NGN HESI RN Critical Care Exam V2
(2025) – Verified Actual Exam | Graded
A+
1. A client in the ICU is receiving mechanical ventilation with a PEEP of 10 cm H₂O.
The nurse notes an SpO₂ of 88% and bilateral crackles. Which action should the
nurse take first?
Decrease the PEEP to 5 cm H₂O
Rationale: High PEEP can cause overdistension and fluid shifts leading to crackles and
hypoxemia; reducing PEEP first addresses potential barotrauma and improves
oxygenation per ARDS protective strategies.
2. A client with acute respiratory distress syndrome (ARDS) is on volume-controlled
ventilation. Which ventilator setting minimizes barotrauma?
Low tidal volume (6 mL/kg ideal body weight)
Rationale: ARDSNet protocol recommends low tidal volumes (4-8 mL/kg IBW, targeting
6 mL/kg) to reduce volutrauma and mortality in ARDS.
3. A client post-percutaneous coronary intervention (PCI) for myocardial infarction
complains of sudden chest pain. Which finding requires immediate provider
notification?
Onset of chest pain
Rationale: Recurrent chest pain post-PCI signals possible stent thrombosis or
reocclusion; immediate notification allows for urgent angiography and intervention to
prevent reinfarction.
, 4. A client with septic shock has a mean arterial pressure (MAP) of 55 mm Hg. Which
medication should the nurse anticipate administering first?
Norepinephrine
Rationale: Surviving Sepsis Campaign guidelines recommend norepinephrine as first-
line vasopressor for septic shock to maintain MAP ≥65 mm Hg, due to its potent alpha-
adrenergic effects on vasoconstriction.
5. During assessment of a client with a T4 spinal cord injury, the nurse notes severe
hypertension, diaphoresis, and flushing above the lesion. What is the priority
intervention?
Elevate the head of the bed to 90 degrees
Rationale: These symptoms indicate autonomic dysreflexia; elevating the HOB removes
noxious stimuli below the lesion and promotes venous return to reduce hypertension.
6. A client on mechanical ventilation suddenly has absent breath sounds on the right
side. What is the most likely cause?
Right mainstem bronchus intubation
Rationale: Endotracheal tube migration into the right mainstem bronchus ventilates only
the right lung, causing unilateral absent sounds; immediate tube withdrawal is needed.
7. For a client with acute kidney injury and potassium of 6.8 mEq/L, which medication
stabilizes the cardiac membrane first?
Calcium gluconate
Rationale: Hyperkalemia causes cardiac irritability; IV calcium gluconate antagonizes
membrane effects within minutes, protecting against arrhythmias before potassium-
lowering therapies.
8. A client with heart failure post-MI develops pulmonary edema. Which medication
reduces fluid overload?
Furosemide
, Rationale: Loop diuretics like furosemide promote rapid diuresis to alleviate pulmonary
congestion in acute decompensated heart failure, improving oxygenation.
9. A burn client with 30% TBSA involvement arrives at the ER 2 hours post-injury.
Using the Parkland formula, what is the fluid goal for the first 8 hours?
Half of total 24-hour requirement
Rationale: Parkland formula (4 mL/kg/%TBSA) totals fluids over 24 hours, with half
administered in the first 8 hours post-burn to restore intravascular volume.
10. A client in third-degree heart block has a transcutaneous pacemaker. Episodes of
failure to sense are noted. What should the nurse do?
Increase the sensitivity threshold
Rationale: Failure to sense occurs when the pacemaker is overly sensitive to extraneous
signals; increasing the mV threshold prevents oversensing and ensures proper pacing.
Case Study 1: 55-year-old male with septic shock (NGN-style) A 55-year-old male is
admitted to the ICU with sepsis from pneumonia. VS: Temp 102°F, HR 120, BP 80/50,
RR 30. Labs: WBC 22,000, lactate 4.2 mmol/L. On norepinephrine infusion.
11. Recognize Cues: Which findings indicate septic shock? (SATA) Hypotension,
elevated lactate, tachycardia, tachypnea
Rationale: Septic shock is SIRS + infection + hypotension refractory to fluids + lactate >2
mmol/L; these cues reflect systemic inflammation and hypoperfusion.
12. Analyze Cues: What is the priority physiological need?
Tissue perfusion
Rationale: Hypotension and elevated lactate indicate inadequate perfusion; Maslow's
hierarchy prioritizes circulation over other needs in shock.
13. Prioritize Hypotheses: Which is the most likely complication?
(2025) – Verified Actual Exam | Graded
A+
1. A client in the ICU is receiving mechanical ventilation with a PEEP of 10 cm H₂O.
The nurse notes an SpO₂ of 88% and bilateral crackles. Which action should the
nurse take first?
Decrease the PEEP to 5 cm H₂O
Rationale: High PEEP can cause overdistension and fluid shifts leading to crackles and
hypoxemia; reducing PEEP first addresses potential barotrauma and improves
oxygenation per ARDS protective strategies.
2. A client with acute respiratory distress syndrome (ARDS) is on volume-controlled
ventilation. Which ventilator setting minimizes barotrauma?
Low tidal volume (6 mL/kg ideal body weight)
Rationale: ARDSNet protocol recommends low tidal volumes (4-8 mL/kg IBW, targeting
6 mL/kg) to reduce volutrauma and mortality in ARDS.
3. A client post-percutaneous coronary intervention (PCI) for myocardial infarction
complains of sudden chest pain. Which finding requires immediate provider
notification?
Onset of chest pain
Rationale: Recurrent chest pain post-PCI signals possible stent thrombosis or
reocclusion; immediate notification allows for urgent angiography and intervention to
prevent reinfarction.
, 4. A client with septic shock has a mean arterial pressure (MAP) of 55 mm Hg. Which
medication should the nurse anticipate administering first?
Norepinephrine
Rationale: Surviving Sepsis Campaign guidelines recommend norepinephrine as first-
line vasopressor for septic shock to maintain MAP ≥65 mm Hg, due to its potent alpha-
adrenergic effects on vasoconstriction.
5. During assessment of a client with a T4 spinal cord injury, the nurse notes severe
hypertension, diaphoresis, and flushing above the lesion. What is the priority
intervention?
Elevate the head of the bed to 90 degrees
Rationale: These symptoms indicate autonomic dysreflexia; elevating the HOB removes
noxious stimuli below the lesion and promotes venous return to reduce hypertension.
6. A client on mechanical ventilation suddenly has absent breath sounds on the right
side. What is the most likely cause?
Right mainstem bronchus intubation
Rationale: Endotracheal tube migration into the right mainstem bronchus ventilates only
the right lung, causing unilateral absent sounds; immediate tube withdrawal is needed.
7. For a client with acute kidney injury and potassium of 6.8 mEq/L, which medication
stabilizes the cardiac membrane first?
Calcium gluconate
Rationale: Hyperkalemia causes cardiac irritability; IV calcium gluconate antagonizes
membrane effects within minutes, protecting against arrhythmias before potassium-
lowering therapies.
8. A client with heart failure post-MI develops pulmonary edema. Which medication
reduces fluid overload?
Furosemide
, Rationale: Loop diuretics like furosemide promote rapid diuresis to alleviate pulmonary
congestion in acute decompensated heart failure, improving oxygenation.
9. A burn client with 30% TBSA involvement arrives at the ER 2 hours post-injury.
Using the Parkland formula, what is the fluid goal for the first 8 hours?
Half of total 24-hour requirement
Rationale: Parkland formula (4 mL/kg/%TBSA) totals fluids over 24 hours, with half
administered in the first 8 hours post-burn to restore intravascular volume.
10. A client in third-degree heart block has a transcutaneous pacemaker. Episodes of
failure to sense are noted. What should the nurse do?
Increase the sensitivity threshold
Rationale: Failure to sense occurs when the pacemaker is overly sensitive to extraneous
signals; increasing the mV threshold prevents oversensing and ensures proper pacing.
Case Study 1: 55-year-old male with septic shock (NGN-style) A 55-year-old male is
admitted to the ICU with sepsis from pneumonia. VS: Temp 102°F, HR 120, BP 80/50,
RR 30. Labs: WBC 22,000, lactate 4.2 mmol/L. On norepinephrine infusion.
11. Recognize Cues: Which findings indicate septic shock? (SATA) Hypotension,
elevated lactate, tachycardia, tachypnea
Rationale: Septic shock is SIRS + infection + hypotension refractory to fluids + lactate >2
mmol/L; these cues reflect systemic inflammation and hypoperfusion.
12. Analyze Cues: What is the priority physiological need?
Tissue perfusion
Rationale: Hypotension and elevated lactate indicate inadequate perfusion; Maslow's
hierarchy prioritizes circulation over other needs in shock.
13. Prioritize Hypotheses: Which is the most likely complication?
