2026 CRITICAL CARE HESI EXIT EXAM 400 QUESTIONS AND
CORRECT ANSWERS (100% VERIFIED) WITH RATIONALE
LATEST UPDATE ALREADY GRADED A+
This comprehensive study guide contains **400 expertly crafted practice
questions** with **detailed, evidence-based rationales** designed to prepare
nursing students and healthcare professionals for the Critical Care HESI Exit
Exam. Covering essential critical care topics including hemodynamic
monitoring, mechanical ventilation, cardiac arrhythmias, shock states, and
emergency interventions, this resource provides realistic clinical scenarios
that mirror the actual exam format. Each question includes four multiple-
choice options, the correct answer, and a thorough rationale explaining the
underlying pathophysiology and clinical reasoning. Perfect for self-study, this
guide builds clinical judgment and confidence. Ideal for nursing students, new
graduates, and critical care nurses preparing for certification or the HESI
Exit Exam.
1. The nurse plans to administer a dose of metoprolol at 0900 to a client with
hypertension. At 0800 the nurse notes the telemetry pattern shows second-degree
heart block with a ventricular rate of 50. Which action should the nurse take?
A) Administer the metoprolol as scheduled
B) Hold the scheduled dose and notify the healthcare provider of the telemetry
pattern
C) Administer a half dose of metoprolol
D) Continue to monitor the telemetry and administer the medication as scheduled
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that decreases heart rate and conduction.
The presence of second-degree heart block with a ventricular rate of 50 is a
contraindication to administering this medication as it can worsen the block and
,further decrease the heart rate . The nurse should hold the dose and notify the
healthcare provider immediately .
2. The nurse is reviewing a client's electrocardiogram (ECG) and determines the
PR interval is prolonged. This finding indicates:
A) Decreased conduction time from the SA node to the AV junction
B) Increased conduction time from the SA node to the AV junction
C) Normal conduction through the ventricles
D) A complete heart block
Correct Answer: B
Rationale: The PR interval represents the time it takes for an electrical impulse to
travel from the sinoatrial (SA) node through the atria and the atrioventricular (AV)
node. A prolonged PR interval (greater than 0.20 seconds) indicates a first-degree
AV block, which means there is a delay in conduction from the SA node to the AV
junction .
3. When assessing a restless, intubated client on mechanical ventilation, the nurse
auscultates breath sounds on the right side only. Which action should the nurse
take?
A) Suction the endotracheal tube
B) Reposition the depth of the endotracheal tube
C) Increase the oxygen concentration
D) Notify the healthcare provider immediately
Correct Answer: B
Rationale: Unilateral breath sounds in an intubated patient suggest that the
endotracheal tube may have migrated into the right mainstem bronchus, which is a
common complication . The priority action is to reposition the tube and verify its
placement to ensure adequate ventilation of both lungs . After repositioning, the
nurse should confirm placement with auscultation and an end-tidal CO2 monitor.
4. A client with pneumonia is admitted with severe shortness of breath. Arterial
blood gases show: pH 7.30, PaO2 60, PaCO2 62, HCO3 35. Which finding
requires immediate communication to the healthcare provider?
,A) Oxygen saturation of 88%
B) Respiratory rate of 24 breaths per minute
C) Drowsiness and difficulty in arousing the client
D) Productive cough with green sputum
Correct Answer: C
Rationale: The ABGs indicate respiratory acidosis (low pH, elevated PaCO2) with
metabolic compensation (elevated HCO3). A change in mental status, such as
drowsiness and difficulty arousing, is a sign of worsening respiratory failure and
impending respiratory arrest . This is a critical finding that requires immediate
intervention and communication with the healthcare provider.
5. The nurse is caring for a burn patient with a serum potassium level of 4.0
mEq/L. Which medication should the nurse question?
A) Potassium chloride supplement
B) Pain medication
C) Antibiotics
D) Proton pump inhibitor
Correct Answer: A
Rationale: In the early phase of a severe burn injury, cell lysis releases large
amounts of potassium into the bloodstream, leading to hyperkalemia. A serum
potassium level of 4.0 mEq/L is within the normal range (3.5-5.0 mEq/L), but
administering a potassium supplement could precipitate dangerous hyperkalemia,
increasing the risk of cardiac arrhythmias . The nurse should question this order
and verify with the healthcare provider .
