RELIAS/PROPHECY GENERAL ICU RN A V3 EXAM
2024–2025 – 100 VERIFIED QUESTIONS WITH
DETAILED RATIONALES || 100% GUARANTEED
PASS <RECENT VERSION>
Relias/Prophecy General ICU RN A V3 Exam (2025–2026)
1. A patient with a severe head injury has a Glasgow Coma Scale (GCS) score
of 6. The nurse should prioritize which action?
A. Administer morphine sulfate for pain.
B. Prepare for emergency intubation.
C. Elevate the head of the bed to 30 degrees.
D. Perform passive range of motion exercises.
Rationale: A GCS score of 8 or less indicates a severe head injury and the patient
is at high risk for losing their airway protective reflexes. Preparing for emergency
intubation is the highest priority to ensure adequate oxygenation and ventilation
and to protect the airway from aspiration.
2. A patient's arterial blood gas (ABG) shows: pH 7.28, PaCO2 52 mm Hg,
HCO3- 24 mEq/L. The nurse interprets this as:
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Rationale: The pH is acidic (<7.35). The PaCO2 is elevated (>45), indicating a
respiratory cause. The bicarbonate (HCO3-) is normal, meaning the kidneys have
not yet started to compensate. This is an uncompensated respiratory acidosis.
3. The nurse is caring for a patient with a subarachnoid hemorrhage. Which
medication is most critical to have at the bedside?
A. Insulin
B. Naloxone (Narcan)
C. Nimodipine (Nimotop)
D. Heparin
,Rationale: Nimodipine is a calcium channel blocker specifically used to prevent
cerebral vasospasm, a common and devastating complication of a subarachnoid
hemorrhage. It is a standard, critical part of the treatment protocol.
4. A patient with a massive pulmonary embolism is most likely to present with:
A. Bradycardia and hypertension
B. Bradypnea and clear lung sounds
C. Sudden onset pleuritic chest pain and hemoptysis
D. Sudden onset dyspnea, tachycardia, and hypotension
Rationale: A massive PE obstructs blood flow to the lungs, causing acute right
heart failure (cor pulmonale). This leads to a dramatic drop in cardiac output,
resulting in syncope, severe dyspnea, tachycardia, and hypotension, which is a life-
threatening emergency.
5. For a patient with a new tracheostomy, the nurse ensures which piece of
equipment is always at the bedside?
A. A spare tracheostomy tube of the same size and one size smaller
B. A laryngoscope and endotracheal tube
C. A bag-mask device without a tracheostomy adapter
D. A pulse oximeter
Rationale: The most immediate emergency in a new trach patient is dislodgement
or obstruction. Having a spare tube and a smaller one (in case of difficulty re-
inserting) allows for immediate re-establishment of the airway.
6. A patient's telemetry strip shows a rhythm that is irregularly irregular with
no discernible P waves and a ventricular rate of 118 bpm. This is interpreted
as:
A. Atrial Flutter
B. Sinus Tachycardia
C. Ventricular Tachycardia
D. Atrial Fibrillation
Rationale: The hallmark characteristics of Atrial Fibrillation are an "irregularly
irregular" rhythm, the absence of P waves, and a often tachycardic ventricular
response.
, 7. The primary goal in the initial management of a patient with a tension
pneumothorax is:
A. Administer high-dose steroids.
B. Prepare for chest tube insertion.
C. Perform immediate needle decompression.
D. Administer 100% oxygen via non-rebreather.
Rationale: A tension pneumothorax is a life-threatening emergency where air is
trapped in the pleural space, shifting the mediastinum and compromising cardiac
output. Immediate needle decompression is required to relieve the pressure before
a chest tube can be placed.
8. A patient with Sepsis has a lactate level of 5.8 mmol/L. The nurse
understands this indicates:
A. Adequate tissue perfusion
B. Anaerobic metabolism due to tissue hypoxia
C. Respiratory alkalosis
D. Over-hydration
Rationale: Lactate is a byproduct of anaerobic metabolism. An elevated lactate
level (>2 mmol/L) indicates that tissues are not receiving enough oxygen and are
resorting to inefficient anaerobic metabolism, a key finding in sepsis-induced
hypoperfusion.
9. When titrating a norepinephrine (Levophed) drip, the nurse should monitor
for which major side effect?
A. Hyperglycemia
B. Severe bradycardia
C. Tissue necrosis with extravasation
D. Pulmonary fibrosis
Rationale: Norepinephrine is a potent vasoconstrictor. If it leaks into the
surrounding tissue (extravasation), it can cause intense vasoconstriction, leading to
ischemia and severe tissue necrosis. It must be administered through a central line.
