HESI – Critical Care Adult Health III
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Free HESI – Critical Care Adult Health III Questions
A client who was involved in a motor vehicle collision while riding a motorcycle without wearing a helmet is brought to the emergency department (ED) by emergency medical services (EMS). Which assessment should the nurse obtain first?
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Degree of pain using a 10-point scale.
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Balance and coordination.
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Bilateral pupillary reaction to light.
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Pulse and blood pressure.
Explanation
Correct Answer:
D. Pulse and blood pressure.
Explanation:
According to the ABC (Airway, Breathing, Circulation) framework, circulation takes priority once the airway and breathing have been secured. Since the client sustained a high-risk trauma (motorcycle crash without a helmet), there is a strong possibility of hypovolemic shock, internal bleeding, or traumatic brain injury. Assessing pulse and blood pressure determines the adequacy of circulation and guides immediate life-saving interventions such as fluid resuscitation or hemorrhage control.
A 52-year-old woman comes into the emergency department with acute shortness of breath, dizziness, and chest pain which started 4 hours ago. Oxygen saturation is 88% on room air. Breath sounds are clear bilaterally, chest X-ray is clear, and the ECG is identical to the one in her medical record from a year ago as pre-operative for radical mastectomy surgery. What should the nurse suspect as most likely causing this client's symptoms?
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STEMI
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Pulmonary embolism.
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Angina pectoris.
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Acute bronchitis.
Explanation
Correct Answer:
B. Pulmonary embolism.
Explanation:
This client’s presentation — sudden dyspnea, chest pain, dizziness, hypoxemia (SpO₂ 88%), and clear lungs on auscultation and X-ray — is classic for a pulmonary embolism (PE). Her history of recent cancer surgery (radical mastectomy) increases the risk for venous thromboembolism, making PE the most likely diagnosis.
STEMI (A) would show new ECG changes. Angina (C) usually resolves with rest and does not cause hypoxemia. Acute bronchitis (D) typically presents with cough, sputum, and abnormal lung sounds, which are absent here.
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 assesses a client following the insertion of an intra-aortic balloon pump (IABP) and determines that the pulmonary artery wedge pressure (PAWP) is decreased and the cardiac output (CO) is increased. When the healthcare provider telephones for a report, which statement by the nurse summarizes the client’s status?
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Mean arterial pressure (MAP) is decreased.
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Hemodynamic indicators show improvement.
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Diastolic pressure is higher than systolic pressure
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Cardiac preload is increasing.
Explanation
Correct Answer:
B. Hemodynamic indicators show improvement.
Explanation:
A decrease in pulmonary artery wedge pressure (PAWP) indicates reduced left ventricular filling pressure (preload), and an increase in cardiac output (CO) demonstrates improved cardiac performance. These findings show that the intra-aortic balloon pump (IABP) is functioning effectively by reducing afterload, improving coronary perfusion, and enhancing overall cardiac efficiency. Therefore, the client’s hemodynamic indicators are improving — the goal of IABP therapy in managing cardiogenic shock or severe heart failure.
A client who is ventilator dependent is struggling to breathe independently. The ventilator is alarming and displaying a malfunction signal. Which action should the nurse implement first?
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Place a STAT call for assistance by respiratory therapy.
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Manually push the ventilate/breath setting 12 times a minute.
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Adjust the fraction of inspired oxygen (FiO₂) setting to provide additional oxygen delivery to the client.
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Detach the client from the ventilator to provide bag-valve-mask breathing.
Explanation
Correct Answer:
D. Detach the client from the ventilator to provide bag-valve-mask breathing.
Explanation:
When a ventilator malfunction occurs and the client shows signs of respiratory distress, the nurse’s first priority is to ensure oxygenation and ventilation manually. The nurse should immediately disconnect the ventilator and use a bag-valve-mask (Ambu bag) connected to 100% oxygen to ventilate the client. This maintains adequate gas exchange while troubleshooting the ventilator or awaiting respiratory therapy assistance.
A client experiencing a sudden onset of confusion and trouble speaking at home is transported to the emergency department (ED). The client does not understand simple commands and appears very frustrated. The nurse should immediately take which action?
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Test for a swallowing reflex and perform communication deficit assessments.
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Determine when symptoms began and if improved or worsened since onset
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Place an indwelling urinary catheter and measure strict intake and output.
