HESI Critical Care Exam 2026/2027 — Actual Exam Test Bank 150 Questions | 100% Correct Answers
HESI CRITICAL CARE EXAM 2026/2027 ACTUAL
EXAM TEST BANK
With Real Exam Questions, Correct Answers, and Comprehensive Rationales
Critical Care Nursing Certification Examination Preparation | Aligned with 2026-2027 HESI Exam Blueprint | 150 Questions Across
7 Domains
Format: 150 multiple-choice questions (4 options, ONE correct) — 75% scenario-based, 25% direct recall and calculation.
Cognitive Distribution: 25% recall, 55% application, 20% analysis. Each question includes a detailed HESI-specific rationale
explaining pathophysiology, pharmacology, evidence-based practice, and patient safety considerations.
SECTION 1: HEMODYNAMIC MONITORING AND CARDIOVASCULAR
CRITICAL CARE
Q1 – Q30 | PA Catheter, CVP, Arterial Lines, Cardiac Output, Shock States, and Vasoactive Medications
Q1: A 68-year-old patient in septic shock has a pulmonary artery (PA) catheter in place. Current
hemodynamic parameters: BP 86/52 mmHg, MAP 63 mmHg, CVP 3 mmHg, PAOP 6 mmHg, CO 8.5
L/min, CI 4.8 L/min/m², SVR 480 dynes·s/cm⁵. The nurse recognizes these values are most consistent
with which type of shock?
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive (septic) shock with low SVR and high cardiac output [CORRECT]
D. Obstructive shock from cardiac tamponade
Correct Answer: C
Rationale: Septic shock is characterized by vasodilation causing low SVR (<800 dynes·s/cm⁵), low filling pressures
(CVP <8 mmHg, PAOP <12 mmHg), and a compensatory high cardiac output (CO >7 L/min) due to decreased
afterload. The low MAP (63 mmHg) confirms persistent hypotension despite compensatory hyperdynamic circulation.
Cardiogenic shock would show low CO with high filling pressures; hypovolemic shock would show low CO with low
filling pressures and high SVR; obstructive shock (tamponade) shows equalization of diastolic pressures (CVP ≈ PAOP
≈ PAD).
Q2: A patient with acute decompensated heart failure has a PA catheter showing PAOP 28 mmHg,
CO 3.2 L/min, SVR 1,890 dynes·s/cm⁵. Which vasoactive medication would the nurse anticipate
administering to improve cardiac output and reduce afterload?
A. Norepinephrine (Levophed) IV
B. Dobutamine (Dobutrex) IV [CORRECT]
C. Phenylephrine (Neo-Synephrine) IV
D. Vasopressin IV
Correct Answer: B
Page 1
,HESI Critical Care Exam 2026/2027 — Actual Exam Test Bank 150 Questions | 100% Correct Answers
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility (positive inotrope), improving cardiac
output in low-output states like cardiogenic shock or acute decompensated heart failure. It also has mild beta-2
vasodilatory effects that reduce afterload (SVR). Norepinephrine and phenylephrine are pure vasoconstrictors that
would worsen afterload in an already high-SVR state; vasopressin is used in vasodilatory shock with vasoplegia. The
patient needs inotropic support and afterload reduction, both achieved with dobutamine.
Q3: The nurse is caring for a patient with a PA catheter. The pulmonary artery pressure (PAP) is
38/18 mmHg, PAOP is 8 mmHg, and the patient has new-onset Bibasilar crackles. Which
interpretation is most accurate?
A. The PAOP is normal; the elevated PAP is caused by pulmonary hypertension, not left heart failure.
B. The PAOP is normal, ruling out left-sided heart failure as the cause of crackles.
C. The PAOP should be elevated if left heart failure is present; the discrepancy suggests catheter
migration or measurement error and warrants re-verification before treatment. [CORRECT]
D. The patient has hypervolemia requiring immediate fluid restriction.
Correct Answer: C
Rationale: Normal PAOP is 6–12 mmHg. In left heart failure, the PAOP should be elevated (>18 mmHg) due to
backward transmission of increased left atrial pressure. The current PAOP of 8 mmHg contradicts the clinical picture of
pulmonary crackles, suggesting possible catheter migration (e.g., into a wedge position persistently, or out of the wedge
zone), transducer misalignment, or incorrect zeroing. The nurse should re-level the transducer at the phlebostatic axis
(4th ICS, mid-axillary line), re-zero, and re-measure before administering diuretics or fluids.
Q4: A patient with cardiogenic shock has the following hemodynamic profile: BP 78/50, MAP 59, HR
122, PAOP 26, CO 2.8 L/min, SVR 2,150. The provider orders an inotrope and a vasodilator. Which
combination is most appropriate?
