HESI CRITICAL CARE EXAM – NEXT
GENERATION NCLEX (2026 EDITION) 200
Questions | Answers & Rationales
Exam blueprint:
Hemodynamics & Shock (20%)
Respiratory Critical Care (15%)
Cardiovascular Critical Care (15%)
Neurologic Critical Care (15%)
Renal/Metabolic/Endocrine (10%)
Multisystem & Sepsis (10%)
Gastrointestinal/Hepatic (5%)
Hematology/Oncology Emergencies (5%)
Legal/Ethical & Professional Issues (5%)
Time limit (simulated): 4 hours
Passing threshold: 70% (140/200)
NGN item types included: multiple choice, select all that apply, ordered
response, hot spot, drag and drop, and case study (bow-tie).
SECTION 1: HEMODYNAMICS & SHOCK (40 Questions)
1. A client with septic shock has a blood pressure of 78/45 mmHg, heart rate
125, central venous pressure (CVP) 4 mmHg, and urine output 15 mL/hour.
Which intervention should the nurse implement first?
A) Administer norepinephrine
,B) Administer a 500 mL IV fluid bolus
C) Obtain blood cultures
D) Administer broad-spectrum antibiotics
Answer: B
Rationale: Septic shock: initial fluid resuscitation (30 mL/kg crystalloid)
before vasopressors unless severe cardiac dysfunction.
2. A client in hypovolemic shock has a pulmonary artery occlusion pressure
(PAOP) of 3 mmHg (normal 6–12). Which finding is expected?
A) Decreased CVP, decreased urine output, tachycardia
B) Increased CVP, decreased urine output
C) Increased PAOP, crackles
D) Jugular venous distention (JVD)
Answer: A
Rationale: Hypovolemic shock: low preload (low CVP, low PAOP), low urine
output, tachycardia.
3. A client with cardiogenic shock has a PAOP of 24 mmHg, cardiac index
(CI) of 1.6 L/min/m² (normal >2.2), and systemic vascular resistance (SVR) of
1400 dynes/sec/cm⁻⁵ (high). Which medication does the nurse anticipate?
A) Dobutamine (positive inotrope)
B) Norepinephrine
C) Phenylephrine
D) IV fluids
Answer: A
Rationale: Cardiogenic shock with low CI and high afterload/SVR:
dobutamine or milrinone (inotropes ± vasodilators).
,4. A client in distributive shock (septic) has a CVP of 4 mmHg, CI of 3.5
(normal/high), and SVR of 400 dynes/sec/cm⁻⁵ (very low). Which
vasopressor is first-line?
A) Norepinephrine
B) Phenylephrine
C) Vasopressin
D) Epinephrine
Answer: A
Rationale: Septic shock: norepinephrine is first-line vasopressor (alpha +
beta effects).
5. A client with an arterial line has a dampened waveform. Which action
should the nurse take first?
A) Zero the transducer
B) Check for air bubbles or kinks; perform fast flush test
C) Replace the transducer
D) Document as normal variation
Answer: B
Rationale: Dampened waveform: check for air, clots, kinks; flush system;
level/zero transducer.
6. A client in shock has a lactate level of 6 mmol/L (normal <2). The nurse
understands that elevated lactate indicates?
A) Tissue hypoperfusion (anaerobic metabolism)
B) Adequate resuscitation
C) Liver failure
D) Respiratory alkalosis
Answer: A
, Rationale: Hyperlactatemia reflects inadequate tissue oxygenation; target
lactate clearance >10% in septic shock.
7. A client with hemorrhagic shock receives blood transfusion. Which
finding indicates a transfusion reaction?
A) Fever, hypotension, dark urine (hemolytic reaction)
B) Mild urticaria
C) Slight temperature rise to 37.8°C (100.0°F)
D) Pain at IV site only
Answer: A
Rationale: Hemolytic transfusion reaction: fever, hypotension,
hemoglobinuria, back pain; stop transfusion immediately.
8. A client with a pulmonary artery catheter has a mixed venous oxygen
saturation (SvO₂) of 50% (normal 60–80%). Which condition is most likely?
A) Increased oxygen extraction (low SvO₂ = poor cardiac output or increased
demand)
B) Decreased oxygen extraction (sepsis, shunting)
C) Normal
D) Hyperoxia
Answer: A
Rationale: Low SvO₂ (<60%) indicates inadequate oxygen delivery or
increased consumption (shock, heart failure).
9. A client with septic shock has been resuscitated with 3 L of crystalloid and
started on norepinephrine. The MAP is 58 mmHg. Which action should the
nurse take?
