HESI – Critical Care Adult Health III
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Free HESI – Critical Care Adult Health III Questions
A client is receiving cardiopulmonary resuscitation (CPR). After asystole is confirmed in two leads and sending for the code cart, which IV medication should be administered?
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Lidocaine
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Adenosine
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Amiodarone
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Epinephrine
Explanation
Correct Answer:
D. Epinephrine.
Explanation:
When a client is in asystole—a flatline with no electrical or mechanical cardiac activity—the priority medication is epinephrine, administered 1 mg IV every 3 to 5 minutes during CPR. Epinephrine increases coronary and cerebral perfusion pressure and stimulates cardiac muscle activity, providing the best chance for the heart to regain electrical function. It is the only drug recommended for asystole and pulseless electrical activity (PEA) in the ACLS algorithm.
The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is unable to maintain a normal oxygen saturation while receiving high-flow oxygen through a bilevel positive airway pressure (BiPAP). Which prescription should the nurse expect next?
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Chest radiograph.
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Bag valve mask application.
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Endotracheal intubation.
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Sedation medications.
Explanation
Correct Answer:
C. Endotracheal intubation.
Explanation:
In acute respiratory distress syndrome (ARDS), if a client cannot maintain adequate oxygen saturation despite high-flow oxygen and noninvasive ventilation (such as BiPAP), the next step is endotracheal intubation followed by mechanical ventilation. Intubation ensures controlled oxygen delivery, positive end-expiratory pressure (PEEP), and adequate gas exchange, all of which are crucial for clients in severe respiratory failure.
A client with pulmonary edema secondary to left-sided heart failure is lethargic. Arterial blood gas (ABG) results are: PaO₂ of 41; SaO₂ of 78%. Despite 100% oxygen therapy, the client's PaO₂ does not improve. What action should the nurse take?
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Administer furosemide (Lasix) as prescribed.
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Attach pulse oximeter to a different finger
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Increase O₂ flow rate.
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Start CPAP.
Explanation
Correct Answer:
D. Start CPAP.
Explanation:
This client has refractory hypoxemia, meaning oxygen levels remain critically low despite 100% oxygen therapy. This indicates alveolar flooding from pulmonary edema is preventing effective gas exchange. The priority action is to initiate continuous positive airway pressure (CPAP), which helps keep alveoli open, improve oxygen diffusion, and reduce the work of breathing.
While furosemide (A) is important to reduce fluid overload, the immediate need is to restore oxygenation. Increasing oxygen flow (C) will not help if alveoli are filled with fluid, and changing the oximeter site (B) does not address the true problem.
A 60-year-old male is brought to the emergency department with a sudden onset of severe “tearing” chest pain. Upon auscultation, an early diastolic decrescendo murmur is heard. Blood pressure is measured on both arms and shows a 30 mm Hg difference between the left and right arm. ECG recording shows ST elevation in the anterio-lateral leads. What should the nurse do first to assist this client?
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Prepare for emergency surgery.
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Administer thrombolytic therapy.
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Draw blood to determine troponin levels.
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Administer epinephrine (Adrenaline).
Explanation
Correct Answer:
A. Prepare for emergency surgery.
Explanation:
The client’s presentation—sudden tearing chest pain, blood pressure discrepancy between arms, and early diastolic decrescendo murmur—is classic for aortic dissection. This is a life-threatening emergency requiring immediate surgical intervention to prevent rupture or cardiac tamponade. Thrombolytics and epinephrine are contraindicated because they could worsen bleeding or dissection. While cardiac markers like troponins may be drawn later, preparing for emergency surgery is the nurse’s top priority.
The nurse observes that a client being treated for septic shock secondary to erysipelas has developed numerous small red dots on the extremities. What should the nurse do first to assist this client?
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Immediately notify the healthcare provider that the client is allergic to the IV antibiotic.
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Inspect the IV injection site and oral mucosa.
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Elevate the client's legs to improve venous return.
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Obtain an order for a lumbar puncture.
Explanation
Correct Answer:
B. Inspect the IV injection site and oral mucosa.
Explanation:
The appearance of numerous small red dots (petechiae) in a client with septic shock may indicate disseminated intravascular coagulation (DIC), a life-threatening complication where widespread microclotting leads to bleeding under the skin and mucous membranes. The nurse should first assess the extent of bleeding by inspecting the IV sites and oral mucosa for further petechiae or oozing, then promptly notify the healthcare provider.
This is not an allergic reaction (A) since petechiae are non-pruritic and non-blanching. Leg elevation (C) does not address the underlying coagulopathy. Lumbar puncture (D) is contraindicated in bleeding disorders due to the risk of hemorrhage.
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.
The nurse is caring for a client with pneumonia with a newly placed endotracheal tube. What finding should cause the nurse the most concern at this time?
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Light swelling over the client's right clavicular area.
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Consolidation over the right lower lobe on chest x-ray.
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Decreased intensity of breath sounds over right lung
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Arterial blood gas results: pH 7.46, PaO₂ 75 mmHg, PaCO₂ 33 mmHg, HCO₃ 21.
Explanation
Correct Answer:
A. Light swelling over the client's right clavicular area.
Explanation:
Swelling over the right clavicular area in a client with a newly placed endotracheal tube raises concern for subcutaneous emphysema, which can indicate barotrauma or pneumothorax caused by improper tube placement or excessive airway pressure. This can rapidly compromise ventilation and oxygenation, making it the priority finding requiring immediate evaluation.
Consolidation on x-ray (B) is expected with pneumonia. Decreased breath sounds (C) may be due to tube malposition but are less immediately dangerous than swelling indicating air leakage. The ABG (D) shows mild respiratory alkalosis, likely from hyperventilation, not an acute emergency.
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 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 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.
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