Relias/Prophecy General ICU RN A V3 practice
questions with verified answers and detailed
rationales
1. A patient in the ICU has a sudden drop in blood pressure, tachycardia, and distended
neck veins. What is the most likely cause?
A. Hypovolemic shock
B. Cardiogenic shock
C. Tension pneumothorax
D. Septic shock
Answer: C. Tension pneumothorax
Rationale: Tension pneumothorax causes decreased venous return due to increased
intrathoracic pressure, leading to hypotension, tachycardia, and distended neck veins.
Hypovolemic shock presents with hypotension and tachycardia but usually with flat neck
veins. Cardiogenic shock often presents with pulmonary edema. Septic shock usually has
warm, flushed skin initially.
2. The nurse is caring for a patient with ARDS. Which ventilator setting is most
appropriate to prevent further lung injury?
A. High tidal volume and low PEEP
B. Low tidal volume and high PEEP
C. High tidal volume and high PEEP
D. Low tidal volume and low PEEP
Answer: B. Low tidal volume and high PEEP
Rationale: ARDS management involves lung-protective strategies, including low tidal
volumes (6 mL/kg ideal body weight) to prevent barotrauma and sufficient PEEP to maintain
alveolar recruitment and oxygenation.
3. Which lab value is most important to monitor in a patient receiving continuous
heparin infusion?
A. PT
B. aPTT
C. INR
D. Platelet count
Answer: B. aPTT
Rationale: Heparin primarily prolongs aPTT, so monitoring aPTT ensures therapeutic
anticoagulation while reducing risk of bleeding. PT and INR are used for warfarin therapy,
and platelet count is monitored for heparin-induced thrombocytopenia but not for dosing.
, 4. A patient with septic shock is receiving norepinephrine. The nurse notes the patient’s
mean arterial pressure (MAP) is 55 mmHg. What is the priority nursing action?
A. Increase norepinephrine infusion
B. Administer IV fluids
C. Obtain blood cultures
D. Call the rapid response team
Answer: A. Increase norepinephrine infusion
Rationale: Septic shock management targets MAP ≥ 65 mmHg to maintain organ perfusion.
If MAP is low despite fluids, vasopressor (norepinephrine) titration is indicated. Blood
cultures and fluids are important but secondary if MAP is critically low.
5. Which electrolyte imbalance is most concerning in a patient on continuous
furosemide infusion?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B. Hypokalemia
Rationale: Loop diuretics like furosemide cause potassium wasting. Hypokalemia can lead to
cardiac arrhythmias, especially in critically ill patients.
6. The nurse is assessing a patient with increased intracranial pressure (ICP). Which of
the following is an early sign?
A. Cushing’s triad
B. Bradycardia
C. Decreased level of consciousness
D. Irregular respirations
Answer: C. Decreased level of consciousness
Rationale: The earliest sign of increased ICP is a change in mental status (confusion,
lethargy). Cushing’s triad (bradycardia, hypertension, irregular respirations) appears later
as ICP becomes critically high.
7. A patient with AKI is oliguric. Which intervention is most appropriate to prevent
fluid overload?
A. Administer IV fluids aggressively
B. Restrict fluid intake
C. Administer loop diuretics to increase urine output
D. Start enteral nutrition
questions with verified answers and detailed
rationales
1. A patient in the ICU has a sudden drop in blood pressure, tachycardia, and distended
neck veins. What is the most likely cause?
A. Hypovolemic shock
B. Cardiogenic shock
C. Tension pneumothorax
D. Septic shock
Answer: C. Tension pneumothorax
Rationale: Tension pneumothorax causes decreased venous return due to increased
intrathoracic pressure, leading to hypotension, tachycardia, and distended neck veins.
Hypovolemic shock presents with hypotension and tachycardia but usually with flat neck
veins. Cardiogenic shock often presents with pulmonary edema. Septic shock usually has
warm, flushed skin initially.
2. The nurse is caring for a patient with ARDS. Which ventilator setting is most
appropriate to prevent further lung injury?
A. High tidal volume and low PEEP
B. Low tidal volume and high PEEP
C. High tidal volume and high PEEP
D. Low tidal volume and low PEEP
Answer: B. Low tidal volume and high PEEP
Rationale: ARDS management involves lung-protective strategies, including low tidal
volumes (6 mL/kg ideal body weight) to prevent barotrauma and sufficient PEEP to maintain
alveolar recruitment and oxygenation.
3. Which lab value is most important to monitor in a patient receiving continuous
heparin infusion?
A. PT
B. aPTT
C. INR
D. Platelet count
Answer: B. aPTT
Rationale: Heparin primarily prolongs aPTT, so monitoring aPTT ensures therapeutic
anticoagulation while reducing risk of bleeding. PT and INR are used for warfarin therapy,
and platelet count is monitored for heparin-induced thrombocytopenia but not for dosing.
, 4. A patient with septic shock is receiving norepinephrine. The nurse notes the patient’s
mean arterial pressure (MAP) is 55 mmHg. What is the priority nursing action?
A. Increase norepinephrine infusion
B. Administer IV fluids
C. Obtain blood cultures
D. Call the rapid response team
Answer: A. Increase norepinephrine infusion
Rationale: Septic shock management targets MAP ≥ 65 mmHg to maintain organ perfusion.
If MAP is low despite fluids, vasopressor (norepinephrine) titration is indicated. Blood
cultures and fluids are important but secondary if MAP is critically low.
5. Which electrolyte imbalance is most concerning in a patient on continuous
furosemide infusion?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B. Hypokalemia
Rationale: Loop diuretics like furosemide cause potassium wasting. Hypokalemia can lead to
cardiac arrhythmias, especially in critically ill patients.
6. The nurse is assessing a patient with increased intracranial pressure (ICP). Which of
the following is an early sign?
A. Cushing’s triad
B. Bradycardia
C. Decreased level of consciousness
D. Irregular respirations
Answer: C. Decreased level of consciousness
Rationale: The earliest sign of increased ICP is a change in mental status (confusion,
lethargy). Cushing’s triad (bradycardia, hypertension, irregular respirations) appears later
as ICP becomes critically high.
7. A patient with AKI is oliguric. Which intervention is most appropriate to prevent
fluid overload?
A. Administer IV fluids aggressively
B. Restrict fluid intake
C. Administer loop diuretics to increase urine output
D. Start enteral nutrition