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Raise the head of the bed to 30 degrees keeping head and neck in neutral alignment
Explanation
Correct Answer:
B. Determine when symptoms began and if improved or worsened since onset.
Explanation:
This client is showing classic signs of an acute stroke — sudden confusion, expressive and receptive aphasia, and frustration due to impaired communication. The most critical first action is to determine the exact time of symptom onset because this information dictates eligibility for thrombolytic therapy (tPA), which must be administered within a narrow window (generally 3 to 4.5 hours from symptom onset). Rapid identification allows the healthcare team to proceed immediately with diagnostic imaging (CT scan) and treatment decisions to minimize brain injury.
The healthcare provider changes a prescription for a nitroglycerin intravenous (IV) infusion from 10 mcg/min to 15 mcg/min. The IV bag contains nitroglycerin 50 mg in dextrose 5% in water (D5W) 250 mL. The nurse should program the infusion pump to deliver how many mL/hr?
(Enter numerical value only. If rounding is required, round to the nearest whole number.)
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3 mL/hr
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4 mL/hr
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5 mL/hr
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6 mL/hr
Explanation
Correct Answer:
C. 5 mL/hr
Step 1: Convert concentration of nitroglycerin in the IV bag.
50 mg ÷ 250 mL = 0.2 mg/mL
Step 2: Convert mg to mcg.
0.2 mg/mL × 1,000 = 200 mcg/mL
Step 3: Determine mL per minute.
15 mcg ÷ 200 mcg/mL = 0.075 mL/min
Step 4: Convert to mL per hour.
0.075 × 60 = 4.5 mL/hr
4.5 rounded to the nearest whole number is 5.
The emergency room nurse is informed by the Emergency Medical Services (EMS) that a client with an acute anterior myocardial infarction and ST elevation (STEMI) on ECG will be treated with percutaneous coronary intervention (PCI) immediately upon arrival. What should the nurse do to best assist this client?
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Administer t-PA (alteplase).
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Administer epinephrine.
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Administer aspirin and clopidogrel.
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Withhold morphine sulfate.
Explanation
Correct Answer:
C. Administer aspirin and clopidogrel.
Explanation:
In clients with ST-elevation myocardial infarction (STEMI) who are proceeding to immediate percutaneous coronary intervention (PCI), the most critical early nursing action is to administer dual antiplatelet therapy—typically aspirin and clopidogrel (Plavix)—to prevent platelet aggregation and reduce the risk of coronary artery re-occlusion during or after the procedure. These medications are essential components of the PCI preparation protocol and significantly improve reperfusion outcomes and reduce mortality when given before the procedure. The nurse should also verify the client has IV access, assess for bleeding risks or allergies, and ensure consent and transport readiness for the cardiac catheterization lab.
The nurse observes that a client with a concussion following a car incident is constantly blowing his nose. What is the best next action for the nurse to take?
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Instruct the client to stop blowing as this activity may increase intracranial pressure and worsen the concussion.
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Offer the client a nasal decongestant.
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Measure the client's temperature and assess lung sounds.
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Look for signs of bruising around the client's eyes.
Explanation
Correct Answer:
D. Look for signs of bruising around the client's eyes.
Explanation:
Persistent nose blowing after a head injury raises concern for a basilar skull fracture with a possible cerebrospinal fluid (CSF) leak through the nose (rhinorrhea). The nurse should immediately assess for other signs of basilar skull fracture, including periorbital ecchymosis (raccoon eyes) and Battle’s sign (bruising behind the ears). These findings indicate a skull base fracture, which can allow CSF to leak and increase the risk of meningitis.
A client with dilated cardiomyopathy develops pulseless ventricular fibrillation. After defibrillation, cardiopulmonary resuscitation (CPR) is continued by one of the nurses. What should the second nurse do first to assist with the care of this client at this time?
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Administer morphine sulfate.
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Administer atropine.
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Administer amiodarone (Cordarone).
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Administer epinephrine.
Explanation
Correct Answer:
D. Administer epinephrine.
Explanation:
In pulseless ventricular fibrillation (VF), after the first defibrillation and continuation of CPR, the next step in the Advanced Cardiac Life Support (ACLS) algorithm is to administer epinephrine 1 mg IV/IO every 3–5 minutes. Epinephrine improves coronary and cerebral perfusion by increasing vascular tone during resuscitation.
If VF persists after additional shocks and epinephrine, amiodarone (C) may be given to help stabilize the cardiac rhythm. Atropine (B) is used for bradycardia, not VF, and morphine (A) is contraindicated in cardiac arrest.
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