RELIAS ED RN EXAM WITH 300+ PRACTICE QUESTIONS &
DETAILED RATIONALESRELIAS ED RN EXAM WITH 300+
PRACTICE QUESTIONS & DETAILED RATIONALES
SECTION 1: TRIAGE, INITIAL ASSESSMENT & ACUITY
(Questions 1-20)
Question 1
Using the Emergency Severity Index (ESI), which patient description meets the criteria
for ESI Level 1 (requires immediate life-saving intervention)?
A. A 65-year-old with chest pain and diaphoresis
B. A 20-year-old with a simple forearm laceration
C. A 40-year-old who is unresponsive, apneic, and pulseless
D. An 8-year-old with a fever of 102°F and a sore throat
Correct Answer: C
Rationale: ESI Level 1 is reserved for patients who are unresponsive, apneic, or in
cardiac or respiratory arrest requiring immediate intervention like CPR or intubation .
While chest pain with diaphoresis (A) is serious and requires rapid evaluation (ESI Level
2), the patient is not immediately dying. A simple laceration (B) is ESI Level 4-5, and
fever with sore throat (D) is typically ESI Level 3-4.
Question 2
You are triaging a patient who presents with acute onset of severe right upper quadrant
pain, fever, and jaundice. The patient is diaphoretic and vomiting. To which ESI level
should this patient be assigned?
A. ESI Level 2 (High-risk situation)
B. ESI Level 3 (Needs 2 or more resources)
,C. ESI Level 4 (Needs 1 resource)
D. ESI Level 5 (No resources needed)
Correct Answer: A
Rationale: This patient is exhibiting signs of possible cholangitis or severe gallbladder
disease, which is considered a high-risk situation that could rapidly deteriorate,
requiring immediate physician evaluation . The combination of fever, jaundice, and RUQ
pain suggests a potentially life-threatening infection that requires urgent intervention.
Question 3
A 32-year-old female presents to triage with a complaint of "the worst headache of my
life" that started suddenly 20 minutes ago. Her vital signs are stable. What is the most
appropriate triage action?
A. Assign ESI Level 4 and have her wait in the lobby
B. Assign ESI Level 5 and advise her to see her PCP
C. Assign ESI Level 2 and send her immediately to the treatment area for a CT scan
D. Assign ESI Level 3 and place her in a room to wait for the physician
Correct Answer: C
Rationale: A sudden severe "thunderclap" headache is a high-risk red flag that requires
immediate diagnostic workup (Level 2) even if vital signs are currently stable . This
presentation is concerning for subarachnoid hemorrhage, which can be life-threatening
and requires prompt CT imaging. ESI Level 2 is appropriate because the patient is at
high risk for deterioration.
Question 4
During the primary survey of a trauma patient, you note the patient is breathing but has
tracheal deviation to the left and absent breath sounds on the right. What intervention
should you prepare for immediately?
,A. Chest tube insertion
B. Intubation
C. Pericardiocentesis
D. Fluid bolus
Correct Answer: A
Rationale: These classic signs indicate a tension pneumothorax, which is a life-
threatening air trapping issue requiring immediate decompression, typically via needle
thoracostomy followed by chest tube insertion . Tension pneumothorax causes tracheal
deviation away from the affected side, absent breath sounds, and can rapidly lead to
cardiac arrest.
Question 5
You are triaging three patients simultaneously. Patient A is a 78-year-old with sudden
confusion and atrial fibrillation (HR 140). Patient B is a 25-year-old with a 2 cm
laceration on the chin requiring sutures. Patient C is a 50-year-old with flank pain and
hematuria. Who is the highest priority for immediate medical evaluation?
A. Patient A (ESI Level 2)
B. Patient B (ESI Level 4)
C. Patient C (ESI Level 3)
D. Patient B because he is bleeding
Correct Answer: A
Rationale: New-onset confusion in an elderly patient with tachycardia suggests a
potential stroke, sepsis, or cardiac crisis, which is a high-risk situation (Level 2) . The
laceration (B) is stable and non-urgent. Flank pain with hematuria (C) suggests possible
nephrolithiasis, which is painful but not immediately life-threatening.
Question 6
, A patient presents with a chemical burn to the eye from an alkaline substance. What is
the priority nursing intervention in triage?
A. Patch the eye and prepare for transfer
B. Apply antibiotic ointment
C. Irrigate the eye copiously with water or saline for at least 15-30 minutes
D. Administer pain medication
Correct Answer: C
Rationale: Alkaline burns can cause severe corneal damage and rapid tissue
destruction. Immediate, copious irrigation with water or saline for at least 15-30 minutes
is the priority to dilute and remove the chemical . Time is critical in preventing
permanent vision loss. Patching or ointment would delay irrigation and worsen the
injury.
Question 7
A confused patient is trying to grasp at their IV with their right hand. Which is the LEAST
restrictive measure to maintain patient safety?
A. 2-point restraint on right arm and left leg
B. Safety "mitt" for both hands
C. 2-point restraints on upper limbs
D. Safety "mitt" for right hand only
Correct Answer: D
Rationale: The least restrictive measure to maintain patient safety is a safety "mitt" for
the right hand only . This addresses the specific behavior (grasping at the IV) without
unnecessarily restricting other limbs. Restraints should always be the least restrictive
option that ensures safety.
