NGN HESI RN CRITICAL CARE EXAM V2 – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
1. Hemodynamic Monitoring and Shock States
2. Mechanical Ventilation and Respiratory Care
3. Cardiovascular Critical Care and Emergencies
4. Neurological Critical Care
5. Renal, Endocrine, and Metabolic Emergencies
6. Multisystem and Trauma Critical Care
7. Pharmacology and Medication Administration
8. Ethics, Legal Issues, and Professional Standards
Introduction
This comprehensive assessment is meticulously designed to prepare candidates for the NGN HESI RN Critical Care
Exam V2. The exam evaluates advanced clinical judgment, critical thinking, and the practical application of evidence-
based nursing knowledge in high-acuity, unstable patient scenarios. It covers a broad spectrum of critical care topics,
including complex hemodynamic data interpretation, ventilator management, and swift decision-making in life-
threatening emergencies. The following 100 multiple-choice questions, complete with detailed rationales, are crafted to
mirror the exam's rigorous standards, integrating Next Generation NCLEX (NGN) style frameworks to ensure
candidates can effectively prioritize care, recognize subtle clinical changes, and deliver safe, competent, and
professional nursing interventions in the critical care setting.
,Question 1
A patient in the intensive care unit (ICU) has a pulmonary artery catheter in place. The nurse notes a cardiac output
(CO) of 2.1 L/min, a cardiac index (CI) of 1.1 L/min/m², and a systemic vascular resistance (SVR) of 1800
dynes·sec·cm⁻⁵. The patient is hypotensive and oliguric. Which type of shock is most consistent with these
hemodynamic findings?
A. Distributive shock (septic)
B. Hypovolemic shock
C. Cardiogenic shock
D. Obstructive shock
🟢 Correct Answer: C. Cardiogenic shock
🔴 Explanation: Low CO/CI with elevated SVR indicates decreased myocardial contractility and compensatory
peripheral vasoconstriction, which is classic for cardiogenic shock. Distributive shock would show low SVR,
hypovolemic shock would show low preload (CVP/PAWP), and obstructive shock would show low CO with variable
SVR depending on the cause .
Question 2
A patient with septic shock has a central venous pressure (CVP) of 4 mm Hg, a mean arterial pressure (MAP) of 55
mm Hg, and a lactate of 6.5 mmol/L. According to the Surviving Sepsis Campaign, which initial intervention should
the nurse anticipate?
A. Administer norepinephrine before fluid resuscitation
B. Initiate broad-spectrum antibiotics after blood cultures
C. Administer a 30 mL/kg crystalloid bolus
D. Start a vasopressin infusion immediately
🟢 Correct Answer: C. Administer a 30 mL/kg crystalloid bolus
🔴 Explanation: Rapid administration of 30 mL/kg of crystalloid is the first-line intervention for hypotension with
lactate >4 mmol/L to restore intravascular volume and improve perfusion. Antibiotics should be given within one
hour, but fluids are the immediate priority .
,Question 3
The nurse is caring for a patient post-cardiac arrest who is receiving therapeutic hypothermia. Which assessment
finding requires immediate intervention?
A. Shivering noted in the extremities
B. Heart rate of 48 beats per minute
C. Absence of cough/gag reflex
D. Cool skin temperature of 34.5°C (94.1°F)
🟢 Correct Answer: C. Absence of cough/gag reflex
🔴 Explanation: An absent cough/gag reflex indicates the patient has lost protective airway reflexes, placing them at
high risk for aspiration and requiring immediate airway protection, likely intubation. Shivering is managed with
sedation, bradycardia is expected during hypothermia, and a cool skin temperature is also expected .
Question 4
A patient on a mechanical ventilator has a plateau pressure (Pplat) of 35 cm H₂O. Which of the following actions
should the nurse anticipate to prevent ventilator-induced lung injury?
