RELIAS/PROPHECY GENERAL ICU RN A V3 PRACTICE
EXAM | STUDY GUIDE | TESTBANK | LATEST UPDATE
2026/2027 | QUESTIONS & 100% CORRECT ANSWERS
## Table of Contents
- Hemodynamic Monitoring
- Respiratory Failure and Mechanical Ventilation
- Cardiovascular Emergencies
- Neurologic Critical Care
- Sepsis and Shock
- Renal and Electrolyte Disorders
- Endocrine Emergencies
- Gastrointestinal and Hepatic Critical Care
- Infection Prevention and Patient Safety
- Critical Care Pharmacology
- Ethical and Professional Decision-Making
Introduction
This practice examination is designed to help ICU nurses prepare for advanced
competency assessments covering the broad scope of adult critical care nursing.
The questions emphasize clinical reasoning, prioritization, evidence-based
interventions, interpretation of diagnostic findings, and safe management of
critically ill patients. Scenarios reflect complex situations commonly encountered in
intensive care settings, requiring integration of pathophysiology, pharmacology,
hemodynamic monitoring, ventilator management, and multidisciplinary
collaboration. Candidates should expect challenging questions that assess
judgment rather than memorization. Reviewing the explanations will reinforce
essential concepts and strengthen readiness for professional ICU competency
examinations and advanced clinical practice.
Question 1
A patient with septic shock has the following values: MAP 58 mmHg, CVP 9 mmHg,
lactate 5.2 mmol/L, ScvO₂ 58%, urine output 15 mL/hr. Which intervention is the
,highest priority after adequate fluid resuscitation?
A. Increase maintenance IV fluids
B. Initiate norepinephrine infusion
C. Administer furosemide
D. Restrict fluids
Correct Answer: B
Explanation: Persistent hypotension after adequate fluid resuscitation requires
vasopressor therapy, with norepinephrine serving as the preferred first-line agent
to restore perfusion.
Question 2
A mechanically ventilated patient develops sudden hypotension, absent breath
sounds on the right, and increasing peak airway pressures. What should the ICU
nurse suspect first?
A. Pulmonary edema
B. Right-sided tension pneumothorax
C. ARDS progression
D. Mucus production
Correct Answer: B
Explanation: The combination of unilateral absent breath sounds, hypotension,
and elevated airway pressures strongly suggests tension pneumothorax requiring
immediate decompression.
,Question 3
Which assessment finding most strongly suggests cardiogenic rather than
hypovolemic shock?
A. Warm extremities
B. Elevated pulmonary capillary wedge pressure
C. Low systemic vascular resistance
D. Increased urine output
Correct Answer: B
Explanation: Cardiogenic shock is characterized by impaired ventricular function
and elevated filling pressures, producing an increased pulmonary capillary wedge
pressure.
Question 4
A patient receiving continuous propofol infusion develops metabolic acidosis,
rhabdomyolysis, and bradycardia. Which complication should the nurse recognize?
A. Neuroleptic malignant syndrome
B. Propofol infusion syndrome
C. Serotonin syndrome
D. Malignant hyperthermia
Correct Answer: B
Explanation: Propofol infusion syndrome is a rare but life-threatening
complication associated with prolonged or high-dose infusions.
, Question 5
Which arterial blood gas is most consistent with uncompensated respiratory
acidosis?
A. pH 7.30, PaCO₂ 58 mmHg, HCO₃⁻ 25 mEq/L
B. pH 7.52, PaCO₂ 28 mmHg, HCO₃⁻ 24 mEq/L
C. pH 7.32, PaCO₂ 30 mmHg, HCO₃⁻ 16 mEq/L
D. pH 7.45, PaCO₂ 40 mmHg, HCO₃⁻ 27 mEq/L
Correct Answer: A
Explanation: Elevated PaCO₂ with acidemia and normal bicarbonate indicates
acute uncompensated respiratory acidosis.
Question 6
A patient with ARDS remains severely hypoxemic despite optimized ventilator
settings. Which intervention has demonstrated mortality benefit in appropriately
selected patients?
A. Routine sodium bicarbonate infusion
B. Early prone positioning
C. High-dose corticosteroids for every patient
D. Routine hyperventilation
Correct Answer: B
Explanation: Early prolonged prone positioning improves oxygenation and
reduces mortality in severe ARDS.
