CRITICAL CARE HESI EXAM 2025/ACTUAL EXAM QUESTIONS
WITH VERIFIED ANSWERS PLUS RATIONALES/GRADED A+
1
A nurse is caring for a patient in septic shock. Which of the following findings
is the most indicative of effective fluid resuscitation?
A) Mean Arterial Pressure (MAP) of 55 mmHg.
B) Urine output of 15 mL/hour.
C) Central Venous Pressure (CVP) of 8-12 mmHg.
D) Lactate level increasing from 4 mmol/L to 6 mmol/L.
E) Heart rate of 120 bpm.
Correct Answer: C) Central Venous Pressure (CVP) of 8-12 mmHg
Rationale: In septic shock, the goal of fluid resuscitation is to
optimize preload. A CVP of 8-12 mmHg is the target range for CVP in
spontaneously breathing patients (or 12-15 mmHg in mechanically
ventilated patients) to indicate adequate intravascular volume after
initial fluid challenges, assuming there are no other underlying
cardiac issues affecting CVP.
2
A patient presents to the ED with crushing chest pain radiating to the left
arm, diaphoresis, and dyspnea. The ECG shows ST-segment elevation in
leads II, III, and aVF. Which type of myocardial infarction does this suggest?
A) Anterior wall MI
B) Septal wall MI
C) Inferior wall MI
D) Lateral wall MI
E) Posterior wall MI
Correct Answer: C) Inferior wall MI
Rationale: ST-segment elevation in leads II, III, and aVF indicates an
inferior wall myocardial infarction, which is typically caused by
occlusion of the right coronary artery (RCA).
,3
The nurse is preparing to administer intravenous nitroglycerin to a patient
with acute coronary syndrome. Which vital sign requires close monitoring
and may necessitate holding the medication?
A) Heart rate of 110 bpm
B) Respiratory rate of 24 breaths/min
C) Blood pressure of 88/50 mmHg
D) Oxygen saturation of 92%
E) Temperature of 38.5°C (101.3°F)
Correct Answer: C) Blood pressure of 88/50 mmHg
Rationale: Nitroglycerin is a potent vasodilator that can cause
significant hypotension. A blood pressure of 88/50 mmHg is
dangerously low, and administering nitroglycerin could worsen the
patient's condition. The medication should be held, and the
physician notified.
4
A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP)
of 20 mmHg. Which nursing intervention is most appropriate to help lower
the ICP?
A) Trendelenburg position
B) Clustering nursing activities
C) Maintaining a quiet environment
D) Administering a hypertonic saline bolus
E) Keeping the head of the bed flat
Correct Answer: D) Administering a hypertonic saline bolus
Rationale: Hypertonic saline (e.g., 3% NaCl) is used to create an
osmotic gradient, drawing fluid from the brain tissue into the
intravascular space, thereby reducing cerebral edema and ICP.
Maintaining a quiet environment and avoiding clustering activities
are also helpful but less direct in actively lowering ICP.
,5
The nurse is caring for a patient on a mechanical ventilator. The high-
pressure alarm frequently sounds. Which action should the nurse take first?
A) Administer a sedative to the patient.
B) Increase the peak inspiratory pressure limit.
C) Assess the patient for secretions or kinks in the tubing.
D) Call the respiratory therapist immediately.
E) Deflate the endotracheal tube cuff.
Correct Answer: C) Assess the patient for secretions or kinks in the
tubing.
Rationale: The high-pressure alarm indicates increased resistance to
airflow. The nurse should first assess for easily reversible causes
such as secretions (requiring suctioning), kinks in the tubing, or the
patient biting the tube. These are immediate actions the nurse can
take.
6
A patient with diabetic ketoacidosis (DKA) has the following arterial blood gas
(ABG) results: pH 7.20, PaCO2 30 mmHg, HCO3 12 mEq/L. This indicates
which acid-base imbalance?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
E) Mixed acid-base disorder
Correct Answer: C) Metabolic acidosis
Rationale: A pH of 7.20 indicates acidosis. A low HCO3 (12 mEq/L,
normal 22-26) indicates a metabolic component. The PaCO2 (30
mmHg, normal 35-45) is low, indicating respiratory compensation,
not a primary respiratory problem. Therefore, it is metabolic
acidosis.
, 7
Which medication is a commonly used inotropic agent that increases
myocardial contractility in patients with cardiogenic shock?
A) Nitroprusside
B) Dobutamine
C) Labetalol
D) Furosemide
E) Enalapril
Correct Answer: B) Dobutamine
Rationale: Dobutamine is a beta-1 adrenergic agonist that primarily
increases myocardial contractility (positive inotropic effect) and
causes vasodilation, making it useful in cardiogenic shock to
improve cardiac output.
8
A nurse is preparing a patient for a central line insertion. Which position
should the nurse place the patient in to prevent air embolism?
A) High Fowler's
B) Supine
C) Prone
D) Trendelenburg
E) Semi-Fowler's
Correct Answer: D) Trendelenburg
Rationale: The Trendelenburg position (head lower than feet)
increases central venous pressure and engorges the jugular veins,
reducing the risk of air entering the central circulation during
insertion or removal of a central line.
9
The nurse is assessing a patient with a suspected pulmonary embolism (PE).
