Prophecy General ICU A V3 – Distinction Level Mastery
Assessment Actual Exam – Complete Questions and
Answers with Detailed Rationales – Pass Guaranteed –
A+ Graded
Hemodynamic Monitoring & Cardiovascular Critical Care
Q1: You are preparing to assist with the insertion of a pulmonary artery catheter
(Swan-Ganz) for a patient in cardiogenic shock. During the flotation of the catheter, you
observe the waveform transition from right atrial pressure to right ventricular pressure.
Which characteristic feature identifies the right ventricular pressure waveform?
A. A prominent 'a' wave followed by a 'v' wave
B. Systolic pressure equal to pulmonary artery systolic pressure
C. Low diastolic pressure with a sharp, rapid upstroke and descent
D. A distinct dicrotic notch and higher diastolic pressure than the right atrium
Q2: A patient with an arterial line has a dampened waveform, and the flush bag is
leaking at the connection site. After replacing the tubing and ensuring the system is
tight, you perform the dynamic response test (fast flush). The waveform oscillates briefly
and then returns to the baseline flatly. What is the most appropriate next action to
troubleshoot this persistent damping?
A. Increase the flush pressure to 300 mmHg manually
B. Reposition the patient’s arm to ensure the transducer is lower than the phlebostatic
axis
C. Check for air bubbles or clots in the tubing and recalibrate the transducer
D. Administer a fluid bolus to increase the patient’s blood pressure [CORRECT]
Q3: You are caring for a patient following a myocardial infarction with a new onset of a
wide, fixed split S2 and jugular venous distension. The pulmonary artery catheter
readings show equalization of diastolic pressures (PAD = PAOP = RAP). You recognize
these hemodynamic findings as classic for which condition?
A. Acute left ventricular failure
B. Cardiac tamponade
C. Severe pulmonary hypertension
D. Right ventricular infarction [CORRECT]
Q4: A 68-year-old patient with septic shock has the following hemodynamic values:
Cardiac Output (CO) 7.5 L/min, Cardiac Index (CI) 3.8 L/min/m², Systemic Vascular
,Resistance (SVR) 600 dynes/sec/cm⁻⁵, and MAP 58 mmHg on norepinephrine. The
patient’s extremities are warm and well-perfused. Based on these values, which
intervention is the priority?
A. Administer a 500 mL crystalloid fluid bolus
B. Titrate norepinephrine up to increase SVR and MAP
C. Start dobutamine to increase cardiac output further
D. Start vasopressin to reduce norepinephrine requirements [CORRECT]
Q5: Your patient has a left radial arterial line. The transducer is currently leveled at the
5th intercostal space, mid-clavicular line. The MAP reading is significantly higher than
the non-invasive cuff pressure on the upper arm. What is the most likely cause of this
discrepancy?
A. The transducer is too high relative to the phlebostatic axis
B. The catheter tip is against the arterial wall (whipping)
C. The transducer is too low relative to the phlebostatic axis
D. There is air in the pressure tubing [CORRECT]
Q6: You are reviewing the CVP waveform of a patient who is on a mechanical ventilator.
You notice that the 'y' descent is absent. This specific finding is most associated with
which cardiac pathology?
A. Tricuspid regurgitation
B. Tricuspid stenosis
C. Cardiac tamponade
D. Atrial fibrillation [CORRECT]
Q7: A patient with a Swan-Ganz catheter is in the ICU. You are asked to obtain the
cardiac output using the thermodilution method. You inject 10 mL of iced saline, and the
monitor displays a value of 2.0 L/min, which is significantly lower than the patient’s
clinical state suggests. What is the most likely source of error?
A. The injectate was at room temperature, not iced
B. The injection was too slow (> 4 seconds)
C. There is a tricuspid regurgitation murmur present
D. The PA catheter tip migrated into the wedge position [CORRECT]
Q8: While caring for a patient on a high-dose norepinephrine infusion for septic shock,
you notice blanching and mottling distal to the arterial line insertion site on the radial
artery. The capillary refill time is 4 seconds. What is the immediate nursing intervention?
A. Stop the norepinephrine infusion immediately
B. Administer phentolamine (Regitine) locally via the arterial line
C. Remove the arterial line and apply warm compresses
D. Increase the vasopressor dose to perfuse the extremity [CORRECT]
, Q9: You are titrating a dobutamine infusion for a patient with acute decompensated
heart failure. The provider’s goal is to increase cardiac output while maintaining a MAP
> 65 mmHg. You notice the patient’s heart rate has increased from 90 to 135 bpm, and
the patient reports new-onset chest pain. What is your priority action?
