CRITICAL CARE 2026/2027 HESI PRACTICE QUESTIONS WITH WELL DETAILED
RATIONALE (GRADED A+)
The nurse is caring for a client who presents with stroke-like symptoms. The healthcare
provider reviews the client's computerized axial tomography (CAT) scan and prescribes
recombinant tissue plasminogen activator (rtPA) IV. Which information should the nurse
obtain to determine if the client is a candidate for this treatment now?
A.) Identify the underlying cause of this condition.
B.) Prepare to administer desmopressin (DDAVP).
C.) Decrease the intravenous fluids to a maintenance rate.
D.) Replace fluid losses with D5W every shift
B.) Prepare to administer desmopressin (DDAVP).
Neurogenic diabetes insipidus (DI) is a condition that can occur when there is trauma to
the brain such as tumors or injury to the brain in particular the pituitary or hypothalamus
area. DI can also occur with cerebral edema present. The antidiuretic hormone deficiency
occurs rapidly and results in polyuria, anywhere between 5- 40 liters of urine/24 hours. The
client demonstrates signs and symptoms of hypovolemia. Electrolyte imbalances include
hypernatremia, along with hypokalemia and hypercalcemia when it is neurogenic etiology.
Clients with neurogenic DI are primarily controlled through administration of exogenous
ADH preparations, of which desmopressin (DDAVP) is most commonly used. Fluid output
is carefully monitored and fluids are replaced every hour.
An intubated client is in the process of being weaned off ventilator support. The client's
baseline parameters are temperature 98.2 F (36.8 C), heart rate 88 beats/minute,
respirations 14 breaths/minute, blood pressure 112/78 mmHg, and oxygen saturation 94%.
Which assessment findings would indicate to the nurse that the client is tolerating the
weaning procedure? (Select all that apply.)
A.) Oxygen saturation is 91%
B.) Slight nasal flaring is present.
,C.) Heart rate is 97 beats/minute.
D.) Work of breathing is done by client
E.) Respiratory rate is 36 breaths/minute.
A.) Oxygen saturation is 91%
C.) Heart rate is 97 beats/minute.
D.) Work of breathing is done by client
Criteria that indicates a client is tolerating weaning off ventilator support are respirations
greater than 8 breaths/minute, but less than 35 breaths/minute; oxygen saturation above
90%; heart rate that does not increase more than 20% from baseline heart rate; most of the
work of breathing is performed by the client; and no signs of accessory muscles are used
for breathing.
The healthcare provider prescribed propofol IV and succinylcholine IV for a client who is
being prepared for intubation. Which action should the nurse implement to assist the
healthcare provider during administration of these two drugs?
A.) Prepare propofol for sedation before giving succinylcholine, a paralytic.
B.) Succinylcholine should be prepared for administration first.
C.) Mix both medications at the same time in the same syringe.
D.) Question the administration and refused to provide propofol.
A.) Prepare propofol for sedation before giving succinylcholine, a paralytic.
Propofol, a sedative-hypnotic, is used to sedate a client during induction of anesthesia,
and succinylcholine is a paralytic drug used to prevent laryngospasm during intubation and
to prevent the client's resistance to intubation. The client should be sedated before being
paralyzed, which can be very stressful to the client who is not able to move, breathe, or
talk. The nurse should prepare propofol for the administration by the healthcare provider
first, then succinylcholine can be given by the healthcare provider.
,A client in the intensive care unit begins to manifest seizure activity while the unlicensed
assistive personnel (UAP) is providing a bedbath. The UAP pulls the emergency call bell and
calls for help. Which action by the UAP should the nurse correct?
A.) Restraining the client's extremities.
B.) Loosening restrictive clothing.
C.) Padding the raised side rails.
D.) Placing the client in a lateral position
A.) Restraining the client's extremities.
A client should be protected as much as possible during seizure activity. The nurse should
direct the UAP to refrain from restricting the client's extremities with restraints, which can
cause injury to the client and the person who is holding or applying restraints on the client.
A client is admitted to the intensive care unit due to a sharp blow to the head after a fall
while ice skating. Which assessment finding should the nurse report to the healthcare
provider that is consistent with increased intracranial pressure?
A.) Papilledema.
B.) Lump at the site of injury.
C.) Unilateral ptosis.
D.) Onsert of a headache.
A.) Papilledema.
Papilledema is observed via ophthalmoscopic view of swelling around the optic disc, which
results from increased intracranial pressure (ICP) in the cerebral vault. The nurse should
report signs of increased ICP to the healthcare provider immediately.
, A client arrives in the emergency department experiencing difficulty breathing. Which
finding requires further assessment?
A.) Use of accessory respiratory muscles.
B.) Auscultation of crackles in lower lobes.
C.) Flushed skin.
D.) Production of white sputum
A.) Use of accessory respiratory muscles.
A client who is experiencing dyspnea and is using accessory respiratory muscles with
severe respiratory effort requires further assessment and management.
The post anesthesia care unit (PACU) nurse transfers a client to the intensive care unit
(ICU) and reports that the client received morphine sulfate 4 mg IV for pain of 8 on a scale
of 1 to 10. On assessment in the ICU, the nurse observes that the client is somnolent,
difficult to arouse, and has a respiratory rate is 6 breaths/minute. Which prescription
should the nurse implement?
A.) Naloxone.
B.) Morphine sulfate.
C.) Albuterol.
D.) Fentanyl.
A.) Naloxone.
The client is experiencing respiratory depression from the morphine. The nurse should
administer naloxone, the antidote for narcotic overdose.
A client arrives in the emergency department with a gunshot wound to the chest. The client
is short of breath, has tracheal deviation to the unaffected side of the chest, and an O2
saturation of 84%. Which pathophysiologic process is precipitating the client's findings?
