HESI – Critical Care Adult Health III
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Free HESI – Critical Care Adult Health III Questions
At the start of a new shift, the nurse receives laboratory results for a client who recently arrived in the emergency department:
Na⁺ 152 mEq/L, K⁺ 4.8 mEq/L, HCO₃⁻ 20 mmol/L, urea 84 mg/dL, creatinine 1.9 mg/dL, serum glucose 680 mg/dL, serum osmolality 334 mOsm/kg, urine negative for ketones. ABGs: normal. WBC count 18,000/µL, CRP 120 mg/L, ESR 70 mm/h.
What should the nurse expect when assessing this client?
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Fruity, acetone breath.
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Dry mucous membranes.
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Pupils narrow and irresponsive to light.
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Distended neck veins.
Explanation
Correct Answer:
B. Dry mucous membranes.
Explanation:
This client’s findings are consistent with Hyperosmolar Hyperglycemic State (HHS), a serious complication of type 2 diabetes mellitus.
Key indicators:
Severe hyperglycemia (glucose 680 mg/dL)
High serum osmolality (334 mOsm/kg)
Absence of ketones in urine and normal ABG values (no acidosis)
Elevated sodium, urea, and creatinine, indicating severe dehydration
Inflammatory markers (WBC, CRP, ESR) elevated due to stress or infection trigger.
Because of the severe dehydration caused by osmotic diuresis, the nurse should expect to find dry mucous membranes, poor skin turgor, tachycardia, and hypotension.
A client who is partly paralyzed after a spinal injury is intubated and started on mechanical ventilation. The nurse implements several actions in order to reduce the risk of ventilation-associated pneumonia (VAP). Which nursing intervention is not a part of standard VAP prevention?
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Provide antibiotic prophylaxis.
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Maintain head of the bed at 35 degrees
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Perform daily sedation interruptions
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Provide peptic ulcer prophylaxis
Explanation
Correct Answer:
A. Provide antibiotic prophylaxis.
Explanation:
Routine antibiotic prophylaxis is not recommended for preventing ventilator-associated pneumonia (VAP) because it promotes antibiotic resistance and alters normal flora without reducing infection risk.
Standard evidence-based VAP prevention strategies include:
Maintaining head-of-bed elevation (30–45°) to reduce aspiration (B).
Performing daily sedation interruptions to assess readiness for extubation (C).
Providing peptic ulcer and deep vein thrombosis prophylaxis to reduce complications in ventilated clients (D).
Thus, antibiotic prophylaxis is not part of the standard VAP prevention bundle.
A client who is admitted to the intensive care unit with acute decompensated heart failure is receiving a continuous infusion of milrinone via a subclavian venous catheter. Which action should the nurse take when preparing to administer the first dose of IV furosemide?
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Infuse furosemide through a central line to prevent extravasation.
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Administer furosemide IV over ten minutes.
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Notify the healthcare provider of the incompatibility of the two drugs.
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Give furosemide through a separate IV access.
Explanation
Correct Answer:
D. Give furosemide through a separate IV access.
Explanation:
Milrinone is an inotrope and vasodilator used in acute decompensated heart failure to improve cardiac contractility and reduce afterload. It must be administered as a continuous IV infusion via a dedicated line, as it is incompatible with many drugs, including furosemide (Lasix). Mixing the two medications in the same line can cause precipitation, leading to line occlusion or embolic risk. Therefore, furosemide should be given through a separate IV line or lumen to maintain safety and drug effectiveness.
A 54-year-old man seeks care in the emergency department for dull aching chest pain radiating to the left arm that started 2 hours ago. He is dyspneic and diaphoretic. An ECG is obtained. The findings are consistent with a 100% occlusion of the left anterior descending artery (LAD). What should the nurse expect to see on this client's ECG?
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Broad complex bradycardia, ST elevation in II, III and aVF, ST depression in I, aVL.
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Small complex tachycardia, ST elevations in V1-V6, pathological Q waves in V1-V4.
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Broad complex tachycardia, delta waves, shortened PR interval.
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QRS prolongation, rSR “rabbit ear” pattern in V1, ST depression in several chest leads.
Explanation
Correct Answer:
B. Small complex tachycardia, ST elevations in V1–V6, pathological Q waves in V1–V4.
Explanation:
A 100% occlusion of the left anterior descending (LAD) artery produces an anterior wall myocardial infarction (MI). ECG findings typically show ST-segment elevations in the precordial leads (V1–V6), especially V1–V4, with the later development of pathologic Q waves in the same leads.
Option A describes an inferior MI (RCA occlusion). Option C reflects Wolff-Parkinson-White (WPW) syndrome, and option D describes a right bundle branch block (RBBB) pattern — neither related to an LAD occlusion.
A client is being treated for a myocardial infarction (MI) that occurred less than 6 hours ago. The cardiologist suspects 100% occlusion of the right coronary artery (RCA). Which findings would the nurse expect to see on this client's 12-lead electrocardiogram (ECG) upon admission?
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Sinus bradycardia, Q waves and ST elevation in inferior leads, QRS lengthening.
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Atrial fibrillation, T wave inversion in anterior leads, irregular P-R intervals
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Supraventricular tachycardia, ST depression in inferior leads, shortened P waves.
