RELIAS / PROPHECY: General ICU RN
(Version 3 2025) – Verified Answers,
Graded A+ ✅✅
1. Q: A patient with acute respiratory distress syndrome (ARDS) on mechanical ventilation has
a sudden drop in SpO2 from 94% to 82% and increased peak airway pressures. What is the
nurse's first action?
A: Perform immediate manual ventilation with a bag-valve-mask and listen for breath
sounds. (Rule out disconnection or pneumothorax first).
2. Q: What is the primary early sign of increased intracranial pressure (ICP) in a comatose
patient?
A: Change in level of consciousness (LOC) or agitation.
3. Q: A patient receiving a nitroprusside infusion for hypertensive crisis develops agitation,
nausea, and tachycardia. The nurse suspects cyanide toxicity. What action is critical?
A: Stop the nitroprusside infusion immediately and notify the provider.
4. Q: Which dysrhythmia requires immediate defibrillation, not synchronized cardioversion?
A: Pulseless Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF).
5. Q: The nurse notes a new, irregular narrow-complex tachycardia at a rate of 160 on a post-
MI patient. The patient is alert with a BP of 108/70. What is the priority intervention?
A: Prepare for synchronized cardioversion as ordered. (Unstable SVT).
6. Q: A patient with a subarachnoid hemorrhage complains of a sudden, severe "thunderclap"
headache. What is the nurse's priority action?
A: Assess for signs of re-bleeding (e.g., decreased LOC, new neurologic deficit) and notify the
provider STAT.
7. Q: What is the most reliable indicator of fluid volume status in a critically ill patient with a
pulmonary artery catheter?
A: Pulmonary Artery Wedge Pressure (PAWP) or Pulmonary Capillary Wedge Pressure
(PCWP).
,8. Q: A patient with septic shock has a MAP of 58 mmHg despite 2L of crystalloid. What is the
next likely intervention?
A: Initiation of a vasopressor infusion (e.g., Norepinephrine).
9. Q: Which finding is a late sign of compartment syndrome?
A: Absent pulse (paresthesia and pain out of proportion are early signs).
10. Q: A patient with a severe TBI has a BP of 80/50 and ICP of 25 mmHg. What is the
calculated Cerebral Perfusion Pressure (CPP)? Is it adequate?
A: CPP = MAP - ICP. MAP ≈ 60. CPP = 60 - 25 = 35 mmHg. No, it is inadequate (goal is typically
>60-70 mmHg).
11. Q: Which acid-base imbalance is most commonly associated with prolonged diarrhea?
A: Metabolic Acidosis (loss of bicarbonate-rich fluids).
12. Q: A patient on mechanical ventilation is triggering the high-pressure alarm. What is the
LEAST likely cause?
A: A ventilator circuit disconnection. (This would trigger a low-pressure alarm).
13. Q: What is the priority nursing action when a patient's transvenous pacemaker fails to
capture?
A: Increase the mA (milliamp) output on the pacemaker generator.
14. Q: A patient with liver failure develops asterixis and confusion. What is the most
appropriate initial nursing action?
A: Assess ammonia level and implement fall precautions/seizure precautions.
15. Q: The nurse notes a sine wave pattern on a patient's cardiac monitor. What is the
immediate treatment?
A: Administer IV Calcium Chloride or Gluconate (for suspected hyperkalemia).
16. Q: Which vasopressor is first-line for septic shock due to its alpha and beta effects?
A: Norepinephrine (Levophed).
17. Q: A patient with a massive PE is likely to present with what classic triad?
A: Dyspnea, pleuritic chest pain, and hemoptysis. (Though not all three are always present).
18. Q: What is the antidote for heparin overdose?
A: Protamine Sulfate.
,19. Q: What is the antidote for warfarin (Coumadin) overdose in a bleeding patient?
A: Prothrombin Complex Concentrate (PCC) or Fresh Frozen Plasma (FFP). Vitamin K works but
is slow.
20. Q: Which lab value is most critical to monitor in a patient receiving a furosemide infusion
for pulmonary edema?
A: Serum Potassium (risk of severe hypokalemia).
21. Q: A patient's arterial blood gas shows: pH 7.22, PaCO2 60, HCO3 24. What is the
interpretation?
A: Acute Respiratory Acidosis (uncompensated).
22. Q: What is the primary treatment for torsades de pointes?
A: IV Magnesium Sulfate.
23. Q: A patient with a sodium level of 118 mEq/L is having seizures. What is the priority
correction guideline?
A: Raise serum sodium no more than 8-10 mEq/L in the first 24 hours to avoid osmotic
demyelination syndrome.
24. Q: What ECG change is hallmark of an acute inferior wall MI?
A: ST elevation in leads II, III, and aVF.
25. Q: Which medication should be held for a heart rate <50 bpm?
A: Metoprolol (a beta-blocker).
26. Q: A burn patient with a hoarse voice, sooty sputum, and stridor is suspected of having
what?
