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NGN HESI RN Critical Care Exam V2 (2025) –
Verified Actual Exam | Graded A+ with Correct
Questions and Expert Answers
1. A client in the ICU is receiving mechanical ventilation with a PEEP of 10 cm H2O. The
nurse notes an SpO2 of 88% and bilateral crackles. What is the priority action?
A. Increase the PEEP to 15 cm H2O
B. Notify the healthcare provider
C. Administer a bronchodilator
D. Suction the endotracheal tube
Correct Answer: B
Rationale: An SpO2 of 88% and bilateral crackles suggest hypoxemia and possible
pulmonary edema or fluid overload, requiring immediate provider notification for
evaluation and potential diuresis. Increasing PEEP, administering a bronchodilator, or
suctioning may be appropriate but are not the priority without further assessment.
2. A client with septic shock has a mean arterial pressure (MAP) of 58 mm Hg despite fluid
resuscitation. Which medication should the nurse anticipate administering?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Dobutamine
Correct Answer: B
Rationale: Norepinephrine is the first-line vasopressor for septic shock to restore MAP
by increasing peripheral vascular resistance. Epinephrine is second -line, dopamine is less
preferred, and dobutamine is used for cardiac output support, not MAP.
3. A client with acute respiratory distress syndrome (ARDS) is on mechanical ventilation.
Which ventilator setting minimizes barotrauma?
A. High tidal volume (10–12 mL/kg)
B. Low tidal volume (6 mL/kg)
C. High respiratory rate (30/min)
D. Decreased PEEP
Correct Answer: B
Rationale: Low tidal volume ventilation (6 mL/kg) reduces barotrauma in ARDS by
minimizing alveolar overdistension. High tidal volumes increase injury risk, high
respiratory rates do not address barotrauma, and PEEP is needed for oxygenation.
4. A client with a traumatic brain injury has an intracranial pressure (ICP) of 22 mm Hg.
Which intervention should the nurse implement first?
A. Administer mannitol as prescribed
B. Elevate the head of the bed to 30 degrees
C. Hyperventilate the client
, 2
D. Restrict fluids to 500 mL/day
Correct Answer: B
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage and
reduces ICP non-invasively. Mannitol requires an order, hyperventilation is used
cautiously, and fluid restriction is not immediate.
5. A client in cardiogenic shock is receiving dobutamine. Which finding indicates the
medication is effective?
A. Heart rate 120/min
B. Blood pressure 90/60 mm Hg
C. Cardiac output 5.2 L/min
D. Pulmonary artery pressure 40/20 mm Hg
Correct Answer: C
Rationale: Dobutamine improves cardiac output in cardiogenic shock by enhancing
contractility. A cardiac output of 5.2 L/min indicates effectiveness. Tachycardia, low
blood pressure, or elevated pulmonary pressures are not specific to dobutamine’s effect.
6. A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL and pH of
7.25. What is the priority intervention?
A. Administer sodium bicarbonate
B. Initiate insulin infusion
C. Give 50% dextrose IV
D. Restrict fluids
Correct Answer: B
Rationale: Insulin infusion corrects hyperglycemia and acidosis in DKA by facilitating
glucose uptake and halting ketone production. Sodium bicarbonate is rarely used,
dextrose is given later, and fluids are essential for hydration.
7. A client with a pulmonary embolism reports sudden dyspnea and chest pain. Which
diagnostic test should the nurse anticipate?
A. Chest X-ray
B. CT pulmonary angiography
C. Arterial blood gas (ABG)
D. Electrocardiogram (ECG)
Correct Answer: B
Rationale: CT pulmonary angiography is the gold standard for diagnosing pulmonary
embolism, visualizing clots directly. Chest X-ray and ECG are non-specific, and ABG
assesses oxygenation but not the cause.
8. A client with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. Which
medication should the nurse administer first?
A. Furosemide
B. Calcium gluconate
C. Sodium polystyrene sulfonate
D. Insulin and glucose
Correct Answer: B
Rationale: Calcium gluconate stabilizes cardiac membranes in hyperkalemia, preventing
arrhythmias, and is the priority in critical settings. Insulin and glucose shift potassium
intracellularly, sodium polystyrene removes it, and furosemide is less immediate.