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Ventricular tachycardia, flattened T waves, P-R interval elongated and regular.
Explanation
Correct Answer:
A. Sinus bradycardia, Q waves and ST elevation in inferior leads, QRS lengthening.
Explanation:
A right coronary artery (RCA) occlusion causes an inferior wall myocardial infarction (MI) because the RCA supplies blood to the right ventricle, inferior wall of the left ventricle, and SA and AV nodes.
Expected ECG findings in an acute inferior MI include:
ST-segment elevation in the inferior leads (II, III, and aVF).
Pathologic Q waves developing later in those leads.
Sinus bradycardia or heart block due to ischemia of the SA or AV node (RCA supplies both).
Possible QRS widening if conduction is delayed from ischemia.
The medical unit admits a patient with active tuberculosis (TB). What is the most crucial thing the nurse should do?
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Fit the client with a respirator mask.
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Assign the client to a negative air-flow room.
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Don a clean gown for client care.
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Place an isolation cart in the hallway.
Explanation
Correct Answer:
B. Assign the client to a negative air-flow room.
Explanation:
Active tuberculosis (TB) is transmitted via airborne droplets, which can remain suspended in the air for extended periods. The priority nursing action upon admission is to place the client in a negative air-flow (airborne isolation) room to prevent the spread of Mycobacterium tuberculosis to others. This room maintains air pressure lower than the hallway so that air flows into the room but not out.
After isolation is established, the nurse should ensure that N95 respirators are worn by all staff entering the room, and the client should wear a surgical mask during transport. Gowns and gloves are not required unless exposure to bodily fluids is expected.
A client with ventricular tachycardia develops dyspnea, palpitations and lightheadedness. Assessment reveals tachypnea, hypotension, pallor, diaphoresis, and jugular vein distention. Which nursing diagnosis should be included in the client's plan of care?
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Increased cardiac output.
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Impaired gas exchange.
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Fluid volume overload.
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Ineffective airway clearance.
Explanation
Correct Answer:
B. Impaired gas exchange.
Explanation:
Ventricular tachycardia causes a rapid, ineffective ventricular contraction that reduces cardiac output and coronary perfusion. This leads to systemic hypoperfusion and impaired gas exchange as oxygen delivery to tissues decreases. The client’s symptoms—dyspnea, hypotension, pallor, and diaphoresis—reflect hypoxia and poor circulation. The nurse should prioritize interventions to restore effective cardiac rhythm, maintain oxygenation, and support tissue perfusion. Increased cardiac output is incorrect because output decreases during VT.
A client who experienced a myocardial infarction 3 days ago is experiencing a new onset chest pain overnight. The nurse is concerned about re-infarction and completes an ECG and draws blood. On what laboratory value should the nurse focus at this time?
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Troponin
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Pro brain natriuretic peptide (Pro-BNP).
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Lactate dehydrogenase (LDH).
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CK-MB (creatine-kinase-MB).
Explanation
Correct Answer:
D. CK-MB (creatine-kinase-MB).
Explanation:
CK-MB is the preferred biomarker for detecting reinfarction because it rises within 4–6 hours of myocardial injury, peaks at 12–24 hours, and returns to normal within 2–3 days. Since this client had an MI 3 days ago, troponin (A) would likely still be elevated from the original infarction and not useful for identifying a new event.
Pro-BNP (B) measures heart failure severity, not infarction. LDH (C) is nonspecific and outdated for MI diagnosis. Therefore, trending CK-MB helps detect recurrent cardiac injury.
The healthcare provider prescribes dopamine 2 mcg/kg/min IV for a client who weighs 60 kg. The IV bag contains "Dopamine 400 mg in dextrose 5% in water (D5W) 500 mL." The nurse should program the infusion pump to deliver how many mL/hour?
(Enter numerical value only. If rounding is required, round to the nearest whole number.)
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9 mL/hr
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10 mL/hr
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12 mL/hr
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15 mL/hr
Explanation
Correct Answer:
A. 9 mL/hr
Step 1: Determine the concentration of dopamine.
400 mg ÷ 500 mL = 0.8 mg/mL = 800 mcg/mL
Step 2: Calculate dose per minute.
2 mcg × 60 kg = 120 mcg/min
Step 3: Convert to mL/min.
120 mcg ÷ 800 mcg/mL = 0.15 mL/min
Step 4: Convert to mL/hour.
0.15 × 60 = 9 mL/hour
The nurse is caring for a client with a T4 spinal cord injury. Which assessment finding should the nurse address immediately?
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Reflexes are absent in the lower extremities.
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Client is incontinent for feces.
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Client's bladder is distended.
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Client has warm, blanching erythema on the sacral area.
Explanation
Correct Answer:
C. Client's bladder is distended.
Explanation:
In a client with a T4 spinal cord injury, a distended bladder can trigger autonomic dysreflexia, a life-threatening emergency characterized by sudden severe hypertension, headache, bradycardia, and possible stroke. The nurse must immediately relieve the bladder distention (e.g., by catheterization) to remove the stimulus.
Absent reflexes (A) and fecal incontinence (B) are expected findings in spinal cord injuries and are not emergencies. Erythema on the sacral area (D) indicates risk for pressure injury but is not immediately life-threatening compared to the danger of autonomic dysreflexia.
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