HESI CRITICAL CARE RN EXIT EXAM LATEST 2026
UPDATE 100 QUESTIONS AND DETAILED VERIFIED
ANSWERS FROM ACTUAL EXAMS TEST GRADE A+
1. A client in septic shock has a MAP of 58 mmHg. Which intervention is
priority?
A. Administer IV antibiotics
B. Increase IV fluids
C. Initiate vasopressors
D. Obtain blood cultures
Answer: B. Increase IV fluids
Rationale: Initial management of septic shock prioritizes fluid resuscitation to
restore perfusion before vasopressors.
2. Which assessment finding indicates worsening ARDS?
A. PaO₂ 90 mmHg
B. Increased lung compliance
C. Decreased oxygen saturation despite oxygen therapy
D. Clear lung sounds
Answer: C. Decreased oxygen saturation despite oxygen therapy
Rationale: ARDS progression leads to refractory hypoxemia even with oxygen
therapy.
3. A patient on a ventilator suddenly develops high peak airway pressures. What
is the first action?
,A. Notify provider
B. Suction the airway
C. Increase tidal volume
D. Administer sedation
Answer: B. Suction the airway
Rationale: Increased peak pressure often indicates obstruction such as secretions;
suctioning is first.
4. Which electrolyte imbalance is most likely with massive transfusion?
A. Hypercalcemia
B. Hypokalemia
C. Hypocalcemia
D. Hypernatremia
Answer: C. Hypocalcemia
Rationale: Citrate in transfused blood binds calcium, causing hypocalcemia.
5. A client with increased ICP should be positioned how?
A. Flat
B. Trendelenburg
C. HOB elevated 30°
D. Prone
Answer: C. HOB elevated 30°
Rationale: Elevation promotes venous drainage and reduces ICP.
6. Which finding indicates cardiogenic shock?
A. Warm skin
B. Low CVP
,C. Pulmonary edema
D. Bounding pulses
Answer: C. Pulmonary edema
Rationale: Cardiogenic shock causes fluid backup into lungs.
7. What is the priority intervention for tension pneumothorax?
A. Chest X-ray
B. Needle decompression
C. Oxygen therapy
D. Antibiotics
Answer: B. Needle decompression
Rationale: This is a life-threatening emergency requiring immediate
decompression.
8. A client has potassium 6.5 mEq/L. Which medication is priority?
A. Furosemide
B. Insulin with glucose
C. Sodium chloride
D. Calcium supplements
Answer: B. Insulin with glucose
Rationale: Insulin shifts potassium into cells rapidly.
9. Which sign indicates digoxin toxicity?
A. Hypertension
B. Yellow vision
C. Bradycardia with irregular rhythm
D. Hyperactivity
, Answer: C. Bradycardia with irregular rhythm
Rationale: Dysrhythmias are key signs of toxicity.
10. A patient post-MI develops sudden dyspnea and crackles. What is likely
occurring?
A. Pulmonary embolism
B. Left-sided heart failure
C. Pneumonia
D. Right-sided heart failure
Answer: B. Left-sided heart failure
Rationale: Leads to pulmonary congestion and crackles.
11. Which lab value is most concerning in DKA?
A. Glucose 300 mg/dL
B. pH 7.25
C. Potassium 5.0 mEq/L
D. Sodium 135 mEq/L
Answer: B. pH 7.25
Rationale: Indicates significant metabolic acidosis.
12. What is the priority for a patient with status epilepticus?
A. EEG monitoring
B. Airway protection
C. Nutrition
D. Physical therapy
Answer: B. Airway protection
Rationale: Airway and breathing take priority during seizures.
UPDATE 100 QUESTIONS AND DETAILED VERIFIED
ANSWERS FROM ACTUAL EXAMS TEST GRADE A+
1. A client in septic shock has a MAP of 58 mmHg. Which intervention is
priority?
A. Administer IV antibiotics
B. Increase IV fluids
C. Initiate vasopressors
D. Obtain blood cultures
Answer: B. Increase IV fluids
Rationale: Initial management of septic shock prioritizes fluid resuscitation to
restore perfusion before vasopressors.
2. Which assessment finding indicates worsening ARDS?
A. PaO₂ 90 mmHg
B. Increased lung compliance
C. Decreased oxygen saturation despite oxygen therapy
D. Clear lung sounds
Answer: C. Decreased oxygen saturation despite oxygen therapy
Rationale: ARDS progression leads to refractory hypoxemia even with oxygen
therapy.
3. A patient on a ventilator suddenly develops high peak airway pressures. What
is the first action?
,A. Notify provider
B. Suction the airway
C. Increase tidal volume
D. Administer sedation
Answer: B. Suction the airway
Rationale: Increased peak pressure often indicates obstruction such as secretions;
suctioning is first.
4. Which electrolyte imbalance is most likely with massive transfusion?
A. Hypercalcemia
B. Hypokalemia
C. Hypocalcemia
D. Hypernatremia
Answer: C. Hypocalcemia
Rationale: Citrate in transfused blood binds calcium, causing hypocalcemia.
5. A client with increased ICP should be positioned how?
A. Flat
B. Trendelenburg
C. HOB elevated 30°
D. Prone
Answer: C. HOB elevated 30°
Rationale: Elevation promotes venous drainage and reduces ICP.
6. Which finding indicates cardiogenic shock?
A. Warm skin
B. Low CVP
,C. Pulmonary edema
D. Bounding pulses
Answer: C. Pulmonary edema
Rationale: Cardiogenic shock causes fluid backup into lungs.
7. What is the priority intervention for tension pneumothorax?
A. Chest X-ray
B. Needle decompression
C. Oxygen therapy
D. Antibiotics
Answer: B. Needle decompression
Rationale: This is a life-threatening emergency requiring immediate
decompression.
8. A client has potassium 6.5 mEq/L. Which medication is priority?
A. Furosemide
B. Insulin with glucose
C. Sodium chloride
D. Calcium supplements
Answer: B. Insulin with glucose
Rationale: Insulin shifts potassium into cells rapidly.
9. Which sign indicates digoxin toxicity?
A. Hypertension
B. Yellow vision
C. Bradycardia with irregular rhythm
D. Hyperactivity
, Answer: C. Bradycardia with irregular rhythm
Rationale: Dysrhythmias are key signs of toxicity.
10. A patient post-MI develops sudden dyspnea and crackles. What is likely
occurring?
A. Pulmonary embolism
B. Left-sided heart failure
C. Pneumonia
D. Right-sided heart failure
Answer: B. Left-sided heart failure
Rationale: Leads to pulmonary congestion and crackles.
11. Which lab value is most concerning in DKA?
A. Glucose 300 mg/dL
B. pH 7.25
C. Potassium 5.0 mEq/L
D. Sodium 135 mEq/L
Answer: B. pH 7.25
Rationale: Indicates significant metabolic acidosis.
12. What is the priority for a patient with status epilepticus?
A. EEG monitoring
B. Airway protection
C. Nutrition
D. Physical therapy
Answer: B. Airway protection
Rationale: Airway and breathing take priority during seizures.
