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RELIAS ED RN A, COMPREHENSIVE ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ALREADY
A GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
1. At a mass casualty scene, a patient has a compound leg fracture, is in
severe pain, but has a respiratory rate of 24 and capillary refill of less
than 2 seconds. Which triage tag is the MOST APPROPRIATE for this
patient?
A) Red Tag (Immediate)
B) Yellow Tag (Delayed)
C) Green Tag (Minor)
D) Black Tag (Deceased/Expectant)
Rationale: This patient has a respiratory rate > 30 (actual RR 24) and
capillary refill < 2 seconds, indicating they are not in immediate life-
threatening distress but have a significant injury requiring treatment
that can be delayed. START triage criteria: Yellow tag is assigned to
patients with non-life-threatening injuries who require medical care
but can wait (delayed).
2. What is the current recommended dose of intravenous or intraosseous
epinephrine for an adult patient in cardiac arrest?
A) 10 mg every 10 minutes
B) 1 mg every 3–5 minutes
C) 1 mg every 7 minutes
D) 0.1 mg every 2 minutes
Rationale: The 2025/2026 AHA resuscitation guidelines recommend
epinephrine 1 mg IV/IO every 3 to 5 minutes during adult cardiac
arrest. This is a standard ACLS protocol.
,2|Page
3. A patient who is 27 weeks pregnant presents with painless bright red
vaginal bleeding. What condition correlates with the presenting
symptoms?
A) Abruptio placentae
B) Placenta previa
C) Ectopic pregnancy
D) Premature rupture of membranes (PROM)
Rationale: Placenta previa presents with painless, bright red vaginal
bleeding in the second or third trimester. Abruptio placentae typically
presents with painful bleeding. Ectopic pregnancy presents earlier
with abdominal pain. PROM presents with fluid leakage, not bleeding.
4. What is the Joint Commission 2026 goal regarding nurse staffing?
A) Staffing is an administrative budget metric
B) Staffing is an official patient safety accreditation metric; acuity
dictates ratios
C) Staffing ratios are determined by hospital census only
D) Staffing is not regulated by The Joint Commission
Rationale: The Joint Commission 2026 (Goal 12) establishes that
staffing is an official patient safety accreditation metric; patient acuity,
not administrative budget, dictates appropriate staffing ratios.
5. A patient with a traumatic brain injury (TBI) is MOST likely to suffer
from which condition?
A) Diabetes mellitus
B) Cerebral palsy
C) Diabetes insipidus
D) Myxedema coma
Rationale: Traumatic brain injury can damage the hypothalamus or
pituitary gland, leading to diabetes insipidus (DI) due to decreased
antidiuretic hormone (ADH) production. DI is characterized by
polyuria, polydipsia, and hypernatremia.
,3|Page
6. A patient presents after sustaining a roll-over motor vehicle accident.
They are complaining of pain around the mid-upper back. On your
initial triage assessment, you find that the patient has preserved motor
function below L5 but is suffering from a loss of sensory function. These
assessment findings are consistent with:
A) Posterior cord syndrome
B) Central cord syndrome
C) Anterior cord syndrome
D) Autonomic syndrome
Rationale: Posterior cord syndrome results from damage to the
posterior columns of the spinal cord, leading to loss of proprioception
and vibration sense (sensory function) while motor function is
preserved. Anterior cord syndrome spares sensory function.
7. What is the critical goal time from arrival to the Emergency
Department to CT brain scan based on the American Heart Association
stroke recommendations?
A) 15 minutes
B) 20 minutes
C) 25 minutes
D) 45 minutes
Rationale: The American Heart Association stroke guidelines
recommend a door-to-CT time of 25 minutes or less for patients
presenting with acute stroke symptoms.
8. Which of the following is the frontline thrombolytic agent for the 4.5-
hour window in acute ischemic stroke per 2026 protocols?
A) Alteplase (tPA)
B) Tenecteplase (TNK)
C) Streptokinase
D) Reteplase
Rationale: 2026 stroke protocols have established Tenecteplase (TNK)
0.25 mg/kg IV push as the dominant frontline agent over tPA
, 4|Page
(Alteplase) for the 4.5-hour treatment window in acute ischemic
stroke.
9. A patient with sepsis and shock or a lactate level > 4 mmol/L should
receive the Sepsis 2025 bundle within which timeframe?
A) 30 minutes
B) 1 hour (STAT)
C) 3 hours
D) 6 hours
Rationale: The 2025 Surviving Sepsis Campaign (SSC) guidelines
specify that patients with septic shock or lactate > 4 require the 1-hour
bundle (STAT). Patients without shock receive the 3-hour bundle.
10. A patient presents with acute onset of central chest pain. They are
tachycardic and tachypneic and appear very anxious and restless. What
would be the MOST important initial intervention for this patient?
A) Obtain an electrocardiogram
B) Administer nitroglycerin
C) Administer oxygen and obtain an ECG
D) Obtain venous blood gas
Rationale: The initial management of a patient with chest pain and
signs of instability (tachycardia, tachypnea, anxiety) should focus on
airway, breathing, and circulation. Administration of oxygen and
obtaining a stat ECG are critical first steps to identify life-threatening
conditions such as STEMI or aortic dissection.
11. What is a common assessment finding in a patient with a tension
pneumothorax?
