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HESI CRITICAL CARE EXAM QUESTIONS AND RIGHT ANSWERS
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HESI CRITICAL CARE EXAM QUESTIONS AND RIGHT ANSWERS
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HESI CRITICAL CARE EXAM QUESTIONSAND RIGHT ANSWERS 2024 - 2025
A,56-year-old,female,client,is,receiving,intracavitary,radiation,via,a,radium,implant.,Which
nurse,should,be,assigned,to,care,for,this,client?
A.,The,nurse,who,is,caring,for,another,client,receiving,intracavitary,radiation.
B.,A,nurse,with,Marfan's,syndrome,who,is,postmenopausal.
C.,A,nurse,with,oncology,experience,who,may,be,pregnant.
D.,The,nurse,who,is,caring,for,another,client,who,has,Clostridium,difficile.,,ANS,-
,,B.,A,nurse,with,Marfan's,syndrome,who,is,postmenopausal.
RATIONALE:
A,client,receiving,intracavity,radiation,poses,a,radiation,hazard,as,long,as,the,intracavity
radiation,source,is,in,place.,A,nurse's,ability,to,care,of,this,client,is,not,affected,by,Marfan's
syndrome,(B),,which,is,a,hereditary,disorder,of,connective,tissues,,bones,,muscles,,ligaments
and,skeletal,structures.,The,goal,is,to,limit,any,one,staff,member's,exposure,to,the,calculated
time,span,based,on,the,half-life,of,radium,,such,as,the,number,of,minutes,at,the,bedside,per,day,
so,(A),should,not,be,assigned.,(C),should,not,be,exposed,to,the,radiation,due,to,the,possible
effect,on,the,fetus.,A,radiation,exposure,decreases,the,immune,response,in,the,client,who,should
not,be,exposed,to,the,potential,inadvertent,transmission,of,an,infectious,organism,(D).
1.A,client,who,has,active,tuberculosis,(TB),is,admitted,to,the,medical,unit.,What,action,is,most
important,for,the,nurse,to,implement?
A.,Fit,the,client,with,a,respirator,mask.
B.,Assign,the,client,to,a,negative,air-flow,room.
C.,Don,a,clean,gown,for,client,care.
D.,Place,an,isolation,cart,in,the,hallway,,ANS,-,,Assign,the,client,to,a,negative,air-flow,room
RATIONALE:
Active,tuberculosis,requires,implementation,of,airborne,precautions,,so,the,client,should,be
assigned,to,a,negative,pressure,air-flow,room,(D).,Although,(A,and,C),should,be,implemented
,for,clients,in,isolation,with,contact,precautions,,it,is,most,important,that,air,flow,from,the,room
is,minimized,when,the,client,has,TB.,(B),should,be,implemented,when,the,client,leaves,the
isolation,environment.
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.,,ANS,-,,Administer,the,medication
RATIONALE:
Atenolol,,a,beta-blocker,,blocks,the,beta,receptors,of,the,sinoatrial,node,to,reduce,the,heart,rate,
so,the,medication,should,be,administered,(C),because,the,client's,apical,pulse,is,greater,than,60.
(A,,B,,and,D),are,not,indicated,at,this,time.
3.The,nurse,is,assessing,a,client,and,identifies,a,bruit,over,the,thyroid.,This,finding,is,consistent
with,which,interpretation?
A.,Hypothyroidism.
B.,Thyroid,cyst.
C.,Thyroid,cancer.
D.,Hyperthyroidism,,ANS,-,,Hyperthyroidism
Rationale:Hyperthyroidism,(D),is,an,enlargement,of,the,thyroid,gland,,often,referred,to,as,a,goiter,,and,a
bruit,may,be,auscultated,over,the,goiter,due,to,an,increase,in,glandular,vascularity,which
increases,as,the,thyroid,gland,becomes,hyperactive.,A,bruit,is,not,common,with,(A,,B,,and,C).
