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ENA Emergency Nursing Orientation Final
Exam Actual Exam 2026/2027 – Complete Exam-
Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
[SECTION 1: Triage & Patient Assessment in the ED — Questions 1-15]
Q1: A 24-year-old male walks into the emergency department complaining of a sprained ankle.
He is alert, oriented, and in no acute distress. According to the Emergency Severity Index (ESI),
which triage level is most appropriate?
A. ESI Level 1
B. ESI Level 2
C. ESI Level 4
D. ESI Level 5
Correct Answer: C
Rationale: Under the ESI algorithm, Level 4 is appropriate for a patient who requires one
resource (e.g., an X-ray) to determine their disposition. The patient is stable with normal vital
signs, so he is not a high-risk (Level 2) or immediate life threat (Level 1). Level 5 is for patients
who require no resources (e.g., a simple prescription refill), which is not the case here.
Q2: A 65-year-old female presents with new onset of atrial fibrillation and a heart rate of 145
bpm. She has a history of hypertension. She is currently stable but experiencing palpitations.
Which ESI level does this patient meet?
A. ESI Level 1
B. ESI Level 2
C. ESI Level 3
D. ESI Level 4
Correct Answer: B
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Rationale: According to ENA guidelines, ESI Level 2 is assigned to patients who are at high risk
for deterioration or have a new onset of confusion, lethargy, or severe pain/distress. New onset
atrial fibrillation with a rapid rate in an elderly patient is considered high risk because it could
lead to hemodynamic instability or decompensation, regardless of how stable they appear at the
moment.
Q3: During the primary survey of a trauma patient, the nurse assesses "A" for Airway. Which
action is the priority?
A. Inserting an oral airway immediately in all patients.
B. Checking for patency and protecting the cervical spine.
C. Listening to breath sounds to detect wheezing.
D. Checking the carotid pulse for strength.
Correct Answer: B
Rationale: The Airway step of the ABCDE primary survey involves ensuring the airway is open
(patent) and clearing any obstructions, while simultaneously protecting the cervical spine (C-
spine) in trauma patients. Option A is incorrect because oral airways are contraindicated in
conscious patients or those with a gag reflex. Options C and D belong to the Breathing and
Circulation assessments, respectively.
Q4: A patient arrives by ambulance after a motor vehicle collision. The nurse notes the patient is
snoring and has a laceration to the forehead. What is the immediate nursing intervention?
A. Apply a cervical collar and perform a jaw thrust.
B. Insert a nasopharyngeal airway.
C. Suction the patient's mouth and perform a finger sweep.
D. Prepare for rapid sequence intubation with manual C-spine stabilization.
Correct Answer: D
Rationale: Snoring indicates a partial upper airway obstruction, likely due to the tongue falling
back. In a trauma patient with a potential head injury (laceration), the priority is securing the
airway definitively (intubation) to prevent aspiration and hypoxia. While manual C-spine
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stabilization is crucial, performing a jaw thrust (A) or inserting an NPA (B) might be temporary
measures, but preparing for intubation addresses the underlying risk of aspiration and inadequate
ventilation. Suction is indicated only if secretions are visible.
Q5: In the "C" (Circulation) step of the primary survey, the nurse assesses for hemorrhage.
Which is the priority intervention for active external bleeding from an extremity?
A. Apply direct pressure over the wound site.
B. Elevate the extremity above the level of the heart.
C. Apply a tourniquet immediately upon arrival.
D. Apply a pressure dressing and do not disturb until clotting occurs.
Correct Answer: A
Rationale: Direct pressure is the first-line intervention for controlling external hemorrhage. It is
effective, safe, and minimizes tissue damage. Elevation (B) is an adjunct but is not effective for
arterial bleeding alone. A tourniquet (C) is only indicated if direct pressure fails to control life-
threatening hemorrhage from a limb. Option D is incorrect because bleeding must be controlled
before a dressing is applied.
Q6: Which component of the SAMPLE history refers to any recent food or drink the patient has
consumed?
A. S - Signs and symptoms
B. P - Provocation
C. L - Last oral intake
D. E - Events
Correct Answer: C
Rationale: In the SAMPLE history mnemonic, "L" stands for Last oral intake. This information
is critical for anesthesia or surgery planning and to assess the risk of aspiration. Option A refers
to the reason for the visit. Option D refers to the circumstances surrounding the illness.
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Q7: A nurse is triaging a patient who presents with suicidal ideation and a plan to overdose on
available medications. The patient is calm and cooperative. Which ESI level is appropriate?
A. ESI Level 2
B. ESI Level 3
C. ESI Level 4
D. ESI Level 5
Correct Answer: A
Rationale: Patients with suicidal ideation, intent, or a specific plan are automatically triaged as
ESI Level 2 (High Risk). Psychiatric safety concerns, regardless of current behavior, require
immediate psychiatric evaluation and a safe environment to prevent self-harm. Level 3, 4, and 5
do not provide the necessary safety priority for a patient with a suicidal plan.
Q8: The nurse is performing a secondary survey. Which assessment technique is used to identify
crepitus or deformities?
A. Palpation
B. Inspection
C. Percussion
D. Auscultation
Correct Answer: A
Rationale: Palpation is the assessment technique of touching the patient to feel for tenderness,
masses, swelling, or crepitus (a grating sensation or sound) and to assess bone alignment.
Inspection is looking. Percussion is tapping. Auscultation is listening.
Q9: According to ENA guidelines, which patient requires immediate medical screening
examination (EMSE) regardless of ability to pay?
