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HESI CRITICAL CARE EXAM 2026/2027 | VERSION 3
| 75 VERIFIED Q&A | DETAILED RATIONALES | NGN-
ALIGNED | PASS GUARANTEED – A+ GRADED
Q1: Shock – Septic Shock Fluid Resuscitation
A client with septic shock is receiving 30 mL/kg crystalloid. The nurse understands that the primary
goal of fluid resuscitation is to:
A. Increase urine output
B. Restore intravascular volume and improve tissue perfusion
C. Lower blood pressure
D. Reduce heart rate
Correct Answer: B
Rationale: Septic shock fluid resuscitation aims to restore intravascular volume, improve cardiac
output, and enhance tissue perfusion. Urine output, blood pressure, and heart rate are secondary
indicators of effectiveness. [100% CORRECT]
Q2: Shock – Cardiogenic Shock Assessment
A client with cardiogenic shock is most likely to exhibit:
A. Warm, flushed skin
B. Cool, clammy extremities and pulmonary congestion
C. Bradycardia and hypertension
D. Polyuria and dehydration
Correct Answer: B
Rationale: Cardiogenic shock: decreased cardiac output leads to cool, clammy extremities,
pulmonary congestion (crackles, dyspnea), hypotension, and tachycardia. [100% CORRECT]
Q3: Shock – Neurogenic Shock vs. Spinal Shock
A client with a T6 spinal cord injury has hypotension and bradycardia. The nurse differentiates
neurogenic shock from spinal shock by noting that neurogenic shock involves:
A. Loss of reflexes below the injury
B. Hemodynamic instability due to loss of sympathetic tone
C. Flaccid paralysis
D. Transient loss of all cord function
Correct Answer: B
Rationale: Neurogenic shock: loss of sympathetic tone causes hypotension and bradycardia. Spinal
shock: temporary loss of reflexes and flaccid paralysis below injury. [100% CORRECT]
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Q4: Shock – Anaphylactic Shock Priority
A client develops anaphylaxis after receiving penicillin. The nurse should first:
A. Administer epinephrine IM
B. Administer diphenhydramine IV
C. Administer corticosteroids IV
D. Obtain vital signs
Correct Answer: A
Rationale: Anaphylaxis: epinephrine IM is first-line. It reverses bronchospasm and vasodilation.
Antihistamines and corticosteroids are adjuncts. [100% CORRECT]
Q5: Shock – Obstructive Shock Causes
Which condition is a cause of obstructive shock?
A. Myocardial infarction
B. Tension pneumothorax
C. Sepsis
D. Hemorrhage
Correct Answer: B
Rationale: Obstructive shock: mechanical obstruction of blood flow (tension pneumothorax, cardiac
tamponade, pulmonary embolism). [100% CORRECT]
Q6: Shock – Monitoring Mixed Venous Oxygen Saturation
A client has an SvO₂ of 50%. The nurse interprets this as:
A. Normal
B. Increased oxygen delivery
C. Decreased oxygen delivery or increased extraction
D. Adequate tissue perfusion
Correct Answer: C
Rationale: Normal SvO₂ is 60–80%. SvO₂ <60% indicates decreased oxygen delivery or increased
oxygen extraction (e.g., shock, low cardiac output). [100% CORRECT]
Q7: Mechanical Ventilation – Positive End-Expiratory Pressure
A client on mechanical ventilation has PEEP set at 10 cm H₂O. The nurse understands that PEEP:
A. Increases functional residual capacity and prevents alveolar collapse
B. Decreases oxygenation
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C. Increases venous return
D. Decreases work of breathing
Correct Answer: A
Rationale: PEEP: increases functional residual capacity, prevents alveolar collapse, improves
oxygenation. It can decrease venous return and cardiac output. [100% CORRECT]
Q8: Mechanical Ventilation – Peak Inspiratory Pressure
A client's peak inspiratory pressure (PIP) is elevated. The nurse should first:
A. Increase the tidal volume
B. Assess for secretions, biting, or kinked tubing
C. Decrease PEEP
D. Administer a bronchodilator
Correct Answer: B
Rationale: Elevated PIP indicates increased airway resistance: secretions, biting, kinked tubing,
bronchospasm, pneumothorax. Assess and suction first. [100% CORRECT]
Q9: Mechanical Ventilation – Auto-PEEP
A client on mechanical ventilation develops auto-PEEP. The nurse should:
A. Increase the respiratory rate
B. Decrease the respiratory rate to allow complete exhalation
C. Increase tidal volume
D. Increase PEEP
Correct Answer: B
Rationale: Auto-PEEP (air trapping): decrease respiratory rate, decrease tidal volume, increase
expiratory time to allow complete exhalation. [100% CORRECT]
Q10: ARDS – Berlin Criteria
A client is diagnosed with ARDS based on Berlin criteria. Which finding is consistent?
A. Acute onset within 1 week
B. Bilateral opacities on chest X-ray
C. PaO₂/FiO₂ <300
D. All of the above
Correct Answer: D
Rationale: ARDS Berlin criteria: acute onset within 1 week, bilateral opacities, PaO₂/FiO₂ <300, not
fully explained by cardiac failure. [100% CORRECT]
HESI CRITICAL CARE EXAM 2026/2027 | VERSION 3
| 75 VERIFIED Q&A | DETAILED RATIONALES | NGN-
ALIGNED | PASS GUARANTEED – A+ GRADED
Q1: Shock – Septic Shock Fluid Resuscitation
A client with septic shock is receiving 30 mL/kg crystalloid. The nurse understands that the primary
goal of fluid resuscitation is to:
A. Increase urine output
B. Restore intravascular volume and improve tissue perfusion
C. Lower blood pressure
D. Reduce heart rate
Correct Answer: B
Rationale: Septic shock fluid resuscitation aims to restore intravascular volume, improve cardiac
output, and enhance tissue perfusion. Urine output, blood pressure, and heart rate are secondary
indicators of effectiveness. [100% CORRECT]
Q2: Shock – Cardiogenic Shock Assessment
A client with cardiogenic shock is most likely to exhibit:
A. Warm, flushed skin
B. Cool, clammy extremities and pulmonary congestion
C. Bradycardia and hypertension
D. Polyuria and dehydration
Correct Answer: B
Rationale: Cardiogenic shock: decreased cardiac output leads to cool, clammy extremities,
pulmonary congestion (crackles, dyspnea), hypotension, and tachycardia. [100% CORRECT]
Q3: Shock – Neurogenic Shock vs. Spinal Shock
A client with a T6 spinal cord injury has hypotension and bradycardia. The nurse differentiates
neurogenic shock from spinal shock by noting that neurogenic shock involves:
A. Loss of reflexes below the injury
B. Hemodynamic instability due to loss of sympathetic tone
C. Flaccid paralysis
D. Transient loss of all cord function
Correct Answer: B
Rationale: Neurogenic shock: loss of sympathetic tone causes hypotension and bradycardia. Spinal
shock: temporary loss of reflexes and flaccid paralysis below injury. [100% CORRECT]
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Q4: Shock – Anaphylactic Shock Priority
A client develops anaphylaxis after receiving penicillin. The nurse should first:
A. Administer epinephrine IM
B. Administer diphenhydramine IV
C. Administer corticosteroids IV
D. Obtain vital signs
Correct Answer: A
Rationale: Anaphylaxis: epinephrine IM is first-line. It reverses bronchospasm and vasodilation.
Antihistamines and corticosteroids are adjuncts. [100% CORRECT]
Q5: Shock – Obstructive Shock Causes
Which condition is a cause of obstructive shock?
A. Myocardial infarction
B. Tension pneumothorax
C. Sepsis
D. Hemorrhage
Correct Answer: B
Rationale: Obstructive shock: mechanical obstruction of blood flow (tension pneumothorax, cardiac
tamponade, pulmonary embolism). [100% CORRECT]
Q6: Shock – Monitoring Mixed Venous Oxygen Saturation
A client has an SvO₂ of 50%. The nurse interprets this as:
A. Normal
B. Increased oxygen delivery
C. Decreased oxygen delivery or increased extraction
D. Adequate tissue perfusion
Correct Answer: C
Rationale: Normal SvO₂ is 60–80%. SvO₂ <60% indicates decreased oxygen delivery or increased
oxygen extraction (e.g., shock, low cardiac output). [100% CORRECT]
Q7: Mechanical Ventilation – Positive End-Expiratory Pressure
A client on mechanical ventilation has PEEP set at 10 cm H₂O. The nurse understands that PEEP:
A. Increases functional residual capacity and prevents alveolar collapse
B. Decreases oxygenation
, 3
C. Increases venous return
D. Decreases work of breathing
Correct Answer: A
Rationale: PEEP: increases functional residual capacity, prevents alveolar collapse, improves
oxygenation. It can decrease venous return and cardiac output. [100% CORRECT]
Q8: Mechanical Ventilation – Peak Inspiratory Pressure
A client's peak inspiratory pressure (PIP) is elevated. The nurse should first:
A. Increase the tidal volume
B. Assess for secretions, biting, or kinked tubing
C. Decrease PEEP
D. Administer a bronchodilator
Correct Answer: B
Rationale: Elevated PIP indicates increased airway resistance: secretions, biting, kinked tubing,
bronchospasm, pneumothorax. Assess and suction first. [100% CORRECT]
Q9: Mechanical Ventilation – Auto-PEEP
A client on mechanical ventilation develops auto-PEEP. The nurse should:
A. Increase the respiratory rate
B. Decrease the respiratory rate to allow complete exhalation
C. Increase tidal volume
D. Increase PEEP
Correct Answer: B
Rationale: Auto-PEEP (air trapping): decrease respiratory rate, decrease tidal volume, increase
expiratory time to allow complete exhalation. [100% CORRECT]
Q10: ARDS – Berlin Criteria
A client is diagnosed with ARDS based on Berlin criteria. Which finding is consistent?
A. Acute onset within 1 week
B. Bilateral opacities on chest X-ray
C. PaO₂/FiO₂ <300
D. All of the above
Correct Answer: D
Rationale: ARDS Berlin criteria: acute onset within 1 week, bilateral opacities, PaO₂/FiO₂ <300, not
fully explained by cardiac failure. [100% CORRECT]
