2025/2026 HESI RN CRITICAL CARE /CRITICAL CARE RN HESI EXIT ACTUAL EXAM
TEST BANK LATEST 350 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+
Question 1
A nurse is caring for a patient in cardiogenic shock. Which hemodynamic parameter should the
nurse expect to be elevated?
A) Cardiac Output (CO)
B) Systemic Vascular Resistance (SVR)
C) Mixed Venous Oxygen Saturation (SvO2)
D) Blood Pressure (BP)
Correct Answer: B) Systemic Vascular Resistance (SVR)
Rationale: In cardiogenic shock, the heart's pumping ability is severely impaired, leading
to decreased cardiac output and hypotension. The body attempts to compensate by
increasing SVR (vasoconstriction) to maintain systemic perfusion, but this increases
afterload and further compromises the failing heart. CO and BP would be decreased, and
SvO2 would typically be decreased due to increased tissue oxygen extraction.
Question 2
A patient with an acute ST-elevation myocardial infarction (STEMI) is prescribed intravenous
nitroglycerin. The nurse understands that this medication's primary action is to:
A) Increase myocardial contractility.
B) Cause systemic vasoconstriction.
C) Reduce preload and afterload through vasodilation.
D) Improve oxygen-carrying capacity of blood.
Correct Answer: C) Reduce preload and afterload through vasodilation.
Rationale: Intravenous nitroglycerin is a potent vasodilator. Its primary benefit in STEMI
is to reduce myocardial oxygen demand by decreasing both preload (venous dilation) and
afterload (arterial dilation), which reduces the workload on the heart and can relieve
ischemia. It also dilates coronary arteries directly.
Question 3
A nurse is managing a patient on a mechanical ventilator. The high-pressure alarm frequently
sounds. Which of the following is the most appropriate initial nursing intervention?
A) Increase the peak inspiratory pressure (PIP) setting.
,B) Administer a sedative.
C) Assess for kinks in the tubing or secretions in the airway.
D) Decrease the tidal volume.
Correct Answer: C) Assess for kinks in the tubing or secretions in the airway.
Rationale: High-pressure alarms indicate increased resistance to airflow. The nurse should
first assess for easily correctable causes: kinks in the ventilator tubing, patient biting the
ETT, accumulation of secretions (requiring suctioning), or patient coughing/fighting the
ventilator. Addressing these issues often resolves the alarm.
Question 4
A patient is admitted to the ICU with suspected sepsis. The nurse anticipates an order for broad-
spectrum antibiotics to be administered within what timeframe?
A) Within 6 hours of diagnosis.
B) Within 3 hours of diagnosis.
C) Within 1 hour of diagnosis.
D) After culture results are available.
Correct Answer: C) Within 1 hour of diagnosis.
Rationale: Current sepsis guidelines (Surviving Sepsis Campaign) recommend initiating
broad-spectrum antibiotic therapy within one hour of recognizing sepsis or septic shock.
Rapid administration is critical to improve patient outcomes. Cultures should be obtained
before antibiotics, but antibiotic administration should not be delayed waiting for results.
Question 5
A nurse is caring for a patient with increased intracranial pressure (ICP). Which neurological
assessment finding is the most sensitive indicator of early deterioration?
A) Fixed and dilated pupils.
B) Projectile vomiting.
C) Change in level of consciousness (LOC).
D) Bradycardia and widening pulse pressure.
Correct Answer: C) Change in level of consciousness (LOC).
Rationale: Subtle changes in level of consciousness, such as restlessness, confusion,
irritability, or decreased alertness, are often the earliest and most sensitive indicators of
,increasing ICP. Fixed/dilated pupils, projectile vomiting, and Cushing's triad (bradycardia,
hypertension with widening pulse pressure, irregular respirations) are typically later signs
of severe or impending brain herniation.
Question 6
A patient in ventricular tachycardia (VT) with a pulse is stable. Which antiarrhythmic medication
should the nurse anticipate administering?
A) Adenosine
B) Amiodarone
C) Atropine
D) Digoxin
Correct Answer: B) Amiodarone
Rationale: For stable ventricular tachycardia with a pulse, intravenous antiarrhythmics
are indicated. Amiodarone is a common first-line agent, along with procainamide or sotalol.
Adenosine is used for SVT. Atropine is for bradycardia. Digoxin is for atrial
fibrillation/flutter with rapid ventricular response or heart failure.
Question 7
A nurse is monitoring a patient with an arterial line. The arterial waveform shows damping.
Which of the following is a possible cause?
A) Over-pressurized flush bag.
