HESI Critical Care Exam V1 | 2026 Q&A
with Rationale (HESI Critical Care Exam
2026)
1. A patient in the intensive care unit (ICU) is on a ventilator and the high-pressure alarm
sounds. Which action should the nurse take first?
A. Suction the patient’s airway for secretions.
B. Check for kinks or obstructions in the ventilator tubing.
C. Increase the oxygen concentration to 100%.
D. Assess the patient’s oxygen saturation level.
Correct Answer: B
Rationale: The first action should be to quickly identify and resolve the cause of the alarm.
Checking for kinks in the tubing is a rapid assessment that can immediately resolve high
pressure. If the tubing is clear, the nurse should then assess the patient’s breath sounds and
the need for suctioning.
2. A patient with septic shock has a blood pressure of 82/46 mmHg and a Central Venous
Pressure (CVP) of 2 mmHg. Which order should the nurse implement first?
A. Administer Norepinephrine infusion.
B. Administer broad-spectrum antibiotics.
C. Obtain blood and urine cultures.
,D. Start a rapid infusion of 0.9% Normal Saline.
Correct Answer: D
Rationale: In the initial resuscitation of septic shock, fluid resuscitation is the priority to
improve preload and cardiac output. A CVP of 2 mmHg indicates significant hypovolemia.
Once the intravascular volume is being replaced, vasopressors and antibiotics can be
initiated.
3. A nurse is caring for a patient with increased intracranial pressure (ICP) following a
traumatic brain injury. Which nursing intervention is most appropriate to minimize ICP?
A. Keep the neck in a flexed position to promote drainage.
B. Perform frequent cluster care to allow for rest periods.
C. Maintain the head of the bed at 30 to 45 degrees.
D. Suction the patient every hour to maintain airway patency.
Correct Answer: C
Rationale: Elevating the head of the bed to 30-45 degrees promotes venous drainage from
the brain and helps reduce ICP. Neck flexion should be avoided as it can obstruct venous
outflow. Cluster care and frequent suctioning can actually increase ICP and should be
limited to necessary instances only.
4. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). Which ventilator
setting should the nurse expect to be utilized to improve oxygenation?
A. Increased Positive End-Expiratory Pressure (PEEP)
, B. Decreased Tidal Volume (Vt)
C. Reduced Fraction of Inspired Oxygen (FiO2)
D. Increased Inspiratory Flow Rate
Correct Answer: A
Rationale: PEEP helps keep alveoli open at the end of expiration, which improves gas
exchange in patients with ARDS. High PEEP levels are often required to manage the
shunting and alveolar collapse associated with this condition. While low tidal volumes are
also used to prevent lung injury, PEEP is the primary setting to specifically improve
oxygenation.
5. The nurse notes the following Arterial Blood Gas (ABG) results: pH 7.28, PaCO2 55 mmHg,
HCO3 26 mEq/L. How should the nurse interpret these findings?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Correct Answer: A
Rationale: A pH below 7.35 indicates acidosis. The PaCO2 is elevated (above 45 mmHg),
which is the primary cause of the low pH, indicating a respiratory origin. The bicarbonate
(HCO3) is within the normal range, suggesting no compensation has occurred yet.
with Rationale (HESI Critical Care Exam
2026)
1. A patient in the intensive care unit (ICU) is on a ventilator and the high-pressure alarm
sounds. Which action should the nurse take first?
A. Suction the patient’s airway for secretions.
B. Check for kinks or obstructions in the ventilator tubing.
C. Increase the oxygen concentration to 100%.
D. Assess the patient’s oxygen saturation level.
Correct Answer: B
Rationale: The first action should be to quickly identify and resolve the cause of the alarm.
Checking for kinks in the tubing is a rapid assessment that can immediately resolve high
pressure. If the tubing is clear, the nurse should then assess the patient’s breath sounds and
the need for suctioning.
2. A patient with septic shock has a blood pressure of 82/46 mmHg and a Central Venous
Pressure (CVP) of 2 mmHg. Which order should the nurse implement first?
A. Administer Norepinephrine infusion.
B. Administer broad-spectrum antibiotics.
C. Obtain blood and urine cultures.
,D. Start a rapid infusion of 0.9% Normal Saline.
Correct Answer: D
Rationale: In the initial resuscitation of septic shock, fluid resuscitation is the priority to
improve preload and cardiac output. A CVP of 2 mmHg indicates significant hypovolemia.
Once the intravascular volume is being replaced, vasopressors and antibiotics can be
initiated.
3. A nurse is caring for a patient with increased intracranial pressure (ICP) following a
traumatic brain injury. Which nursing intervention is most appropriate to minimize ICP?
A. Keep the neck in a flexed position to promote drainage.
B. Perform frequent cluster care to allow for rest periods.
C. Maintain the head of the bed at 30 to 45 degrees.
D. Suction the patient every hour to maintain airway patency.
Correct Answer: C
Rationale: Elevating the head of the bed to 30-45 degrees promotes venous drainage from
the brain and helps reduce ICP. Neck flexion should be avoided as it can obstruct venous
outflow. Cluster care and frequent suctioning can actually increase ICP and should be
limited to necessary instances only.
4. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). Which ventilator
setting should the nurse expect to be utilized to improve oxygenation?
A. Increased Positive End-Expiratory Pressure (PEEP)
, B. Decreased Tidal Volume (Vt)
C. Reduced Fraction of Inspired Oxygen (FiO2)
D. Increased Inspiratory Flow Rate
Correct Answer: A
Rationale: PEEP helps keep alveoli open at the end of expiration, which improves gas
exchange in patients with ARDS. High PEEP levels are often required to manage the
shunting and alveolar collapse associated with this condition. While low tidal volumes are
also used to prevent lung injury, PEEP is the primary setting to specifically improve
oxygenation.
5. The nurse notes the following Arterial Blood Gas (ABG) results: pH 7.28, PaCO2 55 mmHg,
HCO3 26 mEq/L. How should the nurse interpret these findings?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Correct Answer: A
Rationale: A pH below 7.35 indicates acidosis. The PaCO2 is elevated (above 45 mmHg),
which is the primary cause of the low pH, indicating a respiratory origin. The bicarbonate
(HCO3) is within the normal range, suggesting no compensation has occurred yet.
