HESI Critical Care Exit Practice Exam 2026 LATEST TEST 150
QUESTIONS AND CORRECT ANSWERS WITH DETAILED RATIONALES
COVERING THE RECENT MOST TESTED QUESTIONS
1. A patient with acute respiratory distress has a PaO₂ of 55 mmHg. The priority nursing action is:
A. Administer supplemental oxygen
B. Encourage coughing and deep breathing
C. Prepare for intubation
D. Monitor oxygen saturation
Answer: C
RATIONALE: PaO₂ <60 mmHg indicates severe hypoxemia. In critical care, immediate airway
management may be required to prevent respiratory failure.
2. A patient with sepsis shows hypotension, tachycardia, and cool extremities. The nurse’s priority is:
A. Administer IV fluids rapidly
B. Apply warm blankets
C. Monitor vital signs every 2 hours
D. Prepare for discharge
Answer: A
RATIONALE: Septic shock leads to hypoperfusion; rapid fluid resuscitation is first-line treatment to
maintain perfusion.
3. A patient with acute MI is receiving nitroglycerin. The nurse monitors for:
A. Hypotension and headache
B. Hypertension and bradycardia
C. Hyperglycemia
D. Shortness of breath
Answer: A
RATIONALE: Nitroglycerin vasodilates, potentially causing hypotension and headache; monitoring
hemodynamic status is essential.
4. A patient in ICU has an arterial line. The nurse should:
A. Zero the transducer at the phlebostatic axis
B. Flush only when readings are abnormal
,C. Use it for IV medications
D. Remove every 12 hours
Answer: A
RATIONALE: Proper leveling (phlebostatic axis) ensures accurate arterial pressure readings; arterial lines
are not for routine IV meds.
5. A patient is on mechanical ventilation with low tidal volumes and high respiratory rate. The nurse
recognizes this as:
A. Acute respiratory distress syndrome (ARDS) ventilator strategy
B. Normal ventilation
C. Hyperventilation syndrome
D. COPD exacerbation
Answer: A
RATIONALE: ARDS is managed with low tidal volumes and higher rate to prevent barotrauma while
maintaining adequate ventilation.
6. A patient with elevated intracranial pressure (ICP) has a change in mental status. Priority nursing
action:
A. Elevate head of bed to 30°
B. Administer sedative
C. Encourage coughing
D. Document only
Answer: A
RATIONALE: Elevating the head of bed promotes venous drainage and reduces ICP; assessment and
rapid intervention are critical.
7. A patient with sepsis is receiving norepinephrine. The nurse monitors for:
A. Hypertension and peripheral ischemia
B. Bradycardia
C. Hyperglycemia
D. Hypothermia
Answer: A
RATIONALE: Norepinephrine is a potent vasoconstrictor; monitor for excessive vasoconstriction and
end-organ perfusion.
8. A patient with ARDS on PEEP 10 cm H₂O has hypotension. The nurse recognizes that:
,A. High PEEP can decrease venous return and cardiac output
B. PEEP causes bradycardia only
C. PEEP improves cardiac output in hypotension
D. Hypotension is unrelated to PEEP
Answer: A
RATIONALE: Positive pressure increases intrathoracic pressure, reducing preload and potentially causing
hypotension.
9. A patient with ventricular tachycardia is pulseless. Nursing action:
A. Start CPR and prepare for defibrillation
B. Administer oral antiarrhythmic
C. Give IV fluids only
D. Monitor and wait
Answer: A
RATIONALE: Pulseless VT is a shockable cardiac arrest rhythm; immediate CPR and defibrillation are
required.
10. A patient has a central venous catheter. The nurse should:
A. Maintain sterile technique during access
B. Flush only if occlusion occurs
C. Use it for routine blood draws only
D. Remove after 24 hours
Answer: A
RATIONALE: Central line infections are a major risk; sterile technique prevents bloodstream infections.
11. A patient with acute kidney injury shows potassium of 6.2 mEq/L. Priority action:
A. Notify provider and prepare for interventions (e.g., calcium gluconate)
B. Encourage oral potassium intake
C. Monitor daily labs only
D. Administer IV fluids only
Answer: A
RATIONALE: Hyperkalemia >6 mEq/L is life-threatening and requires immediate treatment to prevent
cardiac arrhythmias.
12. A patient is on continuous cardiac monitoring. The nurse identifies peaked T waves on ECG. This
indicates:
, A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Answer: A
RATIONALE: Peaked T waves are an early ECG sign of hyperkalemia.
13. A patient with septic shock has urine output 10 mL/hr. The nurse recognizes:
A. Oliguria indicating possible acute kidney injury
B. Normal output
C. Polyuria
D. Requires diuretics
Answer: A
RATIONALE: Urine output <0.5 mL/kg/hr signals renal hypoperfusion and early AKI.
14. A patient with ARDS is receiving low tidal volume ventilation. The rationale is:
A. Prevent barotrauma and ventilator-induced lung injury
B. Improve oxygen saturation immediately
C. Reduce CO₂ clearance
D. Decrease sedation requirement
Answer: A
RATIONALE: Low tidal volumes minimize alveolar overdistention and lung injury.
15. A patient post-MI develops acute pulmonary edema. Nursing priority:
A. Elevate head of bed, administer oxygen, and prepare diuretics
B. Encourage ambulation
C. Provide IV fluids
D. Document and monitor
Answer: A
RATIONALE: Pulmonary edema is life-threatening; immediate oxygenation and diuresis improve
respiratory function.
