HESI Critical Care RN Exit Exam Actual Exam Questions And Answers Practice
Questions with Solutions Newest | Already Graded A+/Newest Update!!!
Question 1
A client is prescribed Metoprolol for the management of chronic hypertension. Which
physiological effect should the nurse monitor for as a direct result of this medication?
A) Increased systemic vascular resistance
B) Selective blockade of beta-1 receptors leading to decreased heart rate
C) Rapid excretion of sodium and water via the distal tubules
D) Inhibition of the conversion of Angiotensin I to Angiotensin II
E) Potentiation of the "fight or flight" sympathetic response
Correct Answer: B) Selective blockade of beta-1 receptors leading to decreased heart rate
Rationale: Metoprolol is a cardioselective beta-adrenergic blocker. It specifically targets
beta-1 receptors located in the heart, reducing the heart rate, myocardial contractility, and
cardiac output. This decrease in cardiac workload effectively lowers blood pressure and is
used to treat hypertension, angina, and prevent secondary myocardial infarctions.
Question 2
The nurse is reviewing a telemetry strip and identifies a second-degree heart block (Type 1).
Which of the following descriptions accurately reflects the electrical conduction occurring in this
rhythm?
A) The impulse is completely blocked at the SA node.
B) A consistent PR interval followed by a sudden dropped QRS complex.
C) A progressively prolonged PR interval followed by a dropped QRS complex.
D) A shortened PR interval with a Delta wave at the start of the QRS.
E) Total dissociation between the atria and the ventricles.
Correct Answer: C) A progressively prolonged PR interval followed by a dropped QRS
complex.
Rationale: In a second-degree heart block (specifically Mobitz Type I or Wenckebach), there
is a progressive delay in conduction from the SA node to the AV junction. This is visualized
on telemetry as a PR interval that gets longer with each beat until one QRS complex is
dropped entirely. The cycle then repeats. This indicates a conduction delay at the level of
the AV node.
Question 3
A client on mechanical ventilation suddenly becomes restless and agitated. Upon auscultation,
the nurse notes breath sounds are present on the right side but absent on the left side. What is the
priority nursing suspicion?
A) The client is developing a pulmonary embolism.
B) The endotracheal tube has migrated into the right mainstem bronchus.
C) The client is experiencing an acute asthma attack.
D) The ventilator is experiencing a circuit leak.
E) The client has developed acute renal failure.
Correct Answer: B) The endotracheal tube has migrated into the right mainstem bronchus.
, 2
Rationale: Because the right mainstem bronchus is straighter and wider than the left, an
endotracheal (ET) tube that is inserted too deeply or migrates will almost always enter the
right side. This results in ventilation of the right lung only, leading to absent breath sounds
on the left. Restlessness is an early sign of hypoxia. The nurse must notify the provider to
reposition the tube based on X-ray or direct measurement.
Question 4
Following a train derailment, the nurse is performing disaster triage. Which of the following
clients should be prioritized for immediate (Red Tag) intervention?
A) A woman sitting quietly wrapped in a blanket with no visible injuries.
B) A child who is crying loudly for their parents.
) A middle-aged man who is wandering aimlessly and appears confused.
D) A mother and father who have just arrived and are requesting information.
E) A man with a small 1cm laceration over his left eye.
Correct Answer: C) A middle-aged man who is wandering aimlessly and appears confused.
Rationale: In disaster triage, clients with altered mental status or head injuries (manifested
here as wandering and confusion) are prioritized because they may have life-threatening
internal injuries or intracranial pressure issues. The crying child and the woman with no
injuries are lower priority (Green Tag), and the parents requesting info are not casualties.
Confused patients are red or yellow depending on the severity of neurological compromise.
Question 5
A client with severe pneumonia presents with the following ABG results: pH 7.30, PaO2 60
mmHg, PaCO2 62 mmHg, and HCO3 35 mEq/L. Which clinical observation warrants the most
immediate communication to the healthcare provider?
A) The client reports a dry mouth.
B) The client is increasingly drowsy and difficult to arouse.
C) The client has a productive cough with yellow sputum.
D) The client's temperature is 100.8°F.
E) The client's urine output is 40 mL per hour.
Correct Answer: B) The client is increasingly drowsy and difficult to arouse.
Rationale: The ABG shows respiratory acidosis (low pH, high CO2) with partial
compensation (elevated HCO3). A PaCO2 of 62 indicates significant CO2 retention
(hypercapnia). CO2 acts as a central nervous system depressant; therefore, drowsiness and
difficulty arousing indicate worsening CO2 narcosis and impending respiratory failure.
