HESI RN ACUTE CARE ACCURATE
COMPREHENSIVE PRACTICE EXAM WITH ALL
POSSIBLE APPROVED WELL ELABORATED
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS EXPERT ANSWER KEY (100% CORRECT
VERIFIED SOLUTIONS) 2026-2027 CURRENTLY
UPDATED VERSION Q&A GUARANTEED PASS A+
INSTANT DOWNLOAD PDF
1. A patient with acute respiratory distress
syndrome (ARDS) is receiving mechanical ventilation
with a tidal volume of 6 mL/kg ideal body weight.
The arterial blood gas shows pH 7.30, PaCO2 55 mm
Hg, and PaO2 65 mm Hg. Which adjustment is most
appropriate?
A. Increase tidal volume to 8 mL/kg
B. Increase positive end-expiratory pressure (PEEP)
,C. Decrease respiratory rate
D. Administer sodium bicarbonate
Correct Answer: B. Increase positive end-expiratory
pressure (PEEP).
Rationale: In ARDS, low tidal volume (6 mL/kg) is
lung-protective. The elevated PaCO2 indicates
respiratory acidosis, but increasing PEEP improves
oxygenation and alveolar recruitment without
increasing tidal volume. Increasing tidal volume
risks barotrauma. Sodium bicarbonate is not first-
line for acute respiratory acidosis.
2. A patient with heart failure presents with
dyspnea, crackles, and a third heart sound (S3).
Which medication should the nurse anticipate
administering first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Spironolactone
Correct Answer: B. Furosemide.
Rationale: Acute decompensated heart failure with
pulmonary congestion requires rapid diuresis.
,Furosemide reduces preload and relieves
symptoms. Digoxin is for rate control or chronic
use; metoprolol is not given acutely in
decompensated HF; spironolactone is adjunctive.
3. A patient with septic shock has a mean arterial
pressure (MAP) of 58 mm Hg after 2 L of crystalloid.
Which vasopressor is the first-line agent?
A. Dobutamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Correct Answer: B. Norepinephrine.
Rationale: Norepinephrine is the first-line
vasopressor for septic shock unresponsive to fluids.
It increases MAP via alpha-adrenergic effects.
Dobutamine is for low cardiac output; epinephrine
is second-line; vasopressin is added as a second
agent.
4. A patient on heparin infusion for pulmonary
embolism develops a sudden headache and left-
sided weakness. Which laboratory value should the
, nurse check immediately?
A. International normalized ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
D. D-dimer
Correct Answer: C. Platelet count.
Rationale: Sudden neurological symptoms in a
patient on heparin suggest heparin-induced
thrombocytopenia (HIT) with thrombosis. The
platelet count may be low. aPTT monitors heparin
effect but does not diagnose HIT. INR monitors
warfarin.
5. A patient with acute pancreatitis has a
nasogastric tube to low suction. Which laboratory
finding indicates worsening severity?
A. Serum calcium 8.0 mg/dL
B. Serum glucose 110 mg/dL
C. Serum amylase 300 U/L
D. Serum lipase 200 U/L
Correct Answer: A. Serum calcium 8.0 mg/dL.
Rationale: Hypocalcemia (calcium <8.5 mg/dL) in
acute pancreatitis is a marker of severe disease
COMPREHENSIVE PRACTICE EXAM WITH ALL
POSSIBLE APPROVED WELL ELABORATED
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS EXPERT ANSWER KEY (100% CORRECT
VERIFIED SOLUTIONS) 2026-2027 CURRENTLY
UPDATED VERSION Q&A GUARANTEED PASS A+
INSTANT DOWNLOAD PDF
1. A patient with acute respiratory distress
syndrome (ARDS) is receiving mechanical ventilation
with a tidal volume of 6 mL/kg ideal body weight.
The arterial blood gas shows pH 7.30, PaCO2 55 mm
Hg, and PaO2 65 mm Hg. Which adjustment is most
appropriate?
A. Increase tidal volume to 8 mL/kg
B. Increase positive end-expiratory pressure (PEEP)
,C. Decrease respiratory rate
D. Administer sodium bicarbonate
Correct Answer: B. Increase positive end-expiratory
pressure (PEEP).
Rationale: In ARDS, low tidal volume (6 mL/kg) is
lung-protective. The elevated PaCO2 indicates
respiratory acidosis, but increasing PEEP improves
oxygenation and alveolar recruitment without
increasing tidal volume. Increasing tidal volume
risks barotrauma. Sodium bicarbonate is not first-
line for acute respiratory acidosis.
2. A patient with heart failure presents with
dyspnea, crackles, and a third heart sound (S3).
Which medication should the nurse anticipate
administering first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Spironolactone
Correct Answer: B. Furosemide.
Rationale: Acute decompensated heart failure with
pulmonary congestion requires rapid diuresis.
,Furosemide reduces preload and relieves
symptoms. Digoxin is for rate control or chronic
use; metoprolol is not given acutely in
decompensated HF; spironolactone is adjunctive.
3. A patient with septic shock has a mean arterial
pressure (MAP) of 58 mm Hg after 2 L of crystalloid.
Which vasopressor is the first-line agent?
A. Dobutamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Correct Answer: B. Norepinephrine.
Rationale: Norepinephrine is the first-line
vasopressor for septic shock unresponsive to fluids.
It increases MAP via alpha-adrenergic effects.
Dobutamine is for low cardiac output; epinephrine
is second-line; vasopressin is added as a second
agent.
4. A patient on heparin infusion for pulmonary
embolism develops a sudden headache and left-
sided weakness. Which laboratory value should the
, nurse check immediately?
A. International normalized ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
D. D-dimer
Correct Answer: C. Platelet count.
Rationale: Sudden neurological symptoms in a
patient on heparin suggest heparin-induced
thrombocytopenia (HIT) with thrombosis. The
platelet count may be low. aPTT monitors heparin
effect but does not diagnose HIT. INR monitors
warfarin.
5. A patient with acute pancreatitis has a
nasogastric tube to low suction. Which laboratory
finding indicates worsening severity?
A. Serum calcium 8.0 mg/dL
B. Serum glucose 110 mg/dL
C. Serum amylase 300 U/L
D. Serum lipase 200 U/L
Correct Answer: A. Serum calcium 8.0 mg/dL.
Rationale: Hypocalcemia (calcium <8.5 mg/dL) in
acute pancreatitis is a marker of severe disease
