Emergency and Triage Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Triage Systems, Primary Survey, Trauma, Chest Pain, Stroke, Sepsis, Anaphylaxis, Poisoning, Heat Stroke, Burns, Paediatric Emergencies, Mass Casualty and Violence in the Emergency Department

Emergency nursing is tested across the critical care, medical-surgical and patient safety domains of the registered nurse paper, typically 10 to 14 questions, and emergency departments are among the largest Gulf recruiters: road traffic trauma, heat illness, chest pain in a young population and mass gatherings at Hajj and major events keep them full. The exam tests prioritisation first (who is seen first and what is done first), then the time-critical pathways. This set covers what recurs; ventilator and ICU content is in the critical care set, and paramedics sit their own paper (paramedic questions).

Triage and prioritisation

Question 1

Five patients arrive within minutes: a 50-year-old with crushing chest pain and sweating; a 6-year-old with a forearm deformity and good distal pulses; a 30-year-old with a 3 cm scalp laceration that has stopped bleeding; a 70-year-old with sudden facial droop and arm weakness that started 40 minutes ago; a 25-year-old with ankle pain after a fall who can walk. Using a five-level triage system, the correct order is:

1. In order of arrival
2. The chest pain and the stroke patient are both emergent (level 2, seen within minutes, with the stroke patient time-critical for thrombolysis and the chest pain patient needing an ECG within 10 minutes), then the child with the fracture (level 3), then the scalp laceration (level 4) and the ankle injury (level 5); any patient with airway compromise, absent pulse or unresponsiveness would be level 1 and seen immediately
3. The child first because children always take priority
4. The scalp laceration first because wounds must be closed quickly

Answer: B. Gulf departments use the Emergency Severity Index, the Canadian Triage and Acuity Scale or the Manchester system; all are five-level and all re-triage waiting patients at defined intervals.

Question 2

A patient in the waiting room triaged as level 4 for abdominal pain two hours ago now looks pale and sweaty and reports worsening pain. The triage nurse should:

1. Tell the patient to wait their turn
2. Reassess vital signs and pain immediately, up-triage to a higher acuity level if findings have changed, move the patient to a treatment area and inform the physician, and document the reassessment; waiting patients are re-triaged at intervals set by their level and whenever their condition appears to change
3. Give analgesia in the waiting room and continue waiting
4. Ask a relative to monitor the patient

Answer: B. Deterioration in the waiting room is a recognised cause of harm; departments audit waiting-room re-triage.

Trauma

Question 3

A motorcyclist arrives after a high-speed collision, confused, with noisy breathing, blood in the mouth and a deformed left thigh. The nurse's priorities in order are:

1. Splint the femur, then take a history, then assess the airway
2. Control any catastrophic external haemorrhage, open and clear the airway with suction while maintaining manual in-line cervical spine stabilisation (a collar or blocks per protocol), assess breathing and give high-flow oxygen, assess circulation (pulse, skin, blood pressure, two large-bore intravenous lines, bloods including crossmatch, tranexamic acid within three hours as prescribed), assess disability (GCS, pupils, glucose), expose fully while preventing hypothermia, then the secondary survey including the femur, with imaging (trauma CT) and the trauma team activated on arrival
3. Take the patient straight to CT before any assessment
4. Give intravenous opioids before assessing the airway

Answer: B. A femoral fracture can lose over a litre of blood and is splinted after circulation is addressed; the log-roll uses at least four people with the spine protected.

Question 4

A worker has a deep laceration of the thigh with bright red pulsatile bleeding that does not stop with firm direct pressure. The next step is:

1. Elevate the leg and apply a loose bandage
2. Apply an arterial tourniquet 5 to 7 cm above the wound (not over a joint), tighten until bleeding stops, note the time of application on the tourniquet and the patient, do not loosen it in the department, call for urgent surgical and vascular review, start fluids or blood as prescribed and keep the patient warm; haemostatic dressings and wound packing are alternatives for junctional wounds where a tourniquet cannot be applied
3. Apply a tourniquet directly over the wound
4. Clamp the vessel blindly with forceps

Answer: B. Modern trauma guidance supports early tourniquet use for life-threatening limb haemorrhage; a tourniquet left in place for over about two hours risks limb injury, so time is recorded.

