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HESI Critical Care Exam 2026/2027 Actual
Exam - 300 Questions with Detailed
Rationales | 100% Verified Graded A+ Pass
Guaranteed - A+ Graded
Section 1: Hemodynamics/Shock
Q1: A patient in the ICU has a pulmonary artery catheter. The nurse reviews the following
hemodynamic values: CVP 12 mmHg, PAP 35/15 mmHg, PAWP 14 mmHg, CO 3.5 L/min, SVR
1800 dynes/sec/cm-5. Which intervention should the nurse anticipate?
A. Administer a 500 mL normal saline bolus
B. Initiate a norepinephrine infusion [CORRECT]
C. Administer a nitroglycerin infusion
D. Increase FiO2 to 60%
Correct Answer: B
Rationale: The elevated SVR indicates profound vasoconstriction typical of distributive or
obstructive shock, requiring vasopressor therapy like norepinephrine. Fluid boluses would not
address the high SVR, and nitroglycerin would worsen hypotension.
Q2: A patient presents with cool, clammy skin, delayed capillary refill, and oliguria. Blood
pressure is 80/50 mmHg, and heart rate is 125 bpm. Which stage of shock is this patient most
likely experiencing?
A. Compensated shock
B. Progressive shock [CORRECT]
C. Irreversible shock
D. Refractory shock
Correct Answer: B
Rationale: Progressive shock is characterized by inadequate perfusion manifesting as
hypotension, tachycardia, and oliguria with cool, clammy skin. Compensated shock maintains
BP, while irreversible/refractory shock involves unresponsive multi-organ failure.
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Q3: The critical care nurse is assessing a patient with septic shock. Which hemodynamic profile
is most consistent with this condition?
A. Increased CVP, increased SVR, decreased CO
B. Decreased CVP, decreased SVR, increased CO [CORRECT]
C. Increased CVP, increased SVR, increased CO
D. Decreased CVP, increased SVR, decreased CO
Correct Answer: B
Rationale: Septic shock causes massive vasodilation, leading to decreased SVR. Cardiac output
is typically high initially due to hyperdynamic circulation, and CVP is low due to venous pooling
and capillary leak.
Q4: A patient with cardiogenic shock has a PAWP of 25 mmHg and a cardiac output of 2.8
L/min. Which medication should the nurse prepare to administer?
A. Dobutamine [CORRECT]
B. Vasopressin
C. Phenylephrine
D. Normal saline 1000 mL
Correct Answer: A
Rationale: Cardiogenic shock requires inotropic support to increase cardiac output and reduce
PAWP. Dobutamine improves contractility and causes mild vasodilation. Fluid boluses would
increase PAWP and worsen pulmonary edema.
Q5: Which hemodynamic parameter directly measures the force of left ventricular contraction?
A. Cardiac Output (CO)
B. Stroke Volume (SV)
C. Left Ventricular Stroke Work Index (LVSWI) [CORRECT]
D. Systemic Vascular Resistance (SVR)
Correct Answer: C
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Rationale: LVSWI incorporates left ventricular preload, afterload, and contractility, making it the
best direct indicator of left ventricular contractile force. CO and SV are influenced by heart rate
and preload.
Q6: A patient is receiving massive blood transfusions after a trauma. The nurse notes bleeding
from IV sites and an elevated PT/aPTT. What is the priority intervention?
A. Administer cryoprecipitate
B. Administer fresh frozen plasma (FFP) [CORRECT]
C. Administer platelets
D. Administer calcium gluconate
Correct Answer: B
Rationale: Elevated PT/aPTT with bleeding indicates coagulopathy from dilutional
thrombocytopenia and factor depletion, best treated with FFP to replace clotting factors.
Cryoprecipitate is for fibrinogen deficiency, and calcium is for hypocalcemia.
Q7: A patient's right atrial pressure (CVP) is 3 mmHg. Blood pressure is 70/40 mmHg. What is
the nurse's first action?
