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Master emergency nursing with 130 evidence-based NCLEX-style questions covering EMTALA, triage, shock, trauma, respiratory failure, and cardiac emergencies. Complete answers and clinical rationales for 2026/2027 certification success. NCLEX emergency nursing questions, CEN certification practice test 2026, Emergency Severity Index triage questions, EMTALA nursing exam questions, Critical care nursing exam with rationales
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Description: Master emergency nursing with 130 evidence-based NCLEX-style questions covering EMTALA, triage, shock, trauma, respiratory failure, and cardiac emergencies. Complete answers and clinical rationales for 2026/2027 certification success. Download the definitive exam prep guide today and pass on your first attempt.
Section 1: Legal and Ethical Issues in Emergency Care Question 1 A newly licensed nurse working in the emergency department (ED) is learning about the Emergency Medical Treatment and Active Labor Act (EMTALA). During a current disaster, the ED is transferring some patients to another facility prior to the patients being stabilized. Which statement by the nurse manager correctly explains this to the newly licensed nurse? A. EMTALA prohibits all patient transfers before stabilization, even during disasters B. A provision of EMTALA permits the transfer of patients before they are completely stabilized C. EMTALA only applies to patients with active labor, not to disaster situations D. Patients must sign a written waiver before any transfer can occur under EMTALA Answer: B Explanation: EMTALA includes provisions that allow for patient transfer before complete stabilization during declared disaster situations when the facility is overwhelmed. This exception acknowledges that transfer may be necessary to provide appropriate care when resources are exhausted, though the receiving facility must accept the transfer and provide necessary stabilization. Question 2 An ED nurse is reporting on a patient who is being transferred to the intensive care unit (ICU). Which of the following sets of people are responsible for the transfer report? A. The ED provider and the ICU provider B. The ED charge nurse and the ICU charge nurse C. The ED nurse and the ICU nurse D. The ED nurse and the patient's family member Answer: C Explanation: The transfer of patient care responsibility occurs between the nurse sending the patient (ED nurse) and the nurse receiving the patient (ICU nurse). This handoff report must include current status, treatment provided, pending tests, and any special considerations to ensure continuity of care and patient safety.
Question 5 A nurse is triaging patients in the ED using the three-tiered triage system. Which of the following patients should the nurse place in the delayed category? A. A patient reporting generalized abdominal pain, nausea, vomiting, and diarrhea for three days with stable vital signs, no comorbidities, and taking no medications B. A patient with chest pain and diaphoresis C. A patient with respiratory rate of 32 breaths per minute and oxygen saturation of 89% D. A patient with an open femur fracture and visible bone Answer: A Explanation: In a three-tiered triage system, the delayed (non-urgent) category includes patients with minor illnesses or injuries who can safely wait for care without risk of deterioration. The patient described has stable vital signs, no comorbidities, and symptoms consistent with a non-emergent gastrointestinal issue, making them appropriate for the delayed category. Section 3: ABCDE Assessment and Emergency Interventions Question 6 A nurse is caring for a patient who was admitted to the ED by ambulance. The patient's blood pressure is 110/62 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 28 breaths per minute. Which of the following represents how the nurse should perform the "D" portion of the ABCDE assessment? A. The nurse should assess deep tendon reflexes and pupillary response B. The nurse should check alertness and response to voice and pain C. The nurse should evaluate the patient's drug history and allergies D. The nurse should measure blood glucose and electrolyte levels Answer: B Explanation: The "D" in the ABCDE assessment stands for Disability, which primarily involves assessing the patient's level of consciousness using the AVPU scale (Alert, Voice responsive, Pain responsive, Unresponsive). This assessment includes checking alertness and response to voice and painful stimuli, as well as assessing pupillary response and blood glucose.
