy
C. Obtain CT scan of the abdomen
D. Insert Foley catheter
Correct Answer: B
Explanation: Positive FAST with hemodynamic instability indicates
intra-abdominal hemorrhage requiring emergent surgical
intervention. Fluid resuscitation should be limited per damage
control resuscitation principles. CT is contraindicated in unstable
patients.
4. A 67-year-old with COPD presents with severe respiratory distress.
ABG shows pH 7.25, PaCO2 68 mmHg, PaO2 52 mmHg, HCO3 29
mEq/L. What type of acid-base disturbance is present?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Acute respiratory acidosis with partial compensation
D. Metabolic alkalosis
Correct Answer: C
Explanation: Low pH + elevated PaCO2 indicates respiratory
, acidosis. Elevated HCO3 suggests some renal compensation
(chronic COPD), but pH remains acidic indicating acute-on-chronic
process. This is acute respiratory acidosis with partial
compensation.
5. A 22-year-old male sustains a gunshot wound to the chest. He has
tracheal deviation to the left, absent breath sounds on the right,
and hypotension. What is the priority intervention?
A. Administer 100% oxygen
B. Perform immediate needle decompression on the right side
C. Insert chest tube on the left side
D. Obtain chest X-ray
Correct Answer: B
Explanation: Classic signs of tension pneumothorax (tracheal
deviation, absent breath sounds, hypotension) require immediate
needle decompression before chest tube placement. This is a life-
saving intervention that cannot wait for imaging.
6. A patient presents with a serum potassium level of 6.8 mEq/L and
peaked T-waves on ECG. Which medication should the nurse
administer FIRST to stabilize the cardiac membrane?
A. Insulin 10 units IV with dextrose
B. Sodium bicarbonate 50 mEq IV
C. Calcium gluconate 10 mL of 10% solution IV
D. Albuterol nebulizer
Correct Answer: C
Explanation: Calcium gluconate stabilizes cardiac membranes
, within minutes and is the first priority in severe hyperkalemia with
ECG changes. Insulin/dextrose, bicarbonate, and albuterol shift
potassium intracellularly but take longer to work.
7. A 55-year-old female presents with sudden onset severe headache
described as "the worst headache of my life." CT head is negative.
What is the next diagnostic test the nurse should anticipate?
A. MRI brain
B. Lumbar puncture
C. EEG
D. CT venogram
Correct Answer: B
Explanation: Classic presentation of subarachnoid hemorrhage
with negative CT requires lumbar puncture to detect
xanthochromia or RBCs. This is the standard diagnostic algorithm
for suspected SAH when CT is negative.
8. A burn victim with 40% total body surface area (TBSA) burns
arrives at the ED. Using the Parkland formula (4 mL × kg × %TBSA),
how much fluid should be administered in the first 8 hours for a
70 kg patient?
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 8,400 mL
Correct Answer: A
Explanation: Parkland formula: 4 mL × 70 kg × 40% = 11,200 mL
