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2025 HESI Exit Critical Thinking Exam Test
Bank | Verified Questions with Rationales |
Graded A+ | Actual Professor-Approved
Version
Question 1
A client with a history of heart failure presents with dyspnea and bilateral crackles. The nurse
notes a heart rate of 110 bpm and BP of 90/60 mmHg. Which action should the nurse prioritize?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Administer IV furosemide as prescribed.
C. Elevate the client’s legs to reduce edema.
D. Encourage deep breathing exercises.
Rationale: The client’s symptoms (dyspnea, crackles, tachycardia, hypotension) indicate acute
heart failure exacerbation with possible pulmonary edema. IV furosemide is the priority to
reduce fluid overload and relieve pulmonary congestion. Oxygen is important but may require
higher flow, leg elevation is contraindicated in pulmonary edema, and deep breathing is
secondary to diuresis.
Question 2
A client post-myocardial infarction reports chest pain unrelieved by nitroglycerin. The nurse
observes ST-segment elevation on the monitor. What is the nurse’s first action?
A. Administer morphine sulfate IV.
B. Notify the healthcare provider immediately.
C. Increase oxygen flow to 4 L/min.
D. Obtain a 12-lead ECG.
Rationale: ST-segment elevation and chest pain unrelieved by nitroglycerin suggest an acute
coronary occlusion requiring urgent intervention (e.g., PCI). Notifying the provider ensures
rapid escalation of care. Morphine, oxygen, and ECG are important but secondary to initiating
emergency response.
Question 3
, 2
A client with type 1 diabetes has a blood glucose of 450 mg/dL and is lethargic. Arterial blood
gas shows pH 7.28, PaCO2 38 mmHg, HCO3 18 mEq/L. What should the nurse anticipate?
A. Administer oral glucose.
B. Provide potassium supplements.
C. Initiate IV insulin infusion.
D. Administer sodium bicarbonate.
Rationale: The client has diabetic ketoacidosis (DKA) (hyperglycemia, lethargy, metabolic
acidosis: pH 7.28, HCO3 18). IV insulin infusion is the primary treatment to correct
hyperglycemia and halt ketoacid production. Glucose is contraindicated, potassium is monitored
but not the first action, and bicarbonate is rarely used unless pH is critically low.
Question 4
A client with a traumatic brain injury has an intracranial pressure (ICP) of 18 mmHg and a mean
arterial pressure (MAP) of 80 mmHg. What is the cerebral perfusion pressure (CPP)?
A. 62 mmHg
B. 98 mmHg
C. 80 mmHg
D. 98 mmHg
Rationale: CPP is calculated as MAP minus ICP: 80 mmHg - 18 mmHg = 62 mmHg. A CPP of
60–100 mmHg is normal; however, this value is borderline low, indicating a need for close
monitoring to prevent cerebral ischemia.
Question 5
A client with sepsis is receiving norepinephrine to maintain MAP >65 mmHg. The nurse notes a
urine output of 10 mL/hr. What should the nurse do next?
A. Increase the norepinephrine dose.
B. Administer a fluid bolus.
C. Notify the healthcare provider.
D. Insert a urinary catheter.
Rationale: Oliguria (10 mL/hr) in sepsis suggests renal hypoperfusion despite vasopressor
support. Notifying the provider is the priority to evaluate the need for fluid resuscitation or
alternative interventions. Increasing norepinephrine may worsen vasoconstriction, a catheter is
likely in place, and fluids require a prescription.
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Question 6
A client with chronic kidney disease is prescribed erythropoietin. What should the nurse monitor
to evaluate its effectiveness?
A. Serum potassium levels.
B. Blood urea nitrogen (BUN).
C. Hemoglobin levels.
D. Serum creatinine levels.
Rationale: Erythropoietin stimulates red blood cell production to treat anemia in CKD.
Hemoglobin levels are monitored to assess effectiveness. Potassium, BUN, and creatinine reflect
kidney function, not erythropoietin response.
Question 7
A client with asthma is prescribed albuterol via nebulizer. After treatment, the nurse notes a heart
rate of 120 bpm and tremors. What should the nurse do?
A. Discontinue the nebulizer treatment.
B. Monitor the client closely.
C. Administer a beta-blocker.
D. Notify the provider immediately.
Rationale: Tachycardia and tremors are common side effects of albuterol, a beta-agonist.
