Critical Care Exit HESI ACTUAL EXAM 2025
REAL QUESTIONS AND ANSWERS A+
GUARANTEED
Course
Hesi
1. A patient with chronic obstructive pulmonary disease (COPD) is admitted to the ICU
with severe dyspnea and a PaO2 of 55 mmHg on room air. What is the most appropriate
initial intervention?
A. Administer high-flow oxygen via non-rebreather mask
B. Administer intravenous (IV) fluids to improve perfusion
C. Provide nebulized bronchodilators as prescribed
D. Intubate the patient and initiate mechanical ventilation
Answer: C. Provide nebulized bronchodilators as prescribed
Rationale: In COPD patients with severe dyspnea and hypoxemia, nebulized bronchodilators
(e.g., albuterol) help relieve bronchospasm and improve airflow. High-flow oxygen should be
used cautiously due to the risk of hypercapnia, and mechanical ventilation is not typically the
first intervention unless respiratory failure is imminent.
2. A 72-year-old patient with a history of heart failure and atrial fibrillation is admitted for
fluid overload. The nurse notes an increase in the patient’s respiratory rate and crackles on
auscultation. Which action is most appropriate?
A. Administer diuretics as prescribed
B. Increase the oxygen flow rate
C. Position the patient in a flat supine position
D. Obtain a chest x-ray to confirm the diagnosis
Answer: A. Administer diuretics as prescribed
Rationale: Fluid overload in heart failure can cause pulmonary edema, leading to crackles and
increased respiratory rate. Diuretics help reduce fluid retention and relieve symptoms. Oxygen
therapy may also be necessary, but addressing the fluid overload with diuretics is the priority.
3. Which of the following is the most accurate sign of inadequate tissue perfusion in a
patient with sepsis?
,A. Warm and dry skin
B. Elevated white blood cell count
C. Cool, clammy skin with delayed capillary refill
D. Increased urine output
Answer: C. Cool, clammy skin with delayed capillary refill
Rationale: Inadequate tissue perfusion in sepsis can lead to hypoperfusion (shock), which
manifests as cool, clammy skin and delayed capillary refill. Elevated white blood cells may
indicate infection, but signs of poor perfusion are the key focus in sepsis.
4. A patient is admitted to the ICU with acute respiratory distress syndrome (ARDS).
Which of the following ventilator settings is most appropriate to help manage ARDS?
A. High tidal volume and low respiratory rate
B. Low tidal volume and high positive end-expiratory pressure (PEEP)
C. High tidal volume and high PEEP
D. Low tidal volume and low PEEP
Answer: B. Low tidal volume and high positive end-expiratory pressure (PEEP)
Rationale: ARDS is managed with low tidal volume (to prevent ventilator-induced lung injury)
and high PEEP (to help keep the alveoli open, improving oxygenation). This strategy helps to
minimize further lung injury and optimize oxygenation.
5. A patient who underwent coronary artery bypass graft (CABG) surgery 24 hours ago
has a urinary output of 20 mL/hr for the past 2 hours. What is the priority action by the
nurse?
A. Increase IV fluids to improve kidney perfusion
B. Administer a diuretic to promote urine output
C. Notify the healthcare provider about the low urine output
D. Check the urinary catheter for obstruction
Answer: C. Notify the healthcare provider about the low urine output
Rationale: Low urine output (oliguria) after surgery may indicate kidney perfusion problems
or fluid imbalance. It’s essential to notify the healthcare provider for further evaluation and
potential interventions. Increasing IV fluids may be necessary, but it should be done based on
healthcare provider orders.
,6. A patient with a history of chronic kidney disease is admitted to the ICU with
hyperkalemia. The nurse notes that the patient’s ECG shows peaked T-waves. Which of
the following is the priority intervention?
A. Administer calcium gluconate IV
B. Encourage potassium-rich foods
C. Administer a potassium-sparing diuretic
D. Perform peritoneal dialysis
Answer: A. Administer calcium gluconate IV
Rationale: Calcium gluconate stabilizes the cardiac membrane in the presence of
hyperkalemia and helps prevent arrhythmias like those seen with peaked T-waves. Dialysis may
also be required to remove potassium, but calcium gluconate is the immediate priority.
7. A patient in the ICU is being mechanically ventilated and is receiving sedation. The
nurse assesses that the patient is awake and appears agitated despite the sedation. Which of
the following is the most appropriate intervention?
