ENA TRIAGE EXAM
Questions with Answers| Latest Update
Based on the ENA Emergency Severity Index (ESI) Handbook, 5th Edition
(Version 5)
1. How many acuity levels does the Emergency Severity Index (ESI)
use, and which level is the most urgent?
A. Three levels; level 3 is the most urgent
B. Five levels; level 1 is the most urgent
C. Four levels; level 4 is the most urgent
D. Five levels; level 5 is the most urgent
Answer: B. Five levels; level 1 is the most urgent
Rationale: The ESI sorts patients into five groups, from level 1 (most
urgent) to level 5 (least urgent) (ESI Handbook v5, Chapters 1 and 2).
2. In the ESI algorithm, which factor separates levels 3, 4, and 5 once
levels 1 and 2 have been ruled out?
A. The patient’s reported pain score
B. The patient’s age
C. The number of different types of resources the patient is expected to
need to reach a disposition
D. How long the patient has already waited
Answer: C. The number of different types of resources the patient is
expected to need to reach a disposition
Rationale: Decision point C is used only for patients who are
physiologically stable with low risk of deterioration. Two or more
resources = level 3, one resource = level 4, no resources = level 5
(Chapter 5).
ENA Triage Practice Exam (ESI v5) | Page 1
,3. The Emergency Severity Index was originally conceived in 1998 by:
A. Emergency physicians Richard Wuerz and David Eitel
B. A committee of flight nurses developing military casualty sorting
C. The American Heart Association’s emergency cardiovascular care
committee
D. The Joint Commission’s patient safety task force
Answer: A. Emergency physicians Richard Wuerz and David Eitel
Rationale: The Preface credits Wuerz and Eitel with the original concept.
ENA became the owner of the ESI in 2019.
4. Which decision point alone is enough to assign ESI level 1?
A. Decision point B: Is this a high-risk situation?
B. Decision point A: Does the patient require immediate lifesaving
intervention?
C. Decision point C: How many resources will the patient need?
D. Decision point D: Are the vital signs high risk?
Answer: B. Decision point A: Does the patient require immediate
lifesaving intervention?
Rationale: Decision point A is the only one needed for ESI level-1
patients, who are defined by the need for immediate lifesaving
intervention (Chapter 2).
ENA Triage Practice Exam (ESI v5) | Page 2
, 5. Which sequence correctly lists the four ESI decision points, in order?
A. A: How many resources? B: Lifesaving intervention needed? C: High-
risk situation? D: High-risk vital signs?
B. A: High-risk vital signs? B: Lifesaving intervention needed? C: How
many resources? D: High-risk situation?
C. A: Lifesaving intervention needed? B: High-risk situation,
confused/lethargic/disoriented, or severe pain/distress? C: How many
resources? D: High-risk vital signs?
D. A: High-risk situation? B: Lifesaving intervention needed? C: High-risk
vital signs? D: How many resources?
Answer: C. A: Lifesaving intervention needed? B: High-risk situation,
confused/lethargic/disoriented, or severe pain/distress? C: How
many resources? D: High-risk vital signs?
Rationale: The decision points must be performed in order, although
higher-acuity patients will need only one or two of them (Chapter 2).
6. Compared with the Canadian Triage and Acuity Scale, the
Australasian Triage Scale, and the Manchester Triage System, the
ESI:
A. Assigns a maximum wait of 10 minutes to every level 2 patient
B. Defines a maximum wait of 60 minutes for level 3 patients
C. Does not define expected time intervals to physician evaluation
D. Is designed only for pediatric patients
Answer: C. Does not define expected time intervals to physician
evaluation
Rationale: Chapter 1 states this is a major difference: the other scales
use the triage decision to set how long a patient can wait, while the ESI
does not define time to physician evaluation.
ENA Triage Practice Exam (ESI v5) | Page 3
Questions with Answers| Latest Update
Based on the ENA Emergency Severity Index (ESI) Handbook, 5th Edition
(Version 5)
1. How many acuity levels does the Emergency Severity Index (ESI)
use, and which level is the most urgent?
A. Three levels; level 3 is the most urgent
B. Five levels; level 1 is the most urgent
C. Four levels; level 4 is the most urgent
D. Five levels; level 5 is the most urgent
Answer: B. Five levels; level 1 is the most urgent
Rationale: The ESI sorts patients into five groups, from level 1 (most
urgent) to level 5 (least urgent) (ESI Handbook v5, Chapters 1 and 2).
2. In the ESI algorithm, which factor separates levels 3, 4, and 5 once
levels 1 and 2 have been ruled out?
A. The patient’s reported pain score
B. The patient’s age
C. The number of different types of resources the patient is expected to
need to reach a disposition
D. How long the patient has already waited
Answer: C. The number of different types of resources the patient is
expected to need to reach a disposition
Rationale: Decision point C is used only for patients who are
physiologically stable with low risk of deterioration. Two or more
resources = level 3, one resource = level 4, no resources = level 5
(Chapter 5).
ENA Triage Practice Exam (ESI v5) | Page 1
,3. The Emergency Severity Index was originally conceived in 1998 by:
A. Emergency physicians Richard Wuerz and David Eitel
B. A committee of flight nurses developing military casualty sorting
C. The American Heart Association’s emergency cardiovascular care
committee
D. The Joint Commission’s patient safety task force
Answer: A. Emergency physicians Richard Wuerz and David Eitel
Rationale: The Preface credits Wuerz and Eitel with the original concept.
ENA became the owner of the ESI in 2019.
4. Which decision point alone is enough to assign ESI level 1?
A. Decision point B: Is this a high-risk situation?
B. Decision point A: Does the patient require immediate lifesaving
intervention?
C. Decision point C: How many resources will the patient need?
D. Decision point D: Are the vital signs high risk?
Answer: B. Decision point A: Does the patient require immediate
lifesaving intervention?
Rationale: Decision point A is the only one needed for ESI level-1
patients, who are defined by the need for immediate lifesaving
intervention (Chapter 2).
ENA Triage Practice Exam (ESI v5) | Page 2
, 5. Which sequence correctly lists the four ESI decision points, in order?
A. A: How many resources? B: Lifesaving intervention needed? C: High-
risk situation? D: High-risk vital signs?
B. A: High-risk vital signs? B: Lifesaving intervention needed? C: How
many resources? D: High-risk situation?
C. A: Lifesaving intervention needed? B: High-risk situation,
confused/lethargic/disoriented, or severe pain/distress? C: How many
resources? D: High-risk vital signs?
D. A: High-risk situation? B: Lifesaving intervention needed? C: High-risk
vital signs? D: How many resources?
Answer: C. A: Lifesaving intervention needed? B: High-risk situation,
confused/lethargic/disoriented, or severe pain/distress? C: How
many resources? D: High-risk vital signs?
Rationale: The decision points must be performed in order, although
higher-acuity patients will need only one or two of them (Chapter 2).
6. Compared with the Canadian Triage and Acuity Scale, the
Australasian Triage Scale, and the Manchester Triage System, the
ESI:
A. Assigns a maximum wait of 10 minutes to every level 2 patient
B. Defines a maximum wait of 60 minutes for level 3 patients
C. Does not define expected time intervals to physician evaluation
D. Is designed only for pediatric patients
Answer: C. Does not define expected time intervals to physician
evaluation
Rationale: Chapter 1 states this is a major difference: the other scales
use the triage decision to set how long a patient can wait, while the ESI
does not define time to physician evaluation.
ENA Triage Practice Exam (ESI v5) | Page 3
