Page 1 of 113
RELIAS ED RN EXAM QUESTIONS 2026 EXAM LATEST VERSION SOLVED QUESTIONS &
ANSWERS VERIFIED 100 %
Relias ED RN Exam — 300+ Questions with Detailed Rationales
1. The Emergency Severity Index (ESI) triage system categorizes patients into how
many distinct levels based on urgency and resource needs?
A) Three levels
B) Four levels
C) Five levels
D) Six levels
Rationale: The ESI system uses five levels (1–5) to prioritize patients, with Level 1 being
the most urgent and Level 5 being the least urgent. This system combines acuity and
anticipated resource utilization.
2. A patient presents with a simple sprained ankle, no pain medication needed, and
requires only a brief examination. What ESI level is MOST appropriate?
A) ESI 1
B) ESI 2
C) ESI 3
D) ESI 5
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Rationale: ESI 5 patients require no resources beyond a basic examination and are
considered non-urgent. A simple sprained ankle with no need for interventions falls into
this category.
3. Which of the following is the PRIMARY determinant for assigning an ESI Level 1
designation?
A) Need for multiple diagnostic tests
B) Severe pain rating of 10/10
C) Need for immediate life-saving intervention
D) Age over 65 years
Rationale: ESI Level 1 is reserved for patients requiring immediate life-saving
interventions. Patients who are unstable or have conditions that threaten life or limb
receive this highest acuity level.
4. An ESI Level 2 patient is characterized by all of the following EXCEPT:
A) High-risk situation
B) Confused or lethargic
C) Severe pain or distress
D) Requires no resources
Rationale: ESI Level 2 patients should not wait and are characterized by high-risk
situations, confusion/lethargy/disorientation, or severe pain/distress. They typically
require multiple resources and are considered high acuity.
5. When determining ESI level, "resources" refer to:
A) Only medications administered
B) Only nursing assessment time
C) Therapeutic and diagnostic interventions beyond history and physical exam
D) Only laboratory tests and imaging studies
, Page 3 of 113
Rationale: Resources include any interventions, diagnostic tests, procedures, or
treatments beyond the basic history and physical examination. This includes labs,
imaging, medications, and specialty consultations.
6. A patient who is alert, oriented, has stable vital signs, and requires only a throat
culture and over-the-counter medication would MOST likely receive which ESI
level?
A) ESI 2
B) ESI 3
C) ESI 4
D) ESI 5
Rationale: ESI 4 patients require one resource (the throat culture). ESI 5 would require
no resources. The over-the-counter medication recommendation does not count as a
resource.
7. A 45-year-old patient presents with acute abdominal pain, requires two
resources, and exhibits a heart rate of 122 bpm and a respiratory rate of 28. What is
the MOST APPROPRIATE ESI level assignment?
A) ESI Level 3, because the patient only requires two resources
B) ESI Level 2, because abnormal vital signs indicate a high-risk situation
C) ESI Level 1, because tachycardia indicates immediate life-saving intervention
D) ESI Level 4, because abdominal pain is a routine complaint
Rationale: ESI v5 mandates that abnormal vital signs (tachycardia, tachypnea) in an
otherwise Level 3 patient must trigger an upgrade to Level 2 to prevent undertriage.
Resources determine the floor of acuity; vital signs determine the ceiling.
8. A 68-year-old with chest pain, diaphoresis, and BP 80/50. What ESI level?
A) ESI 1
B) ESI 2
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C) ESI 3
D) ESI 4
Rationale: Unstable vitals (hypotension) with life-threatening symptom (chest pain,
possible MI) requires immediate life-saving intervention. This is ESI Level 1.
9. A child with stridor, drooling, and tripod positioning. ESI level?
A) ESI 1
B) ESI 2
C) ESI 3
D) ESI 5
Rationale: Stridor + drooling + tripod = impending airway obstruction (e.g., epiglottitis).
High risk for deterioration. This is ESI Level 1.
10. A patient with active seizure lasting 5 minutes. ESI level?
A) ESI 1
B) ESI 2
C) ESI 3
D) ESI 4
Rationale: Active seizure = life-threatening, requires immediate intervention
(benzodiazepines, airway support). This is ESI Level 1.
11. ESI level 3 requires:
A) 0 resources
B) 1 resource
C) 2+ resources
D) Immediate life-saving intervention
Rationale: ESI Level 3 patients require two or more resources. This includes laboratory
tests, imaging, IV medications, and specialty consultations.
