HESI RN Critical Care Nursing 2026/2027 Exam verified with correct answers plus
rationales 2026/2027 pdf
1. A mechanically ventilated client suddenly develops severe dyspnea, absent
breath sounds on the right side, hypotension, and tracheal deviation. Which
complication should the nurse suspect?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Correct Answer: B. Tension pneumothorax
Rationale: Sudden respiratory deterioration, unilateral absent breath sounds, hypotension, and
tracheal deviation are classic findings of tension pneumothorax. This is an emergency requiring
immediate intervention.
2. A client with septic shock has a MAP of 58 mmHg despite fluid resuscitation.
Which medication does the nurse anticipate administering?
A. Norepinephrine
B. Furosemide
C. Digoxin
D. Metoprolol
Correct Answer: A. Norepinephrine
Rationale: Norepinephrine is a first-line vasopressor for persistent hypotension in septic shock
after appropriate fluid resuscitation.
3. Which assessment finding is most concerning in a client with increased
intracranial pressure?
A. Mild headache
B. Increasing level of consciousness
C. Decreasing level of consciousness with unequal pupils
D. Increased appetite
Correct Answer: C. Decreasing level of consciousness with unequal pupils
,Rationale: A declining level of consciousness and pupillary changes can indicate worsening
intracranial pressure and possible brain herniation.
4. A client with a traumatic brain injury has an ICP of 26 mmHg. Which nursing
action is appropriate?
A. Keep the head of bed elevated and maintain neutral head alignment
B. Place the client flat
C. Encourage frequent coughing
D. Flex the client's neck
Correct Answer: A. Keep the head of bed elevated and maintain neutral head alignment
Rationale: Elevating the head and maintaining neutral alignment can promote venous drainage
from the brain and help reduce ICP.
5. Which laboratory value is most specific for myocardial injury?
A. Myoglobin
B. Troponin I
C. Sodium
D. D-dimer
Correct Answer: B. Troponin I
Rationale: Cardiac troponins are highly specific biomarkers for myocardial injury.
6. A client receiving unfractionated heparin develops a significant platelet-count
decrease. What complication should the nurse suspect?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Iron-deficiency anemia
D. Thrombotic thrombocytopenic purpura
Correct Answer: B. Heparin-induced thrombocytopenia
Rationale: A substantial platelet decline after heparin exposure raises concern for HIT, which is
associated with thrombosis despite thrombocytopenia.
,7. A client with ARDS is receiving mechanical ventilation. Which intervention is
consistent with lung-protective ventilation?
A. Using unnecessarily large tidal volumes
B. Using low tidal volumes based on predicted body weight
C. Eliminating PEEP
D. Maintaining maximal airway pressures
Correct Answer: B. Using low tidal volumes based on predicted body weight
Rationale: Lung-protective ventilation uses lower tidal volumes to reduce ventilator-induced
lung injury.
8. A mechanically ventilated client suddenly has a high-pressure alarm. What
should the nurse assess first?
A. Whether the tubing is kinked or obstructed
B. The client's dietary intake
C. The urine color
D. The room temperature
Correct Answer: A. Whether the tubing is kinked or obstructed
Rationale: High-pressure alarms commonly result from increased airway resistance, such as
secretions, biting the tube, bronchospasm, or a kinked circuit.
9. A ventilator's low-pressure alarm suddenly activates. Which problem should
the nurse suspect?
A. Circuit disconnection or leak
B. Excessive airway secretions
C. Bronchospasm
D. Kinked endotracheal tube
Correct Answer: A. Circuit disconnection or leak
Rationale: A low-pressure alarm commonly indicates loss of pressure from a disconnected
circuit, cuff leak, or other system leak.
, 10. A client with COPD has an ABG of pH 7.28, PaCO₂ 58 mmHg, and HCO₃⁻ 25
mEq/L. How should the nurse interpret these results?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
Correct Answer: C. Respiratory acidosis
Rationale: The low pH indicates acidemia, while the elevated PaCO₂ indicates a respiratory
cause.
11. A client with DKA is receiving IV insulin. Which laboratory value requires
particularly close monitoring?
A. Potassium
B. Calcium only
C. Hemoglobin
D. Albumin
Correct Answer: A. Potassium
Rationale: Insulin drives potassium into cells, potentially causing hypokalemia. Potassium must
therefore be monitored closely during DKA treatment.
