NGN HESI RN CRITICAL CARE
V2 (2025) — Enhanced Critical Care Study
Reviewer
Clinical judgment • prioritization • shock • hemodynamics • ventilation • emergencies
Purpose: High-yield educational preparation built from the publicly visible Stuvia preview and expanded with original
critical-care review material. This is not a reproduction of the paid document and does not provide or claim access to
actual/current HESI exam questions.
Source note: The supplied Stuvia listing is 28 pages, uploaded June 23, 2025, and its public preview includes a ventilated ICU client with SpO■
88% and bilateral crackles. Related listings emphasize shock/sepsis, hemodynamic monitoring, cardiac emergencies, ventilator management, and
multisystem failure. ■cite■turn0search0■turn0search4■
NGN HESI RN Critical Care V2 — Enhanced Study Reviewer Page 1
, 1. MASTER HIGH-YIELD MAP
• ABCs first: airway patency, breathing/oxygenation, circulation/perfusion, then neurologic status and exposure/secondary
survey.
• Shock: recognize inadequate tissue perfusion early—hypotension is important, but it can be a late finding.
• Sepsis: infection plus organ dysfunction; trend perfusion, mental status, urine output, lactate and hemodynamics.
• Hemodynamics: know preload, afterload, contractility, cardiac output, SVR, MAP and how therapies change them.
• Ventilation: distinguish oxygenation problems (FiO■/PEEP) from ventilation problems (minute ventilation/PaCO■).
• Cardiac emergencies: ACS, dysrhythmias, acute heart failure, tamponade and aortic emergencies demand rapid pattern
recognition.
• Neurocritical care: airway protection, ICP prevention, stroke recognition and seizure safety are priority themes.
• Renal/metabolic: AKI, electrolyte abnormalities, acid-base disturbances and medication accumulation can rapidly
destabilize an ICU patient.
• NGN mindset: identify cues → analyze/cluster cues → prioritize hypotheses → choose actions → reassess outcomes.
2. THE CRITICAL-CARE PRIORITY ENGINE
Step 1 — Find the immediate threat. Look for loss of airway, severe hypoxemia, respiratory fatigue, shock, active
bleeding, malignant dysrhythmia, rapidly changing neurologic status, or severe hypoglycemia/hyperkalemia.
Step 2 — Separate abnormal from dangerous. A dramatic number is not automatically the priority. Ask: what threatens
life or organ perfusion first?
Step 3 — Trend. Compare current findings with baseline and direction of change. A patient falling from MAP 75 to 58 with
declining urine output is more concerning than a stable isolated abnormality.
Step 4 — Act, then reassess. NGN questions frequently reward an action that addresses the underlying physiologic
problem and a subsequent evaluation of response.
Exam trap: Do not reflexively suction, increase ventilator settings, give fluids, or call the provider before assessing whether
the intervention is appropriate to the clinical picture.
3. SHOCK: RECOGNITION AND DIFFERENTIATION
Type Core problem Typical clues Common direction of treatment
Hypovolemic Low circulating volume Bleeding, dehydration, tachycardia, cool skin, low Volume/blood
filling pressures
replacement; stop loss
Cardiogenic Pump failure Pulmonary edema, JVD, hypotension, ischemia, low
Treat
COcause; support pump; cautious fluids
Distributive Pathologic vasodilation Warm skin early in some cases, low SVR, relativeSource
hypovolemia
control, fluids as indicated, vasopressor support
Obstructive Mechanical impediment to flow
Tamponade, massive PE, tension pneumothorax Relieve obstruction urgently
Perfusion clues: altered mentation, oliguria, cool/mottled skin, delayed capillary refill, rising lactate, weak pulses and
hypotension. Interpret them together rather than relying on one vital sign.
MAP formula: approximately (SBP + 2×DBP) / 3 when heart rate is regular. Example: 90/60 → MAP ≈ 70 mmHg.
Important distinction: cardiogenic shock can have pulmonary congestion, so indiscriminate fluid loading may worsen
oxygenation.
