RELIAS MEDICAL-SURGICAL RN A EXAM 2026/2027 – COMPREHENSIVE PRACTICE
QUESTIONS WITH VERIFIED SOLUTIONS
Relias Medical-Surgical RN A Examination | Core Domains: Cardiovascular Disorders, Respiratory
Disorders, Neurological Disorders, Endocrine Disorders, Gastrointestinal Disorders, Renal & Urinary
Disorders, Musculoskeletal Disorders, Integumentary Disorders, Hematological Disorders,
Immunological Disorders, Perioperative Care, Pain Management, Fluid & Electrolyte Balance,
Acid-Base Balance, Pharmacology, Infection Control, Patient Safety, Prioritization & Delegation,
Documentation, Patient Education | RN Competency Assessment | 2026/2027 Testing Cycle
Exam Structure
The Relias Medical-Surgical RN A Exam 2026/2027 is structured to evaluate clinical judgment,
prioritization, and evidence-based practice through exactly 85 practice questions. The assessment
includes multiple-choice, select all that apply (SATA), ordered response, and calculation formats. A
passing score of 80% is generally required to demonstrate competency in the adult medical-surgical
setting.
Introduction
This comprehensive collection of 85 practice questions is designed for the 2026/2027 testing cycle. It
reflects current standards of care and nursing competencies required for RNs in medical-surgical units.
The questions integrate pathophysiology, pharmacological management, and nursing interventions across
all major body systems, with a specific focus on safety, delegation, and prioritization.
1. The medical-surgical nurse is caring for four patients. Which patient should the
nurse assess first?
A. A 45-year-old with pneumonia who has a temperature of 38.3°C (101.0°F) and productive
cough.
B. A 60-year-old with heart failure who has 1+ pitting edema and weight gain of 1 kg since
yesterday.
C. A 72-year-old 2 days post-hip replacement who reports sudden shortness of breath and chest
pain.
D. A 55-year-old with diabetes who has a blood glucose of 210 mg/dL and is requesting insulin.
C. A 72-year-old 2 days post-hip replacement who reports sudden shortness of breath and
chest pain
Rationale: This patient presents with signs of pulmonary embolism (sudden dyspnea, chest pain), which
is a life-threatening complication requiring immediate assessment and intervention. Postoperative
patients are at high risk for DVT/PE. The pneumonia patient (A) is stable despite the fever. The heart
failure patient (B) has chronic symptoms. The diabetic patient (D) is stable. Prioritization follows ABCs.
2. Which of the following tasks can the RN delegate to the unlicensed assistive
personnel (UAP)? (Select all that apply)
A. Obtain vital signs on a stable patient.
B. Assess a patient with new-onset chest pain.
, C. Ambulate a patient who is post-op day 2.
D. Administer oral medications.
E. Document intake and output.
A. Obtain vital signs on a stable patient, C. Ambulate a patient who is post-op day 2, E.
Document intake and output
Rationale: UAP can perform routine tasks for stable patients: vital signs (A), ambulation (C), and I&O
documentation (E). Assessment (B) requires nursing judgment and cannot be delegated. Medication
administration (D) is within LPN or RN scope but not UAP scope.
3. A patient with heart failure is receiving furosemide. Which findings indicate the
medication is effective? (Select all that apply)
A. Decreased peripheral edema.
B. Increased crackles in lung bases.
C. Weight loss of 2 kg in 24 hours.
D. Increased jugular venous distention.
E. Improved shortness of breath.
A. Decreased peripheral edema, C. Weight loss of 2 kg in 24 hours, E. Improved shortness
of breath
Rationale: Furosemide is a loop diuretic that reduces fluid volume. Effectiveness is indicated by
decreased edema (A), weight loss (C), and improved dyspnea (E). Increased crackles (B) and increased
JVD (D) indicate worsening fluid overload.
4. A patient is prescribed heparin 18 units/kg/hr. The patient weighs 75 kg. The
available IV bag is 25,000 units in 500 mL D5W. Calculate the infusion rate in
mL/hr. (Round to the nearest whole number)
27 mL/hr
Rationale: Step 1: 18 units × 75 kg = 1,350 units/hr. Step 2: Concentration is 25,000 units ÷ 500 mL =
50 units/mL. Step 3: 1,350 units/hr ÷ 50 units/mL = 27 mL/hr.
5. A patient is found unresponsive and not breathing. Place the following
interventions in the correct order:
A. Begin chest compressions.
B. Check for breathing and pulse.
C. Call for help and activate code.
D. Open the airway.
E. Use AED as soon as available.
B → C → A → D → E
Rationale: According to BLS guidelines (CAB): Check responsiveness/pulse/breathing (B), Activate
emergency response (C), Start compressions (A), Open airway (D), and use AED (E).
