CRITICAL CARE NURSING CERTIF ICATION
EXAMINATION
Relias/Prophecy
General ICU RN A V3
Actual Exam
100 verified multiple-choice questions with detailed answers and
rationales, aligned with Relias/Prophecy General ICU RN competency
standards, the AACN Essentials of Critical Care Nursing, and evidence-
based critical care guidelines for the 2026/2027 testing cycle.
General ICU RN Competency Examination
2026/2027 Edition
1 0 0 V E R I F I E D Q U E S T I O N S · D E TA I L E D A N S W E R S A N D
RATI O N A L E S
,Relias/Prophecy General ICU RN A V3 Actual Exam 2026/2027 Edition
RELIAS/PROPHECY GENERAL ICU RN A V3 ACTUAL
EXAM
100 Verified Questions with Detailed Answers and Rationales | 2026/2027 Edition
Aligned with Relias/Prophecy General ICU RN Competency Standards, AACN Essentials of Critical Care Nursing, and
Evidence-Based Critical Care Guidelines (2026/2027 Edition)
Examination Length: 100 Questions | Cognitive Levels: 20% Recall, 50% Application, 30% Analysis | Question Style: 80%
Scenario-Based, 20% Direct Knowledge
Section 1: Cardiovascular Critical Care
Questions 1-20
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the jaw for 45
minutes. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF with ST
depression in V1-V2. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery [CORRECT]
C. Left circumflex artery
D. Left main coronary artery
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF localizes an inferior wall STEMI, which is supplied by the
right coronary artery in approximately 80 percent of patients. ST depression in V1-V2 suggests reciprocal
change or posterior involvement, common with RCA occlusion. The LAD supplies the anterior wall (V1-V4),
and the circumflex supplies the lateral wall (I, aVL, V5-V6). Per AHA/ACS competency standards, the ICU
nurse must also screen for right ventricular infarction before giving preload-reducing agents such as
nitroglycerin.
Q2: A 62-year-old female admitted with chest pain has Troponin I of 4.2 ng/mL (elevated), ST
depression in V4-V6, and a history of coronary artery disease. She is diagnosed with a NSTEMI.
Which pharmacologic regimen should the nurse anticipate initiating?
A. Aspirin, a P2Y12 inhibitor, and a parenteral anticoagulant [CORRECT]
B. Fibrinolytic therapy with tenecteplase
C. Warfarin monotherapy for anticoagulation
D. Aspirin and clopidogrel only, with no anticoagulant
Correct Answer: A
Rationale: Management of NSTEMI follows the AHA/ACC guideline of dual antiplatelet therapy (aspirin
plus a P2Y12 inhibitor such as ticagrelor or clopidogrel) combined with an anticoagulant such as heparin or
enoxaparin, followed by an early invasive strategy within 24 hours for high-risk patients. Fibrinolytics are
NOT given for NSTEMI because complete vessel occlusion is absent and bleeding risk outweighs benefit.
Warfarin monotherapy provides no antiplatelet protection and is not indicated in the acute phase.
Critical Care Nursing Education - General ICU RN Competency Examination 1
,Relias/Prophecy General ICU RN A V3 Actual Exam 2026/2027 Edition
Q3: Three days after an anterior MI, a patient becomes hypotensive with a BP of 78/52 mmHg,
cold and mottled extremities, pulmonary crackles, cardiac index 1.6 L/min/m2, and PCWP 24
mmHg. Which intervention is the priority?
A. Administer sublingual nitroglycerin to reduce afterload
B. Administer a 1-liter rapid crystalloid bolus to raise preload
C. Give IV furosemide 40 mg to reduce preload
D. Initiate norepinephrine to maintain MAP at 65 mmHg or higher and prepare for urgent
revascularization or mechanical circulatory support [CORRECT]
Correct Answer: D
Rationale: This patient is in cardiogenic shock: low cardiac index, high filling pressures (PCWP 24),
hypotension, and signs of hypoperfusion. Per AHA/SCAI shock-stage standards, vasopressor support
(norepinephrine is preferred over dopamine due to lower arrhythmia risk) maintains coronary and end-organ
perfusion while urgent revascularization or mechanical support (IABP, Impella, ECMO) is arranged. Fluid
boluses and nitroglycerin would worsen pulmonary edema, and furosemide would further reduce preload in a
failing pump.
