This comprehensive 350-question practice exam is designed for nurses seeking
competency in Sharp HealthCare's Emergency Standing Orders (ESO). It features 350
unique, multiple-choice questions that systematically cover all critical ESO protocols,
including cardiac arrest algorithms (PEA, V-Fib, Asystole, V-Tach), symptomatic
bradycardia and hypotension management, respiratory distress interventions, anaphylaxis
treatment, status epilepticus, opioid and benzodiazepine reversal, sepsis screening, and
increased ICP protocols. Each question includes a correct answer and a detailed evidence-
based rationale. This resource provides rigorous preparation for the ESO certification
exam by reinforcing clinical decision-making, medication dosages, and proper
documentation in life-threatening emergencies.
SECTION 1: EMERGENCY STANDING ORDERS OVERVIEW AND FOUNDATIONS
1. What is the primary definition of an Emergency Standing Order (ESO) at Sharp
HealthCare?
A) Orders given by a physician over the phone for a non-emergency condition
B) A protocol for routine patient admission assessments
C) Established medical orders to be administered in the absence of a physician
D) A checklist for discharge planning
Answer: C
Rationale: An Emergency Standing Order is a set of pre-established medical orders
approved by medical staff to be implemented in life-threatening situations when a
physician is not immediately available to provide direct orders. These protocols ensure
timely intervention during critical events.
2. An ESO-competent nurse must be proficient in the identification and treatment of what
type of patient conditions?
A) Chronic non-communicable diseases
B) Routine post-operative care needs
C) Life-threatening patient conditions
D) Minor injuries and lacerations
Answer: C
Rationale: ESO competency requires the nurse to have the knowledge to identify and treat
life-threatening conditions, as these are the only scenarios where an ESO is initiated. The
protocols are specifically designed for emergencies such as cardiac arrest, respiratory
failure, and severe hemodynamic instability.
,3. When initiating an ESO, what is the first step a nurse should take in notifying a patient's
physician?
A) Send a secure text message to the physician
B) Call the physician directly
C) Call a Code Blue or the Rapid Response Team (RRT)
D) Document the intervention in the patient's chart
Answer: C
Rationale: The proper sequence for physician notification begins with activating the
emergency response system by calling Code Blue or the Rapid Response Team (RRT) first,
before contacting the patient's primary provider. This ensures immediate life-saving
resources are deployed while notification occurs concurrently.
4. What is an essential piece of equipment that the Rapid Response Team (RRT) brings to
the bedside?
A) A portable ultrasound machine
B) A critical care cart
C) A portable X-ray machine
D) A defibrillator
Answer: B
Rationale: The RRT brings critical care equipment to the bedside, which includes all
necessary supplies for advanced life support interventions. The critical care cart contains
airway equipment, resuscitation medications, intravenous supplies, and monitoring devices
essential for emergency management.
5. What does ETCO2 (end-tidal carbon dioxide) monitoring primarily reflect during CPR?
A) The patient's oxygen saturation level
B) The effectiveness of chest compressions and cardiac output
C) The patient's neurological status
D) The blood pressure
Answer: B
Rationale: ETCO2 is a valuable indicator of cardiac output during CPR. The measurement
reflects the amount of CO2 being exhaled, which correlates with the effectiveness of chest
compressions and the return of spontaneous circulation (ROSC). An ETCO2 value greater
than 10 mmHg during CPR suggests adequate compression quality.
6. What is the target temperature range for therapeutic hypothermia per Sharp ESO
protocol?
A) 28 to 32 degrees Celsius
B) 32 to 36 degrees Celsius
C) 36 to 38 degrees Celsius
D) 38 to 40 degrees Celsius
Answer: B
Rationale: Therapeutic hypothermia is performed within a temperature range of 32 to 36
degrees Celsius, as per the ESO protocol. This targeted temperature management helps
,reduce neurological injury following cardiac arrest by decreasing cerebral metabolic
demand and inflammatory response.
