Relias Prophecy General ICU RN A V3
Actual Exam 2026/2027: Verified
Questions & Correct Answers
SECTION 1: CARDIOVASCULAR CRITICAL CARE (Questions 1-15)
Q1: A patient with cardiogenic shock has the following hemodynamic parameters: MAP
58 mmHg, CVP 18 mmHg, PAOP 24 mmHg, CI 1.8 L/min/m². The patient is receiving
norepinephrine at 0.3 mcg/kg/min. Which intervention is the priority?
A. Administer a 500mL fluid bolus
B. Increase norepinephrine to 0.5 mcg/kg/min
C. Initiate dobutamine 5 mcg/kg/min
D. Prepare for emergency pericardiocentesis
Correct Answer: C
Rationale:
● Why correct: The hemodynamic profile (elevated CVP/PAOP with low CI)
indicates pump failure. Dobutamine (beta-1 agonist) increases contractility and
cardiac output without significantly increasing afterload. The patient has
adequate preload (CVP 18, PAOP 24) but poor contractility (CI 1.8).
● Distractor analysis:
, ○ A is incorrect because: The patient has elevated filling pressures
indicating fluid overload, not hypovolemia; additional fluids will worsen
pulmonary edema
○ B is incorrect because: Increasing afterload with more norepinephrine will
further decrease cardiac output in cardiogenic shock
○ D is incorrect because: While tamponade causes elevated CVP, the
elevated PAOP and clinical context suggest LV failure, not pericardial
effusion
● Critical nursing action: Initiate inotropic support to improve contractility while
monitoring for increased myocardial oxygen demand
● Reference: ACC/AHA Guidelines for Management of Heart Failure, AACN
Hemodynamic Monitoring Standards
Q2: The ICU nurse is monitoring a patient with an arterial line. The waveform shows a
systolic peak of 110 mmHg, then a sharp downstroke with a dicrotic notch at 82 mmHg,
followed by a gradual decline to 70 mmHg. What does this waveform suggest?
A. The catheter is positioned in the pulmonary artery
B. The system is underdamped with artifact
C. The waveform is consistent with aortic regurgitation
D. This is a normal arterial waveform with proper damping
Correct Answer: D
Rationale:
● Why correct: A normal arterial waveform shows a rapid upstroke (anacrotic limb),
rounded peak, sharp downstroke with dicrotic notch (aortic valve closure), and
gradual diastolic runoff. The described values (110/70) and waveform
morphology are characteristic of properly damped arterial pressure monitoring.
● Distractor analysis:
, ○ A is incorrect because: PA waveforms have distinct differences—no
dicrotic notch, lower pressures (25/10), and characteristic PAOP
waveform when wedged
○ B is incorrect because: Underdamped systems show exaggerated systolic
peaks, ringing artifact, and false high readings; this description shows
normal morphology
○ C is incorrect because: Aortic regurgitation produces a bounding pulse
with wide pulse pressure, rapid upstroke, and absent dicrotic notch due to
diastolic backflow
● Critical nursing action: Continue routine monitoring and verify zeroing/calibration
per protocol
● Reference: AACN Procedure Manual for High Acuity, Progressive, and Critical
Care, Arterial Pressure Monitoring Chapter
Q3: A patient in septic shock has the following parameters: MAP 52 mmHg, HR 128,
CVP 4 mmHg, ScvO2 58%. The patient has received 2L of crystalloid. Which is the most
appropriate next intervention?
A. Administer another 1L fluid bolus
B. Start norepinephrine to achieve MAP >65 mmHg
C. Initiate dobutamine to improve ScvO2
D. Begin stress-dose hydrocortisone
Correct Answer: B
Rationale:
● Why correct: Per Surviving Sepsis Campaign 2023, after initial fluid resuscitation
(30 mL/kg), if hypotension persists, vasopressors should be initiated to maintain
MAP ≥65 mmHg. The low CVP (4) suggests ongoing hypovolemia, but MAP <65
with signs of tissue hypoperfusion (ScvO2 58%) indicates need for pressor
support.
● Distractor analysis:
, ○ A is incorrect because: While more fluids may be needed, persistent
hypotension despite initial resuscitation warrants vasopressor initiation to
prevent prolonged hypotension
○ C is incorrect because: Dobutamine is reserved for patients with low
cardiac output despite adequate MAP and filling pressures; this patient
needs pressure support first
○ D is incorrect because: Steroids are considered for refractory shock
requiring high-dose vasopressors, not as first-line therapy
● Critical nursing action: Initiate norepinephrine via central line and titrate to MAP
>65 mmHg while continuing fluid resuscitation
● Reference: Surviving Sepsis Campaign 2023 Guidelines; Rivers E, et al. Early
Goal-Directed Therapy
Q4: The nurse is caring for a patient with an inferior wall STEMI who develops
hypotension (SBP 78/52), bradycardia (HR 48), and clear lung sounds. The 12-lead
shows new ST elevation in leads II, III, aVF with ST depression in V1-V3. What is the
priority intervention?
A. Administer sublingual nitroglycerin
B. Give atropine 0.5mg IV push
C. Prepare for immediate synchronized cardioversion
D. Administer rapid IV fluid bolus
Correct Answer: D
Rationale:
● Why correct: Inferior wall MI often involves right ventricular infarction (indicated
by ST depression in V1-V3, reciprocal changes). RV infarction causes
preload-dependent hypotension due to impaired filling. The patient has clear
lungs (no pulmonary edema) and bradycardia (vagal response or AV nodal
ischemia). Volume loading is essential to maintain RV preload.
