RELIAS ED RN A, Exam (Latest Update)
Questions & Answers
Question 1
What staff member would you ask to accompany you when transporting an intubated
patient to imaging for a CT?
Lift team
Respiratory therapist
Physician's assistant
Nursing assistant
Correct Answer
RT
Question 2
A patient who is 27 weeks pregnant presents with painless bright red vaginal
bleeding. What condition correlates with the presenting symptoms?
Abruptio placenta
Placenta Previa
Ectopic pregnancy
Premature rupture of membranes (PROM)
Correct Answer
Placenta Previa
Page 1 of 64
,Question 3
You see a fellow nurse placing an opioid medication in their pocket rather than
administering it as ordered. What would you do NEXT?
Don't say anything.
Tell another coworker.
Confront your coworker.
Tell your immediate supervisor.
Correct Answer
Tell your immediate supervisor
Question 1: A 68-year-old male presents to the emergency department via
EMS complaining of sudden onset, severe, "tearing" chest pain radiating to
his mid-back. His vital signs are: blood pressure 195/110 mmHg, heart rate
118 bpm, respiratory rate 26 breaths/min, SpO2 93% on room air, and
temperature 37.1°C. He has a known history of uncontrolled hypertension
and Marfan syndrome. The triage nurse notes unequal radial pulses. Based
on this clinical presentation, what is the most appropriate immediate
nursing action?
A. Administer sublingual nitroglycerin and obtain a 12-lead ECG.
B. Prepare the patient for immediate administration of IV beta-blockers and
notify the provider for a stat CT angiogram.
C. Administer 324 mg of chewable aspirin and prepare for immediate cardiac
catheterization.
D. Initiate a heparin drip and prepare the patient for a stat echocardiogram.
CORRECT ANSWER: B. Prepare the patient for immediate administration of
IV beta-blockers and notify the provider for a stat CT angiogram.
Rationale: The patient's presentation is highly suspicious for an acute aortic
dissection. The immediate nursing priority is to reduce shear stress on the
aortic wall by lowering the heart rate and blood pressure, typically with IV
beta-blockers (e.g., esmolol or labetalol), followed by definitive imaging (CT
angiogram). Nitroglycerin and aspirin are contraindicated as they can
exacerbate the dissection or increase bleeding risk.
Question 2: A 24-year-old female presents to the triage desk complaining
of sudden onset, severe right lower quadrant abdominal pain, dizziness,
and a missed menstrual period for 6 weeks. Her vital signs are: blood
pressure 88/50 mmHg, heart rate 125 bpm, respiratory rate 22
breaths/min, and SpO2 98% on room air. She appears pale and
diaphoretic. According to the Emergency Severity Index (ESI), what triage
level should be assigned to this patient, and what is the primary rationale?
A. ESI Level 2, because she is in severe pain but currently maintaining her
Page 2 of 64
,airway.
B. ESI Level 1, because she is exhibiting signs of hemodynamic instability and
suspected ruptured ectopic pregnancy requiring immediate, life-saving
intervention.
C. ESI Level 3, because she requires multiple resources including an
ultrasound and IV fluids.
D. ESI Level 2, because she requires immediate laboratory testing and a
pelvic exam.
CORRECT ANSWER: B. ESI Level 1, because she is exhibiting signs of
hemodynamic instability and suspected ruptured ectopic pregnancy
requiring immediate, life-saving intervention.
Rationale: ESI Level 1 is reserved for patients who are in immediate life-
threatening condition and require immediate, life-saving intervention. This
patient's hypotension, tachycardia, and clinical presentation strongly suggest
a ruptured ectopic pregnancy with hemorrhagic shock, necessitating
immediate resuscitation and potential surgical intervention.
Question 3: A 55-year-old male arrives at the ED complaining of crushing
substernal chest pain that began 45 minutes ago while mowing the lawn.
He rates the pain as 9/10. His 12-lead ECG shows ST-segment elevation in
leads II, III, and aVF. The ED physician activates the STEMI protocol. What is
the target "door-to-balloon" time for this patient, and what is the nurse's
priority medication to administer first if not contraindicated?
A. 60 minutes; administer IV morphine.
B. 90 minutes; administer 324 mg of chewable aspirin.
C. 120 minutes; administer sublingual nitroglycerin.
D. 30 minutes; administer IV metoprolol.
CORRECT ANSWER: B. 90 minutes; administer 324 mg of chewable aspirin.
Rationale: The American Heart Association (AHA) target door-to-balloon
time for a STEMI patient undergoing primary percutaneous coronary
intervention (PCI) is 90 minutes or less. The immediate nursing priority is to
administer 162-324 mg of chewable aspirin to inhibit platelet aggregation,
which has been shown to significantly reduce mortality in acute myocardial
infarction.
Question 4: A 30-year-old female is brought to the ED by her family after
developing sudden onset facial swelling, difficulty breathing, and
widespread hives shortly after eating at a restaurant. Her vital signs are:
blood pressure 70/40 mmHg, heart rate 130 bpm, respiratory rate 32
breaths/min with audible stridor, and SpO2 85% on room air. What is the
most critical, first-line medication the nurse should prepare to administer
immediately?
