CRITICAL CARE HESI EXIT EXAM V1 2025
REVIEW GUIDE & COMPREHENSIVE STUDY
MANUAL || NEW VERSION
Section 1: Cardiac & Hemodynamic (Questions 1-25)
1. A patient with an acute anterior MI develops new crackles, tachycardia, and a PaO2 of 88%
on room air. The hemodynamic profile most consistent with cardiogenic shock is:
A) High CVP, High PAWP, Low SVR
B) Low CVP, Low PAWP, High SVR
C) High CVP, High PAWP, High SVR
D) Low CVP, Low PAWP, Low SVR
2. The primary goal of afterload reduction in cardiogenic shock is to:
A) Increase myocardial contractility
B) Decrease myocardial oxygen demand and improve stroke volume
C) Increase coronary artery perfusion pressure
D) Reduce preload and pulmonary congestion
3. A patient's arterial line waveform is dampened and reads 80/40, while a manual cuff reads
110/70. The nurse's first action should be to:
A) Zero and level the transducer
B) Flush the arterial line
C) Notify the physician immediately
D) Check the patient's peripheral pulses
4. The drug of choice for treating symptomatic bradycardia in an acute MI patient is:
A) Epinephrine
B) Atropine
C) Dopamine
D) Isoproterenol
5. A patient with an inferior wall MI becomes hypotensive and jugular venous distention is
noted. This is most suggestive of:
A) Left ventricular failure
B) Right ventricular infarction
,C) Cardiac tamponade
D) Ventricular septal rupture
6. The most reliable indicator of adequate cardiac output in a critically ill patient is:
A) Blood pressure
B) Heart rate
C) Urine output
D) Level of consciousness
7. A patient on a nitroprusside (Nipride) infusion for hypertensive crisis should be monitored
for which primary toxic effect?
A) Hypernatremia
B) Cyanide/Thiocyanate toxicity
C) Metabolic alkalosis
D) Hyperkalemia
8. For a patient in ventricular fibrillation, the correct sequence during an AED-equipped code
is:
A) CPR, Analyze rhythm, Shock, Resume CPR immediately
B) Shock, Analyze rhythm, CPR
C) Analyze rhythm, Shock, Check pulse, CPR
D) CPR, Shock, Analyze rhythm, CPR
9. The primary purpose of an intra-aortic balloon pump (IABP) is to:
A) Oxygenate the blood
B) Increase afterload and decrease preload
C) Increase coronary perfusion and decrease afterload
D) Replace the function of the left ventricle
10. Dopamine at a "renal dose" (1-3 mcg/kg/min) primarily acts to:
A) Increase heart rate
B) Dilate renal and mesenteric arteries
C) Cause systemic vasoconstriction
D) Increase myocardial contractility
11. ST-segment elevation in leads II, III, and aVF indicates injury to which area of the heart?
A) Anterior
B) Lateral
C) Inferior
D) Septal
,12. A patient with a pulmonary artery catheter has the following readings: CVP 2, PAWP 4, CO
8.0. This profile is most consistent with:
A) Cardiogenic shock
B) Hypovolemic shock
C) Septic shock
D) Neurogenic shock
13. The priority intervention for a patient with unstable ventricular tachycardia and a pulse is:
A) Immediate synchronized cardioversion
B) Administration of Amiodarone IV push
C) Rapid defibrillation at 360J
D) Starting a Lidocaine drip
14. A patient with a new permanent pacemaker should be instructed to avoid:
A) Using a microwave oven
B) Lifting the arm on the pacemaker side above shoulder level for 2-4 weeks
C) Using a cellular phone
D) All electromagnetic devices
15. The hallmark assessment finding in cardiac tamponade is:
A) Hypertension with bounding pulses
B) Pulsus paradoxus
C) Clear lung sounds
D) Widening pulse pressure
16. A patient with an acute MI receives tissue plasminogen activator (tPA). The nurse should
discontinue the infusion and notify the physician immediately if the patient develops:
A) Headache and hypertension
B) Sudden, severe headache and neurological changes
C) Mild bleeding at the IV site
D) Nausea and vomiting
17. The primary mechanism of action of milrinone (Primacor) is:
A) Beta-1 adrenergic agonist
B) Phosphodiesterase III inhibitor (inotrope/vasodilator)
C) Calcium channel blocker
D) Alpha-1 adrenergic antagonist
18. A patient's ECG shows a rhythm with a rate of 40, no discernible P waves, and wide,
bizarre QRS complexes. This is:
, A) Sinus bradycardia
B) Junctional rhythm
C) Ventricular escape rhythm
D) Complete heart block
19. The most common complication of central venous catheter insertion is:
A) Pneumothorax
B) Air embolism
C) Catheter-related bloodstream infection
D) Arterial puncture
20. Which lab value is most critical to monitor in a patient receiving a heparin infusion for
ACS?
