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HESI RN CRITICAL CARE /CRITICAL CARE RN HESI EXIT /HESI RN
CRITICAL CARE EXTRA PREPARATION ACTUAL EXAM TEST BANK
LATEST 170 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) 2025/2026
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 - ......ANSWER........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
A child with bacterial conjunctivitis receives a prescription for erythromycin eye drops.
Which information is most important for the nurse to include in the teaching plan?
A. Apply warm compresses to reduce swelling.
B. Take acetaminophen (Tylenol) for any eye discomfort.
C. Avoid sharing towels and washcloths with siblings
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D. Wear sunglasses to protect eyes from sunlight. - ......ANSWER........C. Avoid sharing
towels and washcloths with siblings
RATIONALE:
All the information is important to include in the teaching plan, but it is most important to
avoid spreading the bacterial infection. The child should avoid sharing towels and
washcloths
(D) and should stay home from school for the first 24 hours after antibiotics are started, to
prevent contamination of others. (A, B, and C) are important measures to reduce the
child's
discomfort, but inhibiting the spread of the infection is the priority intervention
A child with Tetro logy of Fallot suffers a hyper cyanotic episode. Which immediate action
by
the nurse can lessen the symptoms of this "TET spell?"
A. Administer a dose of digoxin stat
B. Place child in knee-chest position.
C. Have child stop all current activity.
D. Remove child's constrictive clothing - ......ANSWER........B. Place child in knee-chest
position.
RATIONALE:
The child should be placed on his or her back in the knee-to-chest position (B) to increase
blood
vessel resistance. The increased pressure reduces the rush of blood through the septal
hole and
improves blood circulation. (A) has nominal effects in hyper cyanosis. (C) is self-regulating.
(D)
is not indicated for immediate relief of Tet spells. It is used to improve cardiac output.
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A client assigned to a female practical nurse (PN) needs total morning care and sterile
wound packing with a wet to dry dressing. The PN tells the nurse that she has never
performed a wound
packing. Which intervention should the charge nurse implement?
A. Note the PN's learning need to perform a wound packing and contact nursing education
to schedule a time for instruction.
B. Demonstrate the wound care procedure to the PN while the PN assists.
C. Advise the PN to review the procedure in the procedure manual and then complete the
wound care.
D. Perform the wound care and have the PN provide the client's morning care.
- ......ANSWER........B. Demonstrate the wound care procedure to the PN while the PN
assists.
RATIONALE:
It is within the PN's scope of practice to perform sterile wound care. The best learning of
skills is
through demonstration and return demonstration, therefore (D) promotes safe practice
while
allowing the PN the best opportunity to learn. (A) does not allow the PN to gain the
experience
needed to perform her role. (B) does not provide the best learning opportunity for the PN,
or
ensure safe practice. While (C) would provide a safe method for learning the wet-to-dry
procedure, it doesn't address the problem immediately and is a more costly way for the PN
to
learn.
A client is admitted to the hospital for alcohol dependency. What is the priority nursing
intervention during the first 48 hours following admission?
A. Monitor for increased blood pressure and pulse.
B. Administer a PRN benzodiazepine as needed for anxiety.
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C. Encourage fluid intake of non-caffeinated beverages.
D. Administer thiamine (B1) to prevent Korsakoff's syndrome. - ......ANSWER........A.
Monitor for increased blood pressure and pulse.
RATIONALE:
Clients with alcohol dependency experience withdrawal symptoms, which include
elevated
blood pressure, pulse, and temperature, so (B) has the highest priority. (A) will prevent
Korsakoff's syndrome (secondary dementia caused by thiamine deficiency, associated
with
malnutrition secondary to excessive alcohol intake), but this intervention does not have
the
priority of (B). (C and D) are important for alcohol detoxification, but do not have the priority
of
(B).
A client is admitted to the hospital with a diagnosis of Type 2 diabetes mellitus and
influenza.
Which categories of illness should the nurse develop goals for the client's plan of care?
A. One chronic and one acute illness.
B. Two acute illnesses.
C. One acute and one infectious illness.
D. Two chronic illnesses. - ......ANSWER........A. One chronic and one acute illness
RATIONALE:
The plan of care should include goals that are specific for chronic and acute illnesses.
Adult-onset diabetes is a life-long chronic disease, whereas influenza is an acute illness
with a short-term duration (C). (A, B, and D) do not include the correct duration categories
for this situation.
A client is admitted with a medical diagnosis of Addisonian crisis. When completing the
HESI RN CRITICAL CARE /CRITICAL CARE RN HESI EXIT /HESI RN
CRITICAL CARE EXTRA PREPARATION ACTUAL EXAM TEST BANK
LATEST 170 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) 2025/2026
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 - ......ANSWER........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
A child with bacterial conjunctivitis receives a prescription for erythromycin eye drops.
Which information is most important for the nurse to include in the teaching plan?
A. Apply warm compresses to reduce swelling.
B. Take acetaminophen (Tylenol) for any eye discomfort.
C. Avoid sharing towels and washcloths with siblings
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D. Wear sunglasses to protect eyes from sunlight. - ......ANSWER........C. Avoid sharing
towels and washcloths with siblings
RATIONALE:
All the information is important to include in the teaching plan, but it is most important to
avoid spreading the bacterial infection. The child should avoid sharing towels and
washcloths
(D) and should stay home from school for the first 24 hours after antibiotics are started, to
prevent contamination of others. (A, B, and C) are important measures to reduce the
child's
discomfort, but inhibiting the spread of the infection is the priority intervention
A child with Tetro logy of Fallot suffers a hyper cyanotic episode. Which immediate action
by
the nurse can lessen the symptoms of this "TET spell?"
A. Administer a dose of digoxin stat
B. Place child in knee-chest position.
C. Have child stop all current activity.
D. Remove child's constrictive clothing - ......ANSWER........B. Place child in knee-chest
position.
RATIONALE:
The child should be placed on his or her back in the knee-to-chest position (B) to increase
blood
vessel resistance. The increased pressure reduces the rush of blood through the septal
hole and
improves blood circulation. (A) has nominal effects in hyper cyanosis. (C) is self-regulating.
(D)
is not indicated for immediate relief of Tet spells. It is used to improve cardiac output.
,3 of 80
A client assigned to a female practical nurse (PN) needs total morning care and sterile
wound packing with a wet to dry dressing. The PN tells the nurse that she has never
performed a wound
packing. Which intervention should the charge nurse implement?
A. Note the PN's learning need to perform a wound packing and contact nursing education
to schedule a time for instruction.
B. Demonstrate the wound care procedure to the PN while the PN assists.
C. Advise the PN to review the procedure in the procedure manual and then complete the
wound care.
D. Perform the wound care and have the PN provide the client's morning care.
- ......ANSWER........B. Demonstrate the wound care procedure to the PN while the PN
assists.
RATIONALE:
It is within the PN's scope of practice to perform sterile wound care. The best learning of
skills is
through demonstration and return demonstration, therefore (D) promotes safe practice
while
allowing the PN the best opportunity to learn. (A) does not allow the PN to gain the
experience
needed to perform her role. (B) does not provide the best learning opportunity for the PN,
or
ensure safe practice. While (C) would provide a safe method for learning the wet-to-dry
procedure, it doesn't address the problem immediately and is a more costly way for the PN
to
learn.
A client is admitted to the hospital for alcohol dependency. What is the priority nursing
intervention during the first 48 hours following admission?
A. Monitor for increased blood pressure and pulse.
B. Administer a PRN benzodiazepine as needed for anxiety.
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C. Encourage fluid intake of non-caffeinated beverages.
D. Administer thiamine (B1) to prevent Korsakoff's syndrome. - ......ANSWER........A.
Monitor for increased blood pressure and pulse.
RATIONALE:
Clients with alcohol dependency experience withdrawal symptoms, which include
elevated
blood pressure, pulse, and temperature, so (B) has the highest priority. (A) will prevent
Korsakoff's syndrome (secondary dementia caused by thiamine deficiency, associated
with
malnutrition secondary to excessive alcohol intake), but this intervention does not have
the
priority of (B). (C and D) are important for alcohol detoxification, but do not have the priority
of
(B).
A client is admitted to the hospital with a diagnosis of Type 2 diabetes mellitus and
influenza.
Which categories of illness should the nurse develop goals for the client's plan of care?
A. One chronic and one acute illness.
B. Two acute illnesses.
C. One acute and one infectious illness.
D. Two chronic illnesses. - ......ANSWER........A. One chronic and one acute illness
RATIONALE:
The plan of care should include goals that are specific for chronic and acute illnesses.
Adult-onset diabetes is a life-long chronic disease, whereas influenza is an acute illness
with a short-term duration (C). (A, B, and D) do not include the correct duration categories
for this situation.
A client is admitted with a medical diagnosis of Addisonian crisis. When completing the
