CRITICAL CARE HESI EXAM PREP 180 VERIFIED
QUESTIONS AND ANSWERS UPDATED 2026 ||
GRADED A+
Hemodynamics & Shock
1. A patient with septic shock has a mean arterial pressure (MAP) of 48 mm Hg. What
is the priority intervention?
o Answer: Initiate vasopressors (norepinephrine) after fluid resuscitation.
o Rationale: MAP <65 mm Hg indicates inadequate organ perfusion.
Norepinephrine is first-line for septic shock.
2. Which finding suggests cardiogenic shock rather than hypovolemic shock?
o Answer: Jugular vein distention (JVD) and pulmonary crackles.
o Rationale: Cardiogenic shock causes fluid backup (high preload); hypovolemic
shock shows flat neck veins.
3. A patient’s pulmonary artery wedge pressure (PAWP) is 22 mm Hg (normal 4–12).
What does this indicate?
o Answer: Left ventricular failure or fluid overload.
o Rationale: Elevated PAWP reflects increased left atrial pressure, often from
heart failure or hypervolemia.
4. In distributive shock, which hemodynamic profile is expected?
o Answer: Low systemic vascular resistance (SVR), high cardiac output (early).
o Rationale: Vasodilation reduces SVR; CO initially rises compensatorily.
5. A patient with neurogenic shock after a C5 spinal injury presents with bradycardia
and hypotension. Which vasopressor is preferred?
o Answer: Phenylephrine (pure alpha-agonist).
o Rationale: Avoid beta-agonists due to unopposed vagal tone; phenylephrine
increases SVR without tachycardia.
6. What is the earliest sign of hypovolemic shock?
o Answer: Increased heart rate.
o Rationale: Tachycardia compensates for reduced stroke volume before BP
drops.
7. A patient with anaphylactic shock has stridor and hypotension. Which medication
is most urgent?
o Answer: Epinephrine IM (or IV if severe).
o Rationale: Epinephrine reverses bronchospasm and vasodilation;
antihistamines are slower.
, 8. Which lab value best indicates adequacy of fluid resuscitation in hemorrhagic
shock?
o Answer: Base deficit (-2 to +2 normal).
o Rationale: Base deficit reflects metabolic acidosis from hypoperfusion;
trending guides resuscitation.
9. A patient in septic shock on norepinephrine has a MAP of 60 mm Hg. Next step?
o Answer: Add vasopressin.
o Rationale: Vasopressin is second-line when norepinephrine fails; do not
increase norepinephrine >15 mcg/min alone.
10. Which cardiac output (CO) and SVR pattern suggests early septic shock?
o Answer: High CO, low SVR.
o Rationale: Hyperdynamic phase: vasodilation (low SVR) with compensatory
high CO.
11. A pulmonary artery catheter shows CO 2.1 L/min (normal 4–8), PAWP 6 mm Hg.
Likely diagnosis?
o Answer: Hypovolemic shock.
o Rationale: Low CO + low PAWP = inadequate preload.
12. What is the target MAP for a patient on vasopressors for septic shock?
o Answer: 65 mm Hg.
o Rationale: Surviving Sepsis Campaign guidelines: MAP ≥65 mm Hg for tissue
perfusion.
13. Which shock type is associated with “warm, flushed” extremities initially?
o Answer: Distributive (septic, anaphylactic, neurogenic).
o Rationale: Vasodilation increases peripheral blood flow, causing warmth.
14. A patient with massive PE develops hypotension, JVD, and clear lungs. Most likely
shock?
o Answer: Obstructive shock.
o Rationale: PE obstructs RV outflow; JVD from RV failure, clear lungs (no
pulmonary edema).
15. Which drug is contraindicated in obstructive shock from tension pneumothorax?
o Answer: Dobutamine.
o Rationale: Increasing contractility without relieving obstruction worsens RV
strain; needle decompression is priority.
16. A patient’s ScvO2 (central venous oxygen saturation) is 55% (normal >70%). What
does this indicate?
o Answer: Inadequate oxygen delivery or increased extraction.
o Rationale: Low ScvO2 suggests shock; high ScvO2 suggests shunting or sepsis.
