HESI Critical Care Exam Prep Document
2026/2027 | Intensive Care Nursing, Clinical
Judgment & NGN Critical Care Review | 50
Verified Questions with Detailed Rationales
This exam contains verified questions drawn from actual HESI Critical Care Exam content for the
2026/2027 cycle. It covers hemodynamic monitoring, mechanical ventilation, neurological critical care,
renal and endocrine emergencies, sepsis and infection management, and the application of the Next
Generation NCLEX Clinical Judgment Measurement Model to high-acuity patient scenarios. Questions
are designed to prepare critical care nursing students to manage complex, rapidly changing patient
conditions and apply clinical reasoning in the intensive care setting.
Section 1: Hemodynamic Monitoring & Cardiovascular Critical Care — Questions 1–10
Q1: A patient in the ICU has an arterial line in the radial artery. The nurse observes that the waveform
has become dampened and the displayed pressure is lower than expected. Which action should the
nurse take first?
A. Increase the pressurized flush bag to 400 mmHg
B. Check the tubing for kinks, blood clots, or air bubbles and flush the line per protocol [CORRECT]
C. Remove the arterial line and insert a new one
D. Document the lower pressure as the patient's true blood pressure
Correct Answer: B
Rationale: The best answer is B. This choice is correct because a dampened arterial waveform usually
indicates a problem with the pressure tubing system—such as a kink, clot, air bubble, or loose
connection—rather than a true change in the patient's hemodynamic status. The nurse should
systematically check the entire system, ensure the flush bag is at 300 mmHg, and perform a gentle flush
per protocol to restore waveform fidelity before considering line replacement.
,Q2: A patient in cardiogenic shock has the following hemodynamic readings: MAP 58 mmHg, CVP 14
mmHg, PAOP 22 mmHg, and cardiac index 1.8 L/min/m². Which clinical finding is most consistent with
these values?
A. Hypovolemia
B. Left ventricular failure with pulmonary congestion [CORRECT]
C. Right ventricular infarction
D. Septic shock with vasodilation
Correct Answer: B
Rationale: The best answer is B. This choice is correct because an elevated PAOP (pulmonary artery
occlusion pressure, normal 6–12 mmHg) with a low cardiac index indicates left ventricular failure and
backward pressure into the pulmonary circulation. The elevated CVP and low MAP further support this
picture. Hypovolemia would show low CVP and PAOP, while septic shock typically presents with low
PAOP and high cardiac output.
Q3: A patient with septic shock has a MAP of 52 mmHg despite fluid resuscitation. The provider orders
norepinephrine. Which mechanism of action makes norepinephrine appropriate for this patient?
A. It causes vasodilation to improve cardiac output
B. It is a potent alpha-1 agonist that increases systemic vascular resistance and MAP [CORRECT]
C. It primarily increases heart rate without affecting vascular tone
D. It causes diuresis to reduce fluid overload
Correct Answer: B
Rationale: The best answer is B. This choice is correct because norepinephrine is a first-line vasopressor
in septic shock due to its potent alpha-1 adrenergic agonist activity, which causes vasoconstriction and
increases systemic vascular resistance, thereby raising MAP. It also has some beta-1 activity for inotropic
support. In septic shock, the primary problem is vasodilation and distributive shock, so restoring vascular
tone is essential.
Q4: A patient has a pulmonary artery catheter in place. The nurse obtains the following readings: PA
systolic 32 mmHg, PA diastolic 18 mmHg, and PAOP 16 mmHg. Which statement about these values is
most accurate?
A. The PAOP is elevated, suggesting left ventricular preload is increased [CORRECT]
B. The PAOP is normal and no intervention is needed
C. The PA systolic pressure is critically low
D. The readings indicate right ventricular failure
, Correct Answer: A
Rationale: The best answer is A. This choice is correct because a PAOP of 16 mmHg is above the normal
range of 6–12 mmHg and indicates increased left ventricular preload, which can occur in heart failure or
fluid overload. The PA systolic of 32 mmHg is mildly elevated but not critical. These readings guide the
nurse and provider in decisions about diuresis, fluid management, or afterload reduction.
Q5: A patient with acute myocardial infarction develops sudden hypotension, muffled heart sounds, and
distended neck veins. The nurse recognizes these findings as consistent with:
A. Acute left ventricular failure
B. Cardiac tamponade [CORRECT]
C. Papillary muscle rupture
D. Ventricular septal defect
Correct Answer: B
Rationale: The best answer is B. This choice is correct because Beck's triad—hypotension, muffled heart
sounds, and jugular venous distension—is the classic presentation of cardiac tamponade, where fluid
accumulation in the pericardium compresses the heart and impairs filling. This is a medical emergency
requiring urgent pericardiocentesis. The nurse must recognize this pattern immediately and prepare for
emergent intervention.
Q6: A patient in the ICU has a cardiac output of 4.5 L/min and a body surface area of 1.8 m². What is the
patient's cardiac index?
A. 2.0 L/min/m²
B. 2.5 L/min/m² [CORRECT]
C. 8.1 L/min/m²
D. 0.4 L/min/m²
Correct Answer: B
Rationale: The best answer is B. This choice is correct because cardiac index is calculated by dividing
cardiac output by body surface area: 4.5 L/min ÷ 1.8 m² = 2.5 L/min/m². The normal cardiac index is 2.5
to 4.0 L/min/m², so this patient is at the low end of normal. This calculation is essential for interpreting
hemodynamic data in the context of individual patient size.
Q7: A patient in hypovolemic shock has the following hemodynamic profile: MAP 62 mmHg, CVP 2
mmHg, PAOP 4 mmHg, and cardiac index 2.0 L/min/m². Which intervention is most appropriate?
2026/2027 | Intensive Care Nursing, Clinical
Judgment & NGN Critical Care Review | 50
Verified Questions with Detailed Rationales
This exam contains verified questions drawn from actual HESI Critical Care Exam content for the
2026/2027 cycle. It covers hemodynamic monitoring, mechanical ventilation, neurological critical care,
renal and endocrine emergencies, sepsis and infection management, and the application of the Next
Generation NCLEX Clinical Judgment Measurement Model to high-acuity patient scenarios. Questions
are designed to prepare critical care nursing students to manage complex, rapidly changing patient
conditions and apply clinical reasoning in the intensive care setting.
Section 1: Hemodynamic Monitoring & Cardiovascular Critical Care — Questions 1–10
Q1: A patient in the ICU has an arterial line in the radial artery. The nurse observes that the waveform
has become dampened and the displayed pressure is lower than expected. Which action should the
nurse take first?
A. Increase the pressurized flush bag to 400 mmHg
B. Check the tubing for kinks, blood clots, or air bubbles and flush the line per protocol [CORRECT]
C. Remove the arterial line and insert a new one
D. Document the lower pressure as the patient's true blood pressure
Correct Answer: B
Rationale: The best answer is B. This choice is correct because a dampened arterial waveform usually
indicates a problem with the pressure tubing system—such as a kink, clot, air bubble, or loose
connection—rather than a true change in the patient's hemodynamic status. The nurse should
systematically check the entire system, ensure the flush bag is at 300 mmHg, and perform a gentle flush
per protocol to restore waveform fidelity before considering line replacement.
,Q2: A patient in cardiogenic shock has the following hemodynamic readings: MAP 58 mmHg, CVP 14
mmHg, PAOP 22 mmHg, and cardiac index 1.8 L/min/m². Which clinical finding is most consistent with
these values?
A. Hypovolemia
B. Left ventricular failure with pulmonary congestion [CORRECT]
C. Right ventricular infarction
D. Septic shock with vasodilation
Correct Answer: B
Rationale: The best answer is B. This choice is correct because an elevated PAOP (pulmonary artery
occlusion pressure, normal 6–12 mmHg) with a low cardiac index indicates left ventricular failure and
backward pressure into the pulmonary circulation. The elevated CVP and low MAP further support this
picture. Hypovolemia would show low CVP and PAOP, while septic shock typically presents with low
PAOP and high cardiac output.
Q3: A patient with septic shock has a MAP of 52 mmHg despite fluid resuscitation. The provider orders
norepinephrine. Which mechanism of action makes norepinephrine appropriate for this patient?
A. It causes vasodilation to improve cardiac output
B. It is a potent alpha-1 agonist that increases systemic vascular resistance and MAP [CORRECT]
C. It primarily increases heart rate without affecting vascular tone
D. It causes diuresis to reduce fluid overload
Correct Answer: B
Rationale: The best answer is B. This choice is correct because norepinephrine is a first-line vasopressor
in septic shock due to its potent alpha-1 adrenergic agonist activity, which causes vasoconstriction and
increases systemic vascular resistance, thereby raising MAP. It also has some beta-1 activity for inotropic
support. In septic shock, the primary problem is vasodilation and distributive shock, so restoring vascular
tone is essential.
Q4: A patient has a pulmonary artery catheter in place. The nurse obtains the following readings: PA
systolic 32 mmHg, PA diastolic 18 mmHg, and PAOP 16 mmHg. Which statement about these values is
most accurate?
A. The PAOP is elevated, suggesting left ventricular preload is increased [CORRECT]
B. The PAOP is normal and no intervention is needed
C. The PA systolic pressure is critically low
D. The readings indicate right ventricular failure
, Correct Answer: A
Rationale: The best answer is A. This choice is correct because a PAOP of 16 mmHg is above the normal
range of 6–12 mmHg and indicates increased left ventricular preload, which can occur in heart failure or
fluid overload. The PA systolic of 32 mmHg is mildly elevated but not critical. These readings guide the
nurse and provider in decisions about diuresis, fluid management, or afterload reduction.
Q5: A patient with acute myocardial infarction develops sudden hypotension, muffled heart sounds, and
distended neck veins. The nurse recognizes these findings as consistent with:
A. Acute left ventricular failure
B. Cardiac tamponade [CORRECT]
C. Papillary muscle rupture
D. Ventricular septal defect
Correct Answer: B
Rationale: The best answer is B. This choice is correct because Beck's triad—hypotension, muffled heart
sounds, and jugular venous distension—is the classic presentation of cardiac tamponade, where fluid
accumulation in the pericardium compresses the heart and impairs filling. This is a medical emergency
requiring urgent pericardiocentesis. The nurse must recognize this pattern immediately and prepare for
emergent intervention.
Q6: A patient in the ICU has a cardiac output of 4.5 L/min and a body surface area of 1.8 m². What is the
patient's cardiac index?
A. 2.0 L/min/m²
B. 2.5 L/min/m² [CORRECT]
C. 8.1 L/min/m²
D. 0.4 L/min/m²
Correct Answer: B
Rationale: The best answer is B. This choice is correct because cardiac index is calculated by dividing
cardiac output by body surface area: 4.5 L/min ÷ 1.8 m² = 2.5 L/min/m². The normal cardiac index is 2.5
to 4.0 L/min/m², so this patient is at the low end of normal. This calculation is essential for interpreting
hemodynamic data in the context of individual patient size.
Q7: A patient in hypovolemic shock has the following hemodynamic profile: MAP 62 mmHg, CVP 2
mmHg, PAOP 4 mmHg, and cardiac index 2.0 L/min/m². Which intervention is most appropriate?
