HESI RN Critical Care Nursing 2026–2027 | Comprehensive
Practice Examination | ICU Nursing Exam Questions &
Answers | Critical Care HESI Review | NGN Clinical Judgment |
Detailed Rationales
1. A patient in the ICU develops sudden dyspnea, tachypnea, and decreased oxygen saturation after
prolonged bed rest. Which condition is the nurse most concerned about initially?
A. Pneumonia
B. Pulmonary embolism
C. Asthma exacerbation
D. Pleural effusion
Answer: B
Rationale: Sudden onset dyspnea and hypoxemia after immobility strongly suggest pulmonary embolism
due to venous thrombus migration. Pneumonia develops more gradually with fever and productive
cough. Asthma is typically episodic with a wheezing history, while pleural effusion presents with gradual
respiratory compromise and decreased breath sounds rather than abrupt hypoxia.
2. A patient on mechanical ventilation shows increased peak airway pressures and decreased tidal
volume delivery. What is the priority nursing action?
A. Increase FiO₂
B. Suction the endotracheal tube
C. Notify the provider immediately
D. Decrease the ventilator rate
,Answer: B
Rationale: Increased peak airway pressure with decreased tidal volume delivery suggests an obstruction
in the airway, most commonly a mucus plug or secretions in the endotracheal tube. Suctioning should
be the priority action to clear the airway and restore adequate ventilation.
3. A patient in the ICU has a pulmonary artery catheter in place. Which of the following readings reflects
the patient's preload?
A. Cardiac output
B. Pulmonary artery wedge pressure (PAWP)
C. Systemic vascular resistance
D. Central venous pressure (CVP)
Answer: B
Rationale: Preload is the volume of blood in the ventricles at the end of diastole. PAWP (also called
pulmonary artery occlusion pressure, PAOP) reflects left ventricular preload. CVP reflects right
ventricular preload. Cardiac output is a measure of function, and SVR reflects afterload.
4. A patient with a pulmonary artery catheter has a cardiac output (CO) of 3.2 L/min and a body surface
area of 1.8 m². What is the patient's cardiac index (CI)?
A. 1.78 L/min/m²
B. 2.22 L/min/m²
C. 3.2 L/min/m²
D. 5.76 L/min/m²
,Answer: A
Rationale: Cardiac index is calculated by dividing cardiac output by body surface area (CI = CO/BSA). 3.2
L/min ÷ 1.8 m² = 1.78 L/min/m². Normal cardiac index is 2.54.0 L/min/m², so this value indicates
decreased cardiac output.
5. A patient has a pulmonary artery pressure (PAP) of 45/20 mm Hg. Which of the following conditions is
most likely?
A. Hypovolemia
B. Pulmonary hypertension
C. Cardiac tamponade
D. Aortic stenosis
Answer: B
Rationale: Normal PAP is 1530/510 mm Hg. Elevated PAP (pulmonary hypertension) can result from left
ventricular failure, chronic lung disease, or pulmonary vascular disease. Hypovolemia decreases PAP,
cardiac tamponade affects filling pressures, and aortic stenosis affects left ventricular pressures.
6. The nurse is assessing a patient with a suspected tension pneumothorax. Which assessment finding is
most concerning?
A. Diminished breath sounds on the affected side
B. Tracheal deviation to the opposite side
C. Subcutaneous emphysema
, D. Chest pain
Answer: B
Rationale: Tracheal deviation to the opposite side indicates a tension pneumothorax, which is a
lifethreatening emergency. Air trapping in the pleural space shifts the mediastinum, compromising
cardiac output. Immediate needle decompression or chest tube insertion is required.
7. A patient is admitted to the ICU with a diagnosis of septic shock. Which of the following findings
would the nurse expect?
A. Warm, flushed skin with bounding pulses
B. Cold, clammy skin with weak pulses
C. Increased urine output
D. Bradycardia
Answer: A
Rationale: In the early (hyperdynamic) phase of septic shock, patients present with warm, flushed skin,
bounding pulses, tachycardia, and increased cardiac output due to systemic vasodilation. As shock
progresses, patients may transition to cold, clammy skin with weak pulses.
8. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with a low
tidal volume strategy. Which of the following is the primary goal of this strategy?