6. A patient admitted with deep second-degree burns of the thighs, chest, and arms
covering 40% of the total body surface area (TBSA). The nurse expects which of
the following findings related to the fluid shift that occurs after a burn injury?
A) Increased cardiac output
B) Decreased cardiac output
C) Increased urine output
D) Pulmonary edema
Correct Answer: B
, Rationale: After a major burn injury, there is a significant fluid shift from the
intravascular space into the interstitial space due to increased capillary
permeability. This results in hypovolemia, leading to decreased cardiac output,
hypotension, and decreased urine output . The patient is at high risk for
hypovolemic shock and requires aggressive fluid resuscitation.
7. A patient has been bedridden for two weeks and has the following lab values:
pH 7.37, PO2 90, PCO2 40, HCO3 25, hypoalbuminemia, and hypocalcemia.
What is the priority nursing action?
A) Turn the patient side to side every 2 hours
B) Apply sequential compression devices
C) Administer calcium supplements
D) Initiate a high-protein diet
Correct Answer: A
Rationale: Immobility is a major risk factor for pressure ulcers and respiratory
complications. The patient's lab values indicate a normal acid-base status but
demonstrate hypoalbuminemia and hypocalcemia, which can be associated with
immobility. Turning the patient every 2 hours is a priority to prevent skin
breakdown, maintain tissue perfusion, and promote lung expansion .
8. There has been a major disaster. The triage nurse should give priority to which
patient?
A) Middle-aged man wandering around
B) Woman sitting on the ground with a blanket
C) Crying child held by another passenger
D) Patient with a cut over the eye
Correct Answer: C
Rationale: In a disaster triage situation, the goal is to do the greatest good for the
greatest number. A crying child is a high priority because children are vulnerable
and may have hidden injuries that are not immediately apparent. The child's
distress could be due to pain, fear, or shock . The other patients are ambulatory
(wandering, sitting) and can be classified as "walking wounded" or "minor" (cut
over the eye), which are lower priority.
CORRECT ANSWERS (100% VERIFIED) WITH RATIONALE
LATEST UPDATE ALREADY GRADED A+
This comprehensive study guide contains **400 expertly crafted practice
questions** with **detailed, evidence-based rationales** designed to prepare
nursing students and healthcare professionals for the Critical Care HESI Exit
Exam. Covering essential critical care topics including hemodynamic
monitoring, mechanical ventilation, cardiac arrhythmias, shock states, and
emergency interventions, this resource provides realistic clinical scenarios
that mirror the actual exam format. Each question includes four multiple-
choice options, the correct answer, and a thorough rationale explaining the
underlying pathophysiology and clinical reasoning. Perfect for self-study, this
guide builds clinical judgment and confidence. Ideal for nursing students, new
graduates, and critical care nurses preparing for certification or the HESI
Exit Exam.
1. The nurse plans to administer a dose of metoprolol at 0900 to a client with
hypertension. At 0800 the nurse notes the telemetry pattern shows second-degree
heart block with a ventricular rate of 50. Which action should the nurse take?
A) Administer the metoprolol as scheduled
B) Hold the scheduled dose and notify the healthcare provider of the telemetry
pattern
C) Administer a half dose of metoprolol
D) Continue to monitor the telemetry and administer the medication as scheduled
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that decreases heart rate and conduction.
The presence of second-degree heart block with a ventricular rate of 50 is a
contraindication to administering this medication as it can worsen the block and
,further decrease the heart rate . The nurse should hold the dose and notify the
healthcare provider immediately .
2. The nurse is reviewing a client's electrocardiogram (ECG) and determines the
PR interval is prolonged. This finding indicates:
A) Decreased conduction time from the SA node to the AV junction
B) Increased conduction time from the SA node to the AV junction
C) Normal conduction through the ventricles
D) A complete heart block
Correct Answer: B
Rationale: The PR interval represents the time it takes for an electrical impulse to
travel from the sinoatrial (SA) node through the atria and the atrioventricular (AV)
node. A prolonged PR interval (greater than 0.20 seconds) indicates a first-degree
AV block, which means there is a delay in conduction from the SA node to the AV
junction .
