RELIAS or PROPHECY GENERAL ICU RN A
VERSION 3 NEWEST 2025 ACTUAL EXAM
WITH COMPLETE QUESTIONS AND
DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+
BRAND NEW!!!
1. A patient with an arterial line has a dampened waveform. What is the nurse's FIRST
action?
* A. Check the patient's blood pressure manually.
* B. Flush the line with pressurized saline.
* C. Level and zero the transducer.
* D. Assess the insertion site for infection.
* Answer: A. Check the patient's blood pressure manually.
* Rationale: Patient safety is paramount. A dampened waveform may indicate an inaccurate
reading or a true hemodynamic change. Obtaining a manual BP provides immediate, reliable
data to assess the patient's true status before manipulating the line.
2. A patient with acute decompensated heart failure is receiving nitroprusside
(Nipride). The nurse must prioritize monitoring for which toxicity?
* A. Hyperkalemia
* B. Cyanide
* C. Magnesium
* D. Digoxin
* Answer: B. Cyanide
* Rationale: Nitroprusside metabolism releases cyanide, which is normally converted to
thiocyanate. Prolonged use, high doses, or renal/hepatic impairment can lead to cyanide
toxicity (acidosis, confusion, tachycardia).
3. The ECG monitor shows a rhythm with no discernible P waves, an irregularly
irregular ventricular response, and a rate of 130-150 bpm. This is most consistent with:
,* A. Atrial flutter
* B. Sinus tachycardia
* C. Ventricular tachycardia
* D. Atrial fibrillation with RVR
* Answer: D. Atrial fibrillation with rapid ventricular response (RVR).
* Rationale: The classic presentation of A-fib is an irregularly irregular rhythm with absent P
waves. A rate >100 bpm is defined as RVR.
4. A patient with a new pulmonary artery catheter has a Pulmonary Artery Wedge
Pressure (PAWP) reading of 18 mm Hg. This most directly assesses:
* A. Right ventricular preload
* B. Left ventricular preload
* C. Cardiac output
* D. Systemic vascular resistance
* Answer: B. Left ventricular preload.
* Rationale: The PAWP (or PCWP) is obtained by inflating the balloon to "wedge" in a
pulmonary capillary, reflecting the pressure in the left atrium and, subsequently, left ventricular
end-diastolic pressure (preload).
5. A patient 24 hours post-MI develops sudden dyspnea, hypotension, and a new
holosystolic murmur at the apex. The nurse suspects:
* A. Cardiac tamponade
* B. Ventricular septal rupture
* C. Papillary muscle rupture
* D. Aortic dissection
* Answer: C. Papillary muscle rupture.
* Rationale: Papillary muscle rupture, often from inferior MI, leads to acute mitral regurgitation.
The hallmark is sudden pulmonary edema, hypotension, and a loud holosystolic murmur
radiating to the axilla.
6. First-line treatment for symptomatic bradycardia (e.g., hypotension, syncope) per
ACLS guidelines is:
* A. Atropine 0.5 mg IV
* B. Transcutaneous pacing
* C. Dopamine infusion
* D. Epinephrine infusion
* Answer: A. Atropine 0.5 mg IV.
* Rationale: Atropine is the first-line pharmacologic intervention for symptomatic bradycardia,
particularly if related to increased vagal tone or AV nodal block.
, 7. What is the target temperature management goal for a post-cardiac arrest patient
receiving therapeutic hypothermia?
* A. 28-30°C (82.4-86°F)
* B. 32-36°C (89.6-96.8°F)
* C. 36-38°C (96.8-100.4°F)
* D. 33-36°C (91.4-96.8°F)
* Answer: D. 33-36°C (91.4-96.8°F).
* Rationale: Current guidelines recommend targeting controlled normothermia (avoiding
fever) or a specific temperature like 33°C for 24 hours, rather than a strict, very low
hypothermia range.
8. A patient on a heparin infusion for a pulmonary embolism has an aPTT of 110
seconds. The nurse should:
* A. Stop the infusion and notify the provider.
* B. Increase the rate per protocol.
* C. Continue the current rate; it's therapeutic.
* D. Administer protamine sulfate.
* Answer: A. Stop the infusion and notify the provider.
* Rationale: An aPTT this high is significantly supratherapeutic and carries a major risk of
bleeding. The infusion must be stopped immediately, and the provider notified for further
orders (likely a bolus hold and rate reduction).
9. The primary purpose of an intra-aortic balloon pump (IABP) is to:
* A. Oxygenate the blood.
* B. Increase afterload and coronary perfusion.
* C. Decrease afterload and increase coronary perfusion.
* D. Replace the function of the left ventricle.
* Answer: C. Decrease afterload and increase coronary perfusion.
* Rationale: The IABP inflates in diastole (increasing coronary artery perfusion) and deflates just
before systole (decreasing afterload, which reduces the heart's workload).
