CRITICAL CARE HESI EXIT EXAM PRACTICE QUESTIONS COMPLETE WITH CORRECT VERIFIED ANSWERS 2026/2027

CRITICAL CARE HESI EXIT EXAM PRACTICE QUESTIONS COMPLETE WITH CORRECT VERIFIED ANSWERS 1. A client who had extensive pelvic surgery 24 hours ago becomes cyanotic, is gasping for breath, and reports right-sided chest pain. What should the nurse do first? A. Obtain vital signs B. Initiate a cardiac arrest code C. Administer oxygen using a face mask D. Encourage the use of an incentive spirometer Answer: C. Administer oxygen using a face mask Explanation: The client is showing signs of a pulmonary embolism (sudden onset cyanosis, dyspnea, chest pain). The priority intervention is to administer oxygen to correct hypoxia. While obtaining vital signs and notifying the provider are important, oxygenation is the immediate priority. Incentive spirometry would not be helpful in this acute situation. ________________________________________ 2. The nurse is caring for a client with burns and reviews the client's laboratory results: blood urea nitrogen (BUN), 30 mg/dL (10.2 mmol/L); creatinine, 2.4 mg/dL (184 mcmol/L); serum potassium, 6.3 mEq/L (6.3 mmol/L); pH, 7.1; Po2, 90 mm Hg; and hemoglobin (Hgb), 7.4 g/dL (74 mmol/L). Which condition does the nurse suspect the client has based upon these findings? A. Hypokalemia B. Metabolic alkalosis C. Azotemia D. Respiratory alkalosis Answer: C. Azotemia Explanation: Azotemia is characterized by elevated BUN and creatinine levels. The normal BUN is 8-20 mg/dL and creatinine is 0.6-1.2 mg/dL. This client's elevated BUN (30 mg/dL) and creatinine (2.4 mg/dL) indicate renal impairment. The potassium is elevated (hyperkalemia), pH is decreased (acidosis), and Po2 is normal, ruling out respiratory alkalosis. ________________________________________ 3. A nurse is caring for a client with severe burns. The nurse determines that this client is at risk for hypovolemic shock. Which physiologic finding supports the nurse's conclusion? A. Decreased rate of glomerular filtration B. Excessive blood loss through the burned tissues C. Plasma proteins moving out of the intravascular compartment D. Sodium retention occurring as a result of the aldosterone mechanism Answer: C. Plasma proteins moving out of the intravascular compartment Explanation: In burn injuries, increased capillary permeability allows plasma proteins to move from the intravascular to the interstitial space. This causes a decrease in plasma colloid osmotic pressure, leading to fluid shifting out of the vasculature and resulting in hypovolemia. This is the primary mechanism of fluid loss in burns, not blood loss. ________________________________________ 4. A burn client is receiving the open method for wound treatment. Which information will the nurse explain to the client? A. Bathing will not be permitted B. Dressings will be changed daily C. Personal protective equipment will be worn by staff D. Room temperature will be kept below 72°F (22.2°C) Answer: C. Personal protective equipment will be worn by staff Explanation: With the open method of burn wound treatment, wounds are exposed to air without dressings. Strict infection control measures are essential, including staff wearing personal protective equipment (gowns, gloves, masks). Bathing is permitted, room temperature is kept warm (80-90°F) to prevent hypothermia, and no dressings are used. ________________________________________ 5. A nurse is assessing a client's ECG reading. The client's atrial and ventricular heart rates are equal at 88 beats per min. The PR interval is 0.14 seconds, and the QRS width is 0.10 seconds. Rhythm is regular with normal P waves and QRS complexes. How will the nurse interpret this rhythm? A. Normal sinus rhythm B. Sinus tachycardia C. Sinus bradycardia D. Sinus arrhythmia Answer: A. Normal sinus rhythm Explanation: Normal sinus rhythm has a rate of 60-100 beats/min with regular rhythm. The PR interval should be 0.12-0.20 seconds and QRS width 0.06-0.12 seconds. This client's findings (rate 88, PR 0.14, QRS 0.10, regular rhythm, normal P waves and QRS complexes) are all within normal limits, indicating normal sinus rhythm. ________________________________________ 6. The nurse is providing postprocedure care to a client who had a cardiac catheterization. The client begins to manifest signs and symptoms associated with embolization. Which action should the nurse take? A. Notify the primary healthcare provider immediately B. Apply a warm, moist compress to the incision site C. Increase the intravenous fluid rate by 20 mL/hr D. Monitor vital signs more frequently Answer: A. Notify the primary healthcare provider immediately Explanation: Embolization is a serious complication of cardiac catheterization that can lead to stroke, myocardial infarction, or loss of a limb. The nurse must immediately notify the healthcare provider for rapid intervention. Applying warm compresses or increasing IV fluids would not address the embolus, and monitoring vital signs more frequently without notification delays critical treatment. ________________________________________ 7. A nurse observes a window washer falling 25 feet (7.6 m) to the ground. The nurse rushes to the scene and determines that the person is in cardiopulmonary arrest. What should the nurse do first? A. Feel for a pulse B. Begin chest compressions C. Leave to call for assistance D. Perform the abdominal thrust maneuver Answer: B. Begin chest compressions Explanation: According to current CPR guidelines, for an unresponsive victim with no breathing or only gasping, the rescuer should start chest compressions immediately. The sequence is compressions, airway, breathing (CAB). The nurse should begin compressions and activate emergency response system. Feeling for a pulse is no longer recommended as the first step for lay rescuers. ________________________________________ 8. A client reports left-sided chest pain after playing racquetball. The client is hospitalized and diagnosed with left pneumothorax. When assessing the client's left chest area, the nurse expects to identify which finding? A. Dull sound on percussion B. Vocal fremitus on palpation C. Rales with rhonchi on auscultation D. Absence of breath sounds on auscultation Answer: D. Absence of breath sounds on auscultation