HESI RN CRITICAL CARE EXAM 2025/2026 EDITION: COMPREHENSIVE
EXIT TEST BANK QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains:
1. Cardiovascular Critical Care
2. Respiratory Critical Care
3. Neurological Critical Care
4. Renal and Fluid-Electrolyte Management
5. Endocrine and Metabolic Emergencies
6. Multisystem Organ Failure and Shock States
7. Pharmacology and Medication Administration in Critical Care
8. Ethics, Legal Issues, and End-of-Life Care
9. Infection Control and Sepsis Management
10. Hemodynamic Monitoring and Diagnostic Interpretation
Introduction
,This comprehensive examination is designed to evaluate the critical care nursing competency of registered nurses
preparing for the HESI RN Critical Care Exit Examination. The assessment encompasses foundational theoretical
knowledge, applied clinical judgment, and advanced decision-making skills essential for safe and effective practice
in high-acuity environments. Through a combination of multiple-choice questions and scenario-based
applications, candidates will demonstrate their ability to synthesize complex patient data, prioritize interventions,
and navigate ethical and legal considerations inherent to critical care nursing. This test bank emphasizes real-
world application and clinical reasoning, ensuring that examinees are prepared to deliver evidence-based, patient-
centered care in dynamic and challenging healthcare settings.
SECTION ONE: QUESTIONS 1–100
1. A patient with septic shock is receiving norepinephrine infusion at 0.5 mcg/kg/min. The patient's mean
arterial pressure (MAP) remains 55 mm Hg despite adequate fluid resuscitation. Which intervention should
the nurse anticipate next?
A. Increase norepinephrine infusion rate
B. Administer dobutamine infusion
C. Start vasopressin infusion
D. Prepare for intra-aortic balloon pump insertion
🟢 Correct Answer: C
,🔴 RATIONALE: Vasopressin is recommended as a second-line vasopressor in septic shock when
norepinephrine fails to achieve target MAP (≥65 mm Hg). It acts through V1 receptors to cause vasoconstriction
and is often added to reduce norepinephrine requirements. Increasing norepinephrine further may cause
excessive vasoconstriction and end-organ damage. Dobutamine is an inotrope, not primarily a vasopressor.
Intra-aortic balloon pump is indicated for cardiogenic shock, not septic shock.
2. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with the following
settings: tidal volume 6 mL/kg ideal body weight, PEEP 12 cm H₂O, FiO₂ 0.8. The arterial blood gas reveals pH
7.28, PaCO₂ 58 mm Hg, PaO₂ 68 mm Hg, HCO₃ 24 mEq/L. Which action is most appropriate?
A. Increase tidal volume to 8 mL/kg
B. Increase PEEP to 15 cm H₂O
C. Increase respiratory rate
D. Decrease FiO₂ to 0.6
🟢 Correct Answer: C
🔴 RATIONALE: The patient has respiratory acidosis (pH 7.28, PaCO₂ 58) with hypoxemia. In ARDS, permissive
hypercapnia is acceptable, but this pH is below 7.30, warranting intervention. Increasing respiratory rate will
increase minute ventilation and lower PaCO₂ without increasing tidal volume, which could cause volutrauma.
Increasing PEEP may improve oxygenation but does not address hypercapnia. Decreasing FiO₂ would worsen
hypoxemia. Increasing tidal volume exceeds the lung-protective strategy recommendation.
, 3. A patient is admitted with suspected acute ischemic stroke. The last known well time was 2 hours ago. The
patient's blood pressure is 185/110 mm Hg. Which medication should the nurse anticipate administering?
A. Alteplase (tPA)
B. Aspirin
C. Labetalol
D. Heparin
🟢 Correct Answer: A
🔴 RATIONALE: This patient is within the 4.5-hour window for alteplase administration in acute ischemic stroke.
However, current guidelines recommend that blood pressure be carefully managed before tPA administration; if
BP is >185/110, it must be lowered before thrombolytic therapy. Labetalol may be used to lower BP prior to tPA,
but the question asks which medication is anticipated for the stroke itself. Aspirin is not given in the acute
setting if tPA is planned. Heparin is not first-line therapy for acute ischemic stroke.
4. The nurse is caring for a patient with a pulmonary artery catheter. The waveform displayed shows a
sudden transition from a normal wedge tracing to a waveform with large V waves. What does this indicate?
