PROPHECY GENERAL ICU A V3 EXAM 2026 | Questions &
Answers | Distinction Level Assignment | Complete ICU RN
Assessment | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR CRITICAL CARE (Questions 1-20)
Q1. A patient in cardiogenic shock has a cardiac output of 4.0 L/min and a systemic
vascular resistance (SVR) of 1,200 dynes·sec/cm⁵. The nurse anticipates which
vasoactive medication as first-line therapy?
A. Norepinephrine B. Dobutamine C. Vasopressin D. Phenylephrine
Correct Answer: B. Dobutamine [CORRECT]
Rationale: Dobutamine is a beta-1 selective inotrope that increases cardiac contractility
and output in cardiogenic shock, which is characterized by decreased CO and elevated
SVR. Norepinephrine (A) is first-line for vasodilatory/distributive shock but increases
afterload, worsening cardiogenic shock. Vasopressin (C) is a pure vasoconstrictor used
as a second-line pressor. Phenylephrine (D) is a pure alpha-agonist that further
increases afterload without inotropic support. The AHA/ACC guidelines recommend
inotropic support (dobutamine or milrinone) for cardiogenic shock with adequate blood
pressure.
Q2. A patient with a pulmonary artery catheter has the following readings: RA 12
mmHg, PA 38/20 mmHg, PCWP 18 mmHg, CO 4.2 L/min. The nurse recognizes this
hemodynamic profile is most consistent with:
A. Hypovolemic shock B. Cardiogenic shock C. Septic shock D. Obstructive shock
Correct Answer: B. Cardiogenic shock [CORRECT]
,Rationale: Cardiogenic shock is characterized by elevated filling pressures (RA 12,
PCWP 18) and low cardiac output (4.2 L/min). Hypovolemic shock (A) shows low RA
and PCWP. Septic shock (C) typically shows low/normal filling pressures with high or
normal CO and low SVR. Obstructive shock (D) shows elevated RA with low/normal
PCWP. The elevated PCWP >18 mmHg indicates left ventricular failure and pulmonary
congestion.
Q3. A patient with STEMI develops ventricular fibrillation. The nurse immediately
delivers a biphasic shock of 200J. After the shock, the rhythm shows organized electrical
activity but no pulse. The next priority action is:
A. Administer epinephrine 1 mg IV push B. Begin CPR immediately C. Deliver another
defibrillation shock D. Administer amiodarone 300 mg IV push
Correct Answer: B. Begin CPR immediately [CORRECT]
Rationale: Post-shock organized electrical activity without a pulse is pulseless electrical
activity (PEA), which requires immediate high-quality CPR per ACLS guidelines.
Epinephrine (A) is given during CPR but CPR must be initiated first. Another shock (C) is
not indicated for PEA. Amiodarone (D) is used for refractory VF/pulseless VT, not PEA.
The AHA ACLS algorithm emphasizes minimizing interruptions in CPR.
Q4. A patient on norepinephrine at 0.5 mcg/kg/min has a MAP of 58 mmHg despite 30
mL/kg fluid resuscitation. Lactate is 4.2 mmol/L. The most appropriate next
intervention is:
A. Increase norepinephrine to achieve MAP ≥65 mmHg B. Add vasopressin 0.03
units/min C. Switch to phenylephrine D. Add dobutamine for inotropic support
Correct Answer: B. Add vasopressin 0.03 units/min [CORRECT]
Rationale: Per SCCM Surviving Sepsis Campaign, vasopressin (0.03 units/min) is
recommended as a second-line agent when norepinephrine doses exceed 0.3-0.5
mcg/kg/min or when additional catecholamine-sparing effect is needed. Vasopressin
,acts on V1 receptors for vasoconstriction without beta-adrenergic stimulation.
Increasing norepinephrine further (A) risks catecholamine toxicity. Phenylephrine (C)
lacks inotropic support. Dobutamine (D) is for cardiogenic shock, not septic shock with
adequate cardiac output.
Q5. A patient with acute decompensated heart failure has the following ABG: pH 7.28,
PaCO₂ 52 mmHg, HCO₃ 24 mEq/L, PaO₂ 68 mmHg. The primary acid-base disorder is:
A. Respiratory acidosis with metabolic compensation B. Metabolic acidosis with
respiratory compensation C. Acute respiratory acidosis without compensation D.
Chronic respiratory acidosis with full compensation
Correct Answer: C. Acute respiratory acidosis without compensation [CORRECT]
Rationale: The pH is 7.28 (acidemia) with elevated PaCO₂ 52 mmHg (respiratory
acidosis). The HCO₃ is 24 (normal), indicating no metabolic compensation has occurred
yet. For acute respiratory acidosis, HCO₃ increases by 1 mEq/L for every 10 mmHg
increase in PaCO₂ above 40; expected HCO₃ would be ~25, which matches the measured
value. Metabolic acidosis (B) would show low HCO₃. Full compensation (D) would show
pH near normal with elevated HCO₃.