4. SEPSIS AND MULTISYSTEM ORGAN DYSFUNCTION
NGN HESI RN Critical Care V2 — Enhanced Study Reviewer Page 2
V2 (2025) — Enhanced Critical Care Study
Reviewer
Clinical judgment • prioritization • shock • hemodynamics • ventilation • emergencies
Purpose: High-yield educational preparation built from the publicly visible Stuvia preview and expanded with original
critical-care review material. This is not a reproduction of the paid document and does not provide or claim access to
actual/current HESI exam questions.
Source note: The supplied Stuvia listing is 28 pages, uploaded June 23, 2025, and its public preview includes a ventilated ICU client with SpO■
88% and bilateral crackles. Related listings emphasize shock/sepsis, hemodynamic monitoring, cardiac emergencies, ventilator management, and
multisystem failure. ■cite■turn0search0■turn0search4■
NGN HESI RN Critical Care V2 — Enhanced Study Reviewer Page 1
, 1. MASTER HIGH-YIELD MAP
• ABCs first: airway patency, breathing/oxygenation, circulation/perfusion, then neurologic status and exposure/secondary
survey.
• Shock: recognize inadequate tissue perfusion early—hypotension is important, but it can be a late finding.
• Sepsis: infection plus organ dysfunction; trend perfusion, mental status, urine output, lactate and hemodynamics.
• Hemodynamics: know preload, afterload, contractility, cardiac output, SVR, MAP and how therapies change them.
• Ventilation: distinguish oxygenation problems (FiO■/PEEP) from ventilation problems (minute ventilation/PaCO■).
• Cardiac emergencies: ACS, dysrhythmias, acute heart failure, tamponade and aortic emergencies demand rapid pattern
recognition.
• Neurocritical care: airway protection, ICP prevention, stroke recognition and seizure safety are priority themes.
• Renal/metabolic: AKI, electrolyte abnormalities, acid-base disturbances and medication accumulation can rapidly
destabilize an ICU patient.
• NGN mindset: identify cues → analyze/cluster cues → prioritize hypotheses → choose actions → reassess outcomes.
2. THE CRITICAL-CARE PRIORITY ENGINE
Step 1 — Find the immediate threat. Look for loss of airway, severe hypoxemia, respiratory fatigue, shock, active
bleeding, malignant dysrhythmia, rapidly changing neurologic status, or severe hypoglycemia/hyperkalemia.
Step 2 — Separate abnormal from dangerous. A dramatic number is not automatically the priority. Ask: what threatens
life or organ perfusion first?
Step 3 — Trend. Compare current findings with baseline and direction of change. A patient falling from MAP 75 to 58 with
declining urine output is more concerning than a stable isolated abnormality.
Step 4 — Act, then reassess. NGN questions frequently reward an action that addresses the underlying physiologic
problem and a subsequent evaluation of response.
Exam trap: Do not reflexively suction, increase ventilator settings, give fluids, or call the provider before assessing whether
the intervention is appropriate to the clinical picture.
3. SHOCK: RECOGNITION AND DIFFERENTIATION
Type Core problem Typical clues Common direction of treatment
Hypovolemic Low circulating volume Bleeding, dehydration, tachycardia, cool skin, low Volume/blood
filling pressures
replacement; stop loss
Cardiogenic Pump failure Pulmonary edema, JVD, hypotension, ischemia, low
Treat
COcause; support pump; cautious fluids
Distributive Pathologic vasodilation Warm skin early in some cases, low SVR, relativeSource
hypovolemia
control, fluids as indicated, vasopressor support
Obstructive Mechanical impediment to flow
Tamponade, massive PE, tension pneumothorax Relieve obstruction urgently
Perfusion clues: altered mentation, oliguria, cool/mottled skin, delayed capillary refill, rising lactate, weak pulses and
hypotension. Interpret them together rather than relying on one vital sign.
MAP formula: approximately (SBP + 2×DBP) / 3 when heart rate is regular. Example: 90/60 → MAP ≈ 70 mmHg.
Important distinction: cardiogenic shock can have pulmonary congestion, so indiscriminate fluid loading may worsen
oxygenation.
4. SEPSIS AND MULTISYSTEM ORGAN DYSFUNCTION
NGN HESI RN Critical Care V2 — Enhanced Study Reviewer Page 2