Page 3 of 64
, A. IV diphenhydramine 50 mg.
B. IV methylprednisolone 125 mg.
C. IM epinephrine 1:1,000 (1 mg/mL) at a dose of 0.3 to 0.5 mg in the
anterolateral thigh.
D. Nebulized albuterol 2.5 mg.
CORRECT ANSWER: C. IM epinephrine 1:1,000 (1 mg/mL) at a dose of 0.3 to
0.5 mg in the anterolateral thigh.
Rationale: The patient is experiencing anaphylactic shock with airway
compromise and severe hypotension. Intramuscular epinephrine is the
absolute first-line, life-saving treatment for anaphylaxis. It provides rapid
alpha-1 adrenergic vasoconstriction to improve blood pressure and beta-2
adrenergic bronchodilation to relieve airway obstruction. Antihistamines and
corticosteroids are secondary treatments and do not reverse acute
anaphylaxis.
Question 5: A 72-year-old male with a history of diabetes and chronic
kidney disease presents with fever, altered mental status, and a productive
cough. His vital signs are: temperature 38.9°C, heart rate 115 bpm, blood
pressure 85/50 mmHg, respiratory rate 24 breaths/min, and SpO2 92% on
room air. The physician suspects septic shock. According to the Surviving
Sepsis Campaign 1-hour bundle, which of the following nursing actions
should be prioritized first?
A. Administer broad-spectrum IV antibiotics after blood cultures are drawn.
B. Measure serum lactate level and obtain two sets of blood cultures before
administering antibiotics.
C. Administer a 30 mL/kg bolus of IV crystalloid fluids for hypotension.
D. Apply vasopressors immediately to maintain a mean arterial pressure
(MAP) > 65 mmHg.
CORRECT ANSWER: B. Measure serum lactate level and obtain two sets of
blood cultures before administering antibiotics.
Rationale: The Surviving Sepsis Campaign 1-hour bundle dictates that within
the first hour of recognition, the nurse should measure lactate, obtain blood
cultures before administering antibiotics (if it does not significantly delay
administration), administer broad-spectrum antibiotics, and begin rapid fluid
resuscitation (30 mL/kg) for hypotension or lactate ≥ 4 mmol/L. Obtaining
cultures before antibiotics is a critical step to ensure accurate pathogen
identification.
Question 6: A 65-year-old female is brought to the ED by her husband,
who reports that she suddenly became unable to speak and developed
right-sided facial droop and right arm weakness approximately 90 minutes
ago. Her blood glucose is 110 mg/dL, and a non-contrast CT scan of the
Page 4 of 64
Questions & Answers
Question 1
What staff member would you ask to accompany you when transporting an intubated
patient to imaging for a CT?
Lift team
Respiratory therapist
Physician's assistant
Nursing assistant
Correct Answer
RT
Question 2
A patient who is 27 weeks pregnant presents with painless bright red vaginal
bleeding. What condition correlates with the presenting symptoms?
Abruptio placenta
Placenta Previa
Ectopic pregnancy
Premature rupture of membranes (PROM)
Correct Answer
Placenta Previa
Page 1 of 64
,Question 3
You see a fellow nurse placing an opioid medication in their pocket rather than
administering it as ordered. What would you do NEXT?
Don't say anything.
Tell another coworker.
Confront your coworker.
Tell your immediate supervisor.
Correct Answer
Tell your immediate supervisor
Question 1: A 68-year-old male presents to the emergency department via
EMS complaining of sudden onset, severe, "tearing" chest pain radiating to
his mid-back. His vital signs are: blood pressure 195/110 mmHg, heart rate
118 bpm, respiratory rate 26 breaths/min, SpO2 93% on room air, and
temperature 37.1°C. He has a known history of uncontrolled hypertension
and Marfan syndrome. The triage nurse notes unequal radial pulses. Based
on this clinical presentation, what is the most appropriate immediate
nursing action?
A. Administer sublingual nitroglycerin and obtain a 12-lead ECG.
B. Prepare the patient for immediate administration of IV beta-blockers and
notify the provider for a stat CT angiogram.
C. Administer 324 mg of chewable aspirin and prepare for immediate cardiac
catheterization.
D. Initiate a heparin drip and prepare the patient for a stat echocardiogram.
CORRECT ANSWER: B. Prepare the patient for immediate administration of
IV beta-blockers and notify the provider for a stat CT angiogram.
Rationale: The patient's presentation is highly suspicious for an acute aortic
dissection. The immediate nursing priority is to reduce shear stress on the
aortic wall by lowering the heart rate and blood pressure, typically with IV
beta-blockers (e.g., esmolol or labetalol), followed by definitive imaging (CT
angiogram). Nitroglycerin and aspirin are contraindicated as they can
exacerbate the dissection or increase bleeding risk.
Question 2: A 24-year-old female presents to the triage desk complaining
of sudden onset, severe right lower quadrant abdominal pain, dizziness,
and a missed menstrual period for 6 weeks. Her vital signs are: blood
pressure 88/50 mmHg, heart rate 125 bpm, respiratory rate 22
breaths/min, and SpO2 98% on room air. She appears pale and
diaphoretic. According to the Emergency Severity Index (ESI), what triage
level should be assigned to this patient, and what is the primary rationale?