3. When assessing a restless, intubated client on mechanical ventilation, the nurse
auscultates breath sounds on the right side only. Which action should the nurse
take?
A) Suction the endotracheal tube
B) Reposition the depth of the endotracheal tube
C) Increase the oxygen concentration
D) Notify the healthcare provider immediately
Correct Answer: B
Rationale: Unilateral breath sounds in an intubated patient suggest that the
endotracheal tube may have migrated into the right mainstem bronchus, which is a
common complication . The priority action is to reposition the tube and verify its
placement to ensure adequate ventilation of both lungs . After repositioning, the
nurse should confirm placement with auscultation and an end-tidal CO2 monitor.
4. A client with pneumonia is admitted with severe shortness of breath. Arterial
blood gases show: pH 7.30, PaO2 60, PaCO2 62, HCO3 35. Which finding
requires immediate communication to the healthcare provider?
,A) Oxygen saturation of 88%
B) Respiratory rate of 24 breaths per minute
C) Drowsiness and difficulty in arousing the client
D) Productive cough with green sputum
Correct Answer: C
Rationale: The ABGs indicate respiratory acidosis (low pH, elevated PaCO2) with
metabolic compensation (elevated HCO3). A change in mental status, such as
drowsiness and difficulty arousing, is a sign of worsening respiratory failure and
impending respiratory arrest . This is a critical finding that requires immediate
intervention and communication with the healthcare provider.
5. The nurse is caring for a burn patient with a serum potassium level of 4.0
mEq/L. Which medication should the nurse question?
A) Potassium chloride supplement
B) Pain medication
C) Antibiotics
D) Proton pump inhibitor
Correct Answer: A
Rationale: In the early phase of a severe burn injury, cell lysis releases large
amounts of potassium into the bloodstream, leading to hyperkalemia. A serum
potassium level of 4.0 mEq/L is within the normal range (3.5-5.0 mEq/L), but
administering a potassium supplement could precipitate dangerous hyperkalemia,
increasing the risk of cardiac arrhythmias . The nurse should question this order
and verify with the healthcare provider .
6. A patient admitted with deep second-degree burns of the thighs, chest, and arms
covering 40% of the total body surface area (TBSA). The nurse expects which of
the following findings related to the fluid shift that occurs after a burn injury?
A) Increased cardiac output
B) Decreased cardiac output
C) Increased urine output
D) Pulmonary edema
Correct Answer: B
, Rationale: After a major burn injury, there is a significant fluid shift from the
intravascular space into the interstitial space due to increased capillary
permeability. This results in hypovolemia, leading to decreased cardiac output,
hypotension, and decreased urine output . The patient is at high risk for
hypovolemic shock and requires aggressive fluid resuscitation.
7. A patient has been bedridden for two weeks and has the following lab values:
pH 7.37, PO2 90, PCO2 40, HCO3 25, hypoalbuminemia, and hypocalcemia.
What is the priority nursing action?
A) Turn the patient side to side every 2 hours
B) Apply sequential compression devices
C) Administer calcium supplements
D) Initiate a high-protein diet
Correct Answer: A
Rationale: Immobility is a major risk factor for pressure ulcers and respiratory
complications. The patient's lab values indicate a normal acid-base status but
demonstrate hypoalbuminemia and hypocalcemia, which can be associated with
immobility. Turning the patient every 2 hours is a priority to prevent skin
breakdown, maintain tissue perfusion, and promote lung expansion .
8. There has been a major disaster. The triage nurse should give priority to which
patient?
A) Middle-aged man wandering around
B) Woman sitting on the ground with a blanket
C) Crying child held by another passenger
D) Patient with a cut over the eye
Correct Answer: C
Rationale: In a disaster triage situation, the goal is to do the greatest good for the
greatest number. A crying child is a high priority because children are vulnerable
and may have hidden injuries that are not immediately apparent. The child's
distress could be due to pain, fear, or shock . The other patients are ambulatory
(wandering, sitting) and can be classified as "walking wounded" or "minor" (cut
over the eye), which are lower priority.
