Updated 2026/2027 HESI RN Critical Care Nursing exam with correct
answers and rationales /instant pdf
1. A client admitted with cardiogenic shock has a blood pressure of 78/40 mmHg,
heart rate of 132 beats/min, cool clammy skin, and urine output of 18 mL/hr.
Which assessment finding requires immediate intervention?
A. Crackles heard throughout both lung fields
B. Heart rate of 132 beats/min
C. Urine output of 18 mL/hr
D. Cool, pale extremities
Correct Answer: A. Crackles heard throughout both lung fields
Rationale: Cardiogenic shock results from ineffective cardiac pumping. Crackles indicate
worsening pulmonary edema caused by left ventricular failure and impaired oxygenation.
Airway and breathing take priority because respiratory failure can rapidly become life-
threatening.
2. A client receiving a heparin infusion has an activated partial thromboplastin
time (aPTT) of 104 seconds. What is the nurse's priority action?
A. Increase the infusion rate
B. Continue the infusion as prescribed
C. Stop the infusion and notify the healthcare provider
D. Administer vitamin K
Correct Answer: C. Stop the infusion and notify the healthcare provider
Rationale: An aPTT of 104 seconds is significantly above the usual therapeutic range, placing
the client at high risk for bleeding. The nurse should stop the infusion according to protocol and
notify the healthcare provider. Vitamin K reverses warfarin, not heparin.
3. A client with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation. Which ventilator setting helps reduce ventilator-induced
lung injury?
A. High tidal volume (10–12 mL/kg)
B. Low tidal volume (4–8 mL/kg)
,C. Respiratory rate of 8 breaths/min
D. FiO₂ of 100% indefinitely
Correct Answer: B. Low tidal volume (4–8 mL/kg)
Rationale: Lung-protective ventilation uses low tidal volumes to reduce alveolar overdistention
and decrease mortality in ARDS. High tidal volumes increase the risk of barotrauma and
volutrauma.
4. A client develops sudden chest pain, hypotension, jugular venous distention,
and muffled heart sounds following cardiac surgery. Which complication should
the nurse suspect?
A. Pulmonary embolism
B. Cardiac tamponade
C. Myocardial infarction
D. Left-sided heart failure
Correct Answer: B. Cardiac tamponade
Rationale: Beck's triad—hypotension, jugular venous distention, and muffled heart sounds—is
characteristic of cardiac tamponade. Blood accumulates in the pericardial sac, impairing
ventricular filling and cardiac output.
5. Which laboratory value is most concerning in a client receiving IV insulin for
diabetic ketoacidosis?
A. Potassium 2.9 mEq/L
B. Sodium 136 mEq/L
C. Glucose 250 mg/dL
D. Bicarbonate 20 mEq/L
Correct Answer: A. Potassium 2.9 mEq/L
Rationale: Insulin drives potassium into cells, increasing the risk of severe hypokalemia. A
potassium level below 3.3 mEq/L requires potassium replacement before continuing insulin
therapy to prevent life-threatening dysrhythmias.
,6. A client with increased intracranial pressure suddenly develops a widened
pulse pressure, bradycardia, and irregular respirations. What should the nurse
do first?
A. Raise the head of the bed to 30 degrees
B. Administer morphine
C. Encourage coughing and deep breathing
D. Place the client flat in bed
Correct Answer: A. Raise the head of the bed to 30 degrees
Rationale: These findings indicate Cushing's triad, suggesting critically increased intracranial
pressure. Elevating the head of the bed promotes venous drainage and helps reduce intracranial
pressure while additional interventions are initiated.
7. A client with acute kidney injury has peaked T waves on the ECG and a serum
potassium level of 6.8 mEq/L. Which medication should the nurse expect to
administer first?
A. Sodium bicarbonate
B. Calcium gluconate
C. Furosemide
D. Regular insulin only
Correct Answer: B. Calcium gluconate
Rationale: Calcium gluconate does not lower potassium but immediately stabilizes the cardiac
membrane, reducing the risk of fatal dysrhythmias. Additional therapies to lower potassium are
administered afterward.
