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RN HESI CRITICAL| HESI RN CRITICAL
CARE ACTIAL EXAM WITH RATIONALES
AND PRACTICE QUESTIONS WITH
VERIFIED SOLUTIONS
The nurse is assessing a client and identifies a bruit over the thyroid. This finding is
consistent with which interpretation? A. Hypothyroidism.
B. Thyroid cyst.
C. Thyroid cancer.
D. Hyperthyroidism -- ANSWER--Hyperthyroidism
Rationale:Hyperthyroidism (D) is an enlargement of the thyroid gland, often referred to as a
goiter, and a bruit may be auscultated over the goiter due to an increase in glandular
vascularity which increases as the thyroid gland becomes hyperactive. A bruit is not
common with (A, B, and
C).
A 6-year-old child is alert but quiet when brought to the emergency center with periorbital
ecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse and
continues to assess the child for additional manifestations of a basilar skull fracture. What
assessment finding would be consistent with a basilar skull fracture? A. Hematemesis and
abdominal distention.
B. Asymmetry of the face and eye movements.
C. Rhinorrhoea or otorrhoea with Halo sign.
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D. Abnormal position and movement of the arm. -- ANSWER--Rhinorrhoea or otorrhoea
with Halo sign.
RATIONALE:
Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind the ear over the
mastoid process) are both signs of a basilar skull fracture, so the nurse should assess for
possible meningeal tears that manifest as a Halo sign with CSF leakage from the ears or
nose (D). (A) is
consistent with orbital fractures. (B) occurs with wrenching traumas of the shoulder or arm
fractures. (C) occurs with blunt abdominal injuries.
The nurse is assessing a client who complains of weight loss, racing heart rate, and difficulty
sleeping. The nurse determines the client has moist skin with fine hair, prominent eyes, lid
retraction, and a staring expression. These findings are consistent with which disorder? A.
Grave's disease.
B. Multiple sclerosis.
C. Addison's disease.
D. Cushing syndrome. -- ANSWER--Grave's disease RATIONALE:
This client is exhibiting symptoms associated with hyperthyroidism or Grave's disease (A),
which is an autoimmune condition affecting the thyroid. (B, C, and D) are not associated with
these symptoms.
The nurse is assessing an older client and determines that the client's left upper eyelid droops,
covering more of the iris than the right eyelid. Which description should the nurse use to
document this finding?
A. A nystagmus on the left.
B. Exophthalmos on the right.
C. Ptosis on the left eyelid.
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D. Astigmatism on the right. -- ANSWER--Ptosis on the left eyelid
Rationale: Ptosis is the term to describe an eyelid droop that covers a large portion of the iris
(A), which may result from oculomotor nerve or eyelid muscle disorder. (B) is characterized
by rapid, rhythmic movement of both eyes. (C) is a distortion of the lens of the eye, causing
decreased visual acuity. (D) is a term used to describe a protrusion of the eyeballs that
occurs with hyperthyroidism.
The nurse is assessing a child's weight and height during a clinic visit prior to starting school.
The nurse plots the child's weight on the growth chart and notes that the child's weight is in
the
95th percentile for the child's height. What action should the nurse take? A.
Question the type and quantity of foods eaten in a typical day.
B. Encourage giving two additional snacks each day to the child.
C. Recommend a daily intake of at least four glasses of whole milk.
D. Assess for signs of poor nutrition, such as a pale appearance -- ANSWER--A. Question
the type and quantity of foods eaten in a typical day.
RATIONALE:
The child is overweight for height, so assessment of the child's daily diet (C) should be
determined. The child does not need (A or B), both of which will increase the child's weight.
Poor nutrition (D) is commonly seen in underweight children, not overweight.
The nurse is developing a teaching plan for an adolescent with a Milwaukee brace. Which
instruction should the nurse include?
A. Wear the brace over a T-shirt 23 hours per day.
B. Dress with the brace over regular clothing.
C. Shower with the brace directly against the skin.
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D. Remove the brace just before going to bed. -- ANSWER--A. Wear the brace over a T-shirt
23 hours per day.
RATIONALE:
Idiopathic scoliosis is an abnormal lateral curvature of the spine in adolescent females. Early
treatment uses a Milwaukee brace that places pressure against the lateral spinal curvature,
under the neck, and against the iliac crest, so it should be worn for 23 hours per day over a
T-shirt
(D) which reduces friction and chafing of the skin. (A, B, and C) reduce the effectiveness
of the brace.
A client with asthma receives a prescription for high blood pressure during a clinic visit.
Which prescription should the nurse anticipate the client to receive that is least likely to
exacerbate asthma?
A. Carteolol (Ocupress).
B. Propranolol hydrochloride (Inderal).
C. Pindolol (Visken).
D. Metoprolol tartrate (Lopressor) -- ANSWER--D. Metoprolol tartrate (Lopressor).
RATIONALE:
The best antihypertensive agent for clients with asthma is metoprolol (Lopressor) (C), a beta2
blocking agent which is also cardio-selective and less likely to cause bronchoconstriction.
Pindolol (A) is a beta2 blocker that can cause bronchoconstriction and increase asthmatic
symptoms. Although carteolol (B) is a beta blocking agent and an effective antihypertensive
agent used in managing angina, it can increase a client's risk for bronchoconstriction due to
its
nonselective beta blocker action. Propranolol (D) also blocks the beta2 receptors in the lungs,
causing bronchoconstriction, and is not indicated in clients with asthma and other obstructive
pulmonary disorders.
