Critical Care HESI Exit Exam V1 2026/2027 NGN – Complete
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
SECTION 1: STANDALONE CRITICAL CARE MCQs (30
Questions)
Question 1
A 68-year-old client admitted with ST-elevation myocardial infarction (STEMI) has the
following hemodynamic parameters 2 hours post-cardiac catheterization: BP 82/54
mmHg, HR 118 bpm, CVP 4 mmHg, PAOP 6 mmHg, CI 1.9 L/min/m², SVR 1800
dynes·sec/cm⁵. The client is cool, clammy, and oliguric. Which intervention should the
nurse anticipate first?
A. Administer a 500 mL bolus of lactated Ringer's solution
B. Initiate dobutamine at 2.5 mcg/kg/min
C. Prepare for intra-aortic balloon pump insertion
D. Begin norepinephrine at 0.05 mcg/kg/min
Correct Answer: A
Rationale: The client exhibits cardiogenic shock with low CI (1.9), low PAOP (6), and low
CVP (4), indicating inadequate preload despite hypotension. While the CI is low, the
PAOP and CVP are also low, suggesting hypovolemia may be contributing. A cautious
fluid bolus is indicated first to optimize preload before initiating vasopressors or
,inotropes. Dobutamine (B) would increase contractility but could worsen hypotension
without adequate preload. Norepinephrine (D) is appropriate if hypotension persists
after preload optimization. IABP (C) is reserved for refractory cardiogenic shock.
Question 2
A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with the following settings: VC-AC, Vt 6 mL/kg (ideal body weight), PEEP 12
cmH₂O, FiO₂ 70%, RR 28. Arterial blood gas results: pH 7.32, PaCO₂ 52 mmHg, PaO₂ 58
mmHg, HCO₃⁻ 26 mEq/L, SaO₂ 88%. Which ventilator adjustment should the nurse
anticipate the provider to order first?
A. Increase FiO₂ to 80%
B. Increase PEEP to 16 cmH₂O
C. Increase respiratory rate to 32
D. Switch to pressure control ventilation
Correct Answer: B
Rationale: The client has refractory hypoxemia (PaO₂ 58 on 70% FiO₂) with adequate
ventilation (PaCO₂ 52 with compensatory metabolic alkalosis). In ARDS, the priority is to
improve oxygenation through alveolar recruitment. Increasing PEEP (B) is the most
appropriate intervention to recruit collapsed alveoli and improve PaO₂ without
increasing oxygen toxicity risk. Increasing FiO₂ (A) above 60% increases risk of oxygen
toxicity. Increasing RR (C) would address ventilation, not oxygenation. Switching modes
(D) may be considered later but does not directly address the primary problem of
refractory hypoxemia.
Question 3
,A client with a Glasgow Coma Scale (GCS) score of 8 following a traumatic brain injury
has the following vital signs: BP 180/92 mmHg, HR 52 bpm, RR 10/min (irregular),
temperature 37.2°C (99.0°F). Pupils are 3 mm right, 5 mm left; left pupil is nonreactive.
Which action should the nurse take first?
A. Administer mannitol 1 g/kg IV
B. Prepare for emergent intubation
C. Hyperventilate the client to a PaCO₂ of 30 mmHg
D. Elevate the head of the bed to 30 degrees
Correct Answer: B
Rationale: The client exhibits signs of uncal herniation (Cushing's triad: hypertension,
bradycardia, irregular respirations; plus unilateral pupillary dilation). A GCS of 8 or less
with declining respiratory status mandates airway protection through emergent
intubation (B) to prevent secondary brain injury from hypoxia and hypercapnia. Mannitol
(A) is appropriate after airway is secured. Hyperventilation (C) is only a temporary
bridge during herniation and is not appropriate without intubation. Head elevation (D) is
appropriate for ICP management but does not address the immediate life threat of
airway compromise.
Question 4
A client in diabetic ketoacidosis (DKA) has the following laboratory values: glucose 485
mg/dL, pH 7.18, PaCO₂ 22 mmHg, HCO₃⁻ 8 mEq/L, potassium 3.2 mEq/L, anion gap 28.
An insulin infusion is running at 0.1 units/kg/hr. Which finding requires immediate
nursing intervention?
A. Blood glucose decreasing to 250 mg/dL over 4 hours
, B. Potassium decreasing from 3.2 to 2.9 mEq/L after 2 hours of insulin
C. Serum bicarbonate increasing from 8 to 12 mEq/L
D. Urine output of 250 mL/hr for 2 consecutive hours
Correct Answer: B
Rationale: Insulin drives potassium intracellularly, and DKA clients are already total-body
potassium depleted despite serum levels. A potassium of 2.9 mEq/L is critically low and
places the client at immediate risk for lethal arrhythmias. Insulin must be held and
potassium aggressively replaced per protocol. Glucose decreasing to 250 (A) is
expected and appropriate. Bicarbonate rising (C) indicates resolution of acidosis.
Polyuria (D) is expected with osmotic diuresis and fluid resuscitation.
Question 5
A client with septic shock has the following parameters after 3 L of crystalloid
resuscitation: BP 88/56 mmHg (MAP 67), HR 128 bpm, CVP 14 mmHg, ScvO₂ 58%,
lactate 5.2 mmol/L. Which intervention is the priority?
