RELIAS ED RN COMPETENCY ASSESSMENT A
(2026/2027) ULTIMATE STUDY GUIDE &
PRACTICE QUESTIONS
This comprehensive study resource features verified multiple-
choice questions and detailed rationales modeled directly after
the 2026/2027 Relias Emergency Department RN A competency
assessment. It provides critical, high-yield practice scenarios
covering trauma triage, advanced cardiac life support, toxicology,
and emergency pharmacology to ensure exam success.
Designed for rapid scanning, each question highlights correct
evidence-based nursing interventions alongside technical
clinical justifications.
1. Advanced Cardiac Life Support (ACLS) Protocols
Question 1:
An adult patient is brought to the emergency
department in pulseless ventricular fibrillation. CPR
is underway, and the team has just delivered the
first shock. What is the correct dosage and
frequency for administering Epinephrine IV/IO?
A) 1 mg every 1–2 minutes
B) 1 mg every 3–5 minutes
C) 0.5 mg every 3–5 minutes
D) 1 mg after every shock delivery
Answer: B) 1 mg every 3–5 minutes
Rationale: According to ACLS guidelines,
,Epinephrine 1 mg should be administered every 3 to
5 minutes during cardiac arrest. Administering it
more frequently can cause severe vasoconstriction
and tachycardia, while less frequent dosing reduces
coronary perfusion pressure.
Question 2:
A patient with an implantable cardioverter-
defibrillator (ICD) enters cardiac arrest with a
shockable rhythm. How should the emergency
nurse place the hands-free defibrillator pads?
A) Directly over the ICD generator device
B) In the standard anterior-lateral position, at least
1 inch (2.5 cm) away from the device
C) Only in the anterior-posterior position directly
touching the device
D) Pads cannot be used if the patient has an active
ICD
Answer: B) In the standard anterior-lateral position,
at least 1 inch (2.5 cm) away from the device
Rationale: Defibrillator pads should be placed at
least 1 inch (2.5 cm) away from an implanted
pacemaker or ICD generator to avoid arcing,
,damage to the device, or attenuation of the
delivered energy.
Question 3:
During a resuscitation attempt for an adult patient
in asystole, high-quality CPR has been continuous
for 10 minutes, and two doses of Epinephrine have
been given. The team notes a sudden spike in
waveform capnography (PETCO₂) from 12 mmHg to
45 mmHg. What does this change signify?
A) Accidental extubation or tube displacement
B) Return of spontaneous circulation (ROSC)
C) Development of a severe tension pneumothorax
D) The need to increase the rate of manual
ventilations
Answer: B) Return of spontaneous circulation
(ROSC)
Rationale: A sudden, sustained increase in PETCO₂
to normal levels (35–45 mmHg) is a reliable
indicator of ROSC. It reflects a significant surge in
cardiac output and systemic blood flow returning to
the lungs.
, Question 4:
A patient presents to the ED with a regular, narrow-
complex tachycardia at a rate of 180 beats/minute.
The patient is alert but complains of chest tightness,
and the blood pressure is 88/52 mmHg. What is the
immediate priority intervention?
A) Administering a fluid bolus of 1 Liter Normal
Saline
B) Performing immediate synchronized
cardioversion
C) Administering Adenosine 6 mg rapid IV push
D) Initiating transcutaneous pacing at 60
beats/minute
Answer: B) Performing immediate synchronized
cardioversion
Rationale: If a patient exhibits unstable signs or
symptoms (such as hypotension, altered mental
status, or ischemic chest pain) due to
tachyarrhythmia, immediate synchronized
cardioversion is indicated rather than chemical
interventions.
Question 5:
An adult patient goes into torsades de pointes
(2026/2027) ULTIMATE STUDY GUIDE &
PRACTICE QUESTIONS
This comprehensive study resource features verified multiple-
choice questions and detailed rationales modeled directly after
the 2026/2027 Relias Emergency Department RN A competency
assessment. It provides critical, high-yield practice scenarios
covering trauma triage, advanced cardiac life support, toxicology,
and emergency pharmacology to ensure exam success.
Designed for rapid scanning, each question highlights correct
evidence-based nursing interventions alongside technical
clinical justifications.
1. Advanced Cardiac Life Support (ACLS) Protocols
Question 1:
An adult patient is brought to the emergency
department in pulseless ventricular fibrillation. CPR
is underway, and the team has just delivered the
first shock. What is the correct dosage and
frequency for administering Epinephrine IV/IO?
A) 1 mg every 1–2 minutes
B) 1 mg every 3–5 minutes
C) 0.5 mg every 3–5 minutes
D) 1 mg after every shock delivery
Answer: B) 1 mg every 3–5 minutes
Rationale: According to ACLS guidelines,
,Epinephrine 1 mg should be administered every 3 to
5 minutes during cardiac arrest. Administering it
more frequently can cause severe vasoconstriction
and tachycardia, while less frequent dosing reduces
coronary perfusion pressure.
Question 2:
A patient with an implantable cardioverter-
defibrillator (ICD) enters cardiac arrest with a
shockable rhythm. How should the emergency
nurse place the hands-free defibrillator pads?
A) Directly over the ICD generator device
B) In the standard anterior-lateral position, at least
1 inch (2.5 cm) away from the device
C) Only in the anterior-posterior position directly
touching the device
D) Pads cannot be used if the patient has an active
ICD
Answer: B) In the standard anterior-lateral position,
at least 1 inch (2.5 cm) away from the device
Rationale: Defibrillator pads should be placed at
least 1 inch (2.5 cm) away from an implanted
pacemaker or ICD generator to avoid arcing,
,damage to the device, or attenuation of the
delivered energy.
Question 3:
During a resuscitation attempt for an adult patient
in asystole, high-quality CPR has been continuous
for 10 minutes, and two doses of Epinephrine have
been given. The team notes a sudden spike in
waveform capnography (PETCO₂) from 12 mmHg to
45 mmHg. What does this change signify?
A) Accidental extubation or tube displacement
B) Return of spontaneous circulation (ROSC)
C) Development of a severe tension pneumothorax
D) The need to increase the rate of manual
ventilations
Answer: B) Return of spontaneous circulation
(ROSC)
Rationale: A sudden, sustained increase in PETCO₂
to normal levels (35–45 mmHg) is a reliable
indicator of ROSC. It reflects a significant surge in
cardiac output and systemic blood flow returning to
the lungs.
, Question 4:
A patient presents to the ED with a regular, narrow-
complex tachycardia at a rate of 180 beats/minute.
The patient is alert but complains of chest tightness,
and the blood pressure is 88/52 mmHg. What is the
immediate priority intervention?
A) Administering a fluid bolus of 1 Liter Normal
Saline
B) Performing immediate synchronized
cardioversion
C) Administering Adenosine 6 mg rapid IV push
D) Initiating transcutaneous pacing at 60
beats/minute
Answer: B) Performing immediate synchronized
cardioversion
Rationale: If a patient exhibits unstable signs or
symptoms (such as hypotension, altered mental
status, or ischemic chest pain) due to
tachyarrhythmia, immediate synchronized
cardioversion is indicated rather than chemical
interventions.
Question 5:
An adult patient goes into torsades de pointes
