NCLEX-RN Emergency & Critical Care Exam Pack | Part
1
50 Questions with Detailed Rationales
Shock, Code Situations, Airway Management, Trauma Care & Rapid Response
Scenarios
HESI ATI Nursing Exit Exam Study Guide | 2026
Exam Focus Emergency and Critical Care Nursing
Part Part 1 of 5
Question Range Questions 1-50
Core Areas Shock, Code Blue, Airway, Trauma, Rapid
Response
Format Multiple Choice, Answer, Rationale, Key Terms
This exam pack is designed for nursing exit exam review and emergency-care clinical judgment
practice.
Page 1
,High-Yield Emergency & Critical Care Rules
Airway comes first when it is directly threatened. Stridor, gurgling respirations, tracheostomy
obstruction, facial burns with hoarseness, and inability to manage secretions are immediate
priorities.
Breathing problems are next. Severe hypoxemia, respiratory distress, cyanosis, silent chest,
mechanical ventilator alarms with desaturation, and near-drowning require rapid escalation.
Circulation problems can become fatal quickly. Shock, active hemorrhage, dysrhythmias,
pulseless rhythms, chest pain with hypotension, and poor perfusion require immediate action.
Shock is about perfusion. Look for changes in mental status, urine output, skin signs, blood
pressure, pulse quality, lactate, and response to fluids or vasopressors.
Do not delay emergency response. Call rapid response or code team when the client shows acute
deterioration, persistent hypoxemia, shock signs, or loss of pulse.
Question Range Primary Focus
1-25 Shock: hypovolemic, septic, cardiogenic,
neurogenic, obstructive and anaphylactic
26-34 Code situations: BLS/ACLS basics, CPR quality,
defibrillation, post-arrest care
35-41 Airway management: oxygenation, tracheostomy,
mechanical ventilation, endotracheal tube
concerns
42-46 Trauma care: chest, head, abdominal, spine, burns
and open fractures
47-50 Rapid response scenarios: deterioration
recognition and escalation
Page 2
,Question 1
The nurse receives shift report for four clients on a medical-surgical unit. Which client should the nurse
assess first?
A. A client with chronic obstructive pulmonary disease whose oxygen saturation is 90%, which is
the client's baseline.
B. A client with a fractured wrist who reports pain rated 8/10 after the splint was applied.
C. A client admitted after a motor vehicle collision who is restless, pale, diaphoretic, and has a blood
pressure of 82/46 mm Hg.
D. A client with type 2 diabetes mellitus whose premeal blood glucose is 248 mg/dL.
Answer: C
Rationale
The client with hypotension, restlessness, pallor, diaphoresis, and recent trauma is showing signs of
hypovolemic shock. Restlessness is often an early sign of decreased tissue oxygenation. Shock threatens
circulation and organ perfusion, so this client is the priority over chronic or less urgent findings.
Key Terms Explained
Hypovolemic shock = Shock caused by loss of circulating volume, commonly from bleeding,
dehydration, or fluid shifts.
Perfusion = Delivery of oxygenated blood to tissues.
Restlessness = An early clinical sign that the brain may not be receiving adequate oxygen.
Diaphoresis = Excessive sweating, often seen with shock or acute cardiac stress.
Page 3
, Question 2
A client with a history of myocardial infarction suddenly develops severe chest pain, cool clammy skin,
crackles in both lung bases, jugular venous distention, and a blood pressure of 86/54 mm Hg. Which
type of shock should the nurse suspect?
A. Hypovolemic shock
B. Cardiogenic shock
C. Neurogenic shock
D. Anaphylactic shock
Answer: B
Rationale
Cardiogenic shock occurs when the heart cannot pump effectively enough to maintain tissue perfusion.
The history of myocardial infarction, hypotension, cool clammy skin, pulmonary crackles, and jugular
venous distention point to pump failure and fluid backing up into the lungs.
Key Terms Explained
Cardiogenic shock = Shock caused by inadequate cardiac pumping ability.
Jugular venous distention = Visible neck vein distention that may indicate increased central venous
pressure.
Crackles = Abnormal lung sounds associated with fluid in the alveoli.
Myocardial infarction = Heart muscle injury caused by reduced coronary blood flow.
Page 4
1
50 Questions with Detailed Rationales
Shock, Code Situations, Airway Management, Trauma Care & Rapid Response
Scenarios
HESI ATI Nursing Exit Exam Study Guide | 2026
Exam Focus Emergency and Critical Care Nursing
Part Part 1 of 5
Question Range Questions 1-50
Core Areas Shock, Code Blue, Airway, Trauma, Rapid
Response
Format Multiple Choice, Answer, Rationale, Key Terms
This exam pack is designed for nursing exit exam review and emergency-care clinical judgment
practice.
Page 1
,High-Yield Emergency & Critical Care Rules
Airway comes first when it is directly threatened. Stridor, gurgling respirations, tracheostomy
obstruction, facial burns with hoarseness, and inability to manage secretions are immediate
priorities.
Breathing problems are next. Severe hypoxemia, respiratory distress, cyanosis, silent chest,
mechanical ventilator alarms with desaturation, and near-drowning require rapid escalation.
Circulation problems can become fatal quickly. Shock, active hemorrhage, dysrhythmias,
pulseless rhythms, chest pain with hypotension, and poor perfusion require immediate action.
Shock is about perfusion. Look for changes in mental status, urine output, skin signs, blood
pressure, pulse quality, lactate, and response to fluids or vasopressors.
Do not delay emergency response. Call rapid response or code team when the client shows acute
deterioration, persistent hypoxemia, shock signs, or loss of pulse.
Question Range Primary Focus
1-25 Shock: hypovolemic, septic, cardiogenic,
neurogenic, obstructive and anaphylactic
26-34 Code situations: BLS/ACLS basics, CPR quality,
defibrillation, post-arrest care
35-41 Airway management: oxygenation, tracheostomy,
mechanical ventilation, endotracheal tube
concerns
42-46 Trauma care: chest, head, abdominal, spine, burns
and open fractures
47-50 Rapid response scenarios: deterioration
recognition and escalation
Page 2
,Question 1
The nurse receives shift report for four clients on a medical-surgical unit. Which client should the nurse
assess first?
A. A client with chronic obstructive pulmonary disease whose oxygen saturation is 90%, which is
the client's baseline.
B. A client with a fractured wrist who reports pain rated 8/10 after the splint was applied.
C. A client admitted after a motor vehicle collision who is restless, pale, diaphoretic, and has a blood
pressure of 82/46 mm Hg.
D. A client with type 2 diabetes mellitus whose premeal blood glucose is 248 mg/dL.
Answer: C
Rationale
The client with hypotension, restlessness, pallor, diaphoresis, and recent trauma is showing signs of
hypovolemic shock. Restlessness is often an early sign of decreased tissue oxygenation. Shock threatens
circulation and organ perfusion, so this client is the priority over chronic or less urgent findings.
Key Terms Explained
Hypovolemic shock = Shock caused by loss of circulating volume, commonly from bleeding,
dehydration, or fluid shifts.
Perfusion = Delivery of oxygenated blood to tissues.
Restlessness = An early clinical sign that the brain may not be receiving adequate oxygen.
Diaphoresis = Excessive sweating, often seen with shock or acute cardiac stress.
Page 3
, Question 2
A client with a history of myocardial infarction suddenly develops severe chest pain, cool clammy skin,
crackles in both lung bases, jugular venous distention, and a blood pressure of 86/54 mm Hg. Which
type of shock should the nurse suspect?
A. Hypovolemic shock
B. Cardiogenic shock
C. Neurogenic shock
D. Anaphylactic shock
Answer: B
Rationale
Cardiogenic shock occurs when the heart cannot pump effectively enough to maintain tissue perfusion.
The history of myocardial infarction, hypotension, cool clammy skin, pulmonary crackles, and jugular
venous distention point to pump failure and fluid backing up into the lungs.
Key Terms Explained
Cardiogenic shock = Shock caused by inadequate cardiac pumping ability.
Jugular venous distention = Visible neck vein distention that may indicate increased central venous
pressure.
Crackles = Abnormal lung sounds associated with fluid in the alveoli.
Myocardial infarction = Heart muscle injury caused by reduced coronary blood flow.
Page 4
