HESI Critical Care Exam ACTUAL
EXAM 2026/2027 | Critical Care
Nursing | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Hemodynamics & Cardiovascular Critical Care (25 Questions)
Q1: A patient with cardiogenic shock has a pulmonary artery catheter inserted. The nurse notes a
cardiac index of 1.8 L/min/m², pulmonary capillary wedge pressure (PCWP) of 24 mmHg, and systemic
vascular resistance (SVR) of 1,800 dynes/sec/cm⁻⁵. Which hemodynamic profile is consistent with these
findings?
A. Hypovolemic shock
B. Septic shock
C. Left ventricular failure. [CORRECT]
D. Right ventricular failure
Correct Answer: C
Rationale: Elevated PCWP with decreased cardiac index and high SVR indicates left ventricular failure
and cardiogenic shock, requiring inotropic support and afterload reduction.
Q2: A patient receiving norepinephrine for septic shock develops a sudden heart rate of 140 bpm with
irregular R-R intervals. The nurse notes no P waves on the ECG. Which rhythm is most likely?
A. Sinus tachycardia
B. Ventricular tachycardia
C. Atrial fibrillation with rapid ventricular response. [CORRECT]
D. Atrial flutter
Correct Answer: C
Rationale: Absent P waves with irregular R-R intervals indicates atrial fibrillation, common in critically ill
patients receiving vasoactive medications that increase myocardial irritability.
,Q3: The nurse is caring for a patient with an intra-aortic balloon pump (IABP) set at 1:1 augmentation.
Which assessment finding indicates effective counterpulsation?
A. Diastolic augmentation pressure exceeds systolic pressure. [CORRECT]
B. Systolic pressure increases by 20 mmHg
C. Mean arterial pressure decreases
D. Diastolic pressure equals systolic pressure
Correct Answer: A
Rationale: Effective IABP function produces diastolic augmentation pressure higher than systolic
pressure, reducing afterload and improving coronary perfusion.
Q4: A patient with acute myocardial infarction develops ventricular tachycardia with a pulse but
deteriorating blood pressure. Which intervention is the priority?
A. Administer amiodarone 300 mg IV push
B. Prepare for synchronized cardioversion. [CORRECT]
C. Begin CPR immediately
D. Administer atropine 1 mg IV
Correct Answer: B
Rationale: Unstable ventricular tachycardia with hemodynamic compromise requires immediate
synchronized cardioversion to restore perfusing rhythm.
Q5: The nurse notes a central venous pressure (CVP) of 4 mmHg in a patient with septic shock. Which
fluid resuscitation strategy is most appropriate?
A. Hold fluids and administer diuretics
B. Administer 30 mL/kg crystalloid bolus. [CORRECT]
C. Begin vasopressors immediately
D. Administer colloids only
Correct Answer: B
Rationale: Low CVP indicates hypovolemia; the Surviving Sepsis Campaign recommends 30 mL/kg
crystalloid resuscitation within the first hour for septic shock.
Q6: A patient with heart failure receiving milrinone develops increased ventricular ectopy. Which
electrolyte imbalance should the nurse anticipate?
A. Hypernatremia
B. Hypokalemia. [CORRECT]
C. Hypercalcemia
,D. Hyponatremia
Correct Answer: B
Rationale: Milrinone promotes intracellular potassium shifts and increases arrhythmia risk; hypokalemia
exacerbates phosphodiesterase inhibitor-induced ectopy.
Q7: The nurse is monitoring a patient after coronary artery bypass grafting. Which finding requires
immediate intervention?
A. Chest tube drainage of 75 mL/hour
B. Cardiac index of 2.2 L/min/m²
C. Sudden drop in mixed venous oxygen saturation to 55%. [CORRECT]
D. Mean arterial pressure of 75 mmHg
Correct Answer: C
Rationale: Mixed venous oxygen saturation below 60% indicates inadequate tissue oxygen delivery,
suggesting low cardiac output or increased oxygen consumption.
Q8: A patient with an LVAD presents with a mean arterial pressure of 55 mmHg and power spikes on the
device console. Which condition is suspected?
A. Hypovolemia
B. Hypertension
C. Suction event/cannula malposition. [CORRECT]
D. Device thrombosis
Correct Answer: C
Rationale: Low MAP with power spikes indicates ventricular suction events from hypovolemia or
cannula malposition, requiring volume administration and position assessment.