A. Administer furosemide
B. Administer a rapid crystalloid bolus [CORRECT]
C. Start dopamine at 5 mcg/kg/min
D. Obtain a chest x-ray
Correct Answer: B
Rationale: A CVP of 3 mmHg indicates severely decreased preload (hypovolemia). The first
priority is volume resuscitation with a crystalloid bolus to restore intravascular volume before
initiating vasopressors.
Q8: The nurse evaluates a patient's stroke volume variation (SVV) on the arterial line monitor.
The reading is 18%. What does this indicate?
A. The patient is volume overloaded
B. The patient is in cardiogenic shock
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C. The patient is fluid responsive [CORRECT]
D. The patient has severe aortic regurgitation
Correct Answer: C
Rationale: An SVV greater than 10-13% indicates that the patient is on the steep portion of the
Frank-Starling curve and will likely respond to a fluid bolus with an increase in stroke volume.
Q9: A patient with anaphylactic shock is unresponsive to epinephrine and fluid resuscitation.
Which medication should the nurse anticipate next?
A. Vasopressin [CORRECT]
B. Milrinone
C. Nitroprusside
D. Hydrocortisone
Correct Answer: A
Rationale: Vasopressin is a potent vasoconstrictor used as a second-line agent for refractory
anaphylactic or septic shock when catecholamines fail. Hydrocortisone is given for
bronchospasm but takes time to work.
Q10: A patient has a PAWP of 8 mmHg and a BP of 90/60 mmHg with a heart rate of 110 bpm.
Which hemodynamic state is this?
A. Left ventricular failure
B. Hypovolemic shock [CORRECT]
C. Right ventricular failure
D. Cardiac tamponade
Correct Answer: B
Rationale: Low PAWP indicates low left ventricular preload, while hypotension and tachycardia
indicate compensatory shock mechanisms. This classic profile points to hypovolemia.
Q11: A nurse is monitoring a patient with a pulmonary artery catheter. The PAWP tracing shows
large "v" waves. What condition should the nurse suspect?
HESI Critical Care Exam 2026/2027 Actual
Exam - 300 Questions with Detailed
Rationales | 100% Verified Graded A+ Pass
Guaranteed - A+ Graded
Section 1: Hemodynamics/Shock
Q1: A patient in the ICU has a pulmonary artery catheter. The nurse reviews the following
hemodynamic values: CVP 12 mmHg, PAP 35/15 mmHg, PAWP 14 mmHg, CO 3.5 L/min, SVR
1800 dynes/sec/cm-5. Which intervention should the nurse anticipate?
A. Administer a 500 mL normal saline bolus
B. Initiate a norepinephrine infusion [CORRECT]
C. Administer a nitroglycerin infusion
D. Increase FiO2 to 60%
Correct Answer: B
Rationale: The elevated SVR indicates profound vasoconstriction typical of distributive or
obstructive shock, requiring vasopressor therapy like norepinephrine. Fluid boluses would not
address the high SVR, and nitroglycerin would worsen hypotension.
Q2: A patient presents with cool, clammy skin, delayed capillary refill, and oliguria. Blood
pressure is 80/50 mmHg, and heart rate is 125 bpm. Which stage of shock is this patient most
likely experiencing?
A. Compensated shock
B. Progressive shock [CORRECT]
C. Irreversible shock
D. Refractory shock
Correct Answer: B
Rationale: Progressive shock is characterized by inadequate perfusion manifesting as
hypotension, tachycardia, and oliguria with cool, clammy skin. Compensated shock maintains
BP, while irreversible/refractory shock involves unresponsive multi-organ failure.
,2
Q3: The critical care nurse is assessing a patient with septic shock. Which hemodynamic profile
is most consistent with this condition?
A. Increased CVP, increased SVR, decreased CO
B. Decreased CVP, decreased SVR, increased CO [CORRECT]
C. Increased CVP, increased SVR, increased CO
D. Decreased CVP, increased SVR, decreased CO
Correct Answer: B
Rationale: Septic shock causes massive vasodilation, leading to decreased SVR. Cardiac output
is typically high initially due to hyperdynamic circulation, and CVP is low due to venous pooling
and capillary leak.
