RELIAS / PROPHECY HEALTHCARE ASSESSMENTS
General ICU RN A V3
Official Practice Exam · 2026/2027 Edition
100 Verified Questions with Detailed Answers and Rationales
Questions: 100 Minutes: 120 Passing Score: 80% Sections: 6
Table of Contents
Section 1: Cardiovascular 18 questions Q1
Section 2: Pulmonary 18 questions Q19
Section 3: Neurological 16 questions Q37
Section 4: Renal & Electrolyte 16 questions Q53
Section 5: Pharmacology & Medication Administration 16 questions Q69
Section 6: Professional Practice & Patient Safety 16 questions Q85
Instructions
This practice exam is designed to simulate the Relias/Prophecy General ICU RN A V3 assessment. The exam
consists of 100 multiple-choice questions divided into 6 clinical sections. You have 120 minutes to complete all
questions. A passing score of 80% (80 out of 100) is required. Each question has four answer choices with
exactly one correct answer. After answering all questions, review the detailed rationales provided for each
question to reinforce your understanding. The correct answer is indicated in green bold text, and a rationale box
explains the clinical reasoning. Use the Answer Key at the end for a quick reference of all correct responses.
Relias ICU RN A V3 -- 2026/2027 | Passing Score: 80% | Page 1 of 52
, Section 1: Cardiovascular
Q1 Question 1 of 100
A 67-year-old male presents to the ICU after an acute ST-elevation myocardial infarction with
persistent chest pain despite two doses of sublingual nitroglycerin. His blood pressure is 88/52
mmHg, heart rate is 112 bpm, and the cardiac monitor shows sinus tachycardia with occasional
PVCs. The nurse should anticipate the immediate initiation of which intervention?
A. Intravenous norepinephrine to support perfusion pressure while preparing for reperfusion therapy
B. Intravenous nitroprusside to reduce afterload and improve coronary perfusion
C. Oral metoprolol to reduce myocardial oxygen demand and control tachycardia
D. Intravenous amiodarone to suppress PVCs and prevent ventricular fibrillation
Correct Answer: A
Rationale:
The patient is in cardiogenic shock with hypotension following an STEMI. Norepinephrine is the vasopressor of choice
to support perfusion pressure while the patient is prepared for emergent reperfusion (PCI or fibrinolytics). Nitroprusside
would worsen hypotension, metoprolol is contraindicated in acute decompensated heart failure, and amiodarone is not
indicated for occasional PVCs in this hemodynamically unstable patient.
Q2 Question 2 of 100
A 72-year-old female with a history of heart failure is admitted with worsening dyspnea, bilateral
crackles, and jugular venous distension. Her current medications include furosemide 40 mg daily,
lisinopril 10 mg daily, and metoprolol 25 mg twice daily. Her BNP level is 1,840 pg/mL and her weight
has increased 6 pounds over three days. The nurse should prioritize which assessment finding as
most concerning for progression to cardiogenic shock?
A. Oliguria with a urine output of 15 mL/hr over the past two hours
B. Bounding peripheral pulses with warm extremities
C. Crackles that clear after one dose of IV furosemide
D. Heart rate increase from 78 to 96 bpm with activity
Correct Answer: A
Rationale:
Oliguria (urine output less than 30 mL/hr) in the setting of acute decompensated heart failure indicates significantly
reduced renal perfusion and is an early warning sign of cardiogenic shock. This finding suggests the cardiac output has
dropped to a level that end-organ perfusion is compromised. Bounding pulses suggest a high-output state, clearing
crackles indicate treatment response, and a mild HR increase with activity is expected.
Relias ICU RN A V3 -- 2026/2027 | Passing Score: 80% | Page 2 of 52
,Q3 Question 3 of 100
A 58-year-old male is admitted to the ICU with new-onset atrial fibrillation with rapid ventricular
response. His heart rate is 156 bpm, blood pressure is 102/64 mmHg, and he reports chest
discomfort and lightheadedness. The physician orders rate control. The nurse should prepare to
administer which first-line medication while closely monitoring for its potential adverse effect?