16. A patient on mechanical ventilation has sudden hypotension and increased peak airway pressures.
Likely cause:
QUESTIONS AND CORRECT ANSWERS WITH DETAILED RATIONALES
COVERING THE RECENT MOST TESTED QUESTIONS
1. A patient with acute respiratory distress has a PaO₂ of 55 mmHg. The priority nursing action is:
A. Administer supplemental oxygen
B. Encourage coughing and deep breathing
C. Prepare for intubation
D. Monitor oxygen saturation
Answer: C
RATIONALE: PaO₂ <60 mmHg indicates severe hypoxemia. In critical care, immediate airway
management may be required to prevent respiratory failure.
2. A patient with sepsis shows hypotension, tachycardia, and cool extremities. The nurse’s priority is:
A. Administer IV fluids rapidly
B. Apply warm blankets
C. Monitor vital signs every 2 hours
D. Prepare for discharge
Answer: A
RATIONALE: Septic shock leads to hypoperfusion; rapid fluid resuscitation is first-line treatment to
maintain perfusion.
3. A patient with acute MI is receiving nitroglycerin. The nurse monitors for:
A. Hypotension and headache
B. Hypertension and bradycardia
C. Hyperglycemia
D. Shortness of breath
Answer: A
RATIONALE: Nitroglycerin vasodilates, potentially causing hypotension and headache; monitoring
hemodynamic status is essential.
4. A patient in ICU has an arterial line. The nurse should:
A. Zero the transducer at the phlebostatic axis
B. Flush only when readings are abnormal
,C. Use it for IV medications
D. Remove every 12 hours
Answer: A
RATIONALE: Proper leveling (phlebostatic axis) ensures accurate arterial pressure readings; arterial lines
are not for routine IV meds.
5. A patient is on mechanical ventilation with low tidal volumes and high respiratory rate. The nurse
recognizes this as:
A. Acute respiratory distress syndrome (ARDS) ventilator strategy
B. Normal ventilation
C. Hyperventilation syndrome
D. COPD exacerbation
Answer: A
RATIONALE: ARDS is managed with low tidal volumes and higher rate to prevent barotrauma while
maintaining adequate ventilation.
6. A patient with elevated intracranial pressure (ICP) has a change in mental status. Priority nursing
action:
A. Elevate head of bed to 30°
B. Administer sedative
C. Encourage coughing
D. Document only
Answer: A
RATIONALE: Elevating the head of bed promotes venous drainage and reduces ICP; assessment and
rapid intervention are critical.
7. A patient with sepsis is receiving norepinephrine. The nurse monitors for:
A. Hypertension and peripheral ischemia
B. Bradycardia
C. Hyperglycemia
D. Hypothermia
Answer: A
RATIONALE: Norepinephrine is a potent vasoconstrictor; monitor for excessive vasoconstriction and
end-organ perfusion.
8. A patient with ARDS on PEEP 10 cm H₂O has hypotension. The nurse recognizes that:
,A. High PEEP can decrease venous return and cardiac output
B. PEEP causes bradycardia only
C. PEEP improves cardiac output in hypotension
D. Hypotension is unrelated to PEEP
Answer: A
RATIONALE: Positive pressure increases intrathoracic pressure, reducing preload and potentially causing
hypotension.
9. A patient with ventricular tachycardia is pulseless. Nursing action:
A. Start CPR and prepare for defibrillation
B. Administer oral antiarrhythmic
C. Give IV fluids only
D. Monitor and wait
Answer: A
RATIONALE: Pulseless VT is a shockable cardiac arrest rhythm; immediate CPR and defibrillation are
required.
10. A patient has a central venous catheter. The nurse should:
A. Maintain sterile technique during access
B. Flush only if occlusion occurs
C. Use it for routine blood draws only
D. Remove after 24 hours
Answer: A
RATIONALE: Central line infections are a major risk; sterile technique prevents bloodstream infections.
11. A patient with acute kidney injury shows potassium of 6.2 mEq/L. Priority action:
A. Notify provider and prepare for interventions (e.g., calcium gluconate)
B. Encourage oral potassium intake
C. Monitor daily labs only
D. Administer IV fluids only
Answer: A
RATIONALE: Hyperkalemia >6 mEq/L is life-threatening and requires immediate treatment to prevent
cardiac arrhythmias.
12. A patient is on continuous cardiac monitoring. The nurse identifies peaked T waves on ECG. This
indicates:
, A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Answer: A
RATIONALE: Peaked T waves are an early ECG sign of hyperkalemia.
13. A patient with septic shock has urine output 10 mL/hr. The nurse recognizes:
A. Oliguria indicating possible acute kidney injury
B. Normal output
C. Polyuria
D. Requires diuretics
Answer: A
RATIONALE: Urine output <0.5 mL/kg/hr signals renal hypoperfusion and early AKI.
14. A patient with ARDS is receiving low tidal volume ventilation. The rationale is:
A. Prevent barotrauma and ventilator-induced lung injury
B. Improve oxygen saturation immediately
C. Reduce CO₂ clearance
D. Decrease sedation requirement
Answer: A
RATIONALE: Low tidal volumes minimize alveolar overdistention and lung injury.
15. A patient post-MI develops acute pulmonary edema. Nursing priority:
A. Elevate head of bed, administer oxygen, and prepare diuretics
B. Encourage ambulation
C. Provide IV fluids
D. Document and monitor
Answer: A
RATIONALE: Pulmonary edema is life-threatening; immediate oxygenation and diuresis improve
respiratory function.
16. A patient on mechanical ventilation has sudden hypotension and increased peak airway pressures.
Likely cause:
