RN Relias Ed Exam Practice Questions 2026-2027 |
Verified Answers Plus Rationales | Graded Q&A Study
Guide | Latest 2027
1. A 45-year-old patient presents to the emergency department complaining of sudden,
severe chest pain radiating to the back between the shoulder blades, described as a
"tearing" sensation. The patient's vital signs are: BP 198/110 mmHg (right arm), BP
162/88 mmHg (left arm), HR 112 bpm, and SpO2 96% on room air. What is the priority
nursing intervention?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes.
B. Establish IV access and prepare an IV antihypertensive infusion.
C. Administer high-flow oxygen via non-rebreather mask.
D. Obtain a stat 12-lead ECG and troponin level.
Rationale: The patient exhibits classic clinical presentation of an acute aortic dissection
(tearing chest/back pain, pulse/BP asymmetry between arms, severe hypertension).
Immediate blood pressure and heart rate control are paramount to minimize shear stress on
the aortic wall and prevent rupture. IV antihypertensives (e.g., labetalol, esmolol, or
nitroprusside) are critical. Nitroglycerin can worsen tachycardia and shear force if used alone
without beta-blockade. Supplemental oxygen is unnecessary as SpO2 is normal.
2. An emergency nurse is caring for a patient who was involved in a motor vehicle collision.
The patient has a Glasgow Coma Scale (GCS) score of 7, decerebrate posturing, and
unequal pupils. Which air management intervention is most urgent?
A. Place a nasopharyngeal airway and apply a simple face mask.
B. Assist ventilation using a bag-valve-mask with high-flow oxygen.
C. Prepare for immediate endotracheal intubation.
D. Place the patient in a side-lying position to prevent aspiration.
Rationale: A GCS score of 8 or less indicates severe brain injury and compromised airway
protective reflexes ("GCS less than 8, intubate"). Decerebrate posturing reflects severe
brainstem dysfunction. Immediate endotracheal intubation is required to secure the airway,
ensure adequate oxygenation, and control ventilation to manage intracranial pressure.
Nasopharyngeal airways are contraindicated in potential facial/basilar skull trauma.
,3. A 62-year-old patient with a history of heart failure arrives at the ED in acute
respiratory distress. The patient is sitting upright, tripod position, pink frothy sputum,
bilateral crackles, and an SpO2 of 82%. Which immediate non-invasive intervention is
most appropriate?
A. Non-invasive positive pressure ventilation (CPAP/BiPAP).
B. Nasal cannula at 4 L/min.
C. Venturi mask at 40% FiO2.
D. Immediate endotracheal intubation without trial of non-invasive ventilation.
Rationale: Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure
(BiPAP) is the first-line non-invasive intervention for acute cardiogenic pulmonary edema.
CPAP decreases preload and afterload, forces fluid out of the alveoli back into the vascular
bed, and significantly reduces the need for invasive mechanical intubation. Oxygen delivery
devices like nasal cannulas or Venturi masks are insufficient for alveolar recruitment.
4. A 28-year-old male presents with severe rightsided lower quadrant abdominal pain,
nausea, low-grade fever, and focal tenderness over McBurney’s point. Which assessment
finding strongly suggests peritoneal irritation secondary to suspected acute appendicitis?
A. Decrease in pain upon firm palpation followed by sudden relief upon release.
B. Rebound tenderness (Blumberg's sign) in the right lower quadrant.
C. Absence of bowel sounds in all four quadrants.
D. Pain in the right upper quadrant upon deep inspiration during palpation.
Rationale: Rebound tenderness (Blumberg's sign) occurs when pain increases upon quick
release of pressure applied to the abdomen, which directly indicates peritoneal inflammation.
McBurney's point tenderness combined with positive rebound tenderness is highly specific for
acute appendicitis. Choice D describes Murphy's sign, which indicates acute cholecystitis.
5. A patient presents to the emergency department following an industrial spill with liquid
chemical burns across their left forearm and upper thigh. What is the immediate primary
nursing action?
