Critical Care Exit HESI - 55 Questions - Updated 2026/2027
Critical Care Exit HESI - 55 Questions
Critical Care Nursing | Answers & Rationales
Updated 2026/2027 | 55 Questions | HESI Exit Blueprint Aligned | AACN Synergy Model | Surviving Sepsis Campaign
| All Answers Verified Correct
This examination is designed to assess mastery of critical care nursing content aligned with the 2026/2027 HESI Critical
Care Exit Examination blueprint and current critical care nursing practice standards. The test bank emphasizes
cardiovascular, pulmonary, neurological, endocrine/renal/fluid-electrolyte, and multisystem/sepsis/professional critical
care content, drawing on AACN Synergy Model principles, the Surviving Sepsis Campaign, and current evidence-based
guidelines. Each question includes a verified rationale that doubles as study-guide content, addressing common HESI exit
exam pitfalls such as incorrect hemodynamic parameter interpretation, ABG misclassification, rhythm misidentification,
medication dosing/selection errors, prioritization errors, and misunderstanding of ethical principles. Cognitive level
distribution: approximately 30% recall, 50% application, and 20% analysis. Question style: 80% scenario-based, 20%
direct recall of critical care concepts and protocols.
SECTION 1: Cardiovascular Critical Care
ACS, Heart Failure, Dysrhythmias, & Hemodynamics | Questions 1-12 | 12 Questions
This section addresses acute coronary syndromes, acute decompensated heart failure and pulmonary edema, lethal
cardiac dysrhythmias, hemodynamic monitoring (CVP, PAOP, CO/CI, SVR), and vasoactive medication
management.
Q1. A 58-year-old male presents to the ED with crushing substernal chest pain radiating to the left arm,
diaphoresis, and dyspnea for the past 45 minutes. The 12-lead ECG shows ST-segment elevation in leads II,
III, and aVF. What is the PRIORITY nursing action?
A. Administer sublingual nitroglycerin every 5 minutes for a maximum of 3 doses
B. Activate the STEMI alert / cath lab pathway, establish IV access, administer aspirin 324 mg chewed, obtain
oxygen saturation, and prepare for immediate reperfusion therapy (PCI within 90 minutes or thrombolytics
within 30 minutes) [CORRECT]
C. Administer morphine 4 mg IV push for pain and reassess
D. Obtain a complete health history and 12-lead ECG now and again in 15 minutes
Correct Answer: B — Activate the STEMI alert / cath lab pathway, establish IV access, administer
aspirin 324 mg chewed, obtain oxygen saturation, and prepare for immediate reperfusion therapy (PCI
within 90 minutes or thrombolytics within 30 minutes)
Rationale: ST elevation in II, III, aVF indicates an inferior STEMI; time-is-muscle priorities are immediate
reperfusion. The AHA/ACC STEMI algorithm specifies first medical contact-to-balloon time of ≤90 minutes for
PCI (or door-to-needle ≤30 minutes for thrombolytics if PCI not available). Aspirin 324 mg chewed reduces
mortality; oxygen only if SpO2 <90%. Nitroglycerin (Option A) is contraindicated in inferior MI (risk of
profound hypotension due to RV involvement). Morphine (Option C) is second-line after reperfusion pathway is
activated. History (Option D) delays lifesaving reperfusion.
Critical Care Exit HESI - Answers & Rationales - 2026/2027 Page 1
,Critical Care Exit HESI - 55 Questions - Updated 2026/2027
Q2. A patient with acute decompensated heart failure has the following hemodynamic profile: BP 88/52
mmHg, HR 118 bpm, PAOP 28 mmHg (normal 8-12), CI 1.8 L/min/m² (normal 2.5-4.0), SVR 1800
dynes·s/cm⁵ (normal 800-1200). The patient is in Forrester Subset IV (cold and wet). Which vasoactive
medication is MOST appropriate?
A. Dobutamine infusion starting at 2.5 mcg/kg/min [CORRECT]
B. Norepinephrine infusion starting at 0.1 mcg/kg/min
C. Dopamine infusion at 5 mcg/kg/min
D. Nitroprusside infusion starting at 0.3 mcg/kg/min
Correct Answer: A — Dobutamine infusion starting at 2.5 mcg/kg/min
Rationale: Forrester Subset IV (low CI = cold; high PAOP = wet) represents cardiogenic shock with pulmonary
congestion. Dobutamine (Option A) is an inotrope that increases contractility (raising CI) with mild vasodilation
(lowering SVR and PAOP). Norepinephrine (Option B) would worsen SVR and PAOP. Dopamine at 5
mcg/kg/min (Option C) is renal-dose (limited evidence of benefit). Nitroprusside (Option D) would lower
SVR/PAOP but would worsen hypotension without improving contractility.
Q3. A patient on a dobutamine infusion at 10 mcg/kg/min for cardiogenic shock develops a heart rate of 142
bpm with new-onset atrial fibrillation and frequent PVCs. BP is 96/58. Which action is the PRIORITY?
A. Increase the dobutamine rate to 15 mcg/kg/min to improve cardiac output
B. Decrease the dobutamine rate and notify the provider; prepare to titrate to an alternative inotrope such as
milrinone [CORRECT]
C. Administer IV diltiazem 20 mg to control ventricular rate
D. Administer synchronized cardioversion at 100 joules
Correct Answer: B — Decrease the dobutamine rate and notify the provider; prepare to titrate to an
alternative inotrope such as milrinone
Rationale: Dobutamine is a β1 agonist that increases myocardial oxygen demand and can precipitate
tachydysrhythmias (atrial fibrillation, ventricular ectopy). The appropriate response is to reduce the dose and
notify the provider for alternative inotrope (e.g., milrinone, a PDE-3 inhibitor with non-adrenergic mechanism).
Increasing dobutamine (Option A) would worsen tachydysrhythmia. Diltiazem (Option C) is a negative inotrope
and would worsen cardiogenic shock. Cardioversion (Option D) is reserved for hemodynamic instability from
the rhythm itself, not for iatrogenic medication-induced tachycardia.
Critical Care Exit HESI - Answers & Rationales - 2026/2027 Page 2
, Critical Care Exit HESI - 55 Questions - Updated 2026/2027
Q4. A patient with a pulmonary artery catheter has the following readings: PAOP 6 mmHg, CVP 2 mmHg, CI
2.2 L/min/m², SVR 700 dynes·s/cm⁵. These findings are MOST consistent with:
A. Cardiogenic shock
B. Hypovolemic shock with low SVR compensatory response - actually pseudonormal, true picture is hypovolemia
with low PAOP/CVP and compensatory vasodilation
C. Septic shock (distributive) with vasodilation (low SVR), low preload (low PAOP/CVP), and high cardiac
index expected; with low CI, this is a mixed picture - consistent with early distributive shock with inadequate
resuscitation [CORRECT]
D. Tamponade
Correct Answer: C — Septic shock (distributive) with vasodilation (low SVR), low preload (low
PAOP/CVP), and high cardiac index expected; with low CI, this is a mixed picture - consistent with early
distributive shock with inadequate resuscitation
Rationale: Low PAOP, low CVP, low SVR, and low CI together suggest distributive shock (low SVR) with
inadequate preload resuscitation (low PAOP/CVP) and inadequate compensatory cardiac response (low rather
than high CI). Cardiogenic shock (Option A) would show high PAOP/CVP and low CI. Pure hypovolemia
(Option B) would show low PAOP/CVP and high SVR (compensatory vasoconstriction). Tamponade (Option D)
shows equalization of diastolic pressures with high CVP/PAOP.
Q5. A patient with acute MI develops sudden loss of consciousness; the monitor shows a wide-complex
tachycardia at 220 bpm with no P waves and QRS >0.12 sec. BP is 64/palpable. Which intervention is the
PRIORITY?
A. Administer IV adenosine 6 mg rapid push
B. Administer synchronized cardioversion at 200 joules (biphasic) with sedation if possible [CORRECT]
C. Administer IV amiodarone 150 mg over 10 minutes
D. Begin chest compressions at a rate of 100-120/min and prepare for defibrillation
Correct Answer: B — Administer synchronized cardioversion at 200 joules (biphasic) with sedation if
possible
Rationale: The rhythm is monomorphic ventricular tachycardia with a pulse but hemodynamic instability
(hypotension, altered consciousness). Per ACLS, the treatment is urgent synchronized cardioversion. Adenosine
(Option A) is for stable SVT, not VT. Amiodarone (Option C) is for stable VT. Defibrillation (Option D) is for
pulseless VT/VF, not VT with a pulse. Synchronized cardioversion delivers the shock on the R-wave to avoid the
T-wave and prevent inducing VF.
Critical Care Exit HESI - Answers & Rationales - 2026/2027 Page 3
Critical Care Exit HESI - 55 Questions
Critical Care Nursing | Answers & Rationales
Updated 2026/2027 | 55 Questions | HESI Exit Blueprint Aligned | AACN Synergy Model | Surviving Sepsis Campaign
| All Answers Verified Correct
This examination is designed to assess mastery of critical care nursing content aligned with the 2026/2027 HESI Critical
Care Exit Examination blueprint and current critical care nursing practice standards. The test bank emphasizes
cardiovascular, pulmonary, neurological, endocrine/renal/fluid-electrolyte, and multisystem/sepsis/professional critical
care content, drawing on AACN Synergy Model principles, the Surviving Sepsis Campaign, and current evidence-based
guidelines. Each question includes a verified rationale that doubles as study-guide content, addressing common HESI exit
exam pitfalls such as incorrect hemodynamic parameter interpretation, ABG misclassification, rhythm misidentification,
medication dosing/selection errors, prioritization errors, and misunderstanding of ethical principles. Cognitive level
distribution: approximately 30% recall, 50% application, and 20% analysis. Question style: 80% scenario-based, 20%
direct recall of critical care concepts and protocols.
SECTION 1: Cardiovascular Critical Care
ACS, Heart Failure, Dysrhythmias, & Hemodynamics | Questions 1-12 | 12 Questions
This section addresses acute coronary syndromes, acute decompensated heart failure and pulmonary edema, lethal
cardiac dysrhythmias, hemodynamic monitoring (CVP, PAOP, CO/CI, SVR), and vasoactive medication
management.
Q1. A 58-year-old male presents to the ED with crushing substernal chest pain radiating to the left arm,
diaphoresis, and dyspnea for the past 45 minutes. The 12-lead ECG shows ST-segment elevation in leads II,
III, and aVF. What is the PRIORITY nursing action?
A. Administer sublingual nitroglycerin every 5 minutes for a maximum of 3 doses
B. Activate the STEMI alert / cath lab pathway, establish IV access, administer aspirin 324 mg chewed, obtain
oxygen saturation, and prepare for immediate reperfusion therapy (PCI within 90 minutes or thrombolytics
within 30 minutes) [CORRECT]
C. Administer morphine 4 mg IV push for pain and reassess
D. Obtain a complete health history and 12-lead ECG now and again in 15 minutes
Correct Answer: B — Activate the STEMI alert / cath lab pathway, establish IV access, administer
aspirin 324 mg chewed, obtain oxygen saturation, and prepare for immediate reperfusion therapy (PCI
within 90 minutes or thrombolytics within 30 minutes)
Rationale: ST elevation in II, III, aVF indicates an inferior STEMI; time-is-muscle priorities are immediate
reperfusion. The AHA/ACC STEMI algorithm specifies first medical contact-to-balloon time of ≤90 minutes for
PCI (or door-to-needle ≤30 minutes for thrombolytics if PCI not available). Aspirin 324 mg chewed reduces
mortality; oxygen only if SpO2 <90%. Nitroglycerin (Option A) is contraindicated in inferior MI (risk of
profound hypotension due to RV involvement). Morphine (Option C) is second-line after reperfusion pathway is
activated. History (Option D) delays lifesaving reperfusion.
Critical Care Exit HESI - Answers & Rationales - 2026/2027 Page 1
,Critical Care Exit HESI - 55 Questions - Updated 2026/2027
Q2. A patient with acute decompensated heart failure has the following hemodynamic profile: BP 88/52
mmHg, HR 118 bpm, PAOP 28 mmHg (normal 8-12), CI 1.8 L/min/m² (normal 2.5-4.0), SVR 1800
dynes·s/cm⁵ (normal 800-1200). The patient is in Forrester Subset IV (cold and wet). Which vasoactive
medication is MOST appropriate?
A. Dobutamine infusion starting at 2.5 mcg/kg/min [CORRECT]
B. Norepinephrine infusion starting at 0.1 mcg/kg/min
C. Dopamine infusion at 5 mcg/kg/min
D. Nitroprusside infusion starting at 0.3 mcg/kg/min
Correct Answer: A — Dobutamine infusion starting at 2.5 mcg/kg/min
Rationale: Forrester Subset IV (low CI = cold; high PAOP = wet) represents cardiogenic shock with pulmonary
congestion. Dobutamine (Option A) is an inotrope that increases contractility (raising CI) with mild vasodilation
(lowering SVR and PAOP). Norepinephrine (Option B) would worsen SVR and PAOP. Dopamine at 5
mcg/kg/min (Option C) is renal-dose (limited evidence of benefit). Nitroprusside (Option D) would lower
SVR/PAOP but would worsen hypotension without improving contractility.
Q3. A patient on a dobutamine infusion at 10 mcg/kg/min for cardiogenic shock develops a heart rate of 142
bpm with new-onset atrial fibrillation and frequent PVCs. BP is 96/58. Which action is the PRIORITY?
A. Increase the dobutamine rate to 15 mcg/kg/min to improve cardiac output
B. Decrease the dobutamine rate and notify the provider; prepare to titrate to an alternative inotrope such as
milrinone [CORRECT]
C. Administer IV diltiazem 20 mg to control ventricular rate
D. Administer synchronized cardioversion at 100 joules
Correct Answer: B — Decrease the dobutamine rate and notify the provider; prepare to titrate to an
alternative inotrope such as milrinone
Rationale: Dobutamine is a β1 agonist that increases myocardial oxygen demand and can precipitate
tachydysrhythmias (atrial fibrillation, ventricular ectopy). The appropriate response is to reduce the dose and
notify the provider for alternative inotrope (e.g., milrinone, a PDE-3 inhibitor with non-adrenergic mechanism).
Increasing dobutamine (Option A) would worsen tachydysrhythmia. Diltiazem (Option C) is a negative inotrope
and would worsen cardiogenic shock. Cardioversion (Option D) is reserved for hemodynamic instability from
the rhythm itself, not for iatrogenic medication-induced tachycardia.
Critical Care Exit HESI - Answers & Rationales - 2026/2027 Page 2
, Critical Care Exit HESI - 55 Questions - Updated 2026/2027
Q4. A patient with a pulmonary artery catheter has the following readings: PAOP 6 mmHg, CVP 2 mmHg, CI
2.2 L/min/m², SVR 700 dynes·s/cm⁵. These findings are MOST consistent with:
A. Cardiogenic shock
B. Hypovolemic shock with low SVR compensatory response - actually pseudonormal, true picture is hypovolemia
with low PAOP/CVP and compensatory vasodilation
C. Septic shock (distributive) with vasodilation (low SVR), low preload (low PAOP/CVP), and high cardiac
index expected; with low CI, this is a mixed picture - consistent with early distributive shock with inadequate
resuscitation [CORRECT]
D. Tamponade
Correct Answer: C — Septic shock (distributive) with vasodilation (low SVR), low preload (low
PAOP/CVP), and high cardiac index expected; with low CI, this is a mixed picture - consistent with early
distributive shock with inadequate resuscitation
Rationale: Low PAOP, low CVP, low SVR, and low CI together suggest distributive shock (low SVR) with
inadequate preload resuscitation (low PAOP/CVP) and inadequate compensatory cardiac response (low rather
than high CI). Cardiogenic shock (Option A) would show high PAOP/CVP and low CI. Pure hypovolemia
(Option B) would show low PAOP/CVP and high SVR (compensatory vasoconstriction). Tamponade (Option D)
shows equalization of diastolic pressures with high CVP/PAOP.
Q5. A patient with acute MI develops sudden loss of consciousness; the monitor shows a wide-complex
tachycardia at 220 bpm with no P waves and QRS >0.12 sec. BP is 64/palpable. Which intervention is the
PRIORITY?
A. Administer IV adenosine 6 mg rapid push
B. Administer synchronized cardioversion at 200 joules (biphasic) with sedation if possible [CORRECT]
C. Administer IV amiodarone 150 mg over 10 minutes
D. Begin chest compressions at a rate of 100-120/min and prepare for defibrillation
Correct Answer: B — Administer synchronized cardioversion at 200 joules (biphasic) with sedation if
possible
Rationale: The rhythm is monomorphic ventricular tachycardia with a pulse but hemodynamic instability
(hypotension, altered consciousness). Per ACLS, the treatment is urgent synchronized cardioversion. Adenosine
(Option A) is for stable SVT, not VT. Amiodarone (Option C) is for stable VT. Defibrillation (Option D) is for
pulseless VT/VF, not VT with a pulse. Synchronized cardioversion delivers the shock on the R-wave to avoid the
T-wave and prevent inducing VF.
Critical Care Exit HESI - Answers & Rationales - 2026/2027 Page 3
