HESI CRITICAL CARE EXAM
2026/2027
Actual Exam Questions and Answers with
Rationales
50 Verified Questions | 5 Clinical Domains | NGN-Aligned
Based on 2026/2027 Elsevier HESI Critical Care Curriculum
Next Generation NCLEX (NGN) Standards | Evidence-Based ICU Guidelines
,Key Features
✓ Advanced hemodynamic monitoring and cardiovascular support
✓ Mechanical ventilation management and arterial blood gas (ABG) interpretation
✓ Complex multisystem failure and shock management
✓ Advanced critical care pharmacology and sedation protocols
✓ Neurological assessments and intracranial pressure (ICP) management
Updates for 2026
1. Updated Surviving Sepsis Campaign guidelines for early recognition and bundle compliance, emphasizing
hourly reassessment and rapid antimicrobial administration within one hour of sepsis identification
2. Revised ARDSnet and advanced prone positioning protocols for severe hypoxemia, recommending early
initiation (within 12-24 hours) and extended prone sessions of at least 16 consecutive hours
3. New Elsevier frameworks for rapid response systems and managing acute clinical deterioration in the
ICU, incorporating NGN clinical judgment measurement model competencies
Abstract
This comprehensive assessment document addresses the advanced critical care nursing domains essential for
the 2026/2027 Elsevier HESI Critical Care specialty examination. It encompasses the complete scope of
intensive care practice, including advanced hemodynamic monitoring and cardiovascular support, mechanical
ventilation management with arterial blood gas interpretation, complex multisystem failure and shock
management, advanced critical care pharmacology and sedation protocols, and neurological assessments with
intracranial pressure management. Each of the 50 verified questions is aligned with Next Generation NCLEX
(NGN) clinical judgment measurement model competencies and reflects current evidence-based intensive care
nursing guidelines from the American Association of Critical-Care Nurses (AACN), the Surviving Sepsis
Campaign, the American Heart Association (AHA), and the Society of Critical Care Medicine (SCCM). The
document emphasizes the clinical judgment required for high-acuity patient care, the integration of life-support
technologies, and the professional and ethical responsibilities inherent in critical care nursing practice.
Keywords
HESI Critical Care, ICU Nursing, Hemodynamics, Mechanical Ventilation, Multisystem Failure, Advanced
Pharmacology, Shock Management, Clinical Judgment, NGN
Content Area Overview
Content Area Questions Key Topics Weight
Cardiovascular & Hemodynamic 1-10 PAWP, Cardiac Index, IABP, 20%
Monitoring Dysrhythmias, CVP, ACS,
Vasopressors, Arterial Lines, Heparin,
LVAD
Pulmonary & Mechanical 11-20 ABG Interpretation, ARDS/Vent 20%
Ventilation Settings, Pneumothorax, Prone
Positioning, Airway Resistance, COPD
Ventilation, SBT, HFOV,
Tracheostomy, Driving Pressure
Neurological & Multisystem 21-30 ICP/CPP, SAH Vasospasm, 20%
Disorders Sepsis/SOFA, Status Epilepticus,
AKI/RRT, DKA, Hepatic
HESI Critical Care Exam 2026/2027 | Page 1
, Content Area Questions Key Topics Weight
Encephalopathy, Neurogenic Shock,
Pancreatitis, GBS
Advanced Pharmacology & 31-40 PADIS/Sedation, HIT/Argatroban, 20%
Sedation Alcohol Withdrawal, Vancomycin,
Insulin DKA, Vasopressor
Extravasation, SVT/Adenosine,
Hyperkalemia, Anaphylaxis, PRIS
Professional Caring & Ethical 41-50 Autonomy/Ethics, Documentation 20%
Practices in ICU Integrity, Palliative Extubation,
HIPAA/Recording, Organ Donation,
Medication Error Reporting, Moral
Distress, DNR, CLABSI Bundle, SBAR
Examination Questions
Domain: Cardiovascular & Hemodynamic Monitoring
1. A patient in the ICU has a pulmonary artery catheter in place. The nurse notes a pulmonary
artery wedge pressure (PAWP) of 18 mmHg. What does this value indicate?