A. Apply neutralizing chemicals directly to the affected skin.
B. Decontaminate the area by flushing with large volumes of tepid water.
C. Apply sterile ointment and dry sterile dressings to the burns.
,D. Ice the chemical burn areas to limit tissue damage.
Rationale: The immediate treatment for chemical burns is copious irrigation with tap water or
saline for at least 20 to 30 minutes to dilute and wash away the chemical agent. Neutralizing
chemicals generate exothermic chemical reactions that can cause severe secondary thermal
burns. Ice induces vasoconstriction and deepens tissue injury.
6. An ED triage nurse evaluates a 70-year-old female complaining of vague epigastric
discomfort, unusual fatigue, shortness of breath, and nausea for the past 4 hours. She has a
history of type 2 diabetes. What should the triage nurse order immediately?
A. Abdominal ultrasound and liver function tests.
B. Serum lipase level and abdominal X-ray.
C. 12-lead electrocardiogram (ECG) and cardiac biomarkers.
D. Intravenous antiemetic and antacid medication.
Rationale: Women, elderly individuals, and diabetic patients frequently present with atypical
symptoms of acute coronary syndrome (ACS), such as epigastric distress, dyspnea, nausea,
and fatigue without classic retrosternal chest pain. An immediate 12-lead ECG (within 10
minutes of arrival) is essential to rule out acute myocardial infarction.
7. A 3-year-old child is brought to the emergency department with sudden onset of stridor,
drooling, high fever, and a tripod positioning. The child appears highly anxious. What is
the most critical safety precaution for the nurse?
A. Perform a visual inspection of the posterior pharynx using a tongue depressor.
B. Obtain a STAT throat swab for bacterial culture.
C. Avoid distressing the child and refrain from direct airway/throat examination.
D. Place the child in a supine position for abdominal examination.
Rationale: The child displays classic signs of acute epiglottitis (drooling, dysphagia, distress,
stridor, tripod position). Invasive maneuvers, including invasive throat examinations with
tongue depressors or throat swabs, can trigger fatal laryngospasm and complete airway
obstruction. The nurse must keep the child calm and prepare for definitive airway placement
in a controlled environment.
8. An adult trauma patient arrives in the ED with severe blunt force chest trauma. The
nurse notes tracheal deviation to the right, absent breath sounds on the left side,
, hypotension (82/46 mmHg), and severe respiratory distress. Which procedure should the
nurse anticipate immediately?
A. Endotracheal intubation.
B. Emergency needle thoracostomy in the left chest wall.
C. Pericardiocentesis.
D. Immediate placement of an indwelling urinary catheter.
Rationale: The patient exhibits classic clinical signs of a left tension pneumothorax (tracheal
deviation away from the affected side, absent left breath sounds, hemodynamic instability
due to vena cava compression). Immediate decompression via needle thoracostomy or finger
thoracostomy on the affected side is required before chest tube placement to restore venous
return and cardiac output.
9. A 35-year-old asthma patient arrives via EMS in severe respiratory distress. On initial
assessment, the patient is speaking in single words, tachycardic, and displaying intercostal
retractions. Auscultation reveals widespread wheezing. Ten minutes after receiving an
nebulized albuterol treatment, the nurse hears no breath sounds or wheezing upon
auscultation. How should the nurse interpret this change?
A. The patient's bronchospasm has successfully resolved.
B. The patient is experiencing an acute allergic reaction to albuterol.
C. The patient's condition has deteriorated into impending respiratory arrest ("silent chest").
D. The patient requires immediate conversion to high-dose oxygen via nasal cannula.
Rationale: A "silent chest" in a severe asthmatic signifies critically diminished air movement
due to extreme airway obstruction or muscle exhaustion. The absence of wheezing in a
severely dyspneic patient is an ominous sign of impending respiratory failure, requiring
emergency airway management and preparation for intubation.
10. An adult patient is admitted with severe sepsis secondary to pneumonia. According to
updated sepsis management guidelines, which initial bundle requirement must be executed
within the first hour of recognition?
A. Administer high-dose steroids and obtain a arterial blood gas.
B. Measure lactate level, obtain blood cultures before antibiotics, and initiate crystalloid
bolus for hypotension or lactate ≥ 4 mmol/L.
