CRITICAL CARE HESI EXIT EXAM TEST BANK
ACTUAL EXAM ALL 300 QUESTIONS AND
CORRECT ANSWERS|ALREADY GRADED A+
SECTION 1: CARDIOVASCULAR CRITICAL CARE (Q1–Q55)
Q1: A client admitted with an inferior wall STEMI develops hypotension, clear lung sounds, and
jugular venous distention. Which action should the nurse take first?
A. Administer furosemide 40 mg IV push
B. Prepare for immediate synchronized cardioversion
C. Administer a 500 mL normal saline bolus over 30 minutes [CORRECT]
D. Initiate dobutamine at 5 mcg/kg/min
Correct Answer: C
Rationale: Inferior wall MI often involves right ventricular infarction, causing preload-dependent
hypotension. Jugular venous distention with clear lungs indicates right-sided failure, not left-
sided fluid overload. Fluid resuscitation restores preload to the failing right ventricle; diuretics or
vasodilators would worsen hypotension.
Q2: A client with acute decompensated heart failure is receiving milrinone at 0.375 mcg/kg/min.
Which assessment finding requires immediate intervention?
A. Heart rate 88 bpm
B. Potassium 3.8 mEq/L
C. Systolic blood pressure 82 mmHg [CORRECT]
D. Urine output 60 mL/hr
Correct Answer: C
Rationale: Milrinone is a phosphodiesterase inhibitor causing systemic vasodilation and
increased cardiac contractility. Significant hypotension is a dose-limiting adverse effect requiring
immediate intervention—rate reduction or discontinuation. The other values are within acceptable
parameters during milrinone therapy.
Q3: The nurse is caring for a client 4 hours post-CABG with mediastinal chest tubes. Which
finding requires immediate notification of the surgeon?
A. Chest tube drainage of 75 mL in the past hour
B. Chest tube drainage of 250 mL in the past hour [CORRECT]
C. Subcutaneous emphysema at the insertion site
D. Tidaling of fluid in the chest tube chamber
Correct Answer: B
,Rationale: Post-CABG mediastinal chest tube drainage exceeding 200 mL/hour indicates active
hemorrhage and requires immediate surgical re-exploration. While subcutaneous emphysema
warrants assessment, it is not as immediately life-threatening as hemorrhagic tamponade or
hypovolemia from excessive bleeding.
Q4: A client with suspected cardiac tamponade presents with hypotension, muffled heart sounds,
and jugular venous distention. What is the nurse's priority action?
A. Obtain a 12-lead ECG
B. Prepare for emergent pericardiocentesis [CORRECT]
C. Administer IV nitroglycerin
D. Insert a urinary catheter
Correct Answer: B
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac tamponade
with impaired ventricular filling. Pericardiocentesis is the definitive emergency treatment to
relieve pericardial pressure and restore cardiac output. Delaying intervention risks pulseless
electrical activity and death.
Q5: A client in cardiogenic shock has a pulmonary artery catheter in place. Which hemodynamic
profile is most consistent with this diagnosis?
A. CI 2.2 L/min/m², PAWP 8 mmHg, SVR 800 dynes/sec/cm⁻⁵
B. CI 1.8 L/min/m², PAWP 24 mmHg, SVR 1800 dynes/sec/cm⁻⁵ [CORRECT]
C. CI 4.5 L/min/m², PAWP 6 mmHg, SVR 600 dynes/sec/cm⁻⁵
D. CI 2.8 L/min/m², PAWP 12 mmHg, SVR 1200 dynes/sec/cm⁻⁵
Correct Answer: B
Rationale: Cardiogenic shock is characterized by low cardiac index (<2.2 L/min/m²), elevated
pulmonary artery wedge pressure (>18 mmHg reflecting left ventricular failure), and high systemic
vascular resistance due to compensatory vasoconstriction. This profile distinguishes it from
hypovolemic or distributive shock.
Q6: A client receiving nitroprusside for hypertensive emergency reports dizziness and nausea.
Blood pressure is 88/52 mmHg. What is the nurse's priority action?