A. Increase the tidal volume
B. Decrease the tidal volume
C. Increase the PEEP
D. Decrease the respiratory rate
🟢 Correct Answer: B. Decrease the tidal volume
🔴 Explanation: A plateau pressure >30 cm H₂O indicates an increased risk of barotrauma and volutrauma. Lung-
protective ventilation strategies aim to maintain plateau pressure below 30 cm H₂O, often by decreasing tidal
volume to 6-8 mL/kg of ideal body weight. The respiratory rate may need to be adjusted to maintain minute
ventilation .
Question 5
A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 22 mm Hg and a cerebral perfusion
, pressure (CPP) of 55 mm Hg. The mean arterial pressure (MAP) is 77 mm Hg. What is the nurse’s priority action?
A. Administer Mannitol as prescribed
B. Notify the provider of the CPP
C. Elevate the head of the bed to 90 degrees
D. Continue to monitor as these values are stable
🟢 Correct Answer: B. Notify the provider of the CPP
🔴 Explanation: CPP = MAP – ICP (77 – 22 = 55 mm Hg). Normal CPP is 60-100 mm Hg. A CPP < 60 mm Hg
indicates inadequate cerebral blood flow, leading to ischemia. The provider must be notified to correct the low CPP
(often by increasing MAP or decreasing ICP). Elevating the HOB to 30 degrees is recommended, not 90 degrees .
Question 6
A patient receiving a dopamine drip for shock has an infiltration at the IV site, with blanching and pain noted. Which
action is most important for the nurse to take?
A. Stop the infusion and prepare phentolamine for local injection
B. Apply a warm compress to the site
C. Continue the infusion and monitor for necrosis
D. Administer a bolus of normal saline through the same line
🟢 Correct Answer: A. Stop the infusion and prepare phentolamine for local injection
🔴 Explanation: Extravasation of vasopressors like dopamine and norepinephrine can cause severe tissue necrosis.
The infusion must be stopped immediately, and phentolamine, an alpha-blocker, should be injected locally to
counteract the vasoconstrictive effects .
Question 7
A patient with a new onset of atrial fibrillation (AF) of 12 hours duration is hemodynamically stable (BP 120/80, HR
110 bpm). Which intervention is indicated first?
A. Rate control with IV diltiazem
B. Immediate synchronized cardioversion
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
1. Hemodynamic Monitoring and Shock States
2. Mechanical Ventilation and Respiratory Care
3. Cardiovascular Critical Care and Emergencies
4. Neurological Critical Care
5. Renal, Endocrine, and Metabolic Emergencies
6. Multisystem and Trauma Critical Care
7. Pharmacology and Medication Administration
8. Ethics, Legal Issues, and Professional Standards
Introduction
This comprehensive assessment is meticulously designed to prepare candidates for the NGN HESI RN Critical Care
Exam V2. The exam evaluates advanced clinical judgment, critical thinking, and the practical application of evidence-
based nursing knowledge in high-acuity, unstable patient scenarios. It covers a broad spectrum of critical care topics,
including complex hemodynamic data interpretation, ventilator management, and swift decision-making in life-
threatening emergencies. The following 100 multiple-choice questions, complete with detailed rationales, are crafted to
mirror the exam's rigorous standards, integrating Next Generation NCLEX (NGN) style frameworks to ensure
candidates can effectively prioritize care, recognize subtle clinical changes, and deliver safe, competent, and
professional nursing interventions in the critical care setting.
,Question 1
A patient in the intensive care unit (ICU) has a pulmonary artery catheter in place. The nurse notes a cardiac output
(CO) of 2.1 L/min, a cardiac index (CI) of 1.1 L/min/m², and a systemic vascular resistance (SVR) of 1800
dynes·sec·cm⁻⁵. The patient is hypotensive and oliguric. Which type of shock is most consistent with these
hemodynamic findings?
A. Distributive shock (septic)
B. Hypovolemic shock
C. Cardiogenic shock
D. Obstructive shock
🟢 Correct Answer: C. Cardiogenic shock
🔴 Explanation: Low CO/CI with elevated SVR indicates decreased myocardial contractility and compensatory
peripheral vasoconstriction, which is classic for cardiogenic shock. Distributive shock would show low SVR,
hypovolemic shock would show low preload (CVP/PAWP), and obstructive shock would show low CO with variable
SVR depending on the cause .