RN HESI CRITICAL| HESI RN CRITICAL
CARE ACTIAL EXAM WITH RATIONALES
AND PRACTICE QUESTIONS WITH
VERIFIED SOLUTIONS
The nurse is assessing a client and identifies a bruit over the thyroid. This finding is
consistent with which interpretation? A. Hypothyroidism.
B. Thyroid cyst.
C. Thyroid cancer.
D. Hyperthyroidism -- ANSWER--Hyperthyroidism
Rationale:Hyperthyroidism (D) is an enlargement of the thyroid gland, often referred to as a
goiter, and a bruit may be auscultated over the goiter due to an increase in glandular
vascularity which increases as the thyroid gland becomes hyperactive. A bruit is not
common with (A, B, and
C).
A 6-year-old child is alert but quiet when brought to the emergency center with periorbital
ecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse and
continues to assess the child for additional manifestations of a basilar skull fracture. What
assessment finding would be consistent with a basilar skull fracture? A. Hematemesis and
abdominal distention.
B. Asymmetry of the face and eye movements.
C. Rhinorrhoea or otorrhoea with Halo sign.
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D. Abnormal position and movement of the arm. -- ANSWER--Rhinorrhoea or otorrhoea
with Halo sign.
RATIONALE:
Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind the ear over the
mastoid process) are both signs of a basilar skull fracture, so the nurse should assess for
possible meningeal tears that manifest as a Halo sign with CSF leakage from the ears or
nose (D). (A) is
consistent with orbital fractures. (B) occurs with wrenching traumas of the shoulder or arm
fractures. (C) occurs with blunt abdominal injuries.
The nurse is assessing a client who complains of weight loss, racing heart rate, and difficulty
sleeping. The nurse determines the client has moist skin with fine hair, prominent eyes, lid
retraction, and a staring expression. These findings are consistent with which disorder? A.
Grave's disease.
B. Multiple sclerosis.
C. Addison's disease.
D. Cushing syndrome. -- ANSWER--Grave's disease RATIONALE:
This client is exhibiting symptoms associated with hyperthyroidism or Grave's disease (A),
which is an autoimmune condition affecting the thyroid. (B, C, and D) are not associated with
these symptoms.
The nurse is assessing an older client and determines that the client's left upper eyelid droops,
covering more of the iris than the right eyelid. Which description should the nurse use to
document this finding?
A. A nystagmus on the left.
B. Exophthalmos on the right.
C. Ptosis on the left eyelid.
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D. Astigmatism on the right. -- ANSWER--Ptosis on the left eyelid
Rationale: Ptosis is the term to describe an eyelid droop that covers a large portion of the iris
(A), which may result from oculomotor nerve or eyelid muscle disorder. (B) is characterized
by rapid, rhythmic movement of both eyes. (C) is a distortion of the lens of the eye, causing
decreased visual acuity. (D) is a term used to describe a protrusion of the eyeballs that
occurs with hyperthyroidism.
The nurse is assessing a child's weight and height during a clinic visit prior to starting school.
The nurse plots the child's weight on the growth chart and notes that the child's weight is in
the
95th percentile for the child's height. What action should the nurse take? A.
Question the type and quantity of foods eaten in a typical day.
B. Encourage giving two additional snacks each day to the child.
C. Recommend a daily intake of at least four glasses of whole milk.
D. Assess for signs of poor nutrition, such as a pale appearance -- ANSWER--A. Question
the type and quantity of foods eaten in a typical day.
RATIONALE:
The child is overweight for height, so assessment of the child's daily diet (C) should be
determined. The child does not need (A or B), both of which will increase the child's weight.
Poor nutrition (D) is commonly seen in underweight children, not overweight.
The nurse is developing a teaching plan for an adolescent with a Milwaukee brace. Which
instruction should the nurse include?
A. Wear the brace over a T-shirt 23 hours per day.
B. Dress with the brace over regular clothing.
C. Shower with the brace directly against the skin.
, Page 4 of 104
D. Remove the brace just before going to bed. -- ANSWER--A. Wear the brace over a T-shirt
23 hours per day.
RATIONALE:
Idiopathic scoliosis is an abnormal lateral curvature of the spine in adolescent females. Early
treatment uses a Milwaukee brace that places pressure against the lateral spinal curvature,
under the neck, and against the iliac crest, so it should be worn for 23 hours per day over a
T-shirt
(D) which reduces friction and chafing of the skin. (A, B, and C) reduce the effectiveness
of the brace.
A client with asthma receives a prescription for high blood pressure during a clinic visit.
Which prescription should the nurse anticipate the client to receive that is least likely to
exacerbate asthma?
A. Carteolol (Ocupress).
B. Propranolol hydrochloride (Inderal).
C. Pindolol (Visken).
D. Metoprolol tartrate (Lopressor) -- ANSWER--D. Metoprolol tartrate (Lopressor).
RATIONALE:
The best antihypertensive agent for clients with asthma is metoprolol (Lopressor) (C), a beta2
blocking agent which is also cardio-selective and less likely to cause bronchoconstriction.
Pindolol (A) is a beta2 blocker that can cause bronchoconstriction and increase asthmatic
symptoms. Although carteolol (B) is a beta blocking agent and an effective antihypertensive
agent used in managing angina, it can increase a client's risk for bronchoconstriction due to
its
nonselective beta blocker action. Propranolol (D) also blocks the beta2 receptors in the lungs,
causing bronchoconstriction, and is not indicated in clients with asthma and other obstructive
pulmonary disorders.