A. Diltiazem IV bolus followed by continuous infusion, monitoring for hypotension
B. Adenosine 6 mg IV push for immediate cardioversion effect
C. Amiodarone IV loading dose, monitoring for pulmonary toxicity
D. Digoxin IV loading dose, monitoring for visual disturbances
Correct Answer: A
Rationale:
IV diltiazem is a first-line rate control agent for AF with RVR in patients without decompensated heart failure. Its primary
adverse effect is hypotension, which must be closely monitored especially during the bolus dose. Adenosine is used for
SVT rather than AF, amiodarone is second-line and acute pulmonary toxicity is not an immediate concern, and digoxin
has a slow onset and is not appropriate for acute rate control.
Q4 Question 4 of 100
A 63-year-old post-coronary artery bypass graft patient has a mediastinal chest tube draining 250 mL
in the first hour and 200 mL in the second hour. The patient becomes tachycardic, hypotensive, and
has muffled heart sounds on auscultation. The nurse should recognize these findings as most
consistent with which complication?
A. Cardiac tamponade requiring emergent surgical intervention
B. Pneumothorax with tension physiology requiring needle decompression
C. Acute myocardial infarction requiring immediate cardiac catheterization
D. Hemothorax requiring placement of a second chest tube
Correct Answer: A
Rationale:
The combination of excessive mediastinal drainage, Beck triad (hypotension, tachycardia, muffled heart sounds), and
recent cardiac surgery is classic for cardiac tamponade. This is a surgical emergency requiring emergent re-exploration.
Pneumothorax would show absent breath sounds, MI would show ECG changes, and hemothorax would present with
decreasing hemoglobin and dullness to percussion rather than muffled heart sounds.
Relias ICU RN A V3 -- 2026/2027 | Passing Score: 80% | Page 3 of 52
, Q5 Question 5 of 100
A 71-year-old female in the ICU has a pulmonary artery catheter in place following mitral valve
replacement. Her hemodynamic profile shows: cardiac output 3.2 L/min, cardiac index 1.7 L/min/m2,
pulmonary artery wedge pressure 22 mmHg, and systemic vascular resistance 1,800 dynes-sec/cm5.
These values are most consistent with which hemodynamic profile?
A. Cardiogenic shock with high filling pressures and low cardiac output
B. Distributive shock with low SVR and high cardiac output
C. Hypovolemic shock with low filling pressures and high SVR
D. Obstructive shock with equalization of diastolic pressures
Correct Answer: A
Rationale:
The hemodynamic profile shows low cardiac output (normal 4-8 L/min), low cardiac index (normal 2.5-4.0), elevated
PAWP (normal 6-12 mmHg), and elevated SVR (normal 800-1200). This pattern of poor pump function with high filling
pressures and compensatory vasoconstriction is classic for cardiogenic shock. Distributive shock has low SVR,
hypovolemic shock has low filling pressures, and obstructive shock shows equalization of diastolic pressures.
Q6 Question 6 of 100
A 55-year-old male is receiving norepinephrine at 0.2 mcg/kg/min for septic shock. Despite escalating
the dose to 0.5 mcg/kg/min, his mean arterial pressure remains at 58 mmHg. The critical care nurse
anticipates the addition of which second-line vasopressor per current sepsis guidelines?
A. Vasopressin at 0.03 units/min as an adjunct to norepinephrine
B. Phenylephrine to provide pure alpha-1 vasoconstriction
C. Epinephrine at 0.1 mcg/kg/min as a replacement for norepinephrine
D. Dopamine at 10 mcg/kg/min to increase both pressure and heart rate
Correct Answer: A
Rationale:
Current Surviving Sepsis Campaign guidelines recommend adding vasopressin at 0.03 units/min as a second-line agent
when norepinephrine doses escalate beyond 0.25-0.5 mcg/kg/min. Vasopressin acts via V1 receptors to cause
vasoconstriction and can help reduce norepinephrine requirements. Phenylephrine reduces cardiac output, epinephrine
increases lactate, and high-dose dopamine causes significant tachyarrhythmias.