B) Air bubble in the tubing.
C) Catheter tip positioned too close to the vessel wall.
D) Patient is hypotensive.
Correct Answer: C) Catheter tip positioned too close to the vessel wall.
Rationale: A damped arterial waveform indicates a loss of accurate pressure transmission.
Common causes include air bubbles in the system, kinks in the tubing, a clot at the catheter
tip, or the catheter tip resting against the vessel wall. An under-pressurized flush bag could
also cause damping, but not an over-pressurized one. Hypotension would affect the
pressure reading but not necessarily cause damping.
Question 8
A patient with acute respiratory distress syndrome (ARDS) is on a mechanical ventilator. The
, nurse notes a PaO2 of 55 mmHg and an FiO2 of 0.8. The nurse anticipates an order to increase
which ventilator setting to improve oxygenation?
A) Respiratory rate
B) Tidal volume
C) Positive End-Expiratory Pressure (PEEP)
D) Inspiratory time
Correct Answer: C) Positive End-Expiratory Pressure (PEEP)
Rationale: In ARDS, the lungs have widespread atelectasis and alveolar collapse, leading to
refractory hypoxemia. PEEP helps to keep alveoli open at the end of expiration, recruit
collapsed alveoli, and improve oxygenation, thus reducing the need for high FiO2 which
can cause oxygen toxicity. Increasing respiratory rate or tidal volume might improve
ventilation but not necessarily oxygenation significantly in ARDS.
Question 9
A patient is experiencing diabetic ketoacidosis (DKA). After initial fluid resuscitation, the nurse
anticipates an order for which medication?
A) Oral glipizide.
B) Subcutaneous insulin glargine.
C) Intravenous regular insulin infusion.
D) Intramuscular glucagon.
Correct Answer: C) Intravenous regular insulin infusion.
Rationale: Intravenous regular insulin, administered as a continuous infusion, is the
cornerstone of DKA treatment after initial fluid resuscitation. It gradually lowers blood
glucose, corrects acidosis, and resolves ketosis. Oral agents, subcutaneous insulin
(especially long-acting), or glucagon are not appropriate for acute DKA management.
Question 10
A nurse is preparing to administer a continuous norepinephrine (Levophed) infusion. Which
nursing intervention is a priority?
A) Administer through a peripheral IV.
B) Monitor for bradycardia.
C) Ensure a patent central venous access device is in place.
TEST BANK LATEST 350 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+
Question 1
A nurse is caring for a patient in cardiogenic shock. Which hemodynamic parameter should the
nurse expect to be elevated?
A) Cardiac Output (CO)
B) Systemic Vascular Resistance (SVR)
C) Mixed Venous Oxygen Saturation (SvO2)
D) Blood Pressure (BP)
Correct Answer: B) Systemic Vascular Resistance (SVR)
Rationale: In cardiogenic shock, the heart's pumping ability is severely impaired, leading
to decreased cardiac output and hypotension. The body attempts to compensate by
increasing SVR (vasoconstriction) to maintain systemic perfusion, but this increases
afterload and further compromises the failing heart. CO and BP would be decreased, and
SvO2 would typically be decreased due to increased tissue oxygen extraction.
Question 2
A patient with an acute ST-elevation myocardial infarction (STEMI) is prescribed intravenous
nitroglycerin. The nurse understands that this medication's primary action is to:
A) Increase myocardial contractility.
B) Cause systemic vasoconstriction.
C) Reduce preload and afterload through vasodilation.
D) Improve oxygen-carrying capacity of blood.
Correct Answer: C) Reduce preload and afterload through vasodilation.
Rationale: Intravenous nitroglycerin is a potent vasodilator. Its primary benefit in STEMI
is to reduce myocardial oxygen demand by decreasing both preload (venous dilation) and
afterload (arterial dilation), which reduces the workload on the heart and can relieve
ischemia. It also dilates coronary arteries directly.
Question 3
A nurse is managing a patient on a mechanical ventilator. The high-pressure alarm frequently
sounds. Which of the following is the most appropriate initial nursing intervention?
A) Increase the peak inspiratory pressure (PIP) setting.
,B) Administer a sedative.
C) Assess for kinks in the tubing or secretions in the airway.
D) Decrease the tidal volume.
Correct Answer: C) Assess for kinks in the tubing or secretions in the airway.
Rationale: High-pressure alarms indicate increased resistance to airflow. The nurse should
first assess for easily correctable causes: kinks in the ventilator tubing, patient biting the
ETT, accumulation of secretions (requiring suctioning), or patient coughing/fighting the
ventilator. Addressing these issues often resolves the alarm.