Question 5

A patient with blunt chest trauma has absent breath sounds on the right, hypotension, distended neck veins and tracheal deviation to the left. The nurse anticipates:

1. A chest radiograph before any intervention
2. Immediate needle decompression (second intercostal space mid-clavicular line, or fourth to fifth intercostal space anterior axillary line per current guidance) or finger thoracostomy by the trained clinician, followed by a chest drain, because this is a tension pneumothorax, a clinical diagnosis; the nurse prepares the equipment, gives high-flow oxygen and monitors continuously
3. Intravenous diuretics
4. Pericardiocentesis

Answer: B. Cardiac tamponade (Beck's triad: hypotension, muffled heart sounds, distended neck veins) and massive haemothorax are the other immediately life-threatening chest injuries.

Medical emergencies

Question 6

A 55-year-old presents with chest pain. The nurse obtains a 12-lead ECG within 10 minutes showing ST elevation in leads II, III and aVF. The nurse's actions include:

1. Sublingual GTN immediately regardless of blood pressure
2. Immediate physician review and activation of the STEMI pathway (primary PCI target door-to-balloon 90 minutes or thrombolysis if PCI is unavailable within the window), continuous monitoring with a defibrillator at hand, aspirin 300 mg chewed if no contraindication, intravenous access and bloods, oxygen only if saturations are below 90%, analgesia, and caution with nitrates and morphine in inferior infarction with possible right ventricular involvement because they can cause profound hypotension; a right-sided ECG (V4R) is obtained
3. Discharge with outpatient follow-up
4. Give a beta blocker before any assessment

Answer: B. Hypotension with clear lungs and raised JVP in an inferior MI suggests right ventricular infarction, which is treated with fluids rather than nitrates.

Question 7

A patient collapses in the waiting room. The nurse finds no response, no normal breathing and no pulse. The sequence is:

1. Check blood pressure, then call the doctor
2. Call for help and the resuscitation team, start chest compressions at 100 to 120 per minute and 5 to 6 cm depth with minimal interruptions, attach the defibrillator or AED as soon as it arrives and deliver a shock if the rhythm is shockable, ventilate with a bag-valve-mask at a 30:2 ratio until an advanced airway is placed, obtain intravenous or intraosseous access for adrenaline every 3 to 5 minutes and amiodarone after the third shock as per the ALS algorithm, and identify reversible causes (hypoxia, hypovolaemia, hypo- or hyperkalaemia, hypothermia, thrombosis, tamponade, tension pneumothorax, toxins)
3. Give two rescue breaths and wait for the team
4. Place the patient in the recovery position

Answer: B. Early high-quality compressions and early defibrillation determine survival; every Gulf authority requires current BLS, and most employers require ACLS for emergency nurses.

Question 8

A 68-year-old is brought in with facial droop, arm weakness and slurred speech that began 50 minutes ago. The nurse's actions are:

1. Register the patient and place in the queue for the next available cubicle
2. Activate the stroke pathway immediately, document the exact time last known well, check glucose (hypoglycaemia mimics stroke), obtain vital signs and intravenous access, keep nil by mouth, perform a stroke scale assessment, arrange urgent CT and CT angiography, and prepare for thrombolysis within 4.5 hours of onset or thrombectomy for large vessel occlusion, with blood pressure managed to protocol thresholds
3. Give aspirin 300 mg before imaging
4. Lie the patient flat and give high-flow oxygen

Answer: B. Door-to-needle under 60 minutes is the target; aspirin waits until haemorrhage is excluded.