This is a medical emergency requiring immediate intervention.
Question 6
A client is admitted with partial and full-thickness burns covering 30% of the body. The lab
reports a serum potassium level of 4.0 mEq/L. Which statement regarding this finding is most
accurate?
, 3
A) The potassium is dangerously high and requires Kayexalate.
B) The potassium is within normal limits but must be monitored closely for shifts.
C) The client needs an immediate IV bolus of Potassium Chloride.
D) This level indicates the client has reached the diuretic phase of recovery.
E) Low potassium is expected in the first 24 hours of a burn injury.
Correct Answer: B) The potassium is within normal limits but must be monitored closely for
shifts.
Rationale: A potassium level of 4.0 mEq/L is within the normal reference range (3.5–5.0).
However, in the acute phase of a burn injury, potassium is released from damaged cells into
the extracellular fluid (hyperkalemia risk). Later, during the diuretic phase, potassium is
lost in the urine (hypokalemia risk). Constant monitoring is essential even if the current
level is normal.
Question 7
A client has been bedridden for 2 weeks following a neurological injury. Current labs: pH 7.37,
PO2 90, PCO2 40, HCO3 25. Which nursing intervention is the priority to maintain this client’s
pulmonary and acid-base stability?
A) Administering high-flow oxygen via a non-rebreather mask.
B) Turning the patient from side to side every 2 hours.
C) Encouraging the client to eat a high-protein diet.
D) Monitoring for signs of spinal shock.
E) Obtaining a STAT arterial blood gas.
Correct Answer: B) Turning the patient side to side q2h
Rationale: The client's ABGs are currently within normal limits. To prevent complications
of immobility such as atelectasis, stasis of secretions, and pneumonia—which would cause
respiratory acidosis—the priority is proactive physical care. Turning the patient every 2
hours promotes lung expansion and prevents the accumulation of fluid in dependent areas
of the lungs.
Question 8
A 40-year-old client is admitted in a sickle cell crisis. Which assessment finding should the nurse
prioritize to prevent permanent tissue damage?
A) A heart rate of 95 beats per minute.
B) A report of joint pain rated 8/10.
C) Neurovascular status including pain, pallor, and pulses in the extremities.
D) The client's request for a high-calorie snack.
E) The presence of a mild headache.
Correct Answer: C) Priority assessment for a 40-year-old with sickle cell crisis
(Neurovascular)
Rationale: In a sickle cell crisis, misshapen red blood cells clump together and obstruct
, 4
small blood vessels (vaso-occlusive crisis). This leads to ischemia and potential necrosis of
the tissues. Assessing the "5 Ps" (pain, pallor, pulse, paresthesia, and paralysis) is critical to
identifying early signs of vascular occlusion and compartment syndrome.
Question 9
During a major disaster triage, the nurse must decide which patient can be safely moved to a
standard medical-surgical unit to clear a critical care bed. Which patient is the most appropriate
candidate?
A) A patient with a major abdominal gunshot wound and MODS.
B) A patient with acute pancreatitis and a BNP of 800.
C) A stable patient with a simple cut over the eye and normal liver levels.
D) A patient in pulseless ventricular tachycardia.
E) A patient with a suspected epidural bleed and a declining LOC.
Correct Answer: C) Priority order: Cut over eye, Move patient to medical surgical unit
Rationale: Standard medical-surgical units are for stable patients who do not require
continuous hemodynamic monitoring or advanced life support. A patient with a simple
laceration and stable vital signs does not require a critical care bed, whereas the other
options describe high-acuity, unstable conditions.
Question 10
The nurse is training a new graduate on how to assess the carotid pulse. Which location should
the nurse point to on the client?
A) The center of the forehead.
B) The radial side of the wrist.
C) The side of the neck, between the trachea and the sternocleidomastoid muscle.
D) The top of the foot between the first and second toes.
E) The inner thigh near the groin.
Correct Answer: C) Pointing to the neck to indicate carotid artery
Rationale: The carotid artery is located in the neck. Assessing this pulse is critical during
CPR and in emergency situations because it remains palpable longer than peripheral
pulses when cardiac output is low.
Question 11
The nurse is checking the effectiveness of a wound vacuum-assisted closure (V.A.C.) system.
What is the most important assessment to ensure the system is functioning correctly?
A) Measuring the volume of drainage in the canister.
B) Checking the seal to ensure no air leaks are present.
C) Asking the patient if they can feel the suction.
D) Changing the foam dressing every 4 hours.
E) Ensuring the machine is set to 200 mmHg of pressure.
