NGN HESI RN Critical Care Exam V2
(2026/2027) Verified Actual Exam
Questions with 100% Correct Answers
& Expert Rationales Graded A+ –
Latest Version
Q1 A client is admitted to the ICU with acute respiratory distress syndrome (ARDS). The nurse
notes the PaO₂/FiO₂ ratio is 140. How should the nurse classify the severity of ARDS?
Answer: Severe ARDS
Rationale: The Berlin Definition classifies ARDS severity as:
Mild: 200–300 mmHg
Moderate: 100–200 mmHg
Severe: ≤100 mmHg A PaO₂/FiO₂ ratio of 140 indicates severe ARDS.
Q2 A client with septic shock is receiving norepinephrine. The nurse notes the client’s mean
arterial pressure (MAP) is 55 mmHg despite a norepinephrine dose of 0.5 mcg/kg/min. What is
the nurse’s priority action?
Answer: Notify the healthcare provider immediately
Rationale: Persistent hypotension (MAP <65 mmHg) despite adequate norepinephrine indicates
refractory septic shock. The provider should be notified for consideration of adding vasopressin
or other therapies (Surviving Sepsis Campaign 2021 guidelines, still current in 2026).
Q3 A client with diabetic ketoacidosis (DKA) has a serum potassium level of 3.1 mEq/L after 4
hours of insulin and fluid therapy. What is the nurse’s priority action?
, Answer: Administer potassium replacement as prescribed
Rationale: Insulin therapy drives potassium into cells, causing hypokalemia even if initial levels
were normal/high. Potassium replacement is critical to prevent arrhythmias.
Q4 A client with acute pancreatitis develops sudden shortness of breath and hypotension. The
nurse suspects:
Answer: Acute respiratory distress syndrome (ARDS)
Rationale: ARDS is a common pulmonary complication of severe acute pancreatitis due to
systemic inflammation and capillary leak.
Q5 The nurse is caring for a client with a pulmonary artery catheter. Which hemodynamic
parameter indicates cardiogenic shock?
Answer: Elevated pulmonary artery wedge pressure (PAWP) and low cardiac index
Rationale: Cardiogenic shock is characterized by pump failure: high filling pressures (PAWP
>18 mmHg) and low cardiac output (cardiac index <2.2 L/min/m²).
Q6 A client is receiving mechanical ventilation with positive end-expiratory pressure (PEEP) at
12 cm H₂O. The nurse notes decreased breath sounds and hypotension. What is the priority
action?
Answer: Decrease PEEP
Rationale: High PEEP can cause tension pneumothorax or decreased venous return →
hypotension. Immediate reduction of PEEP is indicated while preparing for chest tube insertion
if pneumothorax is suspected.
Q7 A client with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 28 mmHg.
Which medication should the nurse anticipate administering?
Answer: Mannitol
Rationale: Mannitol is an osmotic diuretic used to reduce ICP in TBI when ICP >20–25 mmHg
and cerebral perfusion pressure is adequate.
(2026/2027) Verified Actual Exam
Questions with 100% Correct Answers
& Expert Rationales Graded A+ –
Latest Version
Q1 A client is admitted to the ICU with acute respiratory distress syndrome (ARDS). The nurse
notes the PaO₂/FiO₂ ratio is 140. How should the nurse classify the severity of ARDS?
Answer: Severe ARDS
Rationale: The Berlin Definition classifies ARDS severity as:
Mild: 200–300 mmHg
Moderate: 100–200 mmHg
Severe: ≤100 mmHg A PaO₂/FiO₂ ratio of 140 indicates severe ARDS.
Q2 A client with septic shock is receiving norepinephrine. The nurse notes the client’s mean
arterial pressure (MAP) is 55 mmHg despite a norepinephrine dose of 0.5 mcg/kg/min. What is
the nurse’s priority action?
Answer: Notify the healthcare provider immediately
Rationale: Persistent hypotension (MAP <65 mmHg) despite adequate norepinephrine indicates
refractory septic shock. The provider should be notified for consideration of adding vasopressin
or other therapies (Surviving Sepsis Campaign 2021 guidelines, still current in 2026).
Q3 A client with diabetic ketoacidosis (DKA) has a serum potassium level of 3.1 mEq/L after 4
hours of insulin and fluid therapy. What is the nurse’s priority action?
, Answer: Administer potassium replacement as prescribed
Rationale: Insulin therapy drives potassium into cells, causing hypokalemia even if initial levels
were normal/high. Potassium replacement is critical to prevent arrhythmias.
Q4 A client with acute pancreatitis develops sudden shortness of breath and hypotension. The
nurse suspects:
Answer: Acute respiratory distress syndrome (ARDS)
Rationale: ARDS is a common pulmonary complication of severe acute pancreatitis due to
systemic inflammation and capillary leak.
Q5 The nurse is caring for a client with a pulmonary artery catheter. Which hemodynamic
parameter indicates cardiogenic shock?
Answer: Elevated pulmonary artery wedge pressure (PAWP) and low cardiac index
Rationale: Cardiogenic shock is characterized by pump failure: high filling pressures (PAWP
>18 mmHg) and low cardiac output (cardiac index <2.2 L/min/m²).
Q6 A client is receiving mechanical ventilation with positive end-expiratory pressure (PEEP) at
12 cm H₂O. The nurse notes decreased breath sounds and hypotension. What is the priority
action?
Answer: Decrease PEEP
Rationale: High PEEP can cause tension pneumothorax or decreased venous return →
hypotension. Immediate reduction of PEEP is indicated while preparing for chest tube insertion
if pneumothorax is suspected.
Q7 A client with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 28 mmHg.
Which medication should the nurse anticipate administering?
Answer: Mannitol
Rationale: Mannitol is an osmotic diuretic used to reduce ICP in TBI when ICP >20–25 mmHg
and cerebral perfusion pressure is adequate.