Question 9

A 40-year-old develops urticaria, lip swelling, wheeze and hypotension minutes after an intravenous antibiotic in the department. The nurse's first drug action is:

1. Intravenous hydrocortisone
2. Stop the infusion, call for help, give adrenaline 0.5 mg (0.5 mL of 1:1,000) intramuscularly into the anterolateral thigh, repeated after 5 minutes if there is no improvement, lie the patient flat with legs raised (or sitting if breathless), give high-flow oxygen and a rapid intravenous fluid bolus, then antihistamine and steroid as adjuncts, monitor for at least 6 to 12 hours for biphasic reactions, and arrange an adrenaline auto-injector and allergy referral at discharge
3. Oral antihistamine and observation
4. Intravenous adrenaline bolus by the nurse

Answer: B. Intravenous adrenaline is for specialists with monitoring; intramuscular adrenaline is safe and the nurse gives it under standing protocol in most Gulf departments.

Question 10

A patient with a lactate of 4.2 mmol/L, temperature 39.5 °C, heart rate 125 and blood pressure 85/50 mmHg has a suspected urinary source. The sepsis bundle the nurse ensures within the first hour includes:

1. Oral antibiotics and oral fluids
2. Blood cultures (two sets) and urine culture before antibiotics without delaying them, broad-spectrum intravenous antibiotics within one hour, 30 mL/kg of crystalloid for hypotension or lactate of 4 or more, lactate measurement and repeat, oxygen to target, urinary catheter for hourly output, and escalation for vasopressors if the mean arterial pressure stays below 65 mmHg after fluids
3. Waiting for culture results before antibiotics
4. Antipyretics only

Answer: B. Every hour of delay in antibiotics increases mortality in septic shock; the nurse documents the times of each bundle element.

Toxicology and environmental

Question 11

A 20-year-old presents four hours after taking 30 tablets of 500 mg paracetamol. She is asymptomatic. The nurse's actions include:

1. Reassure and discharge because she has no symptoms
2. Take a paracetamol level at four hours post-ingestion (or immediately if later), liver function, renal function, INR and glucose, plot the level on the treatment nomogram, start intravenous acetylcysteine as prescribed if above the treatment line, if the time of ingestion is uncertain or if a staggered overdose is reported, monitor for nausea and anaphylactoid reactions to acetylcysteine, perform a mental health risk assessment with one-to-one observation if needed, and involve the psychiatric team; activated charcoal may be given within one hour of ingestion
3. Induce vomiting with salt water
4. Give naloxone

Answer: B. Paracetamol toxicity is silent for the first day; a dose over 150 mg/kg (here about 250 mg/kg) is potentially lethal without treatment.

Question 12

A patient is brought in unresponsive with pinpoint pupils, a respiratory rate of 6 and track marks on the arms. The nurse's actions are:

1. Wait for the toxicology screen before treatment
2. Support the airway and ventilate with a bag-valve-mask and oxygen, give naloxone (intravenous, intramuscular or intranasal) titrated to restore adequate breathing rather than full consciousness, monitor closely because naloxone's effect is shorter than most opioids and the patient can re-sedate (an infusion may be needed), check glucose, and manage withdrawal agitation calmly; a flumazenil reversal is avoided in mixed or unknown overdoses because of seizure risk
3. Give flumazenil first
4. Give a stimulant

Answer: B. Drug offences carry serious legal consequences in Gulf states, but the nurse's duty is clinical care and confidentiality within the law; mandatory reporting rules vary by jurisdiction.

Question 13

A farm worker presents with excessive salivation, sweating, tearing, vomiting, diarrhoea, pinpoint pupils, bradycardia, wheeze and muscle twitching after spraying crops. The nurse recognises and anticipates:

1. Food poisoning; oral rehydration
2. Organophosphate (cholinesterase inhibitor) poisoning; staff wear protective equipment and remove and bag the patient's clothing and decontaminate the skin to prevent secondary exposure, secure the airway and give oxygen with suctioning of secretions, and administer atropine in escalating doses until secretions dry and bronchospasm resolves (not titrated to pupil size), plus pralidoxime as prescribed, benzodiazepines for seizures, and ICU monitoring for the intermediate syndrome of respiratory muscle weakness
3. Opioid overdose; naloxone
4. Anaphylaxis; adrenaline

Answer: B. The SLUDGE/DUMBELS mnemonics summarise the cholinergic features; large atropine doses are often needed.