Correct Answer: B) Checking seal to ensure no leaks in wound vac
Questions with Solutions Newest | Already Graded A+/Newest Update!!!
Question 1
A client is prescribed Metoprolol for the management of chronic hypertension. Which
physiological effect should the nurse monitor for as a direct result of this medication?
A) Increased systemic vascular resistance
B) Selective blockade of beta-1 receptors leading to decreased heart rate
C) Rapid excretion of sodium and water via the distal tubules
D) Inhibition of the conversion of Angiotensin I to Angiotensin II
E) Potentiation of the "fight or flight" sympathetic response
Correct Answer: B) Selective blockade of beta-1 receptors leading to decreased heart rate
Rationale: Metoprolol is a cardioselective beta-adrenergic blocker. It specifically targets
beta-1 receptors located in the heart, reducing the heart rate, myocardial contractility, and
cardiac output. This decrease in cardiac workload effectively lowers blood pressure and is
used to treat hypertension, angina, and prevent secondary myocardial infarctions.
Question 2
The nurse is reviewing a telemetry strip and identifies a second-degree heart block (Type 1).
Which of the following descriptions accurately reflects the electrical conduction occurring in this
rhythm?
A) The impulse is completely blocked at the SA node.
B) A consistent PR interval followed by a sudden dropped QRS complex.
C) A progressively prolonged PR interval followed by a dropped QRS complex.
D) A shortened PR interval with a Delta wave at the start of the QRS.
E) Total dissociation between the atria and the ventricles.
Correct Answer: C) A progressively prolonged PR interval followed by a dropped QRS
complex.
Rationale: In a second-degree heart block (specifically Mobitz Type I or Wenckebach), there
is a progressive delay in conduction from the SA node to the AV junction. This is visualized
on telemetry as a PR interval that gets longer with each beat until one QRS complex is
dropped entirely. The cycle then repeats. This indicates a conduction delay at the level of
the AV node.
Question 3
A client on mechanical ventilation suddenly becomes restless and agitated. Upon auscultation,
the nurse notes breath sounds are present on the right side but absent on the left side. What is the
priority nursing suspicion?
A) The client is developing a pulmonary embolism.
B) The endotracheal tube has migrated into the right mainstem bronchus.
C) The client is experiencing an acute asthma attack.
D) The ventilator is experiencing a circuit leak.
E) The client has developed acute renal failure.
Correct Answer: B) The endotracheal tube has migrated into the right mainstem bronchus.
, 2
Rationale: Because the right mainstem bronchus is straighter and wider than the left, an
endotracheal (ET) tube that is inserted too deeply or migrates will almost always enter the
right side. This results in ventilation of the right lung only, leading to absent breath sounds
on the left. Restlessness is an early sign of hypoxia. The nurse must notify the provider to
reposition the tube based on X-ray or direct measurement.
Question 4
Following a train derailment, the nurse is performing disaster triage. Which of the following
clients should be prioritized for immediate (Red Tag) intervention?
A) A woman sitting quietly wrapped in a blanket with no visible injuries.
B) A child who is crying loudly for their parents.
) A middle-aged man who is wandering aimlessly and appears confused.
D) A mother and father who have just arrived and are requesting information.
E) A man with a small 1cm laceration over his left eye.
Correct Answer: C) A middle-aged man who is wandering aimlessly and appears confused.
Rationale: In disaster triage, clients with altered mental status or head injuries (manifested
here as wandering and confusion) are prioritized because they may have life-threatening
internal injuries or intracranial pressure issues. The crying child and the woman with no
injuries are lower priority (Green Tag), and the parents requesting info are not casualties.
Confused patients are red or yellow depending on the severity of neurological compromise.
Question 5
A client with severe pneumonia presents with the following ABG results: pH 7.30, PaO2 60
mmHg, PaCO2 62 mmHg, and HCO3 35 mEq/L. Which clinical observation warrants the most
immediate communication to the healthcare provider?
A) The client reports a dry mouth.
B) The client is increasingly drowsy and difficult to arouse.
C) The client has a productive cough with yellow sputum.
D) The client's temperature is 100.8°F.
E) The client's urine output is 40 mL per hour.
Correct Answer: B) The client is increasingly drowsy and difficult to arouse.
Rationale: The ABG shows respiratory acidosis (low pH, high CO2) with partial
compensation (elevated HCO3). A PaCO2 of 62 indicates significant CO2 retention
(hypercapnia). CO2 acts as a central nervous system depressant; therefore, drowsiness and
difficulty arousing indicate worsening CO2 narcosis and impending respiratory failure.
This is a medical emergency requiring immediate intervention.
