WGU C790 NURSING INFORMATICS OA EXAM 400 ACTUAL
QUESTIONS AND CORRECT ANSWERS WITH RATIONALE
LATEST UPDATE
This comprehensive study guide contains **400 expertly crafted practice
questions** with **detailed, evidence-based rationales** designed to prepare
nursing students for the Critical Care HESI Exit Exam. Covering essential
topics including hemodynamic monitoring, mechanical ventilation, cardiac
arrhythmias, shock states, ABG interpretation, medication administration,
and emergency interventions, this resource provides realistic clinical scenarios
that mirror the actual exam format. Each question includes four multiple-
choice options, the correct answer, and a thorough rationale explaining the
underlying pathophysiology and clinical reasoning. Perfect for self-study, this
guide builds clinical judgment and confidence. Ideal for nursing students, new
graduates, and critical care nurses preparing for certification or the HESI
Exit Exam.
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. Which assessment finding indicates the
therapy is effective?
A) Respiratory rate of 28 breaths per minute
B) Oxygen saturation of 92%
C) Use of accessory muscles
D) PaCO2 of 55 mmHg
Correct Answer: B
Rationale: For a patient with COPD, the goal of oxygen therapy is to maintain an
oxygen saturation of 88-92% to provide adequate oxygenation while avoiding the
risk of suppressing the hypoxic drive. An SpO2 of 92% indicates effective therapy.
2. The nurse is caring for a patient with a chest tube connected to a water-seal
drainage system. Which finding indicates the chest tube is functioning properly?
,A) Continuous bubbling in the water-seal chamber
B) Tidaling in the water-seal chamber
C) Absence of drainage in the collection chamber
D) Suction pressure of -40 cm H2O
Correct Answer: B
Rationale: Tidaling in the water-seal chamber is a normal fluctuation that occurs
with respiration and indicates that the chest tube is patent and functioning
correctly. Continuous bubbling indicates an air leak. Absence of drainage may be
normal but is not a sign of proper function.
3. The nurse is caring for a client receiving mechanical ventilation. The high-
pressure alarm sounds. Which action should the nurse take first?
A) Suction the client's endotracheal tube
B) Check for a kink in the ventilator tubing
C) Assess the client's respiratory status
D) Notify the respiratory therapist
Correct Answer: C
Rationale: The first action when any ventilator alarm sounds is to assess the client's
respiratory status to determine if the cause is client-related. After assessing the
client, the nurse should check the ventilator circuit for kinks, secretions, or other
obstructions.
4. A client with a history of heart failure is admitted with pulmonary edema.
Which medication should the nurse anticipate administering?
A) Furosemide (Lasix)
B) Digoxin (Lanoxin)
C) Metoprolol (Lopressor)
D) Amiodarone (Cordarone)
Correct Answer: A
,Rationale: Furosemide is a loop diuretic that reduces preload by decreasing venous
return and promoting diuresis. It is the first-line medication for pulmonary edema
to reduce fluid overload and pulmonary congestion.
5. The nurse is assessing a client who is 2 hours post-cardiac catheterization.
Which finding requires immediate intervention?
A) The client reports a headache
B) The access site is slightly swollen
C) The client's foot is pale and cool distal to the access site
D) The client is thirsty
Correct Answer: C
Rationale: A pale and cool extremity distal to the access site suggests arterial
occlusion or embolization, which is a medical emergency. The nurse must
immediately notify the healthcare provider to prevent tissue necrosis.
6. A client with sepsis is receiving a norepinephrine infusion. Which assessment
finding indicates the medication is achieving the desired effect?
A) Heart rate increases from 110 to 125
B) Blood pressure increases from 80/50 to 100/70
C) Urine output decreases from 30 mL/hr to 20 mL/hr
D) Cardiac output decreases
Correct Answer: B
Rationale: Norepinephrine is a potent vasopressor used to increase blood pressure
in septic shock by causing vasoconstriction. The desired effect is an increase in
mean arterial pressure (MAP) to improve tissue perfusion.
7. The nurse is caring for a client with a pulmonary artery catheter. The pulmonary
artery wedge pressure (PAWP) is 25 mmHg. Which complication does this
indicate?
A) Hypovolemia
B) Pulmonary edema
C) Dehydration
D) Tension pneumothorax
, Correct Answer: B
Rationale: PAWP reflects left atrial pressure. A normal PAWP is 6-12 mmHg. A
value greater than 18 mmHg indicates fluid overload and risk of pulmonary edema.
A value of 25 mmHg indicates severe pulmonary edema.
8. A client is receiving a continuous infusion of heparin. The nurse notes that the
client's aPTT is 120 seconds. What is the priority action?
A) Increase the heparin infusion rate
B) Decrease the heparin infusion rate
C) Continue the infusion as ordered
D) Administer protamine sulfate
Correct Answer: B
Rationale: An aPTT of 120 seconds is significantly elevated, indicating a high risk
of bleeding. The heparin infusion rate should be decreased and the aPTT
rechecked. Protamine sulfate is the antidote for heparin overdose, but this would be
given if there is active bleeding.
9. The nurse is caring for a client with a central line who develops shortness of
breath and chest pain. What is the priority action?
A) Administer oxygen
B) Place the client in a high-Fowler's position
C) Clamp the central line
D) Notify the healthcare provider
Correct Answer: C
Rationale: Sudden shortness of breath and chest pain in a client with a central line
should immediately raise suspicion for an air embolism. The priority action is to
clamp the central line to prevent further air entry. The client should then be placed
on the left side in Trendelenburg position.
10. A client is diagnosed with an acute myocardial infarction (AMI). Which
medication should be administered to reduce myocardial oxygen demand?