A. Hypovolemia
B. Normal left ventricular preload
C. Elevated left ventricular preload
D. Right ventricular failure
Correct Answer: C
Rationale: The normal PAWP range is 4 to 12 mmHg. A PAWP of 18 mmHg indicates elevated left
ventricular preload, which suggests fluid overload, left ventricular dysfunction, or mitral regurgitation.
The nurse should anticipate interventions such as diuretic administration or afterload reduction to
decrease the volume burden on the left ventricle and improve cardiac output.
Why Wrong: A is incorrect because hypovolemia would present with a low PAWP (below 4 mmHg). B is
incorrect because 18 mmHg exceeds the normal range. D is incorrect because right ventricular failure is
reflected by elevated right atrial pressure (CVP), not PAWP.
Reference: Elsevier HESI Critical Care Review, Ch. 4: Hemodynamic Monitoring; AACN Procedure
Manual, 8th ed.
2. A patient with cardiogenic shock has a cardiac index (CI) of 1.8 L/min/m2 and a systemic
vascular resistance (SVR) of 2200 dynes/sec/cm-5. Which vasopressor-inotrope combination is
most appropriate?
A. Nitroprusside alone
B. Dobutamine plus low-dose dopamine
C. Norepinephrine plus dobutamine
D. Epinephrine alone
Correct Answer: C
Rationale: Cardiogenic shock with a low CI and high SVR indicates a cold, vasoconstricted state with
poor pump function. Norepinephrine provides vasopressor support to maintain coronary perfusion
pressure, while dobutamine improves myocardial contractility and cardiac output. This combination
addresses both the low output and the need for adequate perfusion pressure without excessively increasing
afterload.
Why Wrong: A is incorrect because nitroprusside would further reduce blood pressure in an already
hypotensive patient. B is incorrect because low-dose dopamine has limited inotropic benefit and carries a
higher arrhythmia risk. D is incorrect because epinephrine alone increases heart rate and myocardial
oxygen demand excessively without targeted afterload management.
HESI Critical Care Exam 2026/2027 | Page 2
2026/2027
Actual Exam Questions and Answers with
Rationales
50 Verified Questions | 5 Clinical Domains | NGN-Aligned
Based on 2026/2027 Elsevier HESI Critical Care Curriculum
Next Generation NCLEX (NGN) Standards | Evidence-Based ICU Guidelines
,Key Features
✓ Advanced hemodynamic monitoring and cardiovascular support
✓ Mechanical ventilation management and arterial blood gas (ABG) interpretation
✓ Complex multisystem failure and shock management
✓ Advanced critical care pharmacology and sedation protocols
✓ Neurological assessments and intracranial pressure (ICP) management
Updates for 2026
1. Updated Surviving Sepsis Campaign guidelines for early recognition and bundle compliance, emphasizing
hourly reassessment and rapid antimicrobial administration within one hour of sepsis identification
2. Revised ARDSnet and advanced prone positioning protocols for severe hypoxemia, recommending early
initiation (within 12-24 hours) and extended prone sessions of at least 16 consecutive hours
3. New Elsevier frameworks for rapid response systems and managing acute clinical deterioration in the
ICU, incorporating NGN clinical judgment measurement model competencies
Abstract
This comprehensive assessment document addresses the advanced critical care nursing domains essential for
the 2026/2027 Elsevier HESI Critical Care specialty examination. It encompasses the complete scope of
intensive care practice, including advanced hemodynamic monitoring and cardiovascular support, mechanical
ventilation management with arterial blood gas interpretation, complex multisystem failure and shock
management, advanced critical care pharmacology and sedation protocols, and neurological assessments with
intracranial pressure management. Each of the 50 verified questions is aligned with Next Generation NCLEX
(NGN) clinical judgment measurement model competencies and reflects current evidence-based intensive care
nursing guidelines from the American Association of Critical-Care Nurses (AACN), the Surviving Sepsis
Campaign, the American Heart Association (AHA), and the Society of Critical Care Medicine (SCCM). The
document emphasizes the clinical judgment required for high-acuity patient care, the integration of life-support
technologies, and the professional and ethical responsibilities inherent in critical care nursing practice.