Q4: A patient with cardiogenic shock has a PAWP of 25 mmHg and a cardiac output of 2.8
L/min. Which medication should the nurse prepare to administer?
A. Dobutamine [CORRECT]
B. Vasopressin
C. Phenylephrine
D. Normal saline 1000 mL
Correct Answer: A
Rationale: Cardiogenic shock requires inotropic support to increase cardiac output and reduce
PAWP. Dobutamine improves contractility and causes mild vasodilation. Fluid boluses would
increase PAWP and worsen pulmonary edema.
Q5: Which hemodynamic parameter directly measures the force of left ventricular contraction?
A. Cardiac Output (CO)
B. Stroke Volume (SV)
C. Left Ventricular Stroke Work Index (LVSWI) [CORRECT]
D. Systemic Vascular Resistance (SVR)
Correct Answer: C
,3
Rationale: LVSWI incorporates left ventricular preload, afterload, and contractility, making it the
best direct indicator of left ventricular contractile force. CO and SV are influenced by heart rate
and preload.
Q6: A patient is receiving massive blood transfusions after a trauma. The nurse notes bleeding
from IV sites and an elevated PT/aPTT. What is the priority intervention?
A. Administer cryoprecipitate
B. Administer fresh frozen plasma (FFP) [CORRECT]
C. Administer platelets
D. Administer calcium gluconate
Correct Answer: B
Rationale: Elevated PT/aPTT with bleeding indicates coagulopathy from dilutional
thrombocytopenia and factor depletion, best treated with FFP to replace clotting factors.
Cryoprecipitate is for fibrinogen deficiency, and calcium is for hypocalcemia.
Q7: A patient's right atrial pressure (CVP) is 3 mmHg. Blood pressure is 70/40 mmHg. What is
the nurse's first action?
A. Administer furosemide
B. Administer a rapid crystalloid bolus [CORRECT]
C. Start dopamine at 5 mcg/kg/min
D. Obtain a chest x-ray
Correct Answer: B
Rationale: A CVP of 3 mmHg indicates severely decreased preload (hypovolemia). The first
priority is volume resuscitation with a crystalloid bolus to restore intravascular volume before
initiating vasopressors.
Q8: The nurse evaluates a patient's stroke volume variation (SVV) on the arterial line monitor.
The reading is 18%. What does this indicate?
A. The patient is volume overloaded
B. The patient is in cardiogenic shock
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C. The patient is fluid responsive [CORRECT]
D. The patient has severe aortic regurgitation
Correct Answer: C
Rationale: An SVV greater than 10-13% indicates that the patient is on the steep portion of the
Frank-Starling curve and will likely respond to a fluid bolus with an increase in stroke volume.
Q9: A patient with anaphylactic shock is unresponsive to epinephrine and fluid resuscitation.
Which medication should the nurse anticipate next?
A. Vasopressin [CORRECT]
B. Milrinone
C. Nitroprusside
D. Hydrocortisone
Correct Answer: A
Rationale: Vasopressin is a potent vasoconstrictor used as a second-line agent for refractory
anaphylactic or septic shock when catecholamines fail. Hydrocortisone is given for
bronchospasm but takes time to work.
Q10: A patient has a PAWP of 8 mmHg and a BP of 90/60 mmHg with a heart rate of 110 bpm.
Which hemodynamic state is this?
A. Left ventricular failure
B. Hypovolemic shock [CORRECT]
C. Right ventricular failure
D. Cardiac tamponade
Correct Answer: B
Rationale: Low PAWP indicates low left ventricular preload, while hypotension and tachycardia
indicate compensatory shock mechanisms. This classic profile points to hypovolemia.
Q11: A nurse is monitoring a patient with a pulmonary artery catheter. The PAWP tracing shows
large "v" waves. What condition should the nurse suspect?
