"Evolve HESI Fundamental Skills Clinical
Judgment Accelerator 2025: 100 Next-Gen
Practice Questions with Proven Rationales for
NCLEX & Exam Success"
Master Clinical Judgment, Prioritization, and Critical Thinking with Unfolding
Case Studies, Ethical Scenarios, and NCLEX-Aligned Rationales
"Developed with Nursing Educators and Aligned with
Elsevier’s Evolve Platform."
Delights Test Bank
,Scenario 1: Hypovolemic Shock (Post-Op Patient)
Case Context: A 65-year-old patient is 24 hours post-op colectomy. VS: BP
88/50, HR 128, RR 24, SpO2 94%.
1. Question: Which finding is the most urgent cue for hypovolemic shock?
o a) BP 88/50
o b) HR 128
o c) Cool/clammy skin
o d) Urine output 20 mL/hr
o Answer: A
o Rationale:
▪ Knowledge: Systolic BP <90 indicates hypotension, a critical
sign of shock.
▪ Clinical Judgment: Prioritizes life-threatening hemodynamic
instability (NCSBN Step 1: Recognize Cues).
2. Question: Which action should the nurse take first?
o a) Administer morphine
o b) Start a rapid IV fluid bolus
o c) Notify the surgeon
o d) Place the patient in Trendelenburg
o Answer: B
o Rationale:
▪ Knowledge: Fluid resuscitation restores perfusion in
hypovolemia.
▪ Clinical Judgment: Immediate action addresses the root
cause (NCSBN Step 5: Take Action).
3. Question (SATA): Which lab values support hypovolemia?
o a) Hemoglobin 7.2 g/dL
o b) BUN 28 mg/dL
o c) Serum sodium 140 mEq/L
, o d) Hematocrit 52%
o Answer: A, B, D
o Rationale:
▪ Knowledge: Elevated BUN, Hct, and low Hgb suggest
dehydration/blood loss.
▪ Clinical Judgment: Linking labs to clinical presentation
(NCSBN Step 2: Analyze Cues).
4. Question: After starting fluids, the patient’s BP rises to 98/62, but SpO2
drops to 89%. What is the priority?
o a) Slow the IV rate
o b) Auscultate lung sounds
o c) Increase oxygen to 6 L/min
o d) Document the response
o Answer: B
o Rationale:
▪ Knowledge: Sudden SpO2 drop may indicate fluid overload.
▪ Clinical Judgment: Assess for complications before escalating
care (NCSBN Step 4: Generate Solutions).
5. Question: The patient’s urine output improves to 50 mL/hr. What does
this indicate?
o a) Adequate renal perfusion
o b) Development of AKI
o c) Overhydration
o d) Medication side effect
o Answer: A
o Rationale:
▪ Knowledge: Urine output >30 mL/hr signals improved
perfusion.
▪ Clinical Judgment: Evaluating intervention effectiveness
(NCSBN Step 6: Evaluate Outcomes).
, Scenario 2: Diabetic Hypoglycemia
Case Context: A 58-year-old with type 2 diabetes complains of dizziness. BG:
48 mg/dL.
6. Question: Which symptom is a late sign of hypoglycemia?
o a) Diaphoresis
o b) Confusion
o c) Tremors
o d) Hunger
o Answer: B
o Rationale:
▪ Knowledge: Confusion/seizures indicate severe
hypoglycemia.
▪ Clinical Judgment: Prioritizing neurological threats (NCSBN
Step 3: Prioritize Hypotheses).
7. Question: What is the immediate intervention?
o a) Administer glucagon IM
o b) Provide 4 oz orange juice
o c) Recheck BG in 15 minutes
o d) Start a dextrose IV
o Answer: B
o Rationale:
▪ Knowledge: Conscious patients receive fast-acting carbs.
▪ Clinical Judgment: Rapid response to prevent deterioration
(NCSBN Step 5: Take Action).
