PROPHECY GENERAL ICU RN A V1 EXAM 2026 | Questions
& Answers | Verified Answers | 85 Questions w/ Detailed
Rationales | Comprehensive Practice | Pass Guaranteed - A+
Graded
SECTION 1: CARDIOVASCULAR (Questions 1-15)
Q1: A patient with a pulmonary artery catheter has the following waveforms: systolic 25
mmHg, diastolic 10 mmHg, mean 15 mmHg. The balloon is inflated and shows a
pressure of 12 mmHg. Which hemodynamic parameter is being measured, and what is
the clinical interpretation?
A. CVP of 15 mmHg indicating fluid overload
B. PAP of 25/10 mmHg with PCWP of 12 mmHg suggesting normal left ventricular
preload
C. PAD of 10 mmHg indicating pulmonary hypertension
D. PCWP of 12 mmHg suggesting cardiogenic shock
Correct Answer: B
Rationale: The pulmonary artery pressure (PAP) waveform shows systolic 25, diastolic
10 (normal PAP 20-30/8-12 mmHg). With balloon inflation, the pulmonary capillary
wedge pressure (PCWP) of 12 mmHg reflects left atrial pressure and left ventricular
end-diastolic pressure (preload).
Hemodynamic interpretation:
, ● Normal PCWP: 6-12 mmHg; 12 mmHg is at upper limit of normal, suggesting
adequate preload
● Elevated PCWP (>18): Suggests left heart failure, fluid overload
● Low PCWP (<6): Hypovolemia
Why other options are incorrect:
● A: CVP is measured in right atrium, not with PA catheter balloon inflation.
● C: PAD (pulmonary artery diastolic) normally approximates PCWP + 1-4 mmHg;
10 mmHg is normal, not pulmonary hypertension.
● D: PCWP 12 is not indicative of cardiogenic shock (typically elevated >18 with
low cardiac output).
AACN Standard: PCWP provides indirect measurement of left ventricular filling pressure;
interpret with cardiac output and clinical picture.
Q2: A patient in septic shock has the following hemodynamics: MAP 58 mmHg, CVP 4
mmHg, CI 4.5 L/min/m², SVR 600 dynes·sec/cm⁵. Which vasoactive medication is most
appropriate as first-line therapy?
A. Dobutamine 5 mcg/kg/min
B. Norepinephrine 0.05 mcg/kg/min
C. Epinephrine 0.1 mcg/kg/min
D. Phenylephrine 100 mcg/min
Correct Answer: B
Rationale: This patient has distributive shock (septic shock): low MAP, low CVP
(preload), high CI (hyperdynamic state), very low SVR (vasodilation). Norepinephrine is
the first-line vasopressor for septic shock per Surviving Sepsis Campaign 2021.
Norepinephrine advantages:
, ● Potent alpha-1 agonist: Increases SVR and MAP
● Beta-1 activity: Maintains/improves cardiac output
● Less arrhythmogenic than dopamine
● Target MAP: ≥65 mmHg (individualized higher if chronic hypertension)
Why other options are inappropriate:
● A: Dobutamine is an inotrope for low CI states; this patient has high CI already.
● C: Epinephrine is second-line for refractory shock; more arrhythmogenic,
metabolic effects.
● D: Pure alpha-agonist increases SVR but may decrease CO (reflex bradycardia,
increased afterload); reserved for specific situations (e.g.,
norepinephrine-induced arrhythmias).
Titration: Start 0.01-0.05 mcg/kg/min, titrate to MAP goal; maximum typically 3.3
mcg/kg/min before adding vasopressin.
Q3: A patient on norepinephrine at 0.5 mcg/kg/min has MAP 62 mmHg, urine output 15
mL/hour, and increasing lactate. Which action is most appropriate?
A. Increase norepinephrine to achieve MAP >80 mmHg
B. Add vasopressin 0.03 units/min
C. Switch to phenylephrine
D. Administer fluid bolus 30 mL/kg crystalloid
Correct Answer: B
Rationale: This patient has refractory septic shock despite high-dose norepinephrine.
Per Surviving Sepsis Campaign, add vasopressin (up to 0.03 units/min) when
norepinephrine dose exceeds 0.25-0.5 mcg/kg/min or to decrease catecholamine
requirements.
, Vasopressin rationale:
● Relative vasopressin deficiency in septic shock
● V1 receptor agonist: Potent vasoconstriction without beta-adrenergic effects
● Allows norepinephrine dose reduction: Decreases arrhythmia risk, myocardial
oxygen demand
● Fixed dose: 0.03 units/min (not titrated); higher doses cause splanchnic/cardiac
ischemia
Why other options are incorrect:
● A: Higher MAP targets (80) not evidence-based; may increase vasopressor
toxicity without mortality benefit.
● C: Phenylephrine pure alpha-agonism reduces CO; not recommended for septic
shock.
● D: Additional fluid unlikely beneficial if CVP/PAOP adequate; risk of fluid
overload.
Q4: A patient with acute decompensated heart failure has the following: BP 82/50
mmHg, HR 118 bpm, PCWP 28 mmHg, CI 1.8 L/min/m². Which interventions are
appropriate? (Select all that apply)
A. Dobutamine 5 mcg/kg/min
B. Norepinephrine 0.05 mcg/kg/min
C. Nitroglycerin 20 mcg/min
D. Furosemide 40 mg IV
E. Milrinone 0.375 mcg/kg/min
Correct Answer: A, B, E
Rationale: This is cardiogenic shock (low CI, high PCWP, hypotension). Management
requires inotropy and vasopressor support while avoiding preload reduction.