A) Petechial chest rash
B) Distended neck veins
C) Equal chest wall expansion
D) Flattened neck veins
Rationale: Tension pneumothorax causes increased intrathoracic
pressure, which compresses the superior vena cava and impedes
RELIAS ED RN A, COMPREHENSIVE ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ALREADY
A GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
1. At a mass casualty scene, a patient has a compound leg fracture, is in
severe pain, but has a respiratory rate of 24 and capillary refill of less
than 2 seconds. Which triage tag is the MOST APPROPRIATE for this
patient?
A) Red Tag (Immediate)
B) Yellow Tag (Delayed)
C) Green Tag (Minor)
D) Black Tag (Deceased/Expectant)
Rationale: This patient has a respiratory rate > 30 (actual RR 24) and
capillary refill < 2 seconds, indicating they are not in immediate life-
threatening distress but have a significant injury requiring treatment
that can be delayed. START triage criteria: Yellow tag is assigned to
patients with non-life-threatening injuries who require medical care
but can wait (delayed).
2. What is the current recommended dose of intravenous or intraosseous
epinephrine for an adult patient in cardiac arrest?
A) 10 mg every 10 minutes
B) 1 mg every 3–5 minutes
C) 1 mg every 7 minutes
D) 0.1 mg every 2 minutes
Rationale: The 2025/2026 AHA resuscitation guidelines recommend
epinephrine 1 mg IV/IO every 3 to 5 minutes during adult cardiac
arrest. This is a standard ACLS protocol.
,2|Page
3. A patient who is 27 weeks pregnant presents with painless bright red
vaginal bleeding. What condition correlates with the presenting
symptoms?
A) Abruptio placentae
B) Placenta previa
C) Ectopic pregnancy
D) Premature rupture of membranes (PROM)
Rationale: Placenta previa presents with painless, bright red vaginal
bleeding in the second or third trimester. Abruptio placentae typically
presents with painful bleeding. Ectopic pregnancy presents earlier
with abdominal pain. PROM presents with fluid leakage, not bleeding.
4. What is the Joint Commission 2026 goal regarding nurse staffing?
A) Staffing is an administrative budget metric
B) Staffing is an official patient safety accreditation metric; acuity
dictates ratios
C) Staffing ratios are determined by hospital census only
D) Staffing is not regulated by The Joint Commission
Rationale: The Joint Commission 2026 (Goal 12) establishes that
staffing is an official patient safety accreditation metric; patient acuity,
not administrative budget, dictates appropriate staffing ratios.
5. A patient with a traumatic brain injury (TBI) is MOST likely to suffer
from which condition?
A) Diabetes mellitus
B) Cerebral palsy
C) Diabetes insipidus
D) Myxedema coma
Rationale: Traumatic brain injury can damage the hypothalamus or
pituitary gland, leading to diabetes insipidus (DI) due to decreased
antidiuretic hormone (ADH) production. DI is characterized by
polyuria, polydipsia, and hypernatremia.
,3|Page
6. A patient presents after sustaining a roll-over motor vehicle accident.
They are complaining of pain around the mid-upper back. On your
initial triage assessment, you find that the patient has preserved motor
function below L5 but is suffering from a loss of sensory function. These
assessment findings are consistent with:
A) Posterior cord syndrome
B) Central cord syndrome
C) Anterior cord syndrome
D) Autonomic syndrome
Rationale: Posterior cord syndrome results from damage to the
posterior columns of the spinal cord, leading to loss of proprioception
and vibration sense (sensory function) while motor function is
preserved. Anterior cord syndrome spares sensory function.
7. What is the critical goal time from arrival to the Emergency
Department to CT brain scan based on the American Heart Association
stroke recommendations?
A) 15 minutes
B) 20 minutes
C) 25 minutes
D) 45 minutes
Rationale: The American Heart Association stroke guidelines
recommend a door-to-CT time of 25 minutes or less for patients
presenting with acute stroke symptoms.
8. Which of the following is the frontline thrombolytic agent for the 4.5-
hour window in acute ischemic stroke per 2026 protocols?
A) Alteplase (tPA)
B) Tenecteplase (TNK)
C) Streptokinase
D) Reteplase
Rationale: 2026 stroke protocols have established Tenecteplase (TNK)
0.25 mg/kg IV push as the dominant frontline agent over tPA
, 4|Page
(Alteplase) for the 4.5-hour treatment window in acute ischemic
stroke.
9. A patient with sepsis and shock or a lactate level > 4 mmol/L should
receive the Sepsis 2025 bundle within which timeframe?
A) 30 minutes
B) 1 hour (STAT)
C) 3 hours
D) 6 hours
Rationale: The 2025 Surviving Sepsis Campaign (SSC) guidelines
specify that patients with septic shock or lactate > 4 require the 1-hour
bundle (STAT). Patients without shock receive the 3-hour bundle.
10. A patient presents with acute onset of central chest pain. They are
tachycardic and tachypneic and appear very anxious and restless. What
would be the MOST important initial intervention for this patient?
A) Obtain an electrocardiogram
B) Administer nitroglycerin
C) Administer oxygen and obtain an ECG
D) Obtain venous blood gas
Rationale: The initial management of a patient with chest pain and
signs of instability (tachycardia, tachypnea, anxiety) should focus on
airway, breathing, and circulation. Administration of oxygen and
obtaining a stat ECG are critical first steps to identify life-threatening
conditions such as STEMI or aortic dissection.
11. What is a common assessment finding in a patient with a tension
pneumothorax?
A) Petechial chest rash
B) Distended neck veins
C) Equal chest wall expansion
D) Flattened neck veins
Rationale: Tension pneumothorax causes increased intrathoracic
pressure, which compresses the superior vena cava and impedes
