CRITICAL CARE HESI EXIT EXAM (V1) WITH
NGN
COMPREHENSIVE TEST BANK • 2026/2027 EDITION
150 High-Acuity Critical-Care & NGN-Style Questions with Answers & Rationales
Section Content Area Questions
1 Hemodynamic Monitoring & Cardiovascular Critical Care 30
2 Respiratory Critical Care 25
3 Neurological Critical Care 20
4 Renal & Fluid/Electrolyte Critical Care 20
5 Endocrine & Multisystem Critical Care 20
6 Pharmacology in Critical Care 15
7 Integrated NGN-Style Case Studies 20
TOTAL 150
Cognitive mix: ~30% recall • ~50% application/clinical judgment • ~20% analysis. Aligned with the NCSBN Clinical
Judgment Measurement Model and AACN critical-care standards. Section 7 presents unfolding NGN-style case
studies mapped to the six clinical-judgment cognitive functions (recognize cues, analyze cues, prioritize hypotheses,
generate solutions, take action, evaluate outcomes).
Original practice material. These are AI-authored study questions modeled on the public HESI/NCLEX critical-care
blueprint. They are NOT actual, copyrighted HESI exam items and are intended for practice only. Always verify
clinical details against current evidence-based references and facility protocols.
Critical Care HESI Exit Exam (V1) with NGN — Comprehensive Test Bank (2026/2027) Page 1
, Section 1: Hemodynamic Monitoring & Cardiovascular Critical Care — CO,
CVP, PAWP, Shock, ACS (30 questions)
Q1. A nurse is monitoring a client with a pulmonary artery catheter. Which value represents a normal
central venous pressure (CVP)?
A. 2-6 mm Hg
B. 10-14 mm Hg
C. 15-20 mm Hg
D. 0 mm Hg
Correct Answer: A
Rationale: Normal CVP (right atrial pressure) is about 2-6 mm Hg, reflecting right-heart preload. Higher values
suggest fluid overload or right-heart failure; the other ranges are abnormal.
Q2. A client's pulmonary artery wedge pressure (PAWP) is 24 mm Hg. This elevated value most directly
reflects:
A. Increased left ventricular preload/left atrial pressure
B. Decreased right ventricular preload
C. Hypovolemia
D. Low systemic vascular resistance
Correct Answer: A
Rationale: PAWP estimates left atrial pressure and left ventricular preload; a value of 24 mm Hg (normal 8-12)
indicates elevated left-sided filling pressures, as in left heart failure. It does not indicate hypovolemia or low SVR.
Q3. A client in cardiogenic shock has a cardiac output of 2.8 L/min and elevated PAWP. Which medication
would the nurse anticipate to improve contractility?
A. Norepinephrine
B. Dobutamine
C. Furosemide bolus only
D. Phenylephrine
Correct Answer: B
Rationale: Dobutamine is a beta-1 inotrope that increases contractility and cardiac output in cardiogenic shock.
Norepinephrine and phenylephrine primarily raise SVR, which increases afterload on a failing heart.
Q4. A nurse calculates a client's cardiac index. Which value is within the normal range?
A. 1.5 L/min/m2
B. 3.0 L/min/m2
C. 6.5 L/min/m2
D. 0.8 L/min/m2
Correct Answer: B
Rationale: Normal cardiac index is approximately 2.5-4.0 L/min/m2. Values of 0.8-1.5 indicate severely reduced
output, and 6.5 is abnormally high.
Critical Care HESI Exit Exam (V1) with NGN — Comprehensive Test Bank (2026/2027) Page 2
, Q5. A client with an arterial line suddenly shows a dampened waveform and low readings. What should
the nurse do first?
A. Document the low pressure and continue
B. Assess the client and check the line for kinks, air, or clots before treating the number
C. Administer a fluid bolus
D. Immediately start a vasopressor
Correct Answer: B
Rationale: A dampened waveform may indicate a system problem (kink, clot, air, loose connection); the nurse
assesses the client and troubleshoots the line before acting on a potentially false reading.