A. Improve oxygenation
B. Prevent ventilatorinduced lung injury
Practice Examination | ICU Nursing Exam Questions &
Answers | Critical Care HESI Review | NGN Clinical Judgment |
Detailed Rationales
1. A patient in the ICU develops sudden dyspnea, tachypnea, and decreased oxygen saturation after
prolonged bed rest. Which condition is the nurse most concerned about initially?
A. Pneumonia
B. Pulmonary embolism
C. Asthma exacerbation
D. Pleural effusion
Answer: B
Rationale: Sudden onset dyspnea and hypoxemia after immobility strongly suggest pulmonary embolism
due to venous thrombus migration. Pneumonia develops more gradually with fever and productive
cough. Asthma is typically episodic with a wheezing history, while pleural effusion presents with gradual
respiratory compromise and decreased breath sounds rather than abrupt hypoxia.
2. A patient on mechanical ventilation shows increased peak airway pressures and decreased tidal
volume delivery. What is the priority nursing action?
A. Increase FiO₂
B. Suction the endotracheal tube
C. Notify the provider immediately
D. Decrease the ventilator rate
,Answer: B
Rationale: Increased peak airway pressure with decreased tidal volume delivery suggests an obstruction
in the airway, most commonly a mucus plug or secretions in the endotracheal tube. Suctioning should
be the priority action to clear the airway and restore adequate ventilation.
3. A patient in the ICU has a pulmonary artery catheter in place. Which of the following readings reflects
the patient's preload?
A. Cardiac output
B. Pulmonary artery wedge pressure (PAWP)
C. Systemic vascular resistance
D. Central venous pressure (CVP)
Answer: B
Rationale: Preload is the volume of blood in the ventricles at the end of diastole. PAWP (also called
pulmonary artery occlusion pressure, PAOP) reflects left ventricular preload. CVP reflects right
ventricular preload. Cardiac output is a measure of function, and SVR reflects afterload.
4. A patient with a pulmonary artery catheter has a cardiac output (CO) of 3.2 L/min and a body surface
area of 1.8 m². What is the patient's cardiac index (CI)?
A. 1.78 L/min/m²
B. 2.22 L/min/m²
C. 3.2 L/min/m²
D. 5.76 L/min/m²
,Answer: A
Rationale: Cardiac index is calculated by dividing cardiac output by body surface area (CI = CO/BSA). 3.2
L/min ÷ 1.8 m² = 1.78 L/min/m². Normal cardiac index is 2.54.0 L/min/m², so this value indicates
decreased cardiac output.
5. A patient has a pulmonary artery pressure (PAP) of 45/20 mm Hg. Which of the following conditions is
most likely?
A. Hypovolemia
B. Pulmonary hypertension
C. Cardiac tamponade
D. Aortic stenosis
Answer: B
Rationale: Normal PAP is 1530/510 mm Hg. Elevated PAP (pulmonary hypertension) can result from left
ventricular failure, chronic lung disease, or pulmonary vascular disease. Hypovolemia decreases PAP,
cardiac tamponade affects filling pressures, and aortic stenosis affects left ventricular pressures.
6. The nurse is assessing a patient with a suspected tension pneumothorax. Which assessment finding is
most concerning?
A. Diminished breath sounds on the affected side
B. Tracheal deviation to the opposite side
C. Subcutaneous emphysema
, D. Chest pain
Answer: B
Rationale: Tracheal deviation to the opposite side indicates a tension pneumothorax, which is a
lifethreatening emergency. Air trapping in the pleural space shifts the mediastinum, compromising
cardiac output. Immediate needle decompression or chest tube insertion is required.
7. A patient is admitted to the ICU with a diagnosis of septic shock. Which of the following findings
would the nurse expect?
A. Warm, flushed skin with bounding pulses
B. Cold, clammy skin with weak pulses
C. Increased urine output
D. Bradycardia
Answer: A
Rationale: In the early (hyperdynamic) phase of septic shock, patients present with warm, flushed skin,
bounding pulses, tachycardia, and increased cardiac output due to systemic vasodilation. As shock
progresses, patients may transition to cold, clammy skin with weak pulses.
8. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with a low
tidal volume strategy. Which of the following is the primary goal of this strategy?
A. Improve oxygenation
B. Prevent ventilatorinduced lung injury
