HESI RN Critical Care Exam
Preparation Guide 2025/2026 -
Comprehensive Test Bank based on
Introduction to Critical Care Nursing
8th Edition by Mary Lou Sole,
Deborah G. Klein, and Marthe J.
Moseley -100 Expert-Verified Q&A
with In-Depth Rationales.
**1. A client with acute decompensated heart failure (ADHF) presents
with dyspnea, crackles in all lung fields, and an SpO2 of 88% on room
air. What is the nurse's priority intervention?**
A) Administer furosemide 40 mg IV push.
B) Place the client in a high Fowler's position.
C) Apply supplemental oxygen via non-rebreather mask.
D) Start a continuous infusion of milrinone.
,**Answer:** C) Apply supplemental oxygen via non-rebreather mask.
**Rationale:** Airway and breathing are always the first priorities.
Hypoxemia (SpO2 < 90%) must be corrected immediately to prevent
tissue hypoxia. Positioning (B) and diuretics (A) are important but
secondary to oxygenation. Milrinone (D) is not first-line therapy.
**2. A client is receiving a nitroglycerin infusion for acute coronary
syndrome. The bag contains 100 mg in 500 mL of D5W, and the rate is 6
mL/hr. How many mcg/min is the client receiving?**
A) 10 mcg/min
B) 20 mcg/min
C) 30 mcg/min
D) 40 mcg/min
**Answer:** B) 20 mcg/min.
**Rationale:** First, calculate concentration: 100 mg / 500 mL = 0.2
mg/mL = 200 mcg/mL. Then, calculate dose: 6 mL/hr x 200 mcg/mL =
1200 mcg/hr. Finally, convert to minutes: 1200 mcg/hr / 60 min/hr = 20
mcg/min .
**3. A patient with a pulmonary artery catheter has a cardiac index (CI)
of 1.6 L/min/m², a PAWP of 22 mmHg, and an SVR of 2,200
dynes·sec/cm⁵. Which condition is most consistent with these
findings?**
A) Hypovolemic shock
B) Distributive shock
,C) Cardiogenic shock
D) Obstructive shock
**Answer:** C) Cardiogenic shock.
**Rationale:** This combination indicates pump failure. Low CI (< 2.2)
signifies low cardiac output. High PAWP (> 18) indicates fluid backup
into the lungs (left heart failure). High SVR (> 1200) reflects
compensatory vasoconstriction .
**4. The nurse suspects a client with a central venous catheter in the
left subclavian vein is experiencing an air embolism. Which signs and
symptoms are most indicative?**
A) Bradycardia and hypertension
B) Sudden onset of chest pain and productive cough
C) Anxiety, confusion, lightheadedness, and loss of consciousness
D) Peripheral edema and jugular vein distention
**Answer:** C) Anxiety, confusion, lightheadedness, and loss of
consciousness.
**Rationale:** An air embolism obstructs pulmonary blood flow,
leading to a rapid decrease in cardiac output and impaired cerebral
perfusion. This results in neurological symptoms such as confusion and
syncope. A cough may be present, but neurological changes are the
hallmark of significant emboli .
, **5. A client with a left ventricular assist device (LVAD) has a low-flow
alarm and a mean arterial pressure (MAP) of 55 mmHg. What is the
most appropriate action?**
A) Immediately start CPR.
B) Administer a fluid bolus if prescribed.
C) Check the driveline connection.
D) Call the LVAD coordinator.
**Answer:** C) Check the driveline connection.
**Rationale:** The alarm and low MAP indicate a mechanical issue or
hypovolemia. The nurse should quickly troubleshoot by checking the
driveline connection to ensure it is secure. If that does not resolve it,
fluids or vasopressors may be needed, but checking the connection is
the immediate first step .
**6. For a client in asystole for 20 minutes who has received
epinephrine and atropine with no change, what intervention should the
nurse implement?**
A) Discontinue resuscitation efforts unilaterally.
B) Increase the epinephrine dose to 5 mg.
C) Bring the family to a private area to discuss the continuation of
efforts.
D) Prepare for emergency thoracotomy.
**Answer:** C) Bring the family to a private area to discuss the
continuation of efforts.
