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ENA: Triage Exam/51 Complete Answered Questions
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ENA: Triage Exam/51 CompleteAnswered Questions
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.
, C. It uses a nonclinical person to greet patients upon arrival.
D. It includes the initiation of patient teaching. - -D. It includes the initiation
of patient teaching.
-When performing an across-the-room assessment, the triage nurse can use
the sense of sight to detect which finding?
A. Stridor
B. Ketones
C. Deformity
D. Poor hygiene - -C. Deformity
-What is the nurse's priority when triaging a patient with a behavioral health
concern?
A. Determine if the patient has recently taken mind-altering medications.
B. Assess the patient for a psychiatric history.
C. Place the patient in a treatment room as soon as possible.
D. Ensure staff and patient safety. - -D. Ensure staff and patient safety.
-Which of these is a goal of triage?
A. To identify patients who are safe to wait for care
B. To establish appropriate fees on a sliding scale
C. To initiate patient teaching
D. To perform a comprehensive history and physical - -A. To identify patients
who are safe to wait for care
-The Emergency Nurses Association recommends that emergency
departments use which triage system?
A. Spot-check triage
B. Traffic director triage
C. Comprehensive triage
D. Disaster triage - -C. Comprehensive triage
-Using the Emergency Severity Index, the triage nurse should assign the
highest priority to which of these patients?
A. A man, age 59, with a head laceration who passed out and is disoriented
B. A child, age 7, with a dislocated arm and a heart rate of 120 beats per
minute
C. A woman, age 38, with moderate abdominal pain who needs one resource
D. A infant, age 9 months, with a fever and a respiratory rate of 25 breaths
per minute - -A. A man, age 59, with a head laceration who passed out and
is disoriented
-Which statement accurately characterizes measurement of a full set of vital
signs in triage?
A. Vital signs frequently change the assigned triage acuity.
B. Vital signs are needed to assign triage acuity accurately.
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