HESI – Critical Care Adult Health III
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Free HESI – Critical Care Adult Health III Questions
A client with exacerbation of COPD is lightly sedated and mechanically ventilated in AC mode with FiO₂ 40% and PEEP 8 cm. Vital signs: Respiratory rate 12 with regular chest excursions, oxygen saturation 95%, heart rate 122 bpm, blood pressure 90/63 mmHg, temperature 98.6°F (37°C). What should the nurse expect the health care provider to prescribe for this client?
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Decrease sedation level.
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Administer fluids.
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Administer beta-blocker.
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Decrease PEEP.
Explanation
Correct Answer:
B. Administer fluids.
Explanation:
This client’s findings—hypotension (90/63 mmHg) and tachycardia (122 bpm)—suggest decreased venous return due to positive pressure ventilation with PEEP. PEEP increases intrathoracic pressure, which can compress the great veins and reduce preload, leading to hypotension. The appropriate response is to administer IV fluids to restore circulating volume and maintain perfusion.
Decreasing sedation (A) is not relevant, and beta-blockers (C) would worsen hypotension. Decreasing PEEP (D) may reduce oxygenation and is not indicated unless directed by the provider after volume status correction.
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 with type 2 diabetes mellitus is recovering from coronary angiography in the intensive care unit (ICU). What finding would be of the most concern to the nurse?
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aPTT is 2 times the normal reference interval.
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Graft donor site is slightly red and swollen.
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Serum creatinine increased ¼ from baseline.
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PaO₂ is 80 mm Hg.
Explanation
Correct Answer:
C. Serum creatinine increased ¼ from baseline.
Explanation:
A 25% increase in serum creatinine following coronary angiography is highly concerning for contrast-induced nephropathy (CIN), a complication caused by exposure to the iodinated contrast dye used during the procedure. Clients with type 2 diabetes mellitus are at increased risk because of preexisting microvascular damage and impaired renal function. This finding indicates acute kidney injury, which can progress to renal failure if not promptly treated with IV hydration and close monitoring of renal function.
A client has been treated for uncontrolled atrial fibrillation with cardioversion. Following the cardioversion, which assessment finding indicates to the nurse that the desired outcome was achieved?
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Normal sinus rhythm (NSR) at 84 beats/minute.
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Regular rhythm with consistent pacemaker capture.
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Increased frequency of QRS complexes
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Return of elevated ST segment to the baseline.
Explanation
Correct Answer:
A. Normal sinus rhythm (NSR) at 84 beats/minute.
Explanation:
The goal of cardioversion for atrial fibrillation (AFib) is to restore the heart’s rhythm to normal sinus rhythm (NSR) — meaning the P wave precedes every QRS complex, the rhythm is regular, and the rate is within normal limits (60–100 beats/minute). Therefore, a sinus rhythm at 84 beats/minute indicates the cardioversion was successful, achieving the desired outcome of normal electrical conduction through the sinoatrial node.
A client with C8 spinal injury is monitored for signs of neurogenic shock. What should the nurse expect to assess?
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HR 48, BP 70/45 mmHg, warm extremities.
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HR 120, BP 70/45 mmHg; cold, clammy skin.
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HR 48, BP 167/95 mmHg, warm flushed skin with diaphoresis.
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HR 120, BP 70/45 mmHg, increased JVP and distended neck veins.
Explanation
Correct Answer:
A. HR 48, BP 70/45 mmHg, warm extremities.
Explanation:
Neurogenic shock results from loss of sympathetic tone due to spinal cord injury (usually above T6), leading to hypotension, bradycardia, and warm, dry skin from peripheral vasodilation. These findings (HR 48, BP 70/45, warm extremities) reflect parasympathetic dominance.
In contrast, option B describes hypovolemic shock (tachycardia, cold skin). Option C reflects autonomic dysreflexia, not shock. Option D indicates cardiogenic shock with venous congestion, which is unrelated to spinal injury-induced vasodilation.
A client arrives in the emergency department (ED) by emergency medical services (EMS) with injuries from being hit by a bus. Vital signs on admission are temperature 99° F (37.2° C), heart rate 100 beats/minute, respirations 28 breaths/minute, and blood pressure 126/78 mm Hg. Bloody drainage is noted at the client’s left ear canal. Which should the nurse do to assess for a possible basilar skull fracture and cerebrospinal fluid (CSF) leak?