Q6. A patient post-cardiac arrest is being prepared for targeted temperature
management (TTM) at 36°C. Which intervention is most appropriate during the cooling
phase?
A. Administer a paralytic agent to prevent shivering B. Use external cooling blankets and
ice packs C. Infuse cold IV saline at 4°C D. All of the above are appropriate
Correct Answer: D. All of the above are appropriate [CORRECT]
Rationale: TTM at 36°C requires multimodal cooling strategies. Shivering increases
metabolic demand and oxygen consumption, so sedation and sometimes paralytics (A)
are used. External cooling methods (B) include cooling blankets and ice packs. Cold IV
saline infusion (C) is an effective internal cooling method. The AHA post-cardiac arrest
, care guidelines support all these methods, with sedation prioritized before paralytics to
assess neurological status.
Q7. A patient with an intra-aortic balloon pump (IABP) has the balloon set to 1:1
counterpulsation. The nurse notes the arterial waveform shows augmentation during
diastole. This indicates:
A. Balloon inflation during systole B. Proper timing with inflation during diastole C.
Balloon deflation during diastole D. IABP malfunction
Correct Answer: B. Proper timing with inflation during diastole [CORRECT]
Rationale: Proper IABP timing requires balloon inflation at the dicrotic notch (beginning
of diastole), which augments coronary and cerebral perfusion. The augmented diastolic
pressure should be higher than the unassisted systolic pressure. Balloon deflation
occurs just before systole to reduce afterload. Inflation during systole (A) would
increase afterload and is dangerous. The waveform showing diastolic augmentation
confirms correct timing per IABP management protocols.
Q8. A patient in atrial fibrillation with rapid ventricular response has a heart rate of 160
bpm and BP 88/52 mmHg. The priority intervention is:
A. Administer diltiazem 0.25 mg/kg IV push B. Administer adenosine 6 mg rapid IV push
C. Perform synchronized cardioversion at 100-200J biphasic D. Administer amiodarone
150 mg IV over 10 minutes
Correct Answer: C. Perform synchronized cardioversion at 100-200J biphasic
[CORRECT]
Rationale: Unstable atrial fibrillation with hypotension (SBP <90 mmHg) requires
immediate synchronized cardioversion per ACLS. Diltiazem (A) and amiodarone (D) are
for stable patients. Adenosine (B) is for SVT with narrow QRS, not AF with RVR. The
AHA ACLS tachycardia algorithm prioritizes electrical cardioversion for unstable
tachyarrhythmias to restore perfusion.
Answers | Distinction Level Assignment | Complete ICU RN
Assessment | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR CRITICAL CARE (Questions 1-20)
Q1. A patient in cardiogenic shock has a cardiac output of 4.0 L/min and a systemic
vascular resistance (SVR) of 1,200 dynes·sec/cm⁵. The nurse anticipates which
vasoactive medication as first-line therapy?
A. Norepinephrine B. Dobutamine C. Vasopressin D. Phenylephrine
Correct Answer: B. Dobutamine [CORRECT]
Rationale: Dobutamine is a beta-1 selective inotrope that increases cardiac contractility
and output in cardiogenic shock, which is characterized by decreased CO and elevated
SVR. Norepinephrine (A) is first-line for vasodilatory/distributive shock but increases
afterload, worsening cardiogenic shock. Vasopressin (C) is a pure vasoconstrictor used
as a second-line pressor. Phenylephrine (D) is a pure alpha-agonist that further
increases afterload without inotropic support. The AHA/ACC guidelines recommend
inotropic support (dobutamine or milrinone) for cardiogenic shock with adequate blood
pressure.
Q2. A patient with a pulmonary artery catheter has the following readings: RA 12
mmHg, PA 38/20 mmHg, PCWP 18 mmHg, CO 4.2 L/min. The nurse recognizes this
hemodynamic profile is most consistent with:
A. Hypovolemic shock B. Cardiogenic shock C. Septic shock D. Obstructive shock
Correct Answer: B. Cardiogenic shock [CORRECT]
,Rationale: Cardiogenic shock is characterized by elevated filling pressures (RA 12,
PCWP 18) and low cardiac output (4.2 L/min). Hypovolemic shock (A) shows low RA
and PCWP. Septic shock (C) typically shows low/normal filling pressures with high or
normal CO and low SVR. Obstructive shock (D) shows elevated RA with low/normal
PCWP. The elevated PCWP >18 mmHg indicates left ventricular failure and pulmonary
congestion.
Q3. A patient with STEMI develops ventricular fibrillation. The nurse immediately
delivers a biphasic shock of 200J. After the shock, the rhythm shows organized electrical
activity but no pulse. The next priority action is:
A. Administer epinephrine 1 mg IV push B. Begin CPR immediately C. Deliver another
defibrillation shock D. Administer amiodarone 300 mg IV push
Correct Answer: B. Begin CPR immediately [CORRECT]
Rationale: Post-shock organized electrical activity without a pulse is pulseless electrical
activity (PEA), which requires immediate high-quality CPR per ACLS guidelines.