RELIAS ED RN EXAM QUESTIONS 2026 EXAM LATEST VERSION SOLVED QUESTIONS &
ANSWERS VERIFIED 100 %
Relias ED RN Exam — 300+ Questions with Detailed Rationales
1. The Emergency Severity Index (ESI) triage system categorizes patients into how
many distinct levels based on urgency and resource needs?
A) Three levels
B) Four levels
C) Five levels
D) Six levels
Rationale: The ESI system uses five levels (1–5) to prioritize patients, with Level 1 being
the most urgent and Level 5 being the least urgent. This system combines acuity and
anticipated resource utilization.
2. A patient presents with a simple sprained ankle, no pain medication needed, and
requires only a brief examination. What ESI level is MOST appropriate?
A) ESI 1
B) ESI 2
C) ESI 3
D) ESI 5
, Page 2 of 113
Rationale: ESI 5 patients require no resources beyond a basic examination and are
considered non-urgent. A simple sprained ankle with no need for interventions falls into
this category.
3. Which of the following is the PRIMARY determinant for assigning an ESI Level 1
designation?
A) Need for multiple diagnostic tests
B) Severe pain rating of 10/10
C) Need for immediate life-saving intervention
D) Age over 65 years
Rationale: ESI Level 1 is reserved for patients requiring immediate life-saving
interventions. Patients who are unstable or have conditions that threaten life or limb
receive this highest acuity level.
4. An ESI Level 2 patient is characterized by all of the following EXCEPT:
A) High-risk situation
B) Confused or lethargic
C) Severe pain or distress
D) Requires no resources
Rationale: ESI Level 2 patients should not wait and are characterized by high-risk
situations, confusion/lethargy/disorientation, or severe pain/distress. They typically
require multiple resources and are considered high acuity.
5. When determining ESI level, "resources" refer to:
A) Only medications administered
B) Only nursing assessment time
C) Therapeutic and diagnostic interventions beyond history and physical exam
D) Only laboratory tests and imaging studies
, Page 3 of 113
Rationale: Resources include any interventions, diagnostic tests, procedures, or
treatments beyond the basic history and physical examination. This includes labs,
imaging, medications, and specialty consultations.
6. A patient who is alert, oriented, has stable vital signs, and requires only a throat
culture and over-the-counter medication would MOST likely receive which ESI
level?
A) ESI 2
B) ESI 3
C) ESI 4
D) ESI 5
Rationale: ESI 4 patients require one resource (the throat culture). ESI 5 would require
no resources. The over-the-counter medication recommendation does not count as a
resource.
7. A 45-year-old patient presents with acute abdominal pain, requires two
resources, and exhibits a heart rate of 122 bpm and a respiratory rate of 28. What is
the MOST APPROPRIATE ESI level assignment?
A) ESI Level 3, because the patient only requires two resources
B) ESI Level 2, because abnormal vital signs indicate a high-risk situation
C) ESI Level 1, because tachycardia indicates immediate life-saving intervention
D) ESI Level 4, because abdominal pain is a routine complaint
Rationale: ESI v5 mandates that abnormal vital signs (tachycardia, tachypnea) in an
otherwise Level 3 patient must trigger an upgrade to Level 2 to prevent undertriage.
Resources determine the floor of acuity; vital signs determine the ceiling.
8. A 68-year-old with chest pain, diaphoresis, and BP 80/50. What ESI level?
A) ESI 1
B) ESI 2
, Page 4 of 113
C) ESI 3
D) ESI 4
Rationale: Unstable vitals (hypotension) with life-threatening symptom (chest pain,
possible MI) requires immediate life-saving intervention. This is ESI Level 1.
9. A child with stridor, drooling, and tripod positioning. ESI level?
A) ESI 1
B) ESI 2
C) ESI 3
D) ESI 5
Rationale: Stridor + drooling + tripod = impending airway obstruction (e.g., epiglottitis).
High risk for deterioration. This is ESI Level 1.
10. A patient with active seizure lasting 5 minutes. ESI level?
A) ESI 1
B) ESI 2
C) ESI 3
D) ESI 4
Rationale: Active seizure = life-threatening, requires immediate intervention
(benzodiazepines, airway support). This is ESI Level 1.
11. ESI level 3 requires:
A) 0 resources
B) 1 resource
C) 2+ resources
D) Immediate life-saving intervention
Rationale: ESI Level 3 patients require two or more resources. This includes laboratory
tests, imaging, IV medications, and specialty consultations.