A. Continue the infusion to support the blood pressure
B. Decrease the dobutamine infusion rate
C. Administer a fluid bolus to preload the heart
D. Administer a beta-blocker to lower the heart rate [CORRECT]
Q10: A patient with a history of COPD presents with acute respiratory failure and
hypotension. The echocardiogram shows right ventricular strain. The hemodynamic
profile shows: MAP 55 mmHg, CVP 14 mmHg, PAOP 8 mmHg. Which type of shock is
this patient primarily experiencing, and what is the most appropriate initial treatment?
A. Distributive shock; administer high-dose norepinephrine
B. Obstructive shock (secondary to pulmonary embolism); consider thrombolytics or
surgical embolectomy
C. Cardiogenic shock; administer inotropes
D. Hypovolemic shock; administer aggressive fluid resuscitation [CORRECT]
Q11: When assessing the arterial line waveform, you note a "damped" downstroke and
a loss of the dicrotic notch. Simultaneously, the patient’s pulse oximeter reading
becomes erratic. Which device-related complication should you suspect first?
A. Air embolism
B. Catheter kinking or partial obstruction
C. Hematoma formation at the site
D. Infection of the catheter site [CORRECT]
Q12: A patient is admitted with anaphylactic shock. They have received epinephrine
and fluids but remain hypotensive with a MAP of 55 mmHg. The provider starts a
vasopressin infusion. What is the mechanism of action of vasopressin in this context?
A. Alpha-1 agonism to increase systemic vascular resistance
B. Beta-1 agonism to increase heart rate and contractility
C. V1 receptor stimulation to cause vasoconstriction
D. Dopamine receptor agonism to increase renal perfusion [CORRECT]
Q13: You are performing the Allen’s test prior to radial arterial line insertion. You
compress the radial and ulnar arteries until the hand blanches, then release the ulnar
artery. The hand remains pale and does not flush for 15 seconds. What does this
indicate?
A. Adequate collateral circulation via the ulnar artery
B. Inadequate collateral circulation; do not use the radial artery
Assessment Actual Exam – Complete Questions and
Answers with Detailed Rationales – Pass Guaranteed –
A+ Graded
Hemodynamic Monitoring & Cardiovascular Critical Care
Q1: You are preparing to assist with the insertion of a pulmonary artery catheter
(Swan-Ganz) for a patient in cardiogenic shock. During the flotation of the catheter, you
observe the waveform transition from right atrial pressure to right ventricular pressure.
Which characteristic feature identifies the right ventricular pressure waveform?
A. A prominent 'a' wave followed by a 'v' wave
B. Systolic pressure equal to pulmonary artery systolic pressure
C. Low diastolic pressure with a sharp, rapid upstroke and descent
D. A distinct dicrotic notch and higher diastolic pressure than the right atrium
Q2: A patient with an arterial line has a dampened waveform, and the flush bag is
leaking at the connection site. After replacing the tubing and ensuring the system is
tight, you perform the dynamic response test (fast flush). The waveform oscillates briefly
and then returns to the baseline flatly. What is the most appropriate next action to
troubleshoot this persistent damping?
A. Increase the flush pressure to 300 mmHg manually
B. Reposition the patient’s arm to ensure the transducer is lower than the phlebostatic
axis
C. Check for air bubbles or clots in the tubing and recalibrate the transducer
D. Administer a fluid bolus to increase the patient’s blood pressure [CORRECT]
Q3: You are caring for a patient following a myocardial infarction with a new onset of a
wide, fixed split S2 and jugular venous distension. The pulmonary artery catheter
readings show equalization of diastolic pressures (PAD = PAOP = RAP). You recognize
these hemodynamic findings as classic for which condition?
A. Acute left ventricular failure
B. Cardiac tamponade
C. Severe pulmonary hypertension
D. Right ventricular infarction [CORRECT]
Q4: A 68-year-old patient with septic shock has the following hemodynamic values:
Cardiac Output (CO) 7.5 L/min, Cardiac Index (CI) 3.8 L/min/m², Systemic Vascular
,Resistance (SVR) 600 dynes/sec/cm⁻⁵, and MAP 58 mmHg on norepinephrine. The
patient’s extremities are warm and well-perfused. Based on these values, which
intervention is the priority?
