Critical Care Hesi Exit Exam (V1) Test Bank Guide 100% Correct ANSWERS Guaranteed A+
(Next Gen Format)
Question 1
A nurse is preparing to administer metoprolol to a client with a history of hypertension and
myocardial infarction. Which of the following is the primary therapeutic action of this
medication?
A) It increases systemic vascular resistance to improve blood flow.
B) It blocks beta-1 receptors to decrease heart rate and cardiac workload.
C) It increases the force of myocardial contraction.
D) It provides rapid diuresis to reduce circulating volume.
E) It inhibits the conversion of Angiotensin I to Angiotensin II.
Correct Answer: B) It blocks beta-1 receptors to decrease heart rate and cardiac workload.
Rationale: Metoprolol is a cardioselective beta-1 adrenergic blocker. By blocking these
receptors, it decreases the heart rate, decreases myocardial contractility, and reduces blood
pressure, which collectively lowers the oxygen demand of the heart. This is vital in
managing hypertension and preventing further damage after a myocardial infarction.
Question 2
A nurse is reviewing a telemetry strip and observes a prolonged PR interval (>0.20 seconds) but
every P wave is followed by a QRS complex. Which cardiac rhythm is being displayed?
A) First-degree heart block
B) Second-degree heart block, Type I (Wenckebach)
C) Second-degree heart block, Type II (Mobitz II)
D) Third-degree heart block
E) Normal Sinus Rhythm
Correct Answer: A) First-degree heart block
Rationale: First-degree heart block is characterized by a consistent delay in conduction
from the SA node to the AV node, resulting in a PR interval greater than 0.20 seconds.
Unlike second-degree blocks, every atrial impulse eventually reaches the ventricles, so there
are no dropped beats. (Note: The keyword prompt mentioned second-degree, but described
the prolonged PR characteristic of first-degree or the conduction delay basics).
Question 3
A client is intubated and receiving mechanical ventilation. The nurse notes the client has become
suddenly restless and, upon auscultation, breath sounds are heard only on the right side. Which
action should the nurse take first?
A) Increase the sedation rate via the PCA pump.
B) Perform a manual resuscitation bag ventilation.
C) Check for endotracheal tube displacement or a pneumothorax.
D) Order a portable chest X-ray immediately.
E) Suction the client’s airway for 15 seconds.
Correct Answer: C) Check for endotracheal tube displacement or a pneumothorax.
, 2
Rationale: In a restless, intubated client with unilateral breath sounds, the nurse must
suspect that the endotracheal tube has migrated into the right mainstem bronchus or that
the client has developed a tension pneumothorax. These are life-threatening emergencies
that require immediate assessment and verification of tube placement.
Question 4
A nurse is responding to a train derailment disaster. Using the START triage system, which client
should be seen first?
A) A middle-aged man wandering the scene looking for his shoes.
B) A woman sitting quietly with a blanket wrapped around her shoulders.
C) A crying child with a minor laceration to the forearm.
D) A client with tachypnea (>30/min) and a weak radial pulse.
E) A mother and father who just arrived and are asking for information.
Correct Answer: D) A client with tachypnea (>30/min) and a weak radial pulse.
Rationale: In mass casualty triage, "Red Tag" (Immediate) priority is given to those with
life-threatening respiratory or circulatory compromise who are still salvageable. A
respiratory rate over 30 and a weak pulse indicate shock or severe respiratory distress. The
"walking wounded" (A, C) and stable individuals (B) are lower priorities.
Question 5
A client with severe pneumonia is admitted with the following ABG results: pH 7.30, PaO2 60,
PaCO2 62, HCO3 35. The nurse notes the client is becoming drowsy and difficult to arouse.
What is the priority nursing action?
A) Encourage the client to cough and deep breathe.
B) Increase the oxygen flow rate via nasal cannula.
C) Notify the healthcare provider (HCP) immediately for potential intubation.
D) Administer a dose of prescribed intravenous antibiotic.
E) Re-position the client into a high-Fowler’s position.
Correct Answer: C) Notify the healthcare provider (HCP) immediately for potential
intubation.
Rationale: The client’s ABGs show respiratory acidosis with significant CO2 retention
(hypercapnia) and hypoxemia. Drowsiness and difficulty arousing are signs of CO2
narcosis and impending respiratory failure. The nurse must communicate these
neurological changes to the HCP immediately as the client likely requires mechanical
ventilation.
Question 6
A client with severe burn injuries has a serum potassium level of 4.0 mEq/L during the acute
phase. The nurse understands that this level is:
A) Critically low, requiring IV potassium replacement.
