RELIAS ED RN A Exam Practice
Questions 100 Questions & Answers
with Detailed Rationales
Question 1
A 45-year-old male presents to the ED with severe chest pain radiating
to his left arm. He is diaphoretic and nauseous. Which of the following
is the priority nursing action?
A) Obtain a 12-lead ECG
B) Administer sublingual nitroglycerin
C) Start an IV line
D) Administer aspirin 324 mg chewable
Answer: A) Obtain a 12-lead ECG
Rationale: The priority in a patient with suspected acute coronary
syndrome (ACS) is to obtain a 12-lead ECG within 10 minutes of
arrival. The ECG will help determine if the patient is having an
ST-segment elevation myocardial infarction (STEMI) requiring
immediate reperfusion therapy. While all options are important in the
management of ACS, the ECG is the most time-sensitive intervention
that drives subsequent treatment decisions. Door-to-ECG time is a
critical quality metric in emergency cardiac care.
,Question 2
A patient with a history of COPD presents with increased shortness of
breath, fever, and productive cough with green sputum. Which arterial
blood gas (ABG) finding would the nurse expect?
A) pH 7.32, PaCO2 55, HCO3 28, PaO2 60
B) pH 7.48, PaCO2 30, HCO3 22, PaO2 75
C) pH 7.38, PaCO2 40, HCO3 24, PaO2 90
D) pH 7.25, PaCO2 35, HCO3 18, PaO2 55
Answer: A) pH 7.32, PaCO2 55, HCO3 28, PaO2 60
Rationale: This ABG shows respiratory acidosis (low pH, elevated
PaCO2) with metabolic compensation (elevated HCO3). The patient
has an acute exacerbation of COPD likely due to infection. The
elevated PaCO2 indicates hypoventilation, which is common in COPD
patients who may have a blunted respiratory drive. The increased
HCO3 shows the kidneys are attempting to compensate by retaining
bicarbonate. Option B shows respiratory alkalosis, option C is normal,
and option D shows metabolic acidosis.
Question 3
The ED nurse is caring for a patient with suspected sepsis. Which of
the following is the most appropriate first-line vasopressor for septic
shock?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Phenylephrine
,Answer: C) Norepinephrine
Rationale: According to the Surviving Sepsis Campaign guidelines,
norepinephrine is the first-line vasopressor for septic shock. It is
preferred due to its strong vasoconstrictive effects with minimal
chronotropic effects compared to other agents. The goal is to
maintain a mean arterial pressure (MAP) ≥ 65 mmHg to ensure
adequate organ perfusion. While other vasopressors may be used as
adjunctive therapy, norepinephrine is the initial agent of choice.
Question 4
Which of the following ECG findings is most consistent with
hyperkalemia?
A) Peaked T waves
B) ST-segment depression
C) Prolonged PR interval
D) Widened QRS complex
Answer: A) Peaked T waves
Rationale: Peaked, tented T waves are the earliest and most
characteristic ECG finding in hyperkalemia. As potassium levels
continue to rise, other changes occur including prolonged PR interval,
flattened or absent P waves, widened QRS complex, and eventually a
sine wave pattern leading to ventricular fibrillation. Prompt recognition
of peaked T waves allows for early intervention to prevent
life-threatening arrhythmias.
, Question 5
A 30-year-old female arrives with acute-onset right lower quadrant
abdominal pain, nausea, and fever. Which of the following is the most
appropriate diagnostic test?
A) CT scan of the abdomen and pelvis with contrast
B) Abdominal ultrasound
C) Plain abdominal X-ray
D) MRI of the abdomen
Answer: A) CT scan of the abdomen and pelvis with contrast
Rationale: CT scan of the abdomen and pelvis with contrast is the
most sensitive and specific imaging modality for diagnosing
appendicitis in adults. It can identify an inflamed appendix,
periappendiceal abscess, or other causes of abdominal pain. While
ultrasound is often used in pediatric patients and pregnant women to
avoid radiation, CT is preferred in adult patients due to its superior
diagnostic accuracy.
Question 6
A patient with a traumatic brain injury has an ICP of 22 mmHg. Which
intervention should the nurse anticipate?
