HESI RN CRITICAL CARE /CRITICAL CARE RN HESI
EXAM 300 ACTUAL QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE LATEST UPDATE
ALREADY GRADED A+
This comprehensive set of 300 unique multiple-choice questions is meticulously
designed to prepare candidates for the HESI RN Critical Care exam by covering
the full spectrum of high-acuity nursing content. The questions are systematically
organized into sections addressing hemodynamic monitoring, respiratory failure,
cardiac emergencies, neurological critical care, sepsis, trauma, burns, endocrine
crises, pharmacology, and complex multi-system conditions. Each question
includes a correct answer with a detailed rationale to reinforce clinical reasoning
and evidence-based practice. The content emphasizes rapid assessment,
prioritization, and intervention skills essential for managing unstable patients in
intensive care, emergency, and other critical care environments. This resource
serves as an invaluable study tool for mastering the complexities of critical care
nursing and achieving success on the HESI examination.
Section 1: Critical Care Patient Assessment and Triage
Question 1: A patient in the ICU develops sudden dyspnea, tachypnea, and
decreased oxygen saturation after prolonged bed rest. Which condition is the nurse
most concerned about initially?
A) Pneumonia
B) Pulmonary embolism
C) Asthma exacerbation
D) Pleural effusion
Correct Answer: B
Rationale: Sudden onset dyspnea and hypoxemia after immobility strongly suggest
pulmonary embolism due to venous thrombus migration. Pneumonia develops
more gradually with fever and productive cough. Asthma is typically episodic with
wheezing history, while pleural effusion presents with gradual respiratory
compromise and decreased breath sounds rather than abrupt hypoxia .
,Question 2: A patient on mechanical ventilation shows increased peak airway
pressures and decreased tidal volume delivery. What is the priority nursing action?
A) Increase FiO₂
B) Suction the endotracheal tube
C) Check for ventilator circuit obstruction
D) Administer sedatives
Correct Answer: C
Rationale: Increased peak pressures with reduced tidal volume often indicate
mechanical obstruction such as kinked tubing or secretions. Oxygen adjustment
does not resolve mechanical issues. Suctioning may be needed but only after
ensuring patency of the system. Sedation is unrelated to ventilator malfunction .
Question 3: An ABG result shows pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L.
How should this be interpreted?
A) Metabolic acidosis with compensation
B) Respiratory acidosis
C) Metabolic alkalosis
D) Respiratory alkalosis
Correct Answer: B
Rationale: The pH is low (acidosis), PaCO₂ is elevated (respiratory component),
and HCO₃⁻ is normal. This indicates acute respiratory acidosis without metabolic
compensation .
Question 4: 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
Correct Answer: B
Rationale: A GCS of 8 or less indicates an inability to protect the airway. GCS of
8, intubate is the gold standard for preventing aspiration and ensuring oxygenation
.
Question 5: Which acid-base imbalance is most commonly seen in early sepsis?
A) Respiratory acidosis
,B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Correct Answer: C
Rationale: Early sepsis causes hyperventilation due to fever and hypoperfusion,
leading to CO₂ loss and respiratory alkalosis. Later stages may progress to
metabolic acidosis due to lactic acid accumulation .
Question 6: A client admitted to the ICU after colon resection with a loop
colostomy has clean and dry abdominal dressing. Vital signs are: HR 130, Temp
100°F, BP 88/65, urine output 10 mL/hr. What intervention should the nurse
implement?
A) Begin antibiotics for infection
B) Give a 500 mL IV fluid bolus challenge
C) Apply a cooling blanket for fever
D) Notify the surgeon for wound assessment
Correct Answer: B
Rationale: Tachycardia, hypotension, and oliguria indicate hypovolemia likely
from bleeding or fluid shifts postoperatively. A fluid bolus is appropriate to restore
circulating volume and improve tissue perfusion .
Question 7: A mechanically ventilated patient suddenly becomes agitated,
tachycardic, and desaturates. What is the first nursing intervention?
