1
NGN HESI RN Critical Care ACTUAL EXAM
2026/2027 | Version 1 | NGN-Dominant with
Verified Questions and Answers | High-Acuity
Scenarios | Graded A+ | Pass Guaranteed
1. BOW-TIE ITEM
Central Case: A 68-year-old male (85 kg) is post-op day 2 after CABG x3. He suddenly
becomes agitated. Vital signs: BP 78/42, HR 128 (atrial fibrillation), RR 28, SpO₂ 91% on 50%
Venturi mask. Pulmonary artery catheter readings: CVP 2 mmHg, PAP 28/12 mmHg, PAOP 4
mmHg, CO 3.1 L/min, SVR 1,850 dynes/sec/cm⁻⁵. Urine output 15 mL/hr for 2 hours. Lactate
4.2 mmol/L.
Table
Copy
Possible Causes Priority Actions
A. Cardiogenic shock from graft
failure 1. Administer 1,000 mL crystalloid bolus STAT
B. Hypovolemic shock from
hemorrhage 2. Start norepinephrine 8 mcg/min, titrate to MAP >65
C. Septic shock from mediastinitis 3. Initiate dobutamine 5 mcg/kg/min
4. Prepare for emergent bedside echocardiogram &
D. Cardiac tamponade chest reopening
E. Pulmonary embolism 5. Transfuse 2 units PRBCs immediately
,2
Task: Select the ONE most likely cause and TWO priority actions (in order of immediate
sequence) that address the life-threat.
2. MATRIX ITEM
Patient: 54-year-old female with severe ARDS (PaO₂/FiO₂ ratio 135) on volume-control
ventilation: VT 380 mL (6 mL/kg IBW), RR 28, FiO₂ 80%, PEEP 14 cmH₂O, Pplat 32 cmH₂O.
Task: For each hemodynamic/ventilatory parameter below, indicate whether it is: (A) Within
Goal Target, (B) Acceptable but Requires Close Monitoring, or (C) Requires Immediate
Intervention.
Table
Copy
Parameter Current Value (A) Within Goal (B) Monitor (C) Intervene
PaO₂ 58 mmHg ☐ ☐ ☐
Pplat 32 cmH₂O ☐ ☐ ☐
Driving Pressure 18 cmH₂O ☐ ☐ ☐
pH 7.21 ☐ ☐ ☐
Mean BP 62 mmHg ☐ ☐ ☐
3. EXTENDED DRAG-AND-DROP / ORDERED RESPONSE
Scenario: A 72-year-old male in septic shock from urosepsis has just been intubated. BP 68/40,
HR 125, lactate 5.1. Central line placed. You are initiating the Surviving Sepsis Campaign 1-
Hour Bundle.
Task: Prioritize the first six actions (1=first, 6=last) that must be completed within 60 minutes
of recognition:
• ☐ Administer 30 mL/kg crystalloid bolus
,3
• ☐ Start broad-spectrum antibiotics (Pip/Tazo + Vancomycin)
• ☐ Collect blood cultures (two sets)
• ☐ Apply cardiac monitor & pulse oximeter
• ☐ Insert Foley catheter
• ☐ Obtain lactate level (if not done)
• ☐ Initiate norepinephrine for MAP <65 mmHg
• ☐ Place arterial line
• ☐ Perform FAST ultrasound exam
4. MULTIPLE RESPONSE (SATA)
A patient with severe traumatic brain injury (GCS 6) has an ICP monitor with these readings:
ICP 28 mmHg, CPP 48 mmHg. Which interventions are absolutely indicated at this time?
Select all that apply.
A. Elevate head of bed to 30-45 degrees
B. Administer mannitol 0.5 g/kg IV bolus
C. Initiate propofol infusion for sedation
D. Hyperventilate to PaCO₂ 28-30 mmHg
E. Drain 10 mL CSF via ventriculostomy
F. Administer 3% hypertonic saline 250 mL IV
G. Initiate pentobarbital coma induction
H. Start norepinephrine to maintain MAP >90 mmHg
5. CLOZE (DROP-DOWN)
Patient: 62-year-old male, 90 kg, in cardiogenic shock post-MI. On norepinephrine 12 mcg/min
(MAP 58 mmHg). Next step is to add vasopressin.