A,6-year-
old,child,is,alert,but,quiet,when,brought,to,the,emergency,center,with,periorbital,ecchymosis,and,ecchy
,mosis,behind,the,ears.,The,nurse,suspects,potential,child,abuse,and,continues,to,assess,the,child,for,addi
tional,manifestations,of,a,basilar,skull,fracture.,What
assessment,finding,would,be,consistent,with,a,basilar,skull,fracture?
A.,Hematemesis,and,abdominal,distention.
B.,Asymmetry,of,the,face,and,eye,movements.
C.,Rhinorrhoea,or,otorrhoea,with,Halo,sign.
D.,Abnormal,position,and,movement,of,the,arm.,,ANS,-,,Rhinorrhoea,or,otorrhoea,with,Halo,sign.
RATIONALE:
Raccoon,eyes,(periorbital,ecchymosis),and,Battle's,sign,(ecchymosis,behind,the,ear,over,the
mastoid,process),are,both,signs,of,a,basilar,skull,fracture,,so,the,nurse,should,assess,for,possible
meningeal,tears,that,manifest,as,a,Halo,sign,with,CSF,leakage,from,the,ears,or,nose,(D).,(A),is
consistent,with,orbital,fractures.,(B),occurs,with,wrenching,traumas,of,the,shoulder,or,arm
fractures.,(C),occurs,with,blunt,abdominal,injuries.
The,nurse,is,assessing,a,client,who,complains,of,weight,loss,,racing,heart,rate,,and,difficulty
sleeping.,The,nurse,determines,the,client,has,moist,skin,with,fine,hair,,prominent,eyes,,lid
retraction,,and,a,staring,expression.,These,findings,are,consistent,with,which,disorder?
A.,Grave's,disease.
B.,Multiple,sclerosis.
C.,Addison's,disease.
D.,Cushing,syndrome.,,ANS,-,,Grave's,disease
RATIONALE:
This,client,is,exhibiting,symptoms,associated,with,hyperthyroidism,or,Grave's,disease,(A),
which,is,an,autoimmune,condition,affecting,the,thyroid.,(B,,C,,and,D),are,not,associated,with
these,symptoms.
The,nurse,is,assessing,an,older,client,and,determines,that,the,client's,left,upper,eyelid,droops,
covering,more,of,the,iris,than,the,right,eyelid.,Which,description,should,the,nurse,use,to
document,this,finding?
, A.,A,nystagmus,on,the,left.
B.,Exophthalmos,on,the,right.
C.,Ptosis,on,the,left,eyelid.
D.,Astigmatism,on,the,right.,,ANS,-,,Ptosis,on,the,left,eyelid
Rationale:,Ptosis,is,the,term,to,describe,an,eyelid,droop,that,covers,a,large,portion,of,the,iris,(A),,which
may,result,from,oculomotor,nerve,or,eyelid,muscle,disorder.,(B),is,characterized,by,rapid,
rhythmic,movement,of,both,eyes.,(C),is,a,distortion,of,the,lens,of,the,eye,,causing,decreased
visual,acuity.,(D),is,a,term,used,to,describe,a,protrusion,of,the,eyeballs,that,occurs,with
hyperthyroidism.
The,nurse,is,assessing,a,child's,weight,and,height,during,a,clinic,visit,prior,to,starting,school.
The,nurse,plots,the,child's,weight,on,the,growth,chart,and,notes,that,the,child's,weight,is,in,the
95th,percentile,for,the,child's,height.,What,action,should,the,nurse,take?
A.,Question,the,type,and,quantity,of,foods,eaten,in,a,typical,day.
B.,Encourage,giving,two,additional,snacks,each,day,to,the,child.
C.,Recommend,a,daily,intake,of,at,least,four,glasses,of,whole,milk.
D.,Assess,for,signs,of,poor,nutrition,,such,as,a,pale,appearance,,ANS,-
,,A.,Question,the,type,and,quantity,of,foods,eaten,in,a,typical,day.
RATIONALE:
The,child,is,overweight,for,height,,so,assessment,of,the,child's,daily,diet,(C),should,be
determined.,The,child,does,not,need,(A,or,B),,both,of,which,will,increase,the,child's,weight.
Poor,nutrition,(D),is,commonly,seen,in,underweight,children,,not,overweight.
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
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