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HESI A2 CRITICAL THINKING ACTUAL
EXAM 2026 | 150 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALE | ALREADY A GRADED | NEW
AND REVISED
This comprehensive, exam-ready assessment is designed to mirror the
structure, rigor, and cognitive demands of the HESI A2 Critical
Thinking Exam. It evaluates a candidate’s ability to apply foundational
nursing concepts, prioritize care, analyze clinical data, make safe and
ethical decisions, and exercise sound clinical judgment across a wide
range of healthcare scenarios. The exam integrates theory, real-world
practice, patient safety, legal and ethical standards, and professional
nursing competencies. Questions are structured to assess recall,
application, analysis, and evaluation skills expected of candidates
preparing for entry into nursing and allied health programs.
1. A nurse reviews four patient assignments at the start of the shift.
Which patient should the nurse assess first?
A. A patient with chronic back pain requesting medication
B. A patient with shortness of breath and oxygen saturation of
88%
C. A patient scheduled for discharge later in the day
D. A patient awaiting routine morning labs
The patient with compromised oxygenation represents an
immediate threat to life and requires priority assessment based
on airway and breathing principles.
2. A nurse is caring for a postoperative patient who suddenly
becomes confused and restless. What is the most appropriate initial
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nursing action?
A. Notify the healthcare provider immediately
B. Apply physical restraints
C. Assess oxygenation and vital signs
D. Administer prescribed sedatives
Acute confusion can be caused by hypoxia or hemodynamic
instability, so assessment is the priority before interventions.
3. A nurse notes that a medication dose appears unusually high.
Which action best demonstrates critical thinking?
A. Administer the medication as ordered
B. Ask another nurse to give the medication
C. Verify the order with the prescribing provider
D. Document concern after administration
Questioning potentially unsafe orders is a professional
responsibility and reflects sound clinical judgment.
4. A patient refuses a prescribed blood transfusion for religious
reasons. What is the nurse’s best response?
A. Explain that refusal may result in death
B. Notify hospital security
C. Respect the refusal and notify the provider
D. Administer the transfusion in an emergency
Respect for patient autonomy and informed refusal is a core
ethical and legal nursing standard.
5. A nurse is teaching a patient newly diagnosed with diabetes.
Which outcome best indicates effective critical thinking in
teaching?
A. The patient listens quietly
B. The patient repeats information verbatim
C. The patient explains how to adjust diet based on glucose
levels
D. The patient receives written materials
Application of knowledge demonstrates true understanding and
effective education.
6. A patient reports chest pain rated 8/10. Which action should the
nurse take first?
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A. Obtain a detailed pain history
B. Administer antacid medication
C. Assess vital signs and apply oxygen
D. Document the pain score
Chest pain may indicate a life-threatening condition, requiring
immediate assessment and support.
7. A nurse identifies a medication error that occurred on the previous
shift. What is the most appropriate action?
A. Ignore it since no harm occurred
B. Confront the nurse who made the error
C. Report the error according to facility policy
D. Document it only in the patient chart
Reporting errors supports patient safety and quality
improvement.
8. A patient becomes hypotensive after receiving an antihypertensive
medication. What is the nurse’s priority?
A. Document the adverse effect
B. Notify the family
C. Assess airway, breathing, and circulation
D. Administer the next scheduled dose
Physiological stability takes precedence over documentation or
communication.
9. A nurse is delegating tasks to a nursing assistant. Which task is
appropriate to delegate?
A. Initial patient assessment
B. Medication administration
C. Assisting a patient with bathing
D. Teaching discharge instructions
Delegation must match task complexity with staff scope of
practice.
10. A patient is anxious before surgery. Which intervention best
reflects therapeutic communication?
A. “You’ll be fine; don’t worry.”
B. “This procedure is routine.”
C. “Tell me what concerns you most right now.”
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D. “Other patients handle this well.”
Open-ended questions encourage expression and support
emotional needs.
11. A nurse receives a handoff report with incomplete
information. What should the nurse do?
A. Proceed with care as usual
B. Document the missing data
C. Clarify missing information before accepting responsibility
D. Ask the charge nurse later
Safe care requires complete and accurate information.
12. A patient suddenly develops stridor. What is the nurse’s best
immediate action?
A. Obtain a throat culture
B. Administer oral fluids
C. Call for emergency assistance
D. Reassess in 15 minutes
Stridor indicates airway obstruction and is a medical emergency.
13. A nurse notices a colleague documenting care that was not
provided. What is the nurse’s ethical obligation?
A. Ignore the situation
B. Confront the colleague privately only
C. Report the behavior through appropriate channels
D. Correct the documentation independently
Falsification of records is unethical and unsafe and must be
reported.
14. A patient with heart failure gains 3 kg in two days. What
does this finding most likely indicate?
A. Improved nutrition
B. Medication effectiveness
C. Fluid retention
D. Measurement error
Rapid weight gain in heart failure suggests worsening fluid
overload.
15. A nurse is prioritizing care for multiple patients. Which
principle should guide decision-making?
