HESI A2 Critical Thinking Logic Pack 2024/2025
100% Scenario-Based Questions with Reasoned Answers & Clinical Judgment
Critical Thinking Questions
Below are 80 unique critical thinking questions simulating real-world clinical decision-
making. The questions assess prioritization, safety, and ethical judgment skills. Each
includes four answer choices, with the correct answer marked and a detailed rationale
explaining the clinical reasoning.
1. Scenario: A nurse is caring for four patients. Patient A has a blood pressure of
190/110 mmHg and reports a headache. Patient B is scheduled for surgery in 2
hours. Patient C has a fever of 101°F and is coughing. Patient D is stable but
requests pain medication for chronic back pain.
Question 1: Which patient should the nurse assess first?
A. Patient A
B. Patient B
C. Patient C
D. Patient D
Correct Answer: A
Rationale: Patient A’s blood pressure of 190/110 mmHg indicates a hyperten-
sive crisis, a life-threatening condition that can lead to stroke or organ damage,
especially with a reported headache. This requires immediate assessment and in-
tervention. Patient B’s surgery preparation is important but not urgent within 2
hours. Patient C’s fever and cough suggest infection but are less critical. Patient
D is stable, making their request lower priority.
2. Scenario: A patient with diabetes is admitted with a blood glucose level of 450
mg/dL. The nurse notices the patient is confused and diaphoretic.
Question 2: What is the nurse’s priority action?
A. Administer insulin as ordered.
B. Check the patient’s oxygen saturation.
C. Offer the patient a snack.
D. Notify the physician immediately.
Correct Answer: A
Rationale: The patient’s symptoms (confusion, diaphoresis) and high blood glu-
cose suggest hyperglycemia, possibly diabetic ketoacidosis. Administering insulin
as ordered is the priority to lower glucose levels and prevent complications. Check-
ing oxygen saturation (B) is not the immediate concern. Offering a snack (C)
could worsen hyperglycemia. Notifying the physician (D) may be necessary but is
secondary to initiating treatment.
3. Scenario: A nurse is preparing to administer medications to a patient with a
history of penicillin allergy. The physician orders amoxicillin, a penicillin derivative.
Question 3: What should the nurse do first?
A. Administer the amoxicillin as ordered.
B. Verify the allergy with the patient and check the chart.
C. Administer a test dose of amoxicillin.
1
, D. Request a different antibiotic from the pharmacy.
Correct Answer: B
Rationale: Patient safety requires verifying the penicillin allergy with the patient
and reviewing the chart to confirm the history before administering amoxicillin,
which could cause a severe allergic reaction. Administering the drug (A) or a test
dose (C) risks harm. Requesting a different antibiotic (D) is premature without
confirmation.
4. Scenario: A patient refuses a blood transfusion due to religious beliefs but is
hemodynamically unstable after surgery.
Question 4: What is the nurse’s best response?
A. Administer the transfusion to save the patient’s life.
B. Respect the patient’s refusal and notify the physician.
C. Convince the patient to accept the transfusion.
D. Delay treatment until the patient consents.
Correct Answer: B
Rationale: Ethical judgment respects the patient’s autonomy and religious beliefs.
The nurse should honor the refusal and notify the physician to explore alternative
treatments, such as volume expanders. Administering the transfusion (A) violates
autonomy. Convincing the patient (C) disregards their beliefs. Delaying treatment
(D) may worsen instability without addressing the issue.
5. Scenario: A nurse is caring for a patient with chest pain. The patient suddenly
becomes unresponsive and has no pulse.
Question 5: What is the nurse’s first action?
A. Administer oxygen via nasal cannula.
B. Begin chest compressions.
C. Call for a defibrillator.
D. Check the patient’s chart for a DNR order.
Correct Answer: B
Rationale: The patient is in cardiac arrest, requiring immediate chest compres-
sions to restore circulation per ACLS guidelines. Administering oxygen (A) or
calling for a defibrillator (C) is secondary to initiating CPR. Checking for a DNR
order (D) is important but not the first action in an emergency.
6. Scenario: A nurse notices a medication error in a colleague’s documentation, where
a patient received twice the ordered dose of a painkiller.
Question 6: What should the nurse do first?
A. Confront the colleague privately.
B. Assess the patient for adverse effects.
C. Report the error to the supervisor.
D. Correct the documentation.
Correct Answer: B
Rationale: Patient safety is the priority. Assessing the patient for adverse ef-
fects (e.g., respiratory depression from overdose) ensures timely intervention. Con-
fronting the colleague (A) or reporting to the supervisor (C) is secondary. Correct-
ing documentation (D) without assessment is unsafe.
7. Scenario: A patient with a history of heart failure reports shortness of breath and
swelling in the legs. The nurse notes a weight gain of 5 pounds in 2 days.
