RELIAS/PROPHECY GENERAL ICU RN A V3 ACTUAL EXAM
LATEST 100 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES |
Question 1
A patient in the ICU is admitted with septic shock. Which of the following is
the most appropriate initial fluid resuscitation strategy?
A) D5W at 100 mL/hr
B) 0.45% Sodium Chloride at 50 mL/hr
C) Rapid infusion of 30 mL/kg intravenous crystalloids
D) Albumin 25% at 500 mL/hr
E) Packed Red Blood Cells (PRBCs)
Correct Answer: C) Rapid infusion of 30 mL/kg intravenous crystalloids
Rationale: Current guidelines for septic shock recommend rapid
administration of 30 mL/kg of intravenous crystalloids within the
first 3 hours to restore intravascular volume and improve perfusion.
Question 2
Which of the following cardiac arrhythmias is characterized by a "sawtooth"
pattern on the electrocardiogram (ECG) and often requires anticoagulation
due to thrombus risk?
A) Sinus tachycardia
B) Ventricular fibrillation
C) Atrial flutter
D) Supraventricular tachycardia
E) Junctional rhythm
Correct Answer: C) Atrial flutter
Rationale: Atrial flutter is characterized by a rapid, regular atrial
rhythm (typically 250-350 bpm) with distinct "sawtooth" flutter
waves on the ECG, particularly in leads II, III, and aVF. Similar to
atrial fibrillation, it carries a significant risk of thrombus formation
and systemic embolization, necessitating anticoagulation.
Question 3
A patient on a mechanical ventilator has a sudden drop in SpO2 and
unilateral breath sounds. What is the most likely cause?
A) Pneumonia
B) Acute Respiratory Distress Syndrome (ARDS)
C) Endotracheal tube (ETT) displacement into the right mainstem bronchus
or pneumothorax
D) Pulmonary embolism
E) Ventilator circuit disconnection
Correct Answer: C) Endotracheal tube (ETT) displacement into the
,right mainstem bronchus or pneumothorax
Rationale: A sudden drop in SpO2 with unilateral breath sounds is
highly indicative of either the ETT having advanced into one of the
mainstem bronchi (most commonly the right) or a developing
pneumothorax. Both require immediate assessment and
intervention.
Question 4
Which assessment finding is most indicative of increased intracranial
pressure (ICP)?
A) Tachycardia, hypertension, and tachypnea
B) Bradycardia, hypertension (widening pulse pressure), and irregular
respirations (Cushing's Triad)
C) Hypothermia, hypotension, and bradycardia
D) Bilateral constricted pupils, normotension, and regular respirations
E) Absent Babinski reflex, normal reflexes, and Glasgow Coma Scale (GCS) of
15
Correct Answer: B) Bradycardia, hypertension (widening pulse
pressure), and irregular respirations (Cushing's Triad)
Rationale: Cushing's Triad (bradycardia, hypertension with a widening
pulse pressure, and irregular respirations) is a classic, late sign of
significantly increased ICP, indicating brainstem compression.
Question 5
A patient is receiving a continuous infusion of norepinephrine (Levophed).
Which hemodynamic parameter is the primary target for titration of this
medication?
A) Central Venous Pressure (CVP)
B) Pulmonary Artery Wedge Pressure (PAWP)
C) Mean Arterial Pressure (MAP)
D) Cardiac Output (CO)
E) Systemic Vascular Resistance (SVR)
Correct Answer: C) Mean Arterial Pressure (MAP)
Rationale: Norepinephrine is primarily a vasopressor used to increase
systemic vascular resistance and blood pressure. It is typically
titrated to achieve a target MAP, commonly 65 mmHg or higher, to
ensure adequate organ perfusion.
Question 6
What is the primary goal of therapeutic hypothermia in a post-cardiac arrest
patient?
,A) To prevent ventricular arrhythmias.
B) To reduce cerebral metabolic rate and minimize neurological injury.
C) To decrease the risk of pulmonary edema.
D) To promote rapid elimination of lactic acid.
E) To increase cardiac output.
Correct Answer: B) To reduce cerebral metabolic rate and minimize
neurological injury.
Rationale: Therapeutic hypothermia (Targeted Temperature
Management - TTM) in post-cardiac arrest patients aims to induce a
mild hypothermic state (typically 32-36°C) to reduce oxygen
demand and metabolic rate in the brain, thereby protecting against
ischemic brain injury.
Question 7
When assessing a patient with a suspected deep vein thrombosis (DVT) in
the lower extremity, which finding is most concerning?
A) Positive Homan's sign
B) Pain with dorsiflexion of the foot
C) Unilateral leg swelling, warmth, and tenderness
D) Bilateral leg edema
E) Cold, pale extremity
Correct Answer: C) Unilateral leg swelling, warmth, and tenderness
Rationale: Unilateral leg swelling, warmth, and tenderness are the
classic and most reliable signs of a DVT. Homan's sign is unreliable
and no longer recommended for DVT diagnosis due to low
sensitivity and specificity.