A. Dobutamine + nitroglycerin [CORRECT]
B. Norepinephrine + vasopressin
C. Phenylephrine + epinephrine
D. Dopamine + normal saline bolus
Correct Answer: A
Rationale: Cardiogenic shock requires increasing contractility and reducing afterload. Dobutamine (beta-1 agonist)
increases contractility and CO; nitroglycerin (venodilator) reduces preload, lowering the elevated PAOP (26 mmHg) and
improving pulmonary congestion. This combination addresses both low CO and high afterload. Norepinephrine +
vasopressin would worsen vasoconstriction (already SVR 2,150); phenylephrine + epinephrine would also worsen
afterload; dopamine + fluids would worsen pulmonary edema given high PAOP. The goal is inotropic support with
concurrent afterload/preload reduction.
Page 2
,HESI Critical Care Exam 2026/2027 — Actual Exam Test Bank 150 Questions | 100% Correct Answers
Q5: A nurse is assessing an arterial line waveform and notes a dampened tracing with an
underdamped systolic pressure of 220 mmHg. Which action should the nurse take first?
A. Check for air bubbles, kinks, or loose connections in the pressure tubing system. [CORRECT]
B. Administer antihypertensive medication immediately.
C. Discontinue the arterial line and replace with a new one.
D. Document the finding; dampening does not affect accuracy.
Correct Answer: A
Rationale: An overdamped waveform falsely lowers systolic pressure and widens the pulse pressure, often caused by air
bubbles, kinks, blood clots, or loose connections in the pressure tubing. The nurse should first inspect the system, remove
any air, ensure tight connections, and verify with a square waveform test (fast flush). An underdamped system (too
"whippy") produces falsely high systolic readings. Administering antihypertensives based on a falsely elevated reading
would harm the patient. Replacing the line is reserved only if troubleshooting fails.
Q6: A patient in shock has a central venous oxygen saturation (ScvO₂) of 58%. Which interpretation
is correct?
A. This is within normal limits.
B. The patient has inadequate oxygen delivery; the normal ScvO₂ is 60–80%, and 58% suggests
increased oxygen extraction due to hypoperfusion. [CORRECT]
C. The patient has excessive oxygen delivery requiring reduced FiO₂.
D. ScvO₂ has no correlation with tissue oxygenation.
Correct Answer: B
Rationale: ScvO₂ (measured from a central venous line in the SVC) reflects the balance between oxygen delivery and
oxygen consumption. Normal range is 60–80% (typically 70% ± 5%). A value below 60% indicates increased oxygen
extraction due to inadequate oxygen delivery, which occurs in shock states (hypovolemic, cardiogenic, septic,
obstructive). The body compensates for low DO₂ by extracting more oxygen from hemoglobin, lowering ScvO₂.
Treatment targets improving DO₂: increase Hgb, SaO₂, or CO, depending on the underlying cause.
Q7: A nurse is caring for a patient with a PA catheter. The wedge pressure (PAOP) is being
measured. Which nursing action is essential during the measurement?
A. Inflate the balloon rapidly to its full capacity to ensure occlusion.
B. Inflate the balloon slowly with no more than 1.5 mL of air, monitor the waveform continuously,
and stop inflation immediately when the wedge pattern appears. [CORRECT]
C. Keep the balloon inflated for at least 60 seconds to obtain an accurate reading.
D. Deflate the balloon only after notifying the physician.
Correct Answer: B
Rationale: PA catheter balloon inflation for wedge pressure measurement must be done slowly with ≤1.5 mL of air,
while continuously observing the waveform. The nurse must stop inflation immediately when the wedge waveform
appears to prevent pulmonary artery rupture or infarction. The balloon should never remain inflated for more than 15
seconds (typically two respiratory cycles) to avoid pulmonary ischemia. Spontaneous wedge (catheter migrating into
wedge position without balloon inflation) is a dangerous complication requiring catheter pullback.
Page 3
, HESI Critical Care Exam 2026/2027 — Actual Exam Test Bank 150 Questions | 100% Correct Answers
Q8: A patient with hypovolemic shock from a GI bleed has a CVP of 2 mmHg, MAP 55 mmHg, and
urine output 10 mL/hr. The nurse anticipates which initial intervention?