Task: Complete the order:
"Start vasopressin at _____ units/minute (range 0.01-0.04 units/min). The primary advantage of
adding vasopressin is _____ and it should _____ be titrated."
Dropdown 1: [0.01 | 0.03 | 0.05 | 0.1]
Dropdown 2: [potent vasoconstriction via V2 receptors | catecholamine-sparing effect on
, 4
norepinephrine | direct inotropic support | increasing SVR while preserving splanchnic flow]
Dropdown 3: [should | should not]
6. STANDARD MULTIPLE CHOICE
A patient on mechanical ventilation (AC/VC, VT 450 mL, RR 16, FiO₂ 40%, PEEP 5) suddenly
develops: HR 130, BP 88/50, SpO₂ 82%, unilateral absent breath sounds, tracheal deviation to
the left, subcutaneous emphysema. Peak airway pressures are >60 cmH₂O. What is the
immediate intervention?
A. STAT portable chest X-ray
B. Needle decompression at 2nd ICS, MCL left side
C. Suction the endotracheal tube
D. Increase PEEP to 10 cmH₂O
7. BOW-TIE ITEM
Central Case: A 45-year-old female with opioid use disorder is admitted with AMS. She
received 4 mg naloxone in ED with brief improvement. Now: RR 6, SpO₂ 78%, BP 100/60, HR
58. ABG: pH 7.18, PaCO₂ 88 mmHg, PaO₂ 52 mmHg, HCO₃⁻ 32 mEq/L.
Table
Copy
Possible Causes Priority Actions
1. Prepare for intubation & mechanical
A. Heroin overdose recurrence ventilation
B. Naloxone-induced pulmonary edema 2. Administer another 2 mg naloxone IV push
C. Respiratory depression from
polypharmacy 3. Initiate bilevel positive pressure ventilation
D. Acute respiratory distress syndrome 4. Obtain STAT chest CT angiography
NGN HESI RN Critical Care ACTUAL EXAM
2026/2027 | Version 1 | NGN-Dominant with
Verified Questions and Answers | High-Acuity
Scenarios | Graded A+ | Pass Guaranteed
1. BOW-TIE ITEM
Central Case: A 68-year-old male (85 kg) is post-op day 2 after CABG x3. He suddenly
becomes agitated. Vital signs: BP 78/42, HR 128 (atrial fibrillation), RR 28, SpO₂ 91% on 50%
Venturi mask. Pulmonary artery catheter readings: CVP 2 mmHg, PAP 28/12 mmHg, PAOP 4
mmHg, CO 3.1 L/min, SVR 1,850 dynes/sec/cm⁻⁵. Urine output 15 mL/hr for 2 hours. Lactate
4.2 mmol/L.
Table
Copy
Possible Causes Priority Actions
A. Cardiogenic shock from graft
failure 1. Administer 1,000 mL crystalloid bolus STAT
B. Hypovolemic shock from
hemorrhage 2. Start norepinephrine 8 mcg/min, titrate to MAP >65
C. Septic shock from mediastinitis 3. Initiate dobutamine 5 mcg/kg/min
4. Prepare for emergent bedside echocardiogram &
D. Cardiac tamponade chest reopening
E. Pulmonary embolism 5. Transfuse 2 units PRBCs immediately
,2
Task: Select the ONE most likely cause and TWO priority actions (in order of immediate
sequence) that address the life-threat.
2. MATRIX ITEM
Patient: 54-year-old female with severe ARDS (PaO₂/FiO₂ ratio 135) on volume-control
ventilation: VT 380 mL (6 mL/kg IBW), RR 28, FiO₂ 80%, PEEP 14 cmH₂O, Pplat 32 cmH₂O.
Task: For each hemodynamic/ventilatory parameter below, indicate whether it is: (A) Within
Goal Target, (B) Acceptable but Requires Close Monitoring, or (C) Requires Immediate
Intervention.