8. A client receiving norepinephrine for septic shock has a MAP of 70 mmHg but
develops cool, pale fingers. What is the nurse's priority action?
A. Discontinue the infusion immediately
B. Assess peripheral perfusion and infusion site
C. Increase the infusion rate
D. Encourage active range-of-motion exercises
Correct Answer: B. Assess peripheral perfusion and infusion site
, Rationale: Norepinephrine causes vasoconstriction, which can decrease peripheral circulation.
The nurse should assess for adequate tissue perfusion and possible IV infiltration before
changing therapy.
9. A client's central venous pressure (CVP) increases from 5 mmHg to 15 mmHg
after rapid fluid administration. Which interpretation is most appropriate?
A. The client remains hypovolemic.
B. The client may be developing fluid overload.
C. The client has improved oxygenation.
D. The client has metabolic alkalosis.
Correct Answer: B. The client may be developing fluid overload.
Rationale: A significant rise in CVP following aggressive fluid administration suggests
increased intravascular volume and possible fluid overload, especially when accompanied by
pulmonary congestion or worsening respiratory status.
10. A client with an inferior-wall myocardial infarction suddenly develops
hypotension after receiving nitroglycerin. What is the most likely explanation?
A. Nitroglycerin increased cardiac output.
B. The client has right ventricular infarction and is preload dependent.
C. The client developed pulmonary edema.
D. Nitroglycerin caused severe bradycardia.
Correct Answer: B. The client has right ventricular infarction and is preload dependent.
Rationale: Clients with right ventricular infarction depend on adequate preload to maintain
cardiac output. Nitroglycerin reduces preload through venodilation, which can cause profound
hypotension in these clients.
11. A client with septic shock has a serum lactate level of 5.8 mmol/L. Which
finding best indicates that treatment is effective?
A. Heart rate decreases from 118 to 108 beats/min
B. Urine output remains 20 mL/hr
C. Serum lactate decreases to 2.1 mmol/L
D. White blood cell count increases to 18,000/mm³
Correct Answer: C. Serum lactate decreases to 2.1 mmol/L
answers and rationales /instant pdf
1. A client admitted with cardiogenic shock has a blood pressure of 78/40 mmHg,
heart rate of 132 beats/min, cool clammy skin, and urine output of 18 mL/hr.
Which assessment finding requires immediate intervention?
A. Crackles heard throughout both lung fields
B. Heart rate of 132 beats/min
C. Urine output of 18 mL/hr
D. Cool, pale extremities
Correct Answer: A. Crackles heard throughout both lung fields
Rationale: Cardiogenic shock results from ineffective cardiac pumping. Crackles indicate
worsening pulmonary edema caused by left ventricular failure and impaired oxygenation.
Airway and breathing take priority because respiratory failure can rapidly become life-
threatening.
2. A client receiving a heparin infusion has an activated partial thromboplastin
time (aPTT) of 104 seconds. What is the nurse's priority action?
A. Increase the infusion rate
B. Continue the infusion as prescribed
C. Stop the infusion and notify the healthcare provider
D. Administer vitamin K
Correct Answer: C. Stop the infusion and notify the healthcare provider
Rationale: An aPTT of 104 seconds is significantly above the usual therapeutic range, placing
the client at high risk for bleeding. The nurse should stop the infusion according to protocol and
notify the healthcare provider. Vitamin K reverses warfarin, not heparin.
3. A client with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation. Which ventilator setting helps reduce ventilator-induced
lung injury?
A. High tidal volume (10–12 mL/kg)
B. Low tidal volume (4–8 mL/kg)
,C. Respiratory rate of 8 breaths/min
D. FiO₂ of 100% indefinitely
Correct Answer: B. Low tidal volume (4–8 mL/kg)
Rationale: Lung-protective ventilation uses low tidal volumes to reduce alveolar overdistention
and decrease mortality in ARDS. High tidal volumes increase the risk of barotrauma and
volutrauma.
4. A client develops sudden chest pain, hypotension, jugular venous distention,
and muffled heart sounds following cardiac surgery. Which complication should
the nurse suspect?
