Prophecy General ICU A V3 Questions & Answers | General ICU A V3 Comprehensive
Critical Care Nursing Review 2026/2027 | ICU Assessment, Ventilator Management,
Hemodynamic Monitoring, Cardiac Rhythm Interpretation, Medication Administration,
Electrolytes, Sepsis, Shock, Airway Management, Chest Tubes, TPN, Patient
Prioritization & Clinical Judgment | Practice Questions, Answers & Detailed Rationales
Question 1: A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with acute respiratory failure. Arterial blood gas (ABG) analysis reveals a pH of 7.25,
PaCO2 of 68 mmHg, and HCO3- of 30 mEq/L. Which of the following best interprets this ABG
result?
A. Acute respiratory acidosis with no metabolic compensation
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Combined respiratory and metabolic acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The pH is acidic (<7.35), PaCO2 is elevated (>45 mmHg), indicating a primary
respiratory acidosis. The HCO3- is elevated (>26 mEq/L), suggesting metabolic compensation.
However, the pH is still abnormal, meaning compensation is not complete. Therefore, this is a
partially compensated respiratory acidosis.
Question 2: A patient is on a mechanical ventilator with settings of assist-control mode, tidal
volume 500 mL, respiratory rate 14 breaths/min, and FiO2 0.50. The patient's peak
inspiratory pressure (PIP) suddenly increases from 25 to 45 cm H2O, while plateau pressure
remains unchanged at 18 cm H2O. What is the most likely cause of this change?
A. A decrease in lung compliance
B. An increase in airway resistance
C. A tension pneumothorax
D. A kink in the endotracheal tube
CORRECT ANSWER: B. An increase in airway resistance
Rationale: An increase in PIP with an unchanged plateau pressure indicates an increase in
airway resistance, as the plateau pressure reflects alveolar pressure and lung compliance.
Causes include bronchospasm, secretions, or a foreign body. A decrease in compliance or
pneumothorax would increase both PIP and plateau pressure.
Question 3: Which of the following hemodynamic parameters is the most accurate indicator
of left ventricular preload?
A. Central venous pressure (CVP)
B. Pulmonary artery occlusion pressure (PAOP)
C. Cardiac index (CI)
D. Systemic vascular resistance (SVR)
,CORRECT ANSWER: B. Pulmonary artery occlusion pressure (PAOP)
Rationale: PAOP, also known as pulmonary capillary wedge pressure (PCWP), reflects left atrial
and left ventricular end-diastolic pressure, making it the most accurate measure of left
ventricular preload. CVP reflects right ventricular preload. CI measures cardiac output relative
to body surface area, and SVR measures afterload.
Question 4: A patient is exhibiting signs of increased intracranial pressure (ICP). Which
nursing intervention is most appropriate to prevent further elevation of ICP?
A. Cluster all nursing activities to minimize disturbance
B. Elevate the head of the bed to 30 degrees
C. Maintain the patient in a prone position
D. Administer a hypotonic intravenous solution
CORRECT ANSWER: B. Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage from the
head, which helps to lower ICP. Clustering activities should be avoided as it increases ICP. The
prone position is not recommended for ICP management. Hypotonic solutions should be
avoided as they can increase cerebral edema.
Question 5: What is the primary mechanism of action of non-depolarizing neuromuscular
blocking agents, such as vecuronium?
A. They stimulate acetylcholine release at the neuromuscular junction
B. They bind to acetylcholine receptors and prevent depolarization
C. They inhibit acetylcholinesterase activity
D. They cause a sustained depolarization of the muscle fiber
CORRECT ANSWER: B. They bind to acetylcholine receptors and prevent depolarization
Rationale: Non-depolarizing neuromuscular blockers act as competitive antagonists at the
nicotinic acetylcholine receptor on the motor endplate, preventing acetylcholine from binding
and causing depolarization. Succinylcholine is a depolarizing agent. Anticholinesterases inhibit
acetylcholinesterase.
Question 6: A patient with severe sepsis is receiving norepinephrine infusion. The nurse
should monitor the patient for which of the following potential adverse effects?
A. Severe bradycardia
B. Decreased systemic vascular resistance
C. Decreased myocardial contractility
D. Decreased renal perfusion
CORRECT ANSWER: D. Decreased renal perfusion
,Rationale: Norepinephrine is a potent vasopressor that causes significant vasoconstriction.
While it increases blood pressure, it can decrease renal perfusion, potentially leading to acute
kidney injury. It typically causes reflex bradycardia, not decreased SVR or contractility.
Question 7: In the context of the Glasgow Coma Scale (GCS), what is the maximum score a
patient can receive for the motor response component?
A. 4
B. 5
C. 6
D. 8
CORRECT ANSWER: C. 6
Rationale: The motor response component of the GCS is scored from 1 (no response) to 6
(obeys commands). The total GCS score ranges from 3 to 15, with eye-opening (1-4), verbal
response (1-5), and motor response (1-6).
Question 8: A patient is receiving a continuous infusion of heparin for a pulmonary embolism.
