Relias Medical-Surgical RN A Exam 2026/2027: Actual
Exam Questions, Correct Answers & Detailed Rationales
Already Graded A+ | 2026 Updated
Pass your 2026 Relias Medical-Surgical RN A Exam with confidence. This comprehensive guide
features verified exam questions and high-yield Rationales covering key NCLEX-style themes:
complex pharmacology, infection control (C. diff protocols), insulin administration, urinary
catheter skills, lab interpretation, and critical clinical scenarios. Perfect for travel nurses and
staff RNs aiming to secure quick credentialing and prove competency. Master the exact logic
tested on the real exam!
,1. A nurse is preparing to mix NPH and Regular insulin in the same syringe. What is the correct
sequence of events?
A) Inject air into the NPH vial, then Regular vial; draw up NPH first, then Regular.
B) Inject air into the NPH vial, then Regular vial; draw up Regular insulin first, then NPH.
C) Draw up Regular insulin, inject air into the NPH vial, then draw up NPH.
D) Mix the insulins in separate syringes and administer as two separate injections.
Rationale: Always draw up clear (Regular) insulin before cloudy (NPH) insulin to prevent
contaminating the short-acting vial with intermediate-acting insulin ("clear before cloudy"). Air
must be injected into both first to maintain vial pressure.
2. A patient with type 1 diabetes is reporting nausea, vomiting, and diarrhea. The patient's
blood glucose is 250 mg/dL. Which instruction should the nurse provide regarding "sick day
rules"?
A) "Discontinue your insulin until you are able to eat solid foods again."
B) "Drink large amounts of sugar-containing fluids to prevent hypoglycemia."
C) "Continue to take your insulin, monitor your blood glucose every 3 to 4 hours, and test your
urine for ketones."
D) "Take an extra dose of rapid-acting insulin to compensate for the nausea."
Rationale: Illness and physiological stress trigger a hormone cascade that increases blood
glucose levels. Stopping insulin can quickly plunge a type 1 diabetic into diabetic ketoacidosis
(DKA).
3. The nurse administers a dose of insulin lispro (Humalog) to a patient at 0730. At what time
should the nurse expect this insulin to reach its peak effect?
A) 0800 to 0900
B) 0830 to 0930
C) 1030 to 1130
D) 1530 to 1730
Rationale: Insulin lispro is a rapid-acting insulin. It has an onset of 15 minutes, peaks within 1 to
2 hours (roughly 30 to 90 minutes), and has a duration of 3 to 5 hours.
4. A patient is prescribed insulin glargine (Lantus). Which of the following is an accurate
characteristic of this insulin?
A) It has an onset of 1 hour and must be given before every meal.
B) It provides a basal level of insulin and is administered once daily, usually at the same time
every day.
C) It is a cloudy suspension that must be gently rolled before administration.
D) It is used to treat acute episodes of severe hyperglycemia.
, Rationale: Insulin glargine is a long-acting, basal insulin that provides a steady, peakless level of
insulin over a 24-hour period. It cannot be mixed in a syringe with any other insulin.
5. To prevent lipodystrophy when administering subcutaneous insulin, the nurse should
instruct the patient to:
A) Reuse the same injection site until it becomes bruised.
B) Massage the injection site vigorously after administering the insulin.
C) Administer the insulin exclusively in the deltoid muscle.
D) Rotate injection sites systematically within the same anatomical region.
Rationale: Systematic rotation of sites within an area (like the abdomen or thighs) prevents local
tissue damage, hypertrophy, or atrophy, ensuring smooth, predictable insulin absorption.
6. A patient with type 1 diabetes wakes up with a fasting blood glucose of 280 mg/dL. The
nurse suspects the Somogyi effect. Which intervention will confirm this diagnosis?
A) Increase the evening dose of intermediate-acting insulin.
B) Check blood glucose levels between 0200 and 0300 for several consecutive nights.
C) Administer a high-calorie bedtime snack to prevent morning hyperglycemia.
D) Switch the patient's insulin regimen to an insulin pump.
Rationale: The Somogyi effect is rebound morning hyperglycemia caused by an unrecognized dip
into hypoglycemia during the night (around 0200–0300). Checking blood sugars at this time
confirms if the drop is occurring.
7. The physician orders Regular insulin to be administered via continuous IV infusion for a
patient in diabetic ketoacidosis (DKA). Which action by the nurse is correct?
A) Flush the IV tubing with the insulin solution before initiating the infusion.
B) Use any available insulin formulation, including NPH or glargine, for the IV infusion.
C) Mix the Regular insulin in a solution of D5W for the infusion.
D) Administer the IV insulin infusion via a gravity drip to ensure slow absorption.
Rationale: Regular insulin binds directly to the plastic inside IV bags and tubing lines. Flushing
the line with the mixture saturates the binding sites so the patient receives the proper dose
immediately. Regular insulin is the only insulin given IV.
8. A nurse assesses a patient with diabetes and finds the patient is diaphoretic, tremulous,
and anxious. The patient's blood glucose level is 45 mg/dL. What is the priority action?
A) Administer an injection of glucagon intramuscularly.
B) Provide 15 grams of a fast-acting carbohydrate, such as 4 ounces of fruit juice.
C) Give the patient a snack containing both protein and carbohydrates, such as crackers with
peanut butter.
D) Notify the healthcare provider immediately for a stat dose of IV D50.