2
, Question 7: What is the nurse’s priority action?
A. Encourage the patient to walk to reduce swelling.
B. Administer a diuretic as ordered.
C. Restrict the patient’s fluid intake immediately.
D. Elevate the patient’s legs.
Correct Answer: B
Rationale: The symptoms (shortness of breath, leg swelling, weight gain) indicate
worsening heart failure due to fluid overload. Administering a diuretic as ordered is
the priority to reduce fluid volume. Walking (A) may worsen symptoms. Restricting
fluids (C) or elevating legs (D) is supportive but not the primary intervention.
8. Scenario: A nurse is preparing to insert an IV line but notices the patient’s arm
is red and swollen at the insertion site from a previous IV.
Question 8: What should the nurse do?
A. Insert the IV in the same arm.
B. Choose a different site for the IV.
C. Apply a warm compress to the swollen area.
D. Administer an antibiotic for the swelling.
Correct Answer: B
Rationale: Redness and swelling suggest infection or phlebitis, making the site
unsafe for IV insertion. Choosing a different site ensures safety and effective IV
therapy. Inserting in the same arm (A) risks complications. A warm compress (C)
or antibiotic (D) may be considered later but are not the priority.
9. Scenario: A patient with a terminal illness asks the nurse, “Am I going to die
soon?” The patient’s family has requested not to disclose the prognosis.
Question 9: How should the nurse respond?
A. Tell the patient they are not going to die soon.
B. Discuss the patient’s feelings and notify the physician.
C. Share the prognosis despite the family’s request.
D. Ignore the question and change the topic.
Correct Answer: B
Rationale: Ethical judgment prioritizes the patient’s autonomy and emotional
needs. Discussing the patient’s feelings respects their concerns, and notifying the
physician ensures proper communication. Lying (A) is unethical. Sharing the
prognosis (C) violates the family’s request without discussion. Ignoring the question
(D) dismisses the patient’s needs.
10. Scenario: A nurse is caring for four patients: Patient A is post-operative with
stable vitals, Patient B has a fever of 102°F, Patient C reports severe abdominal
pain, and Patient D is due for a dressing change.
Question 10: Which patient should the nurse prioritize?
A. Patient A
B. Patient B
C. Patient C
D. Patient D
Correct Answer: C
Rationale: Severe abdominal pain (C) may indicate a serious condition like perfo-
ration or obstruction, requiring immediate assessment. Patient A is stable, Patient
3
100% Scenario-Based Questions with Reasoned Answers & Clinical Judgment
Critical Thinking Questions
Below are 80 unique critical thinking questions simulating real-world clinical decision-
making. The questions assess prioritization, safety, and ethical judgment skills. Each
includes four answer choices, with the correct answer marked and a detailed rationale
explaining the clinical reasoning.
1. Scenario: A nurse is caring for four patients. Patient A has a blood pressure of
190/110 mmHg and reports a headache. Patient B is scheduled for surgery in 2
hours. Patient C has a fever of 101°F and is coughing. Patient D is stable but
requests pain medication for chronic back pain.
Question 1: Which patient should the nurse assess first?
A. Patient A
B. Patient B
C. Patient C
D. Patient D
Correct Answer: A
Rationale: Patient A’s blood pressure of 190/110 mmHg indicates a hyperten-
sive crisis, a life-threatening condition that can lead to stroke or organ damage,
especially with a reported headache. This requires immediate assessment and in-
tervention. Patient B’s surgery preparation is important but not urgent within 2
hours. Patient C’s fever and cough suggest infection but are less critical. Patient
D is stable, making their request lower priority.
2. Scenario: A patient with diabetes is admitted with a blood glucose level of 450
mg/dL. The nurse notices the patient is confused and diaphoretic.
Question 2: What is the nurse’s priority action?
A. Administer insulin as ordered.
B. Check the patient’s oxygen saturation.
C. Offer the patient a snack.
D. Notify the physician immediately.
Correct Answer: A
Rationale: The patient’s symptoms (confusion, diaphoresis) and high blood glu-
cose suggest hyperglycemia, possibly diabetic ketoacidosis. Administering insulin
as ordered is the priority to lower glucose levels and prevent complications. Check-
ing oxygen saturation (B) is not the immediate concern. Offering a snack (C)
could worsen hyperglycemia. Notifying the physician (D) may be necessary but is
secondary to initiating treatment.
3. Scenario: A nurse is preparing to administer medications to a patient with a
history of penicillin allergy. The physician orders amoxicillin, a penicillin derivative.
Question 3: What should the nurse do first?
A. Administer the amoxicillin as ordered.
B. Verify the allergy with the patient and check the chart.
C. Administer a test dose of amoxicillin.
1
, D. Request a different antibiotic from the pharmacy.