& Answers | Verified Answers | 85 Questions w/ Detailed
Rationales | Comprehensive Practice | Pass Guaranteed - A+
Graded
SECTION 1: CARDIOVASCULAR (Questions 1-15)
Q1: A patient with a pulmonary artery catheter has the following waveforms: systolic 25
mmHg, diastolic 10 mmHg, mean 15 mmHg. The balloon is inflated and shows a
pressure of 12 mmHg. Which hemodynamic parameter is being measured, and what is
the clinical interpretation?
A. CVP of 15 mmHg indicating fluid overload
B. PAP of 25/10 mmHg with PCWP of 12 mmHg suggesting normal left ventricular
preload
C. PAD of 10 mmHg indicating pulmonary hypertension
D. PCWP of 12 mmHg suggesting cardiogenic shock
Correct Answer: B
Rationale: The pulmonary artery pressure (PAP) waveform shows systolic 25, diastolic
10 (normal PAP 20-30/8-12 mmHg). With balloon inflation, the pulmonary capillary
wedge pressure (PCWP) of 12 mmHg reflects left atrial pressure and left ventricular
end-diastolic pressure (preload).
Hemodynamic interpretation:
, ● Normal PCWP: 6-12 mmHg; 12 mmHg is at upper limit of normal, suggesting
adequate preload
● Elevated PCWP (>18): Suggests left heart failure, fluid overload
● Low PCWP (<6): Hypovolemia
Why other options are incorrect:
● A: CVP is measured in right atrium, not with PA catheter balloon inflation.
● C: PAD (pulmonary artery diastolic) normally approximates PCWP + 1-4 mmHg;
10 mmHg is normal, not pulmonary hypertension.
● D: PCWP 12 is not indicative of cardiogenic shock (typically elevated >18 with
low cardiac output).
AACN Standard: PCWP provides indirect measurement of left ventricular filling pressure;
interpret with cardiac output and clinical picture.
Q2: A patient in septic shock has the following hemodynamics: MAP 58 mmHg, CVP 4
mmHg, CI 4.5 L/min/m², SVR 600 dynes·sec/cm⁵. Which vasoactive medication is most
appropriate as first-line therapy?
A. Dobutamine 5 mcg/kg/min
B. Norepinephrine 0.05 mcg/kg/min
C. Epinephrine 0.1 mcg/kg/min
D. Phenylephrine 100 mcg/min
Correct Answer: B
Rationale: This patient has distributive shock (septic shock): low MAP, low CVP
(preload), high CI (hyperdynamic state), very low SVR (vasodilation). Norepinephrine is
the first-line vasopressor for septic shock per Surviving Sepsis Campaign 2021.
Norepinephrine advantages:
, ● Potent alpha-1 agonist: Increases SVR and MAP
● Beta-1 activity: Maintains/improves cardiac output
● Less arrhythmogenic than dopamine
● Target MAP: ≥65 mmHg (individualized higher if chronic hypertension)
Why other options are inappropriate:
● A: Dobutamine is an inotrope for low CI states; this patient has high CI already.
● C: Epinephrine is second-line for refractory shock; more arrhythmogenic,
metabolic effects.
● D: Pure alpha-agonist increases SVR but may decrease CO (reflex bradycardia,
increased afterload); reserved for specific situations (e.g.,
norepinephrine-induced arrhythmias).
Titration: Start 0.01-0.05 mcg/kg/min, titrate to MAP goal; maximum typically 3.3
mcg/kg/min before adding vasopressin.
Q3: A patient on norepinephrine at 0.5 mcg/kg/min has MAP 62 mmHg, urine output 15
mL/hour, and increasing lactate. Which action is most appropriate?
A. Increase norepinephrine to achieve MAP >80 mmHg
B. Add vasopressin 0.03 units/min
C. Switch to phenylephrine
D. Administer fluid bolus 30 mL/kg crystalloid
Correct Answer: B
Rationale: This patient has refractory septic shock despite high-dose norepinephrine.
Per Surviving Sepsis Campaign, add vasopressin (up to 0.03 units/min) when
norepinephrine dose exceeds 0.25-0.5 mcg/kg/min or to decrease catecholamine
requirements.
, Vasopressin rationale:
● Relative vasopressin deficiency in septic shock
● V1 receptor agonist: Potent vasoconstriction without beta-adrenergic effects
● Allows norepinephrine dose reduction: Decreases arrhythmia risk, myocardial
oxygen demand
● Fixed dose: 0.03 units/min (not titrated); higher doses cause splanchnic/cardiac
ischemia
Why other options are incorrect:
● A: Higher MAP targets (80) not evidence-based; may increase vasopressor
toxicity without mortality benefit.
● C: Phenylephrine pure alpha-agonism reduces CO; not recommended for septic
shock.
● D: Additional fluid unlikely beneficial if CVP/PAOP adequate; risk of fluid
overload.
Q4: A patient with acute decompensated heart failure has the following: BP 82/50
mmHg, HR 118 bpm, PCWP 28 mmHg, CI 1.8 L/min/m². Which interventions are
appropriate? (Select all that apply)
A. Dobutamine 5 mcg/kg/min
B. Norepinephrine 0.05 mcg/kg/min
C. Nitroglycerin 20 mcg/min
D. Furosemide 40 mg IV
E. Milrinone 0.375 mcg/kg/min
Correct Answer: A, B, E
Rationale: This is cardiogenic shock (low CI, high PCWP, hypotension). Management
requires inotropy and vasopressor support while avoiding preload reduction.
