HESI CRITICAL CARE –QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
• Hemodynamic Monitoring and Management• Advanced Cardiac Life Support (ACLS)• Ventilatory Support and
Respiratory Failure• Neurological Emergencies and ICP Management• Renal Replacement Therapy and
Electrolyte Imbalances• Multisystem Organ Failure and Sepsis Protocols• End-of-Life Care and Ethical Decision
Making• Pharmacological Interventions in Critical Care
INTRODUCTION
The HESI Critical Care Exam serves as a comprehensive assessment tool designed to evaluate the clinical
proficiency and decision-making capabilities of nursing students in high-acuity environments. This exam
focuses on the integration of complex physiological data and the application of evidence-based interventions for
critically ill patients. Assessment areas include advanced hemodynamics, respiratory failure, and multisystem
trauma. Utilizing a mix of foundational theory and scenario-based questions, the exam emphasizes real-world
application, prioritizing patient safety and rapid intervention. This assessment ensures that candidates possess
the necessary skills to manage life-threatening conditions and uphold professional standards within intensive
care units.
SECTION ONE: QUESTIONS 1–100
1. A patient with a pulmonary artery catheter has a pulmonary artery wedge pressure (PAWP) of 22 mmHg.
Which clinical finding should the nurse expect?
A. Dehydration
B. Clinical signs of hypovolemia
C. Bilateral crackles in the lungs
D. Increased cardiac output
🟢 Correct answer: C. Bilateral crackles in the lungs
,🔴 RATIONALE: A PAWP of 22 mmHg indicates fluid volume overload or left ventricular failure. Normal PAWP
ranges from 6–12 mmHg. Elevated pressures lead to pulmonary congestion, manifesting as crackles.
2. A patient in the ICU is diagnosed with Septic Shock. Which MAP (Mean Arterial Pressure) is the minimum
goal for ensuring adequate organ perfusion?
A. 50 mmHg
B. 65 mmHg
C. 80 mmHg
D. 95 mmHg
🟢 Correct answer: B. 65 mmHg
🔴 RATIONALE: Current Surviving Sepsis Guidelines recommend maintaining a MAP of at least 65 mmHg to
ensure sufficient tissue perfusion to vital organs during shock states.
3. Which of the following ECG rhythms is a "shockable" rhythm in the context of ACLS pulseless arrest?
A. Asystole
B. Pulseless Electrical Activity (PEA)
C. Ventricular Fibrillation
D. Normal Sinus Rhythm
🟢 Correct answer: C. Ventricular Fibrillation
🔴 RATIONALE: Defibrillation is indicated for Ventricular Fibrillation and pulseless Ventricular Tachycardia.
Asystole and PEA are managed with CPR and epinephrine but are not shockable rhythms.
4. A patient on a mechanical ventilator is fighting the breaths, and the high-pressure alarm is sounding. What
is the nurse's first action?
A. Increase the sedation dosage
B. Check the tubing for kinks or secretions
,C. Disconnect the patient and use a manual resuscitator
D. Change the ventilator settings
🟢 Correct answer: B. Check the tubing for kinks or secretions
🔴 RATIONALE: The first step in troubleshooting a high-pressure alarm is to assess for simple obstructions like
kinks, patient biting the tube, or the need for suctioning.
5. When assessing a patient with a traumatic brain injury, the nurse notes a Glasgow Coma Scale (GCS)
score of 7. What is the priority intervention?
A. Administering IV fluids
B. Preparing for endotracheal intubation
C. Assessing pupillary reaction
D. Checking blood glucose levels
🟢 Correct answer: B. Preparing for endotracheal intubation
🔴 RATIONALE: A GCS score of 8 or less generally indicates that the patient cannot maintain a patent airway
or protect it from aspiration, necessitating intubation ("Less than 8, intubate").
6. A patient is receiving a dopamine infusion at 15 mcg/kg/min. Which physiological effect is the nurse
primarily monitoring for at this dosage?
A. Renal vasodilation
B. Increased heart rate
C. Systemic vasoconstriction
D. Bronchodilation
🟢 Correct answer: C. Systemic vasoconstriction
🔴 RATIONALE: High-dose dopamine (greater than 10 mcg/kg/min) acts primarily on alpha-adrenergic
receptors, causing systemic vasoconstriction to increase blood pressure.
, 7. Which lab value is most indicative of the onset of Disseminated Intravascular Coagulation (DIC)?
A. Decreased D-dimer
B. Increased Fibrinogen
C. Prolonged Prothrombin Time (PT)
D. Increased Platelet count
🟢 Correct answer: C. Prolonged Prothrombin Time (PT)
🔴 RATIONALE: DIC is characterized by the depletion of clotting factors, leading to prolonged PT/PTT times,
decreased fibrinogen, decreased platelets, and elevated D-dimer levels.
8. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed in the prone position. What is the
primary rationale for this intervention?
A. To prevent pressure ulcers
B. To improve recruitment of posterior lung segments
C. To decrease the patient's work of breathing
D. To facilitate easier suctioning
🟢 Correct answer: B. To improve recruitment of posterior lung segments
🔴 RATIONALE: Prone positioning helps redistribute pulmonary edema and improves oxygenation by
recruiting collapsed alveoli in the dorsal (posterior) areas of the lungs.
9. Following a carotid endarterectomy, the nurse notes a midline shift in the trachea and respiratory distress.
What is the priority action?