Correct Answer: B
Rationale: Patient safety requires verifying the penicillin allergy with the patient
and reviewing the chart to confirm the history before administering amoxicillin,
which could cause a severe allergic reaction. Administering the drug (A) or a test
dose (C) risks harm. Requesting a different antibiotic (D) is premature without
confirmation.
4. Scenario: A patient refuses a blood transfusion due to religious beliefs but is
hemodynamically unstable after surgery.
Question 4: What is the nurse’s best response?
A. Administer the transfusion to save the patient’s life.
B. Respect the patient’s refusal and notify the physician.
C. Convince the patient to accept the transfusion.
D. Delay treatment until the patient consents.
Correct Answer: B
Rationale: Ethical judgment respects the patient’s autonomy and religious beliefs.
The nurse should honor the refusal and notify the physician to explore alternative
treatments, such as volume expanders. Administering the transfusion (A) violates
autonomy. Convincing the patient (C) disregards their beliefs. Delaying treatment
(D) may worsen instability without addressing the issue.
5. Scenario: A nurse is caring for a patient with chest pain. The patient suddenly
becomes unresponsive and has no pulse.
Question 5: What is the nurse’s first action?
A. Administer oxygen via nasal cannula.
B. Begin chest compressions.
C. Call for a defibrillator.
D. Check the patient’s chart for a DNR order.
Correct Answer: B
Rationale: The patient is in cardiac arrest, requiring immediate chest compres-
sions to restore circulation per ACLS guidelines. Administering oxygen (A) or
calling for a defibrillator (C) is secondary to initiating CPR. Checking for a DNR
order (D) is important but not the first action in an emergency.
6. Scenario: A nurse notices a medication error in a colleague’s documentation, where
a patient received twice the ordered dose of a painkiller.
Question 6: What should the nurse do first?
A. Confront the colleague privately.
B. Assess the patient for adverse effects.
C. Report the error to the supervisor.
D. Correct the documentation.
Correct Answer: B
Rationale: Patient safety is the priority. Assessing the patient for adverse ef-
fects (e.g., respiratory depression from overdose) ensures timely intervention. Con-
fronting the colleague (A) or reporting to the supervisor (C) is secondary. Correct-
ing documentation (D) without assessment is unsafe.
7. Scenario: A patient with a history of heart failure reports shortness of breath and
swelling in the legs. The nurse notes a weight gain of 5 pounds in 2 days.
2
, Question 7: What is the nurse’s priority action?
A. Encourage the patient to walk to reduce swelling.
B. Administer a diuretic as ordered.
C. Restrict the patient’s fluid intake immediately.
D. Elevate the patient’s legs.
Correct Answer: B
Rationale: The symptoms (shortness of breath, leg swelling, weight gain) indicate
worsening heart failure due to fluid overload. Administering a diuretic as ordered is
the priority to reduce fluid volume. Walking (A) may worsen symptoms. Restricting
fluids (C) or elevating legs (D) is supportive but not the primary intervention.
8. Scenario: A nurse is preparing to insert an IV line but notices the patient’s arm
is red and swollen at the insertion site from a previous IV.
Question 8: What should the nurse do?
A. Insert the IV in the same arm.
B. Choose a different site for the IV.
C. Apply a warm compress to the swollen area.
D. Administer an antibiotic for the swelling.
Correct Answer: B
Rationale: Redness and swelling suggest infection or phlebitis, making the site
unsafe for IV insertion. Choosing a different site ensures safety and effective IV
therapy. Inserting in the same arm (A) risks complications. A warm compress (C)
or antibiotic (D) may be considered later but are not the priority.
9. Scenario: A patient with a terminal illness asks the nurse, “Am I going to die
soon?” The patient’s family has requested not to disclose the prognosis.
Question 9: How should the nurse respond?
A. Tell the patient they are not going to die soon.
B. Discuss the patient’s feelings and notify the physician.
C. Share the prognosis despite the family’s request.
D. Ignore the question and change the topic.
Correct Answer: B
Rationale: Ethical judgment prioritizes the patient’s autonomy and emotional
needs. Discussing the patient’s feelings respects their concerns, and notifying the
physician ensures proper communication. Lying (A) is unethical. Sharing the
prognosis (C) violates the family’s request without discussion. Ignoring the question
(D) dismisses the patient’s needs.
10. Scenario: A nurse is caring for four patients: Patient A is post-operative with
stable vitals, Patient B has a fever of 102°F, Patient C reports severe abdominal
pain, and Patient D is due for a dressing change.
Question 10: Which patient should the nurse prioritize?
A. Patient A
B. Patient B
C. Patient C
D. Patient D
Correct Answer: C
Rationale: Severe abdominal pain (C) may indicate a serious condition like perfo-
ration or obstruction, requiring immediate assessment. Patient A is stable, Patient
3