7. When should therapeutic hypothermia be considered for a patient after ROSC?
A) Immediately upon return of spontaneous circulation
B) If the patient is not following commands or showing purposeful movement within 120
minutes after ROSC
C) Only if the patient has a fever
D) If the patient is awake and alert
Answer: B
Rationale: Therapeutic hypothermia is indicated for patients who are not following
commands or showing purposeful movement within 120 minutes after the return of
spontaneous circulation (ROSC). This window allows for stabilization and appropriate
patient selection for the neuroprotective therapy.
8. What are the "H's and T's" assessed for in a PEA (Pulseless Electrical Activity) arrest?
A) To determine the patient's past medical history
B) To identify reversible causes of cardiac arrest
C) To check the patient's vital signs
D) To assess the patient's neurological status
Answer: B
Rationale: The H's (Hypovolemia, Hypoxia, Hydrogen ion/acidosis, Hypo/Hyperkalemia,
Hypoglycemia, Hypothermia) and T's (Toxins, Tamponade, Thrombosis, Trauma, Tension
pneumothorax) are a mnemonic used to identify and treat reversible causes of PEA and
asystole. Addressing these underlying causes is essential for successful resuscitation.
9. What is the maximum dose of Atropine that can be administered for symptomatic
bradycardia per ESO?
A) 1 mg
B) 2 mg
C) 3 mg
D) 4 mg
Answer: C
Rationale: For symptomatic bradycardia, the ESO protocol allows for Atropine 0.5 mg
IV/P/IO every 3-5 minutes, up to a maximum total dose of 3 mg (or 0.04 mg/kg). Doses
beyond this maximum are unlikely to provide additional benefit and may cause adverse
effects.
10. If transcutaneous pacing is not available for a patient with symptomatic bradycardia,
what medication can be started?
A) Amiodarone
B) Adenosine
C) Dopamine
D) Epinephrine
Answer: C
, Rationale: If pacing is ineffective or unavailable after Atropine administration, a
Dopamine infusion can be initiated at 5 mcg/kg/min and titrated to response up to 20
mcg/kg/min. Dopamine provides inotropic and chronotropic support to increase heart rate
and blood pressure.
11. What is the starting dose for a Dopamine infusion in the treatment of symptomatic
bradycardia or symptomatic hypotension?
A) 2 mcg/kg/min
B) 5 mcg/kg/min
C) 10 mcg/kg/min
D) 20 mcg/kg/min
Answer: B
Rationale: The Dopamine infusion is typically started at 5 mcg/kg/min and titrated up to
a maximum of 20 mcg/kg/min to achieve the desired effect (e.g., SBP >90 mmHg or
MAP >60 mmHg). Starting at a lower dose allows for careful titration while monitoring
hemodynamic response.
12. What is the reversal agent for Vensed (Midazolam)?
A) Narcan (Naloxone)
B) Romazicon (Flumazenil)
C) Atropine
D) Epinephrine
Answer: B
Rationale: Romazicon (Flumazenil) is a specific benzodiazepine antagonist used to reverse
the effects of Vensed, a benzodiazepine. It competitively inhibits the benzodiazepine
binding site on the GABA receptor complex, rapidly reversing sedation and respiratory
depression.
13. What is the recommended dose of Romazicon for reversing benzodiazepine-induced
respiratory depression?
A) 0.1 mg IVP, with a max of 0.4 mg
B) 0.2 mg IVP over 15 seconds, can be repeated up to a max of 0.6 mg
C) 1 mg IVP
D) 2 mg IVP
Answer: B
Rationale: The recommended dose of Romazicon (Flumazenil) is 0.2 mg IVP over 15
seconds, which can be repeated up to a maximum total dose of 0.6 mg. This dosing
strategy allows for gradual reversal while minimizing the risk of acute withdrawal
symptoms in benzodiazepine-dependent patients.
