ENA CCC: Triage 2025/2026 Exam
Questions and Verified Answers |
Already Graded A+
During triage, the nurse should perform which action first for a patient who
presents after a fall?
A. Perform electrocardiography.
B. Obtain a set of vital signs.
C. Use protocol orders to obtain the appropriate radiograph.
D. Determine what caused the fall. - 🧠ANSWER ✔✔D. Determine what
caused the fall.
Although the triage nurse may perform all of these actions, the priority is to
determine why the patient fell. A patient who fell because of syncope
requires different treatment than a patient who tripped over a bump in the
sidewalk. The patient who tripped is not likely to need electrocardiography.
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1
,Which individual could qualify to be a triage nurse?
A. A new graduate who was a paramedic for several years
B. An experienced nurse who has just transferred from a medical unit
C. A nurse with 1 year of experience in emergency nursing
D. An orientee who has successfully completed Advanced Cardiac Life
Support training - 🧠ANSWER ✔✔C. A nurse with 1 year of experience in
emergency nursing.
The nurse with 1 year of emergency nursing experience meets the
Emergency Nurses Association's recommendation that a nurse in the triage
role should have at least 6 months of emergency nursing experience before
being oriented to the triage role. The emergency nurse in the triage role
should have successfully completed Basic Life Support, Advanced Cardiac
Life Support, the Trauma Nursing Core Course, and the Emergency
Nursing Pediatric Course. The nurse from the medical unit, the new
graduate, and the orientee do not meet the Emergency Nurses
Association's recommendations.
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STATEMENT. ALL RIGHTS RESERVED
2
, Which patient poses the greatest risk for violence at triage? - 🧠ANSWER
✔✔A patient who is speaking loudly and pacing in the waiting room
Which function differentiates the Canadian Triage and Acuity Scale from
the Emergency Severity Index? - 🧠ANSWER ✔✔It identifies a
recommended time to physician examination for each triage level.
The triage nurse should bring which patient to the patient care area first? -
🧠ANSWER ✔✔A man who presents to triage with diaphoresis and
complaints of chest pain
When using the three-level acuity rating system, you should assign which
level to a man with abdominal pain?
A. Resuscitative
B. Emergent
C. Urgent
D. Nonurgent - 🧠ANSWER ✔✔C. Urgent
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
3
Questions and Verified Answers |
Already Graded A+
During triage, the nurse should perform which action first for a patient who
presents after a fall?
A. Perform electrocardiography.
B. Obtain a set of vital signs.
C. Use protocol orders to obtain the appropriate radiograph.
D. Determine what caused the fall. - 🧠ANSWER ✔✔D. Determine what
caused the fall.
Although the triage nurse may perform all of these actions, the priority is to
determine why the patient fell. A patient who fell because of syncope
requires different treatment than a patient who tripped over a bump in the
sidewalk. The patient who tripped is not likely to need electrocardiography.
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
1
,Which individual could qualify to be a triage nurse?
A. A new graduate who was a paramedic for several years
B. An experienced nurse who has just transferred from a medical unit
C. A nurse with 1 year of experience in emergency nursing
D. An orientee who has successfully completed Advanced Cardiac Life
Support training - 🧠ANSWER ✔✔C. A nurse with 1 year of experience in
emergency nursing.
The nurse with 1 year of emergency nursing experience meets the
Emergency Nurses Association's recommendation that a nurse in the triage
role should have at least 6 months of emergency nursing experience before
being oriented to the triage role. The emergency nurse in the triage role
should have successfully completed Basic Life Support, Advanced Cardiac
Life Support, the Trauma Nursing Core Course, and the Emergency
Nursing Pediatric Course. The nurse from the medical unit, the new
graduate, and the orientee do not meet the Emergency Nurses
Association's recommendations.
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
2
, Which patient poses the greatest risk for violence at triage? - 🧠ANSWER
✔✔A patient who is speaking loudly and pacing in the waiting room
Which function differentiates the Canadian Triage and Acuity Scale from
the Emergency Severity Index? - 🧠ANSWER ✔✔It identifies a
recommended time to physician examination for each triage level.
The triage nurse should bring which patient to the patient care area first? -
🧠ANSWER ✔✔A man who presents to triage with diaphoresis and
complaints of chest pain
When using the three-level acuity rating system, you should assign which
level to a man with abdominal pain?
A. Resuscitative
B. Emergent
C. Urgent
D. Nonurgent - 🧠ANSWER ✔✔C. Urgent
COPYRIGHT©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
3
