HESI A2 - Critical Thinking Test Questions with Answers
Graded A+
1. The nurse is working in the emergency which diminishes his or her sense of importance.
department (ED) of a children's medical center. It also may interrupt the patient's narrative flow,
Which client should the nurse assess first? and it impedes the observation of the patient's
1. The 1-month-old infant who has developed nonverbal behavior.
colic and is crying.
2. The 2-year-old toddler who was bitten by
another child at the day-care center. 3. The 6-
year-old school-age child who was hit by a car 2. The 8-year-old client diagnosed with a vaso-
while riding a bicycle. occlusive sickle cell crisis is complaining of a
4. The 14-year-old adolescent whose mother severe headache. Which intervention should the
suspects her child is sexually active. - nurse implement first?
ANSWER -Rationale 1. Administer 6 L of oxygen via nasal cannula.
2. Assess the client's neurological status.
Correct - 3-The child hit by a car should be 3. Administer a narcotic analgesic by intravenous
assessed first because he or she may have life- push (IVP). 4. Increase the client's intravenous
threatening injuries that must be assessed and (IV) rate. - ANSWER -Rationale
treated promptly. Correct - 2-Because the client is complaining of a
headache, the nurse should first rule out
cerebrovascular accident (CVA) by assess- ing
the client's neurological status and then
1. In an interview, the nurse may find it determine whether it is a headache that can be
necessary to take notes to aid his or her memory treated with medication.
later. Which statement is true regarding note-
taking?
A) Note-taking may impede the nurse's 2. During an interview, the nurse states, "You
observation of the patient's nonverbal behaviors. mentioned shortness of breath. Tell me more
B) Note-taking allows the patient to continue at about that." Which verbal skill is used with this
his or her own pace as the nurse records what is statement?
said.
C) Note-taking allows the nurse to shift attention A) Reflection
away from the patient, resulting in an increased B) Facilitation
comfort level. C) Direct question
D) Note-taking allows the nurse to break eye D) Open-ended question - ANSWER -D)
contact with the patient, which may increase his Open-ended question
or her level of comfort. - ANSWER -A)
Note-taking may impede the nurse's observation Page: 32 The open-ended question asks for
of the patient's nonverbal behaviors. narrative information. It states the topic to be
discussed but only in general terms. The nurse
Page: 31 Some use of history forms and note- should use it to begin the interview, to introduce a
taking may be unavoidable. But be aware that new section of questions, and whenever the
note-taking during the interview has person introduces a new topic.
disadvantages. It breaks eye contact too often,
and it shifts attention away from the patient,
,HESI A2 - Critical Thinking Test Questions with Answers
Graded A+
4. The nurse is caring for clients on the pediatric
3. The 6-year-old client who has undergone medical unit. Which client should the nurse
abdominal surgery is attempting to make a assess first?
pinwheel spin by blowing on it with the nurse's 1. The child diagnosed with type 1 diabetes who
assistance. The child starts crying because the has a blood glucose level
pinwheel won't spin. Which action should the of 180 mg/dL.
nurse implement first? 2. The child diagnosed with pneumonia who is
1. Praise the child for the attempt to make the coughing and has a temperature of
pinwheel spin. 100°F.
2. Notify the respiratory therapist to implement 3. The child diagnosed with gastroenteritis who
incentive spirometry. 3. Encourage the child to has a potassium (K+) level
turn from side to side and cough. of 3.9 mEq/L.
4. Demonstrate how to make the pinwheel spin 4. The child diagnosed with cystic fibrosis who
by blowing on it. - ANSWER -Rationale has a pulse oximeter reading of 90%. -
ANSWER -Rationale
Correct -1. The nurse should always praise the
child for attempts at cooperation even if the child Correct - 4. A pulse oximeter reading of less than
did not accomplish what the nurse asked. 93% is significant and indicates hypoxia, which is
life threatening; therefore, this child should be
assessed first.
3. A nurse is taking complete health histories on
all of the patients attending a wellness workshop.