QUESTIONS AND CORRECT ANSWERS WITH RATIONALE
LATEST UPDATE
This comprehensive study guide contains **400 expertly crafted practice
questions** with **detailed, evidence-based rationales** designed to prepare
nursing students for the Critical Care HESI Exit Exam. Covering essential
topics including hemodynamic monitoring, mechanical ventilation, cardiac
arrhythmias, shock states, ABG interpretation, medication administration,
and emergency interventions, this resource provides realistic clinical scenarios
that mirror the actual exam format. Each question includes four multiple-
choice options, the correct answer, and a thorough rationale explaining the
underlying pathophysiology and clinical reasoning. Perfect for self-study, this
guide builds clinical judgment and confidence. Ideal for nursing students, new
graduates, and critical care nurses preparing for certification or the HESI
Exit Exam.
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. Which assessment finding indicates the
therapy is effective?
A) Respiratory rate of 28 breaths per minute
B) Oxygen saturation of 92%
C) Use of accessory muscles
D) PaCO2 of 55 mmHg
Correct Answer: B
Rationale: For a patient with COPD, the goal of oxygen therapy is to maintain an
oxygen saturation of 88-92% to provide adequate oxygenation while avoiding the
risk of suppressing the hypoxic drive. An SpO2 of 92% indicates effective therapy.
2. The nurse is caring for a patient with a chest tube connected to a water-seal
drainage system. Which finding indicates the chest tube is functioning properly?
,A) Continuous bubbling in the water-seal chamber
B) Tidaling in the water-seal chamber
C) Absence of drainage in the collection chamber
D) Suction pressure of -40 cm H2O
Correct Answer: B
Rationale: Tidaling in the water-seal chamber is a normal fluctuation that occurs
with respiration and indicates that the chest tube is patent and functioning
correctly. Continuous bubbling indicates an air leak. Absence of drainage may be
normal but is not a sign of proper function.
3. The nurse is caring for a client receiving mechanical ventilation. The high-
pressure alarm sounds. Which action should the nurse take first?
A) Suction the client's endotracheal tube
B) Check for a kink in the ventilator tubing
C) Assess the client's respiratory status
D) Notify the respiratory therapist
Correct Answer: C
Rationale: The first action when any ventilator alarm sounds is to assess the client's
respiratory status to determine if the cause is client-related. After assessing the
client, the nurse should check the ventilator circuit for kinks, secretions, or other
obstructions.
4. A client with a history of heart failure is admitted with pulmonary edema.
Which medication should the nurse anticipate administering?
A) Furosemide (Lasix)
B) Digoxin (Lanoxin)
C) Metoprolol (Lopressor)
D) Amiodarone (Cordarone)
Correct Answer: A
,Rationale: Furosemide is a loop diuretic that reduces preload by decreasing venous
return and promoting diuresis. It is the first-line medication for pulmonary edema
to reduce fluid overload and pulmonary congestion.
5. The nurse is assessing a client who is 2 hours post-cardiac catheterization.
Which finding requires immediate intervention?
A) The client reports a headache
B) The access site is slightly swollen
C) The client's foot is pale and cool distal to the access site
D) The client is thirsty
Correct Answer: C
Rationale: A pale and cool extremity distal to the access site suggests arterial
occlusion or embolization, which is a medical emergency. The nurse must
immediately notify the healthcare provider to prevent tissue necrosis.
6. A client with sepsis is receiving a norepinephrine infusion. Which assessment
finding indicates the medication is achieving the desired effect?
A) Heart rate increases from 110 to 125
B) Blood pressure increases from 80/50 to 100/70
C) Urine output decreases from 30 mL/hr to 20 mL/hr
D) Cardiac output decreases
Correct Answer: B
Rationale: Norepinephrine is a potent vasopressor used to increase blood pressure
in septic shock by causing vasoconstriction. The desired effect is an increase in
mean arterial pressure (MAP) to improve tissue perfusion.
7. The nurse is caring for a client with a pulmonary artery catheter. The pulmonary
artery wedge pressure (PAWP) is 25 mmHg. Which complication does this
indicate?
A) Hypovolemia
B) Pulmonary edema
C) Dehydration
D) Tension pneumothorax
, Correct Answer: B
Rationale: PAWP reflects left atrial pressure. A normal PAWP is 6-12 mmHg. A
value greater than 18 mmHg indicates fluid overload and risk of pulmonary edema.
A value of 25 mmHg indicates severe pulmonary edema.
8. A client is receiving a continuous infusion of heparin. The nurse notes that the
client's aPTT is 120 seconds. What is the priority action?
A) Increase the heparin infusion rate
B) Decrease the heparin infusion rate
C) Continue the infusion as ordered
D) Administer protamine sulfate
Correct Answer: B
Rationale: An aPTT of 120 seconds is significantly elevated, indicating a high risk
of bleeding. The heparin infusion rate should be decreased and the aPTT
rechecked. Protamine sulfate is the antidote for heparin overdose, but this would be
given if there is active bleeding.
9. The nurse is caring for a client with a central line who develops shortness of
breath and chest pain. What is the priority action?
A) Administer oxygen
B) Place the client in a high-Fowler's position
C) Clamp the central line
D) Notify the healthcare provider
Correct Answer: C
Rationale: Sudden shortness of breath and chest pain in a client with a central line
should immediately raise suspicion for an air embolism. The priority action is to
clamp the central line to prevent further air entry. The client should then be placed
on the left side in Trendelenburg position.
10. A client is diagnosed with an acute myocardial infarction (AMI). Which
medication should be administered to reduce myocardial oxygen demand?