A. A patient requesting a work note for a previous cold.
B. A patient with a toothache requesting pain medication.
C. A patient presenting with chest pain and shortness of breath.
ENA Emergency Nursing Orientation Final
Exam Actual Exam 2026/2027 – Complete Exam-
Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
[SECTION 1: Triage & Patient Assessment in the ED — Questions 1-15]
Q1: A 24-year-old male walks into the emergency department complaining of a sprained ankle.
He is alert, oriented, and in no acute distress. According to the Emergency Severity Index (ESI),
which triage level is most appropriate?
A. ESI Level 1
B. ESI Level 2
C. ESI Level 4
D. ESI Level 5
Correct Answer: C
Rationale: Under the ESI algorithm, Level 4 is appropriate for a patient who requires one
resource (e.g., an X-ray) to determine their disposition. The patient is stable with normal vital
signs, so he is not a high-risk (Level 2) or immediate life threat (Level 1). Level 5 is for patients
who require no resources (e.g., a simple prescription refill), which is not the case here.
Q2: A 65-year-old female presents with new onset of atrial fibrillation and a heart rate of 145
bpm. She has a history of hypertension. She is currently stable but experiencing palpitations.
Which ESI level does this patient meet?
A. ESI Level 1
B. ESI Level 2
C. ESI Level 3
D. ESI Level 4
Correct Answer: B
,2
Rationale: According to ENA guidelines, ESI Level 2 is assigned to patients who are at high risk
for deterioration or have a new onset of confusion, lethargy, or severe pain/distress. New onset
atrial fibrillation with a rapid rate in an elderly patient is considered high risk because it could
lead to hemodynamic instability or decompensation, regardless of how stable they appear at the
moment.
Q3: During the primary survey of a trauma patient, the nurse assesses "A" for Airway. Which
action is the priority?
A. Inserting an oral airway immediately in all patients.
B. Checking for patency and protecting the cervical spine.
C. Listening to breath sounds to detect wheezing.
D. Checking the carotid pulse for strength.
Correct Answer: B
Rationale: The Airway step of the ABCDE primary survey involves ensuring the airway is open
(patent) and clearing any obstructions, while simultaneously protecting the cervical spine (C-
spine) in trauma patients. Option A is incorrect because oral airways are contraindicated in
conscious patients or those with a gag reflex. Options C and D belong to the Breathing and
Circulation assessments, respectively.
Q4: A patient arrives by ambulance after a motor vehicle collision. The nurse notes the patient is
snoring and has a laceration to the forehead. What is the immediate nursing intervention?
A. Apply a cervical collar and perform a jaw thrust.
B. Insert a nasopharyngeal airway.
C. Suction the patient's mouth and perform a finger sweep.
D. Prepare for rapid sequence intubation with manual C-spine stabilization.
Correct Answer: D
Rationale: Snoring indicates a partial upper airway obstruction, likely due to the tongue falling
back. In a trauma patient with a potential head injury (laceration), the priority is securing the
airway definitively (intubation) to prevent aspiration and hypoxia. While manual C-spine
,3
stabilization is crucial, performing a jaw thrust (A) or inserting an NPA (B) might be temporary
measures, but preparing for intubation addresses the underlying risk of aspiration and inadequate
ventilation. Suction is indicated only if secretions are visible.
Q5: In the "C" (Circulation) step of the primary survey, the nurse assesses for hemorrhage.
Which is the priority intervention for active external bleeding from an extremity?
A. Apply direct pressure over the wound site.
B. Elevate the extremity above the level of the heart.
C. Apply a tourniquet immediately upon arrival.
D. Apply a pressure dressing and do not disturb until clotting occurs.
Correct Answer: A
Rationale: Direct pressure is the first-line intervention for controlling external hemorrhage. It is
effective, safe, and minimizes tissue damage. Elevation (B) is an adjunct but is not effective for
arterial bleeding alone. A tourniquet (C) is only indicated if direct pressure fails to control life-
threatening hemorrhage from a limb. Option D is incorrect because bleeding must be controlled
before a dressing is applied.
Q6: Which component of the SAMPLE history refers to any recent food or drink the patient has
consumed?
A. S - Signs and symptoms
B. P - Provocation
C. L - Last oral intake
D. E - Events
Correct Answer: C
Rationale: In the SAMPLE history mnemonic, "L" stands for Last oral intake. This information
is critical for anesthesia or surgery planning and to assess the risk of aspiration. Option A refers
to the reason for the visit. Option D refers to the circumstances surrounding the illness.
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Q7: A nurse is triaging a patient who presents with suicidal ideation and a plan to overdose on
available medications. The patient is calm and cooperative. Which ESI level is appropriate?
A. ESI Level 2
B. ESI Level 3
C. ESI Level 4
D. ESI Level 5
Correct Answer: A
Rationale: Patients with suicidal ideation, intent, or a specific plan are automatically triaged as
ESI Level 2 (High Risk). Psychiatric safety concerns, regardless of current behavior, require
immediate psychiatric evaluation and a safe environment to prevent self-harm. Level 3, 4, and 5
do not provide the necessary safety priority for a patient with a suicidal plan.
Q8: The nurse is performing a secondary survey. Which assessment technique is used to identify
crepitus or deformities?
A. Palpation
B. Inspection
C. Percussion
D. Auscultation
Correct Answer: A
Rationale: Palpation is the assessment technique of touching the patient to feel for tenderness,
masses, swelling, or crepitus (a grating sensation or sound) and to assess bone alignment.
Inspection is looking. Percussion is tapping. Auscultation is listening.
Q9: According to ENA guidelines, which patient requires immediate medical screening
examination (EMSE) regardless of ability to pay?
A. A patient requesting a work note for a previous cold.
B. A patient with a toothache requesting pain medication.
C. A patient presenting with chest pain and shortness of breath.