Which laboratory value is the most important to monitor to assess the therapeutic effect of
this medication?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated Partial Thromboplastin Time (aPTT)
D. Platelet count
CORRECT ANSWER: C. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin exerts its anticoagulant effect by potentiating antithrombin III, which
inactivates thrombin and factor Xa. The aPTT is the standard laboratory test used to monitor
the therapeutic effect of unfractionated heparin. PT/INR is used to monitor warfarin therapy.
Question 9: A patient with a history of myocardial infarction is prescribed amiodarone. The
nurse understands that this medication has a significant drug interaction with which of the
following?
A. Metoprolol
B. Digoxin
C. Furosemide
D. Aspirin
CORRECT ANSWER: B. Digoxin
, Rationale: Amiodarone significantly increases serum digoxin concentrations by displacing
digoxin from tissue binding sites and decreasing renal clearance. This can lead to digoxin
toxicity. The dose of digoxin should be reduced when amiodarone is initiated.
Question 10: A patient is intubated and mechanically ventilated. The high-pressure alarm
sounds. The nurse assesses the patient and notes decreased breath sounds on the left side
with a hyper-resonant percussion note. What is the priority nursing action?
A. Administer a sedative
B. Suction the endotracheal tube
C. Prepare for needle decompression
D. Check the ventilator settings
CORRECT ANSWER: C. Prepare for needle decompression
Rationale: The assessment findings (decreased breath sounds on one side, hyper-resonance)
are classic signs of a tension pneumothorax, a life-threatening condition. The high-pressure
alarm is triggered. The priority is to relieve the pressure by preparing for needle decompression
or chest tube insertion.
Question 11: Which of the following ventilator modes delivers a preset tidal volume for every
breath, regardless of the patient's own respiratory effort?
A. Pressure Support Ventilation (PSV)
B. Assist-Control Ventilation (ACV)
C. Continuous Positive Airway Pressure (CPAP)
D. Pressure Regulated Volume Control (PRVC)
CORRECT ANSWER: B. Assist-Control Ventilation (ACV)
Rationale: In Assist-Control Ventilation, the ventilator delivers a preset tidal volume with each
breath initiated by the patient (assist) or the machine (control). PSV delivers a preset pressure
to augment spontaneous breaths. CPAP provides positive pressure throughout the respiratory
cycle.
Question 12: A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which of the following serum laboratory findings is expected?
A. Hypernatremia and high serum osmolality
B. Hyponatremia and low serum osmolality
C. Hyperkalemia and high serum osmolality
D. Hypokalemia and low serum osmolality
CORRECT ANSWER: B. Hyponatremia and low serum osmolality
Critical Care Nursing Review 2026/2027 | ICU Assessment, Ventilator Management,
Hemodynamic Monitoring, Cardiac Rhythm Interpretation, Medication Administration,
Electrolytes, Sepsis, Shock, Airway Management, Chest Tubes, TPN, Patient
Prioritization & Clinical Judgment | Practice Questions, Answers & Detailed Rationales
Question 1: A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with acute respiratory failure. Arterial blood gas (ABG) analysis reveals a pH of 7.25,
PaCO2 of 68 mmHg, and HCO3- of 30 mEq/L. Which of the following best interprets this ABG
result?
A. Acute respiratory acidosis with no metabolic compensation
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Combined respiratory and metabolic acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The pH is acidic (<7.35), PaCO2 is elevated (>45 mmHg), indicating a primary
respiratory acidosis. The HCO3- is elevated (>26 mEq/L), suggesting metabolic compensation.
However, the pH is still abnormal, meaning compensation is not complete. Therefore, this is a
partially compensated respiratory acidosis.
Question 2: A patient is on a mechanical ventilator with settings of assist-control mode, tidal
volume 500 mL, respiratory rate 14 breaths/min, and FiO2 0.50. The patient's peak
inspiratory pressure (PIP) suddenly increases from 25 to 45 cm H2O, while plateau pressure
remains unchanged at 18 cm H2O. What is the most likely cause of this change?
A. A decrease in lung compliance
B. An increase in airway resistance
C. A tension pneumothorax
D. A kink in the endotracheal tube
CORRECT ANSWER: B. An increase in airway resistance
Rationale: An increase in PIP with an unchanged plateau pressure indicates an increase in
airway resistance, as the plateau pressure reflects alveolar pressure and lung compliance.
Causes include bronchospasm, secretions, or a foreign body. A decrease in compliance or
pneumothorax would increase both PIP and plateau pressure.
Question 3: Which of the following hemodynamic parameters is the most accurate indicator
of left ventricular preload?
A. Central venous pressure (CVP)
B. Pulmonary artery occlusion pressure (PAOP)
C. Cardiac index (CI)
D. Systemic vascular resistance (SVR)
,CORRECT ANSWER: B. Pulmonary artery occlusion pressure (PAOP)
Rationale: PAOP, also known as pulmonary capillary wedge pressure (PCWP), reflects left atrial
and left ventricular end-diastolic pressure, making it the most accurate measure of left
ventricular preload. CVP reflects right ventricular preload. CI measures cardiac output relative
to body surface area, and SVR measures afterload.
