HESI Critical Care Exam V2 | 2026 Q&A
with Rationale (HESI Critical Care Exam
2026)
1. A client in the ICU is being treated for Acute Respiratory Distress Syndrome (ARDS) and is
currently on mechanical ventilation with a high PEEP setting. Which assessment finding
should the nurse prioritize as a potential complication of high PEEP?
A. Increased urine output
B. Respiratory alkalosis on ABG
C. Decreased cardiac output and hypotension
D. Hyperactive bowel sounds
Correct Answer: C
Rationale: High Positive End-Expiratory Pressure (PEEP) increases intrathoracic pressure,
which can decrease venous return to the heart. This reduction in preload leads to a
decrease in cardiac output and subsequent hypotension. The nurse must monitor
hemodynamic stability closely when PEEP levels are elevated.
2. The nurse is caring for a client with a pulmonary artery catheter. The current pulmonary
artery wedge pressure (PAWP) is 22 mmHg. Which intervention should the nurse anticipate?
A. Administration of a 500 mL bolus of Normal Saline
B. Increasing the IV maintenance fluid rate
,C. Administration of a diuretic like Furosemide
D. Placing the patient in Trendelenburg position
Correct Answer: C
Rationale: A normal PAWP ranges from 6 to 12 mmHg; a reading of 22 mmHg indicates
left ventricular fluid volume overload or heart failure. Diuretics are typically administered
to reduce preload and decrease the pressure in the left atrium. The nurse should also
assess for clinical signs of pulmonary edema.
3. A client with a traumatic brain injury has an intracranial pressure (ICP) of 25 mmHg. Which
nursing action is most appropriate to help lower the ICP?
A. Maintain the head of the bed at 30 to 45 degrees
B. Cluster nursing care to allow for longer rest periods
C. Encourage the client to cough and deep breathe
D. Perform frequent endotracheal suctioning
Correct Answer: A
Rationale: Elevating the head of the bed to 30-45 degrees promotes venous drainage from
the brain, which helps reduce intracranial pressure. Clustering care can actually lead to
sustained elevations in ICP due to prolonged stimulation. Suctioning and coughing should
be minimized as they significantly increase intrathoracic and intracranial pressure.
, 4. The nurse is monitoring a client in the early stages of septic shock. Which clinical
manifestation is most characteristic of the ‘warm’ phase of sepsis?
A. Increased cardiac output and tachycardia
B. Cool, clammy skin
C. Decreased urinary output
D. Bradycardia and hypotension
Correct Answer: A
Rationale: In the early (hyperdynamic) or ‘warm’ phase of septic shock, the body
compensates for vasodilation with an increase in cardiac output. Patients typically present
with tachycardia, warm/flushed skin, and a normal or slightly low blood pressure. As the
shock progresses to the ‘cold’ phase, cardiac output falls and skin becomes cool.
5. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a blood glucose of
450 mg/dL and the presence of Kussmaul respirations. What is the primary physiological
purpose of Kussmaul respirations?
A. To increase oxygen saturation in the blood
B. To facilitate the excretion of glucose through the lungs
C. To reduce the workload of the diaphragm
D. To compensate for metabolic acidosis by blowing off CO2
Correct Answer: D
with Rationale (HESI Critical Care Exam
2026)
1. A client in the ICU is being treated for Acute Respiratory Distress Syndrome (ARDS) and is
currently on mechanical ventilation with a high PEEP setting. Which assessment finding
should the nurse prioritize as a potential complication of high PEEP?
A. Increased urine output
B. Respiratory alkalosis on ABG
C. Decreased cardiac output and hypotension
D. Hyperactive bowel sounds
Correct Answer: C
Rationale: High Positive End-Expiratory Pressure (PEEP) increases intrathoracic pressure,
which can decrease venous return to the heart. This reduction in preload leads to a
decrease in cardiac output and subsequent hypotension. The nurse must monitor
hemodynamic stability closely when PEEP levels are elevated.
2. The nurse is caring for a client with a pulmonary artery catheter. The current pulmonary
artery wedge pressure (PAWP) is 22 mmHg. Which intervention should the nurse anticipate?
A. Administration of a 500 mL bolus of Normal Saline
B. Increasing the IV maintenance fluid rate
,C. Administration of a diuretic like Furosemide
D. Placing the patient in Trendelenburg position
Correct Answer: C
Rationale: A normal PAWP ranges from 6 to 12 mmHg; a reading of 22 mmHg indicates
left ventricular fluid volume overload or heart failure. Diuretics are typically administered
to reduce preload and decrease the pressure in the left atrium. The nurse should also
assess for clinical signs of pulmonary edema.
3. A client with a traumatic brain injury has an intracranial pressure (ICP) of 25 mmHg. Which
nursing action is most appropriate to help lower the ICP?
A. Maintain the head of the bed at 30 to 45 degrees
B. Cluster nursing care to allow for longer rest periods
C. Encourage the client to cough and deep breathe
D. Perform frequent endotracheal suctioning
Correct Answer: A
Rationale: Elevating the head of the bed to 30-45 degrees promotes venous drainage from
the brain, which helps reduce intracranial pressure. Clustering care can actually lead to
sustained elevations in ICP due to prolonged stimulation. Suctioning and coughing should
be minimized as they significantly increase intrathoracic and intracranial pressure.
, 4. The nurse is monitoring a client in the early stages of septic shock. Which clinical
manifestation is most characteristic of the ‘warm’ phase of sepsis?
A. Increased cardiac output and tachycardia
B. Cool, clammy skin
C. Decreased urinary output
D. Bradycardia and hypotension
Correct Answer: A
Rationale: In the early (hyperdynamic) or ‘warm’ phase of septic shock, the body
compensates for vasodilation with an increase in cardiac output. Patients typically present
with tachycardia, warm/flushed skin, and a normal or slightly low blood pressure. As the
shock progresses to the ‘cold’ phase, cardiac output falls and skin becomes cool.
5. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a blood glucose of
450 mg/dL and the presence of Kussmaul respirations. What is the primary physiological
purpose of Kussmaul respirations?
A. To increase oxygen saturation in the blood
B. To facilitate the excretion of glucose through the lungs
C. To reduce the workload of the diaphragm
D. To compensate for metabolic acidosis by blowing off CO2
Correct Answer: D