Q4: A patient presents with BP 224/140 mmHg, acute pulmonary edema, and a headache. The
ICU team diagnoses a hypertensive emergency. Which management strategy is correct?
A. Normalize BP over 24 to 48 hours with no monitoring required
B. Reduce the BP rapidly to 120/80 mmHg within 10 minutes using sublingual nifedipine
C. Lower mean arterial pressure by no more than 25 percent within the first hour using a
titratable IV agent such as nicardipine [CORRECT]
D. Administer oral lisinopril and reassess in the morning
Correct Answer: C
Rationale: Hypertensive emergency requires prompt but CONTROLLED pressure reduction with a
short-acting titratable IV infusion (nicardipine, labetalol, or nitroprusside), lowering MAP by no more than 20
to 25 percent in the first hour to preserve cerebral and coronary autoregulation. Rapid normalization can
precipitate cerebral hypoperfusion, infarction, or coronary ischemia. Immediate-release sublingual nifedipine
is prohibited for this purpose because its uncontrolled drop in BP causes stroke and MI. Relias/Prophecy
hypertensive crisis competencies emphasize titration discipline and continuous intra-arterial or frequent cuff
monitoring.
Critical Care Nursing Education - General ICU RN Competency Examination 2
, Relias/Prophecy General ICU RN A V3 Actual Exam 2026/2027 Edition
Q5: A postoperative cardiac surgery patient develops hypotension, distended neck veins, and
muffled heart sounds. Arterial pressure tracing shows a pulsus paradoxus of 18 mmHg. These
findings are most consistent with which condition?
A. Cardiac tamponade [CORRECT]
B. Tension pneumothorax
C. Cardiogenic shock from left ventricular failure
D. Hypovolemic shock
Correct Answer: A
Rationale: Beck triad (hypotension, JVD, muffled heart sounds) plus pulsus paradoxus greater than 10
mmHg is the classic presentation of cardiac tamponade, in which pericardial fluid compresses the chambers
and equalizes diastolic pressures. Tension pneumothorax also causes JVD and hypotension but presents with
unilateral absent breath sounds, tracheal deviation, and respiratory distress. Pulsus paradoxus is an exaggerated
inspiratory drop in systolic pressure caused by ventricular interdependence, a hallmark validated in Relias
hemodynamic monitoring competencies. The priority is emergent pericardiocentesis.
Q6: A 66-year-old presents with sudden tearing chest pain radiating to the back, BP 190/105
mmHg in the right arm and 150/90 mmHg in the left, and a widened mediastinum on chest
X-ray. Type A aortic dissection is suspected. What is the priority intervention?
A. Prepare the patient for immediate thrombolytic therapy
B. Start an IV esmolol infusion to reduce heart rate below 60 bpm, then add a vasodilator
targeting systolic BP of 100 to 120 mmHg [CORRECT]
C. Administer IV heparin bolus to prevent coronary thrombosis
D. Give sublingual nitroglycerin and reassess pain in 30 minutes
Correct Answer: B
Rationale: In acute aortic dissection, the priority is to decrease shear stress on the torn intima by first blunting
the force of ventricular contraction with an IV beta-blocker (esmolol) targeting HR below 60 bpm, and only
then adding a vasodilator (nicardipine or nitroprusside) to bring systolic BP to 100 to 120 mmHg. Giving a
pure vasodilator first causes reflex tachycardia and increases dP/dt, propagating the dissection. Heparin and
thrombolytics are catastrophic if dissection is mistaken for STEMI, which is why dissection must be excluded
before anticoagulation, a critical Relias/Prophecy prioritization competency.