Rationale: Following the rule of 15s for a conscious, alert patient, give 15g of fast-acting simple
Exam Questions, Correct Answers & Detailed Rationales
Already Graded A+ | 2026 Updated
Pass your 2026 Relias Medical-Surgical RN A Exam with confidence. This comprehensive guide
features verified exam questions and high-yield Rationales covering key NCLEX-style themes:
complex pharmacology, infection control (C. diff protocols), insulin administration, urinary
catheter skills, lab interpretation, and critical clinical scenarios. Perfect for travel nurses and
staff RNs aiming to secure quick credentialing and prove competency. Master the exact logic
tested on the real exam!
,1. A nurse is preparing to mix NPH and Regular insulin in the same syringe. What is the correct
sequence of events?
A) Inject air into the NPH vial, then Regular vial; draw up NPH first, then Regular.
B) Inject air into the NPH vial, then Regular vial; draw up Regular insulin first, then NPH.
C) Draw up Regular insulin, inject air into the NPH vial, then draw up NPH.
D) Mix the insulins in separate syringes and administer as two separate injections.
Rationale: Always draw up clear (Regular) insulin before cloudy (NPH) insulin to prevent
contaminating the short-acting vial with intermediate-acting insulin ("clear before cloudy"). Air
must be injected into both first to maintain vial pressure.
2. A patient with type 1 diabetes is reporting nausea, vomiting, and diarrhea. The patient's
blood glucose is 250 mg/dL. Which instruction should the nurse provide regarding "sick day
rules"?
A) "Discontinue your insulin until you are able to eat solid foods again."
B) "Drink large amounts of sugar-containing fluids to prevent hypoglycemia."
C) "Continue to take your insulin, monitor your blood glucose every 3 to 4 hours, and test your
urine for ketones."
D) "Take an extra dose of rapid-acting insulin to compensate for the nausea."
Rationale: Illness and physiological stress trigger a hormone cascade that increases blood
glucose levels. Stopping insulin can quickly plunge a type 1 diabetic into diabetic ketoacidosis
(DKA).
3. The nurse administers a dose of insulin lispro (Humalog) to a patient at 0730. At what time
should the nurse expect this insulin to reach its peak effect?
A) 0800 to 0900
B) 0830 to 0930
C) 1030 to 1130
D) 1530 to 1730
Rationale: Insulin lispro is a rapid-acting insulin. It has an onset of 15 minutes, peaks within 1 to
2 hours (roughly 30 to 90 minutes), and has a duration of 3 to 5 hours.
4. A patient is prescribed insulin glargine (Lantus). Which of the following is an accurate
characteristic of this insulin?
A) It has an onset of 1 hour and must be given before every meal.
B) It provides a basal level of insulin and is administered once daily, usually at the same time
every day.
C) It is a cloudy suspension that must be gently rolled before administration.
D) It is used to treat acute episodes of severe hyperglycemia.
, Rationale: Insulin glargine is a long-acting, basal insulin that provides a steady, peakless level of
insulin over a 24-hour period. It cannot be mixed in a syringe with any other insulin.
5. To prevent lipodystrophy when administering subcutaneous insulin, the nurse should
instruct the patient to:
A) Reuse the same injection site until it becomes bruised.
B) Massage the injection site vigorously after administering the insulin.
C) Administer the insulin exclusively in the deltoid muscle.
D) Rotate injection sites systematically within the same anatomical region.
Rationale: Systematic rotation of sites within an area (like the abdomen or thighs) prevents local
tissue damage, hypertrophy, or atrophy, ensuring smooth, predictable insulin absorption.
6. A patient with type 1 diabetes wakes up with a fasting blood glucose of 280 mg/dL. The
nurse suspects the Somogyi effect. Which intervention will confirm this diagnosis?
A) Increase the evening dose of intermediate-acting insulin.
B) Check blood glucose levels between 0200 and 0300 for several consecutive nights.
C) Administer a high-calorie bedtime snack to prevent morning hyperglycemia.
D) Switch the patient's insulin regimen to an insulin pump.
Rationale: The Somogyi effect is rebound morning hyperglycemia caused by an unrecognized dip
into hypoglycemia during the night (around 0200–0300). Checking blood sugars at this time
confirms if the drop is occurring.
7. The physician orders Regular insulin to be administered via continuous IV infusion for a
patient in diabetic ketoacidosis (DKA). Which action by the nurse is correct?
A) Flush the IV tubing with the insulin solution before initiating the infusion.
B) Use any available insulin formulation, including NPH or glargine, for the IV infusion.
C) Mix the Regular insulin in a solution of D5W for the infusion.
D) Administer the IV insulin infusion via a gravity drip to ensure slow absorption.
Rationale: Regular insulin binds directly to the plastic inside IV bags and tubing lines. Flushing
the line with the mixture saturates the binding sites so the patient receives the proper dose
immediately. Regular insulin is the only insulin given IV.
8. A nurse assesses a patient with diabetes and finds the patient is diaphoretic, tremulous,
and anxious. The patient's blood glucose level is 45 mg/dL. What is the priority action?
A) Administer an injection of glucagon intramuscularly.
B) Provide 15 grams of a fast-acting carbohydrate, such as 4 ounces of fruit juice.
C) Give the patient a snack containing both protein and carbohydrates, such as crackers with
peanut butter.
D) Notify the healthcare provider immediately for a stat dose of IV D50.
Rationale: Following the rule of 15s for a conscious, alert patient, give 15g of fast-acting simple