Question 8
A patient receiving mechanical ventilation is exhibiting signs of ventilator-
associated pneumonia (VAP). Which intervention is most effective in
preventing VAP?
A) Administering prophylactic antibiotics to all ventilated patients.
B) Maintaining the patient in a supine position.
C) Performing frequent oral care with chlorhexidine and elevating the head of
the bed to 30-45 degrees.
D) Daily chest physiotherapy for all patients.
E) Suctioning the ETT every hour around the clock.
Correct Answer: C) Performing frequent oral care with chlorhexidine
and elevating the head of the bed to 30-45 degrees.
Rationale: Key VAP prevention strategies include elevating the head
of the bed to 30-45 degrees, performing meticulous oral care (often
, with chlorhexidine), daily sedation vacations, and assessing
readiness for extubation.
Question 9
What is the most critical intervention for managing acute pulmonary edema
in a patient with severe heart failure?
A) Increased oral fluid intake.
B) Administration of IV diuretics (e.g., Furosemide) and vasodilators (e.g.,
Nitroglycerin).
C) Immediate surgical intervention.
D) Placement of a nasogastric tube.
E) Withholding all medications.
Correct Answer: B) Administration of IV diuretics (e.g., Furosemide)
and vasodilators (e.g., Nitroglycerin).
Rationale: Acute pulmonary edema requires aggressive fluid removal
and reduction of preload and afterload. IV diuretics rapidly reduce
fluid overload, and vasodilators decrease venous return and
systemic vascular resistance, improving cardiac function and
reducing pulmonary congestion.
Question 10
Which electrolyte imbalance is most commonly associated with the
administration of large volumes of normal saline (0.9% NaCl)?
A) Hypokalemia
B) Hyperkalemia
C) Hyperchloremic metabolic acidosis
D) Hyponatremia
E) Hypocalcemia
Correct Answer: C) Hyperchloremic metabolic acidosis
Rationale: Normal saline has a high chloride content. Administering
large volumes can lead to an excess of chloride ions, which causes a
shift in the body's acid-base balance towards metabolic acidosis,
specifically hyperchloremic metabolic acidosis.
Question 11
A patient is admitted with a severe acute pancreatitis. Which laboratory
value is most indicative of the severity and prognosis of pancreatitis?
A) Amylase level
B) Lipase level
C) C-reactive protein (CRP)
D) White blood cell count
LATEST 100 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES |
Question 1
A patient in the ICU is admitted with septic shock. Which of the following is
the most appropriate initial fluid resuscitation strategy?
A) D5W at 100 mL/hr
B) 0.45% Sodium Chloride at 50 mL/hr
C) Rapid infusion of 30 mL/kg intravenous crystalloids
D) Albumin 25% at 500 mL/hr
E) Packed Red Blood Cells (PRBCs)
Correct Answer: C) Rapid infusion of 30 mL/kg intravenous crystalloids
Rationale: Current guidelines for septic shock recommend rapid
administration of 30 mL/kg of intravenous crystalloids within the
first 3 hours to restore intravascular volume and improve perfusion.
Question 2
Which of the following cardiac arrhythmias is characterized by a "sawtooth"
pattern on the electrocardiogram (ECG) and often requires anticoagulation
due to thrombus risk?
A) Sinus tachycardia
B) Ventricular fibrillation
C) Atrial flutter
D) Supraventricular tachycardia
E) Junctional rhythm
Correct Answer: C) Atrial flutter
Rationale: Atrial flutter is characterized by a rapid, regular atrial
rhythm (typically 250-350 bpm) with distinct "sawtooth" flutter
waves on the ECG, particularly in leads II, III, and aVF. Similar to
atrial fibrillation, it carries a significant risk of thrombus formation
and systemic embolization, necessitating anticoagulation.
Question 3
A patient on a mechanical ventilator has a sudden drop in SpO2 and
unilateral breath sounds. What is the most likely cause?
A) Pneumonia
B) Acute Respiratory Distress Syndrome (ARDS)
C) Endotracheal tube (ETT) displacement into the right mainstem bronchus
or pneumothorax
D) Pulmonary embolism
E) Ventilator circuit disconnection
Correct Answer: C) Endotracheal tube (ETT) displacement into the
,right mainstem bronchus or pneumothorax
Rationale: A sudden drop in SpO2 with unilateral breath sounds is
highly indicative of either the ETT having advanced into one of the
mainstem bronchi (most commonly the right) or a developing
pneumothorax. Both require immediate assessment and
intervention.
Question 4
Which assessment finding is most indicative of increased intracranial
pressure (ICP)?
A) Tachycardia, hypertension, and tachypnea
B) Bradycardia, hypertension (widening pulse pressure), and irregular
respirations (Cushing's Triad)
C) Hypothermia, hypotension, and bradycardia
D) Bilateral constricted pupils, normotension, and regular respirations
E) Absent Babinski reflex, normal reflexes, and Glasgow Coma Scale (GCS) of
15
Correct Answer: B) Bradycardia, hypertension (widening pulse
pressure), and irregular respirations (Cushing's Triad)
Rationale: Cushing's Triad (bradycardia, hypertension with a widening
pulse pressure, and irregular respirations) is a classic, late sign of
significantly increased ICP, indicating brainstem compression.
Question 5
A patient is receiving a continuous infusion of norepinephrine (Levophed).
Which hemodynamic parameter is the primary target for titration of this
medication?
A) Central Venous Pressure (CVP)
B) Pulmonary Artery Wedge Pressure (PAWP)
C) Mean Arterial Pressure (MAP)
D) Cardiac Output (CO)
E) Systemic Vascular Resistance (SVR)
Correct Answer: C) Mean Arterial Pressure (MAP)
Rationale: Norepinephrine is primarily a vasopressor used to increase
systemic vascular resistance and blood pressure. It is typically
titrated to achieve a target MAP, commonly 65 mmHg or higher, to
ensure adequate organ perfusion.
Question 6
What is the primary goal of therapeutic hypothermia in a post-cardiac arrest
patient?
,A) To prevent ventricular arrhythmias.
B) To reduce cerebral metabolic rate and minimize neurological injury.
C) To decrease the risk of pulmonary edema.
D) To promote rapid elimination of lactic acid.
E) To increase cardiac output.
Correct Answer: B) To reduce cerebral metabolic rate and minimize
neurological injury.
Rationale: Therapeutic hypothermia (Targeted Temperature
Management - TTM) in post-cardiac arrest patients aims to induce a
mild hypothermic state (typically 32-36°C) to reduce oxygen
demand and metabolic rate in the brain, thereby protecting against
ischemic brain injury.
Question 7
When assessing a patient with a suspected deep vein thrombosis (DVT) in
the lower extremity, which finding is most concerning?
A) Positive Homan's sign
B) Pain with dorsiflexion of the foot
C) Unilateral leg swelling, warmth, and tenderness
D) Bilateral leg edema
E) Cold, pale extremity
Correct Answer: C) Unilateral leg swelling, warmth, and tenderness
Rationale: Unilateral leg swelling, warmth, and tenderness are the
classic and most reliable signs of a DVT. Homan's sign is unreliable
and no longer recommended for DVT diagnosis due to low
sensitivity and specificity.
Question 8
A patient receiving mechanical ventilation is exhibiting signs of ventilator-
associated pneumonia (VAP). Which intervention is most effective in
preventing VAP?
A) Administering prophylactic antibiotics to all ventilated patients.
B) Maintaining the patient in a supine position.
C) Performing frequent oral care with chlorhexidine and elevating the head of
the bed to 30-45 degrees.
D) Daily chest physiotherapy for all patients.
E) Suctioning the ETT every hour around the clock.
Correct Answer: C) Performing frequent oral care with chlorhexidine
and elevating the head of the bed to 30-45 degrees.
Rationale: Key VAP prevention strategies include elevating the head
of the bed to 30-45 degrees, performing meticulous oral care (often
, with chlorhexidine), daily sedation vacations, and assessing
readiness for extubation.
Question 9
What is the most critical intervention for managing acute pulmonary edema
in a patient with severe heart failure?
A) Increased oral fluid intake.
B) Administration of IV diuretics (e.g., Furosemide) and vasodilators (e.g.,
Nitroglycerin).
C) Immediate surgical intervention.
D) Placement of a nasogastric tube.
E) Withholding all medications.
Correct Answer: B) Administration of IV diuretics (e.g., Furosemide)
and vasodilators (e.g., Nitroglycerin).
Rationale: Acute pulmonary edema requires aggressive fluid removal
and reduction of preload and afterload. IV diuretics rapidly reduce
fluid overload, and vasodilators decrease venous return and
systemic vascular resistance, improving cardiac function and
reducing pulmonary congestion.
Question 10
Which electrolyte imbalance is most commonly associated with the
administration of large volumes of normal saline (0.9% NaCl)?
A) Hypokalemia
B) Hyperkalemia
C) Hyperchloremic metabolic acidosis
D) Hyponatremia
E) Hypocalcemia
Correct Answer: C) Hyperchloremic metabolic acidosis
Rationale: Normal saline has a high chloride content. Administering
large volumes can lead to an excess of chloride ions, which causes a
shift in the body's acid-base balance towards metabolic acidosis,
specifically hyperchloremic metabolic acidosis.
Question 11
A patient is admitted with a severe acute pancreatitis. Which laboratory
value is most indicative of the severity and prognosis of pancreatitis?
A) Amylase level
B) Lipase level
C) C-reactive protein (CRP)
D) White blood cell count