6. A patient with type 1 diabetes reports feeling shaky, diaphoretic, and anxious. The
nurse obtains a blood glucose of 52 mg/dL. Which action should the nurse take
first?
A. Administer glucagon IM.
B. Give 4 ounces of orange juice.
, C. Notify the healthcare provider.
D. Recheck blood glucose in 15 minutes.
B. Give 4 ounces of orange juice
Rationale: The patient is conscious and experiencing hypoglycemia (BG <70). The first-line treatment is
15g of fast-acting carbohydrates (4 oz juice). Glucagon is for unconscious patients. Rechecking occurs
after the intervention.
7. A patient on telemetry develops a rhythm with no visible P waves, an irregularly
irregular ventricular response, and a heart rate of 110-130. Which dysrhythmia does
the nurse identify?
A. Atrial flutter.
B. Atrial fibrillation.
C. Ventricular tachycardia.
D. Sinus tachycardia.
B. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm and absence of P waves.
Atrial flutter has sawtooth waves. V-tach has wide QRS. Sinus tachycardia is regular with P waves.
8. A patient is admitted with suspected pulmonary tuberculosis. Which precautions
should the nurse implement?
A. Standard precautions only.
B. Contact precautions.
C. Droplet precautions.
D. Airborne precautions.
D. Airborne precautions
Rationale: TB requires airborne precautions, including an N95 respirator and a negative-pressure room,
as the nuclei stay suspended in air.
9. A patient is prescribed digoxin. Which assessment finding requires immediate
action?
A. Heart rate 62 bpm.
B. Serum potassium 3.2 mEq/L.
C. Blood pressure 130/80 mmHg.
D. Respiratory rate 18/min.
B. Serum potassium 3.2 mEq/L
Rationale: Hypokalemia increases the risk of digoxin toxicity. Digoxin and potassium compete for the
same binding site on the ATPase pump; low K+ allows more digoxin to bind, causing toxicity.
10. A patient has a stage 3 pressure injury on the sacrum with necrotic tissue. Which
wound care order should the nurse anticipate?
A. Transparent film dressing.
B. Hydrocolloid dressing.
C. Debridement and alginate dressing.
D. Dry gauze dressing.
QUESTIONS WITH VERIFIED SOLUTIONS
Relias Medical-Surgical RN A Examination | Core Domains: Cardiovascular Disorders, Respiratory
Disorders, Neurological Disorders, Endocrine Disorders, Gastrointestinal Disorders, Renal & Urinary
Disorders, Musculoskeletal Disorders, Integumentary Disorders, Hematological Disorders,
Immunological Disorders, Perioperative Care, Pain Management, Fluid & Electrolyte Balance,
Acid-Base Balance, Pharmacology, Infection Control, Patient Safety, Prioritization & Delegation,
Documentation, Patient Education | RN Competency Assessment | 2026/2027 Testing Cycle
Exam Structure
The Relias Medical-Surgical RN A Exam 2026/2027 is structured to evaluate clinical judgment,
prioritization, and evidence-based practice through exactly 85 practice questions. The assessment
includes multiple-choice, select all that apply (SATA), ordered response, and calculation formats. A
passing score of 80% is generally required to demonstrate competency in the adult medical-surgical
setting.
Introduction
This comprehensive collection of 85 practice questions is designed for the 2026/2027 testing cycle. It
reflects current standards of care and nursing competencies required for RNs in medical-surgical units.
The questions integrate pathophysiology, pharmacological management, and nursing interventions across
all major body systems, with a specific focus on safety, delegation, and prioritization.
1. The medical-surgical nurse is caring for four patients. Which patient should the
nurse assess first?
A. A 45-year-old with pneumonia who has a temperature of 38.3°C (101.0°F) and productive
cough.
B. A 60-year-old with heart failure who has 1+ pitting edema and weight gain of 1 kg since
yesterday.
C. A 72-year-old 2 days post-hip replacement who reports sudden shortness of breath and chest
pain.
D. A 55-year-old with diabetes who has a blood glucose of 210 mg/dL and is requesting insulin.
C. A 72-year-old 2 days post-hip replacement who reports sudden shortness of breath and
chest pain
Rationale: This patient presents with signs of pulmonary embolism (sudden dyspnea, chest pain), which
is a life-threatening complication requiring immediate assessment and intervention. Postoperative
patients are at high risk for DVT/PE. The pneumonia patient (A) is stable despite the fever. The heart
failure patient (B) has chronic symptoms. The diabetic patient (D) is stable. Prioritization follows ABCs.