A) Increase norepinephrine dose (target MAP ≥65)
B) Give another fluid bolus
C) Add vasopressin
GENERATION NCLEX (2026 EDITION) 200
Questions | Answers & Rationales
Exam blueprint:
Hemodynamics & Shock (20%)
Respiratory Critical Care (15%)
Cardiovascular Critical Care (15%)
Neurologic Critical Care (15%)
Renal/Metabolic/Endocrine (10%)
Multisystem & Sepsis (10%)
Gastrointestinal/Hepatic (5%)
Hematology/Oncology Emergencies (5%)
Legal/Ethical & Professional Issues (5%)
Time limit (simulated): 4 hours
Passing threshold: 70% (140/200)
NGN item types included: multiple choice, select all that apply, ordered
response, hot spot, drag and drop, and case study (bow-tie).
SECTION 1: HEMODYNAMICS & SHOCK (40 Questions)
1. A client with septic shock has a blood pressure of 78/45 mmHg, heart rate
125, central venous pressure (CVP) 4 mmHg, and urine output 15 mL/hour.
Which intervention should the nurse implement first?
A) Administer norepinephrine
,B) Administer a 500 mL IV fluid bolus
C) Obtain blood cultures
D) Administer broad-spectrum antibiotics
Answer: B
Rationale: Septic shock: initial fluid resuscitation (30 mL/kg crystalloid)
before vasopressors unless severe cardiac dysfunction.
2. A client in hypovolemic shock has a pulmonary artery occlusion pressure
(PAOP) of 3 mmHg (normal 6–12). Which finding is expected?
A) Decreased CVP, decreased urine output, tachycardia
B) Increased CVP, decreased urine output
C) Increased PAOP, crackles
D) Jugular venous distention (JVD)
Answer: A
Rationale: Hypovolemic shock: low preload (low CVP, low PAOP), low urine
output, tachycardia.
3. A client with cardiogenic shock has a PAOP of 24 mmHg, cardiac index
(CI) of 1.6 L/min/m² (normal >2.2), and systemic vascular resistance (SVR) of
1400 dynes/sec/cm⁻⁵ (high). Which medication does the nurse anticipate?
A) Dobutamine (positive inotrope)
B) Norepinephrine
C) Phenylephrine
D) IV fluids
Answer: A
Rationale: Cardiogenic shock with low CI and high afterload/SVR:
dobutamine or milrinone (inotropes ± vasodilators).
,4. A client in distributive shock (septic) has a CVP of 4 mmHg, CI of 3.5
(normal/high), and SVR of 400 dynes/sec/cm⁻⁵ (very low). Which
vasopressor is first-line?
A) Norepinephrine
B) Phenylephrine
C) Vasopressin
D) Epinephrine
Answer: A
Rationale: Septic shock: norepinephrine is first-line vasopressor (alpha +
beta effects).
5. A client with an arterial line has a dampened waveform. Which action
should the nurse take first?
A) Zero the transducer
B) Check for air bubbles or kinks; perform fast flush test
C) Replace the transducer
D) Document as normal variation
Answer: B
Rationale: Dampened waveform: check for air, clots, kinks; flush system;
level/zero transducer.
6. A client in shock has a lactate level of 6 mmol/L (normal <2). The nurse
understands that elevated lactate indicates?
A) Tissue hypoperfusion (anaerobic metabolism)
B) Adequate resuscitation
C) Liver failure
D) Respiratory alkalosis
Answer: A
, Rationale: Hyperlactatemia reflects inadequate tissue oxygenation; target
lactate clearance >10% in septic shock.
7. A client with hemorrhagic shock receives blood transfusion. Which
finding indicates a transfusion reaction?
A) Fever, hypotension, dark urine (hemolytic reaction)
B) Mild urticaria
C) Slight temperature rise to 37.8°C (100.0°F)
D) Pain at IV site only
Answer: A
Rationale: Hemolytic transfusion reaction: fever, hypotension,
hemoglobinuria, back pain; stop transfusion immediately.
8. A client with a pulmonary artery catheter has a mixed venous oxygen
saturation (SvO₂) of 50% (normal 60–80%). Which condition is most likely?
A) Increased oxygen extraction (low SvO₂ = poor cardiac output or increased
demand)
B) Decreased oxygen extraction (sepsis, shunting)
C) Normal
D) Hyperoxia
Answer: A
Rationale: Low SvO₂ (<60%) indicates inadequate oxygen delivery or
increased consumption (shock, heart failure).
9. A client with septic shock has been resuscitated with 3 L of crystalloid and
started on norepinephrine. The MAP is 58 mmHg. Which action should the
nurse take?
A) Increase norepinephrine dose (target MAP ≥65)
B) Give another fluid bolus
C) Add vasopressin