Question 14

A labourer collapses on a construction site in July and arrives with a rectal temperature of 41.5 °C, confusion and hot dry skin. The nurse's priorities are:

1. Paracetamol and a fan
2. Recognise exertional heat stroke, a medical emergency; start immediate aggressive cooling (cold-water immersion if available, or evaporative cooling with water spray and fans plus ice packs to the neck, axillae and groin, and cold intravenous fluids), aiming for a core temperature below 39 °C within 30 minutes with continuous core monitoring, stopping active cooling at about 38.5 °C to avoid overshoot; secure the airway, give oxygen, check glucose, monitor for seizures, rhabdomyolysis, acute kidney injury, DIC and liver injury, and avoid antipyretics, which do not work and can harm
3. Slow rewarming
4. Oral fluids only

Answer: B. Gulf states enforce midday outdoor work bans in summer; heat exhaustion (temperature under 40 °C with normal mental status) is treated with rest, cooling and oral or intravenous fluids.

Burns, children and obstetrics

Question 15

A 75 kg man has partial-thickness burns to the whole of the front of the trunk and the front of one arm after a gas cylinder flash fire, with singed nasal hairs and a hoarse voice. The nurse's priorities are:

1. Apply burn cream and refer to outpatients
2. Assess the airway for inhalation injury (singed hairs, soot, hoarseness, facial burns) and prepare for early intubation, give high-flow oxygen (carbon monoxide poisoning gives falsely normal oximetry), estimate the burn area with the rule of nines (anterior trunk 18% plus front of one arm 4.5%, about 22.5%), start fluid resuscitation by the Parkland formula (4 mL × 75 kg × 22.5% = 6.75 litres over 24 hours, half in the first 8 hours from the time of injury) titrated to urine output of 0.5 mL/kg/h, cool the burns with running water for 20 minutes within three hours of injury while keeping the patient warm, cover with cling film, give analgesia and tetanus prophylaxis, remove jewellery, assess for circumferential burns, and refer to the burns unit
3. Apply ice directly to the burns
4. Burst all blisters and apply antiseptic

Answer: B. Burns over 10% in adults, any full-thickness burn, burns to face, hands, feet, perineum or major joints, inhalation, electrical and chemical burns meet referral criteria.

Question 16

A 2-year-old is brought in with a fever of 39.8 °C, lethargy, mottled skin, a capillary refill of 4 seconds, a heart rate of 170 and a non-blanching rash on the legs. The nurse should:

1. Give paracetamol and ask the parents to wait
2. Triage as level 1 or 2, call the paediatric team immediately, recognise possible meningococcal sepsis, give high-flow oxygen, obtain intravenous or intraosseous access and bloods including cultures, give intravenous antibiotics (ceftriaxone) and a 10 to 20 mL/kg fluid bolus as prescribed with reassessment, check glucose, implement droplet precautions, and support the parents; chemoprophylaxis for contacts and notification follow
3. Apply topical cream to the rash
4. Give oral antibiotics and discharge

Answer: B. The paediatric assessment triangle (appearance, work of breathing, circulation to skin) identifies the sick child within seconds; a non-blanching rash is sepsis until proven otherwise.

Question 17

A woman at 36 weeks of pregnancy arrives in the emergency department with a blood pressure of 170/112 mmHg, headache and visual disturbance, and then has a tonic-clonic seizure. The nurse's actions include:

1. Give intravenous phenytoin as first line
2. Protect the patient from injury, position in the left lateral position to relieve aortocaval compression, maintain the airway and give oxygen, call the obstetric and anaesthetic teams immediately, administer magnesium sulfate (a 4 g loading dose then an infusion) as prescribed as the first-line treatment for eclampsia, give antihypertensives (labetalol, hydralazine or nifedipine) to lower blood pressure to safe levels, monitor reflexes, respiratory rate and urine output for magnesium toxicity with calcium gluconate available, monitor the fetus, and prepare for delivery, which is the definitive treatment
3. Lie the patient flat on her back
4. Discharge once the seizure stops

Answer: B. Postpartum haemorrhage, cord prolapse and shoulder dystocia are the other obstetric emergencies that reach the department; every emergency nurse knows the first steps.

