Critical Care HESI
LATEST UPDATE 2024 /
2025 GRADED A+
A 47-year-old female client is admitted to the cardiac ICU with an acute MI, which
occurred following a vigorous as a goal workout. She tells the nurse, "I just had a little
indigestion; I'll be fine a little while." Which client problem has the highest priority? -
ANS-Decreased cardiac output
The nurses calculating fluid resuscitation for young adult male who was burned in a
bloody accident at 1200 and is seen in the ER at 1400. The HCP determines that the
client has burn over 30% of his body, mainly over his arms and chest. Using the
Parkland formula for fluid resuscitation, the client is to receive 7000 mL of fluid in 24
hours. Which goal should the nurse establish for this clients plan of care? - ANS-By
2000, the client will have received 3500 mL of fluid
When caring for a client on a vent, which finding provides the greatest indication that the
client has an open airway? - ANS-Bilateral breath sounds can be auscultated
The nurse performs a prescribed a neurological check at the beginning of the shift on a
client who was admitted with a subarachnoid brain attack (Stroke). The client's GCS is
9. What information is most important for the nurse to determine? - ANS-The client's
previous GCS score
, An adult female with a history of type 1 diabetes has been vomiting for the past 48
hours and is admitted to the ICU with DKA. Which assessment finding warrants
immediate intervention by the nurse? - ANS-Excessive thirst
A client admitted to the ICU after a colon resection with the formation of the loop
colostomy. The nurse determines that the clients abdominal dressing is clean and dry.
Vital signs are: HR: 130, temperature: 100, BP: 88/65, and urine output of 10 mL/hr.
What interventions should the nurse implement? - ANS-Give a 500 mL IV fluid bolus
challenge
A client is admitted with syncopal episodes related to a third degree heart block. After
the placement of a transcutaneous pacemaker, the nurse observes several episodes
the pacemaker failure to sense. What action should the nurse take? - ANS-Increase the
sensitivity
A client is receiving CPR. After systole is confirmed in two leads and sending the
transcutaneous pacemaker, which IV medication should be administered? - ANS-
Epinephrine (adrenaline)
A client has a chest tube connected to a closed water seal drainage system with
suction. What equipment should the nurse always have available at the clients bedside?
- ANS-Occlusive dressing
Bretylium 1 mg/min via infusion is prescribed for a client and ventricular tachycardia.
The available solution is 500 mL D5W contains bretylium 1 gram. The nurse should
program the infusion time to deliver how many mL/hr? - ANS-30
The client is receiving an infusion of nitroglycerin 100 mg and 500 mL D5W at 6 mL/hr.
How many mcg/min of nitroglycerin is infusing? - ANS-20
A client arrives in the ER complaining of pain. What description of pain should prompt
the nurse to suspect it originated in the myocardium? - ANS-Produces chest heaviness
with left arm pain
Four days ago a chest tube was inserted into the second intercostal space of a client
who has a pneumothorax. Today the nurse notes that there is no fluctuation in the
water-seal chamber of the Pleuravac. Which intervention would be most appropriate for
the nurse to implement? - ANS-Assess the clients breath sounds of the affected lung
In developing a care plan for a client that has a chest tube due to a hemothorax, the
nurse should recognize which intervention is essential? - ANS-Encourage the client to
breathe deeply and cough at frequent intervals
A postoperative client is admitted the ICU with an inflated pressure infuser containing
solution of heparin 2 units/mL attached to an intraarterial cannula. Which finding
LATEST UPDATE 2024 /
2025 GRADED A+
A 47-year-old female client is admitted to the cardiac ICU with an acute MI, which
occurred following a vigorous as a goal workout. She tells the nurse, "I just had a little
indigestion; I'll be fine a little while." Which client problem has the highest priority? -
ANS-Decreased cardiac output
The nurses calculating fluid resuscitation for young adult male who was burned in a
bloody accident at 1200 and is seen in the ER at 1400. The HCP determines that the
client has burn over 30% of his body, mainly over his arms and chest. Using the
Parkland formula for fluid resuscitation, the client is to receive 7000 mL of fluid in 24
hours. Which goal should the nurse establish for this clients plan of care? - ANS-By
2000, the client will have received 3500 mL of fluid
When caring for a client on a vent, which finding provides the greatest indication that the
client has an open airway? - ANS-Bilateral breath sounds can be auscultated
The nurse performs a prescribed a neurological check at the beginning of the shift on a
client who was admitted with a subarachnoid brain attack (Stroke). The client's GCS is
9. What information is most important for the nurse to determine? - ANS-The client's
previous GCS score
, An adult female with a history of type 1 diabetes has been vomiting for the past 48
hours and is admitted to the ICU with DKA. Which assessment finding warrants
immediate intervention by the nurse? - ANS-Excessive thirst
A client admitted to the ICU after a colon resection with the formation of the loop
colostomy. The nurse determines that the clients abdominal dressing is clean and dry.
Vital signs are: HR: 130, temperature: 100, BP: 88/65, and urine output of 10 mL/hr.
What interventions should the nurse implement? - ANS-Give a 500 mL IV fluid bolus
challenge
A client is admitted with syncopal episodes related to a third degree heart block. After
the placement of a transcutaneous pacemaker, the nurse observes several episodes
the pacemaker failure to sense. What action should the nurse take? - ANS-Increase the
sensitivity
A client is receiving CPR. After systole is confirmed in two leads and sending the
transcutaneous pacemaker, which IV medication should be administered? - ANS-
Epinephrine (adrenaline)
A client has a chest tube connected to a closed water seal drainage system with
suction. What equipment should the nurse always have available at the clients bedside?
- ANS-Occlusive dressing
Bretylium 1 mg/min via infusion is prescribed for a client and ventricular tachycardia.
The available solution is 500 mL D5W contains bretylium 1 gram. The nurse should
program the infusion time to deliver how many mL/hr? - ANS-30
The client is receiving an infusion of nitroglycerin 100 mg and 500 mL D5W at 6 mL/hr.
How many mcg/min of nitroglycerin is infusing? - ANS-20
A client arrives in the ER complaining of pain. What description of pain should prompt
the nurse to suspect it originated in the myocardium? - ANS-Produces chest heaviness
with left arm pain
Four days ago a chest tube was inserted into the second intercostal space of a client
who has a pneumothorax. Today the nurse notes that there is no fluctuation in the
water-seal chamber of the Pleuravac. Which intervention would be most appropriate for
the nurse to implement? - ANS-Assess the clients breath sounds of the affected lung
In developing a care plan for a client that has a chest tube due to a hemothorax, the
nurse should recognize which intervention is essential? - ANS-Encourage the client to
breathe deeply and cough at frequent intervals
A postoperative client is admitted the ICU with an inflated pressure infuser containing
solution of heparin 2 units/mL attached to an intraarterial cannula. Which finding
