1
CRITICAL CARE HESI EXIT EXAM| QUESTIONS WITH
VERIFIED ANSWERS | 2026
Version 1 (Questions 1–25) | Version 2 (Questions 26–50) |
Version 3 (Questions 51–75)
Version 1 – Critical Care (Questions 1–25)
1. A client in the intensive care unit (icu) is mechanically ventilated with an
endotracheal tube. The high-pressure alarm sounds. Which action should the nurse
take first?
A. Suction the endotracheal tube
B. Check for a cuff leak
C. Disconnect the client from the ventilator
D. Increase the pressure limit
Answer: a. Suction the endotracheal tube
, 2
Rationale: high-pressure alarm最常见 causes: mucus plugging, biting the tube, kinked
tubing, or bronchospasm. Suctioning is the most common first intervention to clear
secretions causing increased resistance. Checking cuff leak (b) would cause low-
pressure alarm.
Disconnecting (c) is unsafe without a manual resuscitation bag. Increasing pressure limit
(d) ignores the underlying problem.
2. A client with septic shock has a mean arterial pressure (map) of 52 mm hg despite
fluid resuscitation. Which medication does the nurse anticipate administering?
A. Dobutamine
B. Norepinephrine (levophed)
C. Nitroprusside (nipride)
D. Furosemide (lasix)
, 3
Answer: b. Norepinephrine (levophed)
Rationale: map <65 mm hg indicates hypotension requiring vasopressors.
Norepinephrine is the first-line vasopressor in septic shock. Dobutamine (a) is an
inotrope used for cardiogenic shock. Nitroprusside (c) is a vasodilator — would worsen
hypotension.
Furosemide (d) is a diuretic — not indicated in shock.
3. (ngn case study – unfolding)
*a 68-year-old client is admitted to the icu with acute respiratory distress syndrome
(ards) secondary to pneumonia. Vital signs: hr 120, rr 32, spo₂ 85% on 6 l nasal
cannula, bp 90/60. Lung sounds reveal crackles bilaterally.*
Question 3a: which ventilator setting does the nurse expect to be ordered for this
client?
A. Low tidal volume (6 ml/kg ideal body weight)
B. High tidal volume (12 ml/kg)
, 4
C. Low positive end-expiratory pressure (peep) of 2 cm h₂o
D. Pressure support ventilation only
Answer: a. Low tidal volume (6 ml/kg ideal body weight)
Rationale: ards management uses low tidal volume (4-6 ml/kg) to prevent ventilator-
induced lung injury (volutrauma, barotrauma). High tidal volume (b) worsens lung injury.
Moderate to high peep (not low, c) is used to recruit alveoli.
Question 3b: one hour later, the client's spo₂ drops to 82%. The nurse notes absent
breath sounds on the right side. Which action should the nurse take first?
A. Increase oxygen to 100%
B. Notify the provider for a chest x-ray
CRITICAL CARE HESI EXIT EXAM| QUESTIONS WITH
VERIFIED ANSWERS | 2026
Version 1 (Questions 1–25) | Version 2 (Questions 26–50) |
Version 3 (Questions 51–75)
Version 1 – Critical Care (Questions 1–25)
1. A client in the intensive care unit (icu) is mechanically ventilated with an
endotracheal tube. The high-pressure alarm sounds. Which action should the nurse
take first?
A. Suction the endotracheal tube
B. Check for a cuff leak
C. Disconnect the client from the ventilator
D. Increase the pressure limit
Answer: a. Suction the endotracheal tube
, 2
Rationale: high-pressure alarm最常见 causes: mucus plugging, biting the tube, kinked
tubing, or bronchospasm. Suctioning is the most common first intervention to clear
secretions causing increased resistance. Checking cuff leak (b) would cause low-
pressure alarm.
Disconnecting (c) is unsafe without a manual resuscitation bag. Increasing pressure limit
(d) ignores the underlying problem.
2. A client with septic shock has a mean arterial pressure (map) of 52 mm hg despite
fluid resuscitation. Which medication does the nurse anticipate administering?
A. Dobutamine
B. Norepinephrine (levophed)
C. Nitroprusside (nipride)
D. Furosemide (lasix)
, 3
Answer: b. Norepinephrine (levophed)
Rationale: map <65 mm hg indicates hypotension requiring vasopressors.
Norepinephrine is the first-line vasopressor in septic shock. Dobutamine (a) is an
inotrope used for cardiogenic shock. Nitroprusside (c) is a vasodilator — would worsen
hypotension.
Furosemide (d) is a diuretic — not indicated in shock.
3. (ngn case study – unfolding)
*a 68-year-old client is admitted to the icu with acute respiratory distress syndrome
(ards) secondary to pneumonia. Vital signs: hr 120, rr 32, spo₂ 85% on 6 l nasal
cannula, bp 90/60. Lung sounds reveal crackles bilaterally.*
Question 3a: which ventilator setting does the nurse expect to be ordered for this
client?
A. Low tidal volume (6 ml/kg ideal body weight)
B. High tidal volume (12 ml/kg)
, 4
C. Low positive end-expiratory pressure (peep) of 2 cm h₂o
D. Pressure support ventilation only
Answer: a. Low tidal volume (6 ml/kg ideal body weight)
Rationale: ards management uses low tidal volume (4-6 ml/kg) to prevent ventilator-
induced lung injury (volutrauma, barotrauma). High tidal volume (b) worsens lung injury.
Moderate to high peep (not low, c) is used to recruit alveoli.
Question 3b: one hour later, the client's spo₂ drops to 82%. The nurse notes absent
breath sounds on the right side. Which action should the nurse take first?
A. Increase oxygen to 100%
B. Notify the provider for a chest x-ray
