ENA Triage and Patient Evaluation — Questions and Answers
Question 1: What is the first step in the triage process in an emergency department?
- Assigning a room
- Ordering diagnostic tests
- Primary assessment of airway, breathing, and circulation (Correct answer)
- Administering medications
Correct answer: Primary assessment of airway, breathing, and circulation
Initial assessment or primary survey is the first step in triage, focusing on life-threatening conditions that need immediate attention.
Question 2: Which triage level indicates a life-threatening condition requiring immediate care?
- Level 3
- Level 2
- Level 4
- Level 1 (Correct answer)
Correct answer: Level 1
Level 1 in the Emergency Severity Index (ESI) is reserved for patients with life-threatening conditions needing immediate resuscitation.
Question 3: What is the primary purpose of the Emergency Severity Index (ESI)?
- To determine insurance coverage
- To manage staffing levels
- To prioritize patients based on acuity and resource needs (Correct answer)
- To track hospital equipment
Correct answer: To prioritize patients based on acuity and resource needs
The ESI is a five-level triage tool used to categorize patients based on urgency and resource needs.
Question 4: A patient arrives with a respiratory rate of 8 breaths per minute. What should be the triage nurse's priority action?
- Check oxygen saturation
- Administer IV fluids
- Initiate airway management (Correct answer)
- Obtain a chest x-ray
Correct answer: Initiate airway management
A respiratory rate of 8 indicates hypoventilation and potential respiratory failure, requiring immediate airway and ventilation support.
Question 5: Which patient should be triaged first in a mass casualty incident?
- Unresponsive patient with no pulse
- Patient with minor cuts
- Patient with severe bleeding and stable airway (Correct answer)
- Patient with a sprained ankle
Correct answer: Patient with severe bleeding and stable airway
In mass casualty triage, patients with life-threatening conditions who are likely to survive with immediate care are prioritized.
Question 6: What is a key sign of decompensated shock in patient evaluation?
- Elevated blood pressure
- Normal urine output
- Altered mental status (Correct answer)
- Warm, flushed skin
Correct answer: Altered mental status
Altered mental status is a critical indicator of decompensated shock, suggesting inadequate perfusion to the brain.
ENA Triage and Patient Evaluation
What is the first step in the triage process in an emergency department?