HESI Critical Care

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Sample questions from HESI Critical Care

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift in a medical ICU, a 52-year-old client with septic shock has a mean arterial pressure (MAP) of 58 mm Hg despite a fluid bolus. The client is receiving norepinephrine through a central line, and a second client is newly admitted with stable diabetic ketoacidosis. Which action should the RN take first?

   • A.Obtain a bedside glucose level for the newly admitted client
   • B.Document the response to the fluid bolus
   • C.Titrate norepinephrine according to the prescribed protocol to reach the MAP goal
   • D.Ask the charge nurse to assign the stable client to another RN

   Rationale: A MAP of 58 mm Hg indicates inadequate perfusion, so the RN should promptly titrate the prescribed vasopressor and reassess. The glucose assessment and assignment discussion can follow once the unstable client's perfusion is addressed. Documentation is important but does not replace immediate intervention for persistent hypotension.

2. 2.During rounds in a cardiac ICU, a 68-year-old client recovering from a myocardial infarction reports new chest pressure and becomes diaphoretic. The monitor shows sinus rhythm at 96/min, and blood pressure is 88/54 mm Hg. Which action should the RN take first?

   • A.Give the prescribed oral beta blocker
   • B.Ask the client to rate the pain again in 15 minutes
   • C.Obtain a routine 12-lead ECG before notifying anyone
   • D.Activate the rapid response or emergency response process

   Rationale: New chest pressure with diaphoresis and hypotension may indicate reinfarction or cardiogenic deterioration and requires immediate escalation. An ECG is important but should not delay activating help for an unstable client. An oral beta blocker may worsen hypotension, and waiting to reassess is unsafe.

3. 3.Refer to the client's chart. Which actions should the RN take now to manage the client's deterioration? Select all that apply.

   • A.Activate the rapid response team
   • B.Stop all IV fluids without clarification
   • C.Titrate the prescribed norepinephrine to the ordered MAP target
   • D.Reassess perfusion and blood pressure after titration
   • E.Transfer the client to an unmonitored room to reduce stimulation

   Rationale: The falling MAP, altered mentation, and oliguria in the chart indicate worsening shock, so the RN should activate the rapid response team and titrate the ordered vasopressor. Reassessment after titration evaluates the response and guides further care. Stopping fluids without an order and moving an unstable client to an unmonitored room are unsafe.

4. 4.In a pediatric ICU, a 9-year-old client with a traumatic brain injury has a Glasgow Coma Scale score that falls from 14 to 11 and develops unequal pupils. Which action should the RN take first?

   • A.Offer oral fluids and reassess neurologic status in 30 minutes
   • B.Notify the provider and activate the facility's urgent escalation process
   • C.Administer the next scheduled analgesic and document the findings
   • D.Lower the head of the bed flat

   Answer and rationale are in the full material.

5. 5.A provider prescribes a medication dose that appears ten times greater than the usual dose for a 31-year-old client in the ICU. The client is stable and the medication has not been prepared. What should the RN do?

   • A.Hold the medication and clarify the prescription with the provider
   • B.Give one tenth of the dose and document the adjustment
   • C.Wait until the next shift to review the prescription
   • D.Ask a second RN to administer the prescribed dose

   Answer and rationale are in the full material.