A. ESI Level 2, because she is in severe pain but currently maintaining her
Page 2 of 64
,airway.
B. ESI Level 1, because she is exhibiting signs of hemodynamic instability and
suspected ruptured ectopic pregnancy requiring immediate, life-saving
intervention.
C. ESI Level 3, because she requires multiple resources including an
ultrasound and IV fluids.
D. ESI Level 2, because she requires immediate laboratory testing and a
pelvic exam.
CORRECT ANSWER: B. ESI Level 1, because she is exhibiting signs of
hemodynamic instability and suspected ruptured ectopic pregnancy
requiring immediate, life-saving intervention.
Rationale: ESI Level 1 is reserved for patients who are in immediate life-
threatening condition and require immediate, life-saving intervention. This
patient's hypotension, tachycardia, and clinical presentation strongly suggest
a ruptured ectopic pregnancy with hemorrhagic shock, necessitating
immediate resuscitation and potential surgical intervention.
Question 3: A 55-year-old male arrives at the ED complaining of crushing
substernal chest pain that began 45 minutes ago while mowing the lawn.
He rates the pain as 9/10. His 12-lead ECG shows ST-segment elevation in
leads II, III, and aVF. The ED physician activates the STEMI protocol. What is
the target "door-to-balloon" time for this patient, and what is the nurse's
priority medication to administer first if not contraindicated?
A. 60 minutes; administer IV morphine.
B. 90 minutes; administer 324 mg of chewable aspirin.
C. 120 minutes; administer sublingual nitroglycerin.
D. 30 minutes; administer IV metoprolol.
CORRECT ANSWER: B. 90 minutes; administer 324 mg of chewable aspirin.
Rationale: The American Heart Association (AHA) target door-to-balloon
time for a STEMI patient undergoing primary percutaneous coronary
intervention (PCI) is 90 minutes or less. The immediate nursing priority is to
administer 162-324 mg of chewable aspirin to inhibit platelet aggregation,
which has been shown to significantly reduce mortality in acute myocardial
infarction.
Question 4: A 30-year-old female is brought to the ED by her family after
developing sudden onset facial swelling, difficulty breathing, and
widespread hives shortly after eating at a restaurant. Her vital signs are:
blood pressure 70/40 mmHg, heart rate 130 bpm, respiratory rate 32
breaths/min with audible stridor, and SpO2 85% on room air. What is the
most critical, first-line medication the nurse should prepare to administer
immediately?
Page 3 of 64
, A. IV diphenhydramine 50 mg.
B. IV methylprednisolone 125 mg.
C. IM epinephrine 1:1,000 (1 mg/mL) at a dose of 0.3 to 0.5 mg in the
anterolateral thigh.
D. Nebulized albuterol 2.5 mg.
CORRECT ANSWER: C. IM epinephrine 1:1,000 (1 mg/mL) at a dose of 0.3 to
0.5 mg in the anterolateral thigh.
Rationale: The patient is experiencing anaphylactic shock with airway
compromise and severe hypotension. Intramuscular epinephrine is the
absolute first-line, life-saving treatment for anaphylaxis. It provides rapid
alpha-1 adrenergic vasoconstriction to improve blood pressure and beta-2
adrenergic bronchodilation to relieve airway obstruction. Antihistamines and
corticosteroids are secondary treatments and do not reverse acute
anaphylaxis.
Question 5: A 72-year-old male with a history of diabetes and chronic
kidney disease presents with fever, altered mental status, and a productive
cough. His vital signs are: temperature 38.9°C, heart rate 115 bpm, blood
pressure 85/50 mmHg, respiratory rate 24 breaths/min, and SpO2 92% on
room air. The physician suspects septic shock. According to the Surviving
Sepsis Campaign 1-hour bundle, which of the following nursing actions
should be prioritized first?
A. Administer broad-spectrum IV antibiotics after blood cultures are drawn.
B. Measure serum lactate level and obtain two sets of blood cultures before
administering antibiotics.
C. Administer a 30 mL/kg bolus of IV crystalloid fluids for hypotension.
D. Apply vasopressors immediately to maintain a mean arterial pressure
(MAP) > 65 mmHg.
CORRECT ANSWER: B. Measure serum lactate level and obtain two sets of
blood cultures before administering antibiotics.
Rationale: The Surviving Sepsis Campaign 1-hour bundle dictates that within
the first hour of recognition, the nurse should measure lactate, obtain blood
cultures before administering antibiotics (if it does not significantly delay
administration), administer broad-spectrum antibiotics, and begin rapid fluid
resuscitation (30 mL/kg) for hypotension or lactate ≥ 4 mmol/L. Obtaining
cultures before antibiotics is a critical step to ensure accurate pathogen
identification.
Question 6: A 65-year-old female is brought to the ED by her husband,
who reports that she suddenly became unable to speak and developed
right-sided facial droop and right arm weakness approximately 90 minutes
ago. Her blood glucose is 110 mg/dL, and a non-contrast CT scan of the
Page 4 of 64