Critical Care Nursing Education - General ICU RN Competency Examination 3
EXAMINATION
Relias/Prophecy
General ICU RN A V3
Actual Exam
100 verified multiple-choice questions with detailed answers and
rationales, aligned with Relias/Prophecy General ICU RN competency
standards, the AACN Essentials of Critical Care Nursing, and evidence-
based critical care guidelines for the 2026/2027 testing cycle.
General ICU RN Competency Examination
2026/2027 Edition
1 0 0 V E R I F I E D Q U E S T I O N S · D E TA I L E D A N S W E R S A N D
RATI O N A L E S
,Relias/Prophecy General ICU RN A V3 Actual Exam 2026/2027 Edition
RELIAS/PROPHECY GENERAL ICU RN A V3 ACTUAL
EXAM
100 Verified Questions with Detailed Answers and Rationales | 2026/2027 Edition
Aligned with Relias/Prophecy General ICU RN Competency Standards, AACN Essentials of Critical Care Nursing, and
Evidence-Based Critical Care Guidelines (2026/2027 Edition)
Examination Length: 100 Questions | Cognitive Levels: 20% Recall, 50% Application, 30% Analysis | Question Style: 80%
Scenario-Based, 20% Direct Knowledge
Section 1: Cardiovascular Critical Care
Questions 1-20
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the jaw for 45
minutes. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF with ST
depression in V1-V2. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery [CORRECT]
C. Left circumflex artery
D. Left main coronary artery
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF localizes an inferior wall STEMI, which is supplied by the
right coronary artery in approximately 80 percent of patients. ST depression in V1-V2 suggests reciprocal
change or posterior involvement, common with RCA occlusion. The LAD supplies the anterior wall (V1-V4),
and the circumflex supplies the lateral wall (I, aVL, V5-V6). Per AHA/ACS competency standards, the ICU
nurse must also screen for right ventricular infarction before giving preload-reducing agents such as
nitroglycerin.
Q2: A 62-year-old female admitted with chest pain has Troponin I of 4.2 ng/mL (elevated), ST
depression in V4-V6, and a history of coronary artery disease. She is diagnosed with a NSTEMI.
Which pharmacologic regimen should the nurse anticipate initiating?
A. Aspirin, a P2Y12 inhibitor, and a parenteral anticoagulant [CORRECT]
B. Fibrinolytic therapy with tenecteplase
C. Warfarin monotherapy for anticoagulation
D. Aspirin and clopidogrel only, with no anticoagulant
Correct Answer: A
Rationale: Management of NSTEMI follows the AHA/ACC guideline of dual antiplatelet therapy (aspirin
plus a P2Y12 inhibitor such as ticagrelor or clopidogrel) combined with an anticoagulant such as heparin or
enoxaparin, followed by an early invasive strategy within 24 hours for high-risk patients. Fibrinolytics are
NOT given for NSTEMI because complete vessel occlusion is absent and bleeding risk outweighs benefit.
Warfarin monotherapy provides no antiplatelet protection and is not indicated in the acute phase.
Critical Care Nursing Education - General ICU RN Competency Examination 1
,Relias/Prophecy General ICU RN A V3 Actual Exam 2026/2027 Edition
Q3: Three days after an anterior MI, a patient becomes hypotensive with a BP of 78/52 mmHg,
cold and mottled extremities, pulmonary crackles, cardiac index 1.6 L/min/m2, and PCWP 24
mmHg. Which intervention is the priority?
A. Administer sublingual nitroglycerin to reduce afterload
B. Administer a 1-liter rapid crystalloid bolus to raise preload
C. Give IV furosemide 40 mg to reduce preload
D. Initiate norepinephrine to maintain MAP at 65 mmHg or higher and prepare for urgent
revascularization or mechanical circulatory support [CORRECT]
Correct Answer: D
Rationale: This patient is in cardiogenic shock: low cardiac index, high filling pressures (PCWP 24),
hypotension, and signs of hypoperfusion. Per AHA/SCAI shock-stage standards, vasopressor support
(norepinephrine is preferred over dopamine due to lower arrhythmia risk) maintains coronary and end-organ
perfusion while urgent revascularization or mechanical support (IABP, Impella, ECMO) is arranged. Fluid
boluses and nitroglycerin would worsen pulmonary edema, and furosemide would further reduce preload in a
failing pump.
