HESI – Critical Care Adult Health III
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Free HESI – Critical Care Adult Health III Questions
The nurse is assessing a client and identifies a bruit over the thyroid. This finding is consistent with which interpretation?
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Hypothyroidism
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Thyroid cyst.
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Thyroid cancer.
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Hyperthyroidism
Explanation
Correct Answer:
D. Hyperthyroidism.
Explanation:
A thyroid bruit is a whooshing sound heard over the thyroid gland during auscultation, caused by increased blood flow through the gland. This finding is most commonly associated with hyperthyroidism, particularly Graves’ disease, where the thyroid becomes hypervascular due to overactivity.
In contrast, hypothyroidism results in a sluggish metabolism and does not increase glandular blood flow. Thyroid cysts and thyroid cancer typically present as nodules or masses but do not cause a bruit. Therefore, the presence of a thyroid bruit indicates increased thyroid activity and vascularity, consistent with hyperthyroidism.
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.
Which client is best assigned to a nurse beginning orientation to a cardiac telemetry unit?
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A client with a sinus arrhythmia and first-degree atrioventricular (AV) block scheduled for a stress test.
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A client with frequent premature ventricular contractions (PVCs) awaiting transfer to the cardiac care unit (CCU).
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A client with uncontrolled atrial fibrillation scheduled for synchronized cardioversion.
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A client with third-degree atrioventricular (AV) block scheduled for a permanent pacemaker insertion.
Explanation
Correct Answer:
A. A client with a sinus arrhythmia and first-degree atrioventricular (AV) block scheduled for a stress test.
Explanation:
A nurse who is new to the cardiac telemetry unit should initially care for a client who is hemodynamically stable and presents a low risk for complications. A client with a sinus arrhythmia and first-degree AV block typically has a benign and stable rhythm that requires routine monitoring and presents a minimal risk of sudden deterioration. This makes the case appropriate for a nurse still gaining experience in cardiac care.
The nurse is assessing a client diagnosed with acute pancreatitis. The nurse should monitor for elevations in which lab value within 24 hours of onset?
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Serum lipase.
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Calcium
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Hydrogen ions.
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Serum amylase.
Explanation
Correct Answer:
D. Serum amylase.
Explanation:
In acute pancreatitis, the serum amylase level rises within 12 to 24 hours after the onset of symptoms due to leakage of pancreatic enzymes into the bloodstream from the inflamed pancreas. Elevated amylase is one of the earliest and most sensitive indicators of acute pancreatitis, typically returning to normal within 2 to 3 days as inflammation subsides.
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 young male adult walks into the emergency department (ED) holding a dead poisonous snake that bit him on his right calf within the last hour. After killing the snake, he tied a tablecloth about 4 inches (10 cm) above the bite. The client is now reporting numbness and tingling from the right knee to ankle. His heart rate is 123 beats/minute, respirations 28 breaths/minute, blood pressure 86/40 mm Hg, and oxygen saturation 94% on room air. Which intervention should the nurse implement?
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Raise extremity above the heart.
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Insert a large bore peripheral IV catheter
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Tighten the cloth around the leg.
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Apply ice over the bite mark.
Explanation
Correct Answer:
B. Insert a large bore peripheral IV catheter.
Explanation:
This client is showing signs of systemic envenomation and shock—hypotension (86/40 mm Hg), tachycardia, tachypnea, and numbness near the bite site. The priority action is to insert a large-bore IV catheter to allow for rapid administration of IV fluids and antivenom once available. Maintaining circulatory volume and perfusion is essential to prevent cardiovascular collapse in snakebite victims.
A client with atrial fibrillation is experiencing palpitations, dyspnea, and dizziness. What should the nurse do first?
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Provide breathing instructions.
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Auscultate heart sounds.
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Measure vital signs.
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Provide nitroglycerin SL.
Explanation
Correct Answer:
C. Measure vital signs.
Explanation:
In a client with atrial fibrillation (AF) presenting with palpitations, dyspnea, and dizziness, the priority is to assess hemodynamic stability by measuring vital signs — especially heart rate and blood pressure. These findings determine whether the AF is causing decreased cardiac output or requires emergency intervention (e.g., cardioversion).
Auscultation (B) is useful but secondary. Breathing instructions (A) and nitroglycerin (D) are not appropriate initial responses; nitroglycerin is for ischemic chest pain, not arrhythmia-related symptoms.
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.
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.
An elderly client is admitted to the emergency department with a temperature of 104°F (40°C), blood pressure of 63/42 mm Hg, heart rate 135 beats/minute, and cool, clammy skin. Oxygen therapy is initiated and fluid resuscitation is started according to the sepsis protocol. Which assessment finding best indicates that the client's health status is improving?
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Oxygen saturation increases from 92% to 95%.
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Temperature drops to 38.5°C (101.3°F).
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Heart rate decreases.
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Jugular venous pressure drops.
Explanation
Correct Answer:
C. Heart rate decreases.
Explanation:
A decreasing heart rate following fluid resuscitation is the best indicator of improved perfusion and stabilization in septic shock. Tachycardia is a compensatory response to hypovolemia and poor tissue perfusion. When fluids restore circulating volume and oxygen delivery, the heart rate begins to normalize. Although improved oxygen saturation and lower temperature are positive signs, they do not directly reflect hemodynamic recovery. A drop in jugular venous pressure, on the other hand, may indicate worsening hypovolemia.
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