Question 8
DETAILED RATIONALESRELIAS ED RN EXAM WITH 300+
PRACTICE QUESTIONS & DETAILED RATIONALES
SECTION 1: TRIAGE, INITIAL ASSESSMENT & ACUITY
(Questions 1-20)
Question 1
Using the Emergency Severity Index (ESI), which patient description meets the criteria
for ESI Level 1 (requires immediate life-saving intervention)?
A. A 65-year-old with chest pain and diaphoresis
B. A 20-year-old with a simple forearm laceration
C. A 40-year-old who is unresponsive, apneic, and pulseless
D. An 8-year-old with a fever of 102°F and a sore throat
Correct Answer: C
Rationale: ESI Level 1 is reserved for patients who are unresponsive, apneic, or in
cardiac or respiratory arrest requiring immediate intervention like CPR or intubation .
While chest pain with diaphoresis (A) is serious and requires rapid evaluation (ESI Level
2), the patient is not immediately dying. A simple laceration (B) is ESI Level 4-5, and
fever with sore throat (D) is typically ESI Level 3-4.
Question 2
You are triaging a patient who presents with acute onset of severe right upper quadrant
pain, fever, and jaundice. The patient is diaphoretic and vomiting. To which ESI level
should this patient be assigned?
A. ESI Level 2 (High-risk situation)
B. ESI Level 3 (Needs 2 or more resources)
,C. ESI Level 4 (Needs 1 resource)
D. ESI Level 5 (No resources needed)
Correct Answer: A
Rationale: This patient is exhibiting signs of possible cholangitis or severe gallbladder
disease, which is considered a high-risk situation that could rapidly deteriorate,
requiring immediate physician evaluation . The combination of fever, jaundice, and RUQ
pain suggests a potentially life-threatening infection that requires urgent intervention.
Question 3
A 32-year-old female presents to triage with a complaint of "the worst headache of my
life" that started suddenly 20 minutes ago. Her vital signs are stable. What is the most
appropriate triage action?
A. Assign ESI Level 4 and have her wait in the lobby
B. Assign ESI Level 5 and advise her to see her PCP
C. Assign ESI Level 2 and send her immediately to the treatment area for a CT scan
D. Assign ESI Level 3 and place her in a room to wait for the physician
Correct Answer: C
Rationale: A sudden severe "thunderclap" headache is a high-risk red flag that requires
immediate diagnostic workup (Level 2) even if vital signs are currently stable . This
presentation is concerning for subarachnoid hemorrhage, which can be life-threatening
and requires prompt CT imaging. ESI Level 2 is appropriate because the patient is at
high risk for deterioration.
Question 4
During the primary survey of a trauma patient, you note the patient is breathing but has
tracheal deviation to the left and absent breath sounds on the right. What intervention
should you prepare for immediately?
,A. Chest tube insertion
B. Intubation
C. Pericardiocentesis
D. Fluid bolus
Correct Answer: A
Rationale: These classic signs indicate a tension pneumothorax, which is a life-
threatening air trapping issue requiring immediate decompression, typically via needle
thoracostomy followed by chest tube insertion . Tension pneumothorax causes tracheal
deviation away from the affected side, absent breath sounds, and can rapidly lead to
cardiac arrest.
Question 5
You are triaging three patients simultaneously. Patient A is a 78-year-old with sudden
confusion and atrial fibrillation (HR 140). Patient B is a 25-year-old with a 2 cm
laceration on the chin requiring sutures. Patient C is a 50-year-old with flank pain and
hematuria. Who is the highest priority for immediate medical evaluation?
A. Patient A (ESI Level 2)
B. Patient B (ESI Level 4)
C. Patient C (ESI Level 3)
D. Patient B because he is bleeding
Correct Answer: A
Rationale: New-onset confusion in an elderly patient with tachycardia suggests a
potential stroke, sepsis, or cardiac crisis, which is a high-risk situation (Level 2) . The
laceration (B) is stable and non-urgent. Flank pain with hematuria (C) suggests possible
nephrolithiasis, which is painful but not immediately life-threatening.
Question 6
, A patient presents with a chemical burn to the eye from an alkaline substance. What is
the priority nursing intervention in triage?
A. Patch the eye and prepare for transfer
B. Apply antibiotic ointment
C. Irrigate the eye copiously with water or saline for at least 15-30 minutes
D. Administer pain medication
Correct Answer: C
Rationale: Alkaline burns can cause severe corneal damage and rapid tissue
destruction. Immediate, copious irrigation with water or saline for at least 15-30 minutes
is the priority to dilute and remove the chemical . Time is critical in preventing
permanent vision loss. Patching or ointment would delay irrigation and worsen the
injury.
Question 7
A confused patient is trying to grasp at their IV with their right hand. Which is the LEAST
restrictive measure to maintain patient safety?
A. 2-point restraint on right arm and left leg
B. Safety "mitt" for both hands
C. 2-point restraints on upper limbs
D. Safety "mitt" for right hand only
Correct Answer: D
Rationale: The least restrictive measure to maintain patient safety is a safety "mitt" for
the right hand only . This addresses the specific behavior (grasping at the IV) without
unnecessarily restricting other limbs. Restraints should always be the least restrictive
option that ensures safety.
Question 8
