RELIAS LEARNING NURSING TEST EXAM 2026/2027
COMPREHENSIVE REVIEW WITH ACCURATE ANSWERS
Relias Nursing Competency Assessment | Key Domains: Clinical Judgment & Critical Thinking,
Patient Safety & Risk Reduction, Disease-Specific Management (Cardiac, Respiratory, Neuro, etc.),
Pharmacology & Medication Safety, Behavioral Health & De-escalation, Age-Specific Care (Geriatrics,
Pediatrics), Regulatory Compliance (CMS, Joint Commission), and Documentation & Communication
| Expert-Aligned Structure | Comprehensive Review Format
Introduction
This structured Relias Learning Nursing Test Review for 2026/2027 provides a comprehensive set
of practice questions and rationales mirroring the style and content of Relias competency
assessments. It emphasizes the application of clinical knowledge to improve patient outcomes,
mitigate risks, and ensure compliance with evidence-based practices and regulatory standards in
acute and post-acute care settings.
Review Structure:
• Comprehensive Competency Review: (120 SCENARIO-BASED QUESTIONS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining the clinical reasoning behind the best intervention, the risk management principle, the
correct application of a clinical guideline or protocol, and why alternative options increase patient
risk, are ineffective, or non-compliant with standards assessed by Relias.
1. A nurse is caring for a client with heart failure who has crackles in the lung bases, +3
pitting edema, and dyspnea at rest. Which action takes priority?
A. Administer furosemide as prescribed
B. Elevate the head of the bed to High Fowler’s
C. Notify the provider immediately
D. Apply oxygen via nasal cannula
,B. Elevate the head of the bed to High Fowler’s
In acute decompensated heart failure with pulmonary edema, the priority is to improve oxygenation
and reduce venous return. High Fowler’s position decreases preload and eases breathing—this is an
immediate, independent nursing action. Oxygen (D) and diuretics (A) are also important but
secondary to positioning. Notification (C) is needed but not before stabilizing the patient.
2. A client with dementia becomes agitated and attempts to remove their IV during the night
shift. What is the first non-restrictive intervention the nurse should implement?
A. Apply soft wrist restraints
B. Administer PRN haloperidol
C. Reorient the client and provide reassurance
D. Move the client to a room near the nurses’ station
C. Reorient the client and provide reassurance
Relias and CMS emphasize least restrictive interventions first. Reorientation, redirection, and
reassurance are non-pharmacological, non-restrictive strategies to de-escalate behavioral symptoms
in dementia. Restraints (A) and antipsychotics (B) require orders and are last resorts due to black box
warnings and fall risk. Environmental changes (D) may help but are not first-line.
3. A nurse is preparing to administer insulin glargine (Lantus). Which action is correct?
A. Mix it with regular insulin in the same syringe
B. Administer at bedtime on a consistent schedule
C. Rotate injection sites within the same body area daily
D. Shake the vial before drawing up the dose
B. Administer at bedtime on a consistent schedule
Insulin glargine is a long-acting basal insulin given once daily at the same time (often bedtime) to
maintain steady blood levels. It should NEVER be mixed with other insulins (A). Injection sites should
,be rotated across different body areas (abdomen, thigh, arm) to prevent lipodystrophy—not just
within one area (C). Glargine is clear; shaking (D) is unnecessary and may create bubbles.
4. A client on a medical-surgical unit falls while going to the bathroom unassisted. The client
is alert and denies pain. What is the nurse’s priority action?
A. Complete an incident report
B. Perform a full head-to-toe assessment
C. Help the client back to bed
D. Notify the provider and family
B. Perform a full head-to-toe assessment
Even if the client appears uninjured, internal injuries or delayed symptoms (e.g., subdural hematoma
in elderly) can occur. A thorough assessment—including neuro checks, skin inspection, and vital
signs—is required before any other action. Incident reports (A) are administrative and done after
assessment. Moving the client (C) before assessment could worsen injury.
5. A nurse notes that a client’s INR is 6.0 (therapeutic range 2.0–3.0) and the client is taking
warfarin. What is the priority intervention?
