HESI RN Critical Care 2026/2027 | HESI RN Critical Care
Exam Study Guide, HESI Critical Care Nursing Exam
Prep, Intensive Care Nursing, Hemodynamic
Monitoring, Mechanical Ventilation, Shock, Sepsis,
Cardiac Emergencies, Respiratory Failure, Neurological
Emergencies, Critical Medications, Practice Questions,
Answers & Rationales
Question 1: A patient in the intensive care unit is demonstrating signs of
increased intracranial pressure. Which of the following assessment findings is
the earliest indicator of this condition?
A. Decreased level of consciousness
B. Fixed and dilated pupils
C. Cushing's triad
D. Decerebrate posturing
CORRECT ANSWER: A. Decreased level of consciousness
Rationale: A decreased level of consciousness is the earliest and most sensitive
indicator of increased intracranial pressure. Pupillary changes, Cushing's triad, and
posturing are later signs indicating significant herniation or brainstem
compression.
Question 2: The nurse is caring for a patient with a pulmonary artery catheter.
Which of the following values indicates a low pulmonary artery wedge pressure
(PAWP)?
A. 4 mmHg
B. 10 mmHg
C. 15 mmHg
D. 20 mmHg
CORRECT ANSWER: A. 4 mmHg
Rationale: Normal PAWP is 6-12 mmHg. A value of 4 mmHg is low and indicates
hypovolemia or decreased left ventricular preload. Values of 10-12 mmHg are
normal, while 15-20 mmHg indicate elevated left ventricular filling pressures.
,Question 3: A patient is admitted with a diagnosis of acute respiratory distress
syndrome (ARDS). Which of the following ABG findings is most consistent with
this condition?
A. pH 7.50, PaCO2 30, PaO2 90
B. pH 7.30, PaCO2 50, PaO2 80
C. pH 7.48, PaCO2 32, PaO2 55
D. pH 7.35, PaCO2 40, PaO2 95
CORRECT ANSWER: C. pH 7.48, PaCO2 32, PaO2 55
Rationale: ARDS is characterized by severe hypoxemia refractory to oxygen
therapy. The ABG shows respiratory alkalosis (elevated pH, low PaCO2) from
hyperventilation and severe hypoxemia (PaO2 55 mmHg). This pattern reflects
the impaired gas exchange characteristic of ARDS.
Question 4: The nurse is monitoring a patient receiving mechanical ventilation.
Which of the following alarms indicates the highest priority for immediate
intervention?
A. Low pressure alarm
B. High pressure alarm
C. Low tidal volume alarm
D. Apnea alarm
CORRECT ANSWER: D. Apnea alarm
Rationale: An apnea alarm indicates the patient has stopped breathing or the
ventilator has failed to deliver breaths. This is an immediate life-threatening
emergency requiring instant intervention. While other alarms require attention,
apnea is the highest priority as it directly threatens oxygenation and ventilation.
Question 5: A patient with sepsis is receiving norepinephrine. The nurse
understands that the primary purpose of this medication is to:
A. Increase cardiac contractility
B. Increase systemic vascular resistance
C. Decrease heart rate
D. Increase urine output
,CORRECT ANSWER: B. Increase systemic vascular resistance
Rationale: Norepinephrine is a potent alpha-adrenergic agonist that primarily
causes vasoconstriction, increasing systemic vascular resistance (SVR) and thereby
raising blood pressure. It is the first-line vasopressor for septic shock. It has some
beta-1 effects but its primary role is vasoconstriction.
Question 6: The nurse is assessing a patient with a chest tube connected to
water seal drainage. Which finding requires immediate intervention?
A. Tidaling in the water seal chamber
B. Bubbling in the water seal chamber
C. Drainage of 50 mL in the first hour
D. Chest tube secured with tape
CORRECT ANSWER: B. Bubbling in the water seal chamber
Rationale: Continuous or intermittent bubbling in the water seal chamber
indicates an air leak in the system. This requires immediate assessment to
determine if the leak is from the patient (lung), the tube connections, or the
drainage system. Tidaling is normal, and 50 mL/hour drainage is within acceptable
limits.
Question 7: A patient is admitted with diabetic ketoacidosis (DKA). Which of the
following findings is most characteristic of this condition?
A. Blood glucose 250 mg/dL, pH 7.25, bicarbonate 15 mEq/L
B. Blood glucose 600 mg/dL, pH 7.40, bicarbonate 24 mEq/L
C. Blood glucose 400 mg/dL, pH 7.50, bicarbonate 30 mEq/L
D. Blood glucose 180 mg/dL, pH 7.35, bicarbonate 22 mEq/L
CORRECT ANSWER: A. Blood glucose 250 mg/dL, pH 7.25, bicarbonate 15 mEq/L
Rationale: DKA is characterized by hyperglycemia (usually >250 mg/dL), metabolic
acidosis (pH <7.30), and low bicarbonate (<18 mEq/L). Option A shows all three
diagnostic criteria. Option B shows normal pH and bicarbonate, which would not
be DKA. Option C shows alkalosis. Option D shows normal values.
, Question 8: The nurse is caring for a patient on a ventilator with an
endotracheal tube. Which intervention is most important to prevent ventilator-
associated pneumonia (VAP)?
A. Suctioning every 2 hours
B. Elevating the head of the bed 30-45 degrees
C. Changing the ventilator circuit daily
D. Instilling normal saline before suctioning
CORRECT ANSWER: B. Elevating the head of the bed 30-45 degrees
Rationale: Elevating the head of the bed 30-45 degrees is a key evidence-based
intervention to prevent VAP by reducing aspiration of gastric contents. Routine
suctioning, daily circuit changes, and saline instillation are not recommended
practices for VAP prevention and may actually increase risk.
Question 9: A patient with heart failure is receiving furosemide. Which
laboratory value should the nurse monitor most closely?
A. Sodium level
B. Potassium level
C. Calcium level
D. Magnesium level
CORRECT ANSWER: B. Potassium level
Rationale: Furosemide is a loop diuretic that causes significant potassium loss,
leading to hypokalemia. Hypokalemia can precipitate dangerous dysrhythmias,
especially in patients with heart failure who may already be prone to arrhythmias.
While other electrolytes can be affected, potassium is the most critical to
monitor.
Question 10: The nurse is assessing a patient with a suspected myocardial
infarction. Which cardiac biomarker is most specific for myocardial damage?
A. CK-MB
B. Troponin I
C. Myoglobin
D. LDH
Exam Study Guide, HESI Critical Care Nursing Exam
Prep, Intensive Care Nursing, Hemodynamic
Monitoring, Mechanical Ventilation, Shock, Sepsis,
Cardiac Emergencies, Respiratory Failure, Neurological
Emergencies, Critical Medications, Practice Questions,
Answers & Rationales
Question 1: A patient in the intensive care unit is demonstrating signs of
increased intracranial pressure. Which of the following assessment findings is
the earliest indicator of this condition?
A. Decreased level of consciousness
B. Fixed and dilated pupils
C. Cushing's triad
D. Decerebrate posturing
CORRECT ANSWER: A. Decreased level of consciousness
Rationale: A decreased level of consciousness is the earliest and most sensitive
indicator of increased intracranial pressure. Pupillary changes, Cushing's triad, and
posturing are later signs indicating significant herniation or brainstem
compression.
Question 2: The nurse is caring for a patient with a pulmonary artery catheter.
Which of the following values indicates a low pulmonary artery wedge pressure
(PAWP)?
A. 4 mmHg
B. 10 mmHg
C. 15 mmHg
D. 20 mmHg
CORRECT ANSWER: A. 4 mmHg
Rationale: Normal PAWP is 6-12 mmHg. A value of 4 mmHg is low and indicates
hypovolemia or decreased left ventricular preload. Values of 10-12 mmHg are
normal, while 15-20 mmHg indicate elevated left ventricular filling pressures.
,Question 3: A patient is admitted with a diagnosis of acute respiratory distress
syndrome (ARDS). Which of the following ABG findings is most consistent with
this condition?
A. pH 7.50, PaCO2 30, PaO2 90
B. pH 7.30, PaCO2 50, PaO2 80
C. pH 7.48, PaCO2 32, PaO2 55
D. pH 7.35, PaCO2 40, PaO2 95
CORRECT ANSWER: C. pH 7.48, PaCO2 32, PaO2 55
Rationale: ARDS is characterized by severe hypoxemia refractory to oxygen
therapy. The ABG shows respiratory alkalosis (elevated pH, low PaCO2) from
hyperventilation and severe hypoxemia (PaO2 55 mmHg). This pattern reflects
the impaired gas exchange characteristic of ARDS.