Question 4
A patient is admitted to the ICU with suspected sepsis. The nurse anticipates an order for broad-
spectrum antibiotics to be administered within what timeframe?
A) Within 6 hours of diagnosis.
B) Within 3 hours of diagnosis.
C) Within 1 hour of diagnosis.
D) After culture results are available.
Correct Answer: C) Within 1 hour of diagnosis.
Rationale: Current sepsis guidelines (Surviving Sepsis Campaign) recommend initiating
broad-spectrum antibiotic therapy within one hour of recognizing sepsis or septic shock.
Rapid administration is critical to improve patient outcomes. Cultures should be obtained
before antibiotics, but antibiotic administration should not be delayed waiting for results.
Question 5
A nurse is caring for a patient with increased intracranial pressure (ICP). Which neurological
assessment finding is the most sensitive indicator of early deterioration?
A) Fixed and dilated pupils.
B) Projectile vomiting.
C) Change in level of consciousness (LOC).
D) Bradycardia and widening pulse pressure.
Correct Answer: C) Change in level of consciousness (LOC).
Rationale: Subtle changes in level of consciousness, such as restlessness, confusion,
irritability, or decreased alertness, are often the earliest and most sensitive indicators of
,increasing ICP. Fixed/dilated pupils, projectile vomiting, and Cushing's triad (bradycardia,
hypertension with widening pulse pressure, irregular respirations) are typically later signs
of severe or impending brain herniation.
Question 6
A patient in ventricular tachycardia (VT) with a pulse is stable. Which antiarrhythmic medication
should the nurse anticipate administering?
A) Adenosine
B) Amiodarone
C) Atropine
D) Digoxin
Correct Answer: B) Amiodarone
Rationale: For stable ventricular tachycardia with a pulse, intravenous antiarrhythmics
are indicated. Amiodarone is a common first-line agent, along with procainamide or sotalol.
Adenosine is used for SVT. Atropine is for bradycardia. Digoxin is for atrial
fibrillation/flutter with rapid ventricular response or heart failure.
Question 7
A nurse is monitoring a patient with an arterial line. The arterial waveform shows damping.
Which of the following is a possible cause?
A) Over-pressurized flush bag.
B) Air bubble in the tubing.
C) Catheter tip positioned too close to the vessel wall.
D) Patient is hypotensive.
Correct Answer: C) Catheter tip positioned too close to the vessel wall.
Rationale: A damped arterial waveform indicates a loss of accurate pressure transmission.
Common causes include air bubbles in the system, kinks in the tubing, a clot at the catheter
tip, or the catheter tip resting against the vessel wall. An under-pressurized flush bag could
also cause damping, but not an over-pressurized one. Hypotension would affect the
pressure reading but not necessarily cause damping.
Question 8
A patient with acute respiratory distress syndrome (ARDS) is on a mechanical ventilator. The
, nurse notes a PaO2 of 55 mmHg and an FiO2 of 0.8. The nurse anticipates an order to increase
which ventilator setting to improve oxygenation?
A) Respiratory rate
B) Tidal volume
C) Positive End-Expiratory Pressure (PEEP)
D) Inspiratory time
Correct Answer: C) Positive End-Expiratory Pressure (PEEP)
Rationale: In ARDS, the lungs have widespread atelectasis and alveolar collapse, leading to
refractory hypoxemia. PEEP helps to keep alveoli open at the end of expiration, recruit
collapsed alveoli, and improve oxygenation, thus reducing the need for high FiO2 which
can cause oxygen toxicity. Increasing respiratory rate or tidal volume might improve
ventilation but not necessarily oxygenation significantly in ARDS.
Question 9
A patient is experiencing diabetic ketoacidosis (DKA). After initial fluid resuscitation, the nurse
anticipates an order for which medication?
A) Oral glipizide.
B) Subcutaneous insulin glargine.
C) Intravenous regular insulin infusion.
D) Intramuscular glucagon.
Correct Answer: C) Intravenous regular insulin infusion.
Rationale: Intravenous regular insulin, administered as a continuous infusion, is the
cornerstone of DKA treatment after initial fluid resuscitation. It gradually lowers blood
glucose, corrects acidosis, and resolves ketosis. Oral agents, subcutaneous insulin
(especially long-acting), or glucagon are not appropriate for acute DKA management.
Question 10
A nurse is preparing to administer a continuous norepinephrine (Levophed) infusion. Which
nursing intervention is a priority?
A) Administer through a peripheral IV.
B) Monitor for bradycardia.
C) Ensure a patent central venous access device is in place.