Question 7 A nurse is caring for a patient in the ED who reports a history of myocardial infarction (MI). Which of the following findings is most concerning? A. Chest pain relieved by rest B. Chest pain unrelieved by nitroglycerin C. Chest pain described as sharp and positional D. Chest pain lasting less than two minutes Answer: B Explanation: Chest pain that is unrelieved by nitroglycerin in a patient with a history of MI is highly concerning for acute coronary syndrome or possible myocardial infarction. This finding suggests inadequate response to standard vasodilator therapy and may indicate complete coronary occlusion requiring immediate intervention. Section 4: Trauma and Burn Injury Question 8 A nurse is caring for a patient who has suffered significant burns in a house fire. For each intervention, specify whether it is INDICATED, CONTRAINDICATED, or UNRELATED to the patient's care. Droplet isolation: UNRELATED Ambulation in the hallway: CONTRAINDICATED Indwelling urinary catheter: INDICATED Mechanical ventilation: INDICATED Gastric intubation: INDICATED Answer: See classifications above Explanation: Droplet isolation is unrelated because burn injuries require contact precautions and sterile wound care. Ambulation is contraindicated due to hemodynamic instability, fluid shifts, and risk of wound disruption. Indwelling urinary catheter is indicated to monitor hourly urine output for fluid resuscitation adequacy. Mechanical ventilation is indicated due to potential inhalation injury, airway edema, and respiratory compromise. Gastric intubation is indicated to decompress the stomach, prevent aspiration, and manage ileus common in major burns.
Question 11 A newly licensed nurse is providing care to a patient admitted to the ED who is experiencing heroin toxicity. The patient becomes violent and strikes the nurse. The nurse speaks with the manager about violence in the ED. Which of the following statements represents how the nurse manager should appropriately respond to the nurse? A. "You should have called security before approaching the patient." B. "Patients may fear the possible outcome of their clinical situation, leading to stress." C. "Violent patients should be immediately restrained and sedated." D. "You must file a police report for any physical assault." Answer: B Explanation: The nurse manager should provide a compassionate and educational response that helps the nurse understand the underlying reasons for patient violence. Patients experiencing drug toxicity, fear, pain, or altered mental status may exhibit violent behavior as a stress response. This response validates the nurse's experience while promoting understanding rather than blame. Question 12 A nurse is caring for a 30-year-old patient who experienced sexual assault two days ago. Which of the following is the most important to ask the patient? A. "Do you want to speak with a counselor?" B. "Do you know if you were exposed to HIV?" C. "Have you bathed or changed clothes since the assault?" D. "Do you wish to press criminal charges?" Answer: B Explanation: Determining potential HIV exposure is critical for timely administration of post-exposure prophylaxis (PEP), which is most effective when started within 72 hours of exposure. Since the assault occurred 48 hours ago, immediate assessment of HIV exposure risk is the priority to ensure the patient can still receive PEP if indicated. Question 13 A new nurse working in the ED is caring for a patient who has been sexually assaulted. Which of the following reasons is the most frequently cited for not reporting sexual assaults? A. Fear of not being believed by authorities B. Fear of being stigmatized
C. Lack of knowledge about reporting procedures D. Concern about financial costs of legal proceedings Answer: B Explanation: Research consistently identifies fear of stigmatization as the most common reason survivors do not report sexual assault. This includes concerns about social judgment, damage to reputation, being blamed for the assault, and facing discrimination from family, peers, or community members. Question 14 A nurse is preparing to discharge a patient who was treated for injuries related to sexual assault. Which of the following is the most important action for the nurse to take before the patient leaves the facility? A. Provide a list of local support groups B. Ask the patient if they wish to return to their home C. Schedule a follow-up appointment for two weeks later D. Ensure