Monitoring closely is appropriate unless symptoms escalate. Discontinuing treatment or
administering a beta-blocker (contraindicated in asthma) is inappropriate, and notification is
unnecessary for expected side effects.
Question 8
A client with a new tracheostomy is coughing and has difficulty speaking. The nurse notes
oxygen saturation of 88%. What is the first action?
A. Suction the tracheostomy.
B. Increase oxygen flow rate.
C. Assess tracheostomy patency.
D. Administer a bronchodilator.
Rationale: Hypoxemia (88%) and coughing suggest possible tracheostomy obstruction.
Assessing patency (e.g., checking for mucus plugs or dislodgement) is the first step. Suctioning
or increasing oxygen may follow, but assessment guides intervention. Bronchodilators are not
indicated without evidence of bronchospasm.
, 4
Question 9
A client with cirrhosis is admitted with hematemesis. The nurse notes a BP of 80/50 mmHg and
a heart rate of 130 bpm. What is the priority intervention?
A. Administer IV proton pump inhibitor.
B. Initiate IV fluid resuscitation.
C. Prepare for endoscopic banding.
D. Administer vitamin K IV.
Rationale: Hematemesis, hypotension, and tachycardia indicate acute variceal bleeding and
hypovolemic shock. IV fluid resuscitation is the priority to restore volume and stabilize
hemodynamics. PPI, banding, and vitamin K are important but secondary to addressing shock.
Question 10
A client with schizophrenia is prescribed clozapine. What is the most critical adverse effect to
monitor?
A. Weight gain.
B. Sedation.
C. Agranulocytosis.
D. Hypertension.
Rationale: Agranulocytosis, a severe reduction in white blood cells, is a life-threatening adverse
effect of clozapine, requiring regular WBC monitoring. Weight gain and sedation are common
but less critical, and hypertension is not typical.
Question 11
A client post-op day 1 after a colectomy has absent bowel sounds and no flatus. What should the
nurse do?
A. Encourage ambulation.
B. Administer a laxative.
C. Continue to monitor.
D. Insert a nasogastric tube.
Rationale: Absent bowel sounds and no flatus on post-op day 1 are expected due to
postoperative ileus. Continued monitoring is appropriate, as bowel function typically returns
within 2–3 days. Ambulation may help later, but laxatives or NG tubes are not indicated without
complications.
2025 HESI Exit Critical Thinking Exam Test
Bank | Verified Questions with Rationales |
Graded A+ | Actual Professor-Approved
Version
Question 1
A client with a history of heart failure presents with dyspnea and bilateral crackles. The nurse
notes a heart rate of 110 bpm and BP of 90/60 mmHg. Which action should the nurse prioritize?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Administer IV furosemide as prescribed.
C. Elevate the client’s legs to reduce edema.
D. Encourage deep breathing exercises.
Rationale: The client’s symptoms (dyspnea, crackles, tachycardia, hypotension) indicate acute
heart failure exacerbation with possible pulmonary edema. IV furosemide is the priority to
reduce fluid overload and relieve pulmonary congestion. Oxygen is important but may require
higher flow, leg elevation is contraindicated in pulmonary edema, and deep breathing is
secondary to diuresis.
Question 2
A client post-myocardial infarction reports chest pain unrelieved by nitroglycerin. The nurse
observes ST-segment elevation on the monitor. What is the nurse’s first action?
A. Administer morphine sulfate IV.
B. Notify the healthcare provider immediately.
C. Increase oxygen flow to 4 L/min.
D. Obtain a 12-lead ECG.
Rationale: ST-segment elevation and chest pain unrelieved by nitroglycerin suggest an acute
coronary occlusion requiring urgent intervention (e.g., PCI). Notifying the provider ensures
rapid escalation of care. Morphine, oxygen, and ECG are important but secondary to initiating
emergency response.
Question 3
, 2
A client with type 1 diabetes has a blood glucose of 450 mg/dL and is lethargic. Arterial blood
gas shows pH 7.28, PaCO2 38 mmHg, HCO3 18 mEq/L. What should the nurse anticipate?
A. Administer oral glucose.
B. Provide potassium supplements.
C. Initiate IV insulin infusion.
D. Administer sodium bicarbonate.
Rationale: The client has diabetic ketoacidosis (DKA) (hyperglycemia, lethargy, metabolic
acidosis: pH 7.28, HCO3 18). IV insulin infusion is the primary treatment to correct
hyperglycemia and halt ketoacid production. Glