HESI Critical Care — Original Questions
with correct Answers & Rationales
1) (Multiple choice — Respiratory)
A 68-year-old on mechanical ventilation has sudden hypotension, absent breath sounds on the
left, and increased peak inspiratory pressure. What is the nurse’s priority action?
A. Increase sedation
B. Auscultate the right chest
C. Prepare for needle decompression of the left chest
D. Disconnect ventilator and manually ventilate
Answer: C — Prepare for needle decompression of the left chest.
Rationale: Sudden hypotension, unilateral absent breath sounds, and rising airway pressures
suggest a tension pneumothorax — immediate decompression is lifesaving.
2) (SATA — Sepsis)
Which findings are consistent with septic shock? (Select all that apply.)
A. Lactate 4.8 mmol/L
B. MAP 58 mmHg despite 30 mL/kg bolus
C. Warm, flushed extremities early in course
D. Urine output 0.6 mL/kg/hr
E. WBC 8,000/µL
Answer: A, B, C.
Rationale: Elevated lactate and hypotension after fluids indicate septic shock; early distributive
shock often causes warm extremities. UO 0.6 mL/kg/hr is marginal; WBC may be normal or
elevated — less specific.
3) (Multiple choice — Cardiac)
,A patient in the ICU develops pulseless ventricular tachycardia. The nurse should:
A. Deliver unsynchronized high-energy shock (defibrillation) immediately
B. Start chest compressions for 2 minutes before shocking
C. Give synchronized cardioversion at low energy
D. Administer IV atropine
Answer: A.
Rationale: Pulseless VT requires immediate unsynchronized defibrillation per ACLS.
4) (Priority ordering — Neuro)
Place in order the nurse’s actions for an intubated patient with sudden unilateral dilated pupil
and declining GCS: (1) Notify provider; (2) Check ventilator and oxygenation; (3) Assess
pupillary responses and document; (4) Prepare for head CT.
Correct order: 3 → 2 → 1 → 4.
Rationale: Prompt neuro assessment first, ensure hypoxia/hypercapnia aren’t causing
deterioration, then notify and arrange imaging.
5) (Multiple choice — Endocrine)
A patient with DKA has serum glucose fall from 720 to 240 mg/dL in 30 minutes after insulin
bolus. Nurse’s best action:
A. Increase insulin infusion
B. Administer hypertonic saline
C. Slow insulin infusion rate and add dextrose when indicated
D. Give IV calcium gluconate
Answer: C.
Rationale: Rapid glucose drops raise cerebral edema risk; slow insulin to achieve
recommended gradual decline and add dextrose when glucose approaches 200 mg/dL per
protocol.
6) (Matrix — Renal/CRRT)
Indicate whether each finding suggests Expected, Alarm/Problem, or Action required for a
patient on CRRT.
Findings: (A) Filtrate clear and yellow; (B) Access pressure alarm high; (C) Net ultrafiltration
achieved as ordered; (D) Blood in circuit tubing.
, Answers: A = Expected; B = Alarm/Problem; C = Expected; D = Action required (stop and
assess/replace circuit).
Rationale: High access pressure and visible blood indicate clotting or circuit failure requiring
immediate intervention.
7) (SATA — Pharmacology)
Which drugs should be available at bedside for a rapidly deteriorating patient with suspected
anaphylaxis? (Select all.)
A. Epinephrine IM/IV
B. Diphenhydramine IV
C. IV normal saline bolus
D. Albuterol nebulizer
E. Heparin IV
Answer: A, B, C, D.
Rationale: Epinephrine and fluids are lifesaving; antihistamine and bronchodilator are adjuncts.
Heparin is not indicated for anaphylaxis.
8) (Multiple choice — Cardiac)
A STEMI patient becomes bradycardic with hypotension and dizziness. Heart monitor shows
complete heart block. Immediate nursing action:
A. Prepare for emergent transcutaneous pacing
B. Give IV metoprolol
C. Administer atropine and observe
D. Start dopamine infusion without cardiology consult
Answer: A.
Rationale: Complete heart block with hemodynamic instability requires immediate pacing
(transcutaneous while preparing for transvenous).
9) (Multiple choice — Respiratory)
ARDS patient on high PEEP has sudden oxygenation drop, hypotension, and distended neck
veins. Likely cause and immediate action?
A. Pulmonary embolism — give heparin
B. Tension pneumothorax — emergent decompression
with correct Answers & Rationales
1) (Multiple choice — Respiratory)
A 68-year-old on mechanical ventilation has sudden hypotension, absent breath sounds on the
left, and increased peak inspiratory pressure. What is the nurse’s priority action?
A. Increase sedation
B. Auscultate the right chest
C. Prepare for needle decompression of the left chest
D. Disconnect ventilator and manually ventilate
Answer: C — Prepare for needle decompression of the left chest.
Rationale: Sudden hypotension, unilateral absent breath sounds, and rising airway pressures
suggest a tension pneumothorax — immediate decompression is lifesaving.
2) (SATA — Sepsis)
Which findings are consistent with septic shock? (Select all that apply.)
A. Lactate 4.8 mmol/L
B. MAP 58 mmHg despite 30 mL/kg bolus
C. Warm, flushed extremities early in course
D. Urine output 0.6 mL/kg/hr
E. WBC 8,000/µL
Answer: A, B, C.
Rationale: Elevated lactate and hypotension after fluids indicate septic shock; early distributive
shock often causes warm extremities. UO 0.6 mL/kg/hr is marginal; WBC may be normal or
elevated — less specific.
3) (Multiple choice — Cardiac)
,A patient in the ICU develops pulseless ventricular tachycardia. The nurse should:
A. Deliver unsynchronized high-energy shock (defibrillation) immediately
B. Start chest compressions for 2 minutes before shocking
C. Give synchronized cardioversion at low energy
D. Administer IV atropine
Answer: A.
Rationale: Pulseless VT requires immediate unsynchronized defibrillation per ACLS.
4) (Priority ordering — Neuro)
Place in order the nurse’s actions for an intubated patient with sudden unilateral dilated pupil
and declining GCS: (1) Notify provider; (2) Check ventilator and oxygenation; (3) Assess
pupillary responses and document; (4) Prepare for head CT.
Correct order: 3 → 2 → 1 → 4.
Rationale: Prompt neuro assessment first, ensure hypoxia/hypercapnia aren’t causing
deterioration, then notify and arrange imaging.
5) (Multiple choice — Endocrine)
A patient with DKA has serum glucose fall from 720 to 240 mg/dL in 30 minutes after insulin
bolus. Nurse’s best action:
A. Increase insulin infusion
B. Administer hypertonic saline
C. Slow insulin infusion rate and add dextrose when indicated
D. Give IV calcium gluconate
Answer: C.
Rationale: Rapid glucose drops raise cerebral edema risk; slow insulin to achieve
recommended gradual decline and add dextrose when glucose approaches 200 mg/dL per
protocol.
6) (Matrix — Renal/CRRT)
Indicate whether each finding suggests Expected, Alarm/Problem, or Action required for a
patient on CRRT.
Findings: (A) Filtrate clear and yellow; (B) Access pressure alarm high; (C) Net ultrafiltration
achieved as ordered; (D) Blood in circuit tubing.
, Answers: A = Expected; B = Alarm/Problem; C = Expected; D = Action required (stop and
assess/replace circuit).
Rationale: High access pressure and visible blood indicate clotting or circuit failure requiring
immediate intervention.
7) (SATA — Pharmacology)
Which drugs should be available at bedside for a rapidly deteriorating patient with suspected
anaphylaxis? (Select all.)
A. Epinephrine IM/IV
B. Diphenhydramine IV
C. IV normal saline bolus
D. Albuterol nebulizer
E. Heparin IV
Answer: A, B, C, D.
Rationale: Epinephrine and fluids are lifesaving; antihistamine and bronchodilator are adjuncts.
Heparin is not indicated for anaphylaxis.
8) (Multiple choice — Cardiac)
A STEMI patient becomes bradycardic with hypotension and dizziness. Heart monitor shows
complete heart block. Immediate nursing action:
A. Prepare for emergent transcutaneous pacing
B. Give IV metoprolol
C. Administer atropine and observe
D. Start dopamine infusion without cardiology consult
Answer: A.
Rationale: Complete heart block with hemodynamic instability requires immediate pacing
(transcutaneous while preparing for transvenous).
9) (Multiple choice — Respiratory)
ARDS patient on high PEEP has sudden oxygenation drop, hypotension, and distended neck
veins. Likely cause and immediate action?
A. Pulmonary embolism — give heparin
B. Tension pneumothorax — emergent decompression