Question 6
A client is admitted with partial and full-thickness burns covering 30% of the body. The lab
reports a serum potassium level of 4.0 mEq/L. Which statement regarding this finding is most
accurate?
, 3
A) The potassium is dangerously high and requires Kayexalate.
B) The potassium is within normal limits but must be monitored closely for shifts.
C) The client needs an immediate IV bolus of Potassium Chloride.
D) This level indicates the client has reached the diuretic phase of recovery.
E) Low potassium is expected in the first 24 hours of a burn injury.
Correct Answer: B) The potassium is within normal limits but must be monitored closely for
shifts.
Rationale: A potassium level of 4.0 mEq/L is within the normal reference range (3.5–5.0).
However, in the acute phase of a burn injury, potassium is released from damaged cells into
the extracellular fluid (hyperkalemia risk). Later, during the diuretic phase, potassium is
lost in the urine (hypokalemia risk). Constant monitoring is essential even if the current
level is normal.
Question 7
A client has been bedridden for 2 weeks following a neurological injury. Current labs: pH 7.37,
PO2 90, PCO2 40, HCO3 25. Which nursing intervention is the priority to maintain this client’s
pulmonary and acid-base stability?
A) Administering high-flow oxygen via a non-rebreather mask.
B) Turning the patient from side to side every 2 hours.
C) Encouraging the client to eat a high-protein diet.
D) Monitoring for signs of spinal shock.
E) Obtaining a STAT arterial blood gas.
Correct Answer: B) Turning the patient side to side q2h
Rationale: The client's ABGs are currently within normal limits. To prevent complications
of immobility such as atelectasis, stasis of secretions, and pneumonia—which would cause
respiratory acidosis—the priority is proactive physical care. Turning the patient every 2
hours promotes lung expansion and prevents the accumulation of fluid in dependent areas
of the lungs.
Question 8
A 40-year-old client is admitted in a sickle cell crisis. Which assessment finding should the nurse
prioritize to prevent permanent tissue damage?
A) A heart rate of 95 beats per minute.
B) A report of joint pain rated 8/10.
C) Neurovascular status including pain, pallor, and pulses in the extremities.
D) The client's request for a high-calorie snack.
E) The presence of a mild headache.
Correct Answer: C) Priority assessment for a 40-year-old with sickle cell crisis
(Neurovascular)
Rationale: In a sickle cell crisis, misshapen red blood cells clump together and obstruct
, 4
small blood vessels (vaso-occlusive crisis). This leads to ischemia and potential necrosis of
the tissues. Assessing the "5 Ps" (pain, pallor, pulse, paresthesia, and paralysis) is critical to
identifying early signs of vascular occlusion and compartment syndrome.
Question 9
During a major disaster triage, the nurse must decide which patient can be safely moved to a
standard medical-surgical unit to clear a critical care bed. Which patient is the most appropriate
candidate?
A) A patient with a major abdominal gunshot wound and MODS.
B) A patient with acute pancreatitis and a BNP of 800.
C) A stable patient with a simple cut over the eye and normal liver levels.
D) A patient in pulseless ventricular tachycardia.
E) A patient with a suspected epidural bleed and a declining LOC.
Correct Answer: C) Priority order: Cut over eye, Move patient to medical surgical unit
Rationale: Standard medical-surgical units are for stable patients who do not require
continuous hemodynamic monitoring or advanced life support. A patient with a simple
laceration and stable vital signs does not require a critical care bed, whereas the other
options describe high-acuity, unstable conditions.
Question 10
The nurse is training a new graduate on how to assess the carotid pulse. Which location should
the nurse point to on the client?
A) The center of the forehead.
B) The radial side of the wrist.
C) The side of the neck, between the trachea and the sternocleidomastoid muscle.
D) The top of the foot between the first and second toes.
E) The inner thigh near the groin.
Correct Answer: C) Pointing to the neck to indicate carotid artery
Rationale: The carotid artery is located in the neck. Assessing this pulse is critical during
CPR and in emergency situations because it remains palpable longer than peripheral
pulses when cardiac output is low.
Question 11
The nurse is checking the effectiveness of a wound vacuum-assisted closure (V.A.C.) system.
What is the most important assessment to ensure the system is functioning correctly?
A) Measuring the volume of drainage in the canister.
B) Checking the seal to ensure no air leaks are present.
C) Asking the patient if they can feel the suction.
D) Changing the foam dressing every 4 hours.
E) Ensuring the machine is set to 200 mmHg of pressure.
Correct Answer: B) Checking seal to ensure no leaks in wound vac