A. Increase the dosage of the sedative
B. Evaluate the patient’s pain level and administer analgesia if needed
C. Remove the ventilator and assess respiratory status
D. Reassure the patient that the sedation will take effect soon
Answer: B. Evaluate the patient’s pain level and administer analgesia if needed
Rationale: Agitation in a sedated patient may indicate uncontrolled pain, especially in an ICU
setting. The nurse should assess and manage pain appropriately, as pain can significantly impact
patient comfort and behavior, even in the presence of sedation.
8. A patient with severe burn injuries is receiving intravenous fluids to maintain adequate
perfusion. What is the best indicator of adequate fluid resuscitation in the first 24 hours?
A. Urine output of 30 mL/hr
B. Mean arterial pressure (MAP) greater than 60 mmHg
C. Heart rate less than 90 beats per minute
D. Oxygen saturation greater than 90%
Answer: A. Urine output of 30 mL/hr
, Rationale: Adequate urine output (30 mL/hr) is a reliable indicator of effective fluid
resuscitation and adequate renal perfusion in the first 24 hours after burn injuries. Other
parameters, like MAP, are also important but urine output is a key marker in this context.
9. A patient with a history of hypertension and diabetes mellitus is admitted to the ICU in
hypertensive crisis. The nurse administers an IV antihypertensive medication. Which of the
following is the priority nursing assessment during this time?
A. Respiratory rate
B. Blood pressure
C. Glucose level
D. Urine output
Answer: B. Blood pressure
Rationale: In a hypertensive crisis, the priority is to carefully monitor the blood pressure to
avoid rapid reductions that could lead to complications such as stroke or myocardial infarction.
Close monitoring of other parameters like glucose and urine output is important but secondary to
blood pressure.
10. A patient with septic shock is receiving norepinephrine as a vasopressor. Which of the
following should the nurse monitor most closely for adverse effects of the medication?
A. Heart rate
B. Blood glucose level
C. Urine output
D. Respiratory rate
Answer: A. Heart rate
Rationale: Norepinephrine is a vasopressor that can increase heart rate and blood pressure.
It’s essential to monitor for signs of tachycardia and potential arrhythmias, as increased heart
rate may be a side effect. Monitoring urine output is also crucial in septic shock, but heart rate
takes priority when administering norepinephrine.
11. A patient with acute myocardial infarction (MI) is receiving thrombolytic therapy. The
nurse should monitor for which of the following complications?
A. Hypotension
B. Hyperkalemia
REAL QUESTIONS AND ANSWERS A+
GUARANTEED
Course
Hesi
1. A patient with chronic obstructive pulmonary disease (COPD) is admitted to the ICU
with severe dyspnea and a PaO2 of 55 mmHg on room air. What is the most appropriate
initial intervention?
A. Administer high-flow oxygen via non-rebreather mask
B. Administer intravenous (IV) fluids to improve perfusion
C. Provide nebulized bronchodilators as prescribed
D. Intubate the patient and initiate mechanical ventilation
Answer: C. Provide nebulized bronchodilators as prescribed
Rationale: In COPD patients with severe dyspnea and hypoxemia, nebulized bronchodilators
(e.g., albuterol) help relieve bronchospasm and improve airflow. High-flow oxygen should be
used cautiously due to the risk of hypercapnia, and mechanical ventilation is not typically the
first intervention unless respiratory failure is imminent.
2. A 72-year-old patient with a history of heart failure and atrial fibrillation is admitted for
fluid overload. The nurse notes an increase in the patient’s respiratory rate and crackles on
auscultation. Which action is most appropriate?
A. Administer diuretics as prescribed
B. Increase the oxygen flow rate
C. Position the patient in a flat supine position
D. Obtain a chest x-ray to confirm the diagnosis
Answer: A. Administer diuretics as prescribed
Rationale: Fluid overload in heart failure can cause pulmonary edema, leading to crackles and
increased respiratory rate. Diuretics help reduce fluid retention and relieve symptoms. Oxygen
therapy may also be necessary, but addressing the fluid overload with diuretics is the priority.
3. Which of the following is the most accurate sign of inadequate tissue perfusion in a
patient with sepsis?
,A. Warm and dry skin
B. Elevated white blood cell count
C. Cool, clammy skin with delayed capillary refill
D. Increased urine output
Answer: C. Cool, clammy skin with delayed capillary refill
Rationale: Inadequate tissue perfusion in sepsis can lead to hypoperfusion (shock), which
manifests as cool, clammy skin and delayed capillary refill. Elevated white blood cells may
indicate infection, but signs of poor perfusion are the key focus in sepsis.
4. A patient is admitted to the ICU with acute respiratory distress syndrome (ARDS).
Which of the following ventilator settings is most appropriate to help manage ARDS?
