Relias Medical-Surgical Nursing
Competency Exam 2026 Practice Questions
& Answers PDF | Study Guide with Verified
Solutions & Rationales
• This study guide contains 200 practice questions covering all core domains of the
Relias Medical-Surgical Nursing Competency Exam 2026, designed to simulate the
actual exam experience and reinforce clinical decision-making skills.
• Each question features five answer choices (A–E), a clearly highlighted correct
answer in bold, and a detailed EXPERT RATIONALE to deepen understanding and
support long-term retention.
1. A nurse is caring for a postoperative patient who had an appendectomy 6
hours ago. The patient reports pain of 8/10. Which intervention should the
nurse prioritize?
A. Reposition the patient to the left lateral position
B. Offer distraction techniques such as music therapy
C. Notify the surgeon immediately
D. Document the pain score and reassess in one hour
E. Administer the prescribed analgesic as ordered
Correct Answer: E. Administer the prescribed analgesic as ordered
EXPERT RATIONALE: Pain management is a priority nursing intervention.
Administering prescribed analgesics addresses the patient's acute pain promptly
and humanely. Repositioning, distraction, or delaying treatment does not
adequately address a pain score of 8/10. Notifying the surgeon is not indicated
unless pain is unrelieved after appropriate intervention.
2. A patient with a history of chronic kidney disease (CKD) is admitted with
fluid overload. Which assessment finding best confirms this diagnosis?
A. Decreased blood pressure
,B. Decreased urine output and peripheral edema
C. Elevated hematocrit
D. Tachycardia with dry mucous membranes
E. Increased skin turgor
Correct Answer: B. Decreased urine output and peripheral edema
EXPERT RATIONALE: Fluid overload in CKD is characterized by decreased urine
output due to impaired kidney filtration and peripheral edema from fluid
accumulation in interstitial spaces. Elevated hematocrit and dry mucous
membranes indicate dehydration, not overload. Increased skin turgor is also a sign
of adequate or excess hydration but is not as specific as the combination presented
in B.
3. A patient is admitted with diabetic ketoacidosis (DKA). Which laboratory
finding is most expected?
A. pH of 7.45, bicarbonate of 26 mEq/L
B. pH of 7.20, bicarbonate of 10 mEq/L
C. pH of 7.50, bicarbonate of 30 mEq/L
D. pH of 7.38, bicarbonate of 22 mEq/L
E. pH of 7.48, potassium of 5.5 mEq/L
Correct Answer: B. pH of 7.20, bicarbonate of 10 mEq/L
EXPERT RATIONALE: DKA produces a high anion gap metabolic acidosis. The
hallmarks are a low pH (acidosis) and low bicarbonate due to buffering of
ketoacids. A pH of 7.20 and bicarbonate of 10 mEq/L are consistent with severe
metabolic acidosis seen in DKA.
,4. A nurse is caring for a patient on a heparin infusion. The aPTT result is 120
seconds (therapeutic range: 60–100 seconds). What is the appropriate nursing
action?
A. Increase the heparin infusion rate
B. Continue the infusion at the current rate
C. Decrease the heparin infusion rate per protocol
D. Discontinue the heparin infusion and notify the physician
E. Administer protamine sulfate immediately
Correct Answer: C. Decrease the heparin infusion rate per protocol
EXPERT RATIONALE: An aPTT of 120 seconds is above the therapeutic range,
indicating excessive anticoagulation. The nurse should reduce the infusion rate per
protocol. Protamine sulfate is the antidote for heparin overdose but is reserved for
serious bleeding events, not a supratherapeutic aPTT alone.
5. Which sign or symptom is the earliest indicator of hypoxia in a
postoperative patient?
A. Cyanosis
B. Bradycardia
C. Restlessness and confusion
D. Decreased respiratory rate
E. Hypotension
Correct Answer: C. Restlessness and confusion
EXPERT RATIONALE: The brain is extremely sensitive to oxygen deprivation.
Restlessness, agitation, and confusion are early neurological signs of hypoxia.
Cyanosis is a late sign. Bradycardia and hypotension indicate deterioration beyond
early hypoxia.
, 6. A patient with deep vein thrombosis (DVT) is started on warfarin therapy.
Which lab value is used to monitor warfarin's therapeutic effect?
A. aPTT
B. Platelet count
C. INR
D. Hemoglobin
E. Fibrinogen level
Correct Answer: C. INR
EXPERT RATIONALE: The International Normalized Ratio (INR) is the standard lab
value used to monitor warfarin therapy. The therapeutic range for DVT is typically
2.0–3.0. The aPTT monitors heparin therapy, not warfarin.
7. A nurse is caring for a patient who just returned from a total hip
replacement. Which position is contraindicated?
A. Supine with legs abducted
B. Head of bed elevated 30 degrees
C. Hip flexion greater than 90 degrees
D. Legs in neutral alignment
E. Slight external rotation of the unaffected leg
Correct Answer: C. Hip flexion greater than 90 degrees
EXPERT RATIONALE: Following total hip replacement, hip flexion beyond 90
degrees risks prosthetic dislocation. Patients are instructed to avoid bending
forward at the hip, crossing legs, or sitting in low chairs. Hip abduction and neutral
alignment are acceptable and recommended positions.
