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

Page 3/81 Crafted for Academic Insight by ©Olivia GreenWays 2025. All rights reserved. RATIONALE: Atenolol, a beta-blocker, blocks the beta receptors of the sinoatrial node to reduce the heart rate, so the medication should be administered (C) because the client's apical pulse is greater than 60. (A, B, and D) are not indicated at this time. 3.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 - 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. Page 4/81 Crafted for Academic Insight by ©Olivia GreenWays 2025. All rights reserved. D. Abnormal position and movement of the arm. - 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. - 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 Page 5/81 Crafted for Academic Insight by ©Olivia GreenWays 2025. All rights reserved. document this finding? A. A nystagmus on the left. B. Exophthalmos on the right. C. Ptosis on the left eyelid. D. Astigmatism on the right. - 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 - 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 Page 6/81 Crafted for Academic Insight by ©Olivia GreenWays 2025. All rights reserved. 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. A child is receiving maintenance intravenous (IV) fluids at the rate of 1000 mL for the first 10 kg of body weight, plus 50 mL/kg per day for each kilogram between 10 and 20. How many milliliters per hour should the nurse program the infusion pump for a child who weighs 19.5 kg? (Enter numeric value only. If rounding is required, round to the nearest whole number.) A. 24 B. 61 C. 73 D. 58 - B. 61 RATIONALE: The formula for calculating daily fluid requirements is: 0 to 10 kg, 100 mL/kg per day; or 10 to 20 kg, 1000 mL for the first 10 kg of body weight plus 50 mL/kg per day for each kilogram between 10 and 20. To determine an hourly rate, divide the total milliliters per day by 24. 19.5 kg x 50 mL/kg = 475 mL + 1000 mL = 1475 mL / 24 hours = 61 mL/hour The nurse obtains the pulse rate of 89 beats/minute for an infant before administering digoxin (Lanoxin). Which action should the nurse take? A. Withhold the medication and contact the healthcare provider. B. Give the medication dosage as scheduled. C. Assess respiratory rate for one minute next. Page 7/81 Crafted for Academic Insight by ©Olivia GreenWays 2025. All rights reserved. D. Wait 30 minutes and give half of the dosage of medication. - A. Withhold the medication and contact the healthcare provider RATIONALE: Bradycardia is an early sign of digoxin toxicity, so if the infant's pulse rate is less than 100 beats/minute, digoxin should be withheld and the healthcare provider should be notified (D). Assessing the respiratory rate (A) is not indicated before administering Lanoxin. (B and C) place the infant at further risk for digoxin toxicity. 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. D. Remove the brace just before going to bed. - 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. Page 8/81 Crafted for Academic Insight by ©Olivia GreenWays 2025. All rights reserved. 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) - 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. A male client who has been taking propranolol (Inderal) for 18 months tells the nurse that the healthcare provider discontinued the medication because his blood pressure has been normal for the past three months. Which instruction should the nurse provide? A. Obtain another antihypertensive prescription to avoid withdrawal symptoms. B. Stop the medication and keep an accurate record of blood pressure Page 9/81 Crafted for Academic Insight by ©Olivia GreenWays 2025. All rights reserved. C. Report any uncomfortable symptoms after stopping the medication. D. Ask the healthcare provider about tapering the drug dose over the next week. - D. Ask the healthcare provider about tapering the drug dose over the next week. RATIONALE: Although the healthcare provider discontinued the propranolol, measures to prevent rebound cardiac excitation, such as progressively reducing the dose over one to two weeks (C), should be recommended to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias. Abrupt cessation (A and B) of the beta-blocking agent may precipitate tachycardia and rebound hypertension, so gradual weaning should be recommended. (D) is not indicated. A client who is taking clonidine (Catapres, Duraclon) reports drowsiness. Which additional assessment should the nurse make? A. Has the client experienced constipation recently? B. Did the client miss any doses of the medication? C. How long has the client been taking the medication? D. Does the client use any tobacco products? - C. How long has the client been taking the medication? RATIONALE: Drowsiness can occur in the early weeks of treatment with clonidine and with continued use becomes less intense, so the length of time the client has been on the medication (A) provides information to direct additional instruction. (B, C, and D) are not relevant. The nurse is preparing to administer atropine, an anticholinergic, to a client who is scheduled Page 10/81 Crafted for Academic Insight by ©Olivia GreenWays 2025. All rights reserved. for a cholecystectomy. The client asks the nurse to explain the reason for the prescribed medication. What response is best for the nurse to provide? A. Provide a more rapid induction of anesthesia. B. Induce relaxation before induction of anesthesia. C. Decrease the risk of bradycardia during surgery. D. Minimize the amount of analgesia needed postoperatively. - C. Decrease the risk of bradycardia during surgery. RATIONALE: Atropine may be prescribed preoperatively to increase the automaticity of the sinoatrial node and prevent a dangerous reduction in heart rate (B) during surgical anesthesia. (A, C and D) do not address the therapeutic action of atropine use perioperatively. An 80-year-old client is given morphine sulphate for postoperative pain. Which concomitant medication should the nurse question that poses a potential development of urinary retention in this geriatric client? A. Antacids. B. Tricyclic antidepressants. C. Nonsteroidal anti-inflammatory agents. D. Insulin. - B. Tricyclic antidepressants. RATIONALE: Drugs with anticholinergic properties, such as tricyclic antidepressants (C), can exacerbate Page 11/81 Crafted for Academic Insight by ©Olivia GreenWays 2025. All rights reserved. urinary retention associated with opioids in the older client. Although tricyclic antidepressants and antihistamines with opioids can exacerbate urinary retention, the concurrent use of (A and B) with opioids do not. Nonsteroidal anti-inflammatory agents (D) can increase the risk for bleeding, but do not increase urinary retention with opioids (D). A client with osteoarthritis is given a new prescription for a nonsteroidal anti-inflammatory drug (NSAID). The client asks the nurse, "How is this medication different from the acetaminophen I have been taking?" Which information about the therapeutic action of NSAIDs should the nurse provide? A. Are less expensive. B. Provide anti-inflammatory response. C. Increase hepatotoxic side effects. D. Cause gastrointestinal bleeding. - B. Provide anti-inflammatory response RATIONALE: Nonsteroidal anti-inflammatory drugs (NSAIDs) have anti-inflammatory properties (B), which relieves pain associated with osteoarthritis and differs from acetaminophen, a non-narcotic analgesic and antipyretic. (A) does not teach the client about the medication's actions. Although NSAIDs are irritating to the gastrointestinal (GI) system and can cause GI bleeding (C), instructions to take with food in the stomach to manage this as an expected side effect sh