A. Increase the nitroprusside infusion rate
B. Decrease the nitroprusside infusion rate and notify the provider [CORRECT]
C. Administer IV normal saline 1 L bolus
D. Place the client in Trendelenburg position
Correct Answer: B
Rationale: Nitroprusside is a potent arterial and venous dilator with a rapid onset and short half-
life. Hypotension indicates excessive vasodilation; the nurse must immediately reduce or stop the
infusion. Because nitroprusside's effect resolves within 1–10 minutes, dose reduction is the
appropriate response rather than fluid bolus which could worsen volume status.
Q7: During insertion of a pulmonary artery catheter, the nurse observes a sudden change in
waveform to a wide, non-pulsatile pressure reading of 25 mmHg. What has most likely occurred?
A. The catheter has advanced into the pulmonary artery
,B. The balloon has ruptured
C. The catheter has "wedged" with the balloon inflated [CORRECT]
D. The catheter has entered the right ventricle
Correct Answer: C
Rationale: A wedged pulmonary artery catheter waveform appears as a non-pulsatile, dampened
pressure tracing reflecting transmitted left atrial pressure (PAWP). Normal PAWP is 6–12 mmHg; a
reading of 25 mmHg suggests the catheter has advanced too far or the balloon is overinflated,
risking pulmonary artery rupture. The nurse should immediately deflate the balloon and notify the
provider.
Q8: A client with acute aortic dissection presents with tearing chest pain radiating to the back.
Blood pressure is 190/110 mmHg in the right arm and 140/90 mmHg in the left arm. What is the
priority nursing intervention?
A. Administer tissue plasminogen activator (tPA)
B. Initiate IV beta-blockade to reduce shear stress [CORRECT]
C. Prepare the client for immediate thrombolytic therapy
D. Insert a femoral arterial line in the left leg
Correct Answer: B
Rationale: Aortic dissection management prioritizes reduction of systolic blood pressure and
heart rate to decrease aortic wall shear stress (dP/dt). Beta-blockers (esmolol or labetalol) are
first-line before vasodilators. Thrombolytics are absolutely contraindicated. Blood pressure
differential between arms is a classic finding confirming the diagnosis.
Q9: A client 2 hours post-cardiac surgery has the following arterial blood gas: pH 7.28, PaCO₂ 48
mmHg, HCO₃ 24 mEq/L, PaO₂ 88 mmHg. Which intervention is most appropriate?
A. Increase the tidal volume on the ventilator
B. Increase the respiratory rate on the ventilator [CORRECT]
C. Administer sodium bicarbonate 50 mEq IV
D. Increase the FiO₂ to 60%
Correct Answer: B
Rationale: The ABG reveals uncompensated respiratory acidosis (pH low, PaCO₂ elevated, HCO₃
normal) in a post-operative ventilated client. Increasing the respiratory rate augments minute
ventilation and reduces PaCO₂. Bicarbonate is not indicated in primary respiratory acidosis. The
PaO₂ of 88 mmHg is acceptable; increasing FiO₂ does not address the acid-base disorder.
Q10: A client with an LVAD is found unresponsive and pulseless. The nurse observes the LVAD is
still functioning. What is the priority action?
A. Perform chest compressions immediately
B. Check the LVAD controller for alarms and call a code [CORRECT]
C. Defibrillate immediately at 200 joules
D. Administer epinephrine 1 mg IV push
Correct Answer: B
, Rationale: LVAD clients may not have a palpable pulse due to continuous flow. Unresponsiveness
requires assessment of LVAD function first—checking controller alarms, power sources, and flow
readings—before initiating chest compressions, which may dislodge the inflow cannula. If the
device is functioning and the client has no signs of life, standard ACLS protocols apply with
caution regarding compressions.
Q11: A client with atrial fibrillation with rapid ventricular response (RVR) has a heart rate of 164
bpm, blood pressure 102/68 mmHg, and complains of dizziness. Which medication should the
nurse prepare to administer?
