HESI Critical Care Exit Exam Practice
Questions and Answers | Critical Care
HESI Exam Review | Rationales and
Nursing Study Guide | Latest 2026/2027
Update
Description: This comprehensive study guide contains 200 multiple-choice practice
questions with correct answers marked ✅ and detailed rationales covering all
essential critical care nursing topics tested on the HESI Critical Care Exit Exam.
Content includes hemodynamics, mechanical ventilation, ABG interpretation,
vasoactive drips, sepsis, ARDS, cardiac emergencies, neurocritical care, renal
replacement therapy, and more — aligned with the latest 2026/2027 test blueprint.
Keywords: HESI Critical Care Exit Exam, Critical Care HESI Review, CCRN practice
questions, hemodynamics, mechanical ventilation, ABG interpretation, vasopressors,
sepsis, ARDS, critical care nursing study guide, NCLEX critical care, 2026/2027 HESI.
SECTION 1: HEMODYNAMICS & VASOACTIVE
MEDICATIONS (Q1–Q25)
1. A patient has a CVP of 1 mmHg. Which action should the nurse anticipate?
A. Administer furosemide
B. ✅ Initiate IV fluid bolus
C. Place in high-Fowler's position
D. Restrict fluids
,Rationale: Normal CVP is 2–8 mmHg. A CVP of 1 indicates hypovolemia, requiring fluid
resuscitation.
2. Which pressure reflects left ventricular end-diastolic pressure?
A. CVP
B. ✅ PAWP (pulmonary artery wedge pressure)
C. PAP
D. SVR
Rationale: PAWP (normal 6–12 mmHg) reflects left ventricular preload.
3. A patient on norepinephrine has a MAP of 58 mmHg. What is the priority
action?
A. Document
B. ✅ Increase the infusion per protocol and notify the provider
C. Stop the drip
D. Position supine
Rationale: MAP goal in critical care is ≥65 mmHg to maintain organ perfusion.
4. Which finding indicates adequate tissue perfusion?
A. Urine output 15 mL/hr
B. ✅ Capillary refill < 3 seconds
C. Lactate 4.5 mmol/L
D. MAP 55 mmHg
Rationale: Capillary refill < 3 seconds indicates adequate peripheral perfusion.
5. Dobutamine primarily acts as a:
A. Vasoconstrictor
B. ✅ Positive inotrope
C. Diuretic
D. Beta-blocker
,Rationale: Dobutamine is a beta-1 agonist that increases contractility (inotrope).
6. A patient with SVR of 1600 dynes/sec/cm⁻⁵ likely has:
A. Septic shock
B. ✅ Vasoconstriction/hypovolemic shock
C. Neurogenic shock
D. Anaphylaxis
Rationale: Normal SVR is 800–1200. Elevated SVR indicates vasoconstriction.
7. Which vasopressor is first-line for septic shock?
A. Dopamine
B. ✅ Norepinephrine
C. Vasopressin
D. Phenylephrine
Rationale: Norepinephrine is first-line per Surviving Sepsis Campaign guidelines.
8. A patient receiving vasopressin should be monitored for:
A. Hyperglycemia
B. ✅ Hyponatremia and ischemia
C. Hypertension only
D. Bradycardia
Rationale: Vasopressin causes water retention (hyponatremia) and can cause
digital/mesenteric ischemia.
9. Which line is required for vasopressor administration?
A. Peripheral 22g
B. ✅ Central venous access
C. PICC only
D. IM injection
Rationale: Central access prevents extravasation necrosis with vasopressors.
, 10. A patient on a nitroprusside drip develops cyanide toxicity signs. Which
finding is expected?
A. Hypertension
B. ✅ Metabolic acidosis and confusion
C. Bradycardia
D. Hyperkalemia
Rationale: Cyanide toxicity causes altered mental status, lactic acidosis, and seizures.
11. Mixed venous oxygen saturation (SvO2) of 50% indicates:
A. Adequate perfusion
B. ✅ Increased oxygen extraction/tissue demand
C. Hyperoxia
D. Normal finding
Rationale: Normal SvO2 is 60–80%; low values indicate increased extraction or
decreased delivery.
12. Which drug reduces preload and afterload in heart failure?
A. Dobutamine
B. ✅ Nitroglycerin
C. Norepinephrine
D. Vasopressin
Rationale: Nitroglycerin is a venous dilator that reduces preload (and afterload at
higher doses).
