HESI CRITICAL CARE EXIT PRACTICE EXAM 2025-2026 EDITION BY ELSEVIER HEALTH
SCIENCES - 150 ESSENTIAL QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
Cardiac Dysrhythmia Management
Hemodynamic Monitoring
Mechanical Ventilation Support
Neurological Critical Care
Renal Failure and Electrolyte Imbalance
Sepsis and Septic Shock Management
Ethics and Legal Nursing Standards
Pharmacology in Critical Care
INTRODUCTION
, *This practice exam is designed to simulate the rigorous environment of the HESI Critical Care
SECTION ONE: QUESTIONS 1–100
A patient in the ICU is being monitored for cardiogenic shock. Which hemodynamic finding is most
consistent
with this diagnosis?
A. Low pulmonary artery wedge pressure (PAWP)
B. Decreased systemic vascular resistance (SVR)
🟢 C. Increased pulmonary artery wedge pressure (PAWP)
D. Increased cardiac output (CO)
🔴 RATIONALE: Cardiogenic shock is characterized by pump failure, leading to fluid backup in the
lungs and elevated PAWP, low cardiac output, and compensatory increased SVR.
A patient is receiving mechanical ventilation. The low-pressure alarm sounds. What is the nurse's
priority action?
🟢 A. Assess the patient and the ventilator tubing connections
B. Suction the airway immediately
C. Increase the fraction of inspired oxygen (FiO2)
D. Document the finding in the chart
🔴 RATIONALE: Low-pressure alarms often indicate a disconnect or leak in the circuit. The nurse
must first ensure the patient's safety by checking connections.
Which rhythm requires immediate synchronized cardioversion?
A. Asystole
B. Stable ventricular tachycardia
🟢 C. Unstable supraventricular tachycardia
D. First-degree heart block
,🔴 RATIONALE: Unstable tachyarrhythmias (where the patient is symptomatic, such as
hypotension or chest pain) require synchronized cardioversion to restore sinus rhythm.
A patient with acute kidney injury is hyperkalemic. Which medication order should the nurse
anticipate to shift potassium into the cells?
A. Calcium gluconate
🟢 B. Regular insulin and dextrose
C. Sodium polystyrene sulfonate
D. Furosemide
🔴 RATIONALE: Regular insulin (with dextrose to prevent hypoglycemia) drives potassium into the
intracellular space, temporarily lowering serum levels.
What is a hallmark sign of neurogenic shock?
A. Tachycardia and diaphoresis
B. Hypertension and tachycardia
🟢 C. Bradycardia and hypotension
D. Warm, flushed skin only
🔴 RATIONALE: Neurogenic shock involves the loss of sympathetic tone, resulting in unopposed
parasympathetic activity, leading to bradycardia and systemic vasodilation (hypotension).
A nurse is caring for a patient with increased intracranial pressure (ICP). Which position is most
appropriate?
A. Trendelenburg position
🟢 B. Head of bed elevated 30 degrees
C. Prone position
D. Flat supine position
🔴 RATIONALE: Elevating the head of the bed to 30 degrees promotes venous drainage from the
brain, which helps reduce intracranial pressure.
, Which electrolyte imbalance is most commonly associated with Trousseau's sign?
🟢 A. Hypocalcemia
B. Hypernatremia
C. Hypokalemia
D. Hypermagnesemia
🔴 RATIONALE: Trousseau’s sign (carpopedal spasm induced by blood pressure cuff inflation) is a
clinical indicator of hypocalcemia.
A patient is on a heparin drip. The nurse notes the PTT is 120 seconds. What is the appropriate
action?
A. Continue the current rate
B. Administer protamine sulfate
🟢 C. Stop the infusion and notify the provider
D. Increase the rate
🔴 RATIONALE: A PTT of 120 seconds is significantly above the therapeutic range, increasing the
risk of hemorrhage. The infusion should be stopped.
A patient is diagnosed with sepsis. Which intervention should be prioritized within the first hour?
A. Administration of oral antibiotics
🟢 B. Administration of broad-spectrum IV antibiotics
C. Insertion of a central venous catheter
D. Initiation of enteral nutrition
🔴 RATIONALE: Early administration of broad-spectrum antibiotics is a core component of the
"sepsis bundle" to reduce mortality.
A patient on a ventilator has an increased peak inspiratory pressure (PIP). What is the most likely
cause?
