HESI Critical Care Practice Exam With Answers (75 Solved Questions)

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HESI Critical Care Exam Questions with Answers and Rationales1. A client with asthma receives a prescription for high blood pressure during a clinic visit.Which prescription should the nurse anticipate the client to receive that is least likely toexacerbate asthma?A.Carteolol (Ocupress).B.Propranolol hydrochloride (Inderal).C.Pindolol (Visken).IncorrectD.Metoprolol tartrate (Lopressor).CorrectThe best antihypertensive agent for clients with asthma ismetoprolol (Lopressor) (C), a beta2blocking agent which is also cardioselective and less likely to cause bronchoconstriction.Pindolol (A) is a beta2 blocker that can cause bronchoconstriction and increase asthmaticsymptoms. Although carteolol (B) is a beta blocking agent and an effective antihypertensiveagent used in managing angina, it can increase a client's risk for bronchoconstriction due to itsnonselective beta blocker action. Propranolol (D) also blocks the beta2 receptors in the lungs,causing bronchoconstriction, and is not indicated in clients with asthma and other obstructivepulmonary disorders.2. A male client who has been taking propranolol (Inderal) for 18 months tells the nurse that thehealthcare provider discontinued the medication because his blood pressure has been normal forthe past three months. Which instruction should the nurse provide?A.Obtain another antihypertensive prescription to avoid withdrawal symptoms.B.Stop the medication and keep an accurate record of blood pressure.

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C.Report any uncomfortable symptoms after stopping the medication.D.Ask the healthcare provider about tapering the drug dose over the next week.CorrectAlthough the healthcareprovider discontinued the propranolol, measures to prevent reboundcardiac excitation, such as progressively reducing the dose over one to two weeks (C), should berecommended to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias.Abrupt cessation (A and B) of the beta-blocking agent may precipitate tachycardia and reboundhypertension, so gradual weaning should be recommended. (D) is not indicated.3. A client who is taking clonidine (Catapres, Duraclon) reports drowsiness. Which additionalassessment should the nurse make?A.Has the client experienced constipation recently?B.Did the client miss any doses of the medication?C.How long has the client been taking the medication?CorrectD.Does the client use any tobacco products?Drowsiness can occur in the early weeks of treatment with clonidine and with continued usebecomes less intense, so the length of time the client has been on the medication (A) providesinformation to direct additional instruction. (B, C, and D) are not relevant.4.ID: 6974873590The nurse is preparing to administer atropine, an anticholinergic, to a client who is scheduled foracholecystectomy. The client asks the nurse to explain the reason for the prescribed medication.What response is best for the nurse to provide?A.Provide a more rapid induction of anesthesia.

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B.Induce relaxation before induction of anesthesia.C.Decrease the risk of bradycardia during surgery.CorrectD.Minimize the amount of analgesia needed postoperatively.Atropine may be prescribed preoperatively to increase the automaticity of thesinoatrial node andprevent a dangerous reduction in heart rate (B) during surgical anesthesia. (A, C and D) do notaddress the therapeutic action of atropine use perioperatively.5.ID: 6974876286An 80-year-old client is given morphine sulphate for postoperative pain. Which concomitantmedication should the nurse question that poses a potential development of urinary retention inthis geriatric client?A.Antacids.B.Tricyclic antidepressants.CorrectC.Nonsteroidal antiinflammatory agents.D.Insulin.Drugs with anticholinergic properties, such as tricyclic antidepressants (C), can exacerbateurinary retention associated with opioids in the older client.Although tricyclic antidepressantsand antihistamines with opioids can exacerbate urinary retention, the concurrent use of (A and B)with opioids do not. Nonsteroidal antiinflammatory agents (D) can increase the risk for bleeding,but do not increase urinary retention with opioids (D).6.ID: 6974873559

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A client with osteoarthritis is given a new prescription for a nonsteroidal antiinflammatorydrug(NSAID). The client asks the nurse, "How is this medication different from the acetaminophen Ihave been taking?" Which information about the therapeutic action of NSAIDs should the nurseprovide?A.Are less expensive.B.Provide antiinflammatory response.CorrectC.Increase hepatotoxic side effects.D.Cause gastrointestinal bleeding.Nonsteroidal antiinflammatory drugs (NSAIDs) have antiinflammatoryproperties (B), whichrelieves pain associated with osteoarthritis and differs from acetaminophen, a non-narcoticanalgesic and antipyretic. (A) does not teach the client about the medication's actions. AlthoughNSAIDs are irritating to the gastrointestinal (GI) system and can cause GI bleeding (C),instructions to take with food in the stomach to manage this as an expected side effect should beincluded, but this does not answer the client's question. Acetaminophen is potentially hepatotoxic(D), not NSAIDs.7.ID: 6974876262A client with cancer has a history of alcohol abuse and is taking acetaminophen (Tylenol) forpain. Which organ function is most important for the nurse to monitor?A.Cardiorespiratory.B.Liver.CorrectC.Sensory.D.Kidney.

