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 31, 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 72-year-old patient presents to the ED with chest pain radiating to the left arm for 30 minutes.
The ECG shows ST elevation. What should the nurse do next?
A) Administer sublingual nitroglycerin.
A) B) Notify the cardiologist immediately.
C) Obtain a full medication history.
D) Apply a warm compress to the chest.
Correct Answer: B
A patient with type 1 diabetes reports nausea and confusion. The blood glucose is 48 mg/dL.
What should the nurse do next?
A) Administer 15 grams of oral glucose.
B) B) Give regular insulin per protocol.
C) Offer a high-protein snack.
D) Recheck glucose in 1 hour.
Correct Answer: A
A postoperative patient develops sudden dyspnea and tachycardia. Oxygen saturation is 86
A) Administer a bronchodilator.
B) Notify the healthcare provider.
C)
C) Increase IV fluids.
D) Reposition to a supine position.
Correct Answer: B
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, A patient with heart failure reports a 6-pound weight gain over 3 days and bilateral leg edema.
What should the nurse do next?
A) Assess lung sounds and oxygen saturation.
D) B) Encourage increased fluid intake.
C) Administer a diuretic immediately.
D) Document and monitor weight daily.
Correct Answer: A
A patient on IV heparin has a new onset of bleeding gums and a platelet count of 70,000/mmş.
What should the nurse do next?
A) Continue the heparin infusion.
E) B) Notify the healthcare provider.
C) Administer a platelet transfusion.
D) Apply pressure to the gums.
Correct Answer: B
A patient with pneumonia has a fever of 102řF and chills. What should the nurse do next?
A) Apply a cooling blanket.
B) Administer acetaminophen as prescribed.
F)
C) Increase room temperature.
D) Restrict oral fluids.
Correct Answer: B
A patient with a new tracheostomy has increased secretions and is coughing. What should the
nurse do next?
A) Suction the tracheostomy.
G) B) Administer oxygen via face mask.
C) Change the tracheostomy tube.
D) Encourage deep breathing.
Correct Answer: A
A patient with end-stage renal disease reports nausea and a potassium level of 6.5 mEq/L. What
should the nurse do next?
A) Administer potassium supplements.
H) B) Notify the healthcare provider.
C) Encourage a banana as a snack.
D) Monitor potassium levels daily.
Correct Answer: B
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Clinical Judgment Practice Questions
80 Case-Based NCLEX-Style Questions
Topics: Critical Thinking and Clinical Judgment in Nursing Practice
May 31, 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 72-year-old patient presents to the ED with chest pain radiating to the left arm for 30 minutes.
The ECG shows ST elevation. What should the nurse do next?
A) Administer sublingual nitroglycerin.
A) B) Notify the cardiologist immediately.
C) Obtain a full medication history.
D) Apply a warm compress to the chest.
Correct Answer: B
A patient with type 1 diabetes reports nausea and confusion. The blood glucose is 48 mg/dL.
What should the nurse do next?
A) Administer 15 grams of oral glucose.
B) B) Give regular insulin per protocol.
C) Offer a high-protein snack.
D) Recheck glucose in 1 hour.
Correct Answer: A
A postoperative patient develops sudden dyspnea and tachycardia. Oxygen saturation is 86
A) Administer a bronchodilator.
B) Notify the healthcare provider.
C)
C) Increase IV fluids.
D) Reposition to a supine position.
Correct Answer: B
1
, A patient with heart failure reports a 6-pound weight gain over 3 days and bilateral leg edema.
What should the nurse do next?
A) Assess lung sounds and oxygen saturation.
D) B) Encourage increased fluid intake.
C) Administer a diuretic immediately.
D) Document and monitor weight daily.
Correct Answer: A
A patient on IV heparin has a new onset of bleeding gums and a platelet count of 70,000/mmş.
What should the nurse do next?
A) Continue the heparin infusion.
E) B) Notify the healthcare provider.
C) Administer a platelet transfusion.
D) Apply pressure to the gums.
Correct Answer: B
A patient with pneumonia has a fever of 102řF and chills. What should the nurse do next?
A) Apply a cooling blanket.
B) Administer acetaminophen as prescribed.
F)
C) Increase room temperature.
D) Restrict oral fluids.
Correct Answer: B
A patient with a new tracheostomy has increased secretions and is coughing. What should the
nurse do next?
A) Suction the tracheostomy.
G) B) Administer oxygen via face mask.
C) Change the tracheostomy tube.
D) Encourage deep breathing.
Correct Answer: A
A patient with end-stage renal disease reports nausea and a potassium level of 6.5 mEq/L. What
should the nurse do next?
A) Administer potassium supplements.
H) B) Notify the healthcare provider.
C) Encourage a banana as a snack.
D) Monitor potassium levels daily.
Correct Answer: B
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