1
HESI CRITICAL CARE EXAM 2026/2027 | VERSION 2
| 75 VERIFIED Q&A | DETAILED RATIONALES | NGN-
ALIGNED | PASS GUARANTEED – A+ GRADED
Q1: Ventilator-Associated Pneumonia – Prevention
A nurse is caring for a client on mechanical ventilation. Which intervention is most effective in
preventing ventilator-associated pneumonia (VAP)?
A. Keeping the head of the bed flat
B. Elevating the head of the bed to 30–45 degrees
C. Suctioning routinely every 2 hours
D. Changing the ventilator circuit daily
Correct Answer: B
Rationale: Elevating the head of the bed to 30–45 degrees reduces aspiration of oropharyngeal
secretions and is a key VAP prevention strategy. Routine suctioning and daily circuit changes are not
recommended. [100% CORRECT]
Q2: Central Line – Air Embolism Prevention
A nurse is removing a central venous catheter. To prevent air embolism, the nurse should:
A. Ask the client to inhale and hold breath
B. Place the client in Trendelenburg position and ask them to hum
C. Remove the catheter quickly
D. Apply pressure after removal
Correct Answer: B
Rationale: Trendelenburg position and having the client hum (or Valsalva) increase intrathoracic
pressure and prevent air from entering the venous system during catheter removal. [100%
CORRECT]
Q3: Arterial Blood Gas – Interpretation
A client has the following ABG: pH 7.28, PaCO₂ 55 mmHg, HCO₃ 24 mEq/L. The nurse interprets this
as:
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: A
,2
Rationale: pH <7.35, PaCO₂ >45 indicates respiratory acidosis. HCO₃ is normal, so it is
uncompensated. [100% CORRECT]
Q4: Arterial Blood Gas – Compensation
A client has pH 7.38, PaCO₂ 60 mmHg, HCO₃ 36 mEq/L. The nurse interprets this as:
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis
Correct Answer: C
Rationale: pH is within normal range (7.35–7.45), PaCO₂ is elevated (respiratory acidosis), HCO₃ is
elevated (metabolic compensation). The pH is normal, so it is fully compensated. [100% CORRECT]
Q5: Sedation – RASS Scale
A nurse is assessing a client using the Richmond Agitation-Sedation Scale (RASS). The client is
combative and violent. The nurse documents this as:
A. RASS +4
B. RASS +3
C. RASS +2
D. RASS +1
Correct Answer: A
Rationale: RASS +4 = combative, violent, danger to staff. RASS +3 = very agitated. RASS +2 = agitated.
RASS +1 = restless. [100% CORRECT]
Q6: Sedation – Daily Interruption
A nurse is caring for a client on continuous sedation. The nurse should:
A. Maintain deep sedation at all times
B. Perform daily sedation interruption and assess readiness for extubation
C. Increase sedation every 4 hours
D. Avoid assessing neurologic status
Correct Answer: B
Rationale: Daily sedation interruption reduces duration of mechanical ventilation, ICU stay, and
complications. Assess neurologic status and readiness for extubation. [100% CORRECT]
Q7: Pain Management – Critical Care
A client in the ICU is unable to self-report pain. Which tool is most appropriate for assessing pain?
, 3
A. Numeric rating scale
B. Wong-Baker FACES scale
C. Critical-Care Pain Observation Tool (CPOT)
D. Visual analog scale
Correct Answer: C
Rationale: CPOT is validated for nonverbal, critically ill clients. It assesses facial expression, body
movements, muscle tension, and ventilator compliance. [100% CORRECT]
Q8: Nutrition – Enteral Feeding
A client in the ICU is receiving enteral nutrition. To prevent aspiration, the nurse should:
A. Keep the head of the bed flat
B. Elevate the head of the bed to 30–45 degrees
C. Administer bolus feedings rapidly
D. Check residual volumes every 8 hours
Correct Answer: B
Rationale: Elevate HOB to 30–45 degrees during and after enteral feedings to prevent aspiration.
Check residual volumes per protocol. [100% CORRECT]
Q9: Nutrition – Parenteral Nutrition
A client is receiving total parenteral nutrition (TPN). The nurse should monitor for:
A. Hyperglycemia
B. Hypoglycemia
C. Fluid overload
D. All of the above
Correct Answer: D
Rationale: TPN complications: hyperglycemia, hypoglycemia (if suddenly stopped), fluid overload,
electrolyte imbalances, infection. Monitor glucose, electrolytes, daily weights. [100% CORRECT]
Q10: End-of-Life Care – Ethical Principles
A client in the ICU is terminally ill and the family requests withdrawal of life support. The nurse
should:
A. Refuse to participate
B. Respect the family's decision and provide palliative care
C. Continue life support against family wishes
D. Ask the client to decide
Correct Answer: B
HESI CRITICAL CARE EXAM 2026/2027 | VERSION 2
| 75 VERIFIED Q&A | DETAILED RATIONALES | NGN-
ALIGNED | PASS GUARANTEED – A+ GRADED
Q1: Ventilator-Associated Pneumonia – Prevention
A nurse is caring for a client on mechanical ventilation. Which intervention is most effective in
preventing ventilator-associated pneumonia (VAP)?
A. Keeping the head of the bed flat
B. Elevating the head of the bed to 30–45 degrees
C. Suctioning routinely every 2 hours
D. Changing the ventilator circuit daily
Correct Answer: B
Rationale: Elevating the head of the bed to 30–45 degrees reduces aspiration of oropharyngeal
secretions and is a key VAP prevention strategy. Routine suctioning and daily circuit changes are not
recommended. [100% CORRECT]
Q2: Central Line – Air Embolism Prevention
A nurse is removing a central venous catheter. To prevent air embolism, the nurse should:
A. Ask the client to inhale and hold breath
B. Place the client in Trendelenburg position and ask them to hum
C. Remove the catheter quickly
D. Apply pressure after removal
Correct Answer: B
Rationale: Trendelenburg position and having the client hum (or Valsalva) increase intrathoracic
pressure and prevent air from entering the venous system during catheter removal. [100%
CORRECT]
Q3: Arterial Blood Gas – Interpretation
A client has the following ABG: pH 7.28, PaCO₂ 55 mmHg, HCO₃ 24 mEq/L. The nurse interprets this
as:
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: A
,2
Rationale: pH <7.35, PaCO₂ >45 indicates respiratory acidosis. HCO₃ is normal, so it is
uncompensated. [100% CORRECT]
Q4: Arterial Blood Gas – Compensation
A client has pH 7.38, PaCO₂ 60 mmHg, HCO₃ 36 mEq/L. The nurse interprets this as:
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis
Correct Answer: C
Rationale: pH is within normal range (7.35–7.45), PaCO₂ is elevated (respiratory acidosis), HCO₃ is
elevated (metabolic compensation). The pH is normal, so it is fully compensated. [100% CORRECT]
Q5: Sedation – RASS Scale
A nurse is assessing a client using the Richmond Agitation-Sedation Scale (RASS). The client is
combative and violent. The nurse documents this as:
A. RASS +4
B. RASS +3
C. RASS +2
D. RASS +1
Correct Answer: A
Rationale: RASS +4 = combative, violent, danger to staff. RASS +3 = very agitated. RASS +2 = agitated.
RASS +1 = restless. [100% CORRECT]
Q6: Sedation – Daily Interruption
A nurse is caring for a client on continuous sedation. The nurse should:
A. Maintain deep sedation at all times
B. Perform daily sedation interruption and assess readiness for extubation
C. Increase sedation every 4 hours
D. Avoid assessing neurologic status
Correct Answer: B
Rationale: Daily sedation interruption reduces duration of mechanical ventilation, ICU stay, and
complications. Assess neurologic status and readiness for extubation. [100% CORRECT]
Q7: Pain Management – Critical Care
A client in the ICU is unable to self-report pain. Which tool is most appropriate for assessing pain?
, 3
A. Numeric rating scale
B. Wong-Baker FACES scale
C. Critical-Care Pain Observation Tool (CPOT)
D. Visual analog scale
Correct Answer: C
Rationale: CPOT is validated for nonverbal, critically ill clients. It assesses facial expression, body
movements, muscle tension, and ventilator compliance. [100% CORRECT]
Q8: Nutrition – Enteral Feeding
A client in the ICU is receiving enteral nutrition. To prevent aspiration, the nurse should:
A. Keep the head of the bed flat
B. Elevate the head of the bed to 30–45 degrees
C. Administer bolus feedings rapidly
D. Check residual volumes every 8 hours
Correct Answer: B
Rationale: Elevate HOB to 30–45 degrees during and after enteral feedings to prevent aspiration.
Check residual volumes per protocol. [100% CORRECT]
Q9: Nutrition – Parenteral Nutrition
A client is receiving total parenteral nutrition (TPN). The nurse should monitor for:
A. Hyperglycemia
B. Hypoglycemia
C. Fluid overload
D. All of the above
Correct Answer: D
Rationale: TPN complications: hyperglycemia, hypoglycemia (if suddenly stopped), fluid overload,
electrolyte imbalances, infection. Monitor glucose, electrolytes, daily weights. [100% CORRECT]
Q10: End-of-Life Care – Ethical Principles
A client in the ICU is terminally ill and the family requests withdrawal of life support. The nurse
should:
A. Refuse to participate
B. Respect the family's decision and provide palliative care
C. Continue life support against family wishes
D. Ask the client to decide
Correct Answer: B