Table
Copy
Parameter Current Value (A) Within Goal (B) Monitor (C) Intervene
PaO₂ 58 mmHg ☐ ☐ ☐
Pplat 32 cmH₂O ☐ ☐ ☐
Driving Pressure 18 cmH₂O ☐ ☐ ☐
pH 7.21 ☐ ☐ ☐
Mean BP 62 mmHg ☐ ☐ ☐
3. EXTENDED DRAG-AND-DROP / ORDERED RESPONSE
Scenario: A 72-year-old male in septic shock from urosepsis has just been intubated. BP 68/40,
HR 125, lactate 5.1. Central line placed. You are initiating the Surviving Sepsis Campaign 1-
Hour Bundle.
Task: Prioritize the first six actions (1=first, 6=last) that must be completed within 60 minutes
of recognition:
• ☐ Administer 30 mL/kg crystalloid bolus
,3
• ☐ Start broad-spectrum antibiotics (Pip/Tazo + Vancomycin)
• ☐ Collect blood cultures (two sets)
• ☐ Apply cardiac monitor & pulse oximeter
• ☐ Insert Foley catheter
• ☐ Obtain lactate level (if not done)
• ☐ Initiate norepinephrine for MAP <65 mmHg
• ☐ Place arterial line
• ☐ Perform FAST ultrasound exam
4. MULTIPLE RESPONSE (SATA)
A patient with severe traumatic brain injury (GCS 6) has an ICP monitor with these readings:
ICP 28 mmHg, CPP 48 mmHg. Which interventions are absolutely indicated at this time?
Select all that apply.
A. Elevate head of bed to 30-45 degrees
B. Administer mannitol 0.5 g/kg IV bolus
C. Initiate propofol infusion for sedation
D. Hyperventilate to PaCO₂ 28-30 mmHg
E. Drain 10 mL CSF via ventriculostomy
F. Administer 3% hypertonic saline 250 mL IV
G. Initiate pentobarbital coma induction
H. Start norepinephrine to maintain MAP >90 mmHg
5. CLOZE (DROP-DOWN)
Patient: 62-year-old male, 90 kg, in cardiogenic shock post-MI. On norepinephrine 12 mcg/min
(MAP 58 mmHg). Next step is to add vasopressin.
Task: Complete the order:
"Start vasopressin at _____ units/minute (range 0.01-0.04 units/min). The primary advantage of
adding vasopressin is _____ and it should _____ be titrated."
Dropdown 1: [0.01 | 0.03 | 0.05 | 0.1]
Dropdown 2: [potent vasoconstriction via V2 receptors | catecholamine-sparing effect on
, 4
norepinephrine | direct inotropic support | increasing SVR while preserving splanchnic flow]
Dropdown 3: [should | should not]
6. STANDARD MULTIPLE CHOICE
A patient on mechanical ventilation (AC/VC, VT 450 mL, RR 16, FiO₂ 40%, PEEP 5) suddenly
develops: HR 130, BP 88/50, SpO₂ 82%, unilateral absent breath sounds, tracheal deviation to
the left, subcutaneous emphysema. Peak airway pressures are >60 cmH₂O. What is the
immediate intervention?
A. STAT portable chest X-ray
B. Needle decompression at 2nd ICS, MCL left side
C. Suction the endotracheal tube
D. Increase PEEP to 10 cmH₂O
7. BOW-TIE ITEM
Central Case: A 45-year-old female with opioid use disorder is admitted with AMS. She
received 4 mg naloxone in ED with brief improvement. Now: RR 6, SpO₂ 78%, BP 100/60, HR
58. ABG: pH 7.18, PaCO₂ 88 mmHg, PaO₂ 52 mmHg, HCO₃⁻ 32 mEq/L.
Table
Copy
Possible Causes Priority Actions
1. Prepare for intubation & mechanical
A. Heroin overdose recurrence ventilation
B. Naloxone-induced pulmonary edema 2. Administer another 2 mg naloxone IV push
C. Respiratory depression from
polypharmacy 3. Initiate bilevel positive pressure ventilation
D. Acute respiratory distress syndrome 4. Obtain STAT chest CT angiography
