Relias/Prophecy — General ICU RN A V3 questions
with correct answers and concise rationales.
(hemodynamics, ventilators, meds, ARDS/sepsis,
neuro, ECG/arrhythmias, ABGs, electrolytes, renal
support, lines/tubes, ethics)..
1
A 68-year-old with septic shock is on norepinephrine 12 mcg/min and MAP is 56
mmHg. What is the nurse’s best immediate action?
A. Increase norepinephrine infusion rate.
B. Start dopamine.
C. Give a 500 mL crystalloid bolus.
D. Call respiratory therapy.
Answer: A.
Rationale: Target MAP ≥65 mmHg in septic shock; increasing vasopressor
(norepinephrine) is appropriate immediate step after initial fluids.
2
An arterial blood gas: pH 7.28, PaCO₂ 54 mmHg, HCO₃⁻ 22 mEq/L. What is the
primary disturbance?
A. Metabolic acidosis.
B. Respiratory acidosis.
C. Mixed metabolic and respiratory alkalosis.
D. Metabolic alkalosis with compensation.
Answer: B.
Rationale: Low pH with elevated PaCO₂ indicates acute respiratory acidosis.
3
Which ventilator setting most directly controls alveolar ventilation (PaCO₂)?
A. FiO₂.
B. PEEP.
C. Tidal volume.
D. Inspiratory flow pattern.
Answer: C.
Rationale: Tidal volume × respiratory rate determines minute ventilation and thus
PaCO₂.
,4
A patient on mechanical ventilation with ARDS: which strategy is recommended?
A. High tidal volumes (10–12 mL/kg).
B. Low tidal volume (6 mL/kg predicted body weight).
C. Zero PEEP.
D. Routine surfactant therapy.
Answer: B.
Rationale: Low tidal volume ventilation reduces ventilator-induced lung injury in
ARDS.
5
Which electrolyte imbalance is most associated with peaked T waves and widened
QRS?
A. Hypokalemia.
B. Hyperkalemia.
C. Hypocalcemia.
D. Hypermagnesemia.
Answer: B.
Rationale: Hyperkalemia causes peaked T waves and can widen QRS, risking
ventricular arrhythmia.
6
The nurse notes new asymmetric pupils and declining consciousness — priority
action:
A. Elevate HOB to 30°.
B. Obtain CT scan ASAP.
C. Check blood glucose.
D. Prepare mannitol and notify provider.
Answer: C.
Rationale: While signs suggest increased intracranial pressure, rapidly check and
correct hypoglycemia first — it’s a reversible cause of decreased consciousness.
(Then neuro interventions and urgent imaging/notification.)
7
A central venous pressure (CVP) reading of 2 mmHg in a hypotensive patient
suggests:
A. Fluid overload.
, B. Normal intravascular volume.
C. Hypovolemia — consider fluid bolus.
D. Pulmonary embolism.
Answer: C.
Rationale: Low CVP often indicates low preload/hypovolemia; consider fluid
resuscitation in hypotensive patient.
8
Which medication is first-line for rapid sequence intubation induction in unstable ICU
patient?
A. Etomidate.
B. Propofol.
C. Midazolam.
D. Succinylcholine.
Answer: A.
Rationale: Etomidate provides hemodynamic stability during induction;
succinylcholine is a paralytic (often used with induction agent), but the question
asked induction agent.
9
A ventilated patient has sudden oxygen desaturation and absent breath sounds on
the left — likely diagnosis?
A. Pulmonary edema.
B. Left mainstem bronchus intubation.
C. Tension pneumothorax.
D. Bronchospasm.
Answer: C.
Rationale: Sudden desaturation with absent breath sounds and hemodynamic
compromise suggests tension pneumothorax; immediate needle decompression is
required.
10
Best initial treatment for symptomatic bradycardia causing hypotension?
A. Amiodarone.
B. Atropine.
C. Adenosine.
D. Synchronized cardioversion.
Answer: B.