, 3
9. A client with a ventricular tachycardia is pulseless. Which action should the nurse take
first?
A. Administer epinephrine
B. Initiate defibrillation
C. Start chest compressions
D. Give amiodarone
Correct Answer: C
Rationale: Per ACLS guidelines, chest compressions are initiated immediately in
pulseless ventricular tachycardia to restore circulation. Defibrillation follows, epinephrine
is given during CPR, and amiodarone is used after initial interventions.
10. A client with sepsis is prescribed vancomycin. Which laboratory value should the nurse
monitor closely?
A. Serum creatinine
B. White blood cell count
C. Platelet count
D. Blood glucose
Correct Answer: A
Rationale: Vancomycin is nephrotoxic, requiring close monitoring of serum creatinine
for renal function. WBC count monitors infection, platelets assess clotting, and glucose is
unrelated.
11. A client with a myocardial infarction (MI) develops heart failure. Which medication
should the nurse anticipate?
A. Metoprolol
B. Nitroglycerin
C. Furosemide
D. Atropine
Correct Answer: C
Rationale: Furosemide treats pulmonary edema in heart failure post-MI by reducing
fluid overload. Metoprolol reduces myocardial demand, nitroglycerin relieves angina, and
atropine treats bradycardia.
12. A client with a subarachnoid hemorrhage reports a severe headache. Which intervention
should the nurse implement first?
A. Administer morphine
B. Dim the room lights
C. Restrict fluids
D. Elevate the head of the bed
Correct Answer: B
Rationale: Dimming lights reduces photophobia and discomfort in subarachnoid
hemorrhage. Morphine requires an order, fluid restriction is not immediate, and head
elevation is secondary.
13. A client with acute pancreatitis has a nasogastric tube to low intermittent suction. Which
finding indicates a complication?
A. Serum amylase 300 U/L
B. Abdominal pain relieved by suction
C. Bloody nasogastric output
D. Heart rate 90/min
NGN HESI RN Critical Care Exam V2 (2025) –
Verified Actual Exam | Graded A+ with Correct
Questions and Expert Answers
1. A client in the ICU is receiving mechanical ventilation with a PEEP of 10 cm H2O. The
nurse notes an SpO2 of 88% and bilateral crackles. What is the priority action?
A. Increase the PEEP to 15 cm H2O
B. Notify the healthcare provider
C. Administer a bronchodilator
D. Suction the endotracheal tube
Correct Answer: B
Rationale: An SpO2 of 88% and bilateral crackles suggest hypoxemia and possible
pulmonary edema or fluid overload, requiring immediate provider notification for
evaluation and potential diuresis. Increasing PEEP, administering a bronchodilator, or
suctioning may be appropriate but are not the priority without further assessment.
2. A client with septic shock has a mean arterial pressure (MAP) of 58 mm Hg despite fluid
resuscitation. Which medication should the nurse anticipate administering?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Dobutamine
Correct Answer: B
Rationale: Norepinephrine is the first-line vasopressor for septic shock to restore MAP
by increasing peripheral vascular resistance. Epinephrine is second -line, dopamine is less
preferred, and dobutamine is used for cardiac output support, not MAP.
3. A client with acute respiratory distress syndrome (ARDS) is on mechanical ventilation.
Which ventilator setting minimizes barotrauma?
A. High tidal volume (10–12 mL/kg)
B. Low tidal volume (6 mL/kg)
C. High respiratory rate (30/min)
D. Decreased PEEP
Correct Answer: B
Rationale: Low tidal volume ventilation (6 mL/kg) reduces barotrauma in ARDS by
minimizing alveolar overdistension. High tidal volumes increase injury risk, high
respiratory rates do not address barotrauma, and PEEP is needed for oxygenation.
4. A client with a traumatic brain injury has an intracranial pressure (ICP) of 22 mm Hg.
Which intervention should the nurse implement first?
