CRITICAL CARE HESI EXAM QUESTIONS & WELL DETAILED ANSWERS
PLUS RATIONALES(2025)GRADE A+ ASSURED
Question 1
A client with a long history of smoking is admitted with shortness of breath. The Arterial Blood
Gas (ABG) results are pH 7.25, PCO 2 ,and HCO 3 24
. Which acid-base imbalance does this client have?
A) Metabolic Acidosis
B) Respiratory Alkalosis
C) Metabolic Alkalosis
D) Respiratory Acidosis
E) Compensated Metabolic Acidosis
Correct Answer: D) Respiratory Acidosis
Rationale: The pH of 7.25 indicates acidosis (below 7.35 ). The PCO 2 of 50 mmHg
is elevated (normal 35−45 mmHg), indicating a respiratory cause, as CO 2 is an acid.
The HCO3 of 24 mEq/L is within the normal range (uncompensated). Therefore, the client
is experiencing uncompensated Respiratory Acidosis.
Question 2
A client reports their "heart is pounding outside of her chest" and the ECG confirms
Supraventricular Tachycardia (SVT). What is the priority initial nursing intervention for this
stable client?
A) Prepare for immediate synchronized cardioversion.
B) Administer a rapid IV push of Adenosine.
C) Coach the client in relaxation and deep breathing (vagal maneuvers).
D) Obtain a 12-lead ECG and call the healthcare provider (HCP).
E) Initiate a dopamine drip at 5 μ g/kg/min
.
Correct Answer: C) Coach the client in relaxation and deep breathing (vagal maneuvers).
Rationale: For a stable client in SVT, the initial intervention is to attempt vagal maneuvers,
such as deep breathing, bearing down (Valsalva), or coughing. These actions stimulate the
,vagus nerve, which can slow the conduction through the AV node and potentially break the
SVT circuit.
Question 3
A client on a continuous intravenous insulin protocol has insulin infused at 5 units/hr , and her
current glucose reading is 165 mg/dL. The protocol states the target range is 100−140 mg/dL.
What is the priority intervention based on the protocol?
A) Maintain the current drip rate of 5 units/hr
.
B) Increase the drip by 1 unit/hr
.
C) Decrease the drip to 3 units/hr
.
D) Stop the infusion and notify the HCP.
E) Change the solution to D5W.
Correct Answer: B) Increase the drip by 1 unit/hr
.
Rationale: The client's glucose level (165 mg/dL) is above the target range (100−140 mg/dL
), indicating that the current rate is insufficient to bring the glucose down effectively. The
priority is to adjust the infusion to meet the therapeutic goal, and increasing the rate
by 1 unit/hr is a standard, conservative adjustment within a typical insulin protocol.
Question 4
A medication is prescribed at 1,500,000 IU
to be infused in 500 mL of 0.9 % NS over 15 hours. What is the infusion rate in mL/ hr ?
A) 50 mL/hr
B) 33 mL/hr
C) 100 mL/hr
,D) 150 mL/hr
E) 75 mL/hr
Correct Answer: B) 33 mL/ hr
Rationale: The infusion rate in mL/ hr
is calculated as: Total Volume/Total Time
. Rate=500 mL/ 15 hours ≈ 33.33 mL/hr
. Given the options, 33 mL/hr
is the correct rate.
Question 5
An older adult client is admitted with Community-Acquired Pneumonia (CAP ) and has an SpO 2
reading of 89 on room air. What is the priority intervention?
A) Administer a prescribed oral antibiotic.
B) Assist the client with turning, coughing, and deep breathing.
C) Prepare the client for an immediate Chest X-ray.
D) Elevate the head of the bed and apply supplemental oxygen via nasal cannula.
E) Administer a loading dose of a nebulized bronchodilator.
Correct Answer: D) Elevate the head of the bed and apply supplemental oxygen via nasal
cannula.
