PROPHECY SURGICAL ICU EXAM A V3 LATEST ACTUAL
EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |A+ GRADE
ASSURED
Question 1
A 58-year-old client post-abdominal aortic aneurysm (AAA) repair is admitted
to the SICU. On assessment, the nurse notes absent pedal pulses, cool and
mottled extremities below the waist, and a sudden decrease in urinary
output. The client's blood pressure is 88/50 mmHg despite fluid resuscitation.
Which complication is the most immediate concern?
A) Acute kidney injury (AKI)
B) Ileus
C) Graft thrombosis or occlusion
D) Pulmonary embolism
E) Incisional hemorrhage
Correct Answer: C) Graft thrombosis or occlusion
Rationale: Absent pulses, cool/mottled extremities, and hypotension
despite fluid resuscitation in a post-AAA repair client are critical
signs of acute graft thrombosis or occlusion, which is a surgical
emergency requiring immediate intervention to prevent limb
ischemia and organ damage.
Question 2
A client in the SICU is on mechanical ventilation with a PEEP of 15 cmH2O.
The nurse notes a sudden drop in SpO2, increased peak inspiratory
pressures, absent breath sounds on the left, and tracheal deviation to the
right. Which life-threatening complication is indicated?
A) Ventilator-associated pneumonia (VAP)
B) Acute respiratory distress syndrome (ARDS)
C) Tension pneumothorax
D) Pulmonary edema
E) Mainstem bronchus intubation
Correct Answer: C) Tension pneumothorax
Rationale: The classic signs of a tension pneumothorax (sudden
respiratory distress, absent breath sounds on the affected side,
tracheal deviation away from the affected side, increased peak
pressures, and hypotension) are present. High PEEP can predispose
to barotrauma leading to pneumothorax.
Question 3
Which of the following interventions is a priority for a client diagnosed with
,diabetic ketoacidosis (DKA) in the SICU?
A) Administer a rapid insulin bolus followed by a dextrose infusion.
B) Administer sodium bicarbonate to correct acidosis quickly.
C) Administer intravenous fluids (e.g., normal saline) followed by a
regular insulin infusion.
D) Provide oral glucose every hour.
E) Restrict all fluid intake to prevent fluid overload.
Correct Answer: C) Administer intravenous fluids (e.g., normal
saline) followed by a regular insulin infusion.
Rationale: The initial and most critical management of DKA involves
aggressive fluid resuscitation to correct dehydration and
hypovolemia, followed by a continuous intravenous infusion of
regular insulin to gradually lower blood glucose and resolve ketosis.
Bicarbonate is rarely indicated, and glucose is contraindicated
initially.
Question 4
The nurse is monitoring a client's intracranial pressure (ICP) following a
traumatic brain injury. The ICP is consistently 22 mmHg, and the client's
mean arterial pressure (MAP) is 70 mmHg. What is the client's cerebral
perfusion pressure (CPP)?
A) 48 mmHg
B) 50 mmHg
C) 48 mmHg
D) 92 mmHg
E) 70 mmHg
Correct Answer: C) 48 mmHg
Rationale: CPP = MAP - ICP. In this case, CPP = 70 mmHg - 22 mmHg
= 48 mmHg. A CPP below 60 mmHg is generally considered
inadequate and can lead to cerebral ischemia.
Question 5
A client with acute pancreatitis develops severe abdominal distention,
increasing ventilatory pressures, and oliguria. The nurse suspects abdominal
compartment syndrome. Which intervention is the most appropriate initial
action?
A) Administer a diuretic.
B) Increase intravenous fluid administration.
C) Measure intra-abdominal pressure (IAP) via a bladder catheter.
D) Place the client in a Trendelenburg position.
E) Administer a broad-spectrum antibiotic.
, Correct Answer: C) Measure intra-abdominal pressure (IAP) via a
bladder catheter.
Rationale: Measuring intra-abdominal pressure (IAP), typically
through a bladder catheter, is the definitive diagnostic method for
abdominal compartment syndrome. This helps confirm the diagnosis
and guide further management, which may include surgical
decompression.
Question 6
Which medication is commonly used in the SICU to rapidly reverse the
effects of opioid overdose or respiratory depression caused by opioids?
A) Lorazepam
B) Fentanyl
C) Midazolam
D) Naloxone
E) Propofol
Correct Answer: D) Naloxone
Rationale: Naloxone (Narcan) is an opioid antagonist that rapidly
reverses opioid-induced respiratory and central nervous system
depression by competing with opioids for receptor sites.
Question 7
A client post-laparotomy for a perforated bowel develops a fever of 102.5°F
(39.2°C), generalized abdominal pain, tachycardia, and hypotension. The
nurse notes cloudy drainage from the surgical drain. What is the most likely
complication?
A) Deep vein thrombosis (DVT)
B) Acute kidney injury (AKI)
C) Peritonitis or anastomotic leak
D) Pulmonary embolism
E) Gastric ulcer
Correct Answer: C) Peritonitis or anastomotic leak
Rationale: Fever, abdominal pain, tachycardia, hypotension, and
cloudy drainage are classic signs of a serious intra-abdominal
infection, such as peritonitis, often resulting from an anastomotic
leak after bowel surgery.
Question 8
When administering a continuous norepinephrine (Levophed) infusion to a
client in septic shock, which assessment parameter is the most critical to
monitor closely?
EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |A+ GRADE
ASSURED
Question 1
A 58-year-old client post-abdominal aortic aneurysm (AAA) repair is admitted
to the SICU. On assessment, the nurse notes absent pedal pulses, cool and
mottled extremities below the waist, and a sudden decrease in urinary
output. The client's blood pressure is 88/50 mmHg despite fluid resuscitation.
Which complication is the most immediate concern?
A) Acute kidney injury (AKI)
B) Ileus
C) Graft thrombosis or occlusion
D) Pulmonary embolism
E) Incisional hemorrhage
Correct Answer: C) Graft thrombosis or occlusion
Rationale: Absent pulses, cool/mottled extremities, and hypotension
despite fluid resuscitation in a post-AAA repair client are critical
signs of acute graft thrombosis or occlusion, which is a surgical
emergency requiring immediate intervention to prevent limb
ischemia and organ damage.
Question 2
A client in the SICU is on mechanical ventilation with a PEEP of 15 cmH2O.
The nurse notes a sudden drop in SpO2, increased peak inspiratory
pressures, absent breath sounds on the left, and tracheal deviation to the
right. Which life-threatening complication is indicated?
A) Ventilator-associated pneumonia (VAP)
B) Acute respiratory distress syndrome (ARDS)
C) Tension pneumothorax
D) Pulmonary edema
E) Mainstem bronchus intubation
Correct Answer: C) Tension pneumothorax
Rationale: The classic signs of a tension pneumothorax (sudden
respiratory distress, absent breath sounds on the affected side,
tracheal deviation away from the affected side, increased peak
pressures, and hypotension) are present. High PEEP can predispose
to barotrauma leading to pneumothorax.
Question 3
Which of the following interventions is a priority for a client diagnosed with
,diabetic ketoacidosis (DKA) in the SICU?
A) Administer a rapid insulin bolus followed by a dextrose infusion.
B) Administer sodium bicarbonate to correct acidosis quickly.
C) Administer intravenous fluids (e.g., normal saline) followed by a
regular insulin infusion.
D) Provide oral glucose every hour.
E) Restrict all fluid intake to prevent fluid overload.
Correct Answer: C) Administer intravenous fluids (e.g., normal
saline) followed by a regular insulin infusion.
Rationale: The initial and most critical management of DKA involves
aggressive fluid resuscitation to correct dehydration and
hypovolemia, followed by a continuous intravenous infusion of
regular insulin to gradually lower blood glucose and resolve ketosis.
Bicarbonate is rarely indicated, and glucose is contraindicated
initially.
Question 4
The nurse is monitoring a client's intracranial pressure (ICP) following a
traumatic brain injury. The ICP is consistently 22 mmHg, and the client's
mean arterial pressure (MAP) is 70 mmHg. What is the client's cerebral
perfusion pressure (CPP)?
A) 48 mmHg
B) 50 mmHg
C) 48 mmHg
D) 92 mmHg
E) 70 mmHg
Correct Answer: C) 48 mmHg
Rationale: CPP = MAP - ICP. In this case, CPP = 70 mmHg - 22 mmHg
= 48 mmHg. A CPP below 60 mmHg is generally considered
inadequate and can lead to cerebral ischemia.
Question 5
A client with acute pancreatitis develops severe abdominal distention,
increasing ventilatory pressures, and oliguria. The nurse suspects abdominal
compartment syndrome. Which intervention is the most appropriate initial
action?
A) Administer a diuretic.
B) Increase intravenous fluid administration.
C) Measure intra-abdominal pressure (IAP) via a bladder catheter.
D) Place the client in a Trendelenburg position.
E) Administer a broad-spectrum antibiotic.
, Correct Answer: C) Measure intra-abdominal pressure (IAP) via a
bladder catheter.
Rationale: Measuring intra-abdominal pressure (IAP), typically
through a bladder catheter, is the definitive diagnostic method for
abdominal compartment syndrome. This helps confirm the diagnosis
and guide further management, which may include surgical
decompression.
Question 6
Which medication is commonly used in the SICU to rapidly reverse the
effects of opioid overdose or respiratory depression caused by opioids?
A) Lorazepam
B) Fentanyl
C) Midazolam
D) Naloxone
E) Propofol
Correct Answer: D) Naloxone
Rationale: Naloxone (Narcan) is an opioid antagonist that rapidly
reverses opioid-induced respiratory and central nervous system
depression by competing with opioids for receptor sites.
Question 7
A client post-laparotomy for a perforated bowel develops a fever of 102.5°F
(39.2°C), generalized abdominal pain, tachycardia, and hypotension. The
nurse notes cloudy drainage from the surgical drain. What is the most likely
complication?
A) Deep vein thrombosis (DVT)
B) Acute kidney injury (AKI)
C) Peritonitis or anastomotic leak
D) Pulmonary embolism
E) Gastric ulcer
Correct Answer: C) Peritonitis or anastomotic leak
Rationale: Fever, abdominal pain, tachycardia, hypotension, and
cloudy drainage are classic signs of a serious intra-abdominal
infection, such as peritonitis, often resulting from an anastomotic
leak after bowel surgery.
Question 8
When administering a continuous norepinephrine (Levophed) infusion to a
client in septic shock, which assessment parameter is the most critical to
monitor closely?