A. Administer mannitol as prescribed
B. Elevate the head of the bed to 30 degrees
C. Hyperventilate the client
, 2
D. Restrict fluids to 500 mL/day
Correct Answer: B
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage and
reduces ICP non-invasively. Mannitol requires an order, hyperventilation is used
cautiously, and fluid restriction is not immediate.
5. A client in cardiogenic shock is receiving dobutamine. Which finding indicates the
medication is effective?
A. Heart rate 120/min
B. Blood pressure 90/60 mm Hg
C. Cardiac output 5.2 L/min
D. Pulmonary artery pressure 40/20 mm Hg
Correct Answer: C
Rationale: Dobutamine improves cardiac output in cardiogenic shock by enhancing
contractility. A cardiac output of 5.2 L/min indicates effectiveness. Tachycardia, low
blood pressure, or elevated pulmonary pressures are not specific to dobutamine’s effect.
6. A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL and pH of
7.25. What is the priority intervention?
A. Administer sodium bicarbonate
B. Initiate insulin infusion
C. Give 50% dextrose IV
D. Restrict fluids
Correct Answer: B
Rationale: Insulin infusion corrects hyperglycemia and acidosis in DKA by facilitating
glucose uptake and halting ketone production. Sodium bicarbonate is rarely used,
dextrose is given later, and fluids are essential for hydration.
7. A client with a pulmonary embolism reports sudden dyspnea and chest pain. Which
diagnostic test should the nurse anticipate?
A. Chest X-ray
B. CT pulmonary angiography
C. Arterial blood gas (ABG)
D. Electrocardiogram (ECG)
Correct Answer: B
Rationale: CT pulmonary angiography is the gold standard for diagnosing pulmonary
embolism, visualizing clots directly. Chest X-ray and ECG are non-specific, and ABG
assesses oxygenation but not the cause.
8. A client with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. Which
medication should the nurse administer first?
A. Furosemide
B. Calcium gluconate
C. Sodium polystyrene sulfonate
D. Insulin and glucose
Correct Answer: B
Rationale: Calcium gluconate stabilizes cardiac membranes in hyperkalemia, preventing
arrhythmias, and is the priority in critical settings. Insulin and glucose shift potassium
intracellularly, sodium polystyrene removes it, and furosemide is less immediate.
, 3
9. A client with a ventricular tachycardia is pulseless. Which action should the nurse take
first?
A. Administer epinephrine
B. Initiate defibrillation
C. Start chest compressions
D. Give amiodarone
Correct Answer: C
Rationale: Per ACLS guidelines, chest compressions are initiated immediately in
pulseless ventricular tachycardia to restore circulation. Defibrillation follows, epinephrine
is given during CPR, and amiodarone is used after initial interventions.
10. A client with sepsis is prescribed vancomycin. Which laboratory value should the nurse
monitor closely?
A. Serum creatinine
B. White blood cell count
C. Platelet count
D. Blood glucose
Correct Answer: A
Rationale: Vancomycin is nephrotoxic, requiring close monitoring of serum creatinine
for renal function. WBC count monitors infection, platelets assess clotting, and glucose is
unrelated.
11. A client with a myocardial infarction (MI) develops heart failure. Which medication
should the nurse anticipate?
A. Metoprolol
B. Nitroglycerin
C. Furosemide
D. Atropine
Correct Answer: C
Rationale: Furosemide treats pulmonary edema in heart failure post-MI by reducing
fluid overload. Metoprolol reduces myocardial demand, nitroglycerin relieves angina, and
atropine treats bradycardia.
12. A client with a subarachnoid hemorrhage reports a severe headache. Which intervention
should the nurse implement first?
A. Administer morphine
B. Dim the room lights
C. Restrict fluids
D. Elevate the head of the bed
Correct Answer: B
Rationale: Dimming lights reduces photophobia and discomfort in subarachnoid
hemorrhage. Morphine requires an order, fluid restriction is not immediate, and head
elevation is secondary.
13. A client with acute pancreatitis has a nasogastric tube to low intermittent suction. Which
finding indicates a complication?
A. Serum amylase 300 U/L
B. Abdominal pain relieved by suction
C. Bloody nasogastric output
D. Heart rate 90/min