A. Adenosine 6 mg rapid IV push
B. Amiodarone 150 mg IV over 10 minutes [CORRECT]
C. Atropine 0.5 mg IV push
D. Lidocaine 1 mg/kg IV push
Correct Answer: B
Rationale: Unstable atrial fibrillation with RVR requires rhythm or rate control. Amiodarone is
effective for both rate control and potential chemical cardioversion in hemodynamically
compromised clients. Adenosine is used for SVT, not AFib. Atropine is for bradycardia. Lidocaine
is for ventricular dysrhythmias. The client's borderline blood pressure and dizziness indicate
hemodynamic compromise.
Q12: A client with an intra-aortic balloon pump (IABP) set at 1:1 augmentation has a systolic blood
pressure of 98 mmHg with augmentation. Which action should the nurse take?
A. Increase the balloon inflation volume
B. Verify timing and assess for mechanical complications [CORRECT]
C. Administer a fluid challenge of 500 mL
D. Increase the helium pressure
Correct Answer: B
Rationale: IABP augmentation should produce a diastolic pressure higher than the unassisted
systolic pressure. Low augmented pressure suggests improper timing (early or late
inflation/deflation) or mechanical failure (balloon rupture, gas leak). The nurse must first assess
timing on the arterial waveform and inspect for complications before other interventions.
Q13: A client is receiving dopamine at 8 mcg/kg/min for septic shock. Which assessment finding
indicates the medication is achieving the desired effect?
A. Urine output increases from 15 mL/hr to 55 mL/hr [CORRECT]
B. Heart rate decreases from 110 bpm to 85 bpm
C. Client reports relief of chest pain
D. Respiratory rate decreases from 28 to 18 breaths/min
Correct Answer: A
Rationale: At 5–10 mcg/kg/min, dopamine primarily stimulates beta-1 receptors, increasing
cardiac contractility and renal perfusion through dopaminergic receptors. Improved urine output
reflects enhanced renal perfusion and is a key therapeutic endpoint. Dopamine typically increases
heart rate, not decreases it. Chest pain relief and respiratory rate reduction are not primary
indicators of dopamine efficacy.
ACTUAL EXAM ALL 300 QUESTIONS AND
CORRECT ANSWERS|ALREADY GRADED A+
SECTION 1: CARDIOVASCULAR CRITICAL CARE (Q1–Q55)
Q1: A client admitted with an inferior wall STEMI develops hypotension, clear lung sounds, and
jugular venous distention. Which action should the nurse take first?
A. Administer furosemide 40 mg IV push
B. Prepare for immediate synchronized cardioversion
C. Administer a 500 mL normal saline bolus over 30 minutes [CORRECT]
D. Initiate dobutamine at 5 mcg/kg/min
Correct Answer: C
Rationale: Inferior wall MI often involves right ventricular infarction, causing preload-dependent
hypotension. Jugular venous distention with clear lungs indicates right-sided failure, not left-
sided fluid overload. Fluid resuscitation restores preload to the failing right ventricle; diuretics or
vasodilators would worsen hypotension.
Q2: A client with acute decompensated heart failure is receiving milrinone at 0.375 mcg/kg/min.
Which assessment finding requires immediate intervention?
A. Heart rate 88 bpm
B. Potassium 3.8 mEq/L
C. Systolic blood pressure 82 mmHg [CORRECT]
D. Urine output 60 mL/hr
Correct Answer: C
Rationale: Milrinone is a phosphodiesterase inhibitor causing systemic vasodilation and
increased cardiac contractility. Significant hypotension is a dose-limiting adverse effect requiring
immediate intervention—rate reduction or discontinuation. The other values are within acceptable
parameters during milrinone therapy.
Q3: The nurse is caring for a client 4 hours post-CABG with mediastinal chest tubes. Which
finding requires immediate notification of the surgeon?
A. Chest tube drainage of 75 mL in the past hour
B. Chest tube drainage of 250 mL in the past hour [CORRECT]
C. Subcutaneous emphysema at the insertion site
D. Tidaling of fluid in the chest tube chamber
Correct Answer: B
,Rationale: Post-CABG mediastinal chest tube drainage exceeding 200 mL/hour indicates active
hemorrhage and requires immediate surgical re-exploration. While subcutaneous emphysema
warrants assessment, it is not as immediately life-threatening as hemorrhagic tamponade or
hypovolemia from excessive bleeding.