A. Administer norepinephrine IV to raise blood pressure.
B. Administer a 500–1,000 mL crystalloid bolus (normal saline or Lactated Ringer's) and reassess.
[CORRECT]
C. Start dobutamine infusion to increase cardiac output.
D. Restrict fluids and administer furosemide.
Correct Answer: B
Rationale: Hypovolemic shock is characterized by low CVP (<8 mmHg), low CO, low MAP, and high SVR
(compensatory vasoconstriction). The treatment is volume replacement with crystalloids (NS or LR) as 500–1,000 mL
boluses over 15–30 minutes, with reassessment of CVP, MAP, and urine output after each bolus. Vasopressors
(norepinephrine) are reserved for distributive shock or when volume resuscitation fails; inotropic agents (dobutamine)
are used for cardiogenic shock; diuretics are contraindicated in hypovolemia. The Surviving Sepsis Campaign and ATLS
guidelines emphasize early, adequate fluid resuscitation.
Q9: A patient is receiving norepinephrine at 0.2 mcg/kg/min for septic shock. The MAP improves
from 55 to 70 mmHg, but the patient develops cool, mottled extremities with capillary refill >5
seconds. Which interpretation is correct?
A. The mottling indicates sepsis is worsening despite adequate vasopressor therapy.
B. The mottling is caused by peripheral vasoconstriction from norepinephrine; the dose may need
titration based on overall perfusion indicators (lactate, ScvO₂, urine output), not just MAP.
[CORRECT]
C. The patient is now fluid-overloaded and requires diuresis.
D. The norepinephrine dose should be increased to further raise MAP.
Correct Answer: B
Rationale: Norepinephrine is an alpha-1 agonist causing peripheral vasoconstriction to raise MAP, but this can lead to
distal extremity hypoperfusion (mottling, prolonged capillary refill). The target MAP of 65 mmHg has been achieved;
further titration should be guided by global perfusion markers (lactate clearance, ScvO₂, urine output, mental status), not
just MAP alone. If perfusion is inadequate despite adequate MAP, adding dobutamine (inotrope) or considering
alternative pressors (vasopressin) may be appropriate. Lactate and urine output trends guide overall therapy
effectiveness.
Q10: A nurse is caring for a patient with an arterial line. The transducer is positioned 10 cm below
the phlebostatic axis. How will this affect the blood pressure reading?
A. The reading will be falsely low.
B. The reading will be falsely high (each 10 cm below the axis adds approximately 7.4 mmHg to the
reading). [CORRECT]
C. The reading will be accurate regardless of transducer position.
D. The reading will fluctuate unpredictably.
Correct Answer: B
Page 4
HESI CRITICAL CARE EXAM 2026/2027 ACTUAL
EXAM TEST BANK
With Real Exam Questions, Correct Answers, and Comprehensive Rationales
Critical Care Nursing Certification Examination Preparation | Aligned with 2026-2027 HESI Exam Blueprint | 150 Questions Across
7 Domains
Format: 150 multiple-choice questions (4 options, ONE correct) — 75% scenario-based, 25% direct recall and calculation.
Cognitive Distribution: 25% recall, 55% application, 20% analysis. Each question includes a detailed HESI-specific rationale
explaining pathophysiology, pharmacology, evidence-based practice, and patient safety considerations.
SECTION 1: HEMODYNAMIC MONITORING AND CARDIOVASCULAR
CRITICAL CARE
Q1 – Q30 | PA Catheter, CVP, Arterial Lines, Cardiac Output, Shock States, and Vasoactive Medications
Q1: A 68-year-old patient in septic shock has a pulmonary artery (PA) catheter in place. Current
hemodynamic parameters: BP 86/52 mmHg, MAP 63 mmHg, CVP 3 mmHg, PAOP 6 mmHg, CO 8.5
L/min, CI 4.8 L/min/m², SVR 480 dynes·s/cm⁵. The nurse recognizes these values are most consistent
with which type of shock?
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive (septic) shock with low SVR and high cardiac output [CORRECT]
D. Obstructive shock from cardiac tamponade
Correct Answer: C
Rationale: Septic shock is characterized by vasodilation causing low SVR (<800 dynes·s/cm⁵), low filling pressures
(CVP <8 mmHg, PAOP <12 mmHg), and a compensatory high cardiac output (CO >7 L/min) due to decreased
afterload. The low MAP (63 mmHg) confirms persistent hypotension despite compensatory hyperdynamic circulation.
Cardiogenic shock would show low CO with high filling pressures; hypovolemic shock would show low CO with low
filling pressures and high SVR; obstructive shock (tamponade) shows equalization of diastolic pressures (CVP ≈ PAOP
≈ PAD).
Q2: A patient with acute decompensated heart failure has a PA catheter showing PAOP 28 mmHg,
CO 3.2 L/min, SVR 1,890 dynes·s/cm⁵. Which vasoactive medication would the nurse anticipate
administering to improve cardiac output and reduce afterload?