On the history form, one of the written questions 4. During an interview, a parent of a hospitalized
asks, "You don't smoke, drink, or take drugs, do child is sitting in an open position. As the
you?" This question is an example of: interviewer begins to discuss his son's treatment,
however, he suddenly crosses his arms against
A) talking too much. his chest and crosses his legs. This would
B) using confrontation. suggest that the parent is:
C) using biased or leading questions.
D) using blunt language to deal with distasteful A) just changing positions.
topics. - ANSWER -C) using biased or B) more comfortable in this position.
leading questions. C) tired and needs a break from the interview.
D) uncomfortable talking about his son's
Page: 36 This is an example of using leading or treatment. - ANSWER -D) uncomfortable
biased questions. Asking, "You don't smoke, do talking about his son's treatment.
you?" implies that one answer is "better" than
another. If the person wants to please someone, Page: 37 Note the person's position. An open
he or she is either forced to answer in a way position with the extension of large muscle
corresponding to their implied values or is made groups shows relaxation, physical comfort, and a
to feel guilty when admitting the other answer. willingness to share information. A closed
position with the arms and legs crossed tends to
look defensive and anxious. Note any change in
posture. If a person in a relaxed position
,HESI A2 - Critical Thinking Test Questions with Answers
Graded A+
suddenly tenses, it suggests possible discomfort meeting with him to help facilitate the
with the new topic. communication.
D) Speak loudly and with exaggerated facial
movement when talking with him because this
helps with lip reading. - ANSWER -A)
5. The nurse has received the a.m. shift report Determine the communication method he prefers.
for clients on a pediatric unit. Which medication
should the nurse administer first? Pages: 40-41 The nurse should ask the deaf
1. The third dose of the aminoglycoside antibiotic person the preferred way to communicate—by
to the child diagnosed with signing, lip reading, or writing. If the person
methicillin-resistant Staphylococcus aureus prefers lip reading, then the nurse should be sure
(MRSA). to face him or her squarely and have good
2. The IVP steroid methylprednisolone (Solu- lighting on the nurse's face. The nurse should not
Medrol) to the child diagnosed with exaggerate lip movements because this distorts
asthma. words. Similarly, shouting distorts the reception
3. The sliding scale insulin to the child diagnosed of a hearing aid the person may wear. The nurse
with type 1 diabetes mellitus. should speak slowly and should supplement his
4. The stimulant methylphenidate (Ritalin) to a or her voice with appropriate hand gestures or
child diagnosed with attention pantomime.
deficit-hyperactivity disorder (ADHD). -
ANSWER -Rationale
Correct - 3-Sliding scale insulin is ordered ac, 6. The nurse enters the client's room and realizes
which is before meals; therefore, this medicationthe 9-month-old infant is not breath- ing. Which
must be administered first after receiving the interventions should the nurse implement?
a.m. shift report. Prioritize the nurse's actions from first (1) to last
4-Routine medications have a 1-hour leeway (5).
before and after the scheduled time; therefore, 1. Perform cardiac compression 30:2.
this medication does not have to be adminis- 2. Check the infant's brachial pulse. 3. Administer
tered first. two puffs to the infant. 4. Determine
unresponsiveness.
5. Open the infant's airway. - ANSWER -
Rationale
5. The nurse is interviewing a patient who has a Correct Answer: 4, 5, 3, 2, 1
hearing impairment. What techniques would be 4. The nurse must first determine the
most beneficial in communicating with this infant's responsiveness by thumping the
patient? baby's feet.
5. The nurse should then open the child's
A) Determine the communication method he airway using the head-tilt chin-lift tech- nique,
prefers. with care taken not to hyperextend the neck.
B) Avoid using facial and hand gestures because Then the nurse should look, listen, and feel for
most hearing-impaired people find this respirations.
degrading. 3. The nurse then administers quick puffs of air
C) Request a sign language interpreter before while covering the child's mouth and nose,
, HESI A2 - Critical Thinking Test Questions with Answers
Graded A+
preferably with a rescue mask. knows medical terminology. In general, an older,
2. The nurse should determine whether the infant more mature interpreter is preferred to a younger,
has a pulse by checking the brachial artery. less experienced one, and the same gender is
1. If the infant has no pulse, the nurse should preferred when possible.
begin chest compressions using two fingers at a
rate of 30:2.