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Acetaminophen and alcohol are both metabolized in the liver. This places the client at risk forhepatotoxicity, so monitoring liver (A) function is the most important assessment because thecombination of acetaminophen and alcohol, even in moderate amounts, can cause potentiallyfatal liver damage. Other non-narcotic analgesics, such as n onsteroidal anti-inflammatory drugs(NSAIDs), are more likely to promote adverse renal effects (B). Acetaminophen does not placethe client at risk for toxic reactions related to (C or D).8.ID: 6974875110The nurse obtains a heart rate of 92 and a blood pressure of 110/76 prior to administering ascheduled dose of verapamil (Calan) for aclient with atrial flutter. Which action should the nurseimplement?A.Give intravenous (IV) calcium gluconate.B.Withhold the drug and notify the healthcare provider.C.Administer the dose as prescribed.CorrectD.Recheck the vital signs in 30 minutes and then administer the dose.Verapamil slows sinoatrial (SA) nodal automaticity, delays atrioventricular (AV) nodalconduction, which slows the ventricular rate, and is used to treat atrial flutter, so (A) should beimplemented, based on the client's heart rate and blood pressure. (B and C) are not indicated. (D)delays the administration of the scheduled dose.9.ID: 6974873583A client is admitted to thehospital with a diagnosis of Type 2 diabetes mellitus and influenza.Which categories of illness should the nurse develop goals for the client's plan of care?

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A.One chronic and one acute illness.CorrectB.Two acute illnesses.C.One acute and one infectious illness.IncorrectD.Two chronic illnesses.The plan of care should include goals that are specific for chronic and acute illnesses. Adult-onset diabetes is a life-long chronic disease, whereas influenza is an acute illness with a shortterm duration (C). (A, B, and D) do not include the correct duration categories for this situation.10.ID: 6974877914Following an emergency Cesarean delivery, the nurse encourages the new mother to breastfeedher newborn. Theclient asks why she should breastfeed now. Which information should thenurse provide?A.Stimulate contraction of the uterus.CorrectB.Initiate the lactation process.C.Facilitate maternal-infant bonding.D.Prevent neonatal hypoglycemia.When the infant suckles at the breast, oxytocin is released by the posterior pituitary to stimulatesthe "letdown" reflex, which causes therelease of colostrum, and contracts the uterus (C) toprevent uterine hemorrhage. (A and B) do not support the client's need in the immediate periodafter the emergency delivery. Although maternal-newborn bonding (D) is facilitated by earlybreastfeeding,the priority is uterine contraction stimulation.11.ID: 6974875104

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Which intervention should the nurse include in the plan of care for a female client with severepostpartum depression who is admitted to the inpatient psychiatric unit?A.Restrict visitors who irritate the client.B.Full rooming-in for the infant and mother.C.Supervised and guided visits with infant.CorrectD.Daily visits with her significant other.Structured visits (C) provide an opportunity for themother and infant to bond and should befacilitated and encouraged according to the client's pace of progress. (A) is unrealistic and maynot be safe for the baby or the client. (B) is an unrealistic expectation. Although daily visits mayprovide support,the significant other may not be able to be there every day (D) based on otherfamily responsibilities.12.ID: 6974873535A 16-year-old male client is admitted to the hospital after falling off a bike and sustaining afractured bone. The healthcare provider explains the surgery needed to immobilize the fracture.Which action should be implemented to obtain a valid informed consent?A.Obtain the permission of the custodial parent for the surgery.CorrectB.Notify the non-custodial parent to also sign a consent form.C.Instruct the client sign the consent before giving medications.D.Obtain the signature of the client’s stepfather for the surgery.IncorrectThe client is a minor and cannot legally sign his own consent unless he is an emancipated minor,so the consent should be obtained from the guardian for this client, which is thecustodial parent(B). (A) is not a legal option. A stepparent is not a legal guardian for a minor unless the child has

