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PROPHECY GENERAL ICU RN A V1
UPDATED SOLUTIONS 2026-2027 EDITION
COMPLETE 250+ QUESTIONS & ANSWERS
WITH DETAILED RATIONALES
## Section 1: Hemodynamics & Shock (Questions 1-50)
---
**1. A patient is post-cardiac arrest. The nurse assesses a heart rate of
110 bpm, blood pressure 78/40 mmHg, CVP 2 mmHg, and PAWP 4
mmHg. The cardiac index is 1.8 L/min/m². The nurse anticipates which
type of shock?**
A. Cardiogenic
B. Hypovolemic
C. Distributive
D. Obstructive
**Answer: B. Hypovolemic**
**Rationale:** Hypovolemic shock is characterized by low preload
indicators: Low CVP (normal 2-8 mmHg) and low PAWP (normal 6-12
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mmHg). Cardiac index is low due to insufficient filling. Cardiogenic
shock would have high preload (high PAWP). Distributive shock (septic)
usually has low CVP but normal or high cardiac index initially.
---
**2. The nurse is titrating norepinephrine (Levophed) for a patient in
septic shock. Which assessment finding requires immediate
intervention?**
A. Mean Arterial Pressure (MAP) of 68 mmHg
B. Heart rate of 95 bpm
C. Urine output of 30 mL/hr
D. Fingertips turning pale and cool
**Answer: D. Fingertips turning pale and cool**
**Rationale:** Norepinephrine is a potent vasoconstrictor.
Extravasation or excessive vasoconstriction leads to ischemia of digits
(cool, pale, mottled). This threatens tissue viability. While MAP goals
are >65 mmHg (A is acceptable), the priority is preventing limb
necrosis.
---
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**3. A patient with a pulmonary artery catheter has a cardiac output
(CO) of 3.2 L/min and a cardiac index (CI) of 1.7 L/min/m². The
systemic vascular resistance (SVR) is 1800 dynes/sec/cm⁻⁵. Which
intervention is most appropriate?**
A. Administer a fluid bolus of 500 mL NS
B. Administer sodium nitroprusside (Nipride)
C. Increase the rate of dobutamine infusion
D. Prepare the patient for pericardiocentesis
**Answer: C. Increase the rate of dobutamine infusion**
**Rationale:** The patient has low CI (<2.4) and high SVR (>1200).
This indicates cardiogenic shock (pump failure with compensatory
vasoconstriction). Dobutamine is an inotrope that increases contractility,
improving CO/CI and reducing afterload.
---
**4. During insertion of a central venous catheter, the patient suddenly
reports shortness of breath and chest pain. The nurse notes a heart rate of
130 bpm and absent breath sounds on the right side. What is the priority
action?**
A. Position patient on the left side with head down
B. Prepare for chest tube insertion
C. Administer morphine for pain
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D. Stop the procedure and apply oxygen
**Answer: D. Stop the procedure and apply oxygen**
**Rationale:** The symptoms suggest a tension pneumothorax. The
immediate priority is to stop the procedure (prevent further air entry),
apply high-flow oxygen, and prepare for needle decompression or chest
tube.
---
**5. The nurse is caring for a patient with a Swan-Ganz catheter. Which
value represents an elevated left ventricular preload?**
A. Central Venous Pressure (CVP): 10 mmHg
B. Pulmonary Artery Wedge Pressure (PAWP): 22 mmHg
C. Cardiac Output (CO): 5.5 L/min
D. Systemic Vascular Resistance (SVR): 700 dynes/sec/cm⁻⁵
**Answer: B. Pulmonary Artery Wedge Pressure (PAWP): 22 mmHg**
**Rationale:** PAWP reflects left ventricular end-diastolic pressure
(preload). Normal is 4-12 mmHg. 22 mmHg indicates fluid overload or
left ventricular failure. CVP reflects right-sided preload.