A. Norepinephrine (Levophed) IV
B. Dobutamine (Dobutrex) IV [CORRECT]
C. Phenylephrine (Neo-Synephrine) IV
D. Vasopressin IV
Correct Answer: B
Page 1
,HESI Critical Care Exam 2026/2027 — Actual Exam Test Bank 150 Questions | 100% Correct Answers
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility (positive inotrope), improving cardiac
output in low-output states like cardiogenic shock or acute decompensated heart failure. It also has mild beta-2
vasodilatory effects that reduce afterload (SVR). Norepinephrine and phenylephrine are pure vasoconstrictors that
would worsen afterload in an already high-SVR state; vasopressin is used in vasodilatory shock with vasoplegia. The
patient needs inotropic support and afterload reduction, both achieved with dobutamine.
Q3: The nurse is caring for a patient with a PA catheter. The pulmonary artery pressure (PAP) is
38/18 mmHg, PAOP is 8 mmHg, and the patient has new-onset Bibasilar crackles. Which
interpretation is most accurate?
A. The PAOP is normal; the elevated PAP is caused by pulmonary hypertension, not left heart failure.
B. The PAOP is normal, ruling out left-sided heart failure as the cause of crackles.
C. The PAOP should be elevated if left heart failure is present; the discrepancy suggests catheter
migration or measurement error and warrants re-verification before treatment. [CORRECT]
D. The patient has hypervolemia requiring immediate fluid restriction.
Correct Answer: C
Rationale: Normal PAOP is 6–12 mmHg. In left heart failure, the PAOP should be elevated (>18 mmHg) due to
backward transmission of increased left atrial pressure. The current PAOP of 8 mmHg contradicts the clinical picture of
pulmonary crackles, suggesting possible catheter migration (e.g., into a wedge position persistently, or out of the wedge
zone), transducer misalignment, or incorrect zeroing. The nurse should re-level the transducer at the phlebostatic axis
(4th ICS, mid-axillary line), re-zero, and re-measure before administering diuretics or fluids.
Q4: A patient with cardiogenic shock has the following hemodynamic profile: BP 78/50, MAP 59, HR
122, PAOP 26, CO 2.8 L/min, SVR 2,150. The provider orders an inotrope and a vasodilator. Which
combination is most appropriate?
A. Dobutamine + nitroglycerin [CORRECT]
B. Norepinephrine + vasopressin
C. Phenylephrine + epinephrine
D. Dopamine + normal saline bolus
Correct Answer: A
Rationale: Cardiogenic shock requires increasing contractility and reducing afterload. Dobutamine (beta-1 agonist)
increases contractility and CO; nitroglycerin (venodilator) reduces preload, lowering the elevated PAOP (26 mmHg) and
improving pulmonary congestion. This combination addresses both low CO and high afterload. Norepinephrine +
vasopressin would worsen vasoconstriction (already SVR 2,150); phenylephrine + epinephrine would also worsen
afterload; dopamine + fluids would worsen pulmonary edema given high PAOP. The goal is inotropic support with
concurrent afterload/preload reduction.
Page 2
,HESI Critical Care Exam 2026/2027 — Actual Exam Test Bank 150 Questions | 100% Correct Answers
Q5: A nurse is assessing an arterial line waveform and notes a dampened tracing with an
underdamped systolic pressure of 220 mmHg. Which action should the nurse take first?
A. Check for air bubbles, kinks, or loose connections in the pressure tubing system. [CORRECT]
B. Administer antihypertensive medication immediately.
C. Discontinue the arterial line and replace with a new one.
D. Document the finding; dampening does not affect accuracy.
Correct Answer: A
Rationale: An overdamped waveform falsely lowers systolic pressure and widens the pulse pressure, often caused by air
bubbles, kinks, blood clots, or loose connections in the pressure tubing. The nurse should first inspect the system, remove
any air, ensure tight connections, and verify with a square waveform test (fast flush). An underdamped system (too
"whippy") produces falsely high systolic readings. Administering antihypertensives based on a falsely elevated reading
would harm the patient. Replacing the line is reserved only if troubleshooting fails.
Q6: A patient in shock has a central venous oxygen saturation (ScvO₂) of 58%. Which interpretation
is correct?
