RELIAS ED RN EXAM — 150 PRACTICE QUESTIONS & ANSWERS
WITH DETAILED RATIONALES | 2026/2027 EDITION
1. A patient arrives in the emergency department unresponsive, apneic, and pulseless.
What is the nurse's priority action?
A. Obtain a complete medical history
B. Begin CPR and activate the emergency response
C. Obtain a urine specimen
D. Complete medication reconciliation
Answer: B. Begin CPR and activate the emergency response
RATIONALE: A pulseless, apneic patient requires immediate resuscitation. CPR and
activation of the emergency response take priority over history or diagnostic testing.
2. The Emergency Severity Index (ESI) is based primarily on:
A. Insurance status and diagnosis
B. Age and arrival time
C. Acuity and anticipated resource needs
D. Room availability only
Answer: C. Acuity and anticipated resource needs
RATIONALE: ESI is a five-level triage system that considers immediate life-saving needs,
acuity, and expected resource utilization.
3. Which patient should the ED nurse assess first?
A. Patient with a closed ankle fracture and stable vital signs
B. Patient with chronic back pain requesting medication
C. Patient with stridor and increasing respiratory distress
D. Patient with a superficial hand laceration
Answer: C. Patient with stridor and increasing respiratory distress
RATIONALE: Stridor suggests upper-airway obstruction. Airway and breathing problems
take priority under the ABC approach.
,4. A patient reports crushing substernal chest pain with diaphoresis and nausea. What
should the nurse prioritize?
A. Place the patient in a waiting area
B. Obtain an ECG promptly according to ED protocol
C. Give oral fluids
D. Obtain a stool specimen
Answer: B. Obtain an ECG promptly according to ED protocol
RATIONALE: Suspected acute coronary syndrome requires rapid ECG evaluation to identify
ischemia or STEMI and expedite treatment.
5. A patient suddenly develops facial drooping, aphasia, and right-sided weakness. What is
the priority action?
A. Ask the patient to wait for registration
B. Activate the facility's stroke response pathway
C. Give oral aspirin immediately
D. Obtain a routine chest x-ray first
Answer: B. Activate the facility's stroke response pathway
RATIONALE: Sudden focal neurologic deficits suggest acute stroke. Rapid activation of the
stroke pathway minimizes treatment delays.
6. Which information is most important when evaluating a possible acute stroke?
A. Last bowel movement
B. Last known well time
C. Usual breakfast
D. Preferred pharmacy
Answer: B. Last known well time
RATIONALE: The last known well time is critical for determining eligibility for time-
sensitive stroke therapies.
,7. A patient with suspected stroke has difficulty speaking. What additional assessment is
particularly important?
A. Neurologic assessment
B. Skin turgor only
C. Bowel sounds only
D. Nail-bed shape
Answer: A. Neurologic assessment
RATIONALE: A focused neurologic assessment establishes deficits and helps determine
changes in neurologic status.
8. A patient presents with severe dyspnea, cyanosis, and an oxygen saturation of 78%.
What is the priority?
A. Obtain a dietary history
B. Support oxygenation and airway/breathing
C. Obtain a complete social history
D. Schedule outpatient follow-up
Answer: B. Support oxygenation and airway/breathing
RATIONALE: Severe hypoxemia represents an immediate threat to life and requires prompt
respiratory support.
9. Which finding in a patient with asthma is most concerning?
A. Mild expiratory wheezing
B. Occasional cough
C. Silent chest with worsening respiratory distress
D. Mild anxiety
Answer: C. Silent chest with worsening respiratory distress
RATIONALE: A markedly diminished or absent wheeze in a deteriorating asthma patient
can indicate critically reduced airflow and impending respiratory failure.
, 10. Which medication is commonly used as a rapid bronchodilator for acute asthma
exacerbation?
A. Albuterol
B. Warfarin
C. Furosemide
D. Omeprazole
Answer: A. Albuterol
RATIONALE: Albuterol is a short-acting beta-2 agonist that rapidly relaxes bronchial
smooth muscle.
11. A patient with COPD is experiencing increased work of breathing. Which position
generally promotes ventilation?
A. Flat supine
B. High-Fowler's
C. Trendelenburg
D. Prone with the head flat
Answer: B. High-Fowler's
RATIONALE: Upright positioning can improve diaphragmatic excursion and reduce the
work of breathing.
12. Pursed-lip breathing in a patient with COPD helps:
A. Increase airway collapse
B. Prolong exhalation and reduce air trapping
C. Eliminate all carbon dioxide immediately
D. Increase respiratory rate
Answer: B. Prolong exhalation and reduce air trapping
RATIONALE: Pursed-lip breathing creates back pressure during exhalation, helping
maintain airway patency and reduce air trapping.
