Relias Learning Nursing Test | Actual Exam Paper 2026 | Graded A+
RELIAS LEARNING NURSING TEST
ACTUAL EXAMINATION PAPER 2026
Questions with Answers | Graded A+ Verified | Competency Assessment
Student: ____________________ Exam Date: ________________ Score: ______ / 100
EXAMINATION INSTRUCTIONS
This Relias-style competency examination contains 28 questions across 13 domains covering nursing fundamentals,
patient safety, medication administration, nutrition, wound care, perioperative care, delegation, legal/ethical issues, end-
of-life care, and NGN clinical judgment. Select the single best answer. Correct answers appear in bold cyan.
Domain Items Pts
I. Patient Safety & Infection Control 1–2 7
II. Vital Signs & Pain 3–4 7
III. Medication Administration 5–6 7
IV. Nutrition & Enteral/Parenteral 7–8 7
V. Elimination & Ostomy 9 3.5
VI. Wound Care & Pressure Injury 10–11 7
VII. Perioperative Nursing 12–13 7
VIII. Oxygenation & Respiratory 14 3.5
IX. Delegation & Prioritization 15–16 7
X. Legal, Ethical & Documentation 17 3.5
XI. End-of-Life & Palliative 18 3.5
XII. Education & Cultural Competence 19–20 7
XIII. NGN Clinical Judgment 21–22 7
TOTAL 22 ~80
I. Patient Safety & Infection Control
1. The nurse is preparing to insert a foley catheter. Which action demonstrates correct surgical asepsis?
A. Clean the periurethral area from rectum toward the urethra
B. Use sterile gloves and maintain sterile field throughout the procedure
C. Wear clean gloves to save time during insertion
D. Open the catheter kit after positioning the patient
Correct Answer: B. Use sterile gloves and maintain sterile field throughout the procedure
Rationale: Sterile (surgical) asepsis is required for all invasive procedures including urinary catheter insertion. The
nurse must use sterile gloves, maintain a sterile field, and clean the periurethral area from front to back (urethra
toward rectum) to prevent rectal flora contamination. Clean technique and rectal-to-urethral cleaning increase
CAUTI risk.
1
, Relias Learning Nursing Test | Actual Exam Paper 2026 | Graded A+
2. Which patient requires airborne precautions in addition to standard precautions?
A. A patient with herpes zoster (shingles)
B. A patient with pulmonary tuberculosis
C. A patient with Clostridioides difficile infection
D. A patient with methicillin-resistant Staphylococcus aureus (MRSA) wound infection
Correct Answer: B. A patient with pulmonary tuberculosis
Rationale: Pulmonary TB requires airborne precautions: N95 respirator for staff, negative pressure room with ≥6
air exchanges per hour, and patient wears surgical mask during transport. C. difficile requires contact precautions
(gown + gloves). MRSA requires contact precautions. Herpes zoster requires contact and airborne precautions only
if disseminated or in an immunocompromised patient.
II. Vital Signs & Pain Assessment
3. A nurse is assessing blood pressure and obtains a reading of 90/58 mmHg sitting and 76/42 mmHg standing.
The patient reports feeling dizzy upon standing. Which finding is documented?
A. Normal orthostatic changes B. Orthostatic hypotension (positive tilt test)
C. White coat hypertension D. Isolated systolic hypertension
Correct Answer: B. Orthostatic hypotension (positive tilt test)
Rationale: Orthostatic hypotension is defined as a drop in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg within
3 minutes of standing. This patient’s drop of 14/16 mmHg meets the diastolic criterion and is accompanied by
dizziness. Causes include dehydration, antihypertensive medications, autonomic dysfunction, and prolonged bed
rest.
4. A patient with dementia is postoperative and cannot self-report pain. Which pain assessment tool is most
appropriate?
A. 0–10 Numeric Rating Scale B. Wong-Baker FACES Pain Scale
C. PAINAD scale (Pain Assessment in Advanced D. CRIES scale
Dementia)
Correct Answer: B. Wong-Baker FACES Pain Scale
Rationale: PAINAD is specifically validated for assessing pain in patients with advanced dementia who cannot self-
report. It evaluates five domains: breathing, negative vocalization, facial expression, body language, and
consolability, each scored 0–2 (total 0–10). The 0–10 NRS and FACES scales require self-report. CRIES is for
neonates.