10. A patient with a serum sodium level of 118 mEq/L is most at risk for:
A. Deep vein thrombosis
2024–2025 – 100 VERIFIED QUESTIONS WITH
DETAILED RATIONALES || 100% GUARANTEED
PASS <RECENT VERSION>
Relias/Prophecy General ICU RN A V3 Exam (2025–2026)
1. A patient with a severe head injury has a Glasgow Coma Scale (GCS) score
of 6. The nurse should prioritize which action?
A. Administer morphine sulfate for pain.
B. Prepare for emergency intubation.
C. Elevate the head of the bed to 30 degrees.
D. Perform passive range of motion exercises.
Rationale: A GCS score of 8 or less indicates a severe head injury and the patient
is at high risk for losing their airway protective reflexes. Preparing for emergency
intubation is the highest priority to ensure adequate oxygenation and ventilation
and to protect the airway from aspiration.
2. A patient's arterial blood gas (ABG) shows: pH 7.28, PaCO2 52 mm Hg,
HCO3- 24 mEq/L. The nurse interprets this as:
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Rationale: The pH is acidic (<7.35). The PaCO2 is elevated (>45), indicating a
respiratory cause. The bicarbonate (HCO3-) is normal, meaning the kidneys have
not yet started to compensate. This is an uncompensated respiratory acidosis.
3. The nurse is caring for a patient with a subarachnoid hemorrhage. Which
medication is most critical to have at the bedside?
A. Insulin
B. Naloxone (Narcan)
C. Nimodipine (Nimotop)
D. Heparin
,Rationale: Nimodipine is a calcium channel blocker specifically used to prevent
cerebral vasospasm, a common and devastating complication of a subarachnoid
hemorrhage. It is a standard, critical part of the treatment protocol.
4. A patient with a massive pulmonary embolism is most likely to present with:
A. Bradycardia and hypertension
B. Bradypnea and clear lung sounds
C. Sudden onset pleuritic chest pain and hemoptysis
D. Sudden onset dyspnea, tachycardia, and hypotension
Rationale: A massive PE obstructs blood flow to the lungs, causing acute right
heart failure (cor pulmonale). This leads to a dramatic drop in cardiac output,
resulting in syncope, severe dyspnea, tachycardia, and hypotension, which is a life-
threatening emergency.
5. For a patient with a new tracheostomy, the nurse ensures which piece of
equipment is always at the bedside?
A. A spare tracheostomy tube of the same size and one size smaller
B. A laryngoscope and endotracheal tube
C. A bag-mask device without a tracheostomy adapter
D. A pulse oximeter
Rationale: The most immediate emergency in a new trach patient is dislodgement
or obstruction. Having a spare tube and a smaller one (in case of difficulty re-
inserting) allows for immediate re-establishment of the airway.
6. A patient's telemetry strip shows a rhythm that is irregularly irregular with
no discernible P waves and a ventricular rate of 118 bpm. This is interpreted
as:
A. Atrial Flutter
B. Sinus Tachycardia
C. Ventricular Tachycardia
D. Atrial Fibrillation
Rationale: The hallmark characteristics of Atrial Fibrillation are an "irregularly
irregular" rhythm, the absence of P waves, and a often tachycardic ventricular
response.
, 7. The primary goal in the initial management of a patient with a tension
pneumothorax is:
A. Administer high-dose steroids.
B. Prepare for chest tube insertion.
C. Perform immediate needle decompression.
D. Administer 100% oxygen via non-rebreather.
Rationale: A tension pneumothorax is a life-threatening emergency where air is
trapped in the pleural space, shifting the mediastinum and compromising cardiac
output. Immediate needle decompression is required to relieve the pressure before
a chest tube can be placed.
8. A patient with Sepsis has a lactate level of 5.8 mmol/L. The nurse
understands this indicates:
A. Adequate tissue perfusion
B. Anaerobic metabolism due to tissue hypoxia
C. Respiratory alkalosis
D. Over-hydration
Rationale: Lactate is a byproduct of anaerobic metabolism. An elevated lactate
level (>2 mmol/L) indicates that tissues are not receiving enough oxygen and are
resorting to inefficient anaerobic metabolism, a key finding in sepsis-induced
hypoperfusion.
9. When titrating a norepinephrine (Levophed) drip, the nurse should monitor
for which major side effect?
A. Hyperglycemia
B. Severe bradycardia
C. Tissue necrosis with extravasation
D. Pulmonary fibrosis
Rationale: Norepinephrine is a potent vasoconstrictor. If it leaks into the
surrounding tissue (extravasation), it can cause intense vasoconstriction, leading to
ischemia and severe tissue necrosis. It must be administered through a central line.
10. A patient with a serum sodium level of 118 mEq/L is most at risk for:
A. Deep vein thrombosis