7. The 3-year-old client has been admitted to the
pediatric unit. Which task should the nurse
6. The nurse is performing a health interview on instruct the unlicensed assistive personnel (UAP)
a patient who has a language barrier, and no to perform first?
interpreter is available. Which is the best 1. Orient the parents and child to the room.
example of an appropriate question for the nurse 2. Obtain an admission kit for the child.
to ask in this situation? 3. Post the child's height and weight at the HOB.
4. Provide the child with a meal tray. -
A) "Do you take medicine?" ANSWER -Rationale
B) "Do you sterilize the bottles?"
C) "Do you have nausea and vomiting?" Correct - 1.The first intervention after the child is
D) "You have been taking your medicine, haven't ad- mitted to the unit is to orient the parents and
you?" - ANSWER -A) "Do you take child to the room, the call system, and the
medicine?" hospital rules, such as not leaving the child alone
in the room.
Page: 46 In a situation where there is a language
barrier and no interpreter available, use simple
words avoiding medical jargon. Avoid using
contractions and pronouns. Use nouns 8. The clinic nurse is preparing to administer an
repeatedly and discuss one topic at a time. intramuscular (IM) injection to the 2-year-old
toddler. Which intervention should the nurse
implement first?
1. Immobilize the child's leg.
7. A female patient does not speak English well, 2. Explain the procedure to the child.
and the nurse needs to choose an interpreter. 3. Cleanse the area with an alcohol swab. 4.
Which of the following would be the most Administer the medication in the thigh. -
appropriate choice? ANSWER -Rationale
Correct - 2-The nurse must explain any
A) A trained interpreter procedure in words the child can understand. It
B) A male family member does not matter how old the child is.
C) A female family member
D) A volunteer college student from the foreign
language studies department - ANSWER -
A) A trained interpreter 8. The nurse is conducting an interview. Which of
these statements is true regarding open-ended
Page: 46 whenever possible, the nurse should questions? Select all that apply.
use a trained interpreter, preferably one who
Graded A+
1. The nurse is working in the emergency which diminishes his or her sense of importance.
department (ED) of a children's medical center. It also may interrupt the patient's narrative flow,
Which client should the nurse assess first? and it impedes the observation of the patient's
1. The 1-month-old infant who has developed nonverbal behavior.
colic and is crying.
2. The 2-year-old toddler who was bitten by
another child at the day-care center. 3. The 6-
year-old school-age child who was hit by a car 2. The 8-year-old client diagnosed with a vaso-
while riding a bicycle. occlusive sickle cell crisis is complaining of a
4. The 14-year-old adolescent whose mother severe headache. Which intervention should the
suspects her child is sexually active. - nurse implement first?
ANSWER -Rationale 1. Administer 6 L of oxygen via nasal cannula.
2. Assess the client's neurological status.
Correct - 3-The child hit by a car should be 3. Administer a narcotic analgesic by intravenous
assessed first because he or she may have life- push (IVP). 4. Increase the client's intravenous
threatening injuries that must be assessed and (IV) rate. - ANSWER -Rationale
treated promptly. Correct - 2-Because the client is complaining of a
headache, the nurse should first rule out
cerebrovascular accident (CVA) by assess- ing
the client's neurological status and then
1. In an interview, the nurse may find it determine whether it is a headache that can be
necessary to take notes to aid his or her memory treated with medication.
later. Which statement is true regarding note-
taking?
A) Note-taking may impede the nurse's 2. During an interview, the nurse states, "You
observation of the patient's nonverbal behaviors. mentioned shortness of breath. Tell me more
B) Note-taking allows the patient to continue at about that." Which verbal skill is used with this
his or her own pace as the nurse records what is statement?
said.