A. High tidal volume and low respiratory rate
B. Low tidal volume and high positive end-expiratory pressure (PEEP)
C. High tidal volume and high PEEP
D. Low tidal volume and low PEEP
Answer: B. Low tidal volume and high positive end-expiratory pressure (PEEP)
Rationale: ARDS is managed with low tidal volume (to prevent ventilator-induced lung injury)
and high PEEP (to help keep the alveoli open, improving oxygenation). This strategy helps to
minimize further lung injury and optimize oxygenation.
5. A patient who underwent coronary artery bypass graft (CABG) surgery 24 hours ago
has a urinary output of 20 mL/hr for the past 2 hours. What is the priority action by the
nurse?
A. Increase IV fluids to improve kidney perfusion
B. Administer a diuretic to promote urine output
C. Notify the healthcare provider about the low urine output
D. Check the urinary catheter for obstruction
Answer: C. Notify the healthcare provider about the low urine output
Rationale: Low urine output (oliguria) after surgery may indicate kidney perfusion problems
or fluid imbalance. It’s essential to notify the healthcare provider for further evaluation and
potential interventions. Increasing IV fluids may be necessary, but it should be done based on
healthcare provider orders.
,6. A patient with a history of chronic kidney disease is admitted to the ICU with
hyperkalemia. The nurse notes that the patient’s ECG shows peaked T-waves. Which of
the following is the priority intervention?
A. Administer calcium gluconate IV
B. Encourage potassium-rich foods
C. Administer a potassium-sparing diuretic
D. Perform peritoneal dialysis
Answer: A. Administer calcium gluconate IV
Rationale: Calcium gluconate stabilizes the cardiac membrane in the presence of
hyperkalemia and helps prevent arrhythmias like those seen with peaked T-waves. Dialysis may
also be required to remove potassium, but calcium gluconate is the immediate priority.
7. A patient in the ICU is being mechanically ventilated and is receiving sedation. The
nurse assesses that the patient is awake and appears agitated despite the sedation. Which of
the following is the most appropriate intervention?
A. Increase the dosage of the sedative
B. Evaluate the patient’s pain level and administer analgesia if needed
C. Remove the ventilator and assess respiratory status
D. Reassure the patient that the sedation will take effect soon
Answer: B. Evaluate the patient’s pain level and administer analgesia if needed
Rationale: Agitation in a sedated patient may indicate uncontrolled pain, especially in an ICU
setting. The nurse should assess and manage pain appropriately, as pain can significantly impact
patient comfort and behavior, even in the presence of sedation.
8. A patient with severe burn injuries is receiving intravenous fluids to maintain adequate
perfusion. What is the best indicator of adequate fluid resuscitation in the first 24 hours?
A. Urine output of 30 mL/hr
B. Mean arterial pressure (MAP) greater than 60 mmHg
C. Heart rate less than 90 beats per minute
D. Oxygen saturation greater than 90%
Answer: A. Urine output of 30 mL/hr
, Rationale: Adequate urine output (30 mL/hr) is a reliable indicator of effective fluid
resuscitation and adequate renal perfusion in the first 24 hours after burn injuries. Other
parameters, like MAP, are also important but urine output is a key marker in this context.
9. A patient with a history of hypertension and diabetes mellitus is admitted to the ICU in
hypertensive crisis. The nurse administers an IV antihypertensive medication. Which of the
following is the priority nursing assessment during this time?
A. Respiratory rate
B. Blood pressure
C. Glucose level
D. Urine output
Answer: B. Blood pressure
Rationale: In a hypertensive crisis, the priority is to carefully monitor the blood pressure to
avoid rapid reductions that could lead to complications such as stroke or myocardial infarction.
Close monitoring of other parameters like glucose and urine output is important but secondary to
blood pressure.
10. A patient with septic shock is receiving norepinephrine as a vasopressor. Which of the
following should the nurse monitor most closely for adverse effects of the medication?
A. Heart rate
B. Blood glucose level
C. Urine output
D. Respiratory rate
Answer: A. Heart rate
Rationale: Norepinephrine is a vasopressor that can increase heart rate and blood pressure.
It’s essential to monitor for signs of tachycardia and potential arrhythmias, as increased heart
rate may be a side effect. Monitoring urine output is also crucial in septic shock, but heart rate
takes priority when administering norepinephrine.
11. A patient with acute myocardial infarction (MI) is receiving thrombolytic therapy. The
nurse should monitor for which of the following complications?
A. Hypotension
B. Hyperkalemia