● Distractor analysis:
Actual Exam 2026/2027: Verified
Questions & Correct Answers
SECTION 1: CARDIOVASCULAR CRITICAL CARE (Questions 1-15)
Q1: A patient with cardiogenic shock has the following hemodynamic parameters: MAP
58 mmHg, CVP 18 mmHg, PAOP 24 mmHg, CI 1.8 L/min/m². The patient is receiving
norepinephrine at 0.3 mcg/kg/min. Which intervention is the priority?
A. Administer a 500mL fluid bolus
B. Increase norepinephrine to 0.5 mcg/kg/min
C. Initiate dobutamine 5 mcg/kg/min
D. Prepare for emergency pericardiocentesis
Correct Answer: C
Rationale:
● Why correct: The hemodynamic profile (elevated CVP/PAOP with low CI)
indicates pump failure. Dobutamine (beta-1 agonist) increases contractility and
cardiac output without significantly increasing afterload. The patient has
adequate preload (CVP 18, PAOP 24) but poor contractility (CI 1.8).
● Distractor analysis:
, ○ A is incorrect because: The patient has elevated filling pressures
indicating fluid overload, not hypovolemia; additional fluids will worsen
pulmonary edema
○ B is incorrect because: Increasing afterload with more norepinephrine will
further decrease cardiac output in cardiogenic shock
○ D is incorrect because: While tamponade causes elevated CVP, the
elevated PAOP and clinical context suggest LV failure, not pericardial
effusion
● Critical nursing action: Initiate inotropic support to improve contractility while
monitoring for increased myocardial oxygen demand
● Reference: ACC/AHA Guidelines for Management of Heart Failure, AACN
Hemodynamic Monitoring Standards
Q2: The ICU nurse is monitoring a patient with an arterial line. The waveform shows a
systolic peak of 110 mmHg, then a sharp downstroke with a dicrotic notch at 82 mmHg,
followed by a gradual decline to 70 mmHg. What does this waveform suggest?
A. The catheter is positioned in the pulmonary artery
B. The system is underdamped with artifact
C. The waveform is consistent with aortic regurgitation
D. This is a normal arterial waveform with proper damping
Correct Answer: D
Rationale:
● Why correct: A normal arterial waveform shows a rapid upstroke (anacrotic limb),
rounded peak, sharp downstroke with dicrotic notch (aortic valve closure), and
gradual diastolic runoff. The described values (110/70) and waveform
morphology are characteristic of properly damped arterial pressure monitoring.
● Distractor analysis:
, ○ A is incorrect because: PA waveforms have distinct differences—no
dicrotic notch, lower pressures (25/10), and characteristic PAOP
waveform when wedged
○ B is incorrect because: Underdamped systems show exaggerated systolic
peaks, ringing artifact, and false high readings; this description shows
normal morphology
○ C is incorrect because: Aortic regurgitation produces a bounding pulse
with wide pulse pressure, rapid upstroke, and absent dicrotic notch due to
diastolic backflow
● Critical nursing action: Continue routine monitoring and verify zeroing/calibration
per protocol
● Reference: AACN Procedure Manual for High Acuity, Progressive, and Critical
Care, Arterial Pressure Monitoring Chapter
Q3: A patient in septic shock has the following parameters: MAP 52 mmHg, HR 128,
CVP 4 mmHg, ScvO2 58%. The patient has received 2L of crystalloid. Which is the most
appropriate next intervention?
A. Administer another 1L fluid bolus
B. Start norepinephrine to achieve MAP >65 mmHg
C. Initiate dobutamine to improve ScvO2
D. Begin stress-dose hydrocortisone
Correct Answer: B
Rationale:
● Why correct: Per Surviving Sepsis Campaign 2023, after initial fluid resuscitation
(30 mL/kg), if hypotension persists, vasopressors should be initiated to maintain
MAP ≥65 mmHg. The low CVP (4) suggests ongoing hypovolemia, but MAP <65
with signs of tissue hypoperfusion (ScvO2 58%) indicates need for pressor
support.
● Distractor analysis:
, ○ A is incorrect because: While more fluids may be needed, persistent
hypotension despite initial resuscitation warrants vasopressor initiation to
prevent prolonged hypotension
○ C is incorrect because: Dobutamine is reserved for patients with low
cardiac output despite adequate MAP and filling pressures; this patient
needs pressure support first
○ D is incorrect because: Steroids are considered for refractory shock
requiring high-dose vasopressors, not as first-line therapy
● Critical nursing action: Initiate norepinephrine via central line and titrate to MAP
>65 mmHg while continuing fluid resuscitation
● Reference: Surviving Sepsis Campaign 2023 Guidelines; Rivers E, et al. Early
Goal-Directed Therapy
Q4: The nurse is caring for a patient with an inferior wall STEMI who develops
hypotension (SBP 78/52), bradycardia (HR 48), and clear lung sounds. The 12-lead
shows new ST elevation in leads II, III, aVF with ST depression in V1-V3. What is the
priority intervention?
A. Administer sublingual nitroglycerin
B. Give atropine 0.5mg IV push
C. Prepare for immediate synchronized cardioversion
D. Administer rapid IV fluid bolus
Correct Answer: D
Rationale:
● Why correct: Inferior wall MI often involves right ventricular infarction (indicated
by ST depression in V1-V3, reciprocal changes). RV infarction causes
preload-dependent hypotension due to impaired filling. The patient has clear
lungs (no pulmonary edema) and bradycardia (vagal response or AV nodal
ischemia). Volume loading is essential to maintain RV preload.
● Distractor analysis:
