Page 1 of 92
HESI RN Critical Care Nursing Exam | Latest Update |
Comprehensive Practice Questions & Answers | Critical Care
Nursing Study Guide & Exam Preparation PDF
1. A critically ill patient with severe sepsis develops metabolic acidosis. Which arterial blood gas
finding is most consistent with this condition?
A) pH 7.48, PaCO2 32, HCO3 24
B) pH 7.32, PaCO2 48, HCO3 26
C) pH 7.25, PaCO2 38, HCO3 16
D) pH 7.50, PaCO2 45, HCO3 30
Correct Answer: C) pH 7.25, PaCO2 38, HCO3 16
Metabolic acidosis is characterized by low pH, normal or low PaCO2 (compensatory), and low
bicarbonate levels indicating a primary metabolic source of acid-base imbalance.
2. A patient with acute respiratory distress syndrome is receiving mechanical ventilation with a
tidal volume of 6 mL/kg. The nurse notes plateau pressures are 32 cm H2O. Which action should
the nurse take?
A) Increase tidal volume to 8 mL/kg
B) Notify the provider immediately
C) Decrease the respiratory rate
D) Suction the patient's airway
Correct Answer: B) Notify the provider immediately
Plateau pressures exceeding 30 cm H2O indicate increased risk of ventilator-induced lung injury
and require immediate provider notification for possible pressure reduction strategies.
3. A patient with traumatic brain injury has an intracranial pressure monitor in place. Which
finding requires immediate nursing intervention?
,Page 2 of 92
A) ICP 12 mm Hg with CPP 72
B) ICP 22 mm Hg with CPP 58
C) ICP 8 mm Hg with CPP 85
D) ICP 15 mm Hg with CPP 65
Correct Answer: B) ICP 22 mm Hg with CPP 58
ICP above 20 mm Hg is elevated, and CPP below 60 mm Hg indicates inadequate cerebral
perfusion requiring immediate intervention to prevent secondary brain injury.
4. The nurse is caring for a patient with status epilepticus who is receiving continuous infusion of
propofol. Which assessment finding is most concerning?
A) Blood pressure 100/60 mm Hg
B) Heart rate 88 beats per minute
C) Respiratory rate 14 breaths per minute
D) Sudden onset of bradycardia with hypotension
Correct Answer: D) Sudden onset of bradycardia with hypotension
Propofol infusion syndrome is a rare but fatal complication characterized by sudden bradycardia
and hypotension requiring immediate discontinuation and supportive care.
5. A patient with acute myocardial infarction develops ventricular fibrillation. The nurse
defibrillates and returns sinus rhythm. Which medication should be administered first to prevent
recurrence?
A) Lidocaine
B) Amiodarone
C) Magnesium
D) Procainamide
Correct Answer: B) Amiodarone
Amiodarone is the first-line antiarrhythmic for ventricular fibrillation after defibrillation, proven
to reduce recurrence rates and improve survival outcomes.
,Page 3 of 92
6. The nurse is assessing a patient receiving continuous renal replacement therapy. Which finding
indicates a complication requiring immediate action?
A) Blood pressure 110/68 mm Hg
B) Filter clotting with rising venous pressures
C) Temperature 37.2°C
D) Urine output 30 mL/hour
Correct Answer: B) Filter clotting with rising venous pressures
Rising venous pressures in continuous renal replacement therapy may indicate filter clotting,
which can lead to circuit failure and inadequate dialysis treatment.
7. A patient with severe pancreatitis develops acute respiratory distress syndrome. The nurse
notes PaO2/FiO2 ratio of 150. Which intervention should the nurse anticipate?
A) Increased FiO2 only
B) Prone positioning therapy
C) Decreased PEEP settings
D) Extubation to high-flow nasal cannula
Correct Answer: B) Prone positioning therapy
Prone positioning improves oxygenation in ARDS patients with PaO2/FiO2 ratios below 150,
enhancing ventilation-perfusion matching and reducing mortality.
8. The nurse is caring for a patient with an intra-aortic balloon pump. Which finding requires
immediate intervention?
A) Aortic pressure waveform showing proper inflation at dicrotic notch
B) Urine output 35 mL over the past 2 hours
C) Absent pedal pulses with cold extremity
D) Mean arterial pressure 70 mm Hg
, Page 4 of 92
Correct Answer: C) Absent pedal pulses with cold extremity
Absent pedal pulses with cold extremity indicate potential vascular compromise from the intra-
aortic balloon pump catheter, requiring immediate assessment and intervention.
9. A patient with heart failure has the following hemodynamic values: cardiac output 3.2 L/min,
pulmonary artery wedge pressure 28 mm Hg, and central venous pressure 16 mm Hg. Which
medication should the nurse anticipate administering?
A) Dobutamine
B) Nitroprusside
C) Norepinephrine
D) Epinephrine
Correct Answer: A) Dobutamine
Low cardiac output with elevated filling pressures indicates heart failure with low output, and
dobutamine provides inotropic support while reducing afterload to improve perfusion.
10. The nurse is assessing a patient who received thrombolytic therapy for acute ischemic stroke.
Which finding is most concerning for intracranial hemorrhage?
A) Headache rating 6/10
B) Blood pressure 148/90 mm Hg
C) Neurological decline with new hemiplegia
D) Nausea and vomiting
Correct Answer: C) Neurological decline with new hemiplegia
Neurological decline after thrombolytic therapy is the primary indicator of intracranial
hemorrhage requiring immediate imaging and potential reversal therapy.
11. A patient with acute liver failure has an ammonia level of 120 mcg/dL. Which clinical
manifestation should the nurse expect to observe first?
A) Jaundice
HESI RN Critical Care Nursing Exam | Latest Update |
Comprehensive Practice Questions & Answers | Critical Care
Nursing Study Guide & Exam Preparation PDF
1. A critically ill patient with severe sepsis develops metabolic acidosis. Which arterial blood gas
finding is most consistent with this condition?
A) pH 7.48, PaCO2 32, HCO3 24
B) pH 7.32, PaCO2 48, HCO3 26
C) pH 7.25, PaCO2 38, HCO3 16
D) pH 7.50, PaCO2 45, HCO3 30
Correct Answer: C) pH 7.25, PaCO2 38, HCO3 16
Metabolic acidosis is characterized by low pH, normal or low PaCO2 (compensatory), and low
bicarbonate levels indicating a primary metabolic source of acid-base imbalance.
2. A patient with acute respiratory distress syndrome is receiving mechanical ventilation with a
tidal volume of 6 mL/kg. The nurse notes plateau pressures are 32 cm H2O. Which action should
the nurse take?
A) Increase tidal volume to 8 mL/kg
B) Notify the provider immediately
C) Decrease the respiratory rate
D) Suction the patient's airway
Correct Answer: B) Notify the provider immediately
Plateau pressures exceeding 30 cm H2O indicate increased risk of ventilator-induced lung injury
and require immediate provider notification for possible pressure reduction strategies.
3. A patient with traumatic brain injury has an intracranial pressure monitor in place. Which
finding requires immediate nursing intervention?
,Page 2 of 92
A) ICP 12 mm Hg with CPP 72
B) ICP 22 mm Hg with CPP 58
C) ICP 8 mm Hg with CPP 85
D) ICP 15 mm Hg with CPP 65
Correct Answer: B) ICP 22 mm Hg with CPP 58
ICP above 20 mm Hg is elevated, and CPP below 60 mm Hg indicates inadequate cerebral
perfusion requiring immediate intervention to prevent secondary brain injury.
4. The nurse is caring for a patient with status epilepticus who is receiving continuous infusion of
propofol. Which assessment finding is most concerning?
A) Blood pressure 100/60 mm Hg
B) Heart rate 88 beats per minute
C) Respiratory rate 14 breaths per minute
D) Sudden onset of bradycardia with hypotension
Correct Answer: D) Sudden onset of bradycardia with hypotension
Propofol infusion syndrome is a rare but fatal complication characterized by sudden bradycardia
and hypotension requiring immediate discontinuation and supportive care.
5. A patient with acute myocardial infarction develops ventricular fibrillation. The nurse
defibrillates and returns sinus rhythm. Which medication should be administered first to prevent
recurrence?
A) Lidocaine
B) Amiodarone
C) Magnesium
D) Procainamide
Correct Answer: B) Amiodarone
Amiodarone is the first-line antiarrhythmic for ventricular fibrillation after defibrillation, proven
to reduce recurrence rates and improve survival outcomes.
,Page 3 of 92
6. The nurse is assessing a patient receiving continuous renal replacement therapy. Which finding
indicates a complication requiring immediate action?
A) Blood pressure 110/68 mm Hg
B) Filter clotting with rising venous pressures
C) Temperature 37.2°C
D) Urine output 30 mL/hour
Correct Answer: B) Filter clotting with rising venous pressures
Rising venous pressures in continuous renal replacement therapy may indicate filter clotting,
which can lead to circuit failure and inadequate dialysis treatment.
7. A patient with severe pancreatitis develops acute respiratory distress syndrome. The nurse
notes PaO2/FiO2 ratio of 150. Which intervention should the nurse anticipate?
A) Increased FiO2 only
B) Prone positioning therapy
C) Decreased PEEP settings
D) Extubation to high-flow nasal cannula
Correct Answer: B) Prone positioning therapy
Prone positioning improves oxygenation in ARDS patients with PaO2/FiO2 ratios below 150,
enhancing ventilation-perfusion matching and reducing mortality.
8. The nurse is caring for a patient with an intra-aortic balloon pump. Which finding requires
immediate intervention?
A) Aortic pressure waveform showing proper inflation at dicrotic notch
B) Urine output 35 mL over the past 2 hours
C) Absent pedal pulses with cold extremity
D) Mean arterial pressure 70 mm Hg
, Page 4 of 92
Correct Answer: C) Absent pedal pulses with cold extremity
Absent pedal pulses with cold extremity indicate potential vascular compromise from the intra-
aortic balloon pump catheter, requiring immediate assessment and intervention.
9. A patient with heart failure has the following hemodynamic values: cardiac output 3.2 L/min,
pulmonary artery wedge pressure 28 mm Hg, and central venous pressure 16 mm Hg. Which
medication should the nurse anticipate administering?
A) Dobutamine
B) Nitroprusside
C) Norepinephrine
D) Epinephrine
Correct Answer: A) Dobutamine
Low cardiac output with elevated filling pressures indicates heart failure with low output, and
dobutamine provides inotropic support while reducing afterload to improve perfusion.
10. The nurse is assessing a patient who received thrombolytic therapy for acute ischemic stroke.
Which finding is most concerning for intracranial hemorrhage?
A) Headache rating 6/10
B) Blood pressure 148/90 mm Hg
C) Neurological decline with new hemiplegia
D) Nausea and vomiting
Correct Answer: C) Neurological decline with new hemiplegia
Neurological decline after thrombolytic therapy is the primary indicator of intracranial
hemorrhage requiring immediate imaging and potential reversal therapy.
11. A patient with acute liver failure has an ammonia level of 120 mcg/dL. Which clinical
manifestation should the nurse expect to observe first?
A) Jaundice