Q4: A client with suspected cardiac tamponade presents with hypotension, muffled heart sounds,
and jugular venous distention. What is the nurse's priority action?
A. Obtain a 12-lead ECG
B. Prepare for emergent pericardiocentesis [CORRECT]
C. Administer IV nitroglycerin
D. Insert a urinary catheter
Correct Answer: B
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac tamponade
with impaired ventricular filling. Pericardiocentesis is the definitive emergency treatment to
relieve pericardial pressure and restore cardiac output. Delaying intervention risks pulseless
electrical activity and death.
Q5: A client in cardiogenic shock has a pulmonary artery catheter in place. Which hemodynamic
profile is most consistent with this diagnosis?
A. CI 2.2 L/min/m², PAWP 8 mmHg, SVR 800 dynes/sec/cm⁻⁵
B. CI 1.8 L/min/m², PAWP 24 mmHg, SVR 1800 dynes/sec/cm⁻⁵ [CORRECT]
C. CI 4.5 L/min/m², PAWP 6 mmHg, SVR 600 dynes/sec/cm⁻⁵
D. CI 2.8 L/min/m², PAWP 12 mmHg, SVR 1200 dynes/sec/cm⁻⁵
Correct Answer: B
Rationale: Cardiogenic shock is characterized by low cardiac index (<2.2 L/min/m²), elevated
pulmonary artery wedge pressure (>18 mmHg reflecting left ventricular failure), and high systemic
vascular resistance due to compensatory vasoconstriction. This profile distinguishes it from
hypovolemic or distributive shock.
Q6: A client receiving nitroprusside for hypertensive emergency reports dizziness and nausea.
Blood pressure is 88/52 mmHg. What is the nurse's priority action?
A. Increase the nitroprusside infusion rate
B. Decrease the nitroprusside infusion rate and notify the provider [CORRECT]
C. Administer IV normal saline 1 L bolus
D. Place the client in Trendelenburg position
Correct Answer: B
Rationale: Nitroprusside is a potent arterial and venous dilator with a rapid onset and short half-
life. Hypotension indicates excessive vasodilation; the nurse must immediately reduce or stop the
infusion. Because nitroprusside's effect resolves within 1–10 minutes, dose reduction is the
appropriate response rather than fluid bolus which could worsen volume status.
Q7: During insertion of a pulmonary artery catheter, the nurse observes a sudden change in
waveform to a wide, non-pulsatile pressure reading of 25 mmHg. What has most likely occurred?
A. The catheter has advanced into the pulmonary artery
,B. The balloon has ruptured
C. The catheter has "wedged" with the balloon inflated [CORRECT]
D. The catheter has entered the right ventricle
Correct Answer: C
Rationale: A wedged pulmonary artery catheter waveform appears as a non-pulsatile, dampened
pressure tracing reflecting transmitted left atrial pressure (PAWP). Normal PAWP is 6–12 mmHg; a
reading of 25 mmHg suggests the catheter has advanced too far or the balloon is overinflated,
risking pulmonary artery rupture. The nurse should immediately deflate the balloon and notify the
provider.
Q8: A client with acute aortic dissection presents with tearing chest pain radiating to the back.
Blood pressure is 190/110 mmHg in the right arm and 140/90 mmHg in the left arm. What is the
priority nursing intervention?
A. Administer tissue plasminogen activator (tPA)
B. Initiate IV beta-blockade to reduce shear stress [CORRECT]
C. Prepare the client for immediate thrombolytic therapy
D. Insert a femoral arterial line in the left leg
Correct Answer: B
Rationale: Aortic dissection management prioritizes reduction of systolic blood pressure and
heart rate to decrease aortic wall shear stress (dP/dt). Beta-blockers (esmolol or labetalol) are
first-line before vasodilators. Thrombolytics are absolutely contraindicated. Blood pressure
differential between arms is a classic finding confirming the diagnosis.