A. Administer vitamin K 10 mg IV stat
B. Hold the next dose of warfarin and notify the provider
C. Repeat the INR in 6 hours
D. Encourage foods high in vitamin K
B. Hold the next dose of warfarin and notify the provider
An INR of 6.0 indicates high risk for bleeding. The first action is to hold warfarin and alert the provider,
who may order vitamin K or fresh frozen plasma depending on bleeding risk. IV vitamin K (A) is
reserved for active bleeding or INR >10. Repeating INR (C) delays intervention. Dietary changes (D)
are too slow to correct acute elevation.
, 6. A client with COPD is receiving oxygen at 6 L/min via nasal cannula. The client becomes
increasingly lethargic and has a respiratory rate of 8 breaths/minute. What is the most likely
cause?
A. Hypoxia
B. Oxygen-induced hypercapnia
C. Pneumonia
D. Pulmonary embolism
B. Oxygen-induced hypercapnia
In COPD patients with chronic CO₂ retention, high-flow oxygen can suppress the hypoxic drive to
breathe, leading to CO₂ narcosis (lethargy, bradypnea). Oxygen should be titrated to SpO₂ 88–92%, not
high flow. Hypoxia (A) would cause agitation, not lethargy. Pneumonia (C) and PE (D) may cause these
symptoms but are less likely with recent high-flow O₂ initiation.
7. Which finding in an older adult requires immediate reporting to the provider?
A. Blood pressure 138/82 mm Hg
B. New onset of confusion
C. Occasional nocturia
D. Dry, thin skin
B. New onset of confusion
In older adults, new confusion (delirium) is a medical emergency often signaling infection (e.g., UTI),
dehydration, hypoxia, or medication toxicity. It is never “normal aging.” BP (A), nocturia (C), and skin
changes (D) are common age-related findings.
8. A nurse is caring for a client with a history of substance use disorder who is in withdrawal.
The client is diaphoretic, tremulous, and tachycardic. What is the priority concern?
COMPREHENSIVE REVIEW WITH ACCURATE ANSWERS
Relias Nursing Competency Assessment | Key Domains: Clinical Judgment & Critical Thinking,
Patient Safety & Risk Reduction, Disease-Specific Management (Cardiac, Respiratory, Neuro, etc.),
Pharmacology & Medication Safety, Behavioral Health & De-escalation, Age-Specific Care (Geriatrics,
Pediatrics), Regulatory Compliance (CMS, Joint Commission), and Documentation & Communication
| Expert-Aligned Structure | Comprehensive Review Format
Introduction
This structured Relias Learning Nursing Test Review for 2026/2027 provides a comprehensive set
of practice questions and rationales mirroring the style and content of Relias competency
assessments. It emphasizes the application of clinical knowledge to improve patient outcomes,
mitigate risks, and ensure compliance with evidence-based practices and regulatory standards in
acute and post-acute care settings.
Review Structure:
• Comprehensive Competency Review: (120 SCENARIO-BASED QUESTIONS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining the clinical reasoning behind the best intervention, the risk management principle, the
correct application of a clinical guideline or protocol, and why alternative options increase patient
risk, are ineffective, or non-compliant with standards assessed by Relias.
1. A nurse is caring for a client with heart failure who has crackles in the lung bases, +3
pitting edema, and dyspnea at rest. Which action takes priority?
A. Administer furosemide as prescribed
B. Elevate the head of the bed to High Fowler’s
C. Notify the provider immediately
D. Apply oxygen via nasal cannula
,B. Elevate the head of the bed to High Fowler’s
In acute decompensated heart failure with pulmonary edema, the priority is to improve oxygenation
and reduce venous return. High Fowler’s position decreases preload and eases breathing—this is an
immediate, independent nursing action. Oxygen (D) and diuretics (A) are also important but
secondary to positioning. Notification (C) is needed but not before stabilizing the patient.
