HESI A2 CRITICAL THINKING 2021
Course
HESI A2 CRITICAL THINKING
Question 1
A nurse is caring for a patient who suddenly becomes short of breath and anxious. Which action
should the nurse take first?
A. Notify the healthcare provider
B. Assess the patient's oxygen saturation
C. Document the symptoms
D. Administer prescribed pain medication
Answer: B. Assess the patient's oxygen saturation
Rationale: The nursing process begins with assessment. Before implementing interventions or
notifying the provider, the nurse should gather objective data regarding the patient's respiratory
status.
Question 2
A patient with diabetes reports dizziness and sweating. What is the nurse's priority action?
A. Check the patient's blood glucose level
B. Encourage fluid intake
C. Call the physician immediately
D. Obtain a urine specimen
Answer: A. Check the patient's blood glucose level
Rationale: Dizziness and diaphoresis may indicate hypoglycemia. Verifying blood glucose
levels helps identify the cause and guides treatment.
Question 3
A nurse receives report on four patients. Which patient should be assessed first?
A. A patient with a blood pressure of 118/74 mmHg
B. A patient awaiting discharge instructions
C. A patient reporting sudden chest pain
D. A patient requesting assistance with hygiene
,Answer: C. A patient reporting sudden chest pain
Rationale: Chest pain may indicate a life-threatening cardiac event. Using prioritization
principles and ABCs (Airway, Breathing, Circulation), this patient requires immediate
assessment.
Question 4
A nurse notices a colleague preparing to administer medication to the wrong patient. What is the
most appropriate action?
A. Ignore the situation
B. Report the colleague after the medication is given
C. Immediately intervene to prevent the error
D. Document the incident first
Answer: C. Immediately intervene to prevent the error
Rationale: Patient safety is the highest priority. Preventing harm takes precedence over
documentation or reporting.
Question 5
A patient states, "I don't think my medication is helping." What should the nurse do first?
A. Tell the patient to continue taking it
B. Assess the patient's symptoms and concerns
C. Notify the provider immediately
D. Suggest stopping the medication
Answer: B. Assess the patient's symptoms and concerns
Rationale: Critical thinking requires gathering additional information before making decisions
or contacting the provider.
Question 6
A postoperative patient has a respiratory rate of 8 breaths per minute. What should the nurse do
first?
A. Assess the patient's level of consciousness
B. Document the finding
, C. Offer fluids
D. Encourage ambulation
Answer: A. Assess the patient's level of consciousness
Rationale: A low respiratory rate may indicate respiratory depression. Further assessment is
needed immediately to determine severity and guide intervention.
Question 7
A nurse finds a patient lying on the floor beside the bed. Which action is most appropriate?
A. Help the patient back into bed immediately
B. Assess the patient for injuries first
C. Complete an incident report before assessment
D. Notify family members first
Answer: B. Assess the patient for injuries first
Rationale: Assessment always comes before moving the patient. Injuries must be identified
before additional actions are taken.
Question 8
A nurse is caring for a patient who refuses a prescribed treatment. Which response is most
appropriate?
A. Force the patient to comply
B. Respect the refusal after ensuring informed decision-making
C. Ignore the patient's wishes
D. Administer the treatment without consent
Answer: B. Respect the refusal after ensuring informed decision-making
Rationale: Competent patients have the right to refuse treatment. The nurse should ensure the
patient understands the risks and benefits before honoring the decision.
Question 9
A patient complains of severe pain despite receiving medication 30 minutes ago. What should the
nurse do first?
Course
HESI A2 CRITICAL THINKING
Question 1
A nurse is caring for a patient who suddenly becomes short of breath and anxious. Which action
should the nurse take first?
A. Notify the healthcare provider
B. Assess the patient's oxygen saturation
C. Document the symptoms
D. Administer prescribed pain medication
Answer: B. Assess the patient's oxygen saturation
Rationale: The nursing process begins with assessment. Before implementing interventions or
notifying the provider, the nurse should gather objective data regarding the patient's respiratory
status.
Question 2
A patient with diabetes reports dizziness and sweating. What is the nurse's priority action?
A. Check the patient's blood glucose level
B. Encourage fluid intake
C. Call the physician immediately
D. Obtain a urine specimen
Answer: A. Check the patient's blood glucose level
Rationale: Dizziness and diaphoresis may indicate hypoglycemia. Verifying blood glucose
levels helps identify the cause and guides treatment.
Question 3
A nurse receives report on four patients. Which patient should be assessed first?
A. A patient with a blood pressure of 118/74 mmHg
B. A patient awaiting discharge instructions
C. A patient reporting sudden chest pain
D. A patient requesting assistance with hygiene
,Answer: C. A patient reporting sudden chest pain
Rationale: Chest pain may indicate a life-threatening cardiac event. Using prioritization
principles and ABCs (Airway, Breathing, Circulation), this patient requires immediate
assessment.
Question 4
A nurse notices a colleague preparing to administer medication to the wrong patient. What is the
most appropriate action?
A. Ignore the situation
B. Report the colleague after the medication is given
C. Immediately intervene to prevent the error
D. Document the incident first
Answer: C. Immediately intervene to prevent the error
Rationale: Patient safety is the highest priority. Preventing harm takes precedence over
documentation or reporting.
Question 5
A patient states, "I don't think my medication is helping." What should the nurse do first?
A. Tell the patient to continue taking it
B. Assess the patient's symptoms and concerns
C. Notify the provider immediately
D. Suggest stopping the medication
Answer: B. Assess the patient's symptoms and concerns
Rationale: Critical thinking requires gathering additional information before making decisions
or contacting the provider.
Question 6
A postoperative patient has a respiratory rate of 8 breaths per minute. What should the nurse do
first?
A. Assess the patient's level of consciousness
B. Document the finding
, C. Offer fluids
D. Encourage ambulation
Answer: A. Assess the patient's level of consciousness
Rationale: A low respiratory rate may indicate respiratory depression. Further assessment is
needed immediately to determine severity and guide intervention.
Question 7
A nurse finds a patient lying on the floor beside the bed. Which action is most appropriate?
A. Help the patient back into bed immediately
B. Assess the patient for injuries first
C. Complete an incident report before assessment
D. Notify family members first
Answer: B. Assess the patient for injuries first
Rationale: Assessment always comes before moving the patient. Injuries must be identified
before additional actions are taken.
Question 8
A nurse is caring for a patient who refuses a prescribed treatment. Which response is most
appropriate?
A. Force the patient to comply
B. Respect the refusal after ensuring informed decision-making
C. Ignore the patient's wishes
D. Administer the treatment without consent
Answer: B. Respect the refusal after ensuring informed decision-making
Rationale: Competent patients have the right to refuse treatment. The nurse should ensure the
patient understands the risks and benefits before honoring the decision.
Question 9
A patient complains of severe pain despite receiving medication 30 minutes ago. What should the
nurse do first?
