HESI – Critical Care Adult Health III
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Free HESI – Critical Care Adult Health III Questions
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 a gunshot wound is brought to the emergency department (ED) with a bullet entry at the spinal level of C8 and T1. The client is able to move the upper arms. To further assess the client’s spinal nerve function, which action should the nurse implement?
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Apply resistance while the client lifts the legs.
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Check the urinary bladder for distention.
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Ask the client to grasp an object or form a fist.
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Determine patellar tendon reflex response.
Explanation
Correct Answer:
C. Ask the client to grasp an object or form a fist.
Explanation:
The C8 and T1 spinal nerves control fine motor movement and strength of the hands and fingers. By asking the client to grasp an object or form a fist, the nurse assesses motor function of these specific spinal levels. The ability (or inability) to flex the fingers and maintain grip strength provides critical information about the extent of neurological impairment below the level of injury.
A client is about to undergo pericardiocentesis. What hemodynamic change should the nurse expect as a result of this procedure?
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Increase in end-diastolic volume (EDV).
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Decrease in stroke volume (SV).
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Decrease in mean arterial pressure (MAP).
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Increase in pulmonary capillary wedge pressure (PCWP).
Explanation
Correct Answer:
A. Increase in end-diastolic volume (EDV).
Explanation:
Pericardiocentesis relieves the external constraint of pericardial tamponade, lowering intrapericardial pressure so ventricular transmural (distending) pressure rises. This immediately improves venous return and diastolic filling of both ventricles, so EDV increases. With more preload, the Frank–Starling mechanism augments stroke volume and cardiac output, typically raising systolic BP and MAP, widening a previously narrow pulse pressure, and reducing tachycardia. Clinically, jugular venous distention decreases, pulsus paradoxus diminishes, and invasive pressures that were equalized in tamponade (RA, RV diastolic, PCWP) fall toward normal as filling improves.
While distributing medication, the nurse is stopped by a bedbound middle-aged female client who reports a sudden onset of chest heaviness and difficulty breathing. Which intervention should the nurse implement first?
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Raise head of the bed.
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Measure vital signs.
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Call the physician.
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Quickly scan client's chart.
Explanation
Correct Answer:
A. Raise head of the bed.
Explanation:
The nurse’s immediate priority when a client develops sudden chest heaviness and dyspnea is to raise the head of the bed to promote optimal lung expansion and improve oxygenation. This action helps reduce the work of breathing and facilitates gas exchange while further assessment and interventions are prepared. Once the client’s position is adjusted, the nurse should promptly assess vital signs, apply oxygen as needed, and notify the healthcare provider after ensuring the client’s immediate safety.
A client, who is 4 hours postoperative laparotomy, has rapidly increasing abdominal distention with elevated pulse and respiratory rates. The client's skin is cool and pale, and there is no change in the blood pressure. Which intervention should the nurse implement immediately?
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Prepare for nasogastric tube insertion.
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Monitor the client's recent hemoglobin levels.
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Measure the client's abdominal girth.
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Notify the healthcare provider of the client's status.
Explanation
Correct Answer:
D. Notify the healthcare provider of the client's status.
Explanation:
The client’s rapidly increasing abdominal distention, tachycardia, tachypnea, and cool, pale skin are early signs of internal hemorrhage or postoperative bleeding that may progress to hypovolemic shock. Even though the blood pressure has not yet changed, compensatory mechanisms (increased heart and respiratory rates) indicate emerging circulatory compromise. The nurse should immediately notify the healthcare provider for urgent evaluation and possible surgical intervention. Delaying action could result in life-threatening shock.
Patient Data
History and Physical
The client is a 36-year-old female who visited her primary healthcare provider (HCP) reporting loss of appetite, a severe headache, nausea, and vomiting. Upon examination, the HCP noted that the client's pupils were dilated and sluggishly reactive to light, and she had nuchal rigidity. As a result of the exam, the client was sent to the hospital for a direct admission. She reports that she has had more headaches in the past few weeks, but this is the worst headache she has ever had. She reports that she smokes about 10 cigarettes per day and occasionally smokes marijuana. She does not drink alcohol. Her home medications include oral birth control pills and an emergency albuterol inhaler that she uses to treat mild asthma.