B) Within the normal range for a healthy adult.
, 3
C) Expectedly high due to cellular destruction.
D) Indicative of metabolic alkalosis.
E) A sign that the client is developing acute renal failure.
Correct Answer: B) Within the normal range for a healthy adult.
Rationale: The normal range for serum potassium is 3.5 to 5.0 mEq/L. While burn patients
are at risk for hyperkalemia (due to potassium leaking out of damaged cells) or
hypokalemia (later during fluid shift/diuresis), a level of 4.0 is currently stable and normal.
Question 7
A client has been bedridden for 2 weeks following a critical illness. Current labs show pH 7.37,
PO2 90, PCO2 40, HCO3 25. Which nursing intervention is the priority for this client?
A) Obtain an order for a STAT electrocardiogram.
B) Turn the patient side to side every 2 hours.
C) Administer sodium bicarbonate intravenously.
D) Increase the frequency of incentive spirometry to every hour.
E) Request a physical therapy consult for ambulation.
Correct Answer: B) Turn the patient side to side q2h
Rationale: The client’s ABGs are within normal limits (compensated/normal). However, a
client who has been bedridden for 2 weeks is at extreme risk for skin breakdown (pressure
ulcers) and venous stasis. Turning the patient every 2 hours is the standard priority nursing
action to prevent complications of immobility.
Question 8
A 40-year-old client is admitted with a sickle cell crisis. Which assessment should the nurse
prioritize?
A) Daily weight and skin turgor.
B) Bowel sounds and frequency of stools.
C) Pain level and neurovascular status of extremities.
D) Pupil reactivity and Glasgow Coma Scale.
E) History of childhood immunizations.
Correct Answer: C) Priority assessment for a 40-year-old with sickle cell crisis
Rationale: Sickle cell crisis involves vaso-occlusive events where sickled red blood cells
block small vessels. This causes intense pain and can lead to tissue ischemia and infarction.
Priority care involves aggressive pain management, oxygenation, and monitoring for
organ/tissue damage.
Question 9
In a major disaster, which of the following patients should be prioritized for transfer to the
medical-surgical unit to make room for incoming critical victims?
A) A patient with an open chest wound and tracheal deviation.
B) A patient with a small cut over the eye and stable vitals.
(Next Gen Format)
Question 1
A nurse is preparing to administer metoprolol to a client with a history of hypertension and
myocardial infarction. Which of the following is the primary therapeutic action of this
medication?
A) It increases systemic vascular resistance to improve blood flow.
B) It blocks beta-1 receptors to decrease heart rate and cardiac workload.
C) It increases the force of myocardial contraction.
D) It provides rapid diuresis to reduce circulating volume.
E) It inhibits the conversion of Angiotensin I to Angiotensin II.
Correct Answer: B) It blocks beta-1 receptors to decrease heart rate and cardiac workload.
Rationale: Metoprolol is a cardioselective beta-1 adrenergic blocker. By blocking these
receptors, it decreases the heart rate, decreases myocardial contractility, and reduces blood
pressure, which collectively lowers the oxygen demand of the heart. This is vital in
managing hypertension and preventing further damage after a myocardial infarction.
Question 2
A nurse is reviewing a telemetry strip and observes a prolonged PR interval (>0.20 seconds) but
every P wave is followed by a QRS complex. Which cardiac rhythm is being displayed?
A) First-degree heart block
B) Second-degree heart block, Type I (Wenckebach)
C) Second-degree heart block, Type II (Mobitz II)
D) Third-degree heart block
E) Normal Sinus Rhythm
Correct Answer: A) First-degree heart block
Rationale: First-degree heart block is characterized by a consistent delay in conduction
from the SA node to the AV node, resulting in a PR interval greater than 0.20 seconds.
Unlike second-degree blocks, every atrial impulse eventually reaches the ventricles, so there
are no dropped beats. (Note: The keyword prompt mentioned second-degree, but described
the prolonged PR characteristic of first-degree or the conduction delay basics).
Question 3
A client is intubated and receiving mechanical ventilation. The nurse notes the client has become
suddenly restless and, upon auscultation, breath sounds are heard only on the right side. Which
action should the nurse take first?
A) Increase the sedation rate via the PCA pump.
B) Perform a manual resuscitation bag ventilation.
C) Check for endotracheal tube displacement or a pneumothorax.
D) Order a portable chest X-ray immediately.
E) Suction the client’s airway for 15 seconds.