A: Inhalation injury with potential for airway edema/obstruction.
27. Q: What is the most common cause of ventilator-associated pneumonia (VAP)?
A: Aspiration of oropharyngeal secretions colonized with pathogens.
28. Q: Which intervention is most effective for preventing VAP?
A: Maintaining the head of bed at 30-45 degrees (unless contraindicated).
29. Q: A patient develops sudden, sharp chest pain and dyspnea 5 days post-MI. The nurse
suspects cardiac tamponade. What is the classic sign?
A: Beck's Triad: Hypotension, JVD, muffled heart sounds.
, 30. Q: What is the primary goal when managing a patient with neurogenic shock?
A: Support BP with vasopressors and fluid resuscitation as needed (due to loss of sympathetic
tone).
31. Q: A patient with a serum magnesium level of 1.0 mg/dL is at risk for what life-threatening
complication?
A: Torsades de pointes or refractory ventricular dysrhythmias.
32. Q: A patient in DKA has a blood glucose of 550 mg/dL. Why must insulin not be given
before checking potassium?
A: Insulin drives potassium into cells, potentially causing severe hypokalemia and cardiac
arrest.
33. Q: What is the first sign of oxygen toxicity in a patient on high FiO2 for an extended
period?
A: Substernal chest pain or tracheobronchitis. (ARDS-like changes are later).
34. Q: Which patient is most at risk for developing hypermagnesemia?
A: A patient with end-stage renal disease (ESRD) receiving magnesium-containing
antacids.
35. Q: A patient has a pH of 7.50, PaCO2 of 30, and HCO3 of 24. What is the interpretation?
A: Acute Respiratory Alkalosis.
36. Q: What is the most specific lab test for diagnosing an acute myocardial infarction?
A: Troponin I or T.
37. Q: A patient with a pneumothorax has a chest tube. The chamber is no longer bubbling,
and breath sounds are absent on that side. What does this indicate?
A: The tube may be clogged or displaced, potentially causing a recurrent
pneumothorax.
38. Q: What is the treatment for malignant hyperthermia?
A: Immediately stop triggering agents (volatile anesthetics/succinylcholine) and administer
Dantrolene.
39. Q: A patient with myasthenia gravis develops sudden respiratory distress and increased
weakness. What is the nurse's priority action?
A: Prepare for intubation and mechanical ventilation (myasthenic crisis).
40. Q: What is the priority assessment for a patient receiving continuous neuromuscular
blockade (e.g., cisatracurium)?
(Version 3 2025) – Verified Answers,
Graded A+ ✅✅
1. Q: A patient with acute respiratory distress syndrome (ARDS) on mechanical ventilation has
a sudden drop in SpO2 from 94% to 82% and increased peak airway pressures. What is the
nurse's first action?
A: Perform immediate manual ventilation with a bag-valve-mask and listen for breath
sounds. (Rule out disconnection or pneumothorax first).
2. Q: What is the primary early sign of increased intracranial pressure (ICP) in a comatose
patient?
A: Change in level of consciousness (LOC) or agitation.
3. Q: A patient receiving a nitroprusside infusion for hypertensive crisis develops agitation,
nausea, and tachycardia. The nurse suspects cyanide toxicity. What action is critical?
A: Stop the nitroprusside infusion immediately and notify the provider.
4. Q: Which dysrhythmia requires immediate defibrillation, not synchronized cardioversion?
A: Pulseless Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF).
5. Q: The nurse notes a new, irregular narrow-complex tachycardia at a rate of 160 on a post-
MI patient. The patient is alert with a BP of 108/70. What is the priority intervention?
A: Prepare for synchronized cardioversion as ordered. (Unstable SVT).
6. Q: A patient with a subarachnoid hemorrhage complains of a sudden, severe "thunderclap"
headache. What is the nurse's priority action?
A: Assess for signs of re-bleeding (e.g., decreased LOC, new neurologic deficit) and notify the
provider STAT.
7. Q: What is the most reliable indicator of fluid volume status in a critically ill patient with a
pulmonary artery catheter?
A: Pulmonary Artery Wedge Pressure (PAWP) or Pulmonary Capillary Wedge Pressure
(PCWP).
,8. Q: A patient with septic shock has a MAP of 58 mmHg despite 2L of crystalloid. What is the
next likely intervention?
A: Initiation of a vasopressor infusion (e.g., Norepinephrine).
9. Q: Which finding is a late sign of compartment syndrome?
A: Absent pulse (paresthesia and pain out of proportion are early signs).
10. Q: A patient with a severe TBI has a BP of 80/50 and ICP of 25 mmHg. What is the
calculated Cerebral Perfusion Pressure (CPP)? Is it adequate?
A: CPP = MAP - ICP. MAP ≈ 60. CPP = 60 - 25 = 35 mmHg. No, it is inadequate (goal is typically
>60-70 mmHg).