8. Question (SATA): Which factors could have contributed to
hypoglycemia?
o a) Skipped meal
Judgment Accelerator 2025: 100 Next-Gen
Practice Questions with Proven Rationales for
NCLEX & Exam Success"
Master Clinical Judgment, Prioritization, and Critical Thinking with Unfolding
Case Studies, Ethical Scenarios, and NCLEX-Aligned Rationales
"Developed with Nursing Educators and Aligned with
Elsevier’s Evolve Platform."
Delights Test Bank
,Scenario 1: Hypovolemic Shock (Post-Op Patient)
Case Context: A 65-year-old patient is 24 hours post-op colectomy. VS: BP
88/50, HR 128, RR 24, SpO2 94%.
1. Question: Which finding is the most urgent cue for hypovolemic shock?
o a) BP 88/50
o b) HR 128
o c) Cool/clammy skin
o d) Urine output 20 mL/hr
o Answer: A
o Rationale:
▪ Knowledge: Systolic BP <90 indicates hypotension, a critical
sign of shock.
▪ Clinical Judgment: Prioritizes life-threatening hemodynamic
instability (NCSBN Step 1: Recognize Cues).
2. Question: Which action should the nurse take first?
o a) Administer morphine
o b) Start a rapid IV fluid bolus
o c) Notify the surgeon
o d) Place the patient in Trendelenburg
o Answer: B
o Rationale:
▪ Knowledge: Fluid resuscitation restores perfusion in
hypovolemia.
▪ Clinical Judgment: Immediate action addresses the root
cause (NCSBN Step 5: Take Action).
3. Question (SATA): Which lab values support hypovolemia?
o a) Hemoglobin 7.2 g/dL
o b) BUN 28 mg/dL
o c) Serum sodium 140 mEq/L
, o d) Hematocrit 52%
o Answer: A, B, D
o Rationale:
▪ Knowledge: Elevated BUN, Hct, and low Hgb suggest
dehydration/blood loss.
▪ Clinical Judgment: Linking labs to clinical presentation
(NCSBN Step 2: Analyze Cues).
4. Question: After starting fluids, the patient’s BP rises to 98/62, but SpO2
drops to 89%. What is the priority?
o a) Slow the IV rate
o b) Auscultate lung sounds
o c) Increase oxygen to 6 L/min
o d) Document the response
o Answer: B
o Rationale:
▪ Knowledge: Sudden SpO2 drop may indicate fluid overload.
▪ Clinical Judgment: Assess for complications before escalating
care (NCSBN Step 4: Generate Solutions).
5. Question: The patient’s urine output improves to 50 mL/hr. What does
this indicate?
o a) Adequate renal perfusion
o b) Development of AKI
o c) Overhydration
o d) Medication side effect
o Answer: A
o Rationale:
▪ Knowledge: Urine output >30 mL/hr signals improved
perfusion.
▪ Clinical Judgment: Evaluating intervention effectiveness
(NCSBN Step 6: Evaluate Outcomes).
, Scenario 2: Diabetic Hypoglycemia
Case Context: A 58-year-old with type 2 diabetes complains of dizziness. BG:
48 mg/dL.
6. Question: Which symptom is a late sign of hypoglycemia?
o a) Diaphoresis
o b) Confusion
o c) Tremors
o d) Hunger
o Answer: B
o Rationale:
▪ Knowledge: Confusion/seizures indicate severe
hypoglycemia.
▪ Clinical Judgment: Prioritizing neurological threats (NCSBN
Step 3: Prioritize Hypotheses).
7. Question: What is the immediate intervention?
o a) Administer glucagon IM
o b) Provide 4 oz orange juice
o c) Recheck BG in 15 minutes
o d) Start a dextrose IV
o Answer: B
o Rationale:
▪ Knowledge: Conscious patients receive fast-acting carbs.
▪ Clinical Judgment: Rapid response to prevent deterioration
(NCSBN Step 5: Take Action).
8. Question (SATA): Which factors could have contributed to
hypoglycemia?
o a) Skipped meal