Which symptom is most classic for PE?
A) Bradycardia
WITH VERIFIED ANSWERS PLUS RATIONALES/GRADED A+
1
A nurse is caring for a patient in septic shock. Which of the following findings
is the most indicative of effective fluid resuscitation?
A) Mean Arterial Pressure (MAP) of 55 mmHg.
B) Urine output of 15 mL/hour.
C) Central Venous Pressure (CVP) of 8-12 mmHg.
D) Lactate level increasing from 4 mmol/L to 6 mmol/L.
E) Heart rate of 120 bpm.
Correct Answer: C) Central Venous Pressure (CVP) of 8-12 mmHg
Rationale: In septic shock, the goal of fluid resuscitation is to
optimize preload. A CVP of 8-12 mmHg is the target range for CVP in
spontaneously breathing patients (or 12-15 mmHg in mechanically
ventilated patients) to indicate adequate intravascular volume after
initial fluid challenges, assuming there are no other underlying
cardiac issues affecting CVP.
2
A patient presents to the ED with crushing chest pain radiating to the left
arm, diaphoresis, and dyspnea. The ECG shows ST-segment elevation in
leads II, III, and aVF. Which type of myocardial infarction does this suggest?
A) Anterior wall MI
B) Septal wall MI
C) Inferior wall MI
D) Lateral wall MI
E) Posterior wall MI
Correct Answer: C) Inferior wall MI
Rationale: ST-segment elevation in leads II, III, and aVF indicates an
inferior wall myocardial infarction, which is typically caused by
occlusion of the right coronary artery (RCA).
,3
The nurse is preparing to administer intravenous nitroglycerin to a patient
with acute coronary syndrome. Which vital sign requires close monitoring
and may necessitate holding the medication?
A) Heart rate of 110 bpm
B) Respiratory rate of 24 breaths/min
C) Blood pressure of 88/50 mmHg
D) Oxygen saturation of 92%
E) Temperature of 38.5°C (101.3°F)
Correct Answer: C) Blood pressure of 88/50 mmHg
Rationale: Nitroglycerin is a potent vasodilator that can cause
significant hypotension. A blood pressure of 88/50 mmHg is
dangerously low, and administering nitroglycerin could worsen the
patient's condition. The medication should be held, and the
physician notified.
4
A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP)
of 20 mmHg. Which nursing intervention is most appropriate to help lower
the ICP?
A) Trendelenburg position
B) Clustering nursing activities
C) Maintaining a quiet environment
D) Administering a hypertonic saline bolus
E) Keeping the head of the bed flat
Correct Answer: D) Administering a hypertonic saline bolus
Rationale: Hypertonic saline (e.g., 3% NaCl) is used to create an
osmotic gradient, drawing fluid from the brain tissue into the
intravascular space, thereby reducing cerebral edema and ICP.
Maintaining a quiet environment and avoiding clustering activities
are also helpful but less direct in actively lowering ICP.
,5
The nurse is caring for a patient on a mechanical ventilator. The high-
pressure alarm frequently sounds. Which action should the nurse take first?
A) Administer a sedative to the patient.
B) Increase the peak inspiratory pressure limit.
C) Assess the patient for secretions or kinks in the tubing.
D) Call the respiratory therapist immediately.
E) Deflate the endotracheal tube cuff.
Correct Answer: C) Assess the patient for secretions or kinks in the
tubing.
Rationale: The high-pressure alarm indicates increased resistance to
airflow. The nurse should first assess for easily reversible causes
such as secretions (requiring suctioning), kinks in the tubing, or the
patient biting the tube. These are immediate actions the nurse can
take.
6
A patient with diabetic ketoacidosis (DKA) has the following arterial blood gas
(ABG) results: pH 7.20, PaCO2 30 mmHg, HCO3 12 mEq/L. This indicates
which acid-base imbalance?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
E) Mixed acid-base disorder
Correct Answer: C) Metabolic acidosis
Rationale: A pH of 7.20 indicates acidosis. A low HCO3 (12 mEq/L,
normal 22-26) indicates a metabolic component. The PaCO2 (30
mmHg, normal 35-45) is low, indicating respiratory compensation,
not a primary respiratory problem. Therefore, it is metabolic
acidosis.
, 7
Which medication is a commonly used inotropic agent that increases
myocardial contractility in patients with cardiogenic shock?
A) Nitroprusside
B) Dobutamine
C) Labetalol
D) Furosemide
E) Enalapril
Correct Answer: B) Dobutamine
Rationale: Dobutamine is a beta-1 adrenergic agonist that primarily
increases myocardial contractility (positive inotropic effect) and
causes vasodilation, making it useful in cardiogenic shock to
improve cardiac output.
8
A nurse is preparing a patient for a central line insertion. Which position
should the nurse place the patient in to prevent air embolism?
A) High Fowler's
B) Supine
C) Prone
D) Trendelenburg
E) Semi-Fowler's
Correct Answer: D) Trendelenburg
Rationale: The Trendelenburg position (head lower than feet)
increases central venous pressure and engorges the jugular veins,
reducing the risk of air entering the central circulation during
insertion or removal of a central line.
9
The nurse is assessing a patient with a suspected pulmonary embolism (PE).
Which symptom is most classic for PE?
A) Bradycardia