A. Pulmonary embolism
B. Cardiac tamponade
C. Myocardial infarction
D. Left-sided heart failure
Correct Answer: B. Cardiac tamponade
Rationale: Beck's triad—hypotension, jugular venous distention, and muffled heart sounds—is
characteristic of cardiac tamponade. Blood accumulates in the pericardial sac, impairing
ventricular filling and cardiac output.
5. Which laboratory value is most concerning in a client receiving IV insulin for
diabetic ketoacidosis?
A. Potassium 2.9 mEq/L
B. Sodium 136 mEq/L
C. Glucose 250 mg/dL
D. Bicarbonate 20 mEq/L
Correct Answer: A. Potassium 2.9 mEq/L
Rationale: Insulin drives potassium into cells, increasing the risk of severe hypokalemia. A
potassium level below 3.3 mEq/L requires potassium replacement before continuing insulin
therapy to prevent life-threatening dysrhythmias.
,6. A client with increased intracranial pressure suddenly develops a widened
pulse pressure, bradycardia, and irregular respirations. What should the nurse
do first?
A. Raise the head of the bed to 30 degrees
B. Administer morphine
C. Encourage coughing and deep breathing
D. Place the client flat in bed
Correct Answer: A. Raise the head of the bed to 30 degrees
Rationale: These findings indicate Cushing's triad, suggesting critically increased intracranial
pressure. Elevating the head of the bed promotes venous drainage and helps reduce intracranial
pressure while additional interventions are initiated.
7. A client with acute kidney injury has peaked T waves on the ECG and a serum
potassium level of 6.8 mEq/L. Which medication should the nurse expect to
administer first?
A. Sodium bicarbonate
B. Calcium gluconate
C. Furosemide
D. Regular insulin only
Correct Answer: B. Calcium gluconate
Rationale: Calcium gluconate does not lower potassium but immediately stabilizes the cardiac
membrane, reducing the risk of fatal dysrhythmias. Additional therapies to lower potassium are
administered afterward.
8. A client receiving norepinephrine for septic shock has a MAP of 70 mmHg but
develops cool, pale fingers. What is the nurse's priority action?
A. Discontinue the infusion immediately
B. Assess peripheral perfusion and infusion site
C. Increase the infusion rate
D. Encourage active range-of-motion exercises
Correct Answer: B. Assess peripheral perfusion and infusion site
, Rationale: Norepinephrine causes vasoconstriction, which can decrease peripheral circulation.
The nurse should assess for adequate tissue perfusion and possible IV infiltration before
changing therapy.
9. A client's central venous pressure (CVP) increases from 5 mmHg to 15 mmHg
after rapid fluid administration. Which interpretation is most appropriate?
A. The client remains hypovolemic.
B. The client may be developing fluid overload.
C. The client has improved oxygenation.
D. The client has metabolic alkalosis.
Correct Answer: B. The client may be developing fluid overload.
Rationale: A significant rise in CVP following aggressive fluid administration suggests
increased intravascular volume and possible fluid overload, especially when accompanied by
pulmonary congestion or worsening respiratory status.
10. A client with an inferior-wall myocardial infarction suddenly develops
hypotension after receiving nitroglycerin. What is the most likely explanation?
A. Nitroglycerin increased cardiac output.
B. The client has right ventricular infarction and is preload dependent.
C. The client developed pulmonary edema.
D. Nitroglycerin caused severe bradycardia.
Correct Answer: B. The client has right ventricular infarction and is preload dependent.
Rationale: Clients with right ventricular infarction depend on adequate preload to maintain
cardiac output. Nitroglycerin reduces preload through venodilation, which can cause profound
hypotension in these clients.
11. A client with septic shock has a serum lactate level of 5.8 mmol/L. Which
finding best indicates that treatment is effective?
A. Heart rate decreases from 118 to 108 beats/min
B. Urine output remains 20 mL/hr
C. Serum lactate decreases to 2.1 mmol/L
D. White blood cell count increases to 18,000/mm³
Correct Answer: C. Serum lactate decreases to 2.1 mmol/L