Q9: Which ECG finding indicates third-degree atrioventricular block?
A. Prolonged PR interval with dropped beats
B. P waves and QRS complexes completely dissociated. [CORRECT]
C. Narrow QRS complexes at 150 bpm
D. Sawtooth pattern in lead II
Correct Answer: B
Rationale: Complete heart block demonstrates atrioventricular dissociation with independent atrial and
ventricular activity, requiring pacemaker intervention.
, Q10: A patient with cardiogenic shock has a right atrial pressure of 15 mmHg and pulmonary artery
pressure of 50/25 mmHg with PCWP of 30 mmHg. Which condition is indicated?
A. Right ventricular infarction
B. Acute mitral regurgitation
C. Severe left ventricular dysfunction. [CORRECT]
D. Pulmonary embolism
Correct Answer: C
Rationale: Elevated PCWP with high pulmonary pressures and elevated right atrial pressure indicates
severe biventricular failure with backward congestion.
Q11: The nurse is preparing to administer dobutamine to a patient with cardiogenic shock. Which
parameter requires continuous monitoring?
A. Respiratory rate
B. Urine output
C. Heart rhythm and rate. [CORRECT]
D. Temperature
Correct Answer: C
Rationale: Dobutamine increases myocardial oxygen demand and arrhythmia risk; continuous cardiac
monitoring detects tachycardia and ventricular ectopy.
Q12: A patient with ST-elevation myocardial infarction develops ventricular fibrillation. Which
intervention is the priority?
A. Administer epinephrine 1 mg IV
B. Defibrillate immediately with 200 joules biphasic. [CORRECT]
C. Begin chest compressions for 2 minutes
D. Administer amiodarone 300 mg IV
Correct Answer: B
Rationale: Pulseless ventricular fibrillation requires immediate defibrillation; CPR is performed only if
defibrillation is delayed or unsuccessful.
Q13: The nurse notes a pulmonary artery diastolic pressure of 18 mmHg and PCWP of 20 mmHg. Which
condition is suggested?
A. Hypovolemia
B. Pulmonary hypertension
C. Left ventricular dysfunction. [CORRECT]
EXAM 2026/2027 | Critical Care
Nursing | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Hemodynamics & Cardiovascular Critical Care (25 Questions)
Q1: A patient with cardiogenic shock has a pulmonary artery catheter inserted. The nurse notes a
cardiac index of 1.8 L/min/m², pulmonary capillary wedge pressure (PCWP) of 24 mmHg, and systemic
vascular resistance (SVR) of 1,800 dynes/sec/cm⁻⁵. Which hemodynamic profile is consistent with these
findings?
A. Hypovolemic shock
B. Septic shock
C. Left ventricular failure. [CORRECT]
D. Right ventricular failure
Correct Answer: C
Rationale: Elevated PCWP with decreased cardiac index and high SVR indicates left ventricular failure
and cardiogenic shock, requiring inotropic support and afterload reduction.
Q2: A patient receiving norepinephrine for septic shock develops a sudden heart rate of 140 bpm with
irregular R-R intervals. The nurse notes no P waves on the ECG. Which rhythm is most likely?
A. Sinus tachycardia
B. Ventricular tachycardia
C. Atrial fibrillation with rapid ventricular response. [CORRECT]
D. Atrial flutter
Correct Answer: C
Rationale: Absent P waves with irregular R-R intervals indicates atrial fibrillation, common in critically ill
patients receiving vasoactive medications that increase myocardial irritability.
,Q3: The nurse is caring for a patient with an intra-aortic balloon pump (IABP) set at 1:1 augmentation.
Which assessment finding indicates effective counterpulsation?
A. Diastolic augmentation pressure exceeds systolic pressure. [CORRECT]
B. Systolic pressure increases by 20 mmHg
C. Mean arterial pressure decreases
D. Diastolic pressure equals systolic pressure
Correct Answer: A
Rationale: Effective IABP function produces diastolic augmentation pressure higher than systolic
pressure, reducing afterload and improving coronary perfusion.
Q4: A patient with acute myocardial infarction develops ventricular tachycardia with a pulse but
deteriorating blood pressure. Which intervention is the priority?