11. Q: Which acid-base imbalance is most commonly associated with prolonged diarrhea?
A: Metabolic Acidosis (loss of bicarbonate-rich fluids).
12. Q: A patient on mechanical ventilation is triggering the high-pressure alarm. What is the
LEAST likely cause?
A: A ventilator circuit disconnection. (This would trigger a low-pressure alarm).
13. Q: What is the priority nursing action when a patient's transvenous pacemaker fails to
capture?
A: Increase the mA (milliamp) output on the pacemaker generator.
14. Q: A patient with liver failure develops asterixis and confusion. What is the most
appropriate initial nursing action?
A: Assess ammonia level and implement fall precautions/seizure precautions.
15. Q: The nurse notes a sine wave pattern on a patient's cardiac monitor. What is the
immediate treatment?
A: Administer IV Calcium Chloride or Gluconate (for suspected hyperkalemia).
16. Q: Which vasopressor is first-line for septic shock due to its alpha and beta effects?
A: Norepinephrine (Levophed).
17. Q: A patient with a massive PE is likely to present with what classic triad?
A: Dyspnea, pleuritic chest pain, and hemoptysis. (Though not all three are always present).
18. Q: What is the antidote for heparin overdose?
A: Protamine Sulfate.
,19. Q: What is the antidote for warfarin (Coumadin) overdose in a bleeding patient?
A: Prothrombin Complex Concentrate (PCC) or Fresh Frozen Plasma (FFP). Vitamin K works but
is slow.
20. Q: Which lab value is most critical to monitor in a patient receiving a furosemide infusion
for pulmonary edema?
A: Serum Potassium (risk of severe hypokalemia).
21. Q: A patient's arterial blood gas shows: pH 7.22, PaCO2 60, HCO3 24. What is the
interpretation?
A: Acute Respiratory Acidosis (uncompensated).
22. Q: What is the primary treatment for torsades de pointes?
A: IV Magnesium Sulfate.
23. Q: A patient with a sodium level of 118 mEq/L is having seizures. What is the priority
correction guideline?
A: Raise serum sodium no more than 8-10 mEq/L in the first 24 hours to avoid osmotic
demyelination syndrome.
24. Q: What ECG change is hallmark of an acute inferior wall MI?
A: ST elevation in leads II, III, and aVF.
25. Q: Which medication should be held for a heart rate <50 bpm?
A: Metoprolol (a beta-blocker).
26. Q: A burn patient with a hoarse voice, sooty sputum, and stridor is suspected of having
what?
A: Inhalation injury with potential for airway edema/obstruction.
27. Q: What is the most common cause of ventilator-associated pneumonia (VAP)?
A: Aspiration of oropharyngeal secretions colonized with pathogens.
28. Q: Which intervention is most effective for preventing VAP?
A: Maintaining the head of bed at 30-45 degrees (unless contraindicated).
29. Q: A patient develops sudden, sharp chest pain and dyspnea 5 days post-MI. The nurse
suspects cardiac tamponade. What is the classic sign?
A: Beck's Triad: Hypotension, JVD, muffled heart sounds.
, 30. Q: What is the primary goal when managing a patient with neurogenic shock?
A: Support BP with vasopressors and fluid resuscitation as needed (due to loss of sympathetic
tone).
31. Q: A patient with a serum magnesium level of 1.0 mg/dL is at risk for what life-threatening
complication?
A: Torsades de pointes or refractory ventricular dysrhythmias.
32. Q: A patient in DKA has a blood glucose of 550 mg/dL. Why must insulin not be given
before checking potassium?
A: Insulin drives potassium into cells, potentially causing severe hypokalemia and cardiac
arrest.
33. Q: What is the first sign of oxygen toxicity in a patient on high FiO2 for an extended
period?
A: Substernal chest pain or tracheobronchitis. (ARDS-like changes are later).
34. Q: Which patient is most at risk for developing hypermagnesemia?
A: A patient with end-stage renal disease (ESRD) receiving magnesium-containing
antacids.
35. Q: A patient has a pH of 7.50, PaCO2 of 30, and HCO3 of 24. What is the interpretation?
A: Acute Respiratory Alkalosis.
36. Q: What is the most specific lab test for diagnosing an acute myocardial infarction?
A: Troponin I or T.
37. Q: A patient with a pneumothorax has a chest tube. The chamber is no longer bubbling,
and breath sounds are absent on that side. What does this indicate?
A: The tube may be clogged or displaced, potentially causing a recurrent
pneumothorax.
38. Q: What is the treatment for malignant hyperthermia?
A: Immediately stop triggering agents (volatile anesthetics/succinylcholine) and administer
Dantrolene.
39. Q: A patient with myasthenia gravis develops sudden respiratory distress and increased
weakness. What is the nurse's priority action?
A: Prepare for intubation and mechanical ventilation (myasthenic crisis).
40. Q: What is the priority assessment for a patient receiving continuous neuromuscular
blockade (e.g., cisatracurium)?