A. Pulmonary hypertension
B. Mitral regurgitation
C. Left ventricular failure
D. Cardiac tamponade
🟢 Correct Answer: B
EXIT TEST BANK QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains:
1. Cardiovascular Critical Care
2. Respiratory Critical Care
3. Neurological Critical Care
4. Renal and Fluid-Electrolyte Management
5. Endocrine and Metabolic Emergencies
6. Multisystem Organ Failure and Shock States
7. Pharmacology and Medication Administration in Critical Care
8. Ethics, Legal Issues, and End-of-Life Care
9. Infection Control and Sepsis Management
10. Hemodynamic Monitoring and Diagnostic Interpretation
Introduction
,This comprehensive examination is designed to evaluate the critical care nursing competency of registered nurses
preparing for the HESI RN Critical Care Exit Examination. The assessment encompasses foundational theoretical
knowledge, applied clinical judgment, and advanced decision-making skills essential for safe and effective practice
in high-acuity environments. Through a combination of multiple-choice questions and scenario-based
applications, candidates will demonstrate their ability to synthesize complex patient data, prioritize interventions,
and navigate ethical and legal considerations inherent to critical care nursing. This test bank emphasizes real-
world application and clinical reasoning, ensuring that examinees are prepared to deliver evidence-based, patient-
centered care in dynamic and challenging healthcare settings.
SECTION ONE: QUESTIONS 1–100
1. A patient with septic shock is receiving norepinephrine infusion at 0.5 mcg/kg/min. The patient's mean
arterial pressure (MAP) remains 55 mm Hg despite adequate fluid resuscitation. Which intervention should
the nurse anticipate next?
A. Increase norepinephrine infusion rate
B. Administer dobutamine infusion
C. Start vasopressin infusion
D. Prepare for intra-aortic balloon pump insertion
🟢 Correct Answer: C
,🔴 RATIONALE: Vasopressin is recommended as a second-line vasopressor in septic shock when
norepinephrine fails to achieve target MAP (≥65 mm Hg). It acts through V1 receptors to cause vasoconstriction
and is often added to reduce norepinephrine requirements. Increasing norepinephrine further may cause
excessive vasoconstriction and end-organ damage. Dobutamine is an inotrope, not primarily a vasopressor.
Intra-aortic balloon pump is indicated for cardiogenic shock, not septic shock.
2. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with the following
settings: tidal volume 6 mL/kg ideal body weight, PEEP 12 cm H₂O, FiO₂ 0.8. The arterial blood gas reveals pH
7.28, PaCO₂ 58 mm Hg, PaO₂ 68 mm Hg, HCO₃ 24 mEq/L. Which action is most appropriate?
A. Increase tidal volume to 8 mL/kg
B. Increase PEEP to 15 cm H₂O
C. Increase respiratory rate
D. Decrease FiO₂ to 0.6
🟢 Correct Answer: C
🔴 RATIONALE: The patient has respiratory acidosis (pH 7.28, PaCO₂ 58) with hypoxemia. In ARDS, permissive
hypercapnia is acceptable, but this pH is below 7.30, warranting intervention. Increasing respiratory rate will
increase minute ventilation and lower PaCO₂ without increasing tidal volume, which could cause volutrauma.
Increasing PEEP may improve oxygenation but does not address hypercapnia. Decreasing FiO₂ would worsen
hypoxemia. Increasing tidal volume exceeds the lung-protective strategy recommendation.
, 3. A patient is admitted with suspected acute ischemic stroke. The last known well time was 2 hours ago. The
patient's blood pressure is 185/110 mm Hg. Which medication should the nurse anticipate administering?
A. Alteplase (tPA)
B. Aspirin
C. Labetalol
D. Heparin
🟢 Correct Answer: A
🔴 RATIONALE: This patient is within the 4.5-hour window for alteplase administration in acute ischemic stroke.
However, current guidelines recommend that blood pressure be carefully managed before tPA administration; if
BP is >185/110, it must be lowered before thrombolytic therapy. Labetalol may be used to lower BP prior to tPA,
but the question asks which medication is anticipated for the stroke itself. Aspirin is not given in the acute
setting if tPA is planned. Heparin is not first-line therapy for acute ischemic stroke.
4. The nurse is caring for a patient with a pulmonary artery catheter. The waveform displayed shows a
sudden transition from a normal wedge tracing to a waveform with large V waves. What does this indicate?
A. Pulmonary hypertension
B. Mitral regurgitation
C. Left ventricular failure
D. Cardiac tamponade
🟢 Correct Answer: B