Relias ICU RN A V3 -- 2026/2027 | Passing Score: 80% | Page 4 of 52
General ICU RN A V3
Official Practice Exam · 2026/2027 Edition
100 Verified Questions with Detailed Answers and Rationales
Questions: 100 Minutes: 120 Passing Score: 80% Sections: 6
Table of Contents
Section 1: Cardiovascular 18 questions Q1
Section 2: Pulmonary 18 questions Q19
Section 3: Neurological 16 questions Q37
Section 4: Renal & Electrolyte 16 questions Q53
Section 5: Pharmacology & Medication Administration 16 questions Q69
Section 6: Professional Practice & Patient Safety 16 questions Q85
Instructions
This practice exam is designed to simulate the Relias/Prophecy General ICU RN A V3 assessment. The exam
consists of 100 multiple-choice questions divided into 6 clinical sections. You have 120 minutes to complete all
questions. A passing score of 80% (80 out of 100) is required. Each question has four answer choices with
exactly one correct answer. After answering all questions, review the detailed rationales provided for each
question to reinforce your understanding. The correct answer is indicated in green bold text, and a rationale box
explains the clinical reasoning. Use the Answer Key at the end for a quick reference of all correct responses.
Relias ICU RN A V3 -- 2026/2027 | Passing Score: 80% | Page 1 of 52
, Section 1: Cardiovascular
Q1 Question 1 of 100
A 67-year-old male presents to the ICU after an acute ST-elevation myocardial infarction with
persistent chest pain despite two doses of sublingual nitroglycerin. His blood pressure is 88/52
mmHg, heart rate is 112 bpm, and the cardiac monitor shows sinus tachycardia with occasional
PVCs. The nurse should anticipate the immediate initiation of which intervention?
A. Intravenous norepinephrine to support perfusion pressure while preparing for reperfusion therapy
B. Intravenous nitroprusside to reduce afterload and improve coronary perfusion
C. Oral metoprolol to reduce myocardial oxygen demand and control tachycardia
D. Intravenous amiodarone to suppress PVCs and prevent ventricular fibrillation
Correct Answer: A
Rationale:
The patient is in cardiogenic shock with hypotension following an STEMI. Norepinephrine is the vasopressor of choice
to support perfusion pressure while the patient is prepared for emergent reperfusion (PCI or fibrinolytics). Nitroprusside
would worsen hypotension, metoprolol is contraindicated in acute decompensated heart failure, and amiodarone is not
indicated for occasional PVCs in this hemodynamically unstable patient.
Q2 Question 2 of 100
A 72-year-old female with a history of heart failure is admitted with worsening dyspnea, bilateral
crackles, and jugular venous distension. Her current medications include furosemide 40 mg daily,
lisinopril 10 mg daily, and metoprolol 25 mg twice daily. Her BNP level is 1,840 pg/mL and her weight
has increased 6 pounds over three days. The nurse should prioritize which assessment finding as
most concerning for progression to cardiogenic shock?
A. Oliguria with a urine output of 15 mL/hr over the past two hours
B. Bounding peripheral pulses with warm extremities
C. Crackles that clear after one dose of IV furosemide
D. Heart rate increase from 78 to 96 bpm with activity
Correct Answer: A
Rationale:
Oliguria (urine output less than 30 mL/hr) in the setting of acute decompensated heart failure indicates significantly
reduced renal perfusion and is an early warning sign of cardiogenic shock. This finding suggests the cardiac output has
dropped to a level that end-organ perfusion is compromised. Bounding pulses suggest a high-output state, clearing
crackles indicate treatment response, and a mild HR increase with activity is expected.
Relias ICU RN A V3 -- 2026/2027 | Passing Score: 80% | Page 2 of 52
,Q3 Question 3 of 100
A 58-year-old male is admitted to the ICU with new-onset atrial fibrillation with rapid ventricular
response. His heart rate is 156 bpm, blood pressure is 102/64 mmHg, and he reports chest
discomfort and lightheadedness. The physician orders rate control. The nurse should prepare to
administer which first-line medication while closely monitoring for its potential adverse effect?
A. Diltiazem IV bolus followed by continuous infusion, monitoring for hypotension
B. Adenosine 6 mg IV push for immediate cardioversion effect
C. Amiodarone IV loading dose, monitoring for pulmonary toxicity
D. Digoxin IV loading dose, monitoring for visual disturbances
Correct Answer: A
Rationale:
IV diltiazem is a first-line rate control agent for AF with RVR in patients without decompensated heart failure. Its primary
adverse effect is hypotension, which must be closely monitored especially during the bolus dose. Adenosine is used for
SVT rather than AF, amiodarone is second-line and acute pulmonary toxicity is not an immediate concern, and digoxin
has a slow onset and is not appropriate for acute rate control.
Q4 Question 4 of 100
A 63-year-old post-coronary artery bypass graft patient has a mediastinal chest tube draining 250 mL
in the first hour and 200 mL in the second hour. The patient becomes tachycardic, hypotensive, and
has muffled heart sounds on auscultation. The nurse should recognize these findings as most
consistent with which complication?
A. Cardiac tamponade requiring emergent surgical intervention
B. Pneumothorax with tension physiology requiring needle decompression
C. Acute myocardial infarction requiring immediate cardiac catheterization
D. Hemothorax requiring placement of a second chest tube
Correct Answer: A
Rationale:
The combination of excessive mediastinal drainage, Beck triad (hypotension, tachycardia, muffled heart sounds), and
recent cardiac surgery is classic for cardiac tamponade. This is a surgical emergency requiring emergent re-exploration.
Pneumothorax would show absent breath sounds, MI would show ECG changes, and hemothorax would present with
decreasing hemoglobin and dullness to percussion rather than muffled heart sounds.
Relias ICU RN A V3 -- 2026/2027 | Passing Score: 80% | Page 3 of 52
, Q5 Question 5 of 100
A 71-year-old female in the ICU has a pulmonary artery catheter in place following mitral valve
replacement. Her hemodynamic profile shows: cardiac output 3.2 L/min, cardiac index 1.7 L/min/m2,
pulmonary artery wedge pressure 22 mmHg, and systemic vascular resistance 1,800 dynes-sec/cm5.
These values are most consistent with which hemodynamic profile?
A. Cardiogenic shock with high filling pressures and low cardiac output
B. Distributive shock with low SVR and high cardiac output
C. Hypovolemic shock with low filling pressures and high SVR
D. Obstructive shock with equalization of diastolic pressures
Correct Answer: A
Rationale:
The hemodynamic profile shows low cardiac output (normal 4-8 L/min), low cardiac index (normal 2.5-4.0), elevated
PAWP (normal 6-12 mmHg), and elevated SVR (normal 800-1200). This pattern of poor pump function with high filling
pressures and compensatory vasoconstriction is classic for cardiogenic shock. Distributive shock has low SVR,
hypovolemic shock has low filling pressures, and obstructive shock shows equalization of diastolic pressures.
Q6 Question 6 of 100
A 55-year-old male is receiving norepinephrine at 0.2 mcg/kg/min for septic shock. Despite escalating
the dose to 0.5 mcg/kg/min, his mean arterial pressure remains at 58 mmHg. The critical care nurse
anticipates the addition of which second-line vasopressor per current sepsis guidelines?
A. Vasopressin at 0.03 units/min as an adjunct to norepinephrine
B. Phenylephrine to provide pure alpha-1 vasoconstriction
C. Epinephrine at 0.1 mcg/kg/min as a replacement for norepinephrine
D. Dopamine at 10 mcg/kg/min to increase both pressure and heart rate
Correct Answer: A
Rationale:
Current Surviving Sepsis Campaign guidelines recommend adding vasopressin at 0.03 units/min as a second-line agent
when norepinephrine doses escalate beyond 0.25-0.5 mcg/kg/min. Vasopressin acts via V1 receptors to cause
vasoconstriction and can help reduce norepinephrine requirements. Phenylephrine reduces cardiac output, epinephrine
increases lactate, and high-dose dopamine causes significant tachyarrhythmias.
Relias ICU RN A V3 -- 2026/2027 | Passing Score: 80% | Page 4 of 52