Systems, safety and law

Question 18

A bus crash brings 25 casualties to a department with four resuscitation bays. Which triage principle applies?

1. Treat the most severely injured first regardless of survivability
2. Activate the major incident or mass casualty plan, use a rapid sieve-and-sort system (such as START or the triage sieve) to categorise patients as immediate (red), urgent (yellow), delayed (green) or deceased/expectant (black) based on walking ability, breathing, perfusion and mental status, with the aim of doing the most good for the most people, assign roles (triage officer, treatment areas, documentation), re-triage repeatedly, and record every patient with a unique identifier; the department also prepares for self-presenting walking wounded who arrive before the ambulances
3. Register every patient fully before any treatment
4. Close the department to new arrivals

Answer: B. Gulf hospitals run regular major incident drills because of mass gatherings, industrial sites and road traffic risk; the Hajj medical response is the largest annual example.

Question 19

A relative of a patient becomes verbally aggressive at the triage desk, shouting and threatening staff about waiting times. The nurse's approach is:

1. Shout back and threaten to call the police
2. Stay calm with a non-threatening posture and safe distance, acknowledge the frustration, give clear information about the process and expected times, offer a quieter space to talk and involve a senior colleague or patient relations, set clear limits on behaviour, and if threats or aggression escalate, withdraw, activate the department's security or duress alarm and follow the violence and aggression policy, documenting the incident; the safety of staff and other patients takes precedence
3. Ignore the relative completely
4. Move the patient to the front of the queue to end the confrontation

Answer: B. Gulf states have laws penalising assault on healthcare workers; departments provide de-escalation training and risk-assess waiting areas.

Question 20

A patient dies in the department after a stabbing. The nursing responsibilities include:

1. Removing all lines and tubes and washing the body before the family sees it
2. Recognising a medicolegal (forensic) death: leaving all lines, tubes and dressings in place, preserving clothing and belongings in paper bags with a chain of custody, not washing the body, documenting injuries and the timeline precisely and objectively, informing the police and following the hospital's reportable death procedure, supporting the family with privacy and cultural and religious needs (including prompt arrangements that respect Islamic burial practices once the authorities release the body), and completing an incident report; the forensic authority, not the hospital, authorises release
3. Issuing the death certificate as a natural death
4. Returning the clothing to the family immediately

Answer: B. Unexpected, violent, suspicious and custodial deaths and deaths within a defined period of a procedure are reportable in all Gulf jurisdictions.

How to practise

• Practise prioritisation with five-level triage logic and the primary survey order.
• Learn the time-critical pathways and their numbers: ECG in 10 minutes, door-to-balloon 90, thrombolysis 4.5 hours, antibiotics within one hour of sepsis recognition, adrenaline 0.5 mg IM, cooling to below 39 °C in 30 minutes, Parkland formula.
• Know the toxicology antidotes: acetylcysteine, naloxone, atropine and pralidoxime, and when not to use flumazenil.
• Know the department's safety and legal rules: mass casualty triage, violence policies, forensic deaths.

Emergency chapters with explanations are in the Registered Nurse bank; related sets are the critical care questions, cardiac questions, neurological questions, paediatric questions and maternal questions. The BLS and ACLS requirements are in certificate requirements, and emergency physicians have their own set (emergency medicine questions).

Frequently asked questions

How many emergency nursing questions are in the Prometric nursing exam?

About 10 to 14 of 150, spread across the critical care, medical-surgical and patient safety domains.

Which emergency nursing topics come up most?

Triage prioritisation, the primary survey, chest pain and stroke pathways, sepsis bundles, anaphylaxis, overdose management, heat stroke and burns assessment.

Which triage system does the exam use?

Questions are written around five-level systems in general (ESI, CTAS or Manchester); the principles are the same, and the exam does not require memorising one system's exact discriminators.

Do I need ACLS for the exam?

Not for the exam itself, but the algorithms are tested, and most Gulf emergency departments require ACLS (and PALS for paediatric areas) for employment.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.