⭐HESI Critical Care Exam – Combination
Format (1–200)_Verified questions and
correct Answers Rationales
📘 CASE 1 — Acute Respiratory Failure
(NGN Mixed)
1. The nurse assesses a patient in acute respiratory failure. Which value
indicates worsening respiratory status?
A. pH 7.44
B. PaCO₂ 38
C. PaO₂ 92
D. PaO₂ 54
Correct Answer: D
Rationale: PaO₂ < 60 = acute hypoxemia → respiratory failure.
2. The nurse prepares to intubate a client. What is the priority action?
A. Apply bilateral restraints
B. Ensure bag-mask ventilation equipment is at bedside
C. Administer IV morphine
D. Lower the head of the bed
Rationale: Always secure airway equipment before intubation.
3. Post-intubation, the nurse hears gurgling sounds. What should the nurse
do first?
,A. Reposition the client
B. Inflate the endotracheal tube cuff
C. Increase FiO₂
D. Call respiratory therapy
Rationale: Gurgling = air leak; cuff inflation needed.
4. Ventilator alarm: “High Pressure.” Which cause is most likely?
A. Extubation
B. Mucus plugging
C. Low tidal volume
D. Circuit disconnection
Rationale: High pressure is usually from obstruction.
5. Which finding indicates the ventilator should be adjusted?
A. PaCO₂ 40
B. SpO₂ 94%
C. pH 7.26
D. PaO₂ 80
Rationale: pH 7.26 = respiratory acidosis → increase ventilation.
📘 CASE 2 — Shock States (NGN Matrix)
6. Match the shock type to the expected finding.
Matrix (Choose one per row):
SHOCK TYPE EXPECTED FINDING
Cardiogenic A. Warm skin
Septic B. Cool, mottled skin
Hypovolemic C. Crackles, pulmonary edema
,Correct Answers:
● Cardiogenic → C
● Septic → A
● Hypovolemic → B
Rationale:
Septic shock = warm early, cardiogenic = fluid backing into lungs, hypovolemic = cold.
7. A client in hypovolemic shock has HR 130, MAP 55. What is the priority?
A. Rapid isotonic fluid bolus
B. Vasopressin
C. Nitroglycerin
D. Blood cultures
Rationale: Fluid replacement is first-line in hypovolemia.
8. A septic shock patient remains hypotensive after fluids. What order
should the nurse expect next?
A. Dobutamine
B. Norepinephrine infusion
C. Sodium bicarbonate
D. Furosemide
Rationale: Norepinephrine = first-line vasopressor.
9. Which lab is the strongest indicator of poor perfusion in sepsis?
A. Sodium
B. Hemoglobin
C. Lactate
D. Calcium
Rationale: Lactate elevation = anaerobic metabolism.
, 10. During sepsis resuscitation, which urine output indicates
improvement?
A. 10 mL/hr
B. 40 mL/hr
C. 15 mL/hr
D. 25 mL/hr
Rationale: Normal perfusion urine output >30 mL/hr.
📘 CASE 3 — Acute MI & Cardiogenic
Shock
11. Chest pain + hypotension + crackles. What is the priority?
A. Nitroglycerin
B. Morphine
C. Dobutamine
D. ACE inhibitor
Rationale: Dobutamine improves cardiac output; nitro would worsen hypotension.
12. Which ECG change indicates STEMI?
A. Flattened T waves
B. Prolonged PR interval
C. ST elevation
D. U waves
Rationale: Classic STEMI = ST elevation.
13. Patient receiving nitroglycerin suddenly becomes hypotensive. First
action?
A. Stop the infusion
B. Give morphine
Format (1–200)_Verified questions and
correct Answers Rationales
📘 CASE 1 — Acute Respiratory Failure
(NGN Mixed)
1. The nurse assesses a patient in acute respiratory failure. Which value
indicates worsening respiratory status?
A. pH 7.44
B. PaCO₂ 38
C. PaO₂ 92
D. PaO₂ 54
Correct Answer: D
Rationale: PaO₂ < 60 = acute hypoxemia → respiratory failure.
2. The nurse prepares to intubate a client. What is the priority action?
A. Apply bilateral restraints
B. Ensure bag-mask ventilation equipment is at bedside
C. Administer IV morphine
D. Lower the head of the bed
Rationale: Always secure airway equipment before intubation.
3. Post-intubation, the nurse hears gurgling sounds. What should the nurse
do first?
,A. Reposition the client
B. Inflate the endotracheal tube cuff
C. Increase FiO₂
D. Call respiratory therapy
Rationale: Gurgling = air leak; cuff inflation needed.
4. Ventilator alarm: “High Pressure.” Which cause is most likely?
A. Extubation
B. Mucus plugging
C. Low tidal volume
D. Circuit disconnection
Rationale: High pressure is usually from obstruction.
5. Which finding indicates the ventilator should be adjusted?
A. PaCO₂ 40
B. SpO₂ 94%
C. pH 7.26
D. PaO₂ 80
Rationale: pH 7.26 = respiratory acidosis → increase ventilation.
📘 CASE 2 — Shock States (NGN Matrix)
6. Match the shock type to the expected finding.
Matrix (Choose one per row):
SHOCK TYPE EXPECTED FINDING
Cardiogenic A. Warm skin
Septic B. Cool, mottled skin
Hypovolemic C. Crackles, pulmonary edema
,Correct Answers:
● Cardiogenic → C
● Septic → A
● Hypovolemic → B
Rationale:
Septic shock = warm early, cardiogenic = fluid backing into lungs, hypovolemic = cold.
7. A client in hypovolemic shock has HR 130, MAP 55. What is the priority?
A. Rapid isotonic fluid bolus
B. Vasopressin
C. Nitroglycerin
D. Blood cultures
Rationale: Fluid replacement is first-line in hypovolemia.
8. A septic shock patient remains hypotensive after fluids. What order
should the nurse expect next?
A. Dobutamine
B. Norepinephrine infusion
C. Sodium bicarbonate
D. Furosemide
Rationale: Norepinephrine = first-line vasopressor.
9. Which lab is the strongest indicator of poor perfusion in sepsis?
A. Sodium
B. Hemoglobin
C. Lactate
D. Calcium
Rationale: Lactate elevation = anaerobic metabolism.
, 10. During sepsis resuscitation, which urine output indicates
improvement?
A. 10 mL/hr
B. 40 mL/hr
C. 15 mL/hr
D. 25 mL/hr
Rationale: Normal perfusion urine output >30 mL/hr.
📘 CASE 3 — Acute MI & Cardiogenic
Shock
11. Chest pain + hypotension + crackles. What is the priority?
A. Nitroglycerin
B. Morphine
C. Dobutamine
D. ACE inhibitor
Rationale: Dobutamine improves cardiac output; nitro would worsen hypotension.
12. Which ECG change indicates STEMI?
A. Flattened T waves
B. Prolonged PR interval
C. ST elevation
D. U waves
Rationale: Classic STEMI = ST elevation.
13. Patient receiving nitroglycerin suddenly becomes hypotensive. First
action?
A. Stop the infusion
B. Give morphine
