HESI Exit Exam Critical Thinking and
Clinical Judgment Practice Questions
80 Case-Based NCLEX-Style Questions
Topics: Critical Thinking and Clinical Judgment in Nursing Practice
May 30, 2025
Instructions
This document contains 80 case-based, NCLEX-style multiple-choice questions designed to
prepare you for the Critical Thinking and Clinical Judgment section of the HESI Exit Exam.
Each question presents a patient scenario and asks what the nurse should do next, with four
answer choices (AD). The correct answer is clearly indicated. Use this practice test to assess
your decision-making skills and clinical judgment. Good luck!
Practice Questions
A 68-year-old patient with chest pain is admitted to the emergency department. The ECG
shows ST elevation. What should the nurse do next?
A) Administer sublingual nitroglycerin.
A) B) Notify the cardiologist immediately.
C) Obtain a complete medication history.
D) Encourage deep breathing exercises.
Correct Answer: B
A patient with type 2 diabetes reports feeling shaky and sweaty. The blood glucose level is 55
mg/dL. What should the nurse do next?
A) Administer 15 grams of oral glucose.
B) B) Give insulin per sliding scale.
C) Offer a high-protein snack.
D) Monitor the patient for 30 minutes.
Correct Answer: A
1
, A postoperative patient reports sudden shortness of breath and chest pain. The oxygen satura-
tion is 88
A) Administer a bronchodilator.
C) B) Notify the healthcare provider.
C) Reposition the patient to a supine position.
D) Increase IV fluid rate.
Correct Answer: B
A patient with a history of heart failure has a weight gain of 5 pounds in 2 days. What should
the nurse do next?
A) Assess for edema and lung sounds.
D) B) Encourage increased fluid intake.
C) Administer a diuretic immediately.
D) Document the weight and continue monitoring.
Correct Answer: A
A patient receiving IV heparin has a sudden drop in platelet count to 80,000/mmş. What should
the nurse do next?
A) Continue the heparin infusion.
E) B) Notify the healthcare provider.
C) Administer a platelet transfusion.
D) Increase the heparin dose.
Correct Answer: B
A patient with pneumonia has a temperature of 101.5řF and is shivering. What should the nurse
do next?
A) Apply a cooling blanket.
F) B) Administer acetaminophen.
C) Increase room temperature.
D) Encourage fluid restriction.
Correct Answer: B
A patient with a new tracheostomy is coughing and has difficulty speaking. What should the
nurse do next?
A) Suction the tracheostomy.
G) B) Administer oxygen via nasal cannula.
C) Change the tracheostomy tube.
D) Encourage the patient to rest.
Correct Answer: A
2
, A patient with chronic kidney disease reports nausea and muscle cramps. The potassium level
is 6.2 mEq/L. What should the nurse do next?
A) Administer oral potassium supplements.
H) B) Notify the healthcare provider.
C) Encourage a high-potassium diet.
D) Monitor the patient for 1 hour.
Correct Answer: B
A patient with a history of seizures suddenly becomes unresponsive and begins convulsing.
What should the nurse do next?
A) Restrain the patients limbs.
I) B) Administer IV lorazepam.
C) Place a tongue depressor in the mouth.
D) Position the patient on their side.
Correct Answer: D
A patient with a central venous catheter reports pain at the insertion site, and the area is red and
swollen. What should the nurse do next?
A) Flush the catheter with saline.
J) B) Notify the healthcare provider.
C) Apply a warm compress.
D) Continue the IV infusion.
Correct Answer: B
A patient with asthma is wheezing and has an oxygen saturation of 90
A) Administer a beta-agonist inhaler.
B) Encourage pursed-lip breathing.
K)
C) Place the patient in a supine position.
D) Monitor respiratory rate hourly.
Correct Answer: A
A patient with a history of atrial fibrillation has a heart rate of 120 bpm and reports dizziness.
What should the nurse do next?
A) Administer aspirin orally.
L) B) Notify the healthcare provider.
C) Encourage ambulation.
D) Apply oxygen via nasal cannula.
Correct Answer: B
3
Clinical Judgment Practice Questions
80 Case-Based NCLEX-Style Questions
Topics: Critical Thinking and Clinical Judgment in Nursing Practice
May 30, 2025
Instructions
This document contains 80 case-based, NCLEX-style multiple-choice questions designed to
prepare you for the Critical Thinking and Clinical Judgment section of the HESI Exit Exam.
Each question presents a patient scenario and asks what the nurse should do next, with four
answer choices (AD). The correct answer is clearly indicated. Use this practice test to assess
your decision-making skills and clinical judgment. Good luck!
Practice Questions
A 68-year-old patient with chest pain is admitted to the emergency department. The ECG
shows ST elevation. What should the nurse do next?
A) Administer sublingual nitroglycerin.
A) B) Notify the cardiologist immediately.
C) Obtain a complete medication history.
D) Encourage deep breathing exercises.
Correct Answer: B
A patient with type 2 diabetes reports feeling shaky and sweaty. The blood glucose level is 55
mg/dL. What should the nurse do next?
A) Administer 15 grams of oral glucose.
B) B) Give insulin per sliding scale.
C) Offer a high-protein snack.
D) Monitor the patient for 30 minutes.
Correct Answer: A
1
, A postoperative patient reports sudden shortness of breath and chest pain. The oxygen satura-
tion is 88
A) Administer a bronchodilator.
C) B) Notify the healthcare provider.
C) Reposition the patient to a supine position.
D) Increase IV fluid rate.
Correct Answer: B
A patient with a history of heart failure has a weight gain of 5 pounds in 2 days. What should
the nurse do next?
A) Assess for edema and lung sounds.
D) B) Encourage increased fluid intake.
C) Administer a diuretic immediately.
D) Document the weight and continue monitoring.
Correct Answer: A
A patient receiving IV heparin has a sudden drop in platelet count to 80,000/mmş. What should
the nurse do next?
A) Continue the heparin infusion.
E) B) Notify the healthcare provider.
C) Administer a platelet transfusion.
D) Increase the heparin dose.
Correct Answer: B
A patient with pneumonia has a temperature of 101.5řF and is shivering. What should the nurse
do next?
A) Apply a cooling blanket.
F) B) Administer acetaminophen.
C) Increase room temperature.
D) Encourage fluid restriction.
Correct Answer: B
A patient with a new tracheostomy is coughing and has difficulty speaking. What should the
nurse do next?
A) Suction the tracheostomy.
G) B) Administer oxygen via nasal cannula.
C) Change the tracheostomy tube.
D) Encourage the patient to rest.
Correct Answer: A
2
, A patient with chronic kidney disease reports nausea and muscle cramps. The potassium level
is 6.2 mEq/L. What should the nurse do next?
A) Administer oral potassium supplements.
H) B) Notify the healthcare provider.
C) Encourage a high-potassium diet.
D) Monitor the patient for 1 hour.
Correct Answer: B
A patient with a history of seizures suddenly becomes unresponsive and begins convulsing.
What should the nurse do next?
A) Restrain the patients limbs.
I) B) Administer IV lorazepam.
C) Place a tongue depressor in the mouth.
D) Position the patient on their side.
Correct Answer: D
A patient with a central venous catheter reports pain at the insertion site, and the area is red and
swollen. What should the nurse do next?
A) Flush the catheter with saline.
J) B) Notify the healthcare provider.
C) Apply a warm compress.
D) Continue the IV infusion.
Correct Answer: B
A patient with asthma is wheezing and has an oxygen saturation of 90
A) Administer a beta-agonist inhaler.
B) Encourage pursed-lip breathing.
K)
C) Place the patient in a supine position.
D) Monitor respiratory rate hourly.
Correct Answer: A
A patient with a history of atrial fibrillation has a heart rate of 120 bpm and reports dizziness.
What should the nurse do next?
A) Administer aspirin orally.
L) B) Notify the healthcare provider.
C) Encourage ambulation.
D) Apply oxygen via nasal cannula.
Correct Answer: B
3