Preparation Guide 2025/2026 -
Comprehensive Test Bank based on
Introduction to Critical Care Nursing
8th Edition by Mary Lou Sole,
Deborah G. Klein, and Marthe J.
Moseley -100 Expert-Verified Q&A
with In-Depth Rationales.
**1. A client with acute decompensated heart failure (ADHF) presents
with dyspnea, crackles in all lung fields, and an SpO2 of 88% on room
air. What is the nurse's priority intervention?**
A) Administer furosemide 40 mg IV push.
B) Place the client in a high Fowler's position.
C) Apply supplemental oxygen via non-rebreather mask.
D) Start a continuous infusion of milrinone.
,**Answer:** C) Apply supplemental oxygen via non-rebreather mask.
**Rationale:** Airway and breathing are always the first priorities.
Hypoxemia (SpO2 < 90%) must be corrected immediately to prevent
tissue hypoxia. Positioning (B) and diuretics (A) are important but
secondary to oxygenation. Milrinone (D) is not first-line therapy.
**2. A client is receiving a nitroglycerin infusion for acute coronary
syndrome. The bag contains 100 mg in 500 mL of D5W, and the rate is 6
mL/hr. How many mcg/min is the client receiving?**
A) 10 mcg/min
B) 20 mcg/min
C) 30 mcg/min
D) 40 mcg/min
**Answer:** B) 20 mcg/min.
**Rationale:** First, calculate concentration: 100 mg / 500 mL = 0.2
mg/mL = 200 mcg/mL. Then, calculate dose: 6 mL/hr x 200 mcg/mL =
1200 mcg/hr. Finally, convert to minutes: 1200 mcg/hr / 60 min/hr = 20
mcg/min .
**3. A patient with a pulmonary artery catheter has a cardiac index (CI)
of 1.6 L/min/m², a PAWP of 22 mmHg, and an SVR of 2,200
dynes·sec/cm⁵. Which condition is most consistent with these
findings?**
A) Hypovolemic shock
B) Distributive shock
,C) Cardiogenic shock
D) Obstructive shock
**Answer:** C) Cardiogenic shock.
**Rationale:** This combination indicates pump failure. Low CI (< 2.2)
signifies low cardiac output. High PAWP (> 18) indicates fluid backup
into the lungs (left heart failure). High SVR (> 1200) reflects
compensatory vasoconstriction .
**4. The nurse suspects a client with a central venous catheter in the
left subclavian vein is experiencing an air embolism. Which signs and
symptoms are most indicative?**
A) Bradycardia and hypertension
B) Sudden onset of chest pain and productive cough
C) Anxiety, confusion, lightheadedness, and loss of consciousness
D) Peripheral edema and jugular vein distention
**Answer:** C) Anxiety, confusion, lightheadedness, and loss of
consciousness.
**Rationale:** An air embolism obstructs pulmonary blood flow,
leading to a rapid decrease in cardiac output and impaired cerebral
perfusion. This results in neurological symptoms such as confusion and
syncope. A cough may be present, but neurological changes are the
hallmark of significant emboli .
, **5. A client with a left ventricular assist device (LVAD) has a low-flow
alarm and a mean arterial pressure (MAP) of 55 mmHg. What is the
most appropriate action?**
A) Immediately start CPR.
B) Administer a fluid bolus if prescribed.
C) Check the driveline connection.
D) Call the LVAD coordinator.
**Answer:** C) Check the driveline connection.
**Rationale:** The alarm and low MAP indicate a mechanical issue or
hypovolemia. The nurse should quickly troubleshoot by checking the
driveline connection to ensure it is secure. If that does not resolve it,
fluids or vasopressors may be needed, but checking the connection is
the immediate first step .
**6. For a client in asystole for 20 minutes who has received
epinephrine and atropine with no change, what intervention should the
nurse implement?**
A) Discontinue resuscitation efforts unilaterally.
B) Increase the epinephrine dose to 5 mg.
C) Bring the family to a private area to discuss the continuation of
efforts.
D) Prepare for emergency thoracotomy.
**Answer:** C) Bring the family to a private area to discuss the
continuation of efforts.
