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HESI Critical Care RN Exit Exam 2026-2027 BANK QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% CORRECT ANSWERS A+
GRADED
1. A patient admitted with acute decompensated heart failure is on a
nitroglycerin infusion for afterload reduction. Which assessment finding
indicates the treatment is having the desired therapeutic effect?
A) Jugular venous distension from baseline of 8 cm to 10 cm
B) Pulmonary capillary wedge pressure from 22 mmHg to 14 mmHg
C) Systemic vascular resistance from 1400 dynes/sec/cm-5 to 1600
dynes/sec/cm-5
D) Mean arterial pressure from 75 mmHg to 55 mmHg
Answer: B
Nitroglycerin primarily reduces preload through venous dilation and, at
higher doses, afterload through arterial dilation. A reduction in
pulmonary capillary wedge pressure from 22 mmHg (elevated) to 14
mmHg (near normal) indicates effective reduction of left ventricular
filling pressure, improving pulmonary congestion.
2. The critical care nurse is caring for a patient with a temporary
transvenous pacemaker set on demand mode at a rate of 70 beats per
minute. The patient's intrinsic heart rate suddenly drops to 50 beats per
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minute. What should the nurse observe on the cardiac monitor if the
pacemaker is functioning correctly?
A) Complete absence of pacemaker spikes
B) Pacemaker spikes followed immediately by wide QRS complexes
C) Pacemaker spikes occurring randomly throughout the cardiac cycle
D) Pacemaker spikes preceding narrow QRS complexes
Answer: B
A transvenous pacemaker wire is typically positioned in the right
ventricle, resulting in direct ventricular stimulation. This produces a
pacemaker spike immediately followed by a wide QRS complex because
the impulse originates in the ventricle rather than traveling through the
normal conduction system.
3. A patient is 24 hours post coronary artery bypass grafting. Chest tube
drainage suddenly increases to 400 mL of bright red blood over 45
minutes. The patient's blood pressure drops to 82/50 mmHg, and heart
rate increases to 122 beats per minute. Which action should the nurse
take first?
A) Increase the intravenous fluid rate per protocol
B) Prepare for emergency resternotomy
C) Check the activated clotting time
D) Apply pressure to the chest tube insertion site
Answer: B
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Sudden massive chest tube drainage exceeding 200 mL per hour with
hemodynamic instability suggests acute surgical bleeding or graft
rupture. This constitutes a cardiac tamponade or exsanguination
emergency requiring immediate surgical re-exploration. The nurse must
prepare the patient for emergency resternotomy while colleagues
provide concurrent volume resuscitation.
4. A patient with septic shock has been started on a norepinephrine
infusion to maintain mean arterial pressure above 65 mmHg. Which
assessment finding indicates a complication specifically related to
extravasation of this medication?
A) Erythema and warmth spreading proximally from the IV site
B) Pallor, coolness, and paresthesia distal to the IV site
C) Localized ecchymosis with mild swelling at the IV insertion point
D) Diffuse urticaria extending along the affected extremity
Answer: B
Norepinephrine is a potent vasoconstrictor. Extravasation causes
intense local vasoconstriction, leading to tissue ischemia characterized
by pallor, coolness, and paresthesia. Without intervention, this can
progress to necrosis. The treatment is local infiltration with
phentolamine, an alpha-adrenergic antagonist.
5. A patient with acute respiratory distress syndrome is being ventilated
using a lung-protective strategy. The arterial blood gas reveals pH 7.22,
PaCO2 68 mmHg, PaO2 58 mmHg, HCO3 26 mEq/L. The patient's tidal
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volume is set at 6 mL/kg ideal body weight, respiratory rate 28, FiO2
0.70, PEEP 14 cm H2O. What intervention should the nurse anticipate?
A) Increase the respiratory rate to 35 breaths per minute
B) Decrease the PEEP to 10 cm H2O
C) Increase the tidal volume to 10 mL/kg
D) Administer sodium bicarbonate intravenously
Answer: A
The arterial blood gas shows a respiratory acidosis with permissive
hypercapnia, a common consequence of lung-protective ventilation.
The pH of 7.22 is approaching but has not yet reached the typical
intervention threshold of 7.15-7.20. Increasing the respiratory rate, if
auto-PEEP is not present, is the next step to improve CO2 clearance
while maintaining the low tidal volume.
6. A patient with a traumatic brain injury has an intracranial pressure of
28 mmHg. The nurse notes the patient's blood pressure is 90/50
mmHg. What is the cerebral perfusion pressure, and what does it
indicate?
A) 42 mmHg; inadequate cerebral perfusion
B) 62 mmHg; inadequate cerebral perfusion
C) 22 mmHg; severely inadequate cerebral perfusion
D) 52 mmHg; marginally adequate cerebral perfusion
Answer: B
HESI Critical Care RN Exit Exam 2026-2027 BANK QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% CORRECT ANSWERS A+
GRADED
1. A patient admitted with acute decompensated heart failure is on a
nitroglycerin infusion for afterload reduction. Which assessment finding
indicates the treatment is having the desired therapeutic effect?
A) Jugular venous distension from baseline of 8 cm to 10 cm
B) Pulmonary capillary wedge pressure from 22 mmHg to 14 mmHg
C) Systemic vascular resistance from 1400 dynes/sec/cm-5 to 1600
dynes/sec/cm-5
D) Mean arterial pressure from 75 mmHg to 55 mmHg
Answer: B
Nitroglycerin primarily reduces preload through venous dilation and, at
higher doses, afterload through arterial dilation. A reduction in
pulmonary capillary wedge pressure from 22 mmHg (elevated) to 14
mmHg (near normal) indicates effective reduction of left ventricular
filling pressure, improving pulmonary congestion.
2. The critical care nurse is caring for a patient with a temporary
transvenous pacemaker set on demand mode at a rate of 70 beats per
minute. The patient's intrinsic heart rate suddenly drops to 50 beats per
,2|Page
minute. What should the nurse observe on the cardiac monitor if the
pacemaker is functioning correctly?
A) Complete absence of pacemaker spikes
B) Pacemaker spikes followed immediately by wide QRS complexes
C) Pacemaker spikes occurring randomly throughout the cardiac cycle
D) Pacemaker spikes preceding narrow QRS complexes
Answer: B
A transvenous pacemaker wire is typically positioned in the right
ventricle, resulting in direct ventricular stimulation. This produces a
pacemaker spike immediately followed by a wide QRS complex because
the impulse originates in the ventricle rather than traveling through the
normal conduction system.
3. A patient is 24 hours post coronary artery bypass grafting. Chest tube
drainage suddenly increases to 400 mL of bright red blood over 45
minutes. The patient's blood pressure drops to 82/50 mmHg, and heart
rate increases to 122 beats per minute. Which action should the nurse
take first?
A) Increase the intravenous fluid rate per protocol
B) Prepare for emergency resternotomy
C) Check the activated clotting time
D) Apply pressure to the chest tube insertion site
Answer: B
,3|Page
Sudden massive chest tube drainage exceeding 200 mL per hour with
hemodynamic instability suggests acute surgical bleeding or graft
rupture. This constitutes a cardiac tamponade or exsanguination
emergency requiring immediate surgical re-exploration. The nurse must
prepare the patient for emergency resternotomy while colleagues
provide concurrent volume resuscitation.
4. A patient with septic shock has been started on a norepinephrine
infusion to maintain mean arterial pressure above 65 mmHg. Which
assessment finding indicates a complication specifically related to
extravasation of this medication?
A) Erythema and warmth spreading proximally from the IV site
B) Pallor, coolness, and paresthesia distal to the IV site
C) Localized ecchymosis with mild swelling at the IV insertion point
D) Diffuse urticaria extending along the affected extremity
Answer: B
Norepinephrine is a potent vasoconstrictor. Extravasation causes
intense local vasoconstriction, leading to tissue ischemia characterized
by pallor, coolness, and paresthesia. Without intervention, this can
progress to necrosis. The treatment is local infiltration with
phentolamine, an alpha-adrenergic antagonist.
5. A patient with acute respiratory distress syndrome is being ventilated
using a lung-protective strategy. The arterial blood gas reveals pH 7.22,
PaCO2 68 mmHg, PaO2 58 mmHg, HCO3 26 mEq/L. The patient's tidal
, 4|Page
volume is set at 6 mL/kg ideal body weight, respiratory rate 28, FiO2
0.70, PEEP 14 cm H2O. What intervention should the nurse anticipate?
A) Increase the respiratory rate to 35 breaths per minute
B) Decrease the PEEP to 10 cm H2O
C) Increase the tidal volume to 10 mL/kg
D) Administer sodium bicarbonate intravenously
Answer: A
The arterial blood gas shows a respiratory acidosis with permissive
hypercapnia, a common consequence of lung-protective ventilation.
The pH of 7.22 is approaching but has not yet reached the typical
intervention threshold of 7.15-7.20. Increasing the respiratory rate, if
auto-PEEP is not present, is the next step to improve CO2 clearance
while maintaining the low tidal volume.
6. A patient with a traumatic brain injury has an intracranial pressure of
28 mmHg. The nurse notes the patient's blood pressure is 90/50
mmHg. What is the cerebral perfusion pressure, and what does it
indicate?
A) 42 mmHg; inadequate cerebral perfusion
B) 62 mmHg; inadequate cerebral perfusion
C) 22 mmHg; severely inadequate cerebral perfusion
D) 52 mmHg; marginally adequate cerebral perfusion
Answer: B