A. Administer additional 1 L crystalloid bolus
B. Initiate norepinephrine to maintain MAP ≥ 65 mmHg
C. Begin dobutamine to improve ScvO₂
D. Transfuse 2 units packed red blood cells
Correct Answer: B
Rationale: Despite adequate fluid resuscitation (CVP 14), the client remains hypotensive
with inadequate tissue perfusion (elevated lactate, low ScvO₂). Per Surviving Sepsis
Campaign guidelines, vasopressors (norepinephrine) should be initiated to maintain
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
SECTION 1: STANDALONE CRITICAL CARE MCQs (30
Questions)
Question 1
A 68-year-old client admitted with ST-elevation myocardial infarction (STEMI) has the
following hemodynamic parameters 2 hours post-cardiac catheterization: BP 82/54
mmHg, HR 118 bpm, CVP 4 mmHg, PAOP 6 mmHg, CI 1.9 L/min/m², SVR 1800
dynes·sec/cm⁵. The client is cool, clammy, and oliguric. Which intervention should the
nurse anticipate first?
A. Administer a 500 mL bolus of lactated Ringer's solution
B. Initiate dobutamine at 2.5 mcg/kg/min
C. Prepare for intra-aortic balloon pump insertion
D. Begin norepinephrine at 0.05 mcg/kg/min
Correct Answer: A
Rationale: The client exhibits cardiogenic shock with low CI (1.9), low PAOP (6), and low
CVP (4), indicating inadequate preload despite hypotension. While the CI is low, the
PAOP and CVP are also low, suggesting hypovolemia may be contributing. A cautious
fluid bolus is indicated first to optimize preload before initiating vasopressors or
,inotropes. Dobutamine (B) would increase contractility but could worsen hypotension
without adequate preload. Norepinephrine (D) is appropriate if hypotension persists
after preload optimization. IABP (C) is reserved for refractory cardiogenic shock.
Question 2
A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with the following settings: VC-AC, Vt 6 mL/kg (ideal body weight), PEEP 12
cmH₂O, FiO₂ 70%, RR 28. Arterial blood gas results: pH 7.32, PaCO₂ 52 mmHg, PaO₂ 58
mmHg, HCO₃⁻ 26 mEq/L, SaO₂ 88%. Which ventilator adjustment should the nurse
anticipate the provider to order first?
A. Increase FiO₂ to 80%
B. Increase PEEP to 16 cmH₂O
C. Increase respiratory rate to 32
D. Switch to pressure control ventilation
Correct Answer: B
Rationale: The client has refractory hypoxemia (PaO₂ 58 on 70% FiO₂) with adequate
ventilation (PaCO₂ 52 with compensatory metabolic alkalosis). In ARDS, the priority is to
improve oxygenation through alveolar recruitment. Increasing PEEP (B) is the most
appropriate intervention to recruit collapsed alveoli and improve PaO₂ without
increasing oxygen toxicity risk. Increasing FiO₂ (A) above 60% increases risk of oxygen
toxicity. Increasing RR (C) would address ventilation, not oxygenation. Switching modes
(D) may be considered later but does not directly address the primary problem of
refractory hypoxemia.
Question 3
,A client with a Glasgow Coma Scale (GCS) score of 8 following a traumatic brain injury
has the following vital signs: BP 180/92 mmHg, HR 52 bpm, RR 10/min (irregular),
temperature 37.2°C (99.0°F). Pupils are 3 mm right, 5 mm left; left pupil is nonreactive.
Which action should the nurse take first?
A. Administer mannitol 1 g/kg IV
B. Prepare for emergent intubation
C. Hyperventilate the client to a PaCO₂ of 30 mmHg
D. Elevate the head of the bed to 30 degrees
Correct Answer: B
Rationale: The client exhibits signs of uncal herniation (Cushing's triad: hypertension,
bradycardia, irregular respirations; plus unilateral pupillary dilation). A GCS of 8 or less
with declining respiratory status mandates airway protection through emergent
intubation (B) to prevent secondary brain injury from hypoxia and hypercapnia. Mannitol
(A) is appropriate after airway is secured. Hyperventilation (C) is only a temporary
bridge during herniation and is not appropriate without intubation. Head elevation (D) is
appropriate for ICP management but does not address the immediate life threat of
airway compromise.
Question 4
A client in diabetic ketoacidosis (DKA) has the following laboratory values: glucose 485
mg/dL, pH 7.18, PaCO₂ 22 mmHg, HCO₃⁻ 8 mEq/L, potassium 3.2 mEq/L, anion gap 28.
An insulin infusion is running at 0.1 units/kg/hr. Which finding requires immediate
nursing intervention?
A. Blood glucose decreasing to 250 mg/dL over 4 hours
, B. Potassium decreasing from 3.2 to 2.9 mEq/L after 2 hours of insulin
C. Serum bicarbonate increasing from 8 to 12 mEq/L
D. Urine output of 250 mL/hr for 2 consecutive hours
Correct Answer: B
Rationale: Insulin drives potassium intracellularly, and DKA clients are already total-body
potassium depleted despite serum levels. A potassium of 2.9 mEq/L is critically low and
places the client at immediate risk for lethal arrhythmias. Insulin must be held and
potassium aggressively replaced per protocol. Glucose decreasing to 250 (A) is
expected and appropriate. Bicarbonate rising (C) indicates resolution of acidosis.
Polyuria (D) is expected with osmotic diuresis and fluid resuscitation.
Question 5
A client with septic shock has the following parameters after 3 L of crystalloid
resuscitation: BP 88/56 mmHg (MAP 67), HR 128 bpm, CVP 14 mmHg, ScvO₂ 58%,
lactate 5.2 mmol/L. Which intervention is the priority?
A. Administer additional 1 L crystalloid bolus
B. Initiate norepinephrine to maintain MAP ≥ 65 mmHg
C. Begin dobutamine to improve ScvO₂
D. Transfuse 2 units packed red blood cells
Correct Answer: B
Rationale: Despite adequate fluid resuscitation (CVP 14), the client remains hypotensive
with inadequate tissue perfusion (elevated lactate, low ScvO₂). Per Surviving Sepsis
Campaign guidelines, vasopressors (norepinephrine) should be initiated to maintain