Question 4: The nurse is monitoring a patient receiving mechanical ventilation.
Which of the following alarms indicates the highest priority for immediate
intervention?
A. Low pressure alarm
B. High pressure alarm
C. Low tidal volume alarm
D. Apnea alarm
CORRECT ANSWER: D. Apnea alarm
Rationale: An apnea alarm indicates the patient has stopped breathing or the
ventilator has failed to deliver breaths. This is an immediate life-threatening
emergency requiring instant intervention. While other alarms require attention,
apnea is the highest priority as it directly threatens oxygenation and ventilation.
Question 5: A patient with sepsis is receiving norepinephrine. The nurse
understands that the primary purpose of this medication is to:
A. Increase cardiac contractility
B. Increase systemic vascular resistance
C. Decrease heart rate
D. Increase urine output
,CORRECT ANSWER: B. Increase systemic vascular resistance
Rationale: Norepinephrine is a potent alpha-adrenergic agonist that primarily
causes vasoconstriction, increasing systemic vascular resistance (SVR) and thereby
raising blood pressure. It is the first-line vasopressor for septic shock. It has some
beta-1 effects but its primary role is vasoconstriction.
Question 6: The nurse is assessing a patient with a chest tube connected to
water seal drainage. Which finding requires immediate intervention?
A. Tidaling in the water seal chamber
B. Bubbling in the water seal chamber
C. Drainage of 50 mL in the first hour
D. Chest tube secured with tape
CORRECT ANSWER: B. Bubbling in the water seal chamber
Rationale: Continuous or intermittent bubbling in the water seal chamber
indicates an air leak in the system. This requires immediate assessment to
determine if the leak is from the patient (lung), the tube connections, or the
drainage system. Tidaling is normal, and 50 mL/hour drainage is within acceptable
limits.
Question 7: A patient is admitted with diabetic ketoacidosis (DKA). Which of the
following findings is most characteristic of this condition?
A. Blood glucose 250 mg/dL, pH 7.25, bicarbonate 15 mEq/L
B. Blood glucose 600 mg/dL, pH 7.40, bicarbonate 24 mEq/L
C. Blood glucose 400 mg/dL, pH 7.50, bicarbonate 30 mEq/L
D. Blood glucose 180 mg/dL, pH 7.35, bicarbonate 22 mEq/L
CORRECT ANSWER: A. Blood glucose 250 mg/dL, pH 7.25, bicarbonate 15 mEq/L
Rationale: DKA is characterized by hyperglycemia (usually >250 mg/dL), metabolic
acidosis (pH <7.30), and low bicarbonate (<18 mEq/L). Option A shows all three
diagnostic criteria. Option B shows normal pH and bicarbonate, which would not
be DKA. Option C shows alkalosis. Option D shows normal values.
, Question 8: The nurse is caring for a patient on a ventilator with an
endotracheal tube. Which intervention is most important to prevent ventilator-
associated pneumonia (VAP)?
A. Suctioning every 2 hours
B. Elevating the head of the bed 30-45 degrees
C. Changing the ventilator circuit daily
D. Instilling normal saline before suctioning
CORRECT ANSWER: B. Elevating the head of the bed 30-45 degrees
Rationale: Elevating the head of the bed 30-45 degrees is a key evidence-based
intervention to prevent VAP by reducing aspiration of gastric contents. Routine
suctioning, daily circuit changes, and saline instillation are not recommended
practices for VAP prevention and may actually increase risk.
Question 9: A patient with heart failure is receiving furosemide. Which
laboratory value should the nurse monitor most closely?
A. Sodium level
B. Potassium level
C. Calcium level
D. Magnesium level
CORRECT ANSWER: B. Potassium level
Rationale: Furosemide is a loop diuretic that causes significant potassium loss,
leading to hypokalemia. Hypokalemia can precipitate dangerous dysrhythmias,
especially in patients with heart failure who may already be prone to arrhythmias.
While other electrolytes can be affected, potassium is the most critical to
monitor.
Question 10: The nurse is assessing a patient with a suspected myocardial
infarction. Which cardiac biomarker is most specific for myocardial damage?
A. CK-MB
B. Troponin I
C. Myoglobin
D. LDH