13. A patient's PAWP is 22 mmHg. This indicates:
A. Hypovolemia
B. ✅ Left ventricular failure/volume overload
C. Right heart failure
D. Normal finding
Questions and Answers | Critical Care
HESI Exam Review | Rationales and
Nursing Study Guide | Latest 2026/2027
Update
Description: This comprehensive study guide contains 200 multiple-choice practice
questions with correct answers marked ✅ and detailed rationales covering all
essential critical care nursing topics tested on the HESI Critical Care Exit Exam.
Content includes hemodynamics, mechanical ventilation, ABG interpretation,
vasoactive drips, sepsis, ARDS, cardiac emergencies, neurocritical care, renal
replacement therapy, and more — aligned with the latest 2026/2027 test blueprint.
Keywords: HESI Critical Care Exit Exam, Critical Care HESI Review, CCRN practice
questions, hemodynamics, mechanical ventilation, ABG interpretation, vasopressors,
sepsis, ARDS, critical care nursing study guide, NCLEX critical care, 2026/2027 HESI.
SECTION 1: HEMODYNAMICS & VASOACTIVE
MEDICATIONS (Q1–Q25)
1. A patient has a CVP of 1 mmHg. Which action should the nurse anticipate?
A. Administer furosemide
B. ✅ Initiate IV fluid bolus
C. Place in high-Fowler's position
D. Restrict fluids
,Rationale: Normal CVP is 2–8 mmHg. A CVP of 1 indicates hypovolemia, requiring fluid
resuscitation.
2. Which pressure reflects left ventricular end-diastolic pressure?
A. CVP
B. ✅ PAWP (pulmonary artery wedge pressure)
C. PAP
D. SVR
Rationale: PAWP (normal 6–12 mmHg) reflects left ventricular preload.
3. A patient on norepinephrine has a MAP of 58 mmHg. What is the priority
action?
A. Document
B. ✅ Increase the infusion per protocol and notify the provider
C. Stop the drip
D. Position supine
Rationale: MAP goal in critical care is ≥65 mmHg to maintain organ perfusion.
4. Which finding indicates adequate tissue perfusion?
A. Urine output 15 mL/hr
B. ✅ Capillary refill < 3 seconds
C. Lactate 4.5 mmol/L
D. MAP 55 mmHg
Rationale: Capillary refill < 3 seconds indicates adequate peripheral perfusion.
5. Dobutamine primarily acts as a:
A. Vasoconstrictor
B. ✅ Positive inotrope
C. Diuretic
D. Beta-blocker
,Rationale: Dobutamine is a beta-1 agonist that increases contractility (inotrope).
6. A patient with SVR of 1600 dynes/sec/cm⁻⁵ likely has:
A. Septic shock
B. ✅ Vasoconstriction/hypovolemic shock
C. Neurogenic shock
D. Anaphylaxis
Rationale: Normal SVR is 800–1200. Elevated SVR indicates vasoconstriction.
7. Which vasopressor is first-line for septic shock?
A. Dopamine
B. ✅ Norepinephrine
C. Vasopressin
D. Phenylephrine
Rationale: Norepinephrine is first-line per Surviving Sepsis Campaign guidelines.
8. A patient receiving vasopressin should be monitored for:
A. Hyperglycemia
B. ✅ Hyponatremia and ischemia
C. Hypertension only
D. Bradycardia
Rationale: Vasopressin causes water retention (hyponatremia) and can cause
digital/mesenteric ischemia.
9. Which line is required for vasopressor administration?
A. Peripheral 22g
B. ✅ Central venous access
C. PICC only
D. IM injection
Rationale: Central access prevents extravasation necrosis with vasopressors.
, 10. A patient on a nitroprusside drip develops cyanide toxicity signs. Which
finding is expected?
A. Hypertension
B. ✅ Metabolic acidosis and confusion
C. Bradycardia
D. Hyperkalemia
Rationale: Cyanide toxicity causes altered mental status, lactic acidosis, and seizures.
11. Mixed venous oxygen saturation (SvO2) of 50% indicates:
A. Adequate perfusion
B. ✅ Increased oxygen extraction/tissue demand
C. Hyperoxia
D. Normal finding
Rationale: Normal SvO2 is 60–80%; low values indicate increased extraction or
decreased delivery.
12. Which drug reduces preload and afterload in heart failure?
A. Dobutamine
B. ✅ Nitroglycerin
C. Norepinephrine
D. Vasopressin
Rationale: Nitroglycerin is a venous dilator that reduces preload (and afterload at
higher doses).
13. A patient's PAWP is 22 mmHg. This indicates:
A. Hypovolemia
B. ✅ Left ventricular failure/volume overload
C. Right heart failure
D. Normal finding
