HESI Critical Care – Full Comprehensive
Practice Exam
SECTION 1: Hemodynamic Monitoring & Shock (Questions 1-20)
Q1. A patient in the ICU has a pulmonary artery catheter in place. The
nurse notes a cardiac output (CO) of 2.1 L/min, a cardiac index (CI) of
1.1 L/min/m², and a systemic vascular resistance (SVR) of 1800
dynes·sec·cm⁻⁵. The patient is hypotensive and oliguric. Which type of
shock is most consistent with these hemodynamic findings?
• A) Distributive shock (septic)
• B) Hypovolemic shock
• C) Cardiogenic shock
• D) Obstructive shock
Answer: C – Cardiogenic shock is characterized by low cardiac output, low
cardiac index (<2.2 L/min/m²), high SVR (compensatory vasoconstriction),
and evidence of end-organ hypoperfusion (hypotension, oliguria). In
distributive shock, SVR would be low. In hypovolemic shock, CVP and
PAWP would be low. In obstructive shock, CVP would be elevated.
Q2. A patient with septic shock has a mean arterial pressure (MAP) of
52 mmHg. What is the priority intervention?
• A) Administer IV fluids as prescribed
• B) Prepare for vasopressor infusion
• C) Recheck blood pressure in 15 minutes
• D) Place the patient in Trendelenburg position
Answer: A – A MAP below 60 mmHg indicates inadequate organ perfusion.
In septic shock, fluid resuscitation is the priority. The Surviving Sepsis
Campaign recommends 30 mL/kg of crystalloid. Vasopressors are added if
,hypotension persists despite fluid resuscitation. Trendelenburg position is
not recommended.
Q3. What is the normal range for central venous pressure (CVP)?
• A) 0–2 mmHg
• B) 2–8 mmHg
• C) 8–15 mmHg
• D) 15–20 mmHg
Answer: B – Normal CVP is 2–8 mmHg. CVP reflects right atrial pressure
and is a measure of preload. Low CVP suggests hypovolemia; high CVP
suggests fluid overload or right heart failure. CVP is less reliable than
dynamic measures for predicting fluid responsiveness.
Q4. A central venous pressure (CVP) reading is 1 mmHg. What does this
indicate?
• A) Fluid overload
• B) Hypovolemia
• C) Right ventricular failure
• D) Pulmonary embolism
Answer: B – Low CVP indicates decreased circulating volume (preload).
This is commonly seen in hypovolemic shock from hemorrhage,
dehydration, or third-spacing. Fluid administration is indicated. High CVP
suggests fluid overload or right-sided heart failure.
Q5. A patient with pulmonary artery catheter has a PAWP reading of 22
mmHg. What condition should the nurse suspect?
• A) Hypovolemia
• B) Left-sided heart failure
, • C) Right-sided heart failure
• D) Pulmonary embolism
Answer: B – Normal PAWP is 4–12 mmHg. A PAWP > 20 mmHg indicates
left-sided heart failure or fluid overload. Hypovolemia would show low
PAWP. Right-sided heart failure would elevate CVP but may not elevate
PAWP. Pulmonary embolism typically shows elevated CVP with normal or
low PAWP.
Q6. Which finding is most consistent with cardiogenic shock?
• A) Warm, flushed skin
• B) Bounding pulses
• C) Pulmonary crackles and hypotension
• D) Fever and leukocytosis
Answer: C – Cardiogenic shock results from left ventricular failure causing
pulmonary congestion (crackles) and reduced cardiac output leading to
hypotension. Warm, flushed skin and bounding pulses are seen in
distributive shock. Fever and leukocytosis suggest septic shock.
Q7. Which of the following findings is consistent with obstructive
shock?
• A) Low CVP, low PAWP, low cardiac output
• B) High CVP, high PAWP, low cardiac output
• C) High CVP, low PAWP, high cardiac output
• D) Low CVP, high PAWP, high cardiac output
Answer: B – Obstructive shock (e.g., cardiac tamponade, massive PE) is
characterized by high CVP (elevated right heart pressures), high PAWP
(elevated left heart pressures), and low cardiac output due to obstruction of
blood flow.
, Q8. A patient is in shock and receiving dopamine (Intropin) infusion.
Which assessment finding indicates a therapeutic response to the
medication?
• A) Decreased urine output
• B) Increased blood pressure
• C) Increased heart rate
• D) Decreased cardiac output
Answer: B – Dopamine is a vasopressor used to increase blood pressure in
shock. A therapeutic response is indicated by improved blood pressure and
tissue perfusion (e.g., increased urine output). Increased heart rate may be
a side effect; decreased urine output indicates worsening perfusion.
Q9. The nurse is caring for a patient who hemorrhaged postoperatively
and is in the early stage of shock. Which cardiopulmonary symptoms
are most indicative of progression into a state of shock?
• A) Decreased pulse rate, increased systolic pressure
• B) Increased pulse rate, lowered systolic pressure, peripheral
extremity mottling
• C) Bounding pulse, warm extremities
• D) Bradycardia, hypertension
Answer: B – Early signs of shock include compensatory tachycardia,
hypotension (as compensatory mechanisms fail), and peripheral
vasoconstriction (mottling, cool extremities). Warm extremities and
bounding pulses are seen in distributive shock (sepsis). Bradycardia with
hypertension is a late, ominous finding.
Q10. A patient with septic shock has an SvO₂ of 75%. Which of the
following is the most likely cause?