A) INR
B) aPTT
C) Platelet count
D) Fibrinogen
21. The priority action for a patient with a suspected tension pneumothorax is:
A) Prepare for chest tube insertion
B) Administer 100% oxygen
C) Perform immediate needle decompression
D) Obtain a stat chest X-ray
22. A patient with a STEMI is scheduled for a percutaneous coronary intervention (PCI). The
antiplatelet agent typically given in the ED prior to PCI is:
A) Warfarin (Coumadin)
B) Clopidogrel (Plavix) or Ticagrelor (Brilinta)
C) Enoxaparin (Lovenox)
D) Alteplase (tPA)
23. A patient develops sudden onset dyspnea, pleuritic chest pain, and tachycardia post-MI. A
loud holosystolic murmur is heard at the lower left sternal border. The nurse suspects:
A) Pulmonary embolism
B) Ventricular septal rupture
C) Aortic dissection
D) Pericarditis
24. In the management of acute decompensated heart failure with pulmonary edema, the
first-line IV vasodilator is typically:
REVIEW GUIDE & COMPREHENSIVE STUDY
MANUAL || NEW VERSION
Section 1: Cardiac & Hemodynamic (Questions 1-25)
1. A patient with an acute anterior MI develops new crackles, tachycardia, and a PaO2 of 88%
on room air. The hemodynamic profile most consistent with cardiogenic shock is:
A) High CVP, High PAWP, Low SVR
B) Low CVP, Low PAWP, High SVR
C) High CVP, High PAWP, High SVR
D) Low CVP, Low PAWP, Low SVR
2. The primary goal of afterload reduction in cardiogenic shock is to:
A) Increase myocardial contractility
B) Decrease myocardial oxygen demand and improve stroke volume
C) Increase coronary artery perfusion pressure
D) Reduce preload and pulmonary congestion
3. A patient's arterial line waveform is dampened and reads 80/40, while a manual cuff reads
110/70. The nurse's first action should be to:
A) Zero and level the transducer
B) Flush the arterial line
C) Notify the physician immediately
D) Check the patient's peripheral pulses
4. The drug of choice for treating symptomatic bradycardia in an acute MI patient is:
A) Epinephrine
B) Atropine
C) Dopamine
D) Isoproterenol
5. A patient with an inferior wall MI becomes hypotensive and jugular venous distention is
noted. This is most suggestive of:
A) Left ventricular failure
B) Right ventricular infarction
,C) Cardiac tamponade
D) Ventricular septal rupture
6. The most reliable indicator of adequate cardiac output in a critically ill patient is:
A) Blood pressure
B) Heart rate
C) Urine output
D) Level of consciousness
7. A patient on a nitroprusside (Nipride) infusion for hypertensive crisis should be monitored
for which primary toxic effect?
