CRITICAL CARE HESI-STYLE Practice
Exam 2 Questions and Answers with
Rationales Latest Versions
1. A client in the ICU develops sudden severe dyspnea, cyanosis, and an oxygen
saturation of 76%. The client is receiving oxygen via nasal cannula. Which action
should the nurse take first?
A. Obtain a chest x-ray
B. Increase oxygen delivery and assess the airway
C. Administer an oral anxiolytic
D. Document the finding
Answer: B. Increase oxygen delivery and assess the airway
Rationale: Severe hypoxemia is an immediate threat to life. The nurse should
address airway and breathing first while rapidly assessing the cause. Diagnostic
testing should not delay stabilization.
2. A client with septic shock has a blood pressure of 82/46 mm Hg after receiving
prescribed fluid resuscitation. Which medication does the nurse anticipate?
A. Norepinephrine
B. Furosemide
C. Propranolol
D. Amlodipine
Answer: A. Norepinephrine
Rationale: Persistent hypotension after adequate fluid resuscitation generally
requires vasopressor therapy. Norepinephrine is commonly the first-line
vasopressor for septic shock.
,3. A mechanically ventilated client has a sudden high-pressure alarm. The client is
coughing and has coarse breath sounds. Which intervention should the nurse
perform?
A. Assess for and suction airway secretions as indicated
B. Decrease the oxygen concentration
C. Disconnect the ventilator permanently
D. Increase the tidal volume
Answer: A. Assess for and suction airway secretions as indicated
Rationale: Secretions can obstruct the endotracheal tube and increase airway
resistance, triggering a high-pressure alarm. The nurse should assess the client and
suction when clinically indicated.
4. A client with an acute myocardial infarction becomes hypotensive, cool, and
clammy and develops oliguria. Which complication is most likely?
A. Cardiogenic shock
B. Neurogenic shock
C. Septic shock
D. Anaphylaxis
Answer: A. Cardiogenic shock
Rationale: Cardiogenic shock occurs when the heart cannot provide adequate
cardiac output. Hypotension, cool clammy skin, oliguria, altered mental status, and
pulmonary congestion may occur.
5. A client with increased intracranial pressure is being cared for in the ICU.
Which nursing intervention is appropriate?
A. Keep the head and neck in neutral alignment
B. Encourage frequent coughing
C. Place the client flat
D. Flex the neck toward the chest
,Answer: A. Keep the head and neck in neutral alignment
Rationale: Neutral head and neck alignment promotes cerebral venous drainage.
Neck flexion, coughing, and other activities that increase intrathoracic pressure can
increase ICP.
6. A client with acute kidney injury has a potassium level of 6.9 mEq/L and peaked
T waves. Which medication should the nurse expect to administer immediately?
A. Calcium gluconate
B. Oral potassium
C. Magnesium sulfate
D. Ferrous sulfate
Answer: A. Calcium gluconate
Rationale: Severe hyperkalemia with ECG changes is an emergency. IV calcium
stabilizes the cardiac membrane while other therapies shift or remove potassium.
7. A client with DKA is receiving IV insulin. Which laboratory value requires
particularly close monitoring?
A. Potassium
B. Hemoglobin
C. Platelet count
D. Albumin
Answer: A. Potassium
Rationale: Insulin shifts potassium from the extracellular space into cells. Serum
potassium can fall rapidly during DKA treatment, potentially causing dangerous
dysrhythmias.
8. A client develops ventricular fibrillation and has no palpable pulse. Which
intervention is the priority?
, A. Defibrillation
B. Synchronized cardioversion
C. Vagal maneuvers
D. Oral beta-blocker administration
Answer: A. Defibrillation
Rationale: Pulseless ventricular fibrillation is a shockable cardiac arrest rhythm.
Immediate CPR and unsynchronized defibrillation are required.
9. A client with acute pulmonary edema has severe respiratory distress and pink,
frothy sputum. Which position should the nurse use?
A. Supine
B. High-Fowler's
C. Trendelenburg
D. Flat with legs elevated
Answer: B. High-Fowler's
Rationale: High-Fowler's positioning improves lung expansion and can decrease
venous return, helping reduce pulmonary congestion and improve breathing.
10. A client with ARDS remains severely hypoxemic despite mechanical
ventilation. Which intervention may be prescribed?
A. Prone positioning
B. Routine fluid loading
C. Discontinuation of PEEP
D. Very high tidal volumes
Answer: A. Prone positioning
Rationale: Prone positioning can improve oxygenation in appropriately selected
patients with severe ARDS by improving ventilation-perfusion matching and
alveolar recruitment.
Exam 2 Questions and Answers with
Rationales Latest Versions
1. A client in the ICU develops sudden severe dyspnea, cyanosis, and an oxygen
saturation of 76%. The client is receiving oxygen via nasal cannula. Which action
should the nurse take first?
A. Obtain a chest x-ray
B. Increase oxygen delivery and assess the airway
C. Administer an oral anxiolytic
D. Document the finding
Answer: B. Increase oxygen delivery and assess the airway
Rationale: Severe hypoxemia is an immediate threat to life. The nurse should
address airway and breathing first while rapidly assessing the cause. Diagnostic
testing should not delay stabilization.
2. A client with septic shock has a blood pressure of 82/46 mm Hg after receiving
prescribed fluid resuscitation. Which medication does the nurse anticipate?
A. Norepinephrine
B. Furosemide
C. Propranolol
D. Amlodipine
Answer: A. Norepinephrine
Rationale: Persistent hypotension after adequate fluid resuscitation generally
requires vasopressor therapy. Norepinephrine is commonly the first-line
vasopressor for septic shock.
,3. A mechanically ventilated client has a sudden high-pressure alarm. The client is
coughing and has coarse breath sounds. Which intervention should the nurse
perform?
A. Assess for and suction airway secretions as indicated
B. Decrease the oxygen concentration
C. Disconnect the ventilator permanently
D. Increase the tidal volume
Answer: A. Assess for and suction airway secretions as indicated
Rationale: Secretions can obstruct the endotracheal tube and increase airway
resistance, triggering a high-pressure alarm. The nurse should assess the client and
suction when clinically indicated.
4. A client with an acute myocardial infarction becomes hypotensive, cool, and
clammy and develops oliguria. Which complication is most likely?
A. Cardiogenic shock
B. Neurogenic shock
C. Septic shock
D. Anaphylaxis
Answer: A. Cardiogenic shock
Rationale: Cardiogenic shock occurs when the heart cannot provide adequate
cardiac output. Hypotension, cool clammy skin, oliguria, altered mental status, and
pulmonary congestion may occur.
5. A client with increased intracranial pressure is being cared for in the ICU.
Which nursing intervention is appropriate?
A. Keep the head and neck in neutral alignment
B. Encourage frequent coughing
C. Place the client flat
D. Flex the neck toward the chest
,Answer: A. Keep the head and neck in neutral alignment
Rationale: Neutral head and neck alignment promotes cerebral venous drainage.
Neck flexion, coughing, and other activities that increase intrathoracic pressure can
increase ICP.
6. A client with acute kidney injury has a potassium level of 6.9 mEq/L and peaked
T waves. Which medication should the nurse expect to administer immediately?
A. Calcium gluconate
B. Oral potassium
C. Magnesium sulfate
D. Ferrous sulfate
Answer: A. Calcium gluconate
Rationale: Severe hyperkalemia with ECG changes is an emergency. IV calcium
stabilizes the cardiac membrane while other therapies shift or remove potassium.
7. A client with DKA is receiving IV insulin. Which laboratory value requires
particularly close monitoring?
A. Potassium
B. Hemoglobin
C. Platelet count
D. Albumin
Answer: A. Potassium
Rationale: Insulin shifts potassium from the extracellular space into cells. Serum
potassium can fall rapidly during DKA treatment, potentially causing dangerous
dysrhythmias.
8. A client develops ventricular fibrillation and has no palpable pulse. Which
intervention is the priority?
, A. Defibrillation
B. Synchronized cardioversion
C. Vagal maneuvers
D. Oral beta-blocker administration
Answer: A. Defibrillation
Rationale: Pulseless ventricular fibrillation is a shockable cardiac arrest rhythm.
Immediate CPR and unsynchronized defibrillation are required.
9. A client with acute pulmonary edema has severe respiratory distress and pink,
frothy sputum. Which position should the nurse use?
A. Supine
B. High-Fowler's
C. Trendelenburg
D. Flat with legs elevated
Answer: B. High-Fowler's
Rationale: High-Fowler's positioning improves lung expansion and can decrease
venous return, helping reduce pulmonary congestion and improve breathing.
10. A client with ARDS remains severely hypoxemic despite mechanical
ventilation. Which intervention may be prescribed?
A. Prone positioning
B. Routine fluid loading
C. Discontinuation of PEEP
D. Very high tidal volumes
Answer: A. Prone positioning
Rationale: Prone positioning can improve oxygenation in appropriately selected
patients with severe ARDS by improving ventilation-perfusion matching and
alveolar recruitment.