Practice Exam
SECTION 1: Hemodynamic Monitoring & Shock (Questions 1-20)
Q1. A patient in the ICU has a pulmonary artery catheter in place. The
nurse notes a cardiac output (CO) of 2.1 L/min, a cardiac index (CI) of
1.1 L/min/m², and a systemic vascular resistance (SVR) of 1800
dynes·sec·cm⁻⁵. The patient is hypotensive and oliguric. Which type of
shock is most consistent with these hemodynamic findings?
• A) Distributive shock (septic)
• B) Hypovolemic shock
• C) Cardiogenic shock
• D) Obstructive shock
Answer: C – Cardiogenic shock is characterized by low cardiac output, low
cardiac index (<2.2 L/min/m²), high SVR (compensatory vasoconstriction),
and evidence of end-organ hypoperfusion (hypotension, oliguria). In
distributive shock, SVR would be low. In hypovolemic shock, CVP and
PAWP would be low. In obstructive shock, CVP would be elevated.
Q2. A patient with septic shock has a mean arterial pressure (MAP) of
52 mmHg. What is the priority intervention?
• A) Administer IV fluids as prescribed
• B) Prepare for vasopressor infusion
• C) Recheck blood pressure in 15 minutes
• D) Place the patient in Trendelenburg position
Answer: A – A MAP below 60 mmHg indicates inadequate organ perfusion.
In septic shock, fluid resuscitation is the priority. The Surviving Sepsis
Campaign recommends 30 mL/kg of crystalloid. Vasopressors are added if
,hypotension persists despite fluid resuscitation. Trendelenburg position is
not recommended.
Q3. What is the normal range for central venous pressure (CVP)?
• A) 0–2 mmHg
• B) 2–8 mmHg
• C) 8–15 mmHg
• D) 15–20 mmHg
Answer: B – Normal CVP is 2–8 mmHg. CVP reflects right atrial pressure
and is a measure of preload. Low CVP suggests hypovolemia; high CVP
suggests fluid overload or right heart failure. CVP is less reliable than
dynamic measures for predicting fluid responsiveness.
Q4. A central venous pressure (CVP) reading is 1 mmHg. What does this
indicate?
• A) Fluid overload
• B) Hypovolemia
• C) Right ventricular failure
• D) Pulmonary embolism
Answer: B – Low CVP indicates decreased circulating volume (preload).
This is commonly seen in hypovolemic shock from hemorrhage,
dehydration, or third-spacing. Fluid administration is indicated. High CVP
suggests fluid overload or right-sided heart failure.
Q5. A patient with pulmonary artery catheter has a PAWP reading of 22
mmHg. What condition should the nurse suspect?
• A) Hypovolemia
• B) Left-sided heart failure
, • C) Right-sided heart failure
• D) Pulmonary embolism
Answer: B – Normal PAWP is 4–12 mmHg. A PAWP > 20 mmHg indicates
left-sided heart failure or fluid overload. Hypovolemia would show low
PAWP. Right-sided heart failure would elevate CVP but may not elevate
PAWP. Pulmonary embolism typically shows elevated CVP with normal or
low PAWP.
Q6. Which finding is most consistent with cardiogenic shock?
• A) Warm, flushed skin
• B) Bounding pulses
• C) Pulmonary crackles and hypotension
• D) Fever and leukocytosis
Answer: C – Cardiogenic shock results from left ventricular failure causing
pulmonary congestion (crackles) and reduced cardiac output leading to
hypotension. Warm, flushed skin and bounding pulses are seen in
distributive shock. Fever and leukocytosis suggest septic shock.
Q7. Which of the following findings is consistent with obstructive
shock?
• A) Low CVP, low PAWP, low cardiac output
• B) High CVP, high PAWP, low cardiac output
• C) High CVP, low PAWP, high cardiac output
• D) Low CVP, high PAWP, high cardiac output
Answer: B – Obstructive shock (e.g., cardiac tamponade, massive PE) is
characterized by high CVP (elevated right heart pressures), high PAWP
(elevated left heart pressures), and low cardiac output due to obstruction of
blood flow.
, Q8. A patient is in shock and receiving dopamine (Intropin) infusion.
Which assessment finding indicates a therapeutic response to the
medication?
• A) Decreased urine output
• B) Increased blood pressure
• C) Increased heart rate
• D) Decreased cardiac output
Answer: B – Dopamine is a vasopressor used to increase blood pressure in
shock. A therapeutic response is indicated by improved blood pressure and
tissue perfusion (e.g., increased urine output). Increased heart rate may be
a side effect; decreased urine output indicates worsening perfusion.
Q9. The nurse is caring for a patient who hemorrhaged postoperatively
and is in the early stage of shock. Which cardiopulmonary symptoms
are most indicative of progression into a state of shock?
• A) Decreased pulse rate, increased systolic pressure
• B) Increased pulse rate, lowered systolic pressure, peripheral
extremity mottling
• C) Bounding pulse, warm extremities
• D) Bradycardia, hypertension
Answer: B – Early signs of shock include compensatory tachycardia,
hypotension (as compensatory mechanisms fail), and peripheral
vasoconstriction (mottling, cool extremities). Warm extremities and
bounding pulses are seen in distributive shock (sepsis). Bradycardia with
hypertension is a late, ominous finding.
Q10. A patient with septic shock has an SvO₂ of 75%. Which of the
following is the most likely cause?