Q6. A client presents with crushing substernal chest pain and ST-segment elevation in leads II, III, and
aVF. This pattern indicates:
A. Lateral wall ischemia
B. Inferior wall STEMI
C. Anterior wall STEMI
D. Pericarditis
Correct Answer: B
Rationale: ST elevation in II, III, and aVF localizes to the inferior wall (right coronary artery distribution). Anterior
involves V1-V4, and lateral involves I, aVL, V5-V6.
Q7. A client with an inferior STEMI becomes hypotensive after receiving sublingual nitroglycerin. The
nurse suspects right ventricular involvement and anticipates:
A. Beta-blocker administration
B. Immediate diuresis
C. Additional nitroglycerin
D. A fluid bolus to increase preload
Correct Answer: D
Rationale: Right ventricular infarction is preload-dependent; nitrates reduce preload and cause hypotension.
Cautious fluid boluses restore RV filling, whereas more nitrates or diuresis would worsen hypotension.
Q8. A client's rhythm strip shows a regular rate of 180/min with narrow QRS complexes and no identifiable
P waves. The client is stable. The nurse anticipates first attempting:
A. Vagal maneuvers and/or adenosine
B. Immediate synchronized cardioversion
C. Administration of atropine
D. Defibrillation
Correct Answer: A
Rationale: Stable supraventricular tachycardia is first treated with vagal maneuvers and adenosine.
Synchronized cardioversion is reserved for unstable clients, and atropine/defibrillation are inappropriate here.
Critical Care HESI Exit Exam (V1) with NGN — Comprehensive Test Bank (2026/2027) Page 3
, Q9. A client develops pulseless ventricular tachycardia. The priority intervention is:
A. Vagal maneuvers
B. Synchronized cardioversion
C. Administration of adenosine
D. Immediate defibrillation and CPR
Correct Answer: D
Rationale: Pulseless VT is a shockable arrest rhythm requiring immediate defibrillation and high-quality CPR.
Synchronized cardioversion cannot sync without a pulse/organized rhythm, and adenosine/vagal maneuvers are
not used.
Q10. A client in distributive (septic) shock would be expected to have which hemodynamic profile early in
warm shock?
A. High SVR, low cardiac output
B. Low cardiac output with cold, clammy skin only
C. High CVP and high PAWP
D. Low SVR, high or normal cardiac output
Correct Answer: D
Rationale: Early septic (distributive) shock causes massive vasodilation, producing low SVR with a compensatory
high/normal cardiac output ('warm shock'). High SVR with low output is typical of cardiogenic shock.
Q11. A client with hypovolemic shock has a low CVP and low PAWP. The priority intervention is:
A. Administer a vasodilator
B. Start a diuretic
C. Restrict fluids
D. Rapid volume resuscitation with IV fluids/blood
Correct Answer: D
Rationale: Hypovolemic shock reflects inadequate volume (low CVP and PAWP); the priority is rapid fluid/blood
resuscitation to restore preload. Vasodilators, diuretics, and fluid restriction would worsen it.
Q12. A nurse is titrating norepinephrine for septic shock. The primary goal of this vasopressor is to:
A. Increase urine output directly
B. Increase systemic vascular resistance and mean arterial pressure
C. Decrease heart rate
D. Reduce preload
Correct Answer: B
Rationale: Norepinephrine is a potent alpha agonist that raises SVR and MAP to restore perfusion in septic
shock. It does not primarily lower heart rate or reduce preload.
Q13. A client with cardiac tamponade (obstructive shock) would most likely present with:
A. Muffled heart sounds, jugular venous distention, and hypotension
B. Hypertension and bradycardia
C. Warm, flushed skin and bounding pulses
D. Low CVP
Correct Answer: A
Rationale: Beck's triad — muffled heart sounds, JVD, and hypotension — characterizes cardiac tamponade,
along with pulsus paradoxus and high CVP. It causes obstructive shock, not warm/flushed skin.