A) Increase sedation immediately
B) Assess airway and ventilator connection
C) Obtain ABG sample
D) Administer bronchodilator
Correct Answer: B
Rationale: Acute deterioration requires immediate assessment of airway patency
and equipment function before medication administration or diagnostics .
Question 8: The nurse is calculating fluid resuscitation for a young adult male who
was burned in an accident at 1200 and is seen in the ER at 1400. The healthcare
provider determines that the client has burns over 30% of his body. Using the
Parkland formula, the client is to receive 7000 mL of fluid in 24 hours. Which goal
should the nurse establish for this client's plan of care?
A) By 1800, the client will have received 3500 mL of fluid
, B) By 2000, the client will have received 3500 mL of fluid
C) By 1400, the client will have received 7000 mL of fluid
D) By 0200, the client will have received 7000 mL of fluid
Correct Answer: B
Rationale: The Parkland formula prescribes half of the total 24-hour fluid volume
within the first 8 hours post-burn, and the remainder over the next 16 hours. Since
the burn occurred at 1200, half (3500 mL) should be infused by 2000 (8 hours after
injury) .
Question 9: Which clinical finding suggests effective oxygenation in a ventilated
patient?
A) PaO₂ 55 mmHg
B) SpO₂ 92% with stable vital signs
C) Respiratory rate 30/min
D) Use of accessory muscles
Correct Answer: B
Rationale: Adequate oxygenation is indicated by acceptable oxygen saturation and
stable hemodynamics. Tachypnea and accessory muscle use suggest distress .
Question 10: A patient with ARDS is placed in prone positioning. What is the
primary expected benefit?
A) Reduced cardiac workload
B) Improved oxygenation by alveolar recruitment
C) Decreased infection risk
D) Increased lung compliance permanently
Correct Answer: B
Rationale: Prone positioning redistributes perfusion and improves ventilation-
perfusion matching, enhancing oxygenation in ARDS .
Section 2: Hemodynamic Monitoring and Shock Management
Question 11: A client's central venous pressure (CVP) reading is 1 mmHg. What
does this indicate?
A) Fluid overload
B) Hypovolemia
C) Right ventricular failure
D) Pulmonary embolism
EXAM 300 ACTUAL QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE LATEST UPDATE
ALREADY GRADED A+
This comprehensive set of 300 unique multiple-choice questions is meticulously
designed to prepare candidates for the HESI RN Critical Care exam by covering
the full spectrum of high-acuity nursing content. The questions are systematically
organized into sections addressing hemodynamic monitoring, respiratory failure,
cardiac emergencies, neurological critical care, sepsis, trauma, burns, endocrine
crises, pharmacology, and complex multi-system conditions. Each question
includes a correct answer with a detailed rationale to reinforce clinical reasoning
and evidence-based practice. The content emphasizes rapid assessment,
prioritization, and intervention skills essential for managing unstable patients in
intensive care, emergency, and other critical care environments. This resource
serves as an invaluable study tool for mastering the complexities of critical care
nursing and achieving success on the HESI examination.
Section 1: Critical Care Patient Assessment and Triage
Question 1: A patient in the ICU develops sudden dyspnea, tachypnea, and
decreased oxygen saturation after prolonged bed rest. Which condition is the nurse
most concerned about initially?
A) Pneumonia
B) Pulmonary embolism
C) Asthma exacerbation
D) Pleural effusion
Correct Answer: B
Rationale: Sudden onset dyspnea and hypoxemia after immobility strongly suggest
pulmonary embolism due to venous thrombus migration. Pneumonia develops
more gradually with fever and productive cough. Asthma is typically episodic with
wheezing history, while pleural effusion presents with gradual respiratory
compromise and decreased breath sounds rather than abrupt hypoxia .
,Question 2: A patient on mechanical ventilation shows increased peak airway
pressures and decreased tidal volume delivery. What is the priority nursing action?
A) Increase FiO₂
B) Suction the endotracheal tube
C) Check for ventilator circuit obstruction
D) Administer sedatives
Correct Answer: C
Rationale: Increased peak pressures with reduced tidal volume often indicate
mechanical obstruction such as kinked tubing or secretions. Oxygen adjustment
does not resolve mechanical issues. Suctioning may be needed but only after
ensuring patency of the system. Sedation is unrelated to ventilator malfunction .