---
PROPHECY GENERAL ICU RN A V1
UPDATED SOLUTIONS 2026-2027 EDITION
COMPLETE 250+ QUESTIONS & ANSWERS
WITH DETAILED RATIONALES
## Section 1: Hemodynamics & Shock (Questions 1-50)
---
**1. A patient is post-cardiac arrest. The nurse assesses a heart rate of
110 bpm, blood pressure 78/40 mmHg, CVP 2 mmHg, and PAWP 4
mmHg. The cardiac index is 1.8 L/min/m². The nurse anticipates which
type of shock?**
A. Cardiogenic
B. Hypovolemic
C. Distributive
D. Obstructive
**Answer: B. Hypovolemic**
**Rationale:** Hypovolemic shock is characterized by low preload
indicators: Low CVP (normal 2-8 mmHg) and low PAWP (normal 6-12
,2|Page
mmHg). Cardiac index is low due to insufficient filling. Cardiogenic
shock would have high preload (high PAWP). Distributive shock (septic)
usually has low CVP but normal or high cardiac index initially.
---
**2. The nurse is titrating norepinephrine (Levophed) for a patient in
septic shock. Which assessment finding requires immediate
intervention?**
A. Mean Arterial Pressure (MAP) of 68 mmHg
B. Heart rate of 95 bpm
C. Urine output of 30 mL/hr
D. Fingertips turning pale and cool
**Answer: D. Fingertips turning pale and cool**
**Rationale:** Norepinephrine is a potent vasoconstrictor.
Extravasation or excessive vasoconstriction leads to ischemia of digits
(cool, pale, mottled). This threatens tissue viability. While MAP goals
are >65 mmHg (A is acceptable), the priority is preventing limb
necrosis.
---
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**3. A patient with a pulmonary artery catheter has a cardiac output
(CO) of 3.2 L/min and a cardiac index (CI) of 1.7 L/min/m². The
systemic vascular resistance (SVR) is 1800 dynes/sec/cm⁻⁵. Which
intervention is most appropriate?**
A. Administer a fluid bolus of 500 mL NS
B. Administer sodium nitroprusside (Nipride)
C. Increase the rate of dobutamine infusion
D. Prepare the patient for pericardiocentesis
**Answer: C. Increase the rate of dobutamine infusion**
**Rationale:** The patient has low CI (<2.4) and high SVR (>1200).
This indicates cardiogenic shock (pump failure with compensatory
vasoconstriction). Dobutamine is an inotrope that increases contractility,
improving CO/CI and reducing afterload.
---
**4. During insertion of a central venous catheter, the patient suddenly
reports shortness of breath and chest pain. The nurse notes a heart rate of
130 bpm and absent breath sounds on the right side. What is the priority
action?**
A. Position patient on the left side with head down
B. Prepare for chest tube insertion
C. Administer morphine for pain
, 4|Page
D. Stop the procedure and apply oxygen
**Answer: D. Stop the procedure and apply oxygen**
**Rationale:** The symptoms suggest a tension pneumothorax. The
immediate priority is to stop the procedure (prevent further air entry),
apply high-flow oxygen, and prepare for needle decompression or chest
tube.
---
**5. The nurse is caring for a patient with a Swan-Ganz catheter. Which
value represents an elevated left ventricular preload?**
A. Central Venous Pressure (CVP): 10 mmHg
B. Pulmonary Artery Wedge Pressure (PAWP): 22 mmHg
C. Cardiac Output (CO): 5.5 L/min
D. Systemic Vascular Resistance (SVR): 700 dynes/sec/cm⁻⁵
**Answer: B. Pulmonary Artery Wedge Pressure (PAWP): 22 mmHg**
**Rationale:** PAWP reflects left ventricular end-diastolic pressure
(preload). Normal is 4-12 mmHg. 22 mmHg indicates fluid overload or
left ventricular failure. CVP reflects right-sided preload.
---