Question 4: A patient is exhibiting signs of increased intracranial pressure (ICP). Which
nursing intervention is most appropriate to prevent further elevation of ICP?
A. Cluster all nursing activities to minimize disturbance
B. Elevate the head of the bed to 30 degrees
C. Maintain the patient in a prone position
D. Administer a hypotonic intravenous solution
CORRECT ANSWER: B. Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage from the
head, which helps to lower ICP. Clustering activities should be avoided as it increases ICP. The
prone position is not recommended for ICP management. Hypotonic solutions should be
avoided as they can increase cerebral edema.
Question 5: What is the primary mechanism of action of non-depolarizing neuromuscular
blocking agents, such as vecuronium?
A. They stimulate acetylcholine release at the neuromuscular junction
B. They bind to acetylcholine receptors and prevent depolarization
C. They inhibit acetylcholinesterase activity
D. They cause a sustained depolarization of the muscle fiber
CORRECT ANSWER: B. They bind to acetylcholine receptors and prevent depolarization
Rationale: Non-depolarizing neuromuscular blockers act as competitive antagonists at the
nicotinic acetylcholine receptor on the motor endplate, preventing acetylcholine from binding
and causing depolarization. Succinylcholine is a depolarizing agent. Anticholinesterases inhibit
acetylcholinesterase.
Question 6: A patient with severe sepsis is receiving norepinephrine infusion. The nurse
should monitor the patient for which of the following potential adverse effects?
A. Severe bradycardia
B. Decreased systemic vascular resistance
C. Decreased myocardial contractility
D. Decreased renal perfusion
CORRECT ANSWER: D. Decreased renal perfusion
,Rationale: Norepinephrine is a potent vasopressor that causes significant vasoconstriction.
While it increases blood pressure, it can decrease renal perfusion, potentially leading to acute
kidney injury. It typically causes reflex bradycardia, not decreased SVR or contractility.
Question 7: In the context of the Glasgow Coma Scale (GCS), what is the maximum score a
patient can receive for the motor response component?
A. 4
B. 5
C. 6
D. 8
CORRECT ANSWER: C. 6
Rationale: The motor response component of the GCS is scored from 1 (no response) to 6
(obeys commands). The total GCS score ranges from 3 to 15, with eye-opening (1-4), verbal
response (1-5), and motor response (1-6).
Question 8: A patient is receiving a continuous infusion of heparin for a pulmonary embolism.
Which laboratory value is the most important to monitor to assess the therapeutic effect of
this medication?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated Partial Thromboplastin Time (aPTT)
D. Platelet count
CORRECT ANSWER: C. Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin exerts its anticoagulant effect by potentiating antithrombin III, which
inactivates thrombin and factor Xa. The aPTT is the standard laboratory test used to monitor
the therapeutic effect of unfractionated heparin. PT/INR is used to monitor warfarin therapy.
Question 9: A patient with a history of myocardial infarction is prescribed amiodarone. The
nurse understands that this medication has a significant drug interaction with which of the
following?
A. Metoprolol
B. Digoxin
C. Furosemide
D. Aspirin
CORRECT ANSWER: B. Digoxin
, Rationale: Amiodarone significantly increases serum digoxin concentrations by displacing
digoxin from tissue binding sites and decreasing renal clearance. This can lead to digoxin
toxicity. The dose of digoxin should be reduced when amiodarone is initiated.
Question 10: A patient is intubated and mechanically ventilated. The high-pressure alarm
sounds. The nurse assesses the patient and notes decreased breath sounds on the left side
with a hyper-resonant percussion note. What is the priority nursing action?
A. Administer a sedative
B. Suction the endotracheal tube
C. Prepare for needle decompression
D. Check the ventilator settings
CORRECT ANSWER: C. Prepare for needle decompression
Rationale: The assessment findings (decreased breath sounds on one side, hyper-resonance)
are classic signs of a tension pneumothorax, a life-threatening condition. The high-pressure
alarm is triggered. The priority is to relieve the pressure by preparing for needle decompression
or chest tube insertion.
Question 11: Which of the following ventilator modes delivers a preset tidal volume for every
breath, regardless of the patient's own respiratory effort?
A. Pressure Support Ventilation (PSV)
B. Assist-Control Ventilation (ACV)
C. Continuous Positive Airway Pressure (CPAP)
D. Pressure Regulated Volume Control (PRVC)
CORRECT ANSWER: B. Assist-Control Ventilation (ACV)
Rationale: In Assist-Control Ventilation, the ventilator delivers a preset tidal volume with each
breath initiated by the patient (assist) or the machine (control). PSV delivers a preset pressure
to augment spontaneous breaths. CPAP provides positive pressure throughout the respiratory
cycle.
Question 12: A patient is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which of the following serum laboratory findings is expected?
A. Hypernatremia and high serum osmolality
B. Hyponatremia and low serum osmolality
C. Hyperkalemia and high serum osmolality
D. Hypokalemia and low serum osmolality
CORRECT ANSWER: B. Hyponatremia and low serum osmolality