Verified Answers Plus Rationales | Graded Q&A Study
Guide | Latest 2027
1. A 45-year-old patient presents to the emergency department complaining of sudden,
severe chest pain radiating to the back between the shoulder blades, described as a
"tearing" sensation. The patient's vital signs are: BP 198/110 mmHg (right arm), BP
162/88 mmHg (left arm), HR 112 bpm, and SpO2 96% on room air. What is the priority
nursing intervention?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes.
B. Establish IV access and prepare an IV antihypertensive infusion.
C. Administer high-flow oxygen via non-rebreather mask.
D. Obtain a stat 12-lead ECG and troponin level.
Rationale: The patient exhibits classic clinical presentation of an acute aortic dissection
(tearing chest/back pain, pulse/BP asymmetry between arms, severe hypertension).
Immediate blood pressure and heart rate control are paramount to minimize shear stress on
the aortic wall and prevent rupture. IV antihypertensives (e.g., labetalol, esmolol, or
nitroprusside) are critical. Nitroglycerin can worsen tachycardia and shear force if used alone
without beta-blockade. Supplemental oxygen is unnecessary as SpO2 is normal.
2. An emergency nurse is caring for a patient who was involved in a motor vehicle collision.
The patient has a Glasgow Coma Scale (GCS) score of 7, decerebrate posturing, and
unequal pupils. Which air management intervention is most urgent?
A. Place a nasopharyngeal airway and apply a simple face mask.
B. Assist ventilation using a bag-valve-mask with high-flow oxygen.
C. Prepare for immediate endotracheal intubation.
D. Place the patient in a side-lying position to prevent aspiration.
Rationale: A GCS score of 8 or less indicates severe brain injury and compromised airway
protective reflexes ("GCS less than 8, intubate"). Decerebrate posturing reflects severe
brainstem dysfunction. Immediate endotracheal intubation is required to secure the airway,
ensure adequate oxygenation, and control ventilation to manage intracranial pressure.
Nasopharyngeal airways are contraindicated in potential facial/basilar skull trauma.
,3. A 62-year-old patient with a history of heart failure arrives at the ED in acute
respiratory distress. The patient is sitting upright, tripod position, pink frothy sputum,
bilateral crackles, and an SpO2 of 82%. Which immediate non-invasive intervention is
most appropriate?
A. Non-invasive positive pressure ventilation (CPAP/BiPAP).
B. Nasal cannula at 4 L/min.
C. Venturi mask at 40% FiO2.
D. Immediate endotracheal intubation without trial of non-invasive ventilation.
Rationale: Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure
(BiPAP) is the first-line non-invasive intervention for acute cardiogenic pulmonary edema.
CPAP decreases preload and afterload, forces fluid out of the alveoli back into the vascular
bed, and significantly reduces the need for invasive mechanical intubation. Oxygen delivery
devices like nasal cannulas or Venturi masks are insufficient for alveolar recruitment.
4. A 28-year-old male presents with severe rightsided lower quadrant abdominal pain,
nausea, low-grade fever, and focal tenderness over McBurney’s point. Which assessment
finding strongly suggests peritoneal irritation secondary to suspected acute appendicitis?
A. Decrease in pain upon firm palpation followed by sudden relief upon release.
B. Rebound tenderness (Blumberg's sign) in the right lower quadrant.
C. Absence of bowel sounds in all four quadrants.
D. Pain in the right upper quadrant upon deep inspiration during palpation.
Rationale: Rebound tenderness (Blumberg's sign) occurs when pain increases upon quick
release of pressure applied to the abdomen, which directly indicates peritoneal inflammation.
McBurney's point tenderness combined with positive rebound tenderness is highly specific for
acute appendicitis. Choice D describes Murphy's sign, which indicates acute cholecystitis.
5. A patient presents to the emergency department following an industrial spill with liquid
chemical burns across their left forearm and upper thigh. What is the immediate primary
nursing action?
A. Apply neutralizing chemicals directly to the affected skin.
B. Decontaminate the area by flushing with large volumes of tepid water.
C. Apply sterile ointment and dry sterile dressings to the burns.
,D. Ice the chemical burn areas to limit tissue damage.