A) Elevate the head of the bed to 30 degrees
B) Place the patient in the Trendelenburg position
C) Administer hypotonic IV fluids
D) Apply a cervical collar
Answer: A) Elevate the head of the bed to 30 degrees
Questions 100 Questions & Answers
with Detailed Rationales
Question 1
A 45-year-old male presents to the ED with severe chest pain radiating
to his left arm. He is diaphoretic and nauseous. Which of the following
is the priority nursing action?
A) Obtain a 12-lead ECG
B) Administer sublingual nitroglycerin
C) Start an IV line
D) Administer aspirin 324 mg chewable
Answer: A) Obtain a 12-lead ECG
Rationale: The priority in a patient with suspected acute coronary
syndrome (ACS) is to obtain a 12-lead ECG within 10 minutes of
arrival. The ECG will help determine if the patient is having an
ST-segment elevation myocardial infarction (STEMI) requiring
immediate reperfusion therapy. While all options are important in the
management of ACS, the ECG is the most time-sensitive intervention
that drives subsequent treatment decisions. Door-to-ECG time is a
critical quality metric in emergency cardiac care.
,Question 2
A patient with a history of COPD presents with increased shortness of
breath, fever, and productive cough with green sputum. Which arterial
blood gas (ABG) finding would the nurse expect?
A) pH 7.32, PaCO2 55, HCO3 28, PaO2 60
B) pH 7.48, PaCO2 30, HCO3 22, PaO2 75
C) pH 7.38, PaCO2 40, HCO3 24, PaO2 90
D) pH 7.25, PaCO2 35, HCO3 18, PaO2 55
Answer: A) pH 7.32, PaCO2 55, HCO3 28, PaO2 60
Rationale: This ABG shows respiratory acidosis (low pH, elevated
PaCO2) with metabolic compensation (elevated HCO3). The patient
has an acute exacerbation of COPD likely due to infection. The
elevated PaCO2 indicates hypoventilation, which is common in COPD
patients who may have a blunted respiratory drive. The increased
HCO3 shows the kidneys are attempting to compensate by retaining
bicarbonate. Option B shows respiratory alkalosis, option C is normal,
and option D shows metabolic acidosis.
Question 3
The ED nurse is caring for a patient with suspected sepsis. Which of
the following is the most appropriate first-line vasopressor for septic
shock?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Phenylephrine
,Answer: C) Norepinephrine
Rationale: According to the Surviving Sepsis Campaign guidelines,
norepinephrine is the first-line vasopressor for septic shock. It is
preferred due to its strong vasoconstrictive effects with minimal
chronotropic effects compared to other agents. The goal is to
maintain a mean arterial pressure (MAP) ≥ 65 mmHg to ensure
adequate organ perfusion. While other vasopressors may be used as
adjunctive therapy, norepinephrine is the initial agent of choice.
Question 4
Which of the following ECG findings is most consistent with
hyperkalemia?
A) Peaked T waves
B) ST-segment depression
C) Prolonged PR interval
D) Widened QRS complex
Answer: A) Peaked T waves
Rationale: Peaked, tented T waves are the earliest and most
characteristic ECG finding in hyperkalemia. As potassium levels
continue to rise, other changes occur including prolonged PR interval,
flattened or absent P waves, widened QRS complex, and eventually a
sine wave pattern leading to ventricular fibrillation. Prompt recognition
of peaked T waves allows for early intervention to prevent
life-threatening arrhythmias.
, Question 5
A 30-year-old female arrives with acute-onset right lower quadrant
abdominal pain, nausea, and fever. Which of the following is the most
appropriate diagnostic test?
A) CT scan of the abdomen and pelvis with contrast
B) Abdominal ultrasound
C) Plain abdominal X-ray
D) MRI of the abdomen
Answer: A) CT scan of the abdomen and pelvis with contrast
Rationale: CT scan of the abdomen and pelvis with contrast is the
most sensitive and specific imaging modality for diagnosing
appendicitis in adults. It can identify an inflamed appendix,
periappendiceal abscess, or other causes of abdominal pain. While
ultrasound is often used in pediatric patients and pregnant women to
avoid radiation, CT is preferred in adult patients due to its superior
diagnostic accuracy.
Question 6
A patient with a traumatic brain injury has an ICP of 22 mmHg. Which
intervention should the nurse anticipate?
A) Elevate the head of the bed to 30 degrees
B) Place the patient in the Trendelenburg position
C) Administer hypotonic IV fluids
D) Apply a cervical collar
Answer: A) Elevate the head of the bed to 30 degrees
