Critical Care HESI 2021 V1 Verified answers
Critical Care HESI 2021 V1 Verified answers
1. What assessment findings should he nurse document in the
electronic medical record for a client who is experiencing autonomic
dysreflexia after a TANSWER-4 spinal cord injury
ANSWER-Severe hypertension, diaphroresis, and flushing above the
lesion
2. As the nurse is turning a client with a chest tube, the chest tube
becomes dislodged from the pleural space. What action should the
nurse take first?
ANSWER-Have the client exhale forcefully and tape 3 sides of a
sterile gauze over the insertion site
3. The nurse plans to administer a low dose prescription for dopamine
(Intropin) to a client who is in septic shock. Which physiological
parameter should the nurse use to evaluate a therapeutic response to
dopamine?
ANSWER-Urinary Output
4. The nurse assesses a male client postoperatively who has an arterial
line in the radial artery. Assessment findings include pallor, parastesia,
and slow capillary refill in the client’s right hand fingers. What action
should the nurse plan?
, Critical Care HESI 2021 V1 Verified answers
ANSWER-Notify the HCP
5. A male client is admitted to the cardiac intensive unit with chest
pain that began twelve hours ago. The nurse recognizes increased
ventricular ectopy? Based on this assessment finding, what actions is
most important for the nurse to implement?
ANSWER-Initiate the unit’s antiarrhythmic protocol if symptomatic.
6. The nurse is assessing a client who was admitted 24 hours ago to
the critical care unit following a motorcycle collision. Which client
finding requires intervention by the nurse to reduce the risk for
complication related to increased intracranial pressure?
ANSWER-Change of PaCo2 to 55 mm Hg following ventilator
setting adjustments
7. A client is receiving cardiopulmonary resuscitation. After asystole
is confirmed in two leads and sending for the transcutaneous
pacemaker, which intravenous medication should be administered?
ANSWER-Epinephrine
8. The nurse performs a prescribed neurological check at the
beginning of the shift on a client who was admitted to the hospital
with a subarachnoid brain attack (stroke). The client’s Glasgow coma
scale is 9. What information is most important for the nurse to
determine?
ANSWER-The client’s previous GCS score
Critical Care HESI 2021 V1 Verified answers
1. What assessment findings should he nurse document in the
electronic medical record for a client who is experiencing autonomic
dysreflexia after a TANSWER-4 spinal cord injury
ANSWER-Severe hypertension, diaphroresis, and flushing above the
lesion
2. As the nurse is turning a client with a chest tube, the chest tube
becomes dislodged from the pleural space. What action should the
nurse take first?
ANSWER-Have the client exhale forcefully and tape 3 sides of a
sterile gauze over the insertion site
3. The nurse plans to administer a low dose prescription for dopamine
(Intropin) to a client who is in septic shock. Which physiological
parameter should the nurse use to evaluate a therapeutic response to
dopamine?
ANSWER-Urinary Output
4. The nurse assesses a male client postoperatively who has an arterial
line in the radial artery. Assessment findings include pallor, parastesia,
and slow capillary refill in the client’s right hand fingers. What action
should the nurse plan?
, Critical Care HESI 2021 V1 Verified answers
ANSWER-Notify the HCP
5. A male client is admitted to the cardiac intensive unit with chest
pain that began twelve hours ago. The nurse recognizes increased
ventricular ectopy? Based on this assessment finding, what actions is
most important for the nurse to implement?
ANSWER-Initiate the unit’s antiarrhythmic protocol if symptomatic.
6. The nurse is assessing a client who was admitted 24 hours ago to
the critical care unit following a motorcycle collision. Which client
finding requires intervention by the nurse to reduce the risk for
complication related to increased intracranial pressure?
ANSWER-Change of PaCo2 to 55 mm Hg following ventilator
setting adjustments
7. A client is receiving cardiopulmonary resuscitation. After asystole
is confirmed in two leads and sending for the transcutaneous
pacemaker, which intravenous medication should be administered?
ANSWER-Epinephrine
8. The nurse performs a prescribed neurological check at the
beginning of the shift on a client who was admitted to the hospital
with a subarachnoid brain attack (stroke). The client’s Glasgow coma
scale is 9. What information is most important for the nurse to
determine?
ANSWER-The client’s previous GCS score