A. Administer amiodarone 300 mg IV push
B. Prepare for synchronized cardioversion. [CORRECT]
C. Begin CPR immediately
D. Administer atropine 1 mg IV
Correct Answer: B
Rationale: Unstable ventricular tachycardia with hemodynamic compromise requires immediate
synchronized cardioversion to restore perfusing rhythm.
Q5: The nurse notes a central venous pressure (CVP) of 4 mmHg in a patient with septic shock. Which
fluid resuscitation strategy is most appropriate?
A. Hold fluids and administer diuretics
B. Administer 30 mL/kg crystalloid bolus. [CORRECT]
C. Begin vasopressors immediately
D. Administer colloids only
Correct Answer: B
Rationale: Low CVP indicates hypovolemia; the Surviving Sepsis Campaign recommends 30 mL/kg
crystalloid resuscitation within the first hour for septic shock.
Q6: A patient with heart failure receiving milrinone develops increased ventricular ectopy. Which
electrolyte imbalance should the nurse anticipate?
A. Hypernatremia
B. Hypokalemia. [CORRECT]
C. Hypercalcemia
,D. Hyponatremia
Correct Answer: B
Rationale: Milrinone promotes intracellular potassium shifts and increases arrhythmia risk; hypokalemia
exacerbates phosphodiesterase inhibitor-induced ectopy.
Q7: The nurse is monitoring a patient after coronary artery bypass grafting. Which finding requires
immediate intervention?
A. Chest tube drainage of 75 mL/hour
B. Cardiac index of 2.2 L/min/m²
C. Sudden drop in mixed venous oxygen saturation to 55%. [CORRECT]
D. Mean arterial pressure of 75 mmHg
Correct Answer: C
Rationale: Mixed venous oxygen saturation below 60% indicates inadequate tissue oxygen delivery,
suggesting low cardiac output or increased oxygen consumption.
Q8: A patient with an LVAD presents with a mean arterial pressure of 55 mmHg and power spikes on the
device console. Which condition is suspected?
A. Hypovolemia
B. Hypertension
C. Suction event/cannula malposition. [CORRECT]
D. Device thrombosis
Correct Answer: C
Rationale: Low MAP with power spikes indicates ventricular suction events from hypovolemia or
cannula malposition, requiring volume administration and position assessment.
Q9: Which ECG finding indicates third-degree atrioventricular block?
A. Prolonged PR interval with dropped beats
B. P waves and QRS complexes completely dissociated. [CORRECT]
C. Narrow QRS complexes at 150 bpm
D. Sawtooth pattern in lead II
Correct Answer: B
Rationale: Complete heart block demonstrates atrioventricular dissociation with independent atrial and
ventricular activity, requiring pacemaker intervention.
, Q10: A patient with cardiogenic shock has a right atrial pressure of 15 mmHg and pulmonary artery
pressure of 50/25 mmHg with PCWP of 30 mmHg. Which condition is indicated?
A. Right ventricular infarction
B. Acute mitral regurgitation
C. Severe left ventricular dysfunction. [CORRECT]
D. Pulmonary embolism
Correct Answer: C
Rationale: Elevated PCWP with high pulmonary pressures and elevated right atrial pressure indicates
severe biventricular failure with backward congestion.
Q11: The nurse is preparing to administer dobutamine to a patient with cardiogenic shock. Which
parameter requires continuous monitoring?
A. Respiratory rate
B. Urine output
C. Heart rhythm and rate. [CORRECT]
D. Temperature
Correct Answer: C
Rationale: Dobutamine increases myocardial oxygen demand and arrhythmia risk; continuous cardiac
monitoring detects tachycardia and ventricular ectopy.
Q12: A patient with ST-elevation myocardial infarction develops ventricular fibrillation. Which
intervention is the priority?
A. Administer epinephrine 1 mg IV
B. Defibrillate immediately with 200 joules biphasic. [CORRECT]
C. Begin chest compressions for 2 minutes
D. Administer amiodarone 300 mg IV
Correct Answer: B
Rationale: Pulseless ventricular fibrillation requires immediate defibrillation; CPR is performed only if
defibrillation is delayed or unsuccessful.
Q13: The nurse notes a pulmonary artery diastolic pressure of 18 mmHg and PCWP of 20 mmHg. Which
condition is suggested?
A. Hypovolemia
B. Pulmonary hypertension
C. Left ventricular dysfunction. [CORRECT]
