Which function differentiates the Emergency Severity Index from the
Canadian Triage and Acuity Scale? Right Ans - It identifies specific vital
signs that place a patient at acuity level 2.
When triaging a potential psychiatric patient, which action is the triage
nurse's priority? Right Ans - Assess patient and staff safety.
Which question is most likely to assess the quality of a patient's symptom?
Right Ans - "What does it feel like?"
Detection of severe jaundice during an across-the-room assessment falls
under which category of assessment? Right Ans - Skin color
Which question best elicits details from a patient seeking treatment in the
emergency department? Right Ans - "Why do you think you fell?"
Triage documentation must include which element? Right Ans -
Assessment of pain
Using the CIAMPEDS mnemonic, the triage nurse evaluates fever control for a
pediatric patient. This reflects which component of the mnemonic? Right
Ans - Medication
What should the nurse do when a person calls on the telephone for medical
advice? Right Ans - Politely inform the caller that the emergency
department does not give out any medical advice.
A pediatric patient with increased work of breathing is likely to display which
assessment finding? Right Ans - Grunting
The triage nurse notes a fruity smell during an across-the-room assessment.
This finding may be a sign of which condition? Right Ans - Diabetic
ketoacidosis
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