Q9: A client 2 hours post-cardiac surgery has the following arterial blood gas: pH 7.28, PaCO₂ 48
mmHg, HCO₃ 24 mEq/L, PaO₂ 88 mmHg. Which intervention is most appropriate?
A. Increase the tidal volume on the ventilator
B. Increase the respiratory rate on the ventilator [CORRECT]
C. Administer sodium bicarbonate 50 mEq IV
D. Increase the FiO₂ to 60%
Correct Answer: B
Rationale: The ABG reveals uncompensated respiratory acidosis (pH low, PaCO₂ elevated, HCO₃
normal) in a post-operative ventilated client. Increasing the respiratory rate augments minute
ventilation and reduces PaCO₂. Bicarbonate is not indicated in primary respiratory acidosis. The
PaO₂ of 88 mmHg is acceptable; increasing FiO₂ does not address the acid-base disorder.
Q10: A client with an LVAD is found unresponsive and pulseless. The nurse observes the LVAD is
still functioning. What is the priority action?
A. Perform chest compressions immediately
B. Check the LVAD controller for alarms and call a code [CORRECT]
C. Defibrillate immediately at 200 joules
D. Administer epinephrine 1 mg IV push
Correct Answer: B
, Rationale: LVAD clients may not have a palpable pulse due to continuous flow. Unresponsiveness
requires assessment of LVAD function first—checking controller alarms, power sources, and flow
readings—before initiating chest compressions, which may dislodge the inflow cannula. If the
device is functioning and the client has no signs of life, standard ACLS protocols apply with
caution regarding compressions.
Q11: A client with atrial fibrillation with rapid ventricular response (RVR) has a heart rate of 164
bpm, blood pressure 102/68 mmHg, and complains of dizziness. Which medication should the
nurse prepare to administer?
A. Adenosine 6 mg rapid IV push
B. Amiodarone 150 mg IV over 10 minutes [CORRECT]
C. Atropine 0.5 mg IV push
D. Lidocaine 1 mg/kg IV push
Correct Answer: B
Rationale: Unstable atrial fibrillation with RVR requires rhythm or rate control. Amiodarone is
effective for both rate control and potential chemical cardioversion in hemodynamically
compromised clients. Adenosine is used for SVT, not AFib. Atropine is for bradycardia. Lidocaine
is for ventricular dysrhythmias. The client's borderline blood pressure and dizziness indicate
hemodynamic compromise.
Q12: A client with an intra-aortic balloon pump (IABP) set at 1:1 augmentation has a systolic blood
pressure of 98 mmHg with augmentation. Which action should the nurse take?
A. Increase the balloon inflation volume
B. Verify timing and assess for mechanical complications [CORRECT]
C. Administer a fluid challenge of 500 mL
D. Increase the helium pressure
Correct Answer: B
Rationale: IABP augmentation should produce a diastolic pressure higher than the unassisted
systolic pressure. Low augmented pressure suggests improper timing (early or late
inflation/deflation) or mechanical failure (balloon rupture, gas leak). The nurse must first assess
timing on the arterial waveform and inspect for complications before other interventions.
Q13: A client is receiving dopamine at 8 mcg/kg/min for septic shock. Which assessment finding
indicates the medication is achieving the desired effect?
A. Urine output increases from 15 mL/hr to 55 mL/hr [CORRECT]
B. Heart rate decreases from 110 bpm to 85 bpm
C. Client reports relief of chest pain
D. Respiratory rate decreases from 28 to 18 breaths/min
Correct Answer: A
Rationale: At 5–10 mcg/kg/min, dopamine primarily stimulates beta-1 receptors, increasing
cardiac contractility and renal perfusion through dopaminergic receptors. Improved urine output
reflects enhanced renal perfusion and is a key therapeutic endpoint. Dopamine typically increases
heart rate, not decreases it. Chest pain relief and respiratory rate reduction are not primary
indicators of dopamine efficacy.