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been adopted by the stepparent (C). The non-custodial parent does not need to co-sign this form(D).13.ID: 6974876258During aclient assessment, the client says, "I can't walk very well." Which action should thenurse implement first?A.Predict the likelihood of the outcome.B.Consider alternatives.C.Choose the most successful approach.D.Identify the problem.CorrectThe sequential steps in problem-solving are to first identify the problem (B), then consideralternatives (C), consider outcomes of the alternatives (D), predict the likelihood of the outcomesoccurring, and choose the alternative with the best chance of success (A).14.ID: 6974875112The nurse identifies a client's needs and formulates the nursing problem of, "Imbalancednutrition: less than body requirements, related to mental impairment and decreased intake, asevidenced by increasingconfusion and weight loss of more than 30 pounds over the last 6months." Which short-term goal is best for this client?A.Verbalize understanding of plan and of intention to eat meals.B.Eat 50% of six small meals each day by the end of one week.CorrectC.Meals prepared during hospitalization will be fed by the nurse.D.Demonstrate progressive weight gain toward the ideal weight.

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Short-term goals should be realistic and attainable and should have a timeline of 7 to 10 daysbefore discharge. (A) meets those criteria. (B) is nurse-oriented. (C) may be beyond thecapabilities of a confused client. (D) is a long-term goal.15.ID: 6974873569A male client is angry and is leaving the hospital against medical advice (AMA). The clientdemands to take his chart with him and states the chart is "his" and he doesn' t want any morecontact with the hospital. How should the nurse respond?A.This hospital does not need to keep it if you are leaving and not returning here.B.Because you are leaving against medical advice, you may not have your chart.C.The information in your chart is confidential and cannot leave this facilitylegally.D.The chart is the property of the hospital but I will see that a copy is made for you.CorrectThe chart is the property of the facility, but the client has a legal right to the information in it,even if he is leaving AMA, so a copy of the record (D) should be provided. The client does notlose his legal rights to his medical record if he leaves AMA (A). The medical record isconfidential, but the hospital protects the client's privacy by not allowing unauthorized access tothe record, so the hospital may provide the client with a copy (B). The hospital must maintainrecords of the care provided and should not release the original record (C).16.ID:6974877906

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The nurse manager is assisting a nurse with improving organizational skills and timemanagement. Which nursing activity is the priority in pre-planning a schedule for selectednursing activities in the daily assignment?A.Tracheostomy tube suctioning.IncorrectB.Medication administration.CorrectC.Colostomy care instruction.D.Client personal hygiene.In developing organizational skills, medication administration is based on a prescribed schedulethat istime-sensitive in the delivery of nursing care and should be the priority in schedulingnursing activities in a daily assignment. Although suctioning a client's tracheostomy takesprecedence in providing care, the client's PRN need is less amenable to a preselected schedule.(B and C) can be scheduled around time-sensitive delivery of care.17.ID: 6974876220What nursing delivery of care provides the nurse to plan and direct care of a group of clients overa 24-hour period?A.Case management.B.Team nursing.IncorrectC.Primary nursing.CorrectD.Functional nursing.Primary nursing (B) is a model of delivery of care where a nurse is accountable for planning carefor clients around the clock. Functional nursing (D) is a care delivery model that provides clientcare by assignment of functions or tasks. Team nursing (A)is a care delivery model where

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assignments to a group of clients are provided by a mixed-staff team. Case management (C) isthe delivery of care that uses a collaborative process of assessment, planning, facilitation, andadvocacy for options and servicesto meet an individual's health needs and promote quality cost-effective outcomes.18.ID: 6974876280Two unlicensed assistive personnel (UAP) are arguing on the unit about who deserves to take abreak first. What is the most important basic guideline thatthe nurse should follow in resolvingthe conflict?A.Require the UAPs to reach a compromise.B.Weigh the consequences of each possible solution.IncorrectC.Encourage the two to view the humor of the conflict.D.Deal with issues and not personalities.CorrectDealing with the issues which are concrete, not personalities (A) which include emotionalreactions, is one of seven important keybehaviors in managing conflict. (B, C, and D) do notresolve the conflict when diverse opinions are expressed emotionally.19.ID: 6974873531The nurse is caring for a client who is unable to void. The plan of care establishes an objectivefor the clientto ingest at least 1000 mL of fluid between 7:00 am and 3:30 pm. Which clientresponse should the nurse document that indicates a successful outcome?A.Demonstrates adequate fluid intake and output.B.Verbalizes abdominal comfort without pressure.