the patient has insurance information for medications Answer: B Explanation: Assessing whether the patient feels safe returning to their home is the priority because the perpetrator may live in or have access to the home. If the patient does not feel safe, the nurse must coordinate with social work to identify alternative safe housing options, including shelters or temporary housing with trusted individuals. Section 6: Disaster Management and Resource Allocation Question 15 An ED nurse is preparing for a pandemic disaster situation that requires more personal protective equipment (PPE) than what is available. Which of the following elements of resource allocation would be most appropriate for the nurse to implement? A. Prioritizing PPE for physicians only B. Reusing C. Cancelling all non-emergent procedures D. Transferring all COVID-positive patients to a single facility Answer: B Explanation: During pandemic disasters when PPE supplies are critically low, extended use
Question 18 A nurse is caring for a patient who is receiving mechanical ventilation. Complete the following sentence: The nurse should first ____________, based upon the patient's ____________. A. The nurse should first increase sedation, based upon the patient's agitation level B. The nurse should first postpone ambulation, based upon the patient's blood pressure C. The nurse should first perform suctioning, based upon the patient's oxygen saturation D. The nurse should first notify the provider, based upon the patient's respiratory rate Answer: B Explanation: The nurse should postpone ambulation based upon the patient's blood pressure. A mechanically ventilated patient requires hemodynamic stability before any mobilization activity. Ambulating a patient with unstable blood pressure increases risk of hypotension, falls, and cardiovascular compromise. Question 19 A nurse is caring for a patient who is 1 day postoperative and is currently receiving ventilation. The nurse is organizing staff to move the patient to a chair. The patient's family asks why it is necessary to move the patient. Which statement best represents how the nurse should respond? A. "Patients must be ambulated as early as possible so they can keep their muscle strength." B. "Moving the patient helps prevent hospital-acquired infections." C. "Early mobilization is required by hospital policy for all ventilated patients." D. "The provider ordered this activity to improve the patient's insurance coverage." Answer: A Explanation: Early mobilization of ventilated patients preserves muscle strength, prevents deconditioning, reduces the risk of ICU-acquired weakness, and improves functional outcomes. The response correctly explains the physiological rationale for the intervention in terms the family can understand.
Section 8: Patient and Family Communication Question 20 A nurse is caring for a patient in the ED who will most likely not survive. The patient's family member asks for an update. Which of the following is the best response by the nurse? A. "I am not allowed to share information without the patient's consent." B. "You should wait for the doctor to come out and speak with you." C. "Work with the provider to frequently update the family on the status of the patient in a compassionate way." D. "The patient is stable right now, so you can go home and rest." Answer: C Explanation: The nurse should collaborate with the healthcare provider to provide frequent, compassionate updates to the family of a patient with a likely fatal outcome. This approach demonstrates empathy, maintains trust, and prepares the family for potential death while ensuring they receive accurate information. Question 21 A nurse turns off lights in an older patient's room every night. Which of the following is the basis for the nurse's intervention? A. The nurse is implementing this strategy to prevent the development of delirium in the patient. B. The nurse is following the patient's documented preference for darkness. C. The nurse is conserving energy according to hospital sustainability goals. D. The nurse is preventing the patient from seeing their surroundings at night. Answer: A Explanation: Maintaining a normal sleep-wake cycle by minimizing light exposure at night is an evidence-based intervention to prevent delirium in older adult patients. Disrupted circadian rhythms are a significant risk factor for delirium, which is common in hospitalized older adults and associated with poor outcomes.
