Critical Care Exit Hesi Exam
Questions And Answers with their
rationales
Course
Hesi
TABLE OF CONTENTS
1. Respiratory & Ventilator Care — Questions 1–20
2. Shock & Sepsis — Questions 21–30
3. Neurological Emergencies — Questions 31–40
4. Critical Care Assessment — Questions 41–50
5. Cardiac & Hemodynamic Emergencies — Questions 51–61
6. Neurological & Renal Care — Questions 62–72
7. Multisystem & Critical Care Complications — Questions 73–80
1. A client with septic shock has a blood pressure of 82/46 mm Hg after receiving an initial IV
fluid bolus. Which prescription should the nurse anticipate?
A. IV norepinephrine
B. Oral furosemide
C. Subcutaneous insulin only
D. Oral metoprolol
Correct Answer: A. IV 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 adequate mean
arterial pressure.
2. A client with acute pulmonary edema is severely dyspneic, has crackles throughout both lungs,
and has an oxygen saturation of 82%. Which intervention should the nurse implement first?
A. Place the client supine
B. Administer oxygen and position the client upright
C. Encourage oral fluids
D. Restrict all oxygen administration
Correct Answer: B. Administer oxygen and position the client upright
Rationale: Severe hypoxemia is an immediate priority. Upright positioning improves lung
expansion and oxygenation, while supplemental oxygen helps correct hypoxemia.
3. A mechanically ventilated client suddenly develops high peak airway pressures. Which
assessment should the nurse perform first?
A. Assess for airway obstruction or secretions
B. Increase the sedation dose automatically
C. Turn off the ventilator
D. Administer oral fluids
Correct Answer: A. Assess for airway obstruction or secretions
,Rationale: A sudden increase in airway pressure can result from secretions, tube obstruction,
bronchospasm, biting the endotracheal tube, decreased lung compliance, or pneumothorax.
Immediate assessment is necessary.
4. A client with a traumatic brain injury has increasing intracranial pressure (ICP). Which
position is generally most appropriate?
A. Head flat with the neck flexed
B. Head elevated with the neck maintained in neutral alignment
C. Trendelenburg position
D. Prone position with the neck rotated
Correct Answer: B. Head elevated with the neck maintained in neutral alignment
Rationale: Elevating the head and maintaining neutral neck alignment promotes venous
drainage from the brain and can help reduce ICP.
5. Which finding is most concerning in a client with increased intracranial pressure?
A. Mild headache
B. Decreasing level of consciousness
C. Increased appetite
D. Warm hands
Correct Answer: B. Decreasing level of consciousness
Rationale: A declining level of consciousness is an important indicator of neurological
deterioration and may signal worsening cerebral edema or increased ICP.
, 6. A client develops ventricular tachycardia and has no palpable pulse. What should the nurse
anticipate?
A. Synchronized cardioversion
B. Immediate defibrillation and CPR
C. Oral antiarrhythmic medication
D. Vagal maneuvers
Correct Answer: B. Immediate defibrillation and CPR
Rationale: Pulseless ventricular tachycardia is a shockable cardiac arrest rhythm. High-quality
CPR and immediate unsynchronized defibrillation are required.
7. A client is in ventricular fibrillation. Which intervention is the priority?
A. Defibrillation
B. Oral aspirin
C. Synchronized cardioversion
D. Vagal stimulation
Correct Answer: A. Defibrillation
Rationale: Ventricular fibrillation is a pulseless shockable rhythm. Immediate defibrillation
combined with high-quality CPR is essential.
8. Which ECG finding is most characteristic of hyperkalemia?
A. Peaked T waves
B. Prominent U waves
Questions And Answers with their
rationales
Course
Hesi
TABLE OF CONTENTS
1. Respiratory & Ventilator Care — Questions 1–20
2. Shock & Sepsis — Questions 21–30
3. Neurological Emergencies — Questions 31–40
4. Critical Care Assessment — Questions 41–50
5. Cardiac & Hemodynamic Emergencies — Questions 51–61
6. Neurological & Renal Care — Questions 62–72
7. Multisystem & Critical Care Complications — Questions 73–80
1. A client with septic shock has a blood pressure of 82/46 mm Hg after receiving an initial IV
fluid bolus. Which prescription should the nurse anticipate?
A. IV norepinephrine
B. Oral furosemide
C. Subcutaneous insulin only
D. Oral metoprolol
Correct Answer: A. IV 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 adequate mean
arterial pressure.
2. A client with acute pulmonary edema is severely dyspneic, has crackles throughout both lungs,
and has an oxygen saturation of 82%. Which intervention should the nurse implement first?
A. Place the client supine
B. Administer oxygen and position the client upright
C. Encourage oral fluids
D. Restrict all oxygen administration
Correct Answer: B. Administer oxygen and position the client upright
Rationale: Severe hypoxemia is an immediate priority. Upright positioning improves lung
expansion and oxygenation, while supplemental oxygen helps correct hypoxemia.
3. A mechanically ventilated client suddenly develops high peak airway pressures. Which
assessment should the nurse perform first?
A. Assess for airway obstruction or secretions
B. Increase the sedation dose automatically
C. Turn off the ventilator
D. Administer oral fluids
Correct Answer: A. Assess for airway obstruction or secretions
,Rationale: A sudden increase in airway pressure can result from secretions, tube obstruction,
bronchospasm, biting the endotracheal tube, decreased lung compliance, or pneumothorax.
Immediate assessment is necessary.
4. A client with a traumatic brain injury has increasing intracranial pressure (ICP). Which
position is generally most appropriate?
A. Head flat with the neck flexed
B. Head elevated with the neck maintained in neutral alignment
C. Trendelenburg position
D. Prone position with the neck rotated
Correct Answer: B. Head elevated with the neck maintained in neutral alignment
Rationale: Elevating the head and maintaining neutral neck alignment promotes venous
drainage from the brain and can help reduce ICP.
5. Which finding is most concerning in a client with increased intracranial pressure?
A. Mild headache
B. Decreasing level of consciousness
C. Increased appetite
D. Warm hands
Correct Answer: B. Decreasing level of consciousness
Rationale: A declining level of consciousness is an important indicator of neurological
deterioration and may signal worsening cerebral edema or increased ICP.
, 6. A client develops ventricular tachycardia and has no palpable pulse. What should the nurse
anticipate?
A. Synchronized cardioversion
B. Immediate defibrillation and CPR
C. Oral antiarrhythmic medication
D. Vagal maneuvers
Correct Answer: B. Immediate defibrillation and CPR
Rationale: Pulseless ventricular tachycardia is a shockable cardiac arrest rhythm. High-quality
CPR and immediate unsynchronized defibrillation are required.
7. A client is in ventricular fibrillation. Which intervention is the priority?
A. Defibrillation
B. Oral aspirin
C. Synchronized cardioversion
D. Vagal stimulation
Correct Answer: A. Defibrillation
Rationale: Ventricular fibrillation is a pulseless shockable rhythm. Immediate defibrillation
combined with high-quality CPR is essential.
8. Which ECG finding is most characteristic of hyperkalemia?
A. Peaked T waves
B. Prominent U waves