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C.Drinks 240 mL of fluid five times during the shift.CorrectD.Voids at least 1000 mL between 7 am and 3 pm.The nurse should evaluate the client's outcome by observing the client's performanceof eachexpected behavior, so drinking 240 mL of fluid five or six times during the shift (D) indicates afluid intake of 1200 to 1440 mL, which meets the objective of at least 1000 mL during thedesignated period. (A) uses the term "adequate," which is not quantified. (B) is not the objective,which establishes an intake of at least 1000 mL. (C) is not an evaluation of the specific fluidintake.20.ID: 6974873553The nurse plans a teaching session with a client but postpones the planned sessionbased onwhich nursing problem?A.Knowledge deficit regarding impending surgery.B.Ineffective management of treatment regimen.C.Activity intolerance related to postoperative pain.CorrectD.Noncompliance with prescribed exercise plan.Pain, fatigue, or anxiety can interfere with the ability to pay attention and participate in learning,so the nursing diagnosis in (A) indicates a need to postpone teaching. (B, C, and D) indicate aneed for instruction.21.ID: 6974875106A client who has active tuberculosis (TB) is admitted to the medical unit. What action is mostimportant for the nurse to implement?

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A.Fit the client with a respirator mask.B.Assign the client to a negative air-flow room.CorrectC.Don a clean gown for client care.D.Place an isolation cart in the hallway.Active tuberculosis requires implementation of airborne precautions, so the client should beassigned to anegative pressure air-flow room (D). Although (A and C) should be implementedfor clients in isolation with contact precautions, it is most important that air flow from the roomis minimized when the client has TB. (B) should be implemented when the clientleaves theisolation environment.22.ID: 6974873585A client is receiving atenolol (Tenormin) 25 mg PO after a myocardial infarction. The nursedetermines the client's apical pulse is 65 beats per minute. What action should the nurseimplement next?A.Measure the blood pressure.B.Reassess the apical pulse.C.Notify the healthcare provider.D.Administer the medication.CorrectAtenolol, a beta-blocker, blocks the beta receptors of the sinoatrial node to reduce the heartrate,so the medication should be administered (C) because the client's apical pulse is greater than 60.(A, B, and D) are not indicated at this time.23.ID: 6974875175

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The nurse is assessing a client and identifies a bruit over the thyroid. Thisfinding is consistentwith which interpretation?A.Hypothyroidism.B.Thyroid cyst.C.Thyroid cancer.D.Hyperthyroidism.CorrectHyperthyroidism (D) is an enlargement of the thyroid gland, often referred to as a goiter, and abruit may be auscultated over the goiter due to an increase in glandular vascularity whichincreases as the thyroid gland becomes hyperactive. A bruit is not common with (A, B, and C).24.ID: 6974876270A 6-year-old child is alert but quiet when broughtto the emergency center with periorbitalecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse andcontinues to assess the child for additional manifestations of a basilar skull fracture. Whatassessment finding would be consistent with a basilar skull fracture?A.Hematemesis and abdominal distention.B.Asymmetry of the face and eye movements.C.Rhinorrhoea or otorrhoea with Halo sign.CorrectD.Abnormal position and movement of the arm.Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind the ear over themastoid process) are both signs of a basilar skull fracture, so the nurse should assess for possiblemeningeal tears that manifest as a Halo sign with CSF leakage from the ears or nose (D). (A) is

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consistent with orbital fractures. (B) occurs with wrenching traumas of the shoulder or armfractures. (C) occurs with blunt abdominal injuries.25.ID: 6974873555Thenurse is assessing a client who complains of weight loss, racing heart rate, and difficultysleeping. The nurse determines the client has moist skin with fine hair, prominent eyes, lidretraction, and a staring expression. These findings are consistent with which disorder?A.Grave's disease.CorrectB.Multiple sclerosis.C.Addison's disease.D.Cushing syndrome.This client is exhibiting symptoms associated with hyperthyroidism or Grave's disease (A),which is an autoimmune condition affecting the thyroid. (B, C, and D) are not associated withthese symptoms.26.ID: 6974875146The nurse is assessing anolder client and determines that the client's left upper eyelid droops,covering more of the iris than the right eyelid. Which description should the nurse use todocument this finding?A.A nystagmus on the left.B.Exophthalmos on the right.C.Ptosis on the left eyelid.CorrectD.Astigmatism on the right.

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