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Clean the ear canal with a swab, and place the drainage on a blood glucose strip.
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Gently dab blood from the ear with a sterile gauze and observe for a halo.
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Prepare the client for a stat lumbar puncture and obtain a culture of the CSF.
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Monitor for increased pulse pressure and slowing of the heart rate.
Explanation
Correct Answer:
B. Gently dab blood from the ear with a sterile gauze and observe for a halo
Explanation:
Bloody or clear drainage from the ear or nose following head trauma may indicate a basilar skull fracture with cerebrospinal fluid (CSF) leakage. The nurse should gently dab the drainage onto sterile gauze—if a “halo sign” appears (a yellowish ring surrounding the central blood spot), it suggests CSF mixed with blood. This simple, noninvasive bedside test helps identify a CSF leak and confirm possible basilar skull injury.
A patient with an acute asthma attack is brought to the emergency department. He is anxious, severely dyspneic, and demonstrating tachypnea and cyanosis. Wheezes are present over all lung fields and the client is using accessory respiratory muscles. High-flow oxygen and albuterol nebulizer therapy (2.5 mg q20 minutes PRN) and ipratropium bromide (500 mcg q20 minutes PRN) are started. After 5 minutes, the nurse notes that the client's wheezing has stopped. What should the nurse do at this time?
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Ask physician to reduce albuterol and ipratropium to q4 hours PRN.
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Administer IV prednisone as prescribed to reduce airway swelling.
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Obtain an arterial blood gas and contact the health care provider.
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Administer lorazepam as prescribed to reduce anxiety
Explanation
Correct Answer:
C. Obtain an arterial blood gas and contact the health care provider.
Explanation:
When wheezing suddenly stops during a severe asthma attack, it is a life-threatening sign of severe airway obstruction or impending respiratory failure, not improvement. The absence of wheezing indicates that little or no air movement is occurring due to extreme bronchoconstriction. The nurse should immediately assess oxygenation and ventilation by obtaining an arterial blood gas (ABG) and notify the healthcare provider.
Reducing bronchodilator frequency (A) or giving lorazepam (D) delays critical intervention. Prednisone (B) is important for inflammation but not the priority in this acute emergency.
A client who is intubated and on mechanical ventilation whispers to the nurse if she can have a glass of water because her throat feels very dry. What should the nurse do?
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Explain to the client that a nothing-by-mouth status should be maintained.
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Get the client a glass of water.
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Increase humidity of the ventilated air.
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Assess the client's cuff pressure.
Explanation
Correct Answer:
C. Increase humidity of the ventilated air.
Explanation:
Clients who are intubated and on mechanical ventilation often experience dryness because the endotracheal tube bypasses the upper airway, which normally humidifies inspired air. The nurse should increase the humidity level of the ventilator circuit to prevent drying of mucous membranes and secretions. Providing oral fluids is unsafe due to aspiration risk, and while nothing-by-mouth status is appropriate, it does not address the underlying issue of inadequate humidification.
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.
A client's cardiac tracing has the following characteristics: atrial rhythm 70 bpm and regular, ventricular rate 60 bpm and regularly irregular. P wave morphology normal, progressive lengthening of the PR interval until one P wave is not conducted. QRS morphology is normal. A quick assessment shows that the client is asymptomatic. What should the nurse do to assist this client?
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Document findings and continue monitoring.
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Start transcutaneous pacing
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Administer atropine.
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Notify the health care provider immediately.
Explanation
Correct Answer:
A. Document findings and continue monitoring.
Explanation:
These ECG findings describe a second-degree atrioventricular (AV) block type I (Mobitz I or Wenckebach), where the PR interval progressively lengthens until a beat is dropped. This rhythm is usually benign and transient, especially when the client is asymptomatic. The appropriate nursing action is to document and continue monitoring for any progression or development of symptoms such as dizziness or hypotension.
Atropine (C) or pacing (B) is indicated only if the client becomes symptomatic or the block worsens to type II or complete heart block. Immediate provider notification (D) is not required in a stable, asymptomatic Mobitz I block.
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