Critical Care Exit Hesi
questions and answers 2025
latest update
1 - answer The nurse cares for a client with a cuffed tracheostomy tube.
Before performing oral care, the nurse notes that the client's
tracheostomy cuff is inflated. Which of the following is the MOST
appropriate action for the nurse to take?
1. Leave the cuff inflated and suction through the tracheostomy.
2. Deflate the cuff and suction through the tracheostomy tube.
3. Inflate the cuff pressure to 40 mm Hg before suctioning.
4. Adjust the wall suction pressure to 160 to 180 mm Hg before
suctioning.
2 - answer A young adult brings a friend to the emergency department
and states that the friend has been using heroin. Which action by the
nurse is the MOST appropriate?
1. Assess pupil size and reactivity.
2. Assess oxygen saturation levels.
3. Palpate dorsalis pedis pulses.
4. Ask the client if he knows today's date
3 - answer The client tells the clinic nurse that the client is thinking
about using nicotine polacrilex (Nicorette). Which question is MOST
important for the nurse to ask?
1. "Have you tried other methods to stop smoking?"
2. "How long have you been smoking?"
3. "Have you ever had chest pain?"
4. "Do you have a partial dental bridge?"
,4 - answer The nurse cares for the client with a client controlled
analgesia (PCA) pump. The nurse determines that the client has pressed
the button 11 times and received 6 doses of morphine during the last
hour. Which is the MOST appropriate action for the nurse to take?
1. Assess the patency of the PCA IV tubing.
2. Determine the client's understanding of the PCA pump function.
3. Obtain an order to begin a PCA infusion of fentanyl.
4. Ask the client to describe the pain.
3 - answer A pregnant woman receives an epidural anesthetic. After
administration of the epidural anesthetic, the client's blood pressure
changes from 120/84 to 94/50. Which action by the nurse is MOST
appropriate?
1. Place the client flat on her back.
2. Elevate the head of the bed 30 degrees.
3. Place the client on her left side with her legs flexed.
4. Place the client supine with the foot of the bed elevated
1 - answer A nursing order, "Increase fluid intake" is written for a client
diagnosed with dehydration. Which finding BEST indicates improving fluid
status?
1. Urinary output of 1,500 mL in 24 hours.
2. Serum hematocrit 52%.
3. Oral fluid intake of 900 mL in 24 hours.
4. Blood pressure of 100/82.
2 - answer The nurse prepares to administer the initial dose of oral
enalapril (Vasotec) 20 mg in the morning. Which medication should the
nurse question giving to the client?
1. 20 mg oral escitalopram (Celexa) in the morning.
2. 40 mg oral furosemide (Lasix) in the morning.
3. 300 mg of oral gabapentin (Neurontin) twice daily.
4. 10 mg zolpidem (Ambien) at bedtime.
, 3 - answer The home care nurse visits a client with a halo fixator traction
device. Which client statement MOST concerns the nurse?
1. "My wife looks at the pin sites every day."
2. "I like to bathe in the tub."
3. "I drove to the library yesterday."
4. "I drink with a straw."
1 - answer the nurse cares for a client diagnosed with depression. Which
statement by the client indicates improvement?
1. "I have been sleeping 6 hours at night."
2. "I have lost 2 lbs in the past week."
3. "Lately, I have trouble watching television."
4. "I have much less muscle tension now."
1 - answer The nurse on the maternity unit must accept a transfer client
from a medical/surgical unit. The nurse considers which transfer client
appropriate?
1. A 38-year-old client with a diagnosis of systemic lupus erythematosus.
2. A 45-year-old client receiving daily external radiation therapy
treatments for breast cancer.
3. A 58-year-old client receiving antibiotic treatment for cellulitis of the
left leg.
4. A 74-year-old client who has received intravenous antibiotics for 7 days.
4 - answer The nurse in the outclient surgery unit prepares a 4-year-old
child for surgery. It is MOST important for the nurse to make which of
these statements?
1. "Your parents are going to leave a half hour before the surgery."
2. "You're going to talk with some other children who had this surgery."
3. "If you have this surgery, your parents will buy you a new toy."
4. "Take this doll and show me where the operation will be done.
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