Critical Care HESI-style Practice Exam
Questions and Answers with Rationales
Latest Versions
1. A client in the intensive care unit develops acute respiratory distress.
The oxygen saturation is 82% despite receiving oxygen via a
nonrebreather mask. Which action should the nurse take first?
A. Obtain an arterial blood gas
B. Prepare the client for endotracheal intubation
C. Increase IV fluids
D. Administer a prescribed opioid
Answer: B. Prepare the client for endotracheal intubation
Rationale: Severe hypoxemia that persists despite high-concentration
oxygen indicates impending respiratory failure. The priority is to
establish and protect the airway and provide adequate ventilation. An
ABG is useful but should not delay life-saving airway management.
2. A client with septic shock has a blood pressure of 78/42 mm Hg after
receiving an initial IV fluid bolus. Which medication should the nurse
anticipate administering?
A. Norepinephrine
B. Furosemide
C. Propranolol
D. Nitroglycerin
Answer: A. Norepinephrine
,Rationale: Norepinephrine is a first-line vasopressor for persistent
hypotension in septic shock after adequate fluid resuscitation. It
increases vascular tone and helps restore mean arterial pressure.
3. A mechanically ventilated client suddenly has absent breath sounds on
the right side, severe respiratory distress, and hypotension. Which
complication should the nurse suspect?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Answer: B. Tension pneumothorax
Rationale: Sudden unilateral absent breath sounds accompanied by
hypotension and respiratory distress strongly suggests tension
pneumothorax. This is an emergency requiring immediate intervention,
commonly needle or catheter decompression followed by chest-tube
placement.
4. A client with increased intracranial pressure is being monitored in the
ICU. Which finding requires immediate intervention?
A. Temperature of 37.4°C (99.3°F)
B. Glasgow Coma Scale score of 14
C. Unequal and newly dilated pupils
D. Blood pressure of 138/82 mm Hg
Answer: C. Unequal and newly dilated pupils
,Rationale: A new change in pupil size or reactivity can indicate
worsening intracranial pressure and possible brain herniation. This
requires immediate assessment and intervention.
5. A client receiving IV heparin develops a platelet count that decreases
significantly from baseline. Which complication should the nurse
suspect?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Vitamin K deficiency
D. Thrombotic thrombocytopenic purpura
Answer: B. Heparin-induced thrombocytopenia
Rationale: A substantial platelet decrease after exposure to heparin
raises concern for HIT, an immune-mediated reaction that can cause
serious thrombosis. Heparin should be discontinued and an alternative
anticoagulant anticipated.
6. A client with acute pulmonary edema is extremely dyspneic and
coughing pink, frothy sputum. Which position should the nurse use?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Left lateral
Answer: C. High-Fowler's
Rationale: High-Fowler's positioning promotes lung expansion and
decreases venous return to the heart, which can reduce pulmonary
congestion and improve oxygenation.
, 7. A client with diabetic ketoacidosis is receiving IV regular insulin.
Which laboratory value is most important for the nurse to monitor
closely?
A. Sodium
B. Potassium
C. Calcium
D. Hemoglobin
Answer: B. Potassium
Rationale: Insulin drives potassium into cells, potentially causing life-
threatening hypokalemia. Serum potassium must be monitored
frequently during DKA treatment.
8. A client in septic shock has a urine output of 15 mL/hr for the past 3
hours. What does this finding most likely indicate?
A. Improved renal perfusion
B. Adequate fluid replacement
C. Decreased renal perfusion
D. Excessive diuresis
Answer: C. Decreased renal perfusion
Rationale: Urine output below approximately 0.5 mL/kg/hr in an adult
can indicate inadequate renal perfusion and developing acute kidney
injury. In septic shock, this may reflect systemic hypoperfusion.
9. The nurse is caring for a client with acute respiratory distress
syndrome (ARDS). Which finding is most characteristic?
Questions and Answers with Rationales
Latest Versions
1. A client in the intensive care unit develops acute respiratory distress.
The oxygen saturation is 82% despite receiving oxygen via a
nonrebreather mask. Which action should the nurse take first?
A. Obtain an arterial blood gas
B. Prepare the client for endotracheal intubation
C. Increase IV fluids
D. Administer a prescribed opioid
Answer: B. Prepare the client for endotracheal intubation
Rationale: Severe hypoxemia that persists despite high-concentration
oxygen indicates impending respiratory failure. The priority is to
establish and protect the airway and provide adequate ventilation. An
ABG is useful but should not delay life-saving airway management.
2. A client with septic shock has a blood pressure of 78/42 mm Hg after
receiving an initial IV fluid bolus. Which medication should the nurse
anticipate administering?
A. Norepinephrine
B. Furosemide
C. Propranolol
D. Nitroglycerin
Answer: A. Norepinephrine
,Rationale: Norepinephrine is a first-line vasopressor for persistent
hypotension in septic shock after adequate fluid resuscitation. It
increases vascular tone and helps restore mean arterial pressure.
3. A mechanically ventilated client suddenly has absent breath sounds on
the right side, severe respiratory distress, and hypotension. Which
complication should the nurse suspect?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Answer: B. Tension pneumothorax
Rationale: Sudden unilateral absent breath sounds accompanied by
hypotension and respiratory distress strongly suggests tension
pneumothorax. This is an emergency requiring immediate intervention,
commonly needle or catheter decompression followed by chest-tube
placement.
4. A client with increased intracranial pressure is being monitored in the
ICU. Which finding requires immediate intervention?
A. Temperature of 37.4°C (99.3°F)
B. Glasgow Coma Scale score of 14
C. Unequal and newly dilated pupils
D. Blood pressure of 138/82 mm Hg
Answer: C. Unequal and newly dilated pupils
,Rationale: A new change in pupil size or reactivity can indicate
worsening intracranial pressure and possible brain herniation. This
requires immediate assessment and intervention.
5. A client receiving IV heparin develops a platelet count that decreases
significantly from baseline. Which complication should the nurse
suspect?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Vitamin K deficiency
D. Thrombotic thrombocytopenic purpura
Answer: B. Heparin-induced thrombocytopenia
Rationale: A substantial platelet decrease after exposure to heparin
raises concern for HIT, an immune-mediated reaction that can cause
serious thrombosis. Heparin should be discontinued and an alternative
anticoagulant anticipated.
6. A client with acute pulmonary edema is extremely dyspneic and
coughing pink, frothy sputum. Which position should the nurse use?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Left lateral
Answer: C. High-Fowler's
Rationale: High-Fowler's positioning promotes lung expansion and
decreases venous return to the heart, which can reduce pulmonary
congestion and improve oxygenation.
, 7. A client with diabetic ketoacidosis is receiving IV regular insulin.
Which laboratory value is most important for the nurse to monitor
closely?
A. Sodium
B. Potassium
C. Calcium
D. Hemoglobin
Answer: B. Potassium
Rationale: Insulin drives potassium into cells, potentially causing life-
threatening hypokalemia. Serum potassium must be monitored
frequently during DKA treatment.
8. A client in septic shock has a urine output of 15 mL/hr for the past 3
hours. What does this finding most likely indicate?
A. Improved renal perfusion
B. Adequate fluid replacement
C. Decreased renal perfusion
D. Excessive diuresis
Answer: C. Decreased renal perfusion
Rationale: Urine output below approximately 0.5 mL/kg/hr in an adult
can indicate inadequate renal perfusion and developing acute kidney
injury. In septic shock, this may reflect systemic hypoperfusion.
9. The nurse is caring for a client with acute respiratory distress
syndrome (ARDS). Which finding is most characteristic?