Critical Care HESI Exit Exam (V1) with NGN — Comprehensive Test Bank (2026/2027) Page 4
NGN
COMPREHENSIVE TEST BANK • 2026/2027 EDITION
150 High-Acuity Critical-Care & NGN-Style Questions with Answers & Rationales
Section Content Area Questions
1 Hemodynamic Monitoring & Cardiovascular Critical Care 30
2 Respiratory Critical Care 25
3 Neurological Critical Care 20
4 Renal & Fluid/Electrolyte Critical Care 20
5 Endocrine & Multisystem Critical Care 20
6 Pharmacology in Critical Care 15
7 Integrated NGN-Style Case Studies 20
TOTAL 150
Cognitive mix: ~30% recall • ~50% application/clinical judgment • ~20% analysis. Aligned with the NCSBN Clinical
Judgment Measurement Model and AACN critical-care standards. Section 7 presents unfolding NGN-style case
studies mapped to the six clinical-judgment cognitive functions (recognize cues, analyze cues, prioritize hypotheses,
generate solutions, take action, evaluate outcomes).
Original practice material. These are AI-authored study questions modeled on the public HESI/NCLEX critical-care
blueprint. They are NOT actual, copyrighted HESI exam items and are intended for practice only. Always verify
clinical details against current evidence-based references and facility protocols.
Critical Care HESI Exit Exam (V1) with NGN — Comprehensive Test Bank (2026/2027) Page 1
, Section 1: Hemodynamic Monitoring & Cardiovascular Critical Care — CO,
CVP, PAWP, Shock, ACS (30 questions)
Q1. A nurse is monitoring a client with a pulmonary artery catheter. Which value represents a normal
central venous pressure (CVP)?
A. 2-6 mm Hg
B. 10-14 mm Hg
C. 15-20 mm Hg
D. 0 mm Hg
Correct Answer: A
Rationale: Normal CVP (right atrial pressure) is about 2-6 mm Hg, reflecting right-heart preload. Higher values
suggest fluid overload or right-heart failure; the other ranges are abnormal.
Q2. A client's pulmonary artery wedge pressure (PAWP) is 24 mm Hg. This elevated value most directly
reflects:
A. Increased left ventricular preload/left atrial pressure
B. Decreased right ventricular preload
C. Hypovolemia
D. Low systemic vascular resistance
Correct Answer: A
Rationale: PAWP estimates left atrial pressure and left ventricular preload; a value of 24 mm Hg (normal 8-12)
indicates elevated left-sided filling pressures, as in left heart failure. It does not indicate hypovolemia or low SVR.
Q3. A client in cardiogenic shock has a cardiac output of 2.8 L/min and elevated PAWP. Which medication
would the nurse anticipate to improve contractility?
A. Norepinephrine
B. Dobutamine
C. Furosemide bolus only
D. Phenylephrine
Correct Answer: B
Rationale: Dobutamine is a beta-1 inotrope that increases contractility and cardiac output in cardiogenic shock.
Norepinephrine and phenylephrine primarily raise SVR, which increases afterload on a failing heart.
Q4. A nurse calculates a client's cardiac index. Which value is within the normal range?
A. 1.5 L/min/m2
B. 3.0 L/min/m2
C. 6.5 L/min/m2
D. 0.8 L/min/m2
Correct Answer: B
Rationale: Normal cardiac index is approximately 2.5-4.0 L/min/m2. Values of 0.8-1.5 indicate severely reduced
output, and 6.5 is abnormally high.
Critical Care HESI Exit Exam (V1) with NGN — Comprehensive Test Bank (2026/2027) Page 2
, Q5. A client with an arterial line suddenly shows a dampened waveform and low readings. What should
the nurse do first?
A. Document the low pressure and continue
B. Assess the client and check the line for kinks, air, or clots before treating the number
C. Administer a fluid bolus
D. Immediately start a vasopressor
Correct Answer: B
Rationale: A dampened waveform may indicate a system problem (kink, clot, air, loose connection); the nurse
assesses the client and troubleshoots the line before acting on a potentially false reading.