14. What is the reversal agent for opioid-induced respiratory depression?
A) Romazicon (Flumazenil)
B) Narcan (Naloxone)
C) Atropine
D) Epinephrine
competency in Sharp HealthCare's Emergency Standing Orders (ESO). It features 350
unique, multiple-choice questions that systematically cover all critical ESO protocols,
including cardiac arrest algorithms (PEA, V-Fib, Asystole, V-Tach), symptomatic
bradycardia and hypotension management, respiratory distress interventions, anaphylaxis
treatment, status epilepticus, opioid and benzodiazepine reversal, sepsis screening, and
increased ICP protocols. Each question includes a correct answer and a detailed evidence-
based rationale. This resource provides rigorous preparation for the ESO certification
exam by reinforcing clinical decision-making, medication dosages, and proper
documentation in life-threatening emergencies.
SECTION 1: EMERGENCY STANDING ORDERS OVERVIEW AND FOUNDATIONS
1. What is the primary definition of an Emergency Standing Order (ESO) at Sharp
HealthCare?
A) Orders given by a physician over the phone for a non-emergency condition
B) A protocol for routine patient admission assessments
C) Established medical orders to be administered in the absence of a physician
D) A checklist for discharge planning
Answer: C
Rationale: An Emergency Standing Order is a set of pre-established medical orders
approved by medical staff to be implemented in life-threatening situations when a
physician is not immediately available to provide direct orders. These protocols ensure
timely intervention during critical events.
2. An ESO-competent nurse must be proficient in the identification and treatment of what
type of patient conditions?
A) Chronic non-communicable diseases
B) Routine post-operative care needs
C) Life-threatening patient conditions
D) Minor injuries and lacerations
Answer: C
Rationale: ESO competency requires the nurse to have the knowledge to identify and treat
life-threatening conditions, as these are the only scenarios where an ESO is initiated. The
protocols are specifically designed for emergencies such as cardiac arrest, respiratory
failure, and severe hemodynamic instability.
,3. When initiating an ESO, what is the first step a nurse should take in notifying a patient's
physician?
A) Send a secure text message to the physician
B) Call the physician directly
C) Call a Code Blue or the Rapid Response Team (RRT)
D) Document the intervention in the patient's chart
Answer: C
Rationale: The proper sequence for physician notification begins with activating the
emergency response system by calling Code Blue or the Rapid Response Team (RRT) first,
before contacting the patient's primary provider. This ensures immediate life-saving
resources are deployed while notification occurs concurrently.
4. What is an essential piece of equipment that the Rapid Response Team (RRT) brings to
the bedside?
A) A portable ultrasound machine
B) A critical care cart
C) A portable X-ray machine
D) A defibrillator
Answer: B
Rationale: The RRT brings critical care equipment to the bedside, which includes all
necessary supplies for advanced life support interventions. The critical care cart contains
airway equipment, resuscitation medications, intravenous supplies, and monitoring devices
essential for emergency management.
5. What does ETCO2 (end-tidal carbon dioxide) monitoring primarily reflect during CPR?
A) The patient's oxygen saturation level
B) The effectiveness of chest compressions and cardiac output
C) The patient's neurological status
D) The blood pressure
Answer: B
Rationale: ETCO2 is a valuable indicator of cardiac output during CPR. The measurement
reflects the amount of CO2 being exhaled, which correlates with the effectiveness of chest
compressions and the return of spontaneous circulation (ROSC). An ETCO2 value greater
than 10 mmHg during CPR suggests adequate compression quality.
6. What is the target temperature range for therapeutic hypothermia per Sharp ESO
protocol?
A) 28 to 32 degrees Celsius
B) 32 to 36 degrees Celsius
C) 36 to 38 degrees Celsius
D) 38 to 40 degrees Celsius
Answer: B
Rationale: Therapeutic hypothermia is performed within a temperature range of 32 to 36
degrees Celsius, as per the ESO protocol. This targeted temperature management helps
,reduce neurological injury following cardiac arrest by decreasing cerebral metabolic
demand and inflammatory response.