10. A patient with a STEMI is scheduled for emergent PCI. The nurse prepares to
administer which antiplatelet medication?
* A. Warfarin
* B. Clopidogrel (Plavix) or Ticagrelor (Brilinta)
* C. Enoxaparin
* D. Alteplase
* Answer: B. Clopidogrel (Plavix) or Ticagrelor (Brilinta).
, * Rationale: Dual antiplatelet therapy (Aspirin + a P2Y12 inhibitor like clopidogrel, ticagrelor, or
prasugrel) is standard pre-PCI to prevent stent thrombosis.
(Questions 11-20 continue with topics like SVR/CO calculations, pericardial tamponade signs
(Beck's triad), endocarditis, hypertensive crisis, and management of ventricular
dysrhythmias.)
Pulmonary (21-40)
21. A patient on volume-controlled mechanical ventilation has a sudden increase in
peak airway pressure, but plateau pressure remains unchanged. The cause is most likely:
* A. Pulmonary edema
* A. Mainstem intubation
* C. A kinked endotracheal tube
* D. Bronchospasm
* Answer: C. A kinked endotracheal tube (or airway secretions).
* Rationale: Increased peak pressure with normal plateau pressure indicates increased airway
resistance, not a lung compliance issue. Choices C and D cause this. A kink is a sudden, common
mechanical problem to assess for first.
22. Which ABG result indicates fully compensated respiratory acidosis?
* A. pH 7.32, PaCO2 50, HCO3- 25
* B. pH 7.35, PaCO2 55, HCO3- 30
* C. pH 7.48, PaCO2 30, HCO3- 23
* D. pH 7.40, PaCO2 40, HCO3- 24
* Answer: B. pH 7.35, PaCO2 55, HCO3- 30.
* Rationale: The pH is on the low side of normal (compensated), PaCO2 is high (primary
respiratory acidosis), and HCO3- is elevated (renal compensation has occurred).
23. A patient with ARDS is on mechanical ventilation. Which strategy is key to
preventing ventilator-induced lung injury?
* A. Using high tidal volumes (10-12 mL/kg)
* B. Applying high levels of PEEP
* C. Using low tidal volumes (4-8 mL/kg) and limiting plateau pressure
* D. Maintaining low respiratory rates
* Answer: C. Using low tidal volumes (4-8 mL/kg) and limiting plateau pressure.
* Rationale: The ARDSNet protocol demonstrates that lung-protective ventilation with low tidal
volumes (often 6 mL/kg predicted body weight) reduces barotrauma and mortality.
VERSION 3 NEWEST 2025 ACTUAL EXAM
WITH COMPLETE QUESTIONS AND
DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+
BRAND NEW!!!
1. A patient with an arterial line has a dampened waveform. What is the nurse's FIRST
action?
* A. Check the patient's blood pressure manually.
* B. Flush the line with pressurized saline.
* C. Level and zero the transducer.
* D. Assess the insertion site for infection.
* Answer: A. Check the patient's blood pressure manually.
* Rationale: Patient safety is paramount. A dampened waveform may indicate an inaccurate
reading or a true hemodynamic change. Obtaining a manual BP provides immediate, reliable
data to assess the patient's true status before manipulating the line.
2. A patient with acute decompensated heart failure is receiving nitroprusside
(Nipride). The nurse must prioritize monitoring for which toxicity?
* A. Hyperkalemia
* B. Cyanide
* C. Magnesium
* D. Digoxin
* Answer: B. Cyanide
* Rationale: Nitroprusside metabolism releases cyanide, which is normally converted to
thiocyanate. Prolonged use, high doses, or renal/hepatic impairment can lead to cyanide
toxicity (acidosis, confusion, tachycardia).
3. The ECG monitor shows a rhythm with no discernible P waves, an irregularly
irregular ventricular response, and a rate of 130-150 bpm. This is most consistent with:
,* A. Atrial flutter
* B. Sinus tachycardia
* C. Ventricular tachycardia
* D. Atrial fibrillation with RVR
* Answer: D. Atrial fibrillation with rapid ventricular response (RVR).
* Rationale: The classic presentation of A-fib is an irregularly irregular rhythm with absent P
waves. A rate >100 bpm is defined as RVR.
4. A patient with a new pulmonary artery catheter has a Pulmonary Artery Wedge
Pressure (PAWP) reading of 18 mm Hg. This most directly assesses:
* A. Right ventricular preload
* B. Left ventricular preload
* C. Cardiac output
* D. Systemic vascular resistance
* Answer: B. Left ventricular preload.
* Rationale: The PAWP (or PCWP) is obtained by inflating the balloon to "wedge" in a
pulmonary capillary, reflecting the pressure in the left atrium and, subsequently, left ventricular
end-diastolic pressure (preload).
5. A patient 24 hours post-MI develops sudden dyspnea, hypotension, and a new
holosystolic murmur at the apex. The nurse suspects:
* A. Cardiac tamponade
* B. Ventricular septal rupture
* C. Papillary muscle rupture
* D. Aortic dissection
* Answer: C. Papillary muscle rupture.