A. Administer a 500 mL crystalloid fluid bolus
B. Titrate norepinephrine up to increase SVR and MAP
C. Start dobutamine to increase cardiac output further
D. Start vasopressin to reduce norepinephrine requirements [CORRECT]
Q5: Your patient has a left radial arterial line. The transducer is currently leveled at the
5th intercostal space, mid-clavicular line. The MAP reading is significantly higher than
the non-invasive cuff pressure on the upper arm. What is the most likely cause of this
discrepancy?
A. The transducer is too high relative to the phlebostatic axis
B. The catheter tip is against the arterial wall (whipping)
C. The transducer is too low relative to the phlebostatic axis
D. There is air in the pressure tubing [CORRECT]
Q6: You are reviewing the CVP waveform of a patient who is on a mechanical ventilator.
You notice that the 'y' descent is absent. This specific finding is most associated with
which cardiac pathology?
A. Tricuspid regurgitation
B. Tricuspid stenosis
C. Cardiac tamponade
D. Atrial fibrillation [CORRECT]
Q7: A patient with a Swan-Ganz catheter is in the ICU. You are asked to obtain the
cardiac output using the thermodilution method. You inject 10 mL of iced saline, and the
monitor displays a value of 2.0 L/min, which is significantly lower than the patient’s
clinical state suggests. What is the most likely source of error?
A. The injectate was at room temperature, not iced
B. The injection was too slow (> 4 seconds)
C. There is a tricuspid regurgitation murmur present
D. The PA catheter tip migrated into the wedge position [CORRECT]
Q8: While caring for a patient on a high-dose norepinephrine infusion for septic shock,
you notice blanching and mottling distal to the arterial line insertion site on the radial
artery. The capillary refill time is 4 seconds. What is the immediate nursing intervention?
A. Stop the norepinephrine infusion immediately
B. Administer phentolamine (Regitine) locally via the arterial line
C. Remove the arterial line and apply warm compresses
D. Increase the vasopressor dose to perfuse the extremity [CORRECT]
, Q9: You are titrating a dobutamine infusion for a patient with acute decompensated
heart failure. The provider’s goal is to increase cardiac output while maintaining a MAP
> 65 mmHg. You notice the patient’s heart rate has increased from 90 to 135 bpm, and
the patient reports new-onset chest pain. What is your priority action?
A. Continue the infusion to support the blood pressure
B. Decrease the dobutamine infusion rate
C. Administer a fluid bolus to preload the heart
D. Administer a beta-blocker to lower the heart rate [CORRECT]
Q10: A patient with a history of COPD presents with acute respiratory failure and
hypotension. The echocardiogram shows right ventricular strain. The hemodynamic
profile shows: MAP 55 mmHg, CVP 14 mmHg, PAOP 8 mmHg. Which type of shock is
this patient primarily experiencing, and what is the most appropriate initial treatment?
A. Distributive shock; administer high-dose norepinephrine
B. Obstructive shock (secondary to pulmonary embolism); consider thrombolytics or
surgical embolectomy
C. Cardiogenic shock; administer inotropes
D. Hypovolemic shock; administer aggressive fluid resuscitation [CORRECT]
Q11: When assessing the arterial line waveform, you note a "damped" downstroke and
a loss of the dicrotic notch. Simultaneously, the patient’s pulse oximeter reading
becomes erratic. Which device-related complication should you suspect first?
A. Air embolism
B. Catheter kinking or partial obstruction
C. Hematoma formation at the site
D. Infection of the catheter site [CORRECT]
Q12: A patient is admitted with anaphylactic shock. They have received epinephrine
and fluids but remain hypotensive with a MAP of 55 mmHg. The provider starts a
vasopressin infusion. What is the mechanism of action of vasopressin in this context?
A. Alpha-1 agonism to increase systemic vascular resistance
B. Beta-1 agonism to increase heart rate and contractility
C. V1 receptor stimulation to cause vasoconstriction
D. Dopamine receptor agonism to increase renal perfusion [CORRECT]
Q13: You are performing the Allen’s test prior to radial arterial line insertion. You
compress the radial and ulnar arteries until the hand blanches, then release the ulnar
artery. The hand remains pale and does not flush for 15 seconds. What does this
indicate?
A. Adequate collateral circulation via the ulnar artery
B. Inadequate collateral circulation; do not use the radial artery