QUESTIONS AND ANSWERS UPDATED 2026 ||
GRADED A+
Hemodynamics & Shock
1. A patient with septic shock has a mean arterial pressure (MAP) of 48 mm Hg. What
is the priority intervention?
o Answer: Initiate vasopressors (norepinephrine) after fluid resuscitation.
o Rationale: MAP <65 mm Hg indicates inadequate organ perfusion.
Norepinephrine is first-line for septic shock.
2. Which finding suggests cardiogenic shock rather than hypovolemic shock?
o Answer: Jugular vein distention (JVD) and pulmonary crackles.
o Rationale: Cardiogenic shock causes fluid backup (high preload); hypovolemic
shock shows flat neck veins.
3. A patient’s pulmonary artery wedge pressure (PAWP) is 22 mm Hg (normal 4–12).
What does this indicate?
o Answer: Left ventricular failure or fluid overload.
o Rationale: Elevated PAWP reflects increased left atrial pressure, often from
heart failure or hypervolemia.
4. In distributive shock, which hemodynamic profile is expected?
o Answer: Low systemic vascular resistance (SVR), high cardiac output (early).
o Rationale: Vasodilation reduces SVR; CO initially rises compensatorily.
5. A patient with neurogenic shock after a C5 spinal injury presents with bradycardia
and hypotension. Which vasopressor is preferred?
o Answer: Phenylephrine (pure alpha-agonist).
o Rationale: Avoid beta-agonists due to unopposed vagal tone; phenylephrine
increases SVR without tachycardia.
6. What is the earliest sign of hypovolemic shock?
o Answer: Increased heart rate.
o Rationale: Tachycardia compensates for reduced stroke volume before BP
drops.
7. A patient with anaphylactic shock has stridor and hypotension. Which medication
is most urgent?
o Answer: Epinephrine IM (or IV if severe).
o Rationale: Epinephrine reverses bronchospasm and vasodilation;
antihistamines are slower.
, 8. Which lab value best indicates adequacy of fluid resuscitation in hemorrhagic
shock?
o Answer: Base deficit (-2 to +2 normal).
o Rationale: Base deficit reflects metabolic acidosis from hypoperfusion;
trending guides resuscitation.
9. A patient in septic shock on norepinephrine has a MAP of 60 mm Hg. Next step?
o Answer: Add vasopressin.
o Rationale: Vasopressin is second-line when norepinephrine fails; do not
increase norepinephrine >15 mcg/min alone.
10. Which cardiac output (CO) and SVR pattern suggests early septic shock?
o Answer: High CO, low SVR.
o Rationale: Hyperdynamic phase: vasodilation (low SVR) with compensatory
high CO.
11. A pulmonary artery catheter shows CO 2.1 L/min (normal 4–8), PAWP 6 mm Hg.
Likely diagnosis?
o Answer: Hypovolemic shock.
o Rationale: Low CO + low PAWP = inadequate preload.
12. What is the target MAP for a patient on vasopressors for septic shock?
o Answer: 65 mm Hg.
o Rationale: Surviving Sepsis Campaign guidelines: MAP ≥65 mm Hg for tissue
perfusion.
13. Which shock type is associated with “warm, flushed” extremities initially?
o Answer: Distributive (septic, anaphylactic, neurogenic).
o Rationale: Vasodilation increases peripheral blood flow, causing warmth.
14. A patient with massive PE develops hypotension, JVD, and clear lungs. Most likely
shock?
o Answer: Obstructive shock.
o Rationale: PE obstructs RV outflow; JVD from RV failure, clear lungs (no
pulmonary edema).
15. Which drug is contraindicated in obstructive shock from tension pneumothorax?
o Answer: Dobutamine.
o Rationale: Increasing contractility without relieving obstruction worsens RV
strain; needle decompression is priority.
16. A patient’s ScvO2 (central venous oxygen saturation) is 55% (normal >70%). What
does this indicate?
o Answer: Inadequate oxygen delivery or increased extraction.
o Rationale: Low ScvO2 suggests shock; high ScvO2 suggests shunting or sepsis.
