CRITICAL CARE EXIT HESI EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Advanced Cardiac Life Support and Hemodynamic Monitoring
Respiratory Failure and Mechanical Ventilation Management
Acute Kidney Injury and Renal Replacement Therapy
Critical Care Pharmacology and Vasoactive Medications
Neurological Critical Care and Intracranial Pressure Management
Sepsis, Shock States, and Multiorgan Dysfunction
Postoperative Critical Care and Surgical Complications
Ethics, End-of-Life Care, and Legal Compliance in Critical Care
Patient Safety, Infection Control, and Regulatory Standards
Clinical Judgment, Prioritization, and Decision-Making in Emergencies
, This comprehensive assessment evaluates critical care nursing competencies
essential for safe and effective practice in high-acuity settings. The exam is designed to measure knowledge
across advanced cardiovascular management, respiratory care, hemodynamic monitoring, critical care
pharmacology, sepsis and shock management, neurological critical care, and multiorgan dysfunction.
Questions employ a multiple-choice format with scenario-based clinical situations that emphasize real-world
application, priority setting, and critical decision-making. Candidates will demonstrate their ability to assess
complex patients, intervene appropriately, prioritize care among competing needs, and apply regulatory and
ethical standards. This exam mirrors the challenges of critical care practice and prepares nurses for the HESI
Critical Care Exit Exam and subsequent professional certification.
Section One: Questions 1–100
Question 1
A patient in the ICU has a blood pressure of 78/40 mmHg, heart rate of 128 bpm, and cool, clammy skin.
Lactate is 5.2 mmol/L. Which type of shock is most likely?
A. Neurogenic shock
B. Anaphylactic shock
C. Cardiogenic shock
D. Hypovolemic shock
🟢 Correct answer: D
🔴 RATIONALE: Cool, clammy skin, tachycardia, hypotension, and elevated lactate indicate hypovolemic shock
from poor tissue perfusion. Cardiogenic shock typically presents with warm skin initially; neurogenic shock has
warm dry skin; anaphylactic shock includes wheezing and rash.
,Question 2
A patient on mechanical ventilation has an arterial blood gas showing pH 7.28, PaCO₂ 52 mmHg, PaO₂ 68
mmHg, and HCO₃ 24 mEq/L. What is the acid-base disturbance?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
🟢 Correct answer: C
🔴 RATIONALE: Low pH with elevated PaCO₂ and normal HCO₃ indicates uncompensated respiratory
acidosis from hypoventilation. Metabolic disturbances would show abnormal HCO₃ levels.
Question 3
Which vasoactive medication is the first-line treatment for septic shock after adequate fluid resuscitation?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
🟢 Correct answer: B
🔴 RATIONALE: Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Guidelines.
Dopamine has higher arrhythmia risk; epinephrine is second-line; vasopressin is added if norepinephrine fails.
, Question 4
A patient with acute kidney injury has a serum potassium of 6.8 mEq/L. Which intervention is the priority?
A. Administer oral potassium binders
B. Prepare for emergent dialysis
C. Give IV calcium gluconate
D. Administer IV insulin and glucose
🟢 Correct answer: C
🔴 RATIONALE: IV calcium gluconate stabilizes the cardiac membrane immediately to prevent arrhythmias
from hyperkalemia. Insulin/glucose lowers potassium but takes 15-30 minutes; dialysis is definitive but not
immediate; oral binders are too slow.
Question 5
Which assessment finding indicates successful treatment of cardiogenic shock?
A. Urine output 15 mL/hour
B. Serum lactate decreasing from 4.5 to 2.1 mmol/L
C. Blood pressure 88/54 mmHg
D. Heart rate 118 bpm
🟢 Correct answer: B
🔴 RATIONALE: Decreasing lactate indicates improved tissue perfusion and resolution of shock. Low urine
output, hypotension, and tachycardia indicate ongoing shock.
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Advanced Cardiac Life Support and Hemodynamic Monitoring
Respiratory Failure and Mechanical Ventilation Management
Acute Kidney Injury and Renal Replacement Therapy
Critical Care Pharmacology and Vasoactive Medications
Neurological Critical Care and Intracranial Pressure Management
Sepsis, Shock States, and Multiorgan Dysfunction
Postoperative Critical Care and Surgical Complications
Ethics, End-of-Life Care, and Legal Compliance in Critical Care
Patient Safety, Infection Control, and Regulatory Standards
Clinical Judgment, Prioritization, and Decision-Making in Emergencies
, This comprehensive assessment evaluates critical care nursing competencies
essential for safe and effective practice in high-acuity settings. The exam is designed to measure knowledge
across advanced cardiovascular management, respiratory care, hemodynamic monitoring, critical care
pharmacology, sepsis and shock management, neurological critical care, and multiorgan dysfunction.
Questions employ a multiple-choice format with scenario-based clinical situations that emphasize real-world
application, priority setting, and critical decision-making. Candidates will demonstrate their ability to assess
complex patients, intervene appropriately, prioritize care among competing needs, and apply regulatory and
ethical standards. This exam mirrors the challenges of critical care practice and prepares nurses for the HESI
Critical Care Exit Exam and subsequent professional certification.
Section One: Questions 1–100
Question 1
A patient in the ICU has a blood pressure of 78/40 mmHg, heart rate of 128 bpm, and cool, clammy skin.
Lactate is 5.2 mmol/L. Which type of shock is most likely?
A. Neurogenic shock
B. Anaphylactic shock
C. Cardiogenic shock
D. Hypovolemic shock
🟢 Correct answer: D
🔴 RATIONALE: Cool, clammy skin, tachycardia, hypotension, and elevated lactate indicate hypovolemic shock
from poor tissue perfusion. Cardiogenic shock typically presents with warm skin initially; neurogenic shock has
warm dry skin; anaphylactic shock includes wheezing and rash.
,Question 2
A patient on mechanical ventilation has an arterial blood gas showing pH 7.28, PaCO₂ 52 mmHg, PaO₂ 68
mmHg, and HCO₃ 24 mEq/L. What is the acid-base disturbance?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
🟢 Correct answer: C
🔴 RATIONALE: Low pH with elevated PaCO₂ and normal HCO₃ indicates uncompensated respiratory
acidosis from hypoventilation. Metabolic disturbances would show abnormal HCO₃ levels.
Question 3
Which vasoactive medication is the first-line treatment for septic shock after adequate fluid resuscitation?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
🟢 Correct answer: B
🔴 RATIONALE: Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Guidelines.
Dopamine has higher arrhythmia risk; epinephrine is second-line; vasopressin is added if norepinephrine fails.
, Question 4
A patient with acute kidney injury has a serum potassium of 6.8 mEq/L. Which intervention is the priority?
A. Administer oral potassium binders
B. Prepare for emergent dialysis
C. Give IV calcium gluconate
D. Administer IV insulin and glucose
🟢 Correct answer: C
🔴 RATIONALE: IV calcium gluconate stabilizes the cardiac membrane immediately to prevent arrhythmias
from hyperkalemia. Insulin/glucose lowers potassium but takes 15-30 minutes; dialysis is definitive but not
immediate; oral binders are too slow.
Question 5
Which assessment finding indicates successful treatment of cardiogenic shock?
A. Urine output 15 mL/hour
B. Serum lactate decreasing from 4.5 to 2.1 mmol/L
C. Blood pressure 88/54 mmHg
D. Heart rate 118 bpm
🟢 Correct answer: B
🔴 RATIONALE: Decreasing lactate indicates improved tissue perfusion and resolution of shock. Low urine
output, hypotension, and tachycardia indicate ongoing shock.