Keywords
HESI Critical Care, ICU Nursing, Hemodynamics, Mechanical Ventilation, Multisystem Failure, Advanced
Pharmacology, Shock Management, Clinical Judgment, NGN
Content Area Overview
Content Area Questions Key Topics Weight
Cardiovascular & Hemodynamic 1-10 PAWP, Cardiac Index, IABP, 20%
Monitoring Dysrhythmias, CVP, ACS,
Vasopressors, Arterial Lines, Heparin,
LVAD
Pulmonary & Mechanical 11-20 ABG Interpretation, ARDS/Vent 20%
Ventilation Settings, Pneumothorax, Prone
Positioning, Airway Resistance, COPD
Ventilation, SBT, HFOV,
Tracheostomy, Driving Pressure
Neurological & Multisystem 21-30 ICP/CPP, SAH Vasospasm, 20%
Disorders Sepsis/SOFA, Status Epilepticus,
AKI/RRT, DKA, Hepatic
HESI Critical Care Exam 2026/2027 | Page 1
, Content Area Questions Key Topics Weight
Encephalopathy, Neurogenic Shock,
Pancreatitis, GBS
Advanced Pharmacology & 31-40 PADIS/Sedation, HIT/Argatroban, 20%
Sedation Alcohol Withdrawal, Vancomycin,
Insulin DKA, Vasopressor
Extravasation, SVT/Adenosine,
Hyperkalemia, Anaphylaxis, PRIS
Professional Caring & Ethical 41-50 Autonomy/Ethics, Documentation 20%
Practices in ICU Integrity, Palliative Extubation,
HIPAA/Recording, Organ Donation,
Medication Error Reporting, Moral
Distress, DNR, CLABSI Bundle, SBAR
Examination Questions
Domain: Cardiovascular & Hemodynamic Monitoring
1. A patient in the ICU has a pulmonary artery catheter in place. The nurse notes a pulmonary
artery wedge pressure (PAWP) of 18 mmHg. What does this value indicate?
A. Hypovolemia
B. Normal left ventricular preload
C. Elevated left ventricular preload
D. Right ventricular failure
Correct Answer: C
Rationale: The normal PAWP range is 4 to 12 mmHg. A PAWP of 18 mmHg indicates elevated left
ventricular preload, which suggests fluid overload, left ventricular dysfunction, or mitral regurgitation.
The nurse should anticipate interventions such as diuretic administration or afterload reduction to
decrease the volume burden on the left ventricle and improve cardiac output.
Why Wrong: A is incorrect because hypovolemia would present with a low PAWP (below 4 mmHg). B is
incorrect because 18 mmHg exceeds the normal range. D is incorrect because right ventricular failure is
reflected by elevated right atrial pressure (CVP), not PAWP.
Reference: Elsevier HESI Critical Care Review, Ch. 4: Hemodynamic Monitoring; AACN Procedure
Manual, 8th ed.
2. A patient with cardiogenic shock has a cardiac index (CI) of 1.8 L/min/m2 and a systemic
vascular resistance (SVR) of 2200 dynes/sec/cm-5. Which vasopressor-inotrope combination is
most appropriate?
A. Nitroprusside alone
B. Dobutamine plus low-dose dopamine
C. Norepinephrine plus dobutamine
D. Epinephrine alone
Correct Answer: C
Rationale: Cardiogenic shock with a low CI and high SVR indicates a cold, vasoconstricted state with
poor pump function. Norepinephrine provides vasopressor support to maintain coronary perfusion
pressure, while dobutamine improves myocardial contractility and cardiac output. This combination
addresses both the low output and the need for adequate perfusion pressure without excessively increasing
afterload.
Why Wrong: A is incorrect because nitroprusside would further reduce blood pressure in an already
hypotensive patient. B is incorrect because low-dose dopamine has limited inotropic benefit and carries a
higher arrhythmia risk. D is incorrect because epinephrine alone increases heart rate and myocardial
oxygen demand excessively without targeted afterload management.
HESI Critical Care Exam 2026/2027 | Page 2