2. A client with dementia becomes agitated and attempts to remove their IV during the night
shift. What is the first non-restrictive intervention the nurse should implement?
A. Apply soft wrist restraints
B. Administer PRN haloperidol
C. Reorient the client and provide reassurance
D. Move the client to a room near the nurses’ station
C. Reorient the client and provide reassurance
Relias and CMS emphasize least restrictive interventions first. Reorientation, redirection, and
reassurance are non-pharmacological, non-restrictive strategies to de-escalate behavioral symptoms
in dementia. Restraints (A) and antipsychotics (B) require orders and are last resorts due to black box
warnings and fall risk. Environmental changes (D) may help but are not first-line.
3. A nurse is preparing to administer insulin glargine (Lantus). Which action is correct?
A. Mix it with regular insulin in the same syringe
B. Administer at bedtime on a consistent schedule
C. Rotate injection sites within the same body area daily
D. Shake the vial before drawing up the dose
B. Administer at bedtime on a consistent schedule
Insulin glargine is a long-acting basal insulin given once daily at the same time (often bedtime) to
maintain steady blood levels. It should NEVER be mixed with other insulins (A). Injection sites should
,be rotated across different body areas (abdomen, thigh, arm) to prevent lipodystrophy—not just
within one area (C). Glargine is clear; shaking (D) is unnecessary and may create bubbles.
4. A client on a medical-surgical unit falls while going to the bathroom unassisted. The client
is alert and denies pain. What is the nurse’s priority action?
A. Complete an incident report
B. Perform a full head-to-toe assessment
C. Help the client back to bed
D. Notify the provider and family
B. Perform a full head-to-toe assessment
Even if the client appears uninjured, internal injuries or delayed symptoms (e.g., subdural hematoma
in elderly) can occur. A thorough assessment—including neuro checks, skin inspection, and vital
signs—is required before any other action. Incident reports (A) are administrative and done after
assessment. Moving the client (C) before assessment could worsen injury.
5. A nurse notes that a client’s INR is 6.0 (therapeutic range 2.0–3.0) and the client is taking
warfarin. What is the priority intervention?
A. Administer vitamin K 10 mg IV stat
B. Hold the next dose of warfarin and notify the provider
C. Repeat the INR in 6 hours
D. Encourage foods high in vitamin K
B. Hold the next dose of warfarin and notify the provider
An INR of 6.0 indicates high risk for bleeding. The first action is to hold warfarin and alert the provider,
who may order vitamin K or fresh frozen plasma depending on bleeding risk. IV vitamin K (A) is
reserved for active bleeding or INR >10. Repeating INR (C) delays intervention. Dietary changes (D)
are too slow to correct acute elevation.
, 6. A client with COPD is receiving oxygen at 6 L/min via nasal cannula. The client becomes
increasingly lethargic and has a respiratory rate of 8 breaths/minute. What is the most likely
cause?
A. Hypoxia
B. Oxygen-induced hypercapnia
C. Pneumonia
D. Pulmonary embolism
B. Oxygen-induced hypercapnia
In COPD patients with chronic CO₂ retention, high-flow oxygen can suppress the hypoxic drive to
breathe, leading to CO₂ narcosis (lethargy, bradypnea). Oxygen should be titrated to SpO₂ 88–92%, not
high flow. Hypoxia (A) would cause agitation, not lethargy. Pneumonia (C) and PE (D) may cause these
symptoms but are less likely with recent high-flow O₂ initiation.
7. Which finding in an older adult requires immediate reporting to the provider?
A. Blood pressure 138/82 mm Hg
B. New onset of confusion
C. Occasional nocturia
D. Dry, thin skin
B. New onset of confusion
In older adults, new confusion (delirium) is a medical emergency often signaling infection (e.g., UTI),
dehydration, hypoxia, or medication toxicity. It is never “normal aging.” BP (A), nocturia (C), and skin
changes (D) are common age-related findings.
8. A nurse is caring for a client with a history of substance use disorder who is in withdrawal.
The client is diaphoretic, tremulous, and tachycardic. What is the priority concern?