Rationale: Atropine is first drug for symptomatic bradycardia; pacing if ineffective.
with correct answers and concise rationales.
(hemodynamics, ventilators, meds, ARDS/sepsis,
neuro, ECG/arrhythmias, ABGs, electrolytes, renal
support, lines/tubes, ethics)..
1
A 68-year-old with septic shock is on norepinephrine 12 mcg/min and MAP is 56
mmHg. What is the nurse’s best immediate action?
A. Increase norepinephrine infusion rate.
B. Start dopamine.
C. Give a 500 mL crystalloid bolus.
D. Call respiratory therapy.
Answer: A.
Rationale: Target MAP ≥65 mmHg in septic shock; increasing vasopressor
(norepinephrine) is appropriate immediate step after initial fluids.
2
An arterial blood gas: pH 7.28, PaCO₂ 54 mmHg, HCO₃⁻ 22 mEq/L. What is the
primary disturbance?
A. Metabolic acidosis.
B. Respiratory acidosis.
C. Mixed metabolic and respiratory alkalosis.
D. Metabolic alkalosis with compensation.
Answer: B.
Rationale: Low pH with elevated PaCO₂ indicates acute respiratory acidosis.
3
Which ventilator setting most directly controls alveolar ventilation (PaCO₂)?
A. FiO₂.
B. PEEP.
C. Tidal volume.
D. Inspiratory flow pattern.
Answer: C.
Rationale: Tidal volume × respiratory rate determines minute ventilation and thus
PaCO₂.
,4
A patient on mechanical ventilation with ARDS: which strategy is recommended?
A. High tidal volumes (10–12 mL/kg).
B. Low tidal volume (6 mL/kg predicted body weight).
C. Zero PEEP.
D. Routine surfactant therapy.
Answer: B.
Rationale: Low tidal volume ventilation reduces ventilator-induced lung injury in
ARDS.
5
Which electrolyte imbalance is most associated with peaked T waves and widened
QRS?
A. Hypokalemia.
B. Hyperkalemia.
C. Hypocalcemia.
D. Hypermagnesemia.
Answer: B.
Rationale: Hyperkalemia causes peaked T waves and can widen QRS, risking
ventricular arrhythmia.
6
The nurse notes new asymmetric pupils and declining consciousness — priority
action:
A. Elevate HOB to 30°.
B. Obtain CT scan ASAP.
C. Check blood glucose.
D. Prepare mannitol and notify provider.
Answer: C.
Rationale: While signs suggest increased intracranial pressure, rapidly check and
correct hypoglycemia first — it’s a reversible cause of decreased consciousness.
(Then neuro interventions and urgent imaging/notification.)
7
A central venous pressure (CVP) reading of 2 mmHg in a hypotensive patient
suggests:
A. Fluid overload.
, B. Normal intravascular volume.
C. Hypovolemia — consider fluid bolus.
D. Pulmonary embolism.
Answer: C.
Rationale: Low CVP often indicates low preload/hypovolemia; consider fluid
resuscitation in hypotensive patient.
8
Which medication is first-line for rapid sequence intubation induction in unstable ICU
patient?
A. Etomidate.
B. Propofol.
C. Midazolam.
D. Succinylcholine.
Answer: A.
Rationale: Etomidate provides hemodynamic stability during induction;
succinylcholine is a paralytic (often used with induction agent), but the question
asked induction agent.
9
A ventilated patient has sudden oxygen desaturation and absent breath sounds on
the left — likely diagnosis?
A. Pulmonary edema.
B. Left mainstem bronchus intubation.
C. Tension pneumothorax.
D. Bronchospasm.
Answer: C.
Rationale: Sudden desaturation with absent breath sounds and hemodynamic
compromise suggests tension pneumothorax; immediate needle decompression is
required.
10
Best initial treatment for symptomatic bradycardia causing hypotension?
A. Amiodarone.
B. Atropine.
C. Adenosine.
D. Synchronized cardioversion.
Answer: B.
Rationale: Atropine is first drug for symptomatic bradycardia; pacing if ineffective.
