HESI Critical Care Exam Prep Document
2026/2027 | Intensive Care Nursing, Clinical
Judgment & NGN Critical Care Review | 50
Verified Questions with Detailed Rationales
SECTION 1: HEMODYNAMICS & SHOCK
1. A patient with septic shock has a pulmonary artery catheter in place. Which
hemodynamic parameter indicates that the patient is in the distributive (warm)
phase of septic shock?
• A) Cardiac Index (CI) 1.8 L/min/m², Systemic Vascular Resistance (SVR) 1400
dynes/sec/cm⁻⁵
• B) Cardiac Index (CI) 4.2 L/min/m², Systemic Vascular Resistance (SVR) 400
dynes/sec/cm⁻⁵
• C) Cardiac Index (CI) 2.1 L/min/m², Pulmonary Artery Wedge Pressure
(PAWP) 18 mmHg
• D) Cardiac Index (CI) 3.0 L/min/m², Central Venous Pressure (CVP) 2 mmHg
Correct Answer: B
Rationale: The distributive (hyperdynamic) phase of septic shock is characterized
by massive vasodilation, leading to a very low SVR (< 800) and a high or normal
cardiac output (CI > 4.0) as the heart tries to compensate. Option A indicates
cardiogenic shock (low CI, high SVR). Option C indicates fluid overload. Option D
indicates hypovolemia.
2. The nurse is caring for a patient on a norepinephrine (Levophed) infusion at
12 mcg/min via a peripheral IV. The patient’s blood pressure is now 168/102
,mmHg, and the hand above the IV site is pale and cold. What is the priority
nursing action?
• A) Decrease the infusion rate by 2 mcg/min.
• B) Stop the infusion and prepare to administer phentolamine.
• C) Apply a warm compress to the affected hand.
• D) Assess the IV site for infiltration and prepare for central line placement.
Correct Answer: D
Rationale: Norepinephrine is a potent vasopressor. Extravasation causes severe
tissue ischemia and necrosis. Pallor and coldness above the IV site indicate
infiltration. The priority is to stop the infusion, assess the site, and prepare for
central line placement (as vasopressors should be given centrally). Phentolamine is
used for local infiltration, but the immediate priority is discontinuing the
peripheral infusion and securing central access.
3. A patient with cardiogenic shock has a cardiac index of 1.6 L/min/m² and an
SVR of 1600 dynes/sec/cm⁻⁵. Which medication order should the nurse
question?
• A) Dobutamine (Dobutrex) continuous infusion
• B) Norepinephrine (Levophed) continuous infusion
• C) Nitroprusside (Nipride) continuous infusion
• D) Milrinone (Primacor) continuous infusion
Correct Answer: C
Rationale: This patient has cardiogenic shock with low cardiac output and high
systemic vascular resistance (afterload). Nitroprusside is a potent vasodilator that
would dramatically drop the afterload and blood pressure, worsening the patient's
perfusion. Dobutamine and Milrinone are inotropes that increase contractility.
Norepinephrine may be used cautiously if hypotension is severe, but afterload
reduction is contraindicated here without mechanical support.
, 4. The nurse is assessing a patient 2 hours post-return of spontaneous circulation
(ROSC) after a cardiac arrest. The patient remains intubated and sedated. Which
targeted temperature management (TTM) intervention is most appropriate
initially?
• A) Apply cooling blankets set to 36.5°C.
• B) Infuse 30 mL/kg of cold (4°C) normal saline rapidly.
• C) Place ice packs in the axillae and groin.
• D) Maintain the patient's current temperature of 37.5°C.
Correct Answer: B
Rationale: Current guidelines recommend rapid induction of hypothermia (32-
36°C) for comatose ROSC patients. The fastest way to initiate cooling is a rapid
infusion of 30 mL/kg of cold IV fluids. Cooling blankets and ice packs are used for
maintenance, not induction.
5. Which assessment finding is the earliest indicator of decreased cardiac output
in a patient with a new intra-aortic balloon pump (IABP) set at a 1:2 ratio?
• A) Mean arterial pressure (MAP) of 68 mmHg
• B) Urine output of 25 mL over the last 2 hours
• C) Heart rate increase from 88 to 104 bpm
• D) Pulmonary artery diastolic pressure of 20 mmHg
Correct Answer: C
Rationale: Tachycardia is one of the earliest compensatory mechanisms for a
dropping cardiac output. The sympathetic nervous system activates baroreceptors,
increasing the heart rate before measurable drops in MAP or urine output occur.