EXAM | STUDY GUIDE | TESTBANK | LATEST UPDATE
2026/2027 | QUESTIONS & 100% CORRECT ANSWERS
## Table of Contents
- Hemodynamic Monitoring
- Respiratory Failure and Mechanical Ventilation
- Cardiovascular Emergencies
- Neurologic Critical Care
- Sepsis and Shock
- Renal and Electrolyte Disorders
- Endocrine Emergencies
- Gastrointestinal and Hepatic Critical Care
- Infection Prevention and Patient Safety
- Critical Care Pharmacology
- Ethical and Professional Decision-Making
Introduction
This practice examination is designed to help ICU nurses prepare for advanced
competency assessments covering the broad scope of adult critical care nursing.
The questions emphasize clinical reasoning, prioritization, evidence-based
interventions, interpretation of diagnostic findings, and safe management of
critically ill patients. Scenarios reflect complex situations commonly encountered in
intensive care settings, requiring integration of pathophysiology, pharmacology,
hemodynamic monitoring, ventilator management, and multidisciplinary
collaboration. Candidates should expect challenging questions that assess
judgment rather than memorization. Reviewing the explanations will reinforce
essential concepts and strengthen readiness for professional ICU competency
examinations and advanced clinical practice.
Question 1
A patient with septic shock has the following values: MAP 58 mmHg, CVP 9 mmHg,
lactate 5.2 mmol/L, ScvO₂ 58%, urine output 15 mL/hr. Which intervention is the
,highest priority after adequate fluid resuscitation?
A. Increase maintenance IV fluids
B. Initiate norepinephrine infusion
C. Administer furosemide
D. Restrict fluids
Correct Answer: B
Explanation: Persistent hypotension after adequate fluid resuscitation requires
vasopressor therapy, with norepinephrine serving as the preferred first-line agent
to restore perfusion.
Question 2
A mechanically ventilated patient develops sudden hypotension, absent breath
sounds on the right, and increasing peak airway pressures. What should the ICU
nurse suspect first?
A. Pulmonary edema
B. Right-sided tension pneumothorax
C. ARDS progression
D. Mucus production
Correct Answer: B
Explanation: The combination of unilateral absent breath sounds, hypotension,
and elevated airway pressures strongly suggests tension pneumothorax requiring
immediate decompression.
,Question 3
Which assessment finding most strongly suggests cardiogenic rather than
hypovolemic shock?
A. Warm extremities
B. Elevated pulmonary capillary wedge pressure
C. Low systemic vascular resistance
D. Increased urine output
Correct Answer: B
Explanation: Cardiogenic shock is characterized by impaired ventricular function
and elevated filling pressures, producing an increased pulmonary capillary wedge
pressure.
Question 4
A patient receiving continuous propofol infusion develops metabolic acidosis,
rhabdomyolysis, and bradycardia. Which complication should the nurse recognize?
A. Neuroleptic malignant syndrome
B. Propofol infusion syndrome
C. Serotonin syndrome
D. Malignant hyperthermia
Correct Answer: B
Explanation: Propofol infusion syndrome is a rare but life-threatening
complication associated with prolonged or high-dose infusions.
, Question 5
Which arterial blood gas is most consistent with uncompensated respiratory
acidosis?
A. pH 7.30, PaCO₂ 58 mmHg, HCO₃⁻ 25 mEq/L
B. pH 7.52, PaCO₂ 28 mmHg, HCO₃⁻ 24 mEq/L
C. pH 7.32, PaCO₂ 30 mmHg, HCO₃⁻ 16 mEq/L
D. pH 7.45, PaCO₂ 40 mmHg, HCO₃⁻ 27 mEq/L
Correct Answer: A
Explanation: Elevated PaCO₂ with acidemia and normal bicarbonate indicates
acute uncompensated respiratory acidosis.
Question 6
A patient with ARDS remains severely hypoxemic despite optimized ventilator
settings. Which intervention has demonstrated mortality benefit in appropriately
selected patients?
A. Routine sodium bicarbonate infusion
B. Early prone positioning
C. High-dose corticosteroids for every patient
D. Routine hyperventilation
Correct Answer: B
Explanation: Early prolonged prone positioning improves oxygenation and
reduces mortality in severe ARDS.