HESI A2 CRITICAL THINKING ACTUAL
EXAM 2026 | 150 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALE | ALREADY A GRADED | NEW
AND REVISED
This comprehensive, exam-ready assessment is designed to mirror the
structure, rigor, and cognitive demands of the HESI A2 Critical
Thinking Exam. It evaluates a candidate’s ability to apply foundational
nursing concepts, prioritize care, analyze clinical data, make safe and
ethical decisions, and exercise sound clinical judgment across a wide
range of healthcare scenarios. The exam integrates theory, real-world
practice, patient safety, legal and ethical standards, and professional
nursing competencies. Questions are structured to assess recall,
application, analysis, and evaluation skills expected of candidates
preparing for entry into nursing and allied health programs.
1. A nurse reviews four patient assignments at the start of the shift.
Which patient should the nurse assess first?
A. A patient with chronic back pain requesting medication
B. A patient with shortness of breath and oxygen saturation of
88%
C. A patient scheduled for discharge later in the day
D. A patient awaiting routine morning labs
The patient with compromised oxygenation represents an
immediate threat to life and requires priority assessment based
on airway and breathing principles.
2. A nurse is caring for a postoperative patient who suddenly
becomes confused and restless. What is the most appropriate initial
,2|Page
nursing action?
A. Notify the healthcare provider immediately
B. Apply physical restraints
C. Assess oxygenation and vital signs
D. Administer prescribed sedatives
Acute confusion can be caused by hypoxia or hemodynamic
instability, so assessment is the priority before interventions.
3. A nurse notes that a medication dose appears unusually high.
Which action best demonstrates critical thinking?
A. Administer the medication as ordered
B. Ask another nurse to give the medication
C. Verify the order with the prescribing provider
D. Document concern after administration
Questioning potentially unsafe orders is a professional
responsibility and reflects sound clinical judgment.
4. A patient refuses a prescribed blood transfusion for religious
reasons. What is the nurse’s best response?
A. Explain that refusal may result in death
B. Notify hospital security
C. Respect the refusal and notify the provider
D. Administer the transfusion in an emergency
Respect for patient autonomy and informed refusal is a core
ethical and legal nursing standard.
5. A nurse is teaching a patient newly diagnosed with diabetes.
Which outcome best indicates effective critical thinking in
teaching?
A. The patient listens quietly
B. The patient repeats information verbatim
C. The patient explains how to adjust diet based on glucose
levels
D. The patient receives written materials
Application of knowledge demonstrates true understanding and
effective education.
6. A patient reports chest pain rated 8/10. Which action should the
nurse take first?
,3|Page
A. Obtain a detailed pain history
B. Administer antacid medication
C. Assess vital signs and apply oxygen
D. Document the pain score
Chest pain may indicate a life-threatening condition, requiring
immediate assessment and support.
7. A nurse identifies a medication error that occurred on the previous
shift. What is the most appropriate action?
A. Ignore it since no harm occurred
B. Confront the nurse who made the error
C. Report the error according to facility policy
D. Document it only in the patient chart
Reporting errors supports patient safety and quality
improvement.
8. A patient becomes hypotensive after receiving an antihypertensive
medication. What is the nurse’s priority?
A. Document the adverse effect
B. Notify the family
C. Assess airway, breathing, and circulation
D. Administer the next scheduled dose
Physiological stability takes precedence over documentation or
communication.
9. A nurse is delegating tasks to a nursing assistant. Which task is
appropriate to delegate?
A. Initial patient assessment
B. Medication administration
C. Assisting a patient with bathing
D. Teaching discharge instructions
Delegation must match task complexity with staff scope of
practice.
10. A patient is anxious before surgery. Which intervention best
reflects therapeutic communication?
A. “You’ll be fine; don’t worry.”
B. “This procedure is routine.”
C. “Tell me what concerns you most right now.”
, 4|Page
D. “Other patients handle this well.”
Open-ended questions encourage expression and support
emotional needs.
11. A nurse receives a handoff report with incomplete
information. What should the nurse do?
A. Proceed with care as usual
B. Document the missing data
C. Clarify missing information before accepting responsibility
D. Ask the charge nurse later
Safe care requires complete and accurate information.
12. A patient suddenly develops stridor. What is the nurse’s best
immediate action?
A. Obtain a throat culture
B. Administer oral fluids
C. Call for emergency assistance
D. Reassess in 15 minutes
Stridor indicates airway obstruction and is a medical emergency.
13. A nurse notices a colleague documenting care that was not
provided. What is the nurse’s ethical obligation?
A. Ignore the situation
B. Confront the colleague privately only
C. Report the behavior through appropriate channels
D. Correct the documentation independently
Falsification of records is unethical and unsafe and must be
reported.
14. A patient with heart failure gains 3 kg in two days. What
does this finding most likely indicate?
A. Improved nutrition
B. Medication effectiveness
C. Fluid retention
D. Measurement error
Rapid weight gain in heart failure suggests worsening fluid
overload.
15. A nurse is prioritizing care for multiple patients. Which
principle should guide decision-making?