2. Which of the following tasks can the RN delegate to the unlicensed assistive
personnel (UAP)? (Select all that apply)
A. Obtain vital signs on a stable patient.
B. Assess a patient with new-onset chest pain.
, C. Ambulate a patient who is post-op day 2.
D. Administer oral medications.
E. Document intake and output.
A. Obtain vital signs on a stable patient, C. Ambulate a patient who is post-op day 2, E.
Document intake and output
Rationale: UAP can perform routine tasks for stable patients: vital signs (A), ambulation (C), and I&O
documentation (E). Assessment (B) requires nursing judgment and cannot be delegated. Medication
administration (D) is within LPN or RN scope but not UAP scope.
3. A patient with heart failure is receiving furosemide. Which findings indicate the
medication is effective? (Select all that apply)
A. Decreased peripheral edema.
B. Increased crackles in lung bases.
C. Weight loss of 2 kg in 24 hours.
D. Increased jugular venous distention.
E. Improved shortness of breath.
A. Decreased peripheral edema, C. Weight loss of 2 kg in 24 hours, E. Improved shortness
of breath
Rationale: Furosemide is a loop diuretic that reduces fluid volume. Effectiveness is indicated by
decreased edema (A), weight loss (C), and improved dyspnea (E). Increased crackles (B) and increased
JVD (D) indicate worsening fluid overload.
4. A patient is prescribed heparin 18 units/kg/hr. The patient weighs 75 kg. The
available IV bag is 25,000 units in 500 mL D5W. Calculate the infusion rate in
mL/hr. (Round to the nearest whole number)
27 mL/hr
Rationale: Step 1: 18 units × 75 kg = 1,350 units/hr. Step 2: Concentration is 25,000 units ÷ 500 mL =
50 units/mL. Step 3: 1,350 units/hr ÷ 50 units/mL = 27 mL/hr.
5. A patient is found unresponsive and not breathing. Place the following
interventions in the correct order:
A. Begin chest compressions.
B. Check for breathing and pulse.
C. Call for help and activate code.
D. Open the airway.
E. Use AED as soon as available.
B → C → A → D → E
Rationale: According to BLS guidelines (CAB): Check responsiveness/pulse/breathing (B), Activate
emergency response (C), Start compressions (A), Open airway (D), and use AED (E).
6. A patient with type 1 diabetes reports feeling shaky, diaphoretic, and anxious. The
nurse obtains a blood glucose of 52 mg/dL. Which action should the nurse take
first?
A. Administer glucagon IM.
B. Give 4 ounces of orange juice.
, C. Notify the healthcare provider.
D. Recheck blood glucose in 15 minutes.
B. Give 4 ounces of orange juice
Rationale: The patient is conscious and experiencing hypoglycemia (BG <70). The first-line treatment is
15g of fast-acting carbohydrates (4 oz juice). Glucagon is for unconscious patients. Rechecking occurs
after the intervention.
7. A patient on telemetry develops a rhythm with no visible P waves, an irregularly
irregular ventricular response, and a heart rate of 110-130. Which dysrhythmia does
the nurse identify?
A. Atrial flutter.
B. Atrial fibrillation.
C. Ventricular tachycardia.
D. Sinus tachycardia.
B. Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm and absence of P waves.
Atrial flutter has sawtooth waves. V-tach has wide QRS. Sinus tachycardia is regular with P waves.
8. A patient is admitted with suspected pulmonary tuberculosis. Which precautions
should the nurse implement?
A. Standard precautions only.
B. Contact precautions.
C. Droplet precautions.
D. Airborne precautions.
D. Airborne precautions
Rationale: TB requires airborne precautions, including an N95 respirator and a negative-pressure room,
as the nuclei stay suspended in air.
9. A patient is prescribed digoxin. Which assessment finding requires immediate
action?
A. Heart rate 62 bpm.
B. Serum potassium 3.2 mEq/L.
C. Blood pressure 130/80 mmHg.
D. Respiratory rate 18/min.
B. Serum potassium 3.2 mEq/L
Rationale: Hypokalemia increases the risk of digoxin toxicity. Digoxin and potassium compete for the
same binding site on the ATPase pump; low K+ allows more digoxin to bind, causing toxicity.
10. A patient has a stage 3 pressure injury on the sacrum with necrotic tissue. Which
wound care order should the nurse anticipate?
A. Transparent film dressing.
B. Hydrocolloid dressing.
C. Debridement and alginate dressing.
D. Dry gauze dressing.