III. Medication Administration
5. A nurse is administering heparin 5,000 units subcutaneously. Which technique is correct?
A. Massage the injection site after administration to enhance absorption
B. Administer into the abdomen at least 2 inches from the umbilicus using a 90-degree angle; do not
massage or aspirate
C. Administer into the deltoid muscle using a 45-degree angle
D. Inject into the lateral thigh and apply firm pressure for 5 minutes
2
RELIAS LEARNING NURSING TEST
ACTUAL EXAMINATION PAPER 2026
Questions with Answers | Graded A+ Verified | Competency Assessment
Student: ____________________ Exam Date: ________________ Score: ______ / 100
EXAMINATION INSTRUCTIONS
This Relias-style competency examination contains 28 questions across 13 domains covering nursing fundamentals,
patient safety, medication administration, nutrition, wound care, perioperative care, delegation, legal/ethical issues, end-
of-life care, and NGN clinical judgment. Select the single best answer. Correct answers appear in bold cyan.
Domain Items Pts
I. Patient Safety & Infection Control 1–2 7
II. Vital Signs & Pain 3–4 7
III. Medication Administration 5–6 7
IV. Nutrition & Enteral/Parenteral 7–8 7
V. Elimination & Ostomy 9 3.5
VI. Wound Care & Pressure Injury 10–11 7
VII. Perioperative Nursing 12–13 7
VIII. Oxygenation & Respiratory 14 3.5
IX. Delegation & Prioritization 15–16 7
X. Legal, Ethical & Documentation 17 3.5
XI. End-of-Life & Palliative 18 3.5
XII. Education & Cultural Competence 19–20 7
XIII. NGN Clinical Judgment 21–22 7
TOTAL 22 ~80
I. Patient Safety & Infection Control
1. The nurse is preparing to insert a foley catheter. Which action demonstrates correct surgical asepsis?
A. Clean the periurethral area from rectum toward the urethra
B. Use sterile gloves and maintain sterile field throughout the procedure
C. Wear clean gloves to save time during insertion
D. Open the catheter kit after positioning the patient
Correct Answer: B. Use sterile gloves and maintain sterile field throughout the procedure
Rationale: Sterile (surgical) asepsis is required for all invasive procedures including urinary catheter insertion. The
nurse must use sterile gloves, maintain a sterile field, and clean the periurethral area from front to back (urethra
toward rectum) to prevent rectal flora contamination. Clean technique and rectal-to-urethral cleaning increase
CAUTI risk.
1
, Relias Learning Nursing Test | Actual Exam Paper 2026 | Graded A+
2. Which patient requires airborne precautions in addition to standard precautions?
A. A patient with herpes zoster (shingles)
B. A patient with pulmonary tuberculosis
C. A patient with Clostridioides difficile infection
D. A patient with methicillin-resistant Staphylococcus aureus (MRSA) wound infection
Correct Answer: B. A patient with pulmonary tuberculosis
Rationale: Pulmonary TB requires airborne precautions: N95 respirator for staff, negative pressure room with ≥6
air exchanges per hour, and patient wears surgical mask during transport. C. difficile requires contact precautions
(gown + gloves). MRSA requires contact precautions. Herpes zoster requires contact and airborne precautions only
if disseminated or in an immunocompromised patient.
II. Vital Signs & Pain Assessment
3. A nurse is assessing blood pressure and obtains a reading of 90/58 mmHg sitting and 76/42 mmHg standing.
The patient reports feeling dizzy upon standing. Which finding is documented?
A. Normal orthostatic changes B. Orthostatic hypotension (positive tilt test)
C. White coat hypertension D. Isolated systolic hypertension
Correct Answer: B. Orthostatic hypotension (positive tilt test)
Rationale: Orthostatic hypotension is defined as a drop in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg within
3 minutes of standing. This patient’s drop of 14/16 mmHg meets the diastolic criterion and is accompanied by
dizziness. Causes include dehydration, antihypertensive medications, autonomic dysfunction, and prolonged bed
rest.
4. A patient with dementia is postoperative and cannot self-report pain. Which pain assessment tool is most
appropriate?
A. 0–10 Numeric Rating Scale B. Wong-Baker FACES Pain Scale
C. PAINAD scale (Pain Assessment in Advanced D. CRIES scale
Dementia)
Correct Answer: B. Wong-Baker FACES Pain Scale
Rationale: PAINAD is specifically validated for assessing pain in patients with advanced dementia who cannot self-
report. It evaluates five domains: breathing, negative vocalization, facial expression, body language, and
consolability, each scored 0–2 (total 0–10). The 0–10 NRS and FACES scales require self-report. CRIES is for
neonates.
III. Medication Administration
5. A nurse is administering heparin 5,000 units subcutaneously. Which technique is correct?
A. Massage the injection site after administration to enhance absorption
B. Administer into the abdomen at least 2 inches from the umbilicus using a 90-degree angle; do not
massage or aspirate
C. Administer into the deltoid muscle using a 45-degree angle
D. Inject into the lateral thigh and apply firm pressure for 5 minutes
2