Correct Answer: C) Check for endotracheal tube displacement or a pneumothorax.
, 2
Rationale: In a restless, intubated client with unilateral breath sounds, the nurse must
suspect that the endotracheal tube has migrated into the right mainstem bronchus or that
the client has developed a tension pneumothorax. These are life-threatening emergencies
that require immediate assessment and verification of tube placement.
Question 4
A nurse is responding to a train derailment disaster. Using the START triage system, which client
should be seen first?
A) A middle-aged man wandering the scene looking for his shoes.
B) A woman sitting quietly with a blanket wrapped around her shoulders.
C) A crying child with a minor laceration to the forearm.
D) A client with tachypnea (>30/min) and a weak radial pulse.
E) A mother and father who just arrived and are asking for information.
Correct Answer: D) A client with tachypnea (>30/min) and a weak radial pulse.
Rationale: In mass casualty triage, "Red Tag" (Immediate) priority is given to those with
life-threatening respiratory or circulatory compromise who are still salvageable. A
respiratory rate over 30 and a weak pulse indicate shock or severe respiratory distress. The
"walking wounded" (A, C) and stable individuals (B) are lower priorities.
Question 5
A client with severe pneumonia is admitted with the following ABG results: pH 7.30, PaO2 60,
PaCO2 62, HCO3 35. The nurse notes the client is becoming drowsy and difficult to arouse.
What is the priority nursing action?
A) Encourage the client to cough and deep breathe.
B) Increase the oxygen flow rate via nasal cannula.
C) Notify the healthcare provider (HCP) immediately for potential intubation.
D) Administer a dose of prescribed intravenous antibiotic.
E) Re-position the client into a high-Fowler’s position.
Correct Answer: C) Notify the healthcare provider (HCP) immediately for potential
intubation.
Rationale: The client’s ABGs show respiratory acidosis with significant CO2 retention
(hypercapnia) and hypoxemia. Drowsiness and difficulty arousing are signs of CO2
narcosis and impending respiratory failure. The nurse must communicate these
neurological changes to the HCP immediately as the client likely requires mechanical
ventilation.
Question 6
A client with severe burn injuries has a serum potassium level of 4.0 mEq/L during the acute
phase. The nurse understands that this level is:
A) Critically low, requiring IV potassium replacement.
B) Within the normal range for a healthy adult.
, 3
C) Expectedly high due to cellular destruction.
D) Indicative of metabolic alkalosis.
E) A sign that the client is developing acute renal failure.
Correct Answer: B) Within the normal range for a healthy adult.
Rationale: The normal range for serum potassium is 3.5 to 5.0 mEq/L. While burn patients
are at risk for hyperkalemia (due to potassium leaking out of damaged cells) or
hypokalemia (later during fluid shift/diuresis), a level of 4.0 is currently stable and normal.
Question 7
A client has been bedridden for 2 weeks following a critical illness. Current labs show pH 7.37,
PO2 90, PCO2 40, HCO3 25. Which nursing intervention is the priority for this client?
A) Obtain an order for a STAT electrocardiogram.
B) Turn the patient side to side every 2 hours.
C) Administer sodium bicarbonate intravenously.
D) Increase the frequency of incentive spirometry to every hour.
E) Request a physical therapy consult for ambulation.
Correct Answer: B) Turn the patient side to side q2h
Rationale: The client’s ABGs are within normal limits (compensated/normal). However, a
client who has been bedridden for 2 weeks is at extreme risk for skin breakdown (pressure
ulcers) and venous stasis. Turning the patient every 2 hours is the standard priority nursing
action to prevent complications of immobility.
Question 8
A 40-year-old client is admitted with a sickle cell crisis. Which assessment should the nurse
prioritize?
A) Daily weight and skin turgor.
B) Bowel sounds and frequency of stools.
C) Pain level and neurovascular status of extremities.
D) Pupil reactivity and Glasgow Coma Scale.
E) History of childhood immunizations.
Correct Answer: C) Priority assessment for a 40-year-old with sickle cell crisis
Rationale: Sickle cell crisis involves vaso-occlusive events where sickled red blood cells
block small vessels. This causes intense pain and can lead to tissue ischemia and infarction.
Priority care involves aggressive pain management, oxygenation, and monitoring for
organ/tissue damage.
Question 9
In a major disaster, which of the following patients should be prioritized for transfer to the
medical-surgical unit to make room for incoming critical victims?
A) A patient with an open chest wound and tracheal deviation.
B) A patient with a small cut over the eye and stable vitals.