A. A disconnected circuit
SCIENCES - 150 ESSENTIAL QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
Cardiac Dysrhythmia Management
Hemodynamic Monitoring
Mechanical Ventilation Support
Neurological Critical Care
Renal Failure and Electrolyte Imbalance
Sepsis and Septic Shock Management
Ethics and Legal Nursing Standards
Pharmacology in Critical Care
INTRODUCTION
, *This practice exam is designed to simulate the rigorous environment of the HESI Critical Care
SECTION ONE: QUESTIONS 1–100
A patient in the ICU is being monitored for cardiogenic shock. Which hemodynamic finding is most
consistent
with this diagnosis?
A. Low pulmonary artery wedge pressure (PAWP)
B. Decreased systemic vascular resistance (SVR)
🟢 C. Increased pulmonary artery wedge pressure (PAWP)
D. Increased cardiac output (CO)
🔴 RATIONALE: Cardiogenic shock is characterized by pump failure, leading to fluid backup in the
lungs and elevated PAWP, low cardiac output, and compensatory increased SVR.
A patient is receiving mechanical ventilation. The low-pressure alarm sounds. What is the nurse's
priority action?
🟢 A. Assess the patient and the ventilator tubing connections
B. Suction the airway immediately
C. Increase the fraction of inspired oxygen (FiO2)
D. Document the finding in the chart
🔴 RATIONALE: Low-pressure alarms often indicate a disconnect or leak in the circuit. The nurse
must first ensure the patient's safety by checking connections.
Which rhythm requires immediate synchronized cardioversion?
A. Asystole
B. Stable ventricular tachycardia
🟢 C. Unstable supraventricular tachycardia
D. First-degree heart block
,🔴 RATIONALE: Unstable tachyarrhythmias (where the patient is symptomatic, such as
hypotension or chest pain) require synchronized cardioversion to restore sinus rhythm.
A patient with acute kidney injury is hyperkalemic. Which medication order should the nurse
anticipate to shift potassium into the cells?
A. Calcium gluconate
🟢 B. Regular insulin and dextrose
C. Sodium polystyrene sulfonate
D. Furosemide
🔴 RATIONALE: Regular insulin (with dextrose to prevent hypoglycemia) drives potassium into the
intracellular space, temporarily lowering serum levels.
What is a hallmark sign of neurogenic shock?
A. Tachycardia and diaphoresis
B. Hypertension and tachycardia
🟢 C. Bradycardia and hypotension
D. Warm, flushed skin only
🔴 RATIONALE: Neurogenic shock involves the loss of sympathetic tone, resulting in unopposed
parasympathetic activity, leading to bradycardia and systemic vasodilation (hypotension).
A nurse is caring for a patient with increased intracranial pressure (ICP). Which position is most
appropriate?
A. Trendelenburg position
🟢 B. Head of bed elevated 30 degrees
C. Prone position
D. Flat supine position
🔴 RATIONALE: Elevating the head of the bed to 30 degrees promotes venous drainage from the
brain, which helps reduce intracranial pressure.
, Which electrolyte imbalance is most commonly associated with Trousseau's sign?
🟢 A. Hypocalcemia
B. Hypernatremia
C. Hypokalemia
D. Hypermagnesemia
🔴 RATIONALE: Trousseau’s sign (carpopedal spasm induced by blood pressure cuff inflation) is a
clinical indicator of hypocalcemia.
A patient is on a heparin drip. The nurse notes the PTT is 120 seconds. What is the appropriate
action?
A. Continue the current rate
B. Administer protamine sulfate
🟢 C. Stop the infusion and notify the provider
D. Increase the rate
🔴 RATIONALE: A PTT of 120 seconds is significantly above the therapeutic range, increasing the
risk of hemorrhage. The infusion should be stopped.
A patient is diagnosed with sepsis. Which intervention should be prioritized within the first hour?
A. Administration of oral antibiotics
🟢 B. Administration of broad-spectrum IV antibiotics
C. Insertion of a central venous catheter
D. Initiation of enteral nutrition
🔴 RATIONALE: Early administration of broad-spectrum antibiotics is a core component of the
"sepsis bundle" to reduce mortality.
A patient on a ventilator has an increased peak inspiratory pressure (PIP). What is the most likely
cause?
A. A disconnected circuit