C) Note-taking allows the nurse to shift attention A) Reflection
away from the patient, resulting in an increased B) Facilitation
comfort level. C) Direct question
D) Note-taking allows the nurse to break eye D) Open-ended question - ANSWER -D)
contact with the patient, which may increase his Open-ended question
or her level of comfort. - ANSWER -A)
Note-taking may impede the nurse's observation Page: 32 The open-ended question asks for
of the patient's nonverbal behaviors. narrative information. It states the topic to be
discussed but only in general terms. The nurse
Page: 31 Some use of history forms and note- should use it to begin the interview, to introduce a
taking may be unavoidable. But be aware that new section of questions, and whenever the
note-taking during the interview has person introduces a new topic.
disadvantages. It breaks eye contact too often,
and it shifts attention away from the patient,
,HESI A2 - Critical Thinking Test Questions with Answers
Graded A+
4. The nurse is caring for clients on the pediatric
3. The 6-year-old client who has undergone medical unit. Which client should the nurse
abdominal surgery is attempting to make a assess first?
pinwheel spin by blowing on it with the nurse's 1. The child diagnosed with type 1 diabetes who
assistance. The child starts crying because the has a blood glucose level
pinwheel won't spin. Which action should the of 180 mg/dL.
nurse implement first? 2. The child diagnosed with pneumonia who is
1. Praise the child for the attempt to make the coughing and has a temperature of
pinwheel spin. 100°F.
2. Notify the respiratory therapist to implement 3. The child diagnosed with gastroenteritis who
incentive spirometry. 3. Encourage the child to has a potassium (K+) level
turn from side to side and cough. of 3.9 mEq/L.
4. Demonstrate how to make the pinwheel spin 4. The child diagnosed with cystic fibrosis who
by blowing on it. - ANSWER -Rationale has a pulse oximeter reading of 90%. -
ANSWER -Rationale
Correct -1. The nurse should always praise the
child for attempts at cooperation even if the child Correct - 4. A pulse oximeter reading of less than
did not accomplish what the nurse asked. 93% is significant and indicates hypoxia, which is
life threatening; therefore, this child should be
assessed first.
3. A nurse is taking complete health histories on
all of the patients attending a wellness workshop.
On the history form, one of the written questions 4. During an interview, a parent of a hospitalized
asks, "You don't smoke, drink, or take drugs, do child is sitting in an open position. As the
you?" This question is an example of: interviewer begins to discuss his son's treatment,
however, he suddenly crosses his arms against
A) talking too much. his chest and crosses his legs. This would
B) using confrontation. suggest that the parent is:
C) using biased or leading questions.
D) using blunt language to deal with distasteful A) just changing positions.
topics. - ANSWER -C) using biased or B) more comfortable in this position.
leading questions. C) tired and needs a break from the interview.
D) uncomfortable talking about his son's
Page: 36 This is an example of using leading or treatment. - ANSWER -D) uncomfortable
biased questions. Asking, "You don't smoke, do talking about his son's treatment.
you?" implies that one answer is "better" than
another. If the person wants to please someone, Page: 37 Note the person's position. An open
he or she is either forced to answer in a way position with the extension of large muscle
corresponding to their implied values or is made groups shows relaxation, physical comfort, and a
to feel guilty when admitting the other answer. willingness to share information. A closed
position with the arms and legs crossed tends to
look defensive and anxious. Note any change in
posture. If a person in a relaxed position
,HESI A2 - Critical Thinking Test Questions with Answers
Graded A+
suddenly tenses, it suggests possible discomfort meeting with him to help facilitate the
with the new topic. communication.
D) Speak loudly and with exaggerated facial
movement when talking with him because this
helps with lip reading. - ANSWER -A)
5. The nurse has received the a.m. shift report Determine the communication method he prefers.
for clients on a pediatric unit. Which medication
should the nurse administer first? Pages: 40-41 The nurse should ask the deaf
1. The third dose of the aminoglycoside antibiotic person the preferred way to communicate—by
to the child diagnosed with signing, lip reading, or writing. If the person
methicillin-resistant Staphylococcus aureus prefers lip reading, then the nurse should be sure
(MRSA). to face him or her squarely and have good
2. The IVP steroid methylprednisolone (Solu- lighting on the nurse's face. The nurse should not
Medrol) to the child diagnosed with exaggerate lip movements because this distorts
asthma. words. Similarly, shouting distorts the reception
3. The sliding scale insulin to the child diagnosed of a hearing aid the person may wear. The nurse
with type 1 diabetes mellitus. should speak slowly and should supplement his
4. The stimulant methylphenidate (Ritalin) to a or her voice with appropriate hand gestures or
child diagnosed with attention pantomime.
deficit-hyperactivity disorder (ADHD). -
ANSWER -Rationale
Correct - 3-Sliding scale insulin is ordered ac, 6. The nurse enters the client's room and realizes
which is before meals; therefore, this medicationthe 9-month-old infant is not breath- ing. Which
must be administered first after receiving the interventions should the nurse implement?
a.m. shift report. Prioritize the nurse's actions from first (1) to last
4-Routine medications have a 1-hour leeway (5).
before and after the scheduled time; therefore, 1. Perform cardiac compression 30:2.
this medication does not have to be adminis- 2. Check the infant's brachial pulse. 3. Administer
tered first. two puffs to the infant. 4. Determine
unresponsiveness.
5. Open the infant's airway. - ANSWER -
Rationale
5. The nurse is interviewing a patient who has a Correct Answer: 4, 5, 3, 2, 1
hearing impairment. What techniques would be 4. The nurse must first determine the
most beneficial in communicating with this infant's responsiveness by thumping the
patient? baby's feet.
5. The nurse should then open the child's
A) Determine the communication method he airway using the head-tilt chin-lift tech- nique,
prefers. with care taken not to hyperextend the neck.
B) Avoid using facial and hand gestures because Then the nurse should look, listen, and feel for
most hearing-impaired people find this respirations.
degrading. 3. The nurse then administers quick puffs of air
C) Request a sign language interpreter before while covering the child's mouth and nose,
, HESI A2 - Critical Thinking Test Questions with Answers
Graded A+
preferably with a rescue mask. knows medical terminology. In general, an older,
2. The nurse should determine whether the infant more mature interpreter is preferred to a younger,
has a pulse by checking the brachial artery. less experienced one, and the same gender is
1. If the infant has no pulse, the nurse should preferred when possible.
begin chest compressions using two fingers at a
rate of 30:2.
7. The 3-year-old client has been admitted to the
pediatric unit. Which task should the nurse
6. The nurse is performing a health interview on instruct the unlicensed assistive personnel (UAP)
a patient who has a language barrier, and no to perform first?
interpreter is available. Which is the best 1. Orient the parents and child to the room.
example of an appropriate question for the nurse 2. Obtain an admission kit for the child.
to ask in this situation? 3. Post the child's height and weight at the HOB.
4. Provide the child with a meal tray. -
A) "Do you take medicine?" ANSWER -Rationale
B) "Do you sterilize the bottles?"
C) "Do you have nausea and vomiting?" Correct - 1.The first intervention after the child is
D) "You have been taking your medicine, haven't ad- mitted to the unit is to orient the parents and
you?" - ANSWER -A) "Do you take child to the room, the call system, and the
medicine?" hospital rules, such as not leaving the child alone
in the room.
Page: 46 In a situation where there is a language
barrier and no interpreter available, use simple
words avoiding medical jargon. Avoid using
contractions and pronouns. Use nouns 8. The clinic nurse is preparing to administer an
repeatedly and discuss one topic at a time. intramuscular (IM) injection to the 2-year-old
toddler. Which intervention should the nurse
implement first?
1. Immobilize the child's leg.
7. A female patient does not speak English well, 2. Explain the procedure to the child.
and the nurse needs to choose an interpreter. 3. Cleanse the area with an alcohol swab. 4.
Which of the following would be the most Administer the medication in the thigh. -
appropriate choice? ANSWER -Rationale
Correct - 2-The nurse must explain any
A) A trained interpreter procedure in words the child can understand. It
B) A male family member does not matter how old the child is.
C) A female family member
D) A volunteer college student from the foreign
language studies department - ANSWER -
A) A trained interpreter 8. The nurse is conducting an interview. Which of
these statements is true regarding open-ended
Page: 46 whenever possible, the nurse should questions? Select all that apply.
use a trained interpreter, preferably one who