Section 11: Cardiovascular Emergencies Question 24 A nurse in the ED is assessing a patient with suspected acute coronary syndrome. Which of the following electrocardiogram (ECG) findings is most indicative of ST-segment elevation myocardial infarction (STEMI)? A. ST-segment depression in leads V1 through V B. Pathologic Q waves in all leads C. ST-segment elevation of 2 mm in two contiguous leads D. Prolonged PR interval with absent P waves Answer: C Explanation: ST-segment elevation of 1 mm or greater in two or more contiguous limb leads or 2 mm or greater in two or more contiguous precordial leads is diagnostic for STEMI. This finding indicates acute transmural myocardial injury and requires immediate reperfusion therapy. Question 25 A nurse is caring for a patient experiencing ventricular tachycardia with a palpable pulse. The patient's blood pressure is 90/58 mm Hg. Which of the following actions should the nurse anticipate first? A. Synchronized cardioversion B. Defibrillation at 200 joules C. Administration of intravenous adenosine D. Immediate endotracheal intubation Answer: A Explanation: For stable ventricular tachycardia with a palpable pulse, synchronized cardioversion is the first-line treatment. Unlike defibrillation, synchronized cardioversion delivers a shock timed with the QRS complex to avoid inducing ventricular fibrillation during the vulnerable period of repolarization. Question 26 A nurse is reviewing laboratory results for a patient admitted with heart failure. Which of the following B-type natriuretic peptide (BNP) levels would be most consistent with this diagnosis? A. 15 pg/mL
B. 45 pg/mL C. 120 pg/mL D. 900 pg/mL Answer: D Explanation: BNP levels above 500 pg/mL are highly suggestive of heart failure. Normal BNP is typically less than 100 pg/mL. A level of 900 pg/mL indicates significant cardiac wall stress and volume overload, consistent with acute decompensated heart failure. Question 27 A nurse is administering tissue plasminogen activator (tPA) to a patient with an acute ischemic stroke. Which of the following findings would require immediate discontinuation of the infusion? A. Blood pressure of 150/90 mm Hg B. Mild headache rated 3 out of 10 C. Sudden onset of severe headache with vomiting D. Blood glucose level of 110 mg/dL Answer: C Explanation: Sudden onset of severe headache with vomiting is a classic sign of intracranial hemorrhage, which is a life-threatening complication of tPA administration. The infusion must be stopped immediately, and the patient requires emergency imaging and potential reversal agents. Question 28 A nurse is assessing a patient with pericarditis. Which of the following physical examination findings is characteristic of this condition? A. Muffled heart sounds with distended neck veins B. Pericardial friction rub heard at the left sternal border C. Splinter hemorrhages in the nail beds D. Opening snap heard after S Answer: B Explanation: A pericardial friction rub is pathognomonic for pericarditis. This high-pitched, scratchy sound is best heard at the left sternal border with the patient leaning forward and holding their breath. It results from inflamed pericardial layers rubbing against each other.
symmetrical chest rise is the priority to confirm proper tube placement in the trachea (rather than the esophagus or a mainstem bronchus). This verification must occur before securing the tube or obtaining confirmatory imaging. Question 32 A nurse is caring for a patient with status asthmaticus receiving continuous albuterol nebulization. Which of the following findings indicates the patient is deteriorating and requires escalation of care? A. Heart rate increase from 110 to 125 beats per minute B. Wheezing becoming quieter with decreased air movement C. Respiratory rate decrease from 32 to 28 breaths per minute D. Patient reporting anxiety and inability to lie flat Answer: B Explanation: Quiet chest or absent wheezing with decreased air movement in a patient with status asthmaticus is a concerning sign indicating severe bronchospasm and impending respiratory failure. This "silent chest" suggests minimal air exchange and requires immediate intervention, including possible intubation. Section 13: Neurologic Emergencies Question 33 A nurse is assessing a patient using the Glasgow Coma Scale (GCS). The patient opens eyes to pain, makes incomprehensible sounds, and exhibits abnormal flexion to pain. Which GCS score should the nurse document? A. 6 B. 7 C. 8 D. 9 Answer: C Explanation: Eye opening to pain = 2 points; Incomprehensible sounds = 2 points; Abnormal flexion (decorticate posturing) = 3 points. Total GCS score = 8, which indicates severe brain injury and coma.