A.) Tension pneumothorax.
RATIONALE (GRADED A+)
The nurse is caring for a client who presents with stroke-like symptoms. The healthcare
provider reviews the client's computerized axial tomography (CAT) scan and prescribes
recombinant tissue plasminogen activator (rtPA) IV. Which information should the nurse
obtain to determine if the client is a candidate for this treatment now?
A.) Identify the underlying cause of this condition.
B.) Prepare to administer desmopressin (DDAVP).
C.) Decrease the intravenous fluids to a maintenance rate.
D.) Replace fluid losses with D5W every shift
B.) Prepare to administer desmopressin (DDAVP).
Neurogenic diabetes insipidus (DI) is a condition that can occur when there is trauma to
the brain such as tumors or injury to the brain in particular the pituitary or hypothalamus
area. DI can also occur with cerebral edema present. The antidiuretic hormone deficiency
occurs rapidly and results in polyuria, anywhere between 5- 40 liters of urine/24 hours. The
client demonstrates signs and symptoms of hypovolemia. Electrolyte imbalances include
hypernatremia, along with hypokalemia and hypercalcemia when it is neurogenic etiology.
Clients with neurogenic DI are primarily controlled through administration of exogenous
ADH preparations, of which desmopressin (DDAVP) is most commonly used. Fluid output
is carefully monitored and fluids are replaced every hour.
An intubated client is in the process of being weaned off ventilator support. The client's
baseline parameters are temperature 98.2 F (36.8 C), heart rate 88 beats/minute,
respirations 14 breaths/minute, blood pressure 112/78 mmHg, and oxygen saturation 94%.
Which assessment findings would indicate to the nurse that the client is tolerating the
weaning procedure? (Select all that apply.)
A.) Oxygen saturation is 91%
B.) Slight nasal flaring is present.
,C.) Heart rate is 97 beats/minute.
D.) Work of breathing is done by client
E.) Respiratory rate is 36 breaths/minute.
A.) Oxygen saturation is 91%
C.) Heart rate is 97 beats/minute.
D.) Work of breathing is done by client
Criteria that indicates a client is tolerating weaning off ventilator support are respirations
greater than 8 breaths/minute, but less than 35 breaths/minute; oxygen saturation above
90%; heart rate that does not increase more than 20% from baseline heart rate; most of the
work of breathing is performed by the client; and no signs of accessory muscles are used
for breathing.
The healthcare provider prescribed propofol IV and succinylcholine IV for a client who is
being prepared for intubation. Which action should the nurse implement to assist the
healthcare provider during administration of these two drugs?
A.) Prepare propofol for sedation before giving succinylcholine, a paralytic.
B.) Succinylcholine should be prepared for administration first.
C.) Mix both medications at the same time in the same syringe.
D.) Question the administration and refused to provide propofol.
A.) Prepare propofol for sedation before giving succinylcholine, a paralytic.
Propofol, a sedative-hypnotic, is used to sedate a client during induction of anesthesia,
and succinylcholine is a paralytic drug used to prevent laryngospasm during intubation and
to prevent the client's resistance to intubation. The client should be sedated before being
paralyzed, which can be very stressful to the client who is not able to move, breathe, or
talk. The nurse should prepare propofol for the administration by the healthcare provider
first, then succinylcholine can be given by the healthcare provider.
,A client in the intensive care unit begins to manifest seizure activity while the unlicensed
assistive personnel (UAP) is providing a bedbath. The UAP pulls the emergency call bell and
calls for help. Which action by the UAP should the nurse correct?
A.) Restraining the client's extremities.
B.) Loosening restrictive clothing.
C.) Padding the raised side rails.
D.) Placing the client in a lateral position
A.) Restraining the client's extremities.
A client should be protected as much as possible during seizure activity. The nurse should
direct the UAP to refrain from restricting the client's extremities with restraints, which can
cause injury to the client and the person who is holding or applying restraints on the client.
A client is admitted to the intensive care unit due to a sharp blow to the head after a fall
while ice skating. Which assessment finding should the nurse report to the healthcare
provider that is consistent with increased intracranial pressure?
A.) Papilledema.
B.) Lump at the site of injury.
C.) Unilateral ptosis.
D.) Onsert of a headache.
A.) Papilledema.
Papilledema is observed via ophthalmoscopic view of swelling around the optic disc, which
results from increased intracranial pressure (ICP) in the cerebral vault. The nurse should
report signs of increased ICP to the healthcare provider immediately.
, A client arrives in the emergency department experiencing difficulty breathing. Which
finding requires further assessment?
A.) Use of accessory respiratory muscles.
B.) Auscultation of crackles in lower lobes.
C.) Flushed skin.
D.) Production of white sputum
A.) Use of accessory respiratory muscles.
A client who is experiencing dyspnea and is using accessory respiratory muscles with
severe respiratory effort requires further assessment and management.
The post anesthesia care unit (PACU) nurse transfers a client to the intensive care unit
(ICU) and reports that the client received morphine sulfate 4 mg IV for pain of 8 on a scale
of 1 to 10. On assessment in the ICU, the nurse observes that the client is somnolent,
difficult to arouse, and has a respiratory rate is 6 breaths/minute. Which prescription
should the nurse implement?
A.) Naloxone.
B.) Morphine sulfate.
C.) Albuterol.
D.) Fentanyl.
A.) Naloxone.
The client is experiencing respiratory depression from the morphine. The nurse should
administer naloxone, the antidote for narcotic overdose.
A client arrives in the emergency department with a gunshot wound to the chest. The client
is short of breath, has tracheal deviation to the unaffected side of the chest, and an O2
saturation of 84%. Which pathophysiologic process is precipitating the client's findings?
A.) Tension pneumothorax.
