HESI Critical Care Exam Prep Document
2026/2027 | Intensive Care Nursing, Clinical
Judgment and NGN
Section 1: Hemodynamics and Shock
1. A client with septic shock has a blood pressure of 78/45 mmHg, heart rate
125, CVP 4 mmHg, and urine output 15 mL/hour. Which intervention should the
nurse implement first?
A. Administer norepinephrine
B. Administer a 500 mL IV fluid bolus
C. Obtain blood cultures
D. Administer broad-spectrum antibiotics
Answer: B) Administer a 500 mL IV fluid bolus
Rationale: The initial treatment for septic shock is fluid resuscitation (30 mL/kg
crystalloid) before vasopressors, unless there is severe cardiac dysfunction. This
patient has low CVP (normal 6-12 mmHg) and low urine output, indicating
hypovolemia. Vasopressors are initiated after fluid resuscitation if hypotension
persists. Blood cultures and antibiotics are important but not first after volume
resuscitation.
2. A client with cardiogenic shock has a PAOP of 24 mmHg, cardiac index (CI) of
1.6 L/min/m² (normal >2.2), and SVR of 1400 dynes/sec/cm⁻⁵ (high). Which
medication does the nurse anticipate?
A. Dobutamine (positive inotrope)
B. Norepinephrine
C. Phenylephrine
D. IV fluids
,Answer: A) Dobutamine (positive inotrope)
Rationale: Cardiogenic shock presents with low cardiac index and high
afterload/SVR. Dobutamine or milrinone (inotropes with vasodilator properties)
are used to improve contractility and reduce afterload. Norepinephrine would
further increase afterload, worsening cardiac workload. Phenylephrine is a pure
vasoconstrictor. IV fluids would worsen pulmonary congestion given the elevated
PAOP.
3. A client in hypovolemic shock has a PAOP of 3 mmHg (normal 6-12). Which
finding is expected?
A. Decreased CVP, decreased urine output, tachycardia
B. Increased CVP, decreased urine output
C. Increased PAOP, crackles
D. Jugular venous distention (JVD)
Answer: A) Decreased CVP, decreased urine output, tachycardia
Rationale: Hypovolemic shock is characterized by low preload (low CVP, low PAOP),
low urine output (due to decreased renal perfusion), and tachycardia
(compensatory response to maintain cardiac output). Increased CVP, increased
PAOP, crackles, and JVD indicate fluid overload, not hypovolemia.
4. What is the target Mean Arterial Pressure (MAP) for adequate organ
perfusion in septic shock?
A. 50 mmHg
B. 60 mmHg
C. 65 mmHg
D. 80 mmHg
Answer: C) 65 mmHg
Rationale: A MAP of 65 mmHg is the minimum pressure required to ensure
adequate perfusion to the kidneys and brain. Vasopressors are titrated to achieve
this target after initial fluid resuscitation.
,5. A patient with a head injury has a GCS of 7 and a BP of 180/60 with
bradycardia. What is the priority?
A. Administer Mannitol
B. Prepare for endotracheal intubation
C. Position the patient in Trendelenburg
D. Obtain a Stat Head CT
Answer: B) Prepare for endotracheal intubation
Rationale: A GCS of 8 or less indicates inability to protect the airway. The priority is
intubation to prevent aspiration and ensure oxygenation. The "GCS of 8, intubate"
guideline takes priority over other interventions, including imaging. The Cushing's
triad (hypertension, bradycardia, irregular respirations) may indicate increased
ICP, but airway is still first.
6. Which EKG change is most concerning in a patient 4 hours post-PCI (stent
placement)?
A. Sinus Bradycardia (HR 58)
B. Occasional PVCs
C. New ST-segment elevation
D. Inverted T-waves
Answer: C) New ST-segment elevation
Rationale: Recurrent ST elevation indicates acute stent thrombosis or re-occlusion,
requiring an immediate return to the cardiac catheterization lab. This is a medical
emergency. Sinus bradycardia and occasional PVCs may be expected post-PCI.
Inverted T-waves can indicate ischemia but are less urgent than new ST elevation.
7. A client with acute decompensated heart failure presents with dyspnea,
crackles in all lung fields, and SpO2 of 88% on room air. Which interventions
should the nurse initiate first? (Select all that apply)
A. Apply supplemental oxygen via non-rebreather mask
B. Place the client in a high Fowler's position
C. Administer furosemide 40 mg IV push
, D. Obtain a stat chest x-ray
E. Start a continuous infusion of milrinone
Answer: A, B, C
Rationale: Immediate priorities are oxygenation (A), positioning to reduce preload
(B), and diuresis (C). A chest x-ray can wait until the patient is stabilized. Milrinone
is a second-line agent, not first-line for acute decompensated heart failure.
8. The nurse is evaluating a client's central venous pressure (CVP) readings that
are trending upwards. Which nursing problem is supported by the
pathophysiologic mechanism most likely causing the increases?
A. Decreased cardiac output
B. Ineffective peripheral tissue perfusion
C. Deficient fluid volume
D. Ineffective airway clearance
Answer: A) Decreased cardiac output
Rationale: Elevated CVP indicates increased right ventricular pressure, which
impairs venous return and decreases cardiac output. This can result from right-
sided heart failure, fluid overload, or pulmonary hypertension. Deficient fluid
volume would cause decreased CVP, not increased.
9. What is the "Classic Triad" for Cardiac Tamponade (Beck's Triad)?
A. Hypotension, muffled heart sounds, and JVD
B. Hypertension, tachycardia, and crackles
C. Fever, chest pain, and pericardial friction rub
D. Tachycardia, hypotension, and cyanosis
Answer: A) Hypotension, muffled heart sounds, and JVD
Rationale: Fluid in the pericardium prevents heart filling, causing hypotension and
JVD, and insulates the heart sounds, making them muffled. This is Beck's triad, a
medical emergency requiring immediate pericardiocentesis.
10. Which lab is the most specific for diagnosing an Acute Myocardial Infarction?
2026/2027 | Intensive Care Nursing, Clinical
Judgment and NGN
Section 1: Hemodynamics and Shock
1. A client with septic shock has a blood pressure of 78/45 mmHg, heart rate
125, CVP 4 mmHg, and urine output 15 mL/hour. Which intervention should the
nurse implement first?
A. Administer norepinephrine
B. Administer a 500 mL IV fluid bolus
C. Obtain blood cultures
D. Administer broad-spectrum antibiotics
Answer: B) Administer a 500 mL IV fluid bolus
Rationale: The initial treatment for septic shock is fluid resuscitation (30 mL/kg
crystalloid) before vasopressors, unless there is severe cardiac dysfunction. This
patient has low CVP (normal 6-12 mmHg) and low urine output, indicating
hypovolemia. Vasopressors are initiated after fluid resuscitation if hypotension
persists. Blood cultures and antibiotics are important but not first after volume
resuscitation.
2. A client with cardiogenic shock has a PAOP of 24 mmHg, cardiac index (CI) of
1.6 L/min/m² (normal >2.2), and SVR of 1400 dynes/sec/cm⁻⁵ (high). Which
medication does the nurse anticipate?
A. Dobutamine (positive inotrope)
B. Norepinephrine
C. Phenylephrine
D. IV fluids
,Answer: A) Dobutamine (positive inotrope)
Rationale: Cardiogenic shock presents with low cardiac index and high
afterload/SVR. Dobutamine or milrinone (inotropes with vasodilator properties)
are used to improve contractility and reduce afterload. Norepinephrine would
further increase afterload, worsening cardiac workload. Phenylephrine is a pure
vasoconstrictor. IV fluids would worsen pulmonary congestion given the elevated
PAOP.
3. A client in hypovolemic shock has a PAOP of 3 mmHg (normal 6-12). Which
finding is expected?
A. Decreased CVP, decreased urine output, tachycardia
B. Increased CVP, decreased urine output
C. Increased PAOP, crackles
D. Jugular venous distention (JVD)
Answer: A) Decreased CVP, decreased urine output, tachycardia
Rationale: Hypovolemic shock is characterized by low preload (low CVP, low PAOP),
low urine output (due to decreased renal perfusion), and tachycardia
(compensatory response to maintain cardiac output). Increased CVP, increased
PAOP, crackles, and JVD indicate fluid overload, not hypovolemia.
4. What is the target Mean Arterial Pressure (MAP) for adequate organ
perfusion in septic shock?
A. 50 mmHg
B. 60 mmHg
C. 65 mmHg
D. 80 mmHg
Answer: C) 65 mmHg
Rationale: A MAP of 65 mmHg is the minimum pressure required to ensure
adequate perfusion to the kidneys and brain. Vasopressors are titrated to achieve
this target after initial fluid resuscitation.
,5. A patient with a head injury has a GCS of 7 and a BP of 180/60 with
bradycardia. What is the priority?
A. Administer Mannitol
B. Prepare for endotracheal intubation
C. Position the patient in Trendelenburg
D. Obtain a Stat Head CT
Answer: B) Prepare for endotracheal intubation
Rationale: A GCS of 8 or less indicates inability to protect the airway. The priority is
intubation to prevent aspiration and ensure oxygenation. The "GCS of 8, intubate"
guideline takes priority over other interventions, including imaging. The Cushing's
triad (hypertension, bradycardia, irregular respirations) may indicate increased
ICP, but airway is still first.
6. Which EKG change is most concerning in a patient 4 hours post-PCI (stent
placement)?
A. Sinus Bradycardia (HR 58)
B. Occasional PVCs
C. New ST-segment elevation
D. Inverted T-waves
Answer: C) New ST-segment elevation
Rationale: Recurrent ST elevation indicates acute stent thrombosis or re-occlusion,
requiring an immediate return to the cardiac catheterization lab. This is a medical
emergency. Sinus bradycardia and occasional PVCs may be expected post-PCI.
Inverted T-waves can indicate ischemia but are less urgent than new ST elevation.
7. A client with acute decompensated heart failure presents with dyspnea,
crackles in all lung fields, and SpO2 of 88% on room air. Which interventions
should the nurse initiate first? (Select all that apply)
A. Apply supplemental oxygen via non-rebreather mask
B. Place the client in a high Fowler's position
C. Administer furosemide 40 mg IV push
, D. Obtain a stat chest x-ray
E. Start a continuous infusion of milrinone
Answer: A, B, C
Rationale: Immediate priorities are oxygenation (A), positioning to reduce preload
(B), and diuresis (C). A chest x-ray can wait until the patient is stabilized. Milrinone
is a second-line agent, not first-line for acute decompensated heart failure.
8. The nurse is evaluating a client's central venous pressure (CVP) readings that
are trending upwards. Which nursing problem is supported by the
pathophysiologic mechanism most likely causing the increases?
A. Decreased cardiac output
B. Ineffective peripheral tissue perfusion
C. Deficient fluid volume
D. Ineffective airway clearance
Answer: A) Decreased cardiac output
Rationale: Elevated CVP indicates increased right ventricular pressure, which
impairs venous return and decreases cardiac output. This can result from right-
sided heart failure, fluid overload, or pulmonary hypertension. Deficient fluid
volume would cause decreased CVP, not increased.
9. What is the "Classic Triad" for Cardiac Tamponade (Beck's Triad)?
A. Hypotension, muffled heart sounds, and JVD
B. Hypertension, tachycardia, and crackles
C. Fever, chest pain, and pericardial friction rub
D. Tachycardia, hypotension, and cyanosis
Answer: A) Hypotension, muffled heart sounds, and JVD
Rationale: Fluid in the pericardium prevents heart filling, causing hypotension and
JVD, and insulates the heart sounds, making them muffled. This is Beck's triad, a
medical emergency requiring immediate pericardiocentesis.
10. Which lab is the most specific for diagnosing an Acute Myocardial Infarction?