7. When should therapeutic hypothermia be considered for a patient after ROSC?
A) Immediately upon return of spontaneous circulation
B) If the patient is not following commands or showing purposeful movement within 120
minutes after ROSC
C) Only if the patient has a fever
D) If the patient is awake and alert
Answer: B
Rationale: Therapeutic hypothermia is indicated for patients who are not following
commands or showing purposeful movement within 120 minutes after the return of
spontaneous circulation (ROSC). This window allows for stabilization and appropriate
patient selection for the neuroprotective therapy.
8. What are the "H's and T's" assessed for in a PEA (Pulseless Electrical Activity) arrest?
A) To determine the patient's past medical history
B) To identify reversible causes of cardiac arrest
C) To check the patient's vital signs
D) To assess the patient's neurological status
Answer: B
Rationale: The H's (Hypovolemia, Hypoxia, Hydrogen ion/acidosis, Hypo/Hyperkalemia,
Hypoglycemia, Hypothermia) and T's (Toxins, Tamponade, Thrombosis, Trauma, Tension
pneumothorax) are a mnemonic used to identify and treat reversible causes of PEA and
asystole. Addressing these underlying causes is essential for successful resuscitation.
9. What is the maximum dose of Atropine that can be administered for symptomatic
bradycardia per ESO?
A) 1 mg
B) 2 mg
C) 3 mg
D) 4 mg
Answer: C
Rationale: For symptomatic bradycardia, the ESO protocol allows for Atropine 0.5 mg
IV/P/IO every 3-5 minutes, up to a maximum total dose of 3 mg (or 0.04 mg/kg). Doses
beyond this maximum are unlikely to provide additional benefit and may cause adverse
effects.
10. If transcutaneous pacing is not available for a patient with symptomatic bradycardia,
what medication can be started?
A) Amiodarone
B) Adenosine
C) Dopamine
D) Epinephrine
Answer: C
, Rationale: If pacing is ineffective or unavailable after Atropine administration, a
Dopamine infusion can be initiated at 5 mcg/kg/min and titrated to response up to 20
mcg/kg/min. Dopamine provides inotropic and chronotropic support to increase heart rate
and blood pressure.
11. What is the starting dose for a Dopamine infusion in the treatment of symptomatic
bradycardia or symptomatic hypotension?
A) 2 mcg/kg/min
B) 5 mcg/kg/min
C) 10 mcg/kg/min
D) 20 mcg/kg/min
Answer: B
Rationale: The Dopamine infusion is typically started at 5 mcg/kg/min and titrated up to
a maximum of 20 mcg/kg/min to achieve the desired effect (e.g., SBP >90 mmHg or
MAP >60 mmHg). Starting at a lower dose allows for careful titration while monitoring
hemodynamic response.
12. What is the reversal agent for Vensed (Midazolam)?
A) Narcan (Naloxone)
B) Romazicon (Flumazenil)
C) Atropine
D) Epinephrine
Answer: B
Rationale: Romazicon (Flumazenil) is a specific benzodiazepine antagonist used to reverse
the effects of Vensed, a benzodiazepine. It competitively inhibits the benzodiazepine
binding site on the GABA receptor complex, rapidly reversing sedation and respiratory
depression.
13. What is the recommended dose of Romazicon for reversing benzodiazepine-induced
respiratory depression?
A) 0.1 mg IVP, with a max of 0.4 mg
B) 0.2 mg IVP over 15 seconds, can be repeated up to a max of 0.6 mg
C) 1 mg IVP
D) 2 mg IVP
Answer: B
Rationale: The recommended dose of Romazicon (Flumazenil) is 0.2 mg IVP over 15
seconds, which can be repeated up to a maximum total dose of 0.6 mg. This dosing
strategy allows for gradual reversal while minimizing the risk of acute withdrawal
symptoms in benzodiazepine-dependent patients.
14. What is the reversal agent for opioid-induced respiratory depression?
A) Romazicon (Flumazenil)
B) Narcan (Naloxone)
C) Atropine
D) Epinephrine