Q4: A patient presents with BP 224/140 mmHg, acute pulmonary edema, and a headache. The
ICU team diagnoses a hypertensive emergency. Which management strategy is correct?
A. Normalize BP over 24 to 48 hours with no monitoring required
B. Reduce the BP rapidly to 120/80 mmHg within 10 minutes using sublingual nifedipine
C. Lower mean arterial pressure by no more than 25 percent within the first hour using a
titratable IV agent such as nicardipine [CORRECT]
D. Administer oral lisinopril and reassess in the morning
Correct Answer: C
Rationale: Hypertensive emergency requires prompt but CONTROLLED pressure reduction with a
short-acting titratable IV infusion (nicardipine, labetalol, or nitroprusside), lowering MAP by no more than 20
to 25 percent in the first hour to preserve cerebral and coronary autoregulation. Rapid normalization can
precipitate cerebral hypoperfusion, infarction, or coronary ischemia. Immediate-release sublingual nifedipine
is prohibited for this purpose because its uncontrolled drop in BP causes stroke and MI. Relias/Prophecy
hypertensive crisis competencies emphasize titration discipline and continuous intra-arterial or frequent cuff
monitoring.
Critical Care Nursing Education - General ICU RN Competency Examination 2
, Relias/Prophecy General ICU RN A V3 Actual Exam 2026/2027 Edition
Q5: A postoperative cardiac surgery patient develops hypotension, distended neck veins, and
muffled heart sounds. Arterial pressure tracing shows a pulsus paradoxus of 18 mmHg. These
findings are most consistent with which condition?
A. Cardiac tamponade [CORRECT]
B. Tension pneumothorax
C. Cardiogenic shock from left ventricular failure
D. Hypovolemic shock
Correct Answer: A
Rationale: Beck triad (hypotension, JVD, muffled heart sounds) plus pulsus paradoxus greater than 10
mmHg is the classic presentation of cardiac tamponade, in which pericardial fluid compresses the chambers
and equalizes diastolic pressures. Tension pneumothorax also causes JVD and hypotension but presents with
unilateral absent breath sounds, tracheal deviation, and respiratory distress. Pulsus paradoxus is an exaggerated
inspiratory drop in systolic pressure caused by ventricular interdependence, a hallmark validated in Relias
hemodynamic monitoring competencies. The priority is emergent pericardiocentesis.
Q6: A 66-year-old presents with sudden tearing chest pain radiating to the back, BP 190/105
mmHg in the right arm and 150/90 mmHg in the left, and a widened mediastinum on chest
X-ray. Type A aortic dissection is suspected. What is the priority intervention?
A. Prepare the patient for immediate thrombolytic therapy
B. Start an IV esmolol infusion to reduce heart rate below 60 bpm, then add a vasodilator
targeting systolic BP of 100 to 120 mmHg [CORRECT]
C. Administer IV heparin bolus to prevent coronary thrombosis
D. Give sublingual nitroglycerin and reassess pain in 30 minutes
Correct Answer: B
Rationale: In acute aortic dissection, the priority is to decrease shear stress on the torn intima by first blunting
the force of ventricular contraction with an IV beta-blocker (esmolol) targeting HR below 60 bpm, and only
then adding a vasodilator (nicardipine or nitroprusside) to bring systolic BP to 100 to 120 mmHg. Giving a
pure vasodilator first causes reflex tachycardia and increases dP/dt, propagating the dissection. Heparin and
thrombolytics are catastrophic if dissection is mistaken for STEMI, which is why dissection must be excluded
before anticoagulation, a critical Relias/Prophecy prioritization competency.
Critical Care Nursing Education - General ICU RN Competency Examination 3