Competency Exam 2026 Practice Questions
& Answers PDF | Study Guide with Verified
Solutions & Rationales
• This study guide contains 200 practice questions covering all core domains of the
Relias Medical-Surgical Nursing Competency Exam 2026, designed to simulate the
actual exam experience and reinforce clinical decision-making skills.
• Each question features five answer choices (A–E), a clearly highlighted correct
answer in bold, and a detailed EXPERT RATIONALE to deepen understanding and
support long-term retention.
1. A nurse is caring for a postoperative patient who had an appendectomy 6
hours ago. The patient reports pain of 8/10. Which intervention should the
nurse prioritize?
A. Reposition the patient to the left lateral position
B. Offer distraction techniques such as music therapy
C. Notify the surgeon immediately
D. Document the pain score and reassess in one hour
E. Administer the prescribed analgesic as ordered
Correct Answer: E. Administer the prescribed analgesic as ordered
EXPERT RATIONALE: Pain management is a priority nursing intervention.
Administering prescribed analgesics addresses the patient's acute pain promptly
and humanely. Repositioning, distraction, or delaying treatment does not
adequately address a pain score of 8/10. Notifying the surgeon is not indicated
unless pain is unrelieved after appropriate intervention.
2. A patient with a history of chronic kidney disease (CKD) is admitted with
fluid overload. Which assessment finding best confirms this diagnosis?
A. Decreased blood pressure
,B. Decreased urine output and peripheral edema
C. Elevated hematocrit
D. Tachycardia with dry mucous membranes
E. Increased skin turgor
Correct Answer: B. Decreased urine output and peripheral edema
EXPERT RATIONALE: Fluid overload in CKD is characterized by decreased urine
output due to impaired kidney filtration and peripheral edema from fluid
accumulation in interstitial spaces. Elevated hematocrit and dry mucous
membranes indicate dehydration, not overload. Increased skin turgor is also a sign
of adequate or excess hydration but is not as specific as the combination presented
in B.
3. A patient is admitted with diabetic ketoacidosis (DKA). Which laboratory
finding is most expected?
A. pH of 7.45, bicarbonate of 26 mEq/L
B. pH of 7.20, bicarbonate of 10 mEq/L
C. pH of 7.50, bicarbonate of 30 mEq/L
D. pH of 7.38, bicarbonate of 22 mEq/L
E. pH of 7.48, potassium of 5.5 mEq/L
Correct Answer: B. pH of 7.20, bicarbonate of 10 mEq/L
EXPERT RATIONALE: DKA produces a high anion gap metabolic acidosis. The
hallmarks are a low pH (acidosis) and low bicarbonate due to buffering of
ketoacids. A pH of 7.20 and bicarbonate of 10 mEq/L are consistent with severe
metabolic acidosis seen in DKA.
,4. A nurse is caring for a patient on a heparin infusion. The aPTT result is 120
seconds (therapeutic range: 60–100 seconds). What is the appropriate nursing
action?
A. Increase the heparin infusion rate
B. Continue the infusion at the current rate
C. Decrease the heparin infusion rate per protocol
D. Discontinue the heparin infusion and notify the physician
E. Administer protamine sulfate immediately
Correct Answer: C. Decrease the heparin infusion rate per protocol
EXPERT RATIONALE: An aPTT of 120 seconds is above the therapeutic range,
indicating excessive anticoagulation. The nurse should reduce the infusion rate per
protocol. Protamine sulfate is the antidote for heparin overdose but is reserved for
serious bleeding events, not a supratherapeutic aPTT alone.
5. Which sign or symptom is the earliest indicator of hypoxia in a
postoperative patient?
A. Cyanosis
B. Bradycardia
C. Restlessness and confusion
D. Decreased respiratory rate
E. Hypotension
Correct Answer: C. Restlessness and confusion
EXPERT RATIONALE: The brain is extremely sensitive to oxygen deprivation.
Restlessness, agitation, and confusion are early neurological signs of hypoxia.
Cyanosis is a late sign. Bradycardia and hypotension indicate deterioration beyond
early hypoxia.
, 6. A patient with deep vein thrombosis (DVT) is started on warfarin therapy.
Which lab value is used to monitor warfarin's therapeutic effect?
A. aPTT
B. Platelet count
C. INR
D. Hemoglobin
E. Fibrinogen level
Correct Answer: C. INR
EXPERT RATIONALE: The International Normalized Ratio (INR) is the standard lab
value used to monitor warfarin therapy. The therapeutic range for DVT is typically
2.0–3.0. The aPTT monitors heparin therapy, not warfarin.
7. A nurse is caring for a patient who just returned from a total hip
replacement. Which position is contraindicated?
A. Supine with legs abducted
B. Head of bed elevated 30 degrees
C. Hip flexion greater than 90 degrees
D. Legs in neutral alignment
E. Slight external rotation of the unaffected leg
Correct Answer: C. Hip flexion greater than 90 degrees
EXPERT RATIONALE: Following total hip replacement, hip flexion beyond 90
degrees risks prosthetic dislocation. Patients are instructed to avoid bending
forward at the hip, crossing legs, or sitting in low chairs. Hip abduction and neutral
alignment are acceptable and recommended positions.