Question 3: An ABG result shows pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L.
How should this be interpreted?
A) Metabolic acidosis with compensation
B) Respiratory acidosis
C) Metabolic alkalosis
D) Respiratory alkalosis
Correct Answer: B
Rationale: The pH is low (acidosis), PaCO₂ is elevated (respiratory component),
and HCO₃⁻ is normal. This indicates acute respiratory acidosis without metabolic
compensation .
Question 4: 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
Correct Answer: B
Rationale: A GCS of 8 or less indicates an inability to protect the airway. GCS of
8, intubate is the gold standard for preventing aspiration and ensuring oxygenation
.
Question 5: Which acid-base imbalance is most commonly seen in early sepsis?
A) Respiratory acidosis
,B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Correct Answer: C
Rationale: Early sepsis causes hyperventilation due to fever and hypoperfusion,
leading to CO₂ loss and respiratory alkalosis. Later stages may progress to
metabolic acidosis due to lactic acid accumulation .
Question 6: A client admitted to the ICU after colon resection with a loop
colostomy has clean and dry abdominal dressing. Vital signs are: HR 130, Temp
100°F, BP 88/65, urine output 10 mL/hr. What intervention should the nurse
implement?
A) Begin antibiotics for infection
B) Give a 500 mL IV fluid bolus challenge
C) Apply a cooling blanket for fever
D) Notify the surgeon for wound assessment
Correct Answer: B
Rationale: Tachycardia, hypotension, and oliguria indicate hypovolemia likely
from bleeding or fluid shifts postoperatively. A fluid bolus is appropriate to restore
circulating volume and improve tissue perfusion .
Question 7: A mechanically ventilated patient suddenly becomes agitated,
tachycardic, and desaturates. What is the first nursing intervention?
A) Increase sedation immediately
B) Assess airway and ventilator connection
C) Obtain ABG sample
D) Administer bronchodilator
Correct Answer: B
Rationale: Acute deterioration requires immediate assessment of airway patency
and equipment function before medication administration or diagnostics .
Question 8: The nurse is calculating fluid resuscitation for a young adult male who
was burned in an accident at 1200 and is seen in the ER at 1400. The healthcare
provider determines that the client has burns over 30% of his body. Using the
Parkland formula, the client is to receive 7000 mL of fluid in 24 hours. Which goal
should the nurse establish for this client's plan of care?
A) By 1800, the client will have received 3500 mL of fluid
, B) By 2000, the client will have received 3500 mL of fluid
C) By 1400, the client will have received 7000 mL of fluid
D) By 0200, the client will have received 7000 mL of fluid
Correct Answer: B
Rationale: The Parkland formula prescribes half of the total 24-hour fluid volume
within the first 8 hours post-burn, and the remainder over the next 16 hours. Since
the burn occurred at 1200, half (3500 mL) should be infused by 2000 (8 hours after
injury) .
Question 9: Which clinical finding suggests effective oxygenation in a ventilated
patient?
A) PaO₂ 55 mmHg
B) SpO₂ 92% with stable vital signs
C) Respiratory rate 30/min
D) Use of accessory muscles
Correct Answer: B
Rationale: Adequate oxygenation is indicated by acceptable oxygen saturation and
stable hemodynamics. Tachypnea and accessory muscle use suggest distress .
Question 10: A patient with ARDS is placed in prone positioning. What is the
primary expected benefit?
A) Reduced cardiac workload
B) Improved oxygenation by alveolar recruitment
C) Decreased infection risk
D) Increased lung compliance permanently
Correct Answer: B
Rationale: Prone positioning redistributes perfusion and improves ventilation-
perfusion matching, enhancing oxygenation in ARDS .
Section 2: Hemodynamic Monitoring and Shock Management
Question 11: A client's central venous pressure (CVP) reading is 1 mmHg. What
does this indicate?
A) Fluid overload
B) Hypovolemia
C) Right ventricular failure
D) Pulmonary embolism
