HESI – Critical Care Adult Health III
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Free HESI – Critical Care Adult Health III Questions
A client with Wolff-Parkinson-White (WPW) syndrome has been treated with catheter ablation. What finding on the client's ECG indicates to the nurse that treatment is effective?
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Cardiac axis has shifted to the left.
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PR interval is 160 ms and HR is 70 bpm.
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QRS complex is 140 ms, with 3 large squares between every complex.
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Rhythm is regular, PR segment has returned to the isoelectric line.
Explanation
Correct Answer:
B. PR interval is 160 ms and HR is 70 bpm.
Explanation:
Wolff-Parkinson-White syndrome is caused by an accessory conduction pathway (Bundle of Kent) that shortens the PR interval and causes a delta wave and widened QRS on the ECG. Successful catheter ablation destroys this pathway, restoring normal AV nodal conduction.
A normal PR interval (120–200 ms) and narrow QRS with normal heart rate (around 70 bpm) confirm that normal electrical conduction has resumed.
Despite frequent reorientation, a client in the intensive care unit continues to be confused about time and place. Which intervention should the nurse implement first to promote the client's safety?
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Administer a PRN mild sedative.
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Put a vest restraint on the client
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Increase direct observation of client.
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Ask the family to stay with the client.
Explanation
Correct Answer:
C. Increase direct observation of client.
Explanation:
When a confused client remains disoriented despite reorientation efforts, the first priority is to increase direct observation to ensure safety and prevent injury, falls, or removal of medical devices. Close supervision allows staff to intervene promptly if the client attempts unsafe movements or behaviors. This approach maintains the client’s safety without immediately resorting to restraints or medications, both of which carry additional risks.
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.
While walking to the mailbox, an older adult male experiences sudden chest tightness and drives himself to the emergency department (ED). When the client gets up to the desk of the triage nurse, he says his heart is pounding out of his chest as he clutches his chest and falls to the floor. Which intervention should the nurse implement first?
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Apply cardiac monitor leads.
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Obtain serum troponin values.
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Prepare for cardiac defibrillation.
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Palpate client’s carotid artery.
Explanation
Correct Answer:
D. Palpate client’s carotid artery.
Explanation:
When a client collapses suddenly, the first nursing action is to assess for responsiveness and the presence of a pulse—in this case, by palpating the carotid artery. This determines whether the client is in cardiac arrest and whether CPR or advanced cardiac life support (ACLS) interventions (such as defibrillation) should begin immediately. Establishing whether the client has a pulse is the priority step in the Basic Life Support (BLS) algorithm.
A 56-year-old female client is receiving intracavitary radiation via a radium implant. Which nurse should be assigned to care for this client?
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The nurse who is caring for another client receiving intracavitary radiation.
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A nurse with Marfan's syndrome who is postmenopausal.
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A nurse with oncology experience who may be pregnant.
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The nurse who is caring for another client who has Clostridium difficile.
Explanation
Correct Answer:
B. A nurse with Marfan's syndrome who is postmenopausal.
Explanation:
Clients receiving intracavitary radiation emit ionizing radiation while the implant is in place. Therefore, care should be provided by staff who are not pregnant or of childbearing potential, as radiation exposure can harm reproductive organs or cause teratogenic effects. The nurse who is postmenopausal presents the least risk for radiation exposure–related reproductive harm. Marfan’s syndrome does not contraindicate radiation exposure.
Nurses assigned to these clients should also follow radiation safety precautions: minimize time spent near the source, maximize distance, and use shielding (lead aprons, tongs). Only essential care should be performed, and pregnant staff must never be assigned to radioactive implant patients.
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.
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 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.
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.
Due to the rapid progress of ascending muscle weakness, a client with Guillain-Barré syndrome (GBS) is admitted to the intensive care unit (ICU). Which intervention(s) should the nurse implement? Select all that apply.
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Turn and reposition client frequently.
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Monitor and document cardiac rhythm.
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Keep limbs in functional position with pillows
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Limit visitation while mechanically ventilated.
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Provide passive range of motion every 2 to 4 hours.
Explanation
Correct Answers:
A. Turn and reposition client frequently; B. Monitor and document cardiac rhythm; C. Keep limbs in functional position with pillows; E. Provide passive range of motion every 2 to 4 hours.
A. Turn and reposition client frequently:
Frequent repositioning prevents pressure injuries and skin breakdown, which clients with paralysis are highly prone to due to immobility.
B. Monitor and document cardiac rhythm:
Guillain-Barré syndrome can cause autonomic nervous system dysfunction, leading to arrhythmias, bradycardia, or sudden cardiac arrest. Continuous cardiac monitoring is essential to detect life-threatening rhythm changes promptly.
C. Keep limbs in functional position with pillows:
Proper limb alignment helps prevent contractures and foot drop, maintaining joint mobility and promoting comfort during paralysis.
E. Provide passive range of motion every 2 to 4 hours:
Passive ROM exercises preserve joint flexibility and circulation and prevent muscle atrophy in clients who cannot move independently due to paralysis.
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