The IABP is meant to reduce afterload and augment coronary perfusion; a 1:2 ratio
2026/2027 | Intensive Care Nursing, Clinical
Judgment & NGN Critical Care Review | 50
Verified Questions with Detailed Rationales
SECTION 1: HEMODYNAMICS & SHOCK
1. A patient with septic shock has a pulmonary artery catheter in place. Which
hemodynamic parameter indicates that the patient is in the distributive (warm)
phase of septic shock?
• A) Cardiac Index (CI) 1.8 L/min/m², Systemic Vascular Resistance (SVR) 1400
dynes/sec/cm⁻⁵
• B) Cardiac Index (CI) 4.2 L/min/m², Systemic Vascular Resistance (SVR) 400
dynes/sec/cm⁻⁵
• C) Cardiac Index (CI) 2.1 L/min/m², Pulmonary Artery Wedge Pressure
(PAWP) 18 mmHg
• D) Cardiac Index (CI) 3.0 L/min/m², Central Venous Pressure (CVP) 2 mmHg
Correct Answer: B
Rationale: The distributive (hyperdynamic) phase of septic shock is characterized
by massive vasodilation, leading to a very low SVR (< 800) and a high or normal
cardiac output (CI > 4.0) as the heart tries to compensate. Option A indicates
cardiogenic shock (low CI, high SVR). Option C indicates fluid overload. Option D
indicates hypovolemia.
2. The nurse is caring for a patient on a norepinephrine (Levophed) infusion at
12 mcg/min via a peripheral IV. The patient’s blood pressure is now 168/102
,mmHg, and the hand above the IV site is pale and cold. What is the priority
nursing action?
• A) Decrease the infusion rate by 2 mcg/min.
• B) Stop the infusion and prepare to administer phentolamine.
• C) Apply a warm compress to the affected hand.
• D) Assess the IV site for infiltration and prepare for central line placement.
Correct Answer: D
Rationale: Norepinephrine is a potent vasopressor. Extravasation causes severe
tissue ischemia and necrosis. Pallor and coldness above the IV site indicate
infiltration. The priority is to stop the infusion, assess the site, and prepare for
central line placement (as vasopressors should be given centrally). Phentolamine is
used for local infiltration, but the immediate priority is discontinuing the
peripheral infusion and securing central access.
3. A patient with cardiogenic shock has a cardiac index of 1.6 L/min/m² and an
SVR of 1600 dynes/sec/cm⁻⁵. Which medication order should the nurse
question?
• A) Dobutamine (Dobutrex) continuous infusion
• B) Norepinephrine (Levophed) continuous infusion
• C) Nitroprusside (Nipride) continuous infusion
• D) Milrinone (Primacor) continuous infusion
Correct Answer: C
Rationale: This patient has cardiogenic shock with low cardiac output and high
systemic vascular resistance (afterload). Nitroprusside is a potent vasodilator that
would dramatically drop the afterload and blood pressure, worsening the patient's
perfusion. Dobutamine and Milrinone are inotropes that increase contractility.
Norepinephrine may be used cautiously if hypotension is severe, but afterload
reduction is contraindicated here without mechanical support.
, 4. The nurse is assessing a patient 2 hours post-return of spontaneous circulation
(ROSC) after a cardiac arrest. The patient remains intubated and sedated. Which
targeted temperature management (TTM) intervention is most appropriate
initially?
• A) Apply cooling blankets set to 36.5°C.
• B) Infuse 30 mL/kg of cold (4°C) normal saline rapidly.
• C) Place ice packs in the axillae and groin.
• D) Maintain the patient's current temperature of 37.5°C.
Correct Answer: B
Rationale: Current guidelines recommend rapid induction of hypothermia (32-
36°C) for comatose ROSC patients. The fastest way to initiate cooling is a rapid
infusion of 30 mL/kg of cold IV fluids. Cooling blankets and ice packs are used for
maintenance, not induction.
5. Which assessment finding is the earliest indicator of decreased cardiac output
in a patient with a new intra-aortic balloon pump (IABP) set at a 1:2 ratio?
• A) Mean arterial pressure (MAP) of 68 mmHg
• B) Urine output of 25 mL over the last 2 hours
• C) Heart rate increase from 88 to 104 bpm
• D) Pulmonary artery diastolic pressure of 20 mmHg
Correct Answer: C
Rationale: Tachycardia is one of the earliest compensatory mechanisms for a
dropping cardiac output. The sympathetic nervous system activates baroreceptors,
increasing the heart rate before measurable drops in MAP or urine output occur.
The IABP is meant to reduce afterload and augment coronary perfusion; a 1:2 ratio