A. Apply a high-flow oxygen mask
B. Notify the surgical team immediately
C. Start a bolus of IV fluids
D. Elevate the head of the bed to 90 degrees
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
• Hemodynamic Monitoring and Management• Advanced Cardiac Life Support (ACLS)• Ventilatory Support and
Respiratory Failure• Neurological Emergencies and ICP Management• Renal Replacement Therapy and
Electrolyte Imbalances• Multisystem Organ Failure and Sepsis Protocols• End-of-Life Care and Ethical Decision
Making• Pharmacological Interventions in Critical Care
INTRODUCTION
The HESI Critical Care Exam serves as a comprehensive assessment tool designed to evaluate the clinical
proficiency and decision-making capabilities of nursing students in high-acuity environments. This exam
focuses on the integration of complex physiological data and the application of evidence-based interventions for
critically ill patients. Assessment areas include advanced hemodynamics, respiratory failure, and multisystem
trauma. Utilizing a mix of foundational theory and scenario-based questions, the exam emphasizes real-world
application, prioritizing patient safety and rapid intervention. This assessment ensures that candidates possess
the necessary skills to manage life-threatening conditions and uphold professional standards within intensive
care units.
SECTION ONE: QUESTIONS 1–100
1. A patient with a pulmonary artery catheter has a pulmonary artery wedge pressure (PAWP) of 22 mmHg.
Which clinical finding should the nurse expect?
A. Dehydration
B. Clinical signs of hypovolemia
C. Bilateral crackles in the lungs
D. Increased cardiac output
🟢 Correct answer: C. Bilateral crackles in the lungs
,🔴 RATIONALE: A PAWP of 22 mmHg indicates fluid volume overload or left ventricular failure. Normal PAWP
ranges from 6–12 mmHg. Elevated pressures lead to pulmonary congestion, manifesting as crackles.
2. A patient in the ICU is diagnosed with Septic Shock. Which MAP (Mean Arterial Pressure) is the minimum
goal for ensuring adequate organ perfusion?
A. 50 mmHg
B. 65 mmHg
C. 80 mmHg
D. 95 mmHg
🟢 Correct answer: B. 65 mmHg
🔴 RATIONALE: Current Surviving Sepsis Guidelines recommend maintaining a MAP of at least 65 mmHg to
ensure sufficient tissue perfusion to vital organs during shock states.
3. Which of the following ECG rhythms is a "shockable" rhythm in the context of ACLS pulseless arrest?
A. Asystole
B. Pulseless Electrical Activity (PEA)
C. Ventricular Fibrillation
D. Normal Sinus Rhythm
🟢 Correct answer: C. Ventricular Fibrillation
🔴 RATIONALE: Defibrillation is indicated for Ventricular Fibrillation and pulseless Ventricular Tachycardia.
Asystole and PEA are managed with CPR and epinephrine but are not shockable rhythms.
4. A patient on a mechanical ventilator is fighting the breaths, and the high-pressure alarm is sounding. What
is the nurse's first action?
A. Increase the sedation dosage
B. Check the tubing for kinks or secretions
,C. Disconnect the patient and use a manual resuscitator
D. Change the ventilator settings
🟢 Correct answer: B. Check the tubing for kinks or secretions
🔴 RATIONALE: The first step in troubleshooting a high-pressure alarm is to assess for simple obstructions like
kinks, patient biting the tube, or the need for suctioning.
5. When assessing a patient with a traumatic brain injury, the nurse notes a Glasgow Coma Scale (GCS)
score of 7. What is the priority intervention?
A. Administering IV fluids
B. Preparing for endotracheal intubation
C. Assessing pupillary reaction
D. Checking blood glucose levels
🟢 Correct answer: B. Preparing for endotracheal intubation
🔴 RATIONALE: A GCS score of 8 or less generally indicates that the patient cannot maintain a patent airway
or protect it from aspiration, necessitating intubation ("Less than 8, intubate").
6. A patient is receiving a dopamine infusion at 15 mcg/kg/min. Which physiological effect is the nurse
primarily monitoring for at this dosage?
A. Renal vasodilation
B. Increased heart rate
C. Systemic vasoconstriction
D. Bronchodilation
🟢 Correct answer: C. Systemic vasoconstriction
🔴 RATIONALE: High-dose dopamine (greater than 10 mcg/kg/min) acts primarily on alpha-adrenergic
receptors, causing systemic vasoconstriction to increase blood pressure.
, 7. Which lab value is most indicative of the onset of Disseminated Intravascular Coagulation (DIC)?
A. Decreased D-dimer
B. Increased Fibrinogen
C. Prolonged Prothrombin Time (PT)
D. Increased Platelet count
🟢 Correct answer: C. Prolonged Prothrombin Time (PT)
🔴 RATIONALE: DIC is characterized by the depletion of clotting factors, leading to prolonged PT/PTT times,
decreased fibrinogen, decreased platelets, and elevated D-dimer levels.
8. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed in the prone position. What is the
primary rationale for this intervention?
A. To prevent pressure ulcers
B. To improve recruitment of posterior lung segments
C. To decrease the patient's work of breathing
D. To facilitate easier suctioning
🟢 Correct answer: B. To improve recruitment of posterior lung segments
🔴 RATIONALE: Prone positioning helps redistribute pulmonary edema and improves oxygenation by
recruiting collapsed alveoli in the dorsal (posterior) areas of the lungs.
9. Following a carotid endarterectomy, the nurse notes a midline shift in the trachea and respiratory distress.
What is the priority action?
A. Apply a high-flow oxygen mask
B. Notify the surgical team immediately
C. Start a bolus of IV fluids
D. Elevate the head of the bed to 90 degrees
