Critical Care HESI Exam 2026/2027
Actual Exam Questions and Rationales for Guaranteed Pass
Critical Care Nursing HESI Specialty Exam
2026
Contains 65 Practice Questions with Detailed Rationales
,Table of Contents
Table of Contents ..................................................................................................................... 2
Section 1: Hemodynamic Monitoring .................................................................................... 3
Section 2: Mechanical Ventilation .......................................................................................... 5
Section 3: ABG Interpretation ................................................................................................ 8
Section 4: Shock Management .............................................................................................. 10
Section 5: Multisystem Organ Dysfunction Syndrome (MODS) ....................................... 12
Section 6: Sepsis and Septic Shock ....................................................................................... 13
Section 7: Acute Respiratory Distress Syndrome (ARDS) ................................................. 15
Section 8: Acute Kidney Injury (AKI) ................................................................................. 17
Section 9: Neurological Emergencies ................................................................................... 19
Section 10: Cardiac Emergencies ......................................................................................... 22
Section 11: Emergency Medications ..................................................................................... 24
Section 12: ACLS Algorithms ............................................................................................... 26
Section 13: Post-Resuscitation Care ..................................................................................... 28
Section 14: Burn Management.............................................................................................. 30
Section 15: Trauma Resuscitation ........................................................................................ 31
Section 16: Ethical and Legal Issues in Critical Care......................................................... 33
Answer Key ............................................................................................................................. 35
Table of Contents ..................................................................................................................... 2
Section 1: Hemodynamic Monitoring .................................................................................... 3
Section 2: Mechanical Ventilation .......................................................................................... 5
Section 3: ABG Interpretation ................................................................................................ 8
Section 4: Shock Management .............................................................................................. 10
Section 5: Multisystem Organ Dysfunction Syndrome (MODS) ....................................... 12
Section 6: Sepsis and Septic Shock ....................................................................................... 13
Page 2
,Section 7: Acute Respiratory Distress Syndrome (ARDS) ................................................. 15
Section 8: Acute Kidney Injury (AKI) ................................................................................. 17
Section 9: Neurological Emergencies ................................................................................... 19
Section 10: Cardiac Emergencies ......................................................................................... 22
Section 11: Emergency Medications ..................................................................................... 24
Section 12: ACLS Algorithms ............................................................................................... 26
Section 13: Post-Resuscitation Care ..................................................................................... 28
Section 14: Burn Management.............................................................................................. 30
Section 15: Trauma Resuscitation ........................................................................................ 31
Section 16: Ethical and Legal Issues in Critical Care......................................................... 33
Answer Key ............................................................................................................................. 35
Section 1: Hemodynamic Monitoring
1. A critical care nurse is reviewing the hemodynamic parameters of a patient with a
pulmonary artery (PA) catheter. Which of the following sets of values is considered within
normal limits for a healthy adult at rest?
A. CVP 2 mmHg, PCWP 6 mmHg, CO 3.0 L/min, SVR 800 dynes·sec/cm⁵
B. CVP 8 mmHg, PCWP 12 mmHg, CO 5.0 L/min, SVR 1200 dynes·sec/cm⁵
C. CVP 12 mmHg, PCWP 18 mmHg, CO 7.5 L/min, SVR 1500 dynes·sec/cm⁵
D. CVP 15 mmHg, PCWP 25 mmHg, CO 2.5 L/min, SVR 2200 dynes·sec/cm⁵
Rationale: Normal hemodynamic values for a healthy adult at rest include: CVP 2–8 mmHg (typically
2–6 mmHg), PCWP 6–12 mmHg (reflects left atrial pressure and left ventricular preload), CO 4–8
L/min, and SVR 800–1200 dynes·sec/cm⁵. Option B falls within these ranges. Option A shows low CVP
and borderline low CO. Option C shows elevated CVP, PCWP, and CO suggesting volume overload
or high-output state. Option D shows markedly elevated CVP and PCWP with low CO, consistent with
cardiogenic shock.
2. A patient has a PA catheter in place. The nurse notes a PAWP (pulmonary artery wedge
pressure) reading of 25 mmHg. Which condition is most likely associated with this finding?
Page 3
, A. Hypovolemic shock
B. Left ventricular failure
C. Septic shock (early phase)
D. Pulmonary embolism
Rationale: PAWP (also called PCWP) reflects left ventricular end-diastolic pressure and left-sided
preload. A PAWP of 25 mmHg is significantly elevated (normal 6–12 mmHg) and is most commonly
associated with left ventricular failure, where the left ventricle cannot effectively eject blood, causing
backup into the left atrium and pulmonary vasculature. Hypovolemic shock would show a low PAWP
(typically <6 mmHg). Early septic shock often shows a normal or low PAWP due to vasodilation and
decreased venous return. Pulmonary embolism classically shows normal PAWP with elevated
pulmonary artery pressures.
3. The nurse is caring for a patient with an arterial line. Which action is correct regarding
zeroing and leveling the transducer system?
A. Level the transducer at the level of the right atrium (midaxillary line, fourth
intercostal space) and zero to atmospheric pressure at end-expiration
B. Level the transducer at the level of the sternal notch and zero to atmospheric pressure at
end-inspiration
C. Level the transducer at the level of the umbilicus and zero to atmospheric pressure before
each reading
D. Level the transducer at the level of the radial artery and zero to atmospheric pressure with
the patient supine
Rationale: The arterial line transducer must be leveled to the phlebostatic axis, which is the
intersection of the fourth intercostal space at the midaxillary line (level of the right atrium). Zeroing
should be performed to atmospheric pressure at end-expiration, when intrathoracic pressure is closest
to zero and least variable. Leveling at the sternal notch, umbilicus, or radial artery would introduce
systematic error, causing falsely high or low pressure readings. Zeroing at end-inspiration would
incorporate intrathoracic pressure effects.
4. A patient with septic shock has the following hemodynamic parameters: CO 8.5 L/min,
SVR 650 dynes·sec/cm⁵, PCWP 8 mmHg. Which intervention is the priority based on these
findings?
A. Administer a diuretic to reduce preload
B. Initiate a norepinephrine infusion to increase SVR
Page 4
Actual Exam Questions and Rationales for Guaranteed Pass
Critical Care Nursing HESI Specialty Exam
2026
Contains 65 Practice Questions with Detailed Rationales
,Table of Contents
Table of Contents ..................................................................................................................... 2
Section 1: Hemodynamic Monitoring .................................................................................... 3
Section 2: Mechanical Ventilation .......................................................................................... 5
Section 3: ABG Interpretation ................................................................................................ 8
Section 4: Shock Management .............................................................................................. 10
Section 5: Multisystem Organ Dysfunction Syndrome (MODS) ....................................... 12
Section 6: Sepsis and Septic Shock ....................................................................................... 13
Section 7: Acute Respiratory Distress Syndrome (ARDS) ................................................. 15
Section 8: Acute Kidney Injury (AKI) ................................................................................. 17
Section 9: Neurological Emergencies ................................................................................... 19
Section 10: Cardiac Emergencies ......................................................................................... 22
Section 11: Emergency Medications ..................................................................................... 24
Section 12: ACLS Algorithms ............................................................................................... 26
Section 13: Post-Resuscitation Care ..................................................................................... 28
Section 14: Burn Management.............................................................................................. 30
Section 15: Trauma Resuscitation ........................................................................................ 31
Section 16: Ethical and Legal Issues in Critical Care......................................................... 33
Answer Key ............................................................................................................................. 35
Table of Contents ..................................................................................................................... 2
Section 1: Hemodynamic Monitoring .................................................................................... 3
Section 2: Mechanical Ventilation .......................................................................................... 5
Section 3: ABG Interpretation ................................................................................................ 8
Section 4: Shock Management .............................................................................................. 10
Section 5: Multisystem Organ Dysfunction Syndrome (MODS) ....................................... 12
Section 6: Sepsis and Septic Shock ....................................................................................... 13
Page 2
,Section 7: Acute Respiratory Distress Syndrome (ARDS) ................................................. 15
Section 8: Acute Kidney Injury (AKI) ................................................................................. 17
Section 9: Neurological Emergencies ................................................................................... 19
Section 10: Cardiac Emergencies ......................................................................................... 22
Section 11: Emergency Medications ..................................................................................... 24
Section 12: ACLS Algorithms ............................................................................................... 26
Section 13: Post-Resuscitation Care ..................................................................................... 28
Section 14: Burn Management.............................................................................................. 30
Section 15: Trauma Resuscitation ........................................................................................ 31
Section 16: Ethical and Legal Issues in Critical Care......................................................... 33
Answer Key ............................................................................................................................. 35
Section 1: Hemodynamic Monitoring
1. A critical care nurse is reviewing the hemodynamic parameters of a patient with a
pulmonary artery (PA) catheter. Which of the following sets of values is considered within
normal limits for a healthy adult at rest?
A. CVP 2 mmHg, PCWP 6 mmHg, CO 3.0 L/min, SVR 800 dynes·sec/cm⁵
B. CVP 8 mmHg, PCWP 12 mmHg, CO 5.0 L/min, SVR 1200 dynes·sec/cm⁵
C. CVP 12 mmHg, PCWP 18 mmHg, CO 7.5 L/min, SVR 1500 dynes·sec/cm⁵
D. CVP 15 mmHg, PCWP 25 mmHg, CO 2.5 L/min, SVR 2200 dynes·sec/cm⁵
Rationale: Normal hemodynamic values for a healthy adult at rest include: CVP 2–8 mmHg (typically
2–6 mmHg), PCWP 6–12 mmHg (reflects left atrial pressure and left ventricular preload), CO 4–8
L/min, and SVR 800–1200 dynes·sec/cm⁵. Option B falls within these ranges. Option A shows low CVP
and borderline low CO. Option C shows elevated CVP, PCWP, and CO suggesting volume overload
or high-output state. Option D shows markedly elevated CVP and PCWP with low CO, consistent with
cardiogenic shock.
2. A patient has a PA catheter in place. The nurse notes a PAWP (pulmonary artery wedge
pressure) reading of 25 mmHg. Which condition is most likely associated with this finding?
Page 3
, A. Hypovolemic shock
B. Left ventricular failure
C. Septic shock (early phase)
D. Pulmonary embolism
Rationale: PAWP (also called PCWP) reflects left ventricular end-diastolic pressure and left-sided
preload. A PAWP of 25 mmHg is significantly elevated (normal 6–12 mmHg) and is most commonly
associated with left ventricular failure, where the left ventricle cannot effectively eject blood, causing
backup into the left atrium and pulmonary vasculature. Hypovolemic shock would show a low PAWP
(typically <6 mmHg). Early septic shock often shows a normal or low PAWP due to vasodilation and
decreased venous return. Pulmonary embolism classically shows normal PAWP with elevated
pulmonary artery pressures.
3. The nurse is caring for a patient with an arterial line. Which action is correct regarding
zeroing and leveling the transducer system?
A. Level the transducer at the level of the right atrium (midaxillary line, fourth
intercostal space) and zero to atmospheric pressure at end-expiration
B. Level the transducer at the level of the sternal notch and zero to atmospheric pressure at
end-inspiration
C. Level the transducer at the level of the umbilicus and zero to atmospheric pressure before
each reading
D. Level the transducer at the level of the radial artery and zero to atmospheric pressure with
the patient supine
Rationale: The arterial line transducer must be leveled to the phlebostatic axis, which is the
intersection of the fourth intercostal space at the midaxillary line (level of the right atrium). Zeroing
should be performed to atmospheric pressure at end-expiration, when intrathoracic pressure is closest
to zero and least variable. Leveling at the sternal notch, umbilicus, or radial artery would introduce
systematic error, causing falsely high or low pressure readings. Zeroing at end-inspiration would
incorporate intrathoracic pressure effects.
4. A patient with septic shock has the following hemodynamic parameters: CO 8.5 L/min,
SVR 650 dynes·sec/cm⁵, PCWP 8 mmHg. Which intervention is the priority based on these
findings?
A. Administer a diuretic to reduce preload
B. Initiate a norepinephrine infusion to increase SVR
Page 4