Rationale: The client's SpO 2 is critically low (89 % ), indicating hypoxemia, which is the
immediate life threat (Airway, Breathing, Circulation priority). The priority intervention is
to immediately improve oxygenation by positioning the client for maximal chest expansion
(elevate HOB ) and applying supplemental oxygen.
, Question 6
A client who received an Endotracheal Tube (ETT ) 7 days ago is currently maintained
on 50 % O 2. The client is observed to be anxious and hyperventilating. What is the priority
intervention for the nurse?
A) Increase the fraction of inspired oxygen (FiO2 ) to 60 %
.B) Administer a STAT dose of a prescribed benzodiazepine.
C) Auscultate the client's lungs bilaterally.
D) Decrease the respiratory rate setting on the ventilator.
E) Suction the client's ETT to remove secretions.
Correct Answer: C) Auscultate the client's lungs bilaterally.
Rationale: Anxiety and hyperventilation in a ventilated patient can be symptoms of various
problems, including an obstructed or displaced tube, pneumothorax, or pulmonary
embolism. The priority is to assess the client's respiratory status and confirm proper ETT
placement and gas distribution by auscultating bilateral breath sounds to rule out
immediate respiratory compromise.
Question 7
A client's husband brings her to the ED because she has been ill and has not taken her prescribed
Cortisone medication for several weeks. The client is suspected to have a syndrome involving a
massive fluid shift, such as SIADH (Syndrome of Inappropriate Antidiuretic Hormone). What is
the priority safety intervention?
A) Administer 3 % Saline infusion.
B) Initiate fall precautions.
C) Restrict the client's fluid intake.
D) Obtain a STAT head CT scan.
E) Administer a dose of Furosemide.
Correct Answer: B) Initiate fall precautions.
Rationale: Severe SIADH causes dilutional hyponatremia (low serum sodium), which can
rapidly lead to cerebral edema and neurological complications such as confusion, altered
mental status, and seizures. Since the client is "not feeling well," the risk of a fall or seizure
is high, making fall and seizure precautions the immediate priority safety intervention.
PLUS RATIONALES(2025)GRADE A+ ASSURED
Question 1
A client with a long history of smoking is admitted with shortness of breath. The Arterial Blood
Gas (ABG) results are pH 7.25, PCO 2 ,and HCO 3 24
. Which acid-base imbalance does this client have?
A) Metabolic Acidosis
B) Respiratory Alkalosis
C) Metabolic Alkalosis
D) Respiratory Acidosis
E) Compensated Metabolic Acidosis
Correct Answer: D) Respiratory Acidosis
Rationale: The pH of 7.25 indicates acidosis (below 7.35 ). The PCO 2 of 50 mmHg
is elevated (normal 35−45 mmHg), indicating a respiratory cause, as CO 2 is an acid.
The HCO3 of 24 mEq/L is within the normal range (uncompensated). Therefore, the client
is experiencing uncompensated Respiratory Acidosis.
Question 2
A client reports their "heart is pounding outside of her chest" and the ECG confirms
Supraventricular Tachycardia (SVT). What is the priority initial nursing intervention for this
stable client?
A) Prepare for immediate synchronized cardioversion.
B) Administer a rapid IV push of Adenosine.
C) Coach the client in relaxation and deep breathing (vagal maneuvers).
D) Obtain a 12-lead ECG and call the healthcare provider (HCP).
E) Initiate a dopamine drip at 5 μ g/kg/min
.
Correct Answer: C) Coach the client in relaxation and deep breathing (vagal maneuvers).
Rationale: For a stable client in SVT, the initial intervention is to attempt vagal maneuvers,
such as deep breathing, bearing down (Valsalva), or coughing. These actions stimulate the
,vagus nerve, which can slow the conduction through the AV node and potentially break the
SVT circuit.
Question 3
A client on a continuous intravenous insulin protocol has insulin infused at 5 units/hr , and her
current glucose reading is 165 mg/dL. The protocol states the target range is 100−140 mg/dL.