Question 2
A patient with septic shock has a central venous pressure (CVP) of 4 mm Hg, a mean arterial pressure (MAP) of 55
mm Hg, and a lactate of 6.5 mmol/L. According to the Surviving Sepsis Campaign, which initial intervention should
the nurse anticipate?
A. Administer norepinephrine before fluid resuscitation
B. Initiate broad-spectrum antibiotics after blood cultures
C. Administer a 30 mL/kg crystalloid bolus
D. Start a vasopressin infusion immediately
🟢 Correct Answer: C. Administer a 30 mL/kg crystalloid bolus
🔴 Explanation: Rapid administration of 30 mL/kg of crystalloid is the first-line intervention for hypotension with
lactate >4 mmol/L to restore intravascular volume and improve perfusion. Antibiotics should be given within one
hour, but fluids are the immediate priority .
,Question 3
The nurse is caring for a patient post-cardiac arrest who is receiving therapeutic hypothermia. Which assessment
finding requires immediate intervention?
A. Shivering noted in the extremities
B. Heart rate of 48 beats per minute
C. Absence of cough/gag reflex
D. Cool skin temperature of 34.5°C (94.1°F)
🟢 Correct Answer: C. Absence of cough/gag reflex
🔴 Explanation: An absent cough/gag reflex indicates the patient has lost protective airway reflexes, placing them at
high risk for aspiration and requiring immediate airway protection, likely intubation. Shivering is managed with
sedation, bradycardia is expected during hypothermia, and a cool skin temperature is also expected .
Question 4
A patient on a mechanical ventilator has a plateau pressure (Pplat) of 35 cm H₂O. Which of the following actions
should the nurse anticipate to prevent ventilator-induced lung injury?
A. Increase the tidal volume
B. Decrease the tidal volume
C. Increase the PEEP
D. Decrease the respiratory rate
🟢 Correct Answer: B. Decrease the tidal volume
🔴 Explanation: A plateau pressure >30 cm H₂O indicates an increased risk of barotrauma and volutrauma. Lung-
protective ventilation strategies aim to maintain plateau pressure below 30 cm H₂O, often by decreasing tidal
volume to 6-8 mL/kg of ideal body weight. The respiratory rate may need to be adjusted to maintain minute
ventilation .
Question 5
A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 22 mm Hg and a cerebral perfusion
, pressure (CPP) of 55 mm Hg. The mean arterial pressure (MAP) is 77 mm Hg. What is the nurse’s priority action?
A. Administer Mannitol as prescribed
B. Notify the provider of the CPP
C. Elevate the head of the bed to 90 degrees
D. Continue to monitor as these values are stable
🟢 Correct Answer: B. Notify the provider of the CPP
🔴 Explanation: CPP = MAP – ICP (77 – 22 = 55 mm Hg). Normal CPP is 60-100 mm Hg. A CPP < 60 mm Hg
indicates inadequate cerebral blood flow, leading to ischemia. The provider must be notified to correct the low CPP
(often by increasing MAP or decreasing ICP). Elevating the HOB to 30 degrees is recommended, not 90 degrees .
Question 6
A patient receiving a dopamine drip for shock has an infiltration at the IV site, with blanching and pain noted. Which
action is most important for the nurse to take?
A. Stop the infusion and prepare phentolamine for local injection
B. Apply a warm compress to the site
C. Continue the infusion and monitor for necrosis
D. Administer a bolus of normal saline through the same line
🟢 Correct Answer: A. Stop the infusion and prepare phentolamine for local injection
🔴 Explanation: Extravasation of vasopressors like dopamine and norepinephrine can cause severe tissue necrosis.
The infusion must be stopped immediately, and phentolamine, an alpha-blocker, should be injected locally to
counteract the vasoconstrictive effects .
Question 7
A patient with a new onset of atrial fibrillation (AF) of 12 hours duration is hemodynamically stable (BP 120/80, HR
110 bpm). Which intervention is indicated first?
A. Rate control with IV diltiazem
B. Immediate synchronized cardioversion