Imaging Studies
. Head computerized tomography (CT) scan: Subarachnoid hemorrhage.
. Angiography: Arteriovenous malformation.
The healthcare provider (HCP) tells the nurse that the client has a grade 2 subarachnoid hemorrhage. Which finding(s) from the history and physical indicate that the client has a subarachnoid hemorrhage? Select all that apply.
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Loss of appetite
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Sluggish pupils
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Age
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Nuchal rigidity
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Smoking history
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Medication history
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Severe headache
Explanation
Correct Answers:
B. Sluggish pupils; D. Nuchal rigidity; G. Severe headache
Explaination
B. Sluggish pupils:
Sluggish or unequal pupillary reaction indicates increased intracranial pressure or irritation of cranial nerves due to bleeding into the subarachnoid space. This finding supports the diagnosis of a subarachnoid hemorrhage and reflects neurological involvement.
D. Nuchal rigidity:
Neck stiffness (nuchal rigidity) is a hallmark sign of meningeal irritation caused by blood in the cerebrospinal fluid from a subarachnoid hemorrhage. This physical finding is highly suggestive of this type of bleeding.
G. Severe headache:
Clients often describe a subarachnoid hemorrhage as “the worst headache of my life.” The sudden, severe headache is caused by increased intracranial pressure and meningeal irritation from the bleeding.
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 is brought to the emergency department following a motor vehicle crash. Initial assessment reveals that the client is unconscious with Blood Pressure 165/73 mmHg, Heart Rate 50 beats/minute, Respiratory Rate 8 and irregular, Temperature 39.4°C (103°F). The client is intubated and interventions to decrease intracranial pressure are implemented. What nursing action is the priority at this time?
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Clean and stitch lacerations on client's face.
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Administer acetaminophen as prescribed.
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Obtain order for portable X-ray to evaluate swollen right ankle
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Contact client's family.
Explanation
Correct Answer:
B. Administer acetaminophen as prescribed.
Explanation:
The client’s elevated temperature (39.4°C) after a traumatic brain injury indicates possible damage to the hypothalamus, which controls body temperature. Hyperthermia increases cerebral metabolism and intracranial pressure (ICP), worsening brain injury. The priority intervention is to reduce temperature promptly, using acetaminophen and cooling measures as prescribed. The other actions—treating lacerations, obtaining imaging, or contacting family—are appropriate but not urgent priorities compared to preventing further neurological deterioration from hyperthermia.
During insertion of a pulmonary artery catheter, which action is most important for the nurse to implement?
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Don sterile gloves and hand instruments to the healthcare provider.
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Assess the insertion site for hemorrhage.
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Keep the family informed about the client’s condition.
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Monitor the client for dysrhythmias.
Explanation
Correct Answer:
D. Monitor the client for dysrhythmias.
Explanation:
During pulmonary artery (PA) catheter insertion, the catheter passes through the right atrium and right ventricle before entering the pulmonary artery. As it moves through the heart chambers, it can irritate the myocardium and cause ventricular dysrhythmias, such as premature ventricular contractions (PVCs) or even ventricular tachycardia. Continuous ECG monitoring is essential to detect and respond immediately to these potentially life-threatening rhythm disturbances.
The nurse assesses a client postoperatively who has an arterial line in the right radial artery. Assessment findings include pallor, paresthesia, and slow capillary refill in the client’s right-hand fingers. Which action should the nurse take?
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Perform the Allen test.
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Notify the healthcare provider.
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Flush the line with heparinized saline.
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Elevate the client’s right arm.
Explanation
Correct Answer:
B. Notify the healthcare provider.
Explanation:
Pallor, paresthesia, and delayed capillary refill in the hand indicate impaired arterial blood flow distal to the arterial line, suggesting arterial occlusion or compromised perfusion. This is a medical emergency, as prolonged ischemia can lead to tissue necrosis and loss of limb function. The nurse should immediately notify the healthcare provider so that the arterial line can be assessed and possibly removed to restore circulation.
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