HESI RN CRITICAL CARE EXAM NEWEST 2026/2027
ACTUAL EXAM TEST BANK | CRITICAL CARE RN HESI
EXIT EXAM PREP WITH COMPLETE REAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS |
ALREADY GRADED A+ (MOST RECENT!!)
CORE DOMAINS
• Hemodynamic Monitoring and Cardiovascular Critical Care
• Respiratory Failure and Mechanical Ventilation
• Neurological Critical Care and Intracranial Pressure Management
• Renal Failure and Fluid-Electrolyte Balance in Critical Illness
• Sepsis, Shock, and Multi-Organ Dysfunction Syndrome
• Pharmacology and Vasoactive Medication Management
• Infection Control and Prevention in Critical Care
• Ethical and Legal Issues in Critical Care Nursing
• End-of-Life Care and Palliative Care in the ICU
• Emergency and Disaster Preparedness in Critical Care
INTRODUCTION
This comprehensive examination is designed to assess the critical care knowledge, clinical judgment, and
decision-making skills essential for the Registered Nurse preparing for the HESI Critical Care Exit
Examination. The exam covers foundational hemodynamic concepts, advanced respiratory management,
neurological assessment, renal replacement therapy, and the management of complex critically ill
patients. Each of the 100 multiple-choice questions challenges the candidate to apply evidence-based
practice, prioritize interventions, and demonstrate safe clinical reasoning in high-acuity settings.
Emphasis is placed on rapid assessment, timely intervention, and interdisciplinary collaboration. This
assessment mirrors the rigor of the HESI Critical Care specialty exam and promotes excellence in critical
care nursing practice.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient is admitted to the ICU with acute respiratory distress syndrome (ARDS). The provider orders
mechanical ventilation. Which ventilator setting is most appropriate to prevent barotrauma?
,A. Tidal volume of 12 mL/kg predicted body weight
B. Tidal volume of 6 mL/kg predicted body weight
C. Peak inspiratory pressure of 50 cmH₂O
D. Positive end-expiratory pressure (PEEP) of 20 cmH₂O
B. Tidal volume of 6 mL/kg predicted body weight
RATIONALE: Lung-protective ventilation with low tidal volumes (6 mL/kg predicted body weight)
reduces mortality in ARDS by minimizing ventilator-induced lung injury and barotrauma. Plateau
pressures should be kept below 30 cmH₂O.
Question 2
A nurse is caring for a patient with a pulmonary artery (PA) catheter. The pulmonary artery wedge
pressure (PAWP) reading is 22 mmHg. What does this finding most likely indicate?
A. Hypovolemia
B. Left ventricular failure
C. Right ventricular failure
D. Pulmonary embolism
B. Left ventricular failure
RATIONALE: A PAWP greater than 18 mmHg indicates elevated left atrial pressure, which is
consistent with left ventricular failure and pulmonary congestion. Normal PAWP is 6–12 mmHg.
Question 3
A patient with sepsis has a mean arterial pressure (MAP) of 52 mmHg despite fluid resuscitation. Which
vasopressor is the first-line agent?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Phenylephrine
B. Norepinephrine
RATIONALE: Norepinephrine is the first-line vasopressor for septic shock. It increases systemic
vascular resistance and improves MAP with fewer arrhythmias compared to dopamine.
Question 4
A patient is receiving mechanical ventilation in the assist-control mode. The high-pressure alarm sounds.
Which action should the nurse take FIRST?
,A. Silence the alarm and document
B. Assess the patient for coughing, secretions, or biting on the endotracheal tube
C. Increase the tidal volume setting
D. Disconnect the ventilator and manually ventilate
B. Assess the patient for coughing, secretions, or biting on the endotracheal tube
RATIONALE: High-pressure alarms indicate increased airway resistance or decreased compliance.
The nurse should first assess the patient for common causes such as secretions, coughing, biting, or
kinking of the tube.
Question 5
A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg. Which
intervention is most appropriate to reduce ICP?
A. Administer hypotonic IV fluids
B. Elevate the head of the bed to 30 degrees
C. Perform frequent suctioning
D. Keep the patient in a supine position
B. Elevate the head of the bed to 30 degrees
RATIONALE: Elevating the head of the bed to 30 degrees promotes venous drainage from the brain
and helps reduce ICP. Hypotonic fluids can worsen cerebral edema, and suctioning can increase ICP.
Question 6
A patient is admitted with diabetic ketoacidosis (DKA). Which laboratory finding is most consistent with
this diagnosis?
A. Blood glucose of 180 mg/dL and pH of 7.45
B. Blood glucose of 450 mg/dL and pH of 7.20
C. Blood glucose of 90 mg/dL and pH of 7.38
D. Blood glucose of 300 mg/dL and pH of 7.50
B. Blood glucose of 450 mg/dL and pH of 7.20
RATIONALE: DKA is characterized by hyperglycemia (typically >250 mg/dL), metabolic acidosis (pH
<7.30), and ketonemia. The combination of high glucose and low pH is classic for DKA.
Question 7
A nurse is assessing a patient with a suspected tension pneumothorax. Which finding is most indicative
of this condition?
, A. Tracheal deviation toward the affected side
B. Tracheal deviation away from the affected side
C. Bilateral breath sounds
D. Bradycardia
B. Tracheal deviation away from the affected side
RATIONALE: Tension pneumothorax causes mediastinal shift away from the affected side, leading to
tracheal deviation away from the affected side, along with severe respiratory distress and hypotension.
Question 8
A patient is receiving a continuous infusion of heparin for a pulmonary embolism. Which laboratory
value should the nurse monitor to evaluate therapeutic effectiveness?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Bleeding time
B. Activated partial thromboplastin time (aPTT)
RATIONALE: aPTT is used to monitor unfractionated heparin therapy. The therapeutic range is
typically 1.5–2.5 times the control value.
Question 9
A patient in the ICU develops new-onset atrial fibrillation with a heart rate of 160 beats per minute and
a blood pressure of 78/42 mmHg. What is the priority intervention?
A. Administer diltiazem IV
B. Prepare for synchronized cardioversion
C. Administer digoxin IV
D. Perform vagal maneuvers
B. Prepare for synchronized cardioversion
RATIONALE: Hemodynamically unstable atrial fibrillation requires immediate synchronized
cardioversion. Rate-control medications are contraindicated in the setting of hypotension.
Question 10
A patient with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. Which intervention should
the nurse anticipate FIRST?
ACTUAL EXAM TEST BANK | CRITICAL CARE RN HESI
EXIT EXAM PREP WITH COMPLETE REAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS |
ALREADY GRADED A+ (MOST RECENT!!)
CORE DOMAINS
• Hemodynamic Monitoring and Cardiovascular Critical Care
• Respiratory Failure and Mechanical Ventilation
• Neurological Critical Care and Intracranial Pressure Management
• Renal Failure and Fluid-Electrolyte Balance in Critical Illness
• Sepsis, Shock, and Multi-Organ Dysfunction Syndrome
• Pharmacology and Vasoactive Medication Management
• Infection Control and Prevention in Critical Care
• Ethical and Legal Issues in Critical Care Nursing
• End-of-Life Care and Palliative Care in the ICU
• Emergency and Disaster Preparedness in Critical Care
INTRODUCTION
This comprehensive examination is designed to assess the critical care knowledge, clinical judgment, and
decision-making skills essential for the Registered Nurse preparing for the HESI Critical Care Exit
Examination. The exam covers foundational hemodynamic concepts, advanced respiratory management,
neurological assessment, renal replacement therapy, and the management of complex critically ill
patients. Each of the 100 multiple-choice questions challenges the candidate to apply evidence-based
practice, prioritize interventions, and demonstrate safe clinical reasoning in high-acuity settings.
Emphasis is placed on rapid assessment, timely intervention, and interdisciplinary collaboration. This
assessment mirrors the rigor of the HESI Critical Care specialty exam and promotes excellence in critical
care nursing practice.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient is admitted to the ICU with acute respiratory distress syndrome (ARDS). The provider orders
mechanical ventilation. Which ventilator setting is most appropriate to prevent barotrauma?
,A. Tidal volume of 12 mL/kg predicted body weight
B. Tidal volume of 6 mL/kg predicted body weight
C. Peak inspiratory pressure of 50 cmH₂O
D. Positive end-expiratory pressure (PEEP) of 20 cmH₂O
B. Tidal volume of 6 mL/kg predicted body weight
RATIONALE: Lung-protective ventilation with low tidal volumes (6 mL/kg predicted body weight)
reduces mortality in ARDS by minimizing ventilator-induced lung injury and barotrauma. Plateau
pressures should be kept below 30 cmH₂O.
Question 2
A nurse is caring for a patient with a pulmonary artery (PA) catheter. The pulmonary artery wedge
pressure (PAWP) reading is 22 mmHg. What does this finding most likely indicate?
A. Hypovolemia
B. Left ventricular failure
C. Right ventricular failure
D. Pulmonary embolism
B. Left ventricular failure
RATIONALE: A PAWP greater than 18 mmHg indicates elevated left atrial pressure, which is
consistent with left ventricular failure and pulmonary congestion. Normal PAWP is 6–12 mmHg.
Question 3
A patient with sepsis has a mean arterial pressure (MAP) of 52 mmHg despite fluid resuscitation. Which
vasopressor is the first-line agent?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Phenylephrine
B. Norepinephrine
RATIONALE: Norepinephrine is the first-line vasopressor for septic shock. It increases systemic
vascular resistance and improves MAP with fewer arrhythmias compared to dopamine.
Question 4
A patient is receiving mechanical ventilation in the assist-control mode. The high-pressure alarm sounds.
Which action should the nurse take FIRST?
,A. Silence the alarm and document
B. Assess the patient for coughing, secretions, or biting on the endotracheal tube
C. Increase the tidal volume setting
D. Disconnect the ventilator and manually ventilate
B. Assess the patient for coughing, secretions, or biting on the endotracheal tube
RATIONALE: High-pressure alarms indicate increased airway resistance or decreased compliance.
The nurse should first assess the patient for common causes such as secretions, coughing, biting, or
kinking of the tube.
Question 5
A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg. Which
intervention is most appropriate to reduce ICP?
A. Administer hypotonic IV fluids
B. Elevate the head of the bed to 30 degrees
C. Perform frequent suctioning
D. Keep the patient in a supine position
B. Elevate the head of the bed to 30 degrees
RATIONALE: Elevating the head of the bed to 30 degrees promotes venous drainage from the brain
and helps reduce ICP. Hypotonic fluids can worsen cerebral edema, and suctioning can increase ICP.
Question 6
A patient is admitted with diabetic ketoacidosis (DKA). Which laboratory finding is most consistent with
this diagnosis?
A. Blood glucose of 180 mg/dL and pH of 7.45
B. Blood glucose of 450 mg/dL and pH of 7.20
C. Blood glucose of 90 mg/dL and pH of 7.38
D. Blood glucose of 300 mg/dL and pH of 7.50
B. Blood glucose of 450 mg/dL and pH of 7.20
RATIONALE: DKA is characterized by hyperglycemia (typically >250 mg/dL), metabolic acidosis (pH
<7.30), and ketonemia. The combination of high glucose and low pH is classic for DKA.
Question 7
A nurse is assessing a patient with a suspected tension pneumothorax. Which finding is most indicative
of this condition?
, A. Tracheal deviation toward the affected side
B. Tracheal deviation away from the affected side
C. Bilateral breath sounds
D. Bradycardia
B. Tracheal deviation away from the affected side
RATIONALE: Tension pneumothorax causes mediastinal shift away from the affected side, leading to
tracheal deviation away from the affected side, along with severe respiratory distress and hypotension.
Question 8
A patient is receiving a continuous infusion of heparin for a pulmonary embolism. Which laboratory
value should the nurse monitor to evaluate therapeutic effectiveness?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Bleeding time
B. Activated partial thromboplastin time (aPTT)
RATIONALE: aPTT is used to monitor unfractionated heparin therapy. The therapeutic range is
typically 1.5–2.5 times the control value.
Question 9
A patient in the ICU develops new-onset atrial fibrillation with a heart rate of 160 beats per minute and
a blood pressure of 78/42 mmHg. What is the priority intervention?
A. Administer diltiazem IV
B. Prepare for synchronized cardioversion
C. Administer digoxin IV
D. Perform vagal maneuvers
B. Prepare for synchronized cardioversion
RATIONALE: Hemodynamically unstable atrial fibrillation requires immediate synchronized
cardioversion. Rate-control medications are contraindicated in the setting of hypotension.
Question 10
A patient with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. Which intervention should
the nurse anticipate FIRST?