13. Which finding suggests tension pneumothorax?
WITH DETAILED RATIONALES | 2026/2027 EDITION
1. A patient arrives in the emergency department unresponsive, apneic, and pulseless.
What is the nurse's priority action?
A. Obtain a complete medical history
B. Begin CPR and activate the emergency response
C. Obtain a urine specimen
D. Complete medication reconciliation
Answer: B. Begin CPR and activate the emergency response
RATIONALE: A pulseless, apneic patient requires immediate resuscitation. CPR and
activation of the emergency response take priority over history or diagnostic testing.
2. The Emergency Severity Index (ESI) is based primarily on:
A. Insurance status and diagnosis
B. Age and arrival time
C. Acuity and anticipated resource needs
D. Room availability only
Answer: C. Acuity and anticipated resource needs
RATIONALE: ESI is a five-level triage system that considers immediate life-saving needs,
acuity, and expected resource utilization.
3. Which patient should the ED nurse assess first?
A. Patient with a closed ankle fracture and stable vital signs
B. Patient with chronic back pain requesting medication
C. Patient with stridor and increasing respiratory distress
D. Patient with a superficial hand laceration
Answer: C. Patient with stridor and increasing respiratory distress
RATIONALE: Stridor suggests upper-airway obstruction. Airway and breathing problems
take priority under the ABC approach.
,4. A patient reports crushing substernal chest pain with diaphoresis and nausea. What
should the nurse prioritize?
A. Place the patient in a waiting area
B. Obtain an ECG promptly according to ED protocol
C. Give oral fluids
D. Obtain a stool specimen
Answer: B. Obtain an ECG promptly according to ED protocol
RATIONALE: Suspected acute coronary syndrome requires rapid ECG evaluation to identify
ischemia or STEMI and expedite treatment.
5. A patient suddenly develops facial drooping, aphasia, and right-sided weakness. What is
the priority action?
A. Ask the patient to wait for registration
B. Activate the facility's stroke response pathway
C. Give oral aspirin immediately
D. Obtain a routine chest x-ray first
Answer: B. Activate the facility's stroke response pathway
RATIONALE: Sudden focal neurologic deficits suggest acute stroke. Rapid activation of the
stroke pathway minimizes treatment delays.
6. Which information is most important when evaluating a possible acute stroke?
A. Last bowel movement
B. Last known well time
C. Usual breakfast
D. Preferred pharmacy
Answer: B. Last known well time
RATIONALE: The last known well time is critical for determining eligibility for time-
sensitive stroke therapies.
,7. A patient with suspected stroke has difficulty speaking. What additional assessment is
particularly important?
A. Neurologic assessment
B. Skin turgor only
C. Bowel sounds only
D. Nail-bed shape
Answer: A. Neurologic assessment
RATIONALE: A focused neurologic assessment establishes deficits and helps determine
changes in neurologic status.
8. A patient presents with severe dyspnea, cyanosis, and an oxygen saturation of 78%.
What is the priority?
A. Obtain a dietary history
B. Support oxygenation and airway/breathing
C. Obtain a complete social history
D. Schedule outpatient follow-up
Answer: B. Support oxygenation and airway/breathing
RATIONALE: Severe hypoxemia represents an immediate threat to life and requires prompt
respiratory support.
9. Which finding in a patient with asthma is most concerning?
A. Mild expiratory wheezing
B. Occasional cough
C. Silent chest with worsening respiratory distress
D. Mild anxiety
Answer: C. Silent chest with worsening respiratory distress
RATIONALE: A markedly diminished or absent wheeze in a deteriorating asthma patient
can indicate critically reduced airflow and impending respiratory failure.
, 10. Which medication is commonly used as a rapid bronchodilator for acute asthma
exacerbation?
A. Albuterol
B. Warfarin
C. Furosemide
D. Omeprazole
Answer: A. Albuterol
RATIONALE: Albuterol is a short-acting beta-2 agonist that rapidly relaxes bronchial
smooth muscle.
11. A patient with COPD is experiencing increased work of breathing. Which position
generally promotes ventilation?
A. Flat supine
B. High-Fowler's
C. Trendelenburg
D. Prone with the head flat
Answer: B. High-Fowler's
RATIONALE: Upright positioning can improve diaphragmatic excursion and reduce the
work of breathing.
12. Pursed-lip breathing in a patient with COPD helps:
A. Increase airway collapse
B. Prolong exhalation and reduce air trapping
C. Eliminate all carbon dioxide immediately
D. Increase respiratory rate
Answer: B. Prolong exhalation and reduce air trapping
RATIONALE: Pursed-lip breathing creates back pressure during exhalation, helping
maintain airway patency and reduce air trapping.
13. Which finding suggests tension pneumothorax?
