ENA TRIAGE STANDARD EXAMS ANSWERS AND
QUESTIONS SET A+
✔✔In which triage system would a nonclinical greeter determine the patient's chief
complaint and determine if the patient is sick or not sick?
A. Spot-check triage
B. Traffic director
C. Comprehensive
D. Two-tiered triage - ✔✔B. Traffic director
✔✔Which factor is considered a best practice for triage?
A. Use of a standardized three-level acuity system
B. Ability to easily obtain verbal orders
C. Handwritten initial documentation
D. Specific education and competency for the area - ✔✔D. Specific education and
competency for the area
✔✔When performing an across-the-room assessment, the triage nurse uses which
senses?
A. Sight and touch
B. Sight and hearing
C. Touch and taste
D. Smell and touch - ✔✔B. Sight and hearing
✔✔What is the safest way to obtain information from a patient who does not speak
English or is more comfortable speaking in his or her native language?
A. Ask a family member to translate.
B. Obtain a medical interpreter.
C. Find a coworker who is fluent in the language.
D. Get a patient advocate who is fluent in the language. - ✔✔B. Obtain a medical
interpreter.
✔✔The triage nurse should bring which patient to the patient care area first?
A. A boy, age 8, with an obvious forearm deformity and strong pulses
, B. A woman, age 52, who arrives by ambulance with abdominal pain and a temperature
of 99°F (37.2°C)
C. A man who presents to triage with diaphoresis and complaints of chest pain
D. An older adult patient who has become more forgetful lately - ✔✔C. A man who
presents to triage with diaphoresis and complaints of chest pain
✔✔ Which statement correctly describes triage protocols?
A. They increase the patient's length of stay.
B. They increase patient and staff satisfaction.
C. They increase the accuracy of assigned triage acuities.
D. They increase the number of patients who choose to leave without being seen. -
✔✔B. They increase patient and staff satisfaction.
✔✔The triage nurse should be most concerned about which pediatric patient?
A. An infant with a petechial rash
B. A toddler with a fever of 101° F (38.3° C) for the last 2 days
C. A preschooler who does not want to eat
D. A child, age 6, with a heart rate of 120 beats per minute - ✔✔A. An infant with a
petechial rash
✔✔Which option for an interpreter meets The Joint Commission requirements?
A. Contact a telephone language bank.
B. Ask a bilingual family member to assist.
C. Use a medical dictionary for the specific language.
D. Contact a housekeeper who speaks the patient's language. - ✔✔A. Contact a
telephone language bank.
✔✔The Emergency Nurses Association and American College of Emergency
Physicians recommend which type of triage acuity system for the best interrater
reliability?
A. Three-level system
B. Four-level system
C. Five-level system
D. Six-level system - ✔✔C. Five-level system
✔✔The triage nurse should screen for which problem in an older adult patient who
presents with a new onset of confusion?
A. Congenital heart defect
B. Elder abuse or neglect
C. Urinary tract infection
D. Long-term use of opioids - ✔✔C. Urinary tract infection
✔✔Which factor is an advantage of comprehensive triage over other triage systems?
A. It is cost-effective because triage does not need to be staffed 24 hours a day.
B. It does not require competency validation.
QUESTIONS SET A+
✔✔In which triage system would a nonclinical greeter determine the patient's chief
complaint and determine if the patient is sick or not sick?
A. Spot-check triage
B. Traffic director
C. Comprehensive
D. Two-tiered triage - ✔✔B. Traffic director
✔✔Which factor is considered a best practice for triage?
A. Use of a standardized three-level acuity system
B. Ability to easily obtain verbal orders
C. Handwritten initial documentation
D. Specific education and competency for the area - ✔✔D. Specific education and
competency for the area
✔✔When performing an across-the-room assessment, the triage nurse uses which
senses?
A. Sight and touch
B. Sight and hearing
C. Touch and taste
D. Smell and touch - ✔✔B. Sight and hearing
✔✔What is the safest way to obtain information from a patient who does not speak
English or is more comfortable speaking in his or her native language?
A. Ask a family member to translate.
B. Obtain a medical interpreter.
C. Find a coworker who is fluent in the language.
D. Get a patient advocate who is fluent in the language. - ✔✔B. Obtain a medical
interpreter.
✔✔The triage nurse should bring which patient to the patient care area first?
A. A boy, age 8, with an obvious forearm deformity and strong pulses
, B. A woman, age 52, who arrives by ambulance with abdominal pain and a temperature
of 99°F (37.2°C)
C. A man who presents to triage with diaphoresis and complaints of chest pain
D. An older adult patient who has become more forgetful lately - ✔✔C. A man who
presents to triage with diaphoresis and complaints of chest pain
✔✔ Which statement correctly describes triage protocols?
A. They increase the patient's length of stay.
B. They increase patient and staff satisfaction.
C. They increase the accuracy of assigned triage acuities.
D. They increase the number of patients who choose to leave without being seen. -
✔✔B. They increase patient and staff satisfaction.
✔✔The triage nurse should be most concerned about which pediatric patient?
A. An infant with a petechial rash
B. A toddler with a fever of 101° F (38.3° C) for the last 2 days
C. A preschooler who does not want to eat
D. A child, age 6, with a heart rate of 120 beats per minute - ✔✔A. An infant with a
petechial rash
✔✔Which option for an interpreter meets The Joint Commission requirements?
A. Contact a telephone language bank.
B. Ask a bilingual family member to assist.
C. Use a medical dictionary for the specific language.
D. Contact a housekeeper who speaks the patient's language. - ✔✔A. Contact a
telephone language bank.
✔✔The Emergency Nurses Association and American College of Emergency
Physicians recommend which type of triage acuity system for the best interrater
reliability?
A. Three-level system
B. Four-level system
C. Five-level system
D. Six-level system - ✔✔C. Five-level system
✔✔The triage nurse should screen for which problem in an older adult patient who
presents with a new onset of confusion?
A. Congenital heart defect
B. Elder abuse or neglect
C. Urinary tract infection
D. Long-term use of opioids - ✔✔C. Urinary tract infection
✔✔Which factor is an advantage of comprehensive triage over other triage systems?
A. It is cost-effective because triage does not need to be staffed 24 hours a day.
B. It does not require competency validation.