* Rationale: Papillary muscle rupture, often from inferior MI, leads to acute mitral regurgitation.
The hallmark is sudden pulmonary edema, hypotension, and a loud holosystolic murmur
radiating to the axilla.
6. First-line treatment for symptomatic bradycardia (e.g., hypotension, syncope) per
ACLS guidelines is:
* A. Atropine 0.5 mg IV
* B. Transcutaneous pacing
* C. Dopamine infusion
* D. Epinephrine infusion
* Answer: A. Atropine 0.5 mg IV.
* Rationale: Atropine is the first-line pharmacologic intervention for symptomatic bradycardia,
particularly if related to increased vagal tone or AV nodal block.
, 7. What is the target temperature management goal for a post-cardiac arrest patient
receiving therapeutic hypothermia?
* A. 28-30°C (82.4-86°F)
* B. 32-36°C (89.6-96.8°F)
* C. 36-38°C (96.8-100.4°F)
* D. 33-36°C (91.4-96.8°F)
* Answer: D. 33-36°C (91.4-96.8°F).
* Rationale: Current guidelines recommend targeting controlled normothermia (avoiding
fever) or a specific temperature like 33°C for 24 hours, rather than a strict, very low
hypothermia range.
8. A patient on a heparin infusion for a pulmonary embolism has an aPTT of 110
seconds. The nurse should:
* A. Stop the infusion and notify the provider.
* B. Increase the rate per protocol.
* C. Continue the current rate; it's therapeutic.
* D. Administer protamine sulfate.
* Answer: A. Stop the infusion and notify the provider.
* Rationale: An aPTT this high is significantly supratherapeutic and carries a major risk of
bleeding. The infusion must be stopped immediately, and the provider notified for further
orders (likely a bolus hold and rate reduction).
9. The primary purpose of an intra-aortic balloon pump (IABP) is to:
* A. Oxygenate the blood.
* B. Increase afterload and coronary perfusion.
* C. Decrease afterload and increase coronary perfusion.
* D. Replace the function of the left ventricle.
* Answer: C. Decrease afterload and increase coronary perfusion.
* Rationale: The IABP inflates in diastole (increasing coronary artery perfusion) and deflates just
before systole (decreasing afterload, which reduces the heart's workload).
10. A patient with a STEMI is scheduled for emergent PCI. The nurse prepares to
administer which antiplatelet medication?
* A. Warfarin
* B. Clopidogrel (Plavix) or Ticagrelor (Brilinta)
* C. Enoxaparin
* D. Alteplase
* Answer: B. Clopidogrel (Plavix) or Ticagrelor (Brilinta).
, * Rationale: Dual antiplatelet therapy (Aspirin + a P2Y12 inhibitor like clopidogrel, ticagrelor, or
prasugrel) is standard pre-PCI to prevent stent thrombosis.
(Questions 11-20 continue with topics like SVR/CO calculations, pericardial tamponade signs
(Beck's triad), endocarditis, hypertensive crisis, and management of ventricular
dysrhythmias.)
Pulmonary (21-40)
21. A patient on volume-controlled mechanical ventilation has a sudden increase in
peak airway pressure, but plateau pressure remains unchanged. The cause is most likely:
* A. Pulmonary edema
* A. Mainstem intubation
* C. A kinked endotracheal tube
* D. Bronchospasm
* Answer: C. A kinked endotracheal tube (or airway secretions).
* Rationale: Increased peak pressure with normal plateau pressure indicates increased airway
resistance, not a lung compliance issue. Choices C and D cause this. A kink is a sudden, common
mechanical problem to assess for first.
22. Which ABG result indicates fully compensated respiratory acidosis?
* A. pH 7.32, PaCO2 50, HCO3- 25
* B. pH 7.35, PaCO2 55, HCO3- 30
* C. pH 7.48, PaCO2 30, HCO3- 23
* D. pH 7.40, PaCO2 40, HCO3- 24
* Answer: B. pH 7.35, PaCO2 55, HCO3- 30.
* Rationale: The pH is on the low side of normal (compensated), PaCO2 is high (primary
respiratory acidosis), and HCO3- is elevated (renal compensation has occurred).
23. A patient with ARDS is on mechanical ventilation. Which strategy is key to
preventing ventilator-induced lung injury?
* A. Using high tidal volumes (10-12 mL/kg)
* B. Applying high levels of PEEP
* C. Using low tidal volumes (4-8 mL/kg) and limiting plateau pressure
* D. Maintaining low respiratory rates
* Answer: C. Using low tidal volumes (4-8 mL/kg) and limiting plateau pressure.
* Rationale: The ARDSNet protocol demonstrates that lung-protective ventilation with low tidal
volumes (often 6 mL/kg predicted body weight) reduces barotrauma and mortality.