A) Hypernatremia
B) Cyanide/Thiocyanate toxicity
C) Metabolic alkalosis
D) Hyperkalemia
8. For a patient in ventricular fibrillation, the correct sequence during an AED-equipped code
is:
A) CPR, Analyze rhythm, Shock, Resume CPR immediately
B) Shock, Analyze rhythm, CPR
C) Analyze rhythm, Shock, Check pulse, CPR
D) CPR, Shock, Analyze rhythm, CPR
9. The primary purpose of an intra-aortic balloon pump (IABP) is to:
A) Oxygenate the blood
B) Increase afterload and decrease preload
C) Increase coronary perfusion and decrease afterload
D) Replace the function of the left ventricle
10. Dopamine at a "renal dose" (1-3 mcg/kg/min) primarily acts to:
A) Increase heart rate
B) Dilate renal and mesenteric arteries
C) Cause systemic vasoconstriction
D) Increase myocardial contractility
11. ST-segment elevation in leads II, III, and aVF indicates injury to which area of the heart?
A) Anterior
B) Lateral
C) Inferior
D) Septal
,12. A patient with a pulmonary artery catheter has the following readings: CVP 2, PAWP 4, CO
8.0. This profile is most consistent with:
A) Cardiogenic shock
B) Hypovolemic shock
C) Septic shock
D) Neurogenic shock
13. The priority intervention for a patient with unstable ventricular tachycardia and a pulse is:
A) Immediate synchronized cardioversion
B) Administration of Amiodarone IV push
C) Rapid defibrillation at 360J
D) Starting a Lidocaine drip
14. A patient with a new permanent pacemaker should be instructed to avoid:
A) Using a microwave oven
B) Lifting the arm on the pacemaker side above shoulder level for 2-4 weeks
C) Using a cellular phone
D) All electromagnetic devices
15. The hallmark assessment finding in cardiac tamponade is:
A) Hypertension with bounding pulses
B) Pulsus paradoxus
C) Clear lung sounds
D) Widening pulse pressure
16. A patient with an acute MI receives tissue plasminogen activator (tPA). The nurse should
discontinue the infusion and notify the physician immediately if the patient develops:
A) Headache and hypertension
B) Sudden, severe headache and neurological changes
C) Mild bleeding at the IV site
D) Nausea and vomiting
17. The primary mechanism of action of milrinone (Primacor) is:
A) Beta-1 adrenergic agonist
B) Phosphodiesterase III inhibitor (inotrope/vasodilator)
C) Calcium channel blocker
D) Alpha-1 adrenergic antagonist
18. A patient's ECG shows a rhythm with a rate of 40, no discernible P waves, and wide,
bizarre QRS complexes. This is:
, A) Sinus bradycardia
B) Junctional rhythm
C) Ventricular escape rhythm
D) Complete heart block
19. The most common complication of central venous catheter insertion is:
A) Pneumothorax
B) Air embolism
C) Catheter-related bloodstream infection
D) Arterial puncture
20. Which lab value is most critical to monitor in a patient receiving a heparin infusion for
ACS?
A) INR
B) aPTT
C) Platelet count
D) Fibrinogen
21. The priority action for a patient with a suspected tension pneumothorax is:
A) Prepare for chest tube insertion
B) Administer 100% oxygen
C) Perform immediate needle decompression
D) Obtain a stat chest X-ray
22. A patient with a STEMI is scheduled for a percutaneous coronary intervention (PCI). The
antiplatelet agent typically given in the ED prior to PCI is:
A) Warfarin (Coumadin)
B) Clopidogrel (Plavix) or Ticagrelor (Brilinta)
C) Enoxaparin (Lovenox)
D) Alteplase (tPA)
23. A patient develops sudden onset dyspnea, pleuritic chest pain, and tachycardia post-MI. A
loud holosystolic murmur is heard at the lower left sternal border. The nurse suspects:
A) Pulmonary embolism
B) Ventricular septal rupture
C) Aortic dissection
D) Pericarditis
24. In the management of acute decompensated heart failure with pulmonary edema, the
first-line IV vasodilator is typically:
