HESI CRITICAL CARE RN NEWEST 2024 ACTUAL EXAM
TEST BANK 2 VERSION (VERSION A AND B) 240
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+||UPDATED MAY 2024!
pt. long history of smoking; sob; ABG pH7.25, PCO2 50, HCO3 24 - ANSWER:
respiratory acidosis (if CO2 is high it will always be resp. acidosis)
"heart is pounding outside of her chest" client is in SVT; intervention - ANSWER:
coach client in relaxation and deep breathing
insulin protocol; pt. insulin is infused at 5 units/hr and her current glucose reading is
165. what to do? - ANSWER: increase drip by 1 unit/hr
calculate; 1,500,000 IU in 500 mL of 0.9% NS - ANSWER: 33
DKA math question - ANSWER: 1000 mL NS with 30 mEq of sodium
older client comes in with CAP and SpO2 89%. what is priority intervention? -
ANSWER: assist client with turning, coughing, and deep breathing
pt. received ETT 7 days ago and is currently on 50% O2. Pt is currently anxious and
hyperventilating. what is the priority intervention? - ANSWER: auscultate lungs
client has not been taking cortisone for either 2 weeks or 2 months and husband
bring her into ED; not feeling well. SIADH. what to do? - ANSWER: initiate fall
precautions (SIADH causes seizures)
UAP assisting nurse in situation where pt is having SVT and nurse has to prepare for
cardioversion. what task for UAP - ANSWER: bring resuscitation cart to the bedside
pt has cardioversion due to uncontrolled a fib. what vital shows that the
cardioversion was successful? - ANSWER: normal sinus rhythm with HR 84
pt. has ortho surgery and 12 hrs after surgery is anxious with SOB; intervention -
ANSWER: position client on the left side
pt. receiving dopamine. monitor for what - ANSWER: monitor urinary output
during insertion of swan gans, what should nurse do - ANSWER: monitor for
dysrhythmias
which vital signs are contraindicative of ICP? - ANSWER: PaCO2 of 55 (normal PaCO2
should be between 35-45; when increased it will cause more ICP)
, SIADH with normal lab values associated with this - ANSWER: hyperkalemia and
hyponatremia
pt. glasgow coma scale of 14. what should the nurse do - ANSWER: document the
findings
when caring for a client on a ventilator which finding shows the airway is open? -
ANSWER: bilateral breath sounds can be auscultated
pt. is in the ICU after a colon resection. vitals are HR 135, temp 103, BP 88/65, urine
output 10 mL/hr. intervention? - ANSWER: give a 500 mL IV bolus challenge (another
question similar with low BP and same answer)
client with syncopal episodes due to 3rd degree block. receives transcutaneous
pacemaker; several fails - ANSWER: increase the sensitivity
which of these drugs are the strongest for most effective vasodilators - ANSWER:
lidocaine
mcg to mg; 4mcg/kg and client weighs 165 lbs - ANSWER: 3.5 mL/hr
female falls down a flight of stairs and is having trouble walking and bearing weight.
prescription for hydrocodone for pain and an xray. intervention - ANSWER: have the
client take a urine pregnancy test
pt. with chest tube has the tube dislodged from pleural space; intervention -
ANSWER: place an occlusive dressing with take on 3 sides
postop client admitted to ED with intra-arterial cannula; heparin infusing at 2 units
per mL. what finding indicates the heparin has achieved therapeutic use - ANSWER:
the IA remain patent
pt. arrives to the ED with pain. description should prompt nurse to suspect an MI -
ANSWER: produces chest heaviness with left arm pain
what equipment should always be made available at the bedside for a pt. with a
chest tube - ANSWER: occlusive dressing
things should be done if an ET tube is in place - ANSWER: chest xray
chest rises and falls bilaterally
auscultate breath sounds
pt. comes in with severe hypotension. what medication should you expect a
prescription for? - ANSWER: amiodaron
TEST BANK 2 VERSION (VERSION A AND B) 240
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+||UPDATED MAY 2024!
pt. long history of smoking; sob; ABG pH7.25, PCO2 50, HCO3 24 - ANSWER:
respiratory acidosis (if CO2 is high it will always be resp. acidosis)
"heart is pounding outside of her chest" client is in SVT; intervention - ANSWER:
coach client in relaxation and deep breathing
insulin protocol; pt. insulin is infused at 5 units/hr and her current glucose reading is
165. what to do? - ANSWER: increase drip by 1 unit/hr
calculate; 1,500,000 IU in 500 mL of 0.9% NS - ANSWER: 33
DKA math question - ANSWER: 1000 mL NS with 30 mEq of sodium
older client comes in with CAP and SpO2 89%. what is priority intervention? -
ANSWER: assist client with turning, coughing, and deep breathing
pt. received ETT 7 days ago and is currently on 50% O2. Pt is currently anxious and
hyperventilating. what is the priority intervention? - ANSWER: auscultate lungs
client has not been taking cortisone for either 2 weeks or 2 months and husband
bring her into ED; not feeling well. SIADH. what to do? - ANSWER: initiate fall
precautions (SIADH causes seizures)
UAP assisting nurse in situation where pt is having SVT and nurse has to prepare for
cardioversion. what task for UAP - ANSWER: bring resuscitation cart to the bedside
pt has cardioversion due to uncontrolled a fib. what vital shows that the
cardioversion was successful? - ANSWER: normal sinus rhythm with HR 84
pt. has ortho surgery and 12 hrs after surgery is anxious with SOB; intervention -
ANSWER: position client on the left side
pt. receiving dopamine. monitor for what - ANSWER: monitor urinary output
during insertion of swan gans, what should nurse do - ANSWER: monitor for
dysrhythmias
which vital signs are contraindicative of ICP? - ANSWER: PaCO2 of 55 (normal PaCO2
should be between 35-45; when increased it will cause more ICP)
, SIADH with normal lab values associated with this - ANSWER: hyperkalemia and
hyponatremia
pt. glasgow coma scale of 14. what should the nurse do - ANSWER: document the
findings
when caring for a client on a ventilator which finding shows the airway is open? -
ANSWER: bilateral breath sounds can be auscultated
pt. is in the ICU after a colon resection. vitals are HR 135, temp 103, BP 88/65, urine
output 10 mL/hr. intervention? - ANSWER: give a 500 mL IV bolus challenge (another
question similar with low BP and same answer)
client with syncopal episodes due to 3rd degree block. receives transcutaneous
pacemaker; several fails - ANSWER: increase the sensitivity
which of these drugs are the strongest for most effective vasodilators - ANSWER:
lidocaine
mcg to mg; 4mcg/kg and client weighs 165 lbs - ANSWER: 3.5 mL/hr
female falls down a flight of stairs and is having trouble walking and bearing weight.
prescription for hydrocodone for pain and an xray. intervention - ANSWER: have the
client take a urine pregnancy test
pt. with chest tube has the tube dislodged from pleural space; intervention -
ANSWER: place an occlusive dressing with take on 3 sides
postop client admitted to ED with intra-arterial cannula; heparin infusing at 2 units
per mL. what finding indicates the heparin has achieved therapeutic use - ANSWER:
the IA remain patent
pt. arrives to the ED with pain. description should prompt nurse to suspect an MI -
ANSWER: produces chest heaviness with left arm pain
what equipment should always be made available at the bedside for a pt. with a
chest tube - ANSWER: occlusive dressing
things should be done if an ET tube is in place - ANSWER: chest xray
chest rises and falls bilaterally
auscultate breath sounds
pt. comes in with severe hypotension. what medication should you expect a
prescription for? - ANSWER: amiodaron
