TEST BANK RATIONALE: 2026 HESI CRITICAL
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CARE EXAM (130 QUESTIONS WITH = = = = =
RATIONALES) =
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Overview Rationale =
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Section 1: Cardiovascular Emergencies
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1. A client presents to the ER complaining of pain. Which
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description of pain should prompt the nurse to suspect it
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originated in the myocardium?
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• A) Sharp, localized chest pain worsened by respiration
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• B) Chest heaviness with pain radiating to the left arm
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• C) Burning epigastric pain after meals
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• D) Stabbing pain focused to one spot
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Answer: B = =
,Rationale: Myocardial ischemic pain typically presents as chest
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heaviness or pressure radiating to the left arm, jaw, or neck, unlike
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pleuritic or GI pain . Patients often describe this as a squeezing,
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heavy, or pressure sensation. Sharp or stabbing pain that worsens
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with respiration (A, D) suggests pleuritic or musculoskeletal causes.
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Burning epigastric pain (C) is more consistent with gastrointestinal
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pathology. =
Cognitive Level: Analysis | Exam Domain: Cardiovascular
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| Reference: HESI Critical Care V2 #11
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2. A client is receiving atenolol (Tenormin) 25 mg PO after a
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myocardial infarction. The nurse determines the client's apical
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pulse is 65 beats per minute. What action should the nurse
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= implement next? = =
• A) Measure the blood pressure
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• B) Reassess the apical pulse
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• C) Notify the healthcare provider
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• D) Administer the medication
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Answer: D = =
,Rationale: Atenolol, a beta- = = =
blocker, blocks the beta receptors of the sinoatrial node to reduce
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the heart rate, so the medication should be administered because
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the client's apical pulse is greater than 60 beats per minute . Beta-
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blockers are standard therapy post-
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MI to reduce myocardial oxygen demand and mortality. Measuring
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blood pressure (A) and reassessing the pulse (B) are not necessary
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before administering the medication when the pulse is within accept
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able parameters.
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Cognitive Level: Application | Exam = = = = =
Domain: Cardiovascular/Pharmacology | Reference: HESI Critical
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Care #2 = =
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3. A client admitted with syncopal episodes related to thirdde
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gree heart block has a transcutaneous pacemaker placed. The
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nurse observes several episodes of pacemaker failure to sense.
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What action should the nurse take?
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• A) Decrease the sensitivity of the pacemaker
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• B) Increase the sensitivity of the pacemaker
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• C) Increase the pacing rate
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, • D) Call the cardiologist immediately
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Answer: B = =
Rationale: Failure to sense occurs when the pacemaker doesn't
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detect the client's intrinsic electrical activity. Increasing sensitivity all
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ows the device to better detect intrinsic beats and avoid
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inappropriate pacing . If increasing sensitivity doesn't resolve the
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issue, the nurse should notify the healthcare provider. Decreasing
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sensitivity (A) would worsen the problem by making the device less
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responsive to intrinsic beats. = = = =
Cognitive Level: Analysis | Exam Domain: Cardiovascular
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| Reference: HESI Critical Care V1 #6
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4. The ECG rhythm changes from a first-
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degree to a thirddegree AV block. What is the nurse's priority
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intervention? =
• A) Administer atropine as prescribed
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• B) Assess the client's blood pressure
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• C) Prepare for transcutaneous pacing
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• D) Notify the healthcare provider immediately
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= = = = = =
CARE EXAM (130 QUESTIONS WITH = = = = =
RATIONALES) =
=
Overview Rationale =
=
Section 1: Cardiovascular Emergencies
= = = =
1. A client presents to the ER complaining of pain. Which
= = = = = = = = = =
description of pain should prompt the nurse to suspect it
= = = = = = = = =
originated in the myocardium?
= = = = =
• A) Sharp, localized chest pain worsened by respiration
= = = = = = = =
• B) Chest heaviness with pain radiating to the left arm
= = = = = = = = = =
• C) Burning epigastric pain after meals
= = = = = =
• D) Stabbing pain focused to one spot
= = = = = = =
Answer: B = =
,Rationale: Myocardial ischemic pain typically presents as chest
= = = = = = = =
heaviness or pressure radiating to the left arm, jaw, or neck, unlike
= = = = = = = = = = =
pleuritic or GI pain . Patients often describe this as a squeezing,
= = = = = = = = = = = =
heavy, or pressure sensation. Sharp or stabbing pain that worsens
= = = = = = = = = = =
with respiration (A, D) suggests pleuritic or musculoskeletal causes.
= = = = = = = = =
Burning epigastric pain (C) is more consistent with gastrointestinal
= = = = = = = = =
pathology. =
Cognitive Level: Analysis | Exam Domain: Cardiovascular
= = = = = = =
| Reference: HESI Critical Care V2 #11
= = = = = = =
=
2. A client is receiving atenolol (Tenormin) 25 mg PO after a
= = = = = = = = = = =
myocardial infarction. The nurse determines the client's apical
= = = = = = = =
pulse is 65 beats per minute. What action should the nurse
= = = = = = = = = =
= implement next? = =
• A) Measure the blood pressure
= = = = =
• B) Reassess the apical pulse
= = = = =
• C) Notify the healthcare provider
= = = = =
• D) Administer the medication
= = = =
Answer: D = =
,Rationale: Atenolol, a beta- = = =
blocker, blocks the beta receptors of the sinoatrial node to reduce
= = = = = = = = = = =
the heart rate, so the medication should be administered because
= = = = = = = = = =
the client's apical pulse is greater than 60 beats per minute . Beta-
= = = = = = = = = = = =
blockers are standard therapy post-
= = = =
MI to reduce myocardial oxygen demand and mortality. Measuring
= = = = = = = = =
blood pressure (A) and reassessing the pulse (B) are not necessary
= = = = = = = = = =
before administering the medication when the pulse is within accept
= = = = = = = = = =
able parameters.
= =
Cognitive Level: Application | Exam = = = = =
Domain: Cardiovascular/Pharmacology | Reference: HESI Critical
= = = = = =
Care #2 = =
=
3. A client admitted with syncopal episodes related to thirdde
= = = = = = = =
gree heart block has a transcutaneous pacemaker placed. The
= = = = = = = = =
nurse observes several episodes of pacemaker failure to sense.
= = = = = = = = =
What action should the nurse take?
= = = = = =
• A) Decrease the sensitivity of the pacemaker
= = = = = = =
• B) Increase the sensitivity of the pacemaker
= = = = = = =
• C) Increase the pacing rate
= = = = =
, • D) Call the cardiologist immediately
= = = = =
Answer: B = =
Rationale: Failure to sense occurs when the pacemaker doesn't
= = = = = = = = =
detect the client's intrinsic electrical activity. Increasing sensitivity all
= = = = = = = =
ows the device to better detect intrinsic beats and avoid
= = = = = = = = = =
inappropriate pacing . If increasing sensitivity doesn't resolve the
= = = = = = = = =
issue, the nurse should notify the healthcare provider. Decreasing
= = = = = = = =
sensitivity (A) would worsen the problem by making the device less
= = = = = = = = = = = =
responsive to intrinsic beats. = = = =
Cognitive Level: Analysis | Exam Domain: Cardiovascular
= = = = = = =
| Reference: HESI Critical Care V1 #6
= = = = = = =
=
4. The ECG rhythm changes from a first-
= = = = = =
degree to a thirddegree AV block. What is the nurse's priority
= = = = = = = = = = =
intervention? =
• A) Administer atropine as prescribed
= = = = =
• B) Assess the client's blood pressure
= = = = = =
• C) Prepare for transcutaneous pacing
= = = = =
• D) Notify the healthcare provider immediately
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