HESI CAT Exam (2025/2026) – Actual Exam
Questions with Correct Detailed Answers
and Rationales | Newest Version | Graded A+
MED-SURG / CRITICAL CARE (Q1–15)
Q1. What is the priority intervention when a client on telemetry suddenly develops sustained
ventricular tachycardia with a pulse? Synchronized cardioversion at 100 J. Rationale: ACLS
2025: Unstable VT with pulse requires immediate synchronized cardioversion; amiodarone only
if stable.
Q2. What laboratory value requires immediate notification in a client receiving total parenteral
nutrition (TPN)? Serum glucose 415 mg/dL. Rationale: Hyperglycemia >400 increases
infection and osmotic diuresis risk; insulin protocol needed.
Q3. What is the first action when a chest tube becomes disconnected from the drainage system?
Place the distal end in sterile water to create a water seal. Rationale: Prevents air entry into
pleural space; do NOT clamp unless ordered.
Q4. What finding indicates therapeutic response to furosemide in acute pulmonary edema?
Clear lung sounds and urine output >30 mL/hr. Rationale: Loop diuretic reduces preload;
monitor for hypokalemia.
Q5. What is the reversal agent for apixaban (Eliquis) in life-threatening bleeding? Andexanet
alfa (Andexxa). Rationale: Specific Factor Xa inhibitor reversal; PCC alternative if unavailable.
Q6. What is the target MAP in septic shock after fluid resuscitation? ≥65 mmHg. Rationale:
Surviving Sepsis 2025: Norepinephrine first-line vasopressor.
, Q7. What position should be avoided in a client with increased intracranial pressure? Neck
flexion and Trendelenburg. Rationale: Impedes venous drainage; keep head midline, 30°
elevation.
Q8. What electrolyte imbalance causes prolonged QT interval and torsades de pointes?
Hypomagnesemia. Rationale: Magnesium <1.5 mg/dL; give 2 g IV over 10 min for torsades.
Q9. What is the priority nursing diagnosis for a client 6 hours post-craniotomy? Risk for
increased intracranial pressure. Rationale: Cerebral edema peaks 24–72 hours post-op.
Q10. What is the treatment for malignant hyperthermia during surgery? Dantrolene 2.5 mg/kg
IV repeated q5min until stable. Rationale: Ryanodine receptor defect; stop volatile anesthetics
immediately.
Q11. What indicates successful treatment of diabetic ketoacidosis? Anion gap <12 and serum
bicarbonate >18 mEq/L. Rationale: Resolution of metabolic acidosis; transition to
subcutaneous insulin.
Q12. What is the first sign of transfusion-related acute lung injury (TRALI)? Acute hypoxemia
within 6 hours of transfusion. Rationale: Stop transfusion; supportive ventilation.
Q13. What is the antidote for beta-blocker overdose causing bradycardia and hypotension?
Glucagon 3–10 mg IV bolus. Rationale: Increases cAMP independent of beta receptors.
Q14. What is the priority action for a client with necrotizing fasciitis? Immediate surgical
debridement. Rationale: Antibiotics alone insufficient; mortality >70% without surgery.
Q15. What is the target PaO2 in ARDS with PEEP titration? 55–80 mmHg or SpO2 88–95%.
Rationale: ARDSNet 2025: Permissive hypoxemia to avoid barotrauma.
Questions with Correct Detailed Answers
and Rationales | Newest Version | Graded A+
MED-SURG / CRITICAL CARE (Q1–15)
Q1. What is the priority intervention when a client on telemetry suddenly develops sustained
ventricular tachycardia with a pulse? Synchronized cardioversion at 100 J. Rationale: ACLS
2025: Unstable VT with pulse requires immediate synchronized cardioversion; amiodarone only
if stable.
Q2. What laboratory value requires immediate notification in a client receiving total parenteral
nutrition (TPN)? Serum glucose 415 mg/dL. Rationale: Hyperglycemia >400 increases
infection and osmotic diuresis risk; insulin protocol needed.
Q3. What is the first action when a chest tube becomes disconnected from the drainage system?
Place the distal end in sterile water to create a water seal. Rationale: Prevents air entry into
pleural space; do NOT clamp unless ordered.
Q4. What finding indicates therapeutic response to furosemide in acute pulmonary edema?
Clear lung sounds and urine output >30 mL/hr. Rationale: Loop diuretic reduces preload;
monitor for hypokalemia.
Q5. What is the reversal agent for apixaban (Eliquis) in life-threatening bleeding? Andexanet
alfa (Andexxa). Rationale: Specific Factor Xa inhibitor reversal; PCC alternative if unavailable.
Q6. What is the target MAP in septic shock after fluid resuscitation? ≥65 mmHg. Rationale:
Surviving Sepsis 2025: Norepinephrine first-line vasopressor.
, Q7. What position should be avoided in a client with increased intracranial pressure? Neck
flexion and Trendelenburg. Rationale: Impedes venous drainage; keep head midline, 30°
elevation.
Q8. What electrolyte imbalance causes prolonged QT interval and torsades de pointes?
Hypomagnesemia. Rationale: Magnesium <1.5 mg/dL; give 2 g IV over 10 min for torsades.
Q9. What is the priority nursing diagnosis for a client 6 hours post-craniotomy? Risk for
increased intracranial pressure. Rationale: Cerebral edema peaks 24–72 hours post-op.
Q10. What is the treatment for malignant hyperthermia during surgery? Dantrolene 2.5 mg/kg
IV repeated q5min until stable. Rationale: Ryanodine receptor defect; stop volatile anesthetics
immediately.
Q11. What indicates successful treatment of diabetic ketoacidosis? Anion gap <12 and serum
bicarbonate >18 mEq/L. Rationale: Resolution of metabolic acidosis; transition to
subcutaneous insulin.
Q12. What is the first sign of transfusion-related acute lung injury (TRALI)? Acute hypoxemia
within 6 hours of transfusion. Rationale: Stop transfusion; supportive ventilation.
Q13. What is the antidote for beta-blocker overdose causing bradycardia and hypotension?
Glucagon 3–10 mg IV bolus. Rationale: Increases cAMP independent of beta receptors.
Q14. What is the priority action for a client with necrotizing fasciitis? Immediate surgical
debridement. Rationale: Antibiotics alone insufficient; mortality >70% without surgery.
Q15. What is the target PaO2 in ARDS with PEEP titration? 55–80 mmHg or SpO2 88–95%.
Rationale: ARDSNet 2025: Permissive hypoxemia to avoid barotrauma.
