HESI Critical Care Exam Questions with Correct
Answers (VerifiedAnswers) Plus Rationales
2026 Q&A Instant Download PDF
1. A client with septic shock has a blood pressure of 82/48 mm
Hg, heart rate of 124/min, cool extremities, and urine output of
15 mL/hr. Which prescription should the nurse implement first?
A. Administer IV furosemide
B. Restrict IV fluids
C. Administer an isotonic crystalloid bolus
D. Place the client in Trendelenburg position
Correct answer: C. Administer an isotonic crystalloid bolus
Rationale: Septic shock causes profound vasodilation and
relative intravascular volume depletion. Initial management
includes rapid administration of isotonic crystalloid fluids to
improve circulating volume and tissue perfusion. Persistent
hypotension after appropriate fluid resuscitation may require
vasopressor therapy, typically with norepinephrine. Diuresis
would worsen hypoperfusion, fluid restriction is inappropriate
during initial resuscitation, and routine Trendelenburg
positioning is not an adequate treatment for septic shock.
,2. A mechanically ventilated client suddenly develops severe
dyspnea, absent breath sounds on the right side, hypotension,
and tracheal deviation toward the left. Which condition should
the nurse suspect?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Correct answer: B. Tension pneumothorax
Rationale: Sudden respiratory deterioration accompanied by
unilateral absent breath sounds, hypotension, and tracheal
deviation away from the affected side strongly indicates tension
pneumothorax. Positive-pressure ventilation can worsen the
condition by increasing intrathoracic pressure. This is an
immediately life-threatening emergency requiring rapid
decompression followed by definitive chest-tube management.
Pulmonary edema and pleural effusion generally do not produce
this classic combination of unilateral findings and mediastinal
shift.
3. A client with diabetic ketoacidosis has a serum potassium of
3.0 mEq/L. An IV regular insulin infusion is prescribed. What
should the nurse do?
,A. Start the insulin immediately
B. Hold insulin and notify the provider
C. Administer sodium bicarbonate first
D. Give oral potassium and start insulin simultaneously
Correct answer: B. Hold insulin and notify the provider
Rationale: Insulin drives potassium from the extracellular space
into cells. When the serum potassium is already severely
depleted, initiating insulin can precipitate life-threatening
hypokalemia and dysrhythmias. Potassium replacement should
be initiated before insulin when potassium is markedly low.
Sodium bicarbonate is not routinely indicated simply because
DKA is present and is reserved for selected cases of severe
metabolic acidosis.
4. A client with acute pulmonary edema is extremely dyspneic,
coughing pink frothy sputum, and has an oxygen saturation of
82%. Which action has the highest priority?
A. Place the client flat
B. Encourage oral fluids
C. Position the client upright and administer oxygen
D. Obtain a routine weight
Correct answer: C. Position the client upright and administer
oxygen
, Rationale: Pulmonary edema causes severe impairment of
oxygen exchange because fluid accumulates within the alveoli.
Upright positioning decreases venous return and improves lung
expansion, while supplemental oxygen addresses hypoxemia.
Depending on the client's status, noninvasive positive-pressure
ventilation may also be required. Lying flat can worsen
pulmonary congestion, and oral fluids are inappropriate during
acute pulmonary edema.
5. A client has an arterial blood gas result of pH 7.25, PaCO₂ 52
mm Hg, and HCO₃⁻ 24 mEq/L. How should the nurse interpret
these findings?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct answer: B. Respiratory acidosis
Rationale: The pH is below the normal range, indicating
acidemia. The PaCO₂ is elevated, demonstrating carbon dioxide
retention as the primary abnormality. The bicarbonate is within
the expected range, indicating little or no metabolic
compensation. This pattern is consistent with acute or relatively
uncompensated respiratory acidosis, which can occur with
Answers (VerifiedAnswers) Plus Rationales
2026 Q&A Instant Download PDF
1. A client with septic shock has a blood pressure of 82/48 mm
Hg, heart rate of 124/min, cool extremities, and urine output of
15 mL/hr. Which prescription should the nurse implement first?
A. Administer IV furosemide
B. Restrict IV fluids
C. Administer an isotonic crystalloid bolus
D. Place the client in Trendelenburg position
Correct answer: C. Administer an isotonic crystalloid bolus
Rationale: Septic shock causes profound vasodilation and
relative intravascular volume depletion. Initial management
includes rapid administration of isotonic crystalloid fluids to
improve circulating volume and tissue perfusion. Persistent
hypotension after appropriate fluid resuscitation may require
vasopressor therapy, typically with norepinephrine. Diuresis
would worsen hypoperfusion, fluid restriction is inappropriate
during initial resuscitation, and routine Trendelenburg
positioning is not an adequate treatment for septic shock.
,2. A mechanically ventilated client suddenly develops severe
dyspnea, absent breath sounds on the right side, hypotension,
and tracheal deviation toward the left. Which condition should
the nurse suspect?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Correct answer: B. Tension pneumothorax
Rationale: Sudden respiratory deterioration accompanied by
unilateral absent breath sounds, hypotension, and tracheal
deviation away from the affected side strongly indicates tension
pneumothorax. Positive-pressure ventilation can worsen the
condition by increasing intrathoracic pressure. This is an
immediately life-threatening emergency requiring rapid
decompression followed by definitive chest-tube management.
Pulmonary edema and pleural effusion generally do not produce
this classic combination of unilateral findings and mediastinal
shift.
3. A client with diabetic ketoacidosis has a serum potassium of
3.0 mEq/L. An IV regular insulin infusion is prescribed. What
should the nurse do?
,A. Start the insulin immediately
B. Hold insulin and notify the provider
C. Administer sodium bicarbonate first
D. Give oral potassium and start insulin simultaneously
Correct answer: B. Hold insulin and notify the provider
Rationale: Insulin drives potassium from the extracellular space
into cells. When the serum potassium is already severely
depleted, initiating insulin can precipitate life-threatening
hypokalemia and dysrhythmias. Potassium replacement should
be initiated before insulin when potassium is markedly low.
Sodium bicarbonate is not routinely indicated simply because
DKA is present and is reserved for selected cases of severe
metabolic acidosis.
4. A client with acute pulmonary edema is extremely dyspneic,
coughing pink frothy sputum, and has an oxygen saturation of
82%. Which action has the highest priority?
A. Place the client flat
B. Encourage oral fluids
C. Position the client upright and administer oxygen
D. Obtain a routine weight
Correct answer: C. Position the client upright and administer
oxygen
, Rationale: Pulmonary edema causes severe impairment of
oxygen exchange because fluid accumulates within the alveoli.
Upright positioning decreases venous return and improves lung
expansion, while supplemental oxygen addresses hypoxemia.
Depending on the client's status, noninvasive positive-pressure
ventilation may also be required. Lying flat can worsen
pulmonary congestion, and oral fluids are inappropriate during
acute pulmonary edema.
5. A client has an arterial blood gas result of pH 7.25, PaCO₂ 52
mm Hg, and HCO₃⁻ 24 mEq/L. How should the nurse interpret
these findings?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Correct answer: B. Respiratory acidosis
Rationale: The pH is below the normal range, indicating
acidemia. The PaCO₂ is elevated, demonstrating carbon dioxide
retention as the primary abnormality. The bicarbonate is within
the expected range, indicating little or no metabolic
compensation. This pattern is consistent with acute or relatively
uncompensated respiratory acidosis, which can occur with