Question 34 A nurse is caring for a patient with increased intracranial pressure (ICP) following a traumatic brain injury. Which of the following nursing interventions is most appropriate to prevent further ICP elevation? A. Clustering all nursing care activities to allow extended rest periods B. Elevating the head of the bed to 30 degrees C. Placing the patient in Trendelenburg position D. Encouraging the patient to cough and deep breathe hourly Answer: B Explanation: Elevating the head of the bed to 30 degrees promotes venous drainage from the brain, reducing intracranial pressure. Clustering care activities actually increases ICP by providing multiple stimuli at once. Trendelenburg position increases ICP by impeding venous return. Question 35 A nurse is assessing a patient with suspected subarachnoid hemorrhage. Which of the following clinical manifestations is most characteristic of this condition? A. Gradual onset of confusion over 48 hours B. "Thunderclap" headache described as the worst headache of life C. Unilateral facial drooping with arm weakness D. Vertigo relieved by lying still with eyes closed Answer: B Explanation: A sudden, severe "thunderclap" headache reaching maximal intensity within seconds to minutes is the hallmark symptom of subarachnoid hemorrhage. Patients often describe it as the worst headache of their life and may associate it with a "popping" sensation in the head. Question 36 A nurse is caring for a patient experiencing a generalized tonic-clonic seizure. Which of the following actions should the nurse take during the seizure? A. Insert a padded tongue blade to prevent tongue biting B. Restrain the patient's limbs to prevent injury C. Turn the patient to the lateral position if possible D. Administer intravenous lorazepam immediately
Question 39 A nurse is assessing a patient with suspected small bowel obstruction. Which of the following findings would the nurse most likely observe? A. Frequent, small-volume, liquid stools B. Projectile vomiting of undigested food C. Abdominal distention with high-pitched, tinkling bowel sounds D. Rigid, board-like abdomen with absent bowel sounds Answer: C Explanation: Small bowel obstruction typically presents with abdominal distention and high- pitched, tinkling, or rushing bowel sounds (borborygmi) as peristalsis attempts to overcome the obstruction. Absent bowel sounds occur in late stages or with peritonitis, not early obstruction. Question 40 A nurse is caring for a patient with acute pancreatitis. Which of the following laboratory values is most specific for this diagnosis? A. Elevated white blood cell count B. Elevated serum lipase C. Elevated blood glucose D. Elevated total bilirubin Answer: B Explanation: Serum lipase is the most specific laboratory marker for acute pancreatitis, with sensitivity and specificity approaching 100% when levels are three times or more above the upper limit of normal. Lipase rises within 4-8 hours of onset and remains elevated longer than amylase. Section 15: Renal and Genitourinary Emergencies Question 41 A nurse is caring for a patient with acute kidney injury (AKI) secondary to dehydration. Which of the following findings would the nurse expect? A. Urine output of 30 mL/hour with specific gravity of 1. B. Urine output of 10 mL/hour with specific gravity of 1. C. Urine output of 100 mL/hour with specific gravity of 1.
D. Urine output of 50 mL/hour with specific gravity of 1. Answer: A Explanation: Prerenal AKI from dehydration results in decreased urine output (oliguria less than 0.5 mL/kg/hour) with concentrated urine (high specific gravity greater than 1.020). The kidneys attempt to conserve water, producing small volumes of concentrated urine. A specific gravity of 1.030 indicates concentrated urine. Question 42 A nurse is assessing a male patient with suspected testicular torsion. Which of the following findings is most characteristic of this condition? A. Gradual onset of dull ache over several days B. Absent cremasteric reflex on the affected side C. Pain relieved by elevation of the testicle D. Urinary frequency and dysuria Answer: B Explanation: Absent cremasteric reflex (the reflex that causes testicular elevation when the inner thigh is stroked) is a key finding in testicular torsion. This is a surgical emergency requiring detorsion within 4-6 hours to preserve testicular viability. The pain is sudden and severe, not gradual. Question 43 A nurse is caring for a patient with a newly placed hemodialysis catheter in the right internal jugular vein. Which of the following findings requires immediate intervention? A. Mild bruising at the insertion site B. Respiratory rate of 22 breaths per minute C. Absence of blood return from one lumen D. Shortness of breath with decreased breath sounds on the right Answer: D Explanation: Shortness of breath with decreased breath sounds on the right side following internal jugular catheter placement is concerning for pneumothorax, a known complication of central line placement. This requires immediate chest x-ray and possible chest tube insertion.