12. Which finding is most characteristic of hypovolemic shock?
A. Warm skin and bounding pulses
B. Tachycardia, cool skin, and decreased urine output
C. Bradycardia with hypertension
D. Increased urine output
Correct Answer: B. Tachycardia, cool skin, and decreased urine output
Rationale: Hypovolemia decreases circulating volume, producing compensatory tachycardia
and vasoconstriction along with reduced renal perfusion.
rationales 2026/2027 pdf
1. A mechanically ventilated client suddenly develops severe dyspnea, absent
breath sounds on the right side, hypotension, and tracheal deviation. Which
complication should the nurse suspect?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Correct Answer: B. Tension pneumothorax
Rationale: Sudden respiratory deterioration, unilateral absent breath sounds, hypotension, and
tracheal deviation are classic findings of tension pneumothorax. This is an emergency requiring
immediate intervention.
2. A client with septic shock has a MAP of 58 mmHg despite fluid resuscitation.
Which medication does the nurse anticipate administering?
A. Norepinephrine
B. Furosemide
C. Digoxin
D. Metoprolol
Correct Answer: A. Norepinephrine
Rationale: Norepinephrine is a first-line vasopressor for persistent hypotension in septic shock
after appropriate fluid resuscitation.
3. Which assessment finding is most concerning in a client with increased
intracranial pressure?
A. Mild headache
B. Increasing level of consciousness
C. Decreasing level of consciousness with unequal pupils
D. Increased appetite
Correct Answer: C. Decreasing level of consciousness with unequal pupils
,Rationale: A declining level of consciousness and pupillary changes can indicate worsening
intracranial pressure and possible brain herniation.
4. A client with a traumatic brain injury has an ICP of 26 mmHg. Which nursing
action is appropriate?
A. Keep the head of bed elevated and maintain neutral head alignment
B. Place the client flat
C. Encourage frequent coughing
D. Flex the client's neck
Correct Answer: A. Keep the head of bed elevated and maintain neutral head alignment
Rationale: Elevating the head and maintaining neutral alignment can promote venous drainage
from the brain and help reduce ICP.
5. Which laboratory value is most specific for myocardial injury?
A. Myoglobin
B. Troponin I
C. Sodium
D. D-dimer
Correct Answer: B. Troponin I
Rationale: Cardiac troponins are highly specific biomarkers for myocardial injury.
6. A client receiving unfractionated heparin develops a significant platelet-count
decrease. What complication should the nurse suspect?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Iron-deficiency anemia
D. Thrombotic thrombocytopenic purpura
Correct Answer: B. Heparin-induced thrombocytopenia
Rationale: A substantial platelet decline after heparin exposure raises concern for HIT, which is
associated with thrombosis despite thrombocytopenia.
,7. A client with ARDS is receiving mechanical ventilation. Which intervention is
consistent with lung-protective ventilation?
A. Using unnecessarily large tidal volumes
B. Using low tidal volumes based on predicted body weight
C. Eliminating PEEP
D. Maintaining maximal airway pressures
Correct Answer: B. Using low tidal volumes based on predicted body weight
Rationale: Lung-protective ventilation uses lower tidal volumes to reduce ventilator-induced
lung injury.
8. A mechanically ventilated client suddenly has a high-pressure alarm. What
should the nurse assess first?
A. Whether the tubing is kinked or obstructed
B. The client's dietary intake
C. The urine color
D. The room temperature
Correct Answer: A. Whether the tubing is kinked or obstructed
Rationale: High-pressure alarms commonly result from increased airway resistance, such as
secretions, biting the tube, bronchospasm, or a kinked circuit.
9. A ventilator's low-pressure alarm suddenly activates. Which problem should
the nurse suspect?
A. Circuit disconnection or leak
B. Excessive airway secretions
C. Bronchospasm
D. Kinked endotracheal tube
Correct Answer: A. Circuit disconnection or leak
Rationale: A low-pressure alarm commonly indicates loss of pressure from a disconnected
circuit, cuff leak, or other system leak.
, 10. A client with COPD has an ABG of pH 7.28, PaCO₂ 58 mmHg, and HCO₃⁻ 25
mEq/L. How should the nurse interpret these results?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
Correct Answer: C. Respiratory acidosis
Rationale: The low pH indicates acidemia, while the elevated PaCO₂ indicates a respiratory
cause.
11. A client with DKA is receiving IV insulin. Which laboratory value requires
particularly close monitoring?
A. Potassium
B. Calcium only
C. Hemoglobin
D. Albumin
Correct Answer: A. Potassium
Rationale: Insulin drives potassium into cells, potentially causing hypokalemia. Potassium must
therefore be monitored closely during DKA treatment.
12. Which finding is most characteristic of hypovolemic shock?
A. Warm skin and bounding pulses
B. Tachycardia, cool skin, and decreased urine output
C. Bradycardia with hypertension
D. Increased urine output
Correct Answer: B. Tachycardia, cool skin, and decreased urine output
Rationale: Hypovolemia decreases circulating volume, producing compensatory tachycardia
and vasoconstriction along with reduced renal perfusion.