Q6. A client presents with crushing substernal chest pain and ST-segment elevation in leads II, III, and
aVF. This pattern indicates:
A. Lateral wall ischemia
B. Inferior wall STEMI
C. Anterior wall STEMI
D. Pericarditis
Correct Answer: B
Rationale: ST elevation in II, III, and aVF localizes to the inferior wall (right coronary artery distribution). Anterior
involves V1-V4, and lateral involves I, aVL, V5-V6.
Q7. A client with an inferior STEMI becomes hypotensive after receiving sublingual nitroglycerin. The
nurse suspects right ventricular involvement and anticipates:
A. Beta-blocker administration
B. Immediate diuresis
C. Additional nitroglycerin
D. A fluid bolus to increase preload
Correct Answer: D
Rationale: Right ventricular infarction is preload-dependent; nitrates reduce preload and cause hypotension.
Cautious fluid boluses restore RV filling, whereas more nitrates or diuresis would worsen hypotension.
Q8. A client's rhythm strip shows a regular rate of 180/min with narrow QRS complexes and no identifiable
P waves. The client is stable. The nurse anticipates first attempting:
A. Vagal maneuvers and/or adenosine
B. Immediate synchronized cardioversion
C. Administration of atropine
D. Defibrillation
Correct Answer: A
Rationale: Stable supraventricular tachycardia is first treated with vagal maneuvers and adenosine.
Synchronized cardioversion is reserved for unstable clients, and atropine/defibrillation are inappropriate here.
Critical Care HESI Exit Exam (V1) with NGN — Comprehensive Test Bank (2026/2027) Page 3
, Q9. A client develops pulseless ventricular tachycardia. The priority intervention is:
A. Vagal maneuvers
B. Synchronized cardioversion
C. Administration of adenosine
D. Immediate defibrillation and CPR
Correct Answer: D
Rationale: Pulseless VT is a shockable arrest rhythm requiring immediate defibrillation and high-quality CPR.
Synchronized cardioversion cannot sync without a pulse/organized rhythm, and adenosine/vagal maneuvers are
not used.
Q10. A client in distributive (septic) shock would be expected to have which hemodynamic profile early in
warm shock?
A. High SVR, low cardiac output
B. Low cardiac output with cold, clammy skin only
C. High CVP and high PAWP
D. Low SVR, high or normal cardiac output
Correct Answer: D
Rationale: Early septic (distributive) shock causes massive vasodilation, producing low SVR with a compensatory
high/normal cardiac output ('warm shock'). High SVR with low output is typical of cardiogenic shock.
Q11. A client with hypovolemic shock has a low CVP and low PAWP. The priority intervention is:
A. Administer a vasodilator
B. Start a diuretic
C. Restrict fluids
D. Rapid volume resuscitation with IV fluids/blood
Correct Answer: D
Rationale: Hypovolemic shock reflects inadequate volume (low CVP and PAWP); the priority is rapid fluid/blood
resuscitation to restore preload. Vasodilators, diuretics, and fluid restriction would worsen it.
Q12. A nurse is titrating norepinephrine for septic shock. The primary goal of this vasopressor is to:
A. Increase urine output directly
B. Increase systemic vascular resistance and mean arterial pressure
C. Decrease heart rate
D. Reduce preload
Correct Answer: B
Rationale: Norepinephrine is a potent alpha agonist that raises SVR and MAP to restore perfusion in septic
shock. It does not primarily lower heart rate or reduce preload.
Q13. A client with cardiac tamponade (obstructive shock) would most likely present with:
A. Muffled heart sounds, jugular venous distention, and hypotension
B. Hypertension and bradycardia
C. Warm, flushed skin and bounding pulses
D. Low CVP
Correct Answer: A
Rationale: Beck's triad — muffled heart sounds, JVD, and hypotension — characterizes cardiac tamponade,
along with pulsus paradoxus and high CVP. It causes obstructive shock, not warm/flushed skin.
Critical Care HESI Exit Exam (V1) with NGN — Comprehensive Test Bank (2026/2027) Page 4