Epinephrine (A) is given during CPR but CPR must be initiated first. Another shock (C) is
not indicated for PEA. Amiodarone (D) is used for refractory VF/pulseless VT, not PEA.
The AHA ACLS algorithm emphasizes minimizing interruptions in CPR.
Q4. A patient on norepinephrine at 0.5 mcg/kg/min has a MAP of 58 mmHg despite 30
mL/kg fluid resuscitation. Lactate is 4.2 mmol/L. The most appropriate next
intervention is:
A. Increase norepinephrine to achieve MAP ≥65 mmHg B. Add vasopressin 0.03
units/min C. Switch to phenylephrine D. Add dobutamine for inotropic support
Correct Answer: B. Add vasopressin 0.03 units/min [CORRECT]
Rationale: Per SCCM Surviving Sepsis Campaign, vasopressin (0.03 units/min) is
recommended as a second-line agent when norepinephrine doses exceed 0.3-0.5
mcg/kg/min or when additional catecholamine-sparing effect is needed. Vasopressin
,acts on V1 receptors for vasoconstriction without beta-adrenergic stimulation.
Increasing norepinephrine further (A) risks catecholamine toxicity. Phenylephrine (C)
lacks inotropic support. Dobutamine (D) is for cardiogenic shock, not septic shock with
adequate cardiac output.
Q5. A patient with acute decompensated heart failure has the following ABG: pH 7.28,
PaCO₂ 52 mmHg, HCO₃ 24 mEq/L, PaO₂ 68 mmHg. The primary acid-base disorder is:
A. Respiratory acidosis with metabolic compensation B. Metabolic acidosis with
respiratory compensation C. Acute respiratory acidosis without compensation D.
Chronic respiratory acidosis with full compensation
Correct Answer: C. Acute respiratory acidosis without compensation [CORRECT]
Rationale: The pH is 7.28 (acidemia) with elevated PaCO₂ 52 mmHg (respiratory
acidosis). The HCO₃ is 24 (normal), indicating no metabolic compensation has occurred
yet. For acute respiratory acidosis, HCO₃ increases by 1 mEq/L for every 10 mmHg
increase in PaCO₂ above 40; expected HCO₃ would be ~25, which matches the measured
value. Metabolic acidosis (B) would show low HCO₃. Full compensation (D) would show
pH near normal with elevated HCO₃.
Q6. A patient post-cardiac arrest is being prepared for targeted temperature
management (TTM) at 36°C. Which intervention is most appropriate during the cooling
phase?
A. Administer a paralytic agent to prevent shivering B. Use external cooling blankets and
ice packs C. Infuse cold IV saline at 4°C D. All of the above are appropriate
Correct Answer: D. All of the above are appropriate [CORRECT]
Rationale: TTM at 36°C requires multimodal cooling strategies. Shivering increases
metabolic demand and oxygen consumption, so sedation and sometimes paralytics (A)
are used. External cooling methods (B) include cooling blankets and ice packs. Cold IV
saline infusion (C) is an effective internal cooling method. The AHA post-cardiac arrest
, care guidelines support all these methods, with sedation prioritized before paralytics to
assess neurological status.
Q7. A patient with an intra-aortic balloon pump (IABP) has the balloon set to 1:1
counterpulsation. The nurse notes the arterial waveform shows augmentation during
diastole. This indicates:
A. Balloon inflation during systole B. Proper timing with inflation during diastole C.
Balloon deflation during diastole D. IABP malfunction
Correct Answer: B. Proper timing with inflation during diastole [CORRECT]
Rationale: Proper IABP timing requires balloon inflation at the dicrotic notch (beginning
of diastole), which augments coronary and cerebral perfusion. The augmented diastolic
pressure should be higher than the unassisted systolic pressure. Balloon deflation
occurs just before systole to reduce afterload. Inflation during systole (A) would
increase afterload and is dangerous. The waveform showing diastolic augmentation
confirms correct timing per IABP management protocols.
Q8. A patient in atrial fibrillation with rapid ventricular response has a heart rate of 160
bpm and BP 88/52 mmHg. The priority intervention is:
A. Administer diltiazem 0.25 mg/kg IV push B. Administer adenosine 6 mg rapid IV push
C. Perform synchronized cardioversion at 100-200J biphasic D. Administer amiodarone
150 mg IV over 10 minutes
Correct Answer: C. Perform synchronized cardioversion at 100-200J biphasic
[CORRECT]
Rationale: Unstable atrial fibrillation with hypotension (SBP <90 mmHg) requires
immediate synchronized cardioversion per ACLS. Diltiazem (A) and amiodarone (D) are
for stable patients. Adenosine (B) is for SVT with narrow QRS, not AF with RVR. The
AHA ACLS tachycardia algorithm prioritizes electrical cardioversion for unstable
tachyarrhythmias to restore perfusion.