What is the priority intervention based on the protocol?
A) Maintain the current drip rate of 5 units/hr
.
B) Increase the drip by 1 unit/hr
.
C) Decrease the drip to 3 units/hr
.
D) Stop the infusion and notify the HCP.
E) Change the solution to D5W.
Correct Answer: B) Increase the drip by 1 unit/hr
.
Rationale: The client's glucose level (165 mg/dL) is above the target range (100−140 mg/dL
), indicating that the current rate is insufficient to bring the glucose down effectively. The
priority is to adjust the infusion to meet the therapeutic goal, and increasing the rate
by 1 unit/hr is a standard, conservative adjustment within a typical insulin protocol.
Question 4
A medication is prescribed at 1,500,000 IU
to be infused in 500 mL of 0.9 % NS over 15 hours. What is the infusion rate in mL/ hr ?
A) 50 mL/hr
B) 33 mL/hr
C) 100 mL/hr
,D) 150 mL/hr
E) 75 mL/hr
Correct Answer: B) 33 mL/ hr
Rationale: The infusion rate in mL/ hr
is calculated as: Total Volume/Total Time
. Rate=500 mL/ 15 hours ≈ 33.33 mL/hr
. Given the options, 33 mL/hr
is the correct rate.
Question 5
An older adult client is admitted with Community-Acquired Pneumonia (CAP ) and has an SpO 2
reading of 89 on room air. What is the priority intervention?
A) Administer a prescribed oral antibiotic.
B) Assist the client with turning, coughing, and deep breathing.
C) Prepare the client for an immediate Chest X-ray.
D) Elevate the head of the bed and apply supplemental oxygen via nasal cannula.
E) Administer a loading dose of a nebulized bronchodilator.
Correct Answer: D) Elevate the head of the bed and apply supplemental oxygen via nasal
cannula.
Rationale: The client's SpO 2 is critically low (89 % ), indicating hypoxemia, which is the
immediate life threat (Airway, Breathing, Circulation priority). The priority intervention is
to immediately improve oxygenation by positioning the client for maximal chest expansion
(elevate HOB ) and applying supplemental oxygen.
, Question 6
A client who received an Endotracheal Tube (ETT ) 7 days ago is currently maintained
on 50 % O 2. The client is observed to be anxious and hyperventilating. What is the priority
intervention for the nurse?
A) Increase the fraction of inspired oxygen (FiO2 ) to 60 %
.B) Administer a STAT dose of a prescribed benzodiazepine.
C) Auscultate the client's lungs bilaterally.
D) Decrease the respiratory rate setting on the ventilator.
E) Suction the client's ETT to remove secretions.
Correct Answer: C) Auscultate the client's lungs bilaterally.
Rationale: Anxiety and hyperventilation in a ventilated patient can be symptoms of various
problems, including an obstructed or displaced tube, pneumothorax, or pulmonary
embolism. The priority is to assess the client's respiratory status and confirm proper ETT
placement and gas distribution by auscultating bilateral breath sounds to rule out
immediate respiratory compromise.
Question 7
A client's husband brings her to the ED because she has been ill and has not taken her prescribed
Cortisone medication for several weeks. The client is suspected to have a syndrome involving a
massive fluid shift, such as SIADH (Syndrome of Inappropriate Antidiuretic Hormone). What is
the priority safety intervention?
A) Administer 3 % Saline infusion.
B) Initiate fall precautions.
C) Restrict the client's fluid intake.
D) Obtain a STAT head CT scan.
E) Administer a dose of Furosemide.
Correct Answer: B) Initiate fall precautions.
Rationale: Severe SIADH causes dilutional hyponatremia (low serum sodium), which can
rapidly lead to cerebral edema and neurological complications such as confusion, altered
mental status, and seizures. Since the client is "not feeling well," the risk of a fall or seizure
is high, making fall and seizure precautions the immediate priority safety intervention.
