HESI CRITICAL CARE RN EXIT EXAM –
PRACTICE TEST
Section 1: Cardiovascular Critical Care (Questions 1–12)
1. A patient with acute decompensated heart failure has pulmonary artery catheter readings: CVP 18
mm Hg, PCWP 28 mm Hg, CO 3.2 L/min, SVR 1800 dynes/sec/cm⁻⁵. Which intervention should the nurse
anticipate first?
A. IV furosemide
B. Dobutamine infusion
C. IV nitroglycerin
D. Fluid bolus
Answer: A – IV furosemide
Rationale: Elevated PCWP (normal 6–12) indicates fluid overload. Low CO and high SVR suggest
compensatory vasoconstriction. Furosemide reduces preload, lowering PCWP and improving symptoms.
Dobutamine would increase CO but is second-line after diuresis if perfusion remains poor.
2. A patient post-cardiac arrest has return of spontaneous circulation (ROSC) but remains unresponsive.
Which targeted temperature management (TTM) goal is current AHA recommendation?
A. Maintain 37.5–38.5°C for 24 hours
B. Cool to 36°C for 24 hours, then slow rewarming
C. Cool to 32–34°C for 24 hours
D. No temperature control needed
Answer: B – Cool to 36°C for 24 hours, then slow rewarming
Rationale: Current AHA guidelines recommend maintaining temperature ≤37.5°C or 36°C for at least 24
hours post-arrest. Strict 32–34°C is no longer universally recommended; avoiding fever is key.
3. A patient with third-degree AV block and heart rate 32 bpm is lethargic, BP 85/50. The nurse prepares
for which intervention?
A. Atropine 0.5 mg IV push
B. Dopamine infusion at 5 mcg/kg/min
C. Transcutaneous pacing
D. Amiodarone bolus
, Answer: C – Transcutaneous pacing
Rationale: Symptomatic bradycardia with hemodynamic instability requires immediate pacing
(transcutaneous until transvenous placed). Atropine is ineffective in complete heart block. Dopamine is
temporary but pacing is definitive.
4. Which ABG finding is expected in a patient with cardiogenic shock?
A. pH 7.25, PaCO2 28, HCO3 16
B. pH 7.50, PaCO2 48, HCO3 30
C. pH 7.38, PaCO2 40, HCO3 24
D. pH 7.32, PaCO2 50, HCO3 26
Answer: A – pH 7.25, PaCO2 28, HCO3 16
Rationale: Cardiogenic shock causes poor tissue perfusion → lactic acidosis → metabolic acidosis with
compensatory respiratory alkalosis (low PaCO2). Option A shows partially compensated metabolic
acidosis.
Section 2: Respiratory Critical Care (13–22)
13. A patient on mechanical ventilation has sudden oxygen desaturation, absent breath sounds on left,
and tracheal deviation to the right. What is the priority action?
A. Suction the ET tube
B. Call for chest x-ray
C. Needle decompression of left chest
D. Increase PEEP to 15 cm H2O
Answer: C – Needle decompression of left chest
Rationale: Findings indicate tension pneumothorax. Immediate decompression with large-bore needle
in 2nd intercostal space, midclavicular line, followed by chest tube. Delay can cause cardiac arrest.
14. Which mode of ventilation delivers a guaranteed tidal volume regardless of patient effort but allows
spontaneous breathing?
A. Pressure control ventilation (PCV)
B. Pressure support ventilation (PSV)
C. Volume control ventilation (VCV)
D. Synchronized intermittent mandatory ventilation (SIMV)
Answer: D – SIMV
Rationale: SIMV delivers a preset tidal volume at set rate, but patient can breathe spontaneously
between mandatory breaths. VCV doesn’t allow spontaneous breaths; PSV only supports spontaneous
breaths.
PRACTICE TEST
Section 1: Cardiovascular Critical Care (Questions 1–12)
1. A patient with acute decompensated heart failure has pulmonary artery catheter readings: CVP 18
mm Hg, PCWP 28 mm Hg, CO 3.2 L/min, SVR 1800 dynes/sec/cm⁻⁵. Which intervention should the nurse
anticipate first?
A. IV furosemide
B. Dobutamine infusion
C. IV nitroglycerin
D. Fluid bolus
Answer: A – IV furosemide
Rationale: Elevated PCWP (normal 6–12) indicates fluid overload. Low CO and high SVR suggest
compensatory vasoconstriction. Furosemide reduces preload, lowering PCWP and improving symptoms.
Dobutamine would increase CO but is second-line after diuresis if perfusion remains poor.
2. A patient post-cardiac arrest has return of spontaneous circulation (ROSC) but remains unresponsive.
Which targeted temperature management (TTM) goal is current AHA recommendation?
A. Maintain 37.5–38.5°C for 24 hours
B. Cool to 36°C for 24 hours, then slow rewarming
C. Cool to 32–34°C for 24 hours
D. No temperature control needed
Answer: B – Cool to 36°C for 24 hours, then slow rewarming
Rationale: Current AHA guidelines recommend maintaining temperature ≤37.5°C or 36°C for at least 24
hours post-arrest. Strict 32–34°C is no longer universally recommended; avoiding fever is key.
3. A patient with third-degree AV block and heart rate 32 bpm is lethargic, BP 85/50. The nurse prepares
for which intervention?
A. Atropine 0.5 mg IV push
B. Dopamine infusion at 5 mcg/kg/min
C. Transcutaneous pacing
D. Amiodarone bolus
, Answer: C – Transcutaneous pacing
Rationale: Symptomatic bradycardia with hemodynamic instability requires immediate pacing
(transcutaneous until transvenous placed). Atropine is ineffective in complete heart block. Dopamine is
temporary but pacing is definitive.
4. Which ABG finding is expected in a patient with cardiogenic shock?
A. pH 7.25, PaCO2 28, HCO3 16
B. pH 7.50, PaCO2 48, HCO3 30
C. pH 7.38, PaCO2 40, HCO3 24
D. pH 7.32, PaCO2 50, HCO3 26
Answer: A – pH 7.25, PaCO2 28, HCO3 16
Rationale: Cardiogenic shock causes poor tissue perfusion → lactic acidosis → metabolic acidosis with
compensatory respiratory alkalosis (low PaCO2). Option A shows partially compensated metabolic
acidosis.
Section 2: Respiratory Critical Care (13–22)
13. A patient on mechanical ventilation has sudden oxygen desaturation, absent breath sounds on left,
and tracheal deviation to the right. What is the priority action?
A. Suction the ET tube
B. Call for chest x-ray
C. Needle decompression of left chest
D. Increase PEEP to 15 cm H2O
Answer: C – Needle decompression of left chest
Rationale: Findings indicate tension pneumothorax. Immediate decompression with large-bore needle
in 2nd intercostal space, midclavicular line, followed by chest tube. Delay can cause cardiac arrest.
14. Which mode of ventilation delivers a guaranteed tidal volume regardless of patient effort but allows
spontaneous breathing?
A. Pressure control ventilation (PCV)
B. Pressure support ventilation (PSV)
C. Volume control ventilation (VCV)
D. Synchronized intermittent mandatory ventilation (SIMV)
Answer: D – SIMV
Rationale: SIMV delivers a preset tidal volume at set rate, but patient can breathe spontaneously
between mandatory breaths. VCV doesn’t allow spontaneous breaths; PSV only supports spontaneous
breaths.