Rationale: The immediate treatment for chemical burns is copious irrigation with tap water or
saline for at least 20 to 30 minutes to dilute and wash away the chemical agent. Neutralizing
chemicals generate exothermic chemical reactions that can cause severe secondary thermal
burns. Ice induces vasoconstriction and deepens tissue injury.
6. An ED triage nurse evaluates a 70-year-old female complaining of vague epigastric
discomfort, unusual fatigue, shortness of breath, and nausea for the past 4 hours. She has a
history of type 2 diabetes. What should the triage nurse order immediately?
A. Abdominal ultrasound and liver function tests.
B. Serum lipase level and abdominal X-ray.
C. 12-lead electrocardiogram (ECG) and cardiac biomarkers.
D. Intravenous antiemetic and antacid medication.
Rationale: Women, elderly individuals, and diabetic patients frequently present with atypical
symptoms of acute coronary syndrome (ACS), such as epigastric distress, dyspnea, nausea,
and fatigue without classic retrosternal chest pain. An immediate 12-lead ECG (within 10
minutes of arrival) is essential to rule out acute myocardial infarction.
7. A 3-year-old child is brought to the emergency department with sudden onset of stridor,
drooling, high fever, and a tripod positioning. The child appears highly anxious. What is
the most critical safety precaution for the nurse?
A. Perform a visual inspection of the posterior pharynx using a tongue depressor.
B. Obtain a STAT throat swab for bacterial culture.
C. Avoid distressing the child and refrain from direct airway/throat examination.
D. Place the child in a supine position for abdominal examination.
Rationale: The child displays classic signs of acute epiglottitis (drooling, dysphagia, distress,
stridor, tripod position). Invasive maneuvers, including invasive throat examinations with
tongue depressors or throat swabs, can trigger fatal laryngospasm and complete airway
obstruction. The nurse must keep the child calm and prepare for definitive airway placement
in a controlled environment.
8. An adult trauma patient arrives in the ED with severe blunt force chest trauma. The
nurse notes tracheal deviation to the right, absent breath sounds on the left side,
, hypotension (82/46 mmHg), and severe respiratory distress. Which procedure should the
nurse anticipate immediately?
A. Endotracheal intubation.
B. Emergency needle thoracostomy in the left chest wall.
C. Pericardiocentesis.
D. Immediate placement of an indwelling urinary catheter.
Rationale: The patient exhibits classic clinical signs of a left tension pneumothorax (tracheal
deviation away from the affected side, absent left breath sounds, hemodynamic instability
due to vena cava compression). Immediate decompression via needle thoracostomy or finger
thoracostomy on the affected side is required before chest tube placement to restore venous
return and cardiac output.
9. A 35-year-old asthma patient arrives via EMS in severe respiratory distress. On initial
assessment, the patient is speaking in single words, tachycardic, and displaying intercostal
retractions. Auscultation reveals widespread wheezing. Ten minutes after receiving an
nebulized albuterol treatment, the nurse hears no breath sounds or wheezing upon
auscultation. How should the nurse interpret this change?
A. The patient's bronchospasm has successfully resolved.
B. The patient is experiencing an acute allergic reaction to albuterol.
C. The patient's condition has deteriorated into impending respiratory arrest ("silent chest").
D. The patient requires immediate conversion to high-dose oxygen via nasal cannula.
Rationale: A "silent chest" in a severe asthmatic signifies critically diminished air movement
due to extreme airway obstruction or muscle exhaustion. The absence of wheezing in a
severely dyspneic patient is an ominous sign of impending respiratory failure, requiring
emergency airway management and preparation for intubation.
10. An adult patient is admitted with severe sepsis secondary to pneumonia. According to
updated sepsis management guidelines, which initial bundle requirement must be executed
within the first hour of recognition?
A. Administer high-dose steroids and obtain a arterial blood gas.
B. Measure lactate level, obtain blood cultures before antibiotics, and initiate crystalloid
bolus for hypotension or lactate ≥ 4 mmol/L.