A. This is within normal limits.
B. The patient has inadequate oxygen delivery; the normal ScvO₂ is 60–80%, and 58% suggests
increased oxygen extraction due to hypoperfusion. [CORRECT]
C. The patient has excessive oxygen delivery requiring reduced FiO₂.
D. ScvO₂ has no correlation with tissue oxygenation.
Correct Answer: B
Rationale: ScvO₂ (measured from a central venous line in the SVC) reflects the balance between oxygen delivery and
oxygen consumption. Normal range is 60–80% (typically 70% ± 5%). A value below 60% indicates increased oxygen
extraction due to inadequate oxygen delivery, which occurs in shock states (hypovolemic, cardiogenic, septic,
obstructive). The body compensates for low DO₂ by extracting more oxygen from hemoglobin, lowering ScvO₂.
Treatment targets improving DO₂: increase Hgb, SaO₂, or CO, depending on the underlying cause.
Q7: A nurse is caring for a patient with a PA catheter. The wedge pressure (PAOP) is being
measured. Which nursing action is essential during the measurement?
A. Inflate the balloon rapidly to its full capacity to ensure occlusion.
B. Inflate the balloon slowly with no more than 1.5 mL of air, monitor the waveform continuously,
and stop inflation immediately when the wedge pattern appears. [CORRECT]
C. Keep the balloon inflated for at least 60 seconds to obtain an accurate reading.
D. Deflate the balloon only after notifying the physician.
Correct Answer: B
Rationale: PA catheter balloon inflation for wedge pressure measurement must be done slowly with ≤1.5 mL of air,
while continuously observing the waveform. The nurse must stop inflation immediately when the wedge waveform
appears to prevent pulmonary artery rupture or infarction. The balloon should never remain inflated for more than 15
seconds (typically two respiratory cycles) to avoid pulmonary ischemia. Spontaneous wedge (catheter migrating into
wedge position without balloon inflation) is a dangerous complication requiring catheter pullback.
Page 3
, HESI Critical Care Exam 2026/2027 — Actual Exam Test Bank 150 Questions | 100% Correct Answers
Q8: A patient with hypovolemic shock from a GI bleed has a CVP of 2 mmHg, MAP 55 mmHg, and
urine output 10 mL/hr. The nurse anticipates which initial intervention?
A. Administer norepinephrine IV to raise blood pressure.
B. Administer a 500–1,000 mL crystalloid bolus (normal saline or Lactated Ringer's) and reassess.
[CORRECT]
C. Start dobutamine infusion to increase cardiac output.
D. Restrict fluids and administer furosemide.
Correct Answer: B
Rationale: Hypovolemic shock is characterized by low CVP (<8 mmHg), low CO, low MAP, and high SVR
(compensatory vasoconstriction). The treatment is volume replacement with crystalloids (NS or LR) as 500–1,000 mL
boluses over 15–30 minutes, with reassessment of CVP, MAP, and urine output after each bolus. Vasopressors
(norepinephrine) are reserved for distributive shock or when volume resuscitation fails; inotropic agents (dobutamine)
are used for cardiogenic shock; diuretics are contraindicated in hypovolemia. The Surviving Sepsis Campaign and ATLS
guidelines emphasize early, adequate fluid resuscitation.
Q9: A patient is receiving norepinephrine at 0.2 mcg/kg/min for septic shock. The MAP improves
from 55 to 70 mmHg, but the patient develops cool, mottled extremities with capillary refill >5
seconds. Which interpretation is correct?
A. The mottling indicates sepsis is worsening despite adequate vasopressor therapy.
B. The mottling is caused by peripheral vasoconstriction from norepinephrine; the dose may need
titration based on overall perfusion indicators (lactate, ScvO₂, urine output), not just MAP.
[CORRECT]
C. The patient is now fluid-overloaded and requires diuresis.
D. The norepinephrine dose should be increased to further raise MAP.
Correct Answer: B
Rationale: Norepinephrine is an alpha-1 agonist causing peripheral vasoconstriction to raise MAP, but this can lead to
distal extremity hypoperfusion (mottling, prolonged capillary refill). The target MAP of 65 mmHg has been achieved;
further titration should be guided by global perfusion markers (lactate clearance, ScvO₂, urine output, mental status), not
just MAP alone. If perfusion is inadequate despite adequate MAP, adding dobutamine (inotrope) or considering
alternative pressors (vasopressin) may be appropriate. Lactate and urine output trends guide overall therapy
effectiveness.
Q10: A nurse is caring for a patient with an arterial line. The transducer is positioned 10 cm below
the phlebostatic axis. How will this affect the blood pressure reading?
A. The reading will be falsely low.
B. The reading will be falsely high (each 10 cm below the axis adds approximately 7.4 mmHg to the
reading). [CORRECT]
C. The reading will be accurate regardless of transducer position.
D. The reading will fluctuate unpredictably.
Correct Answer: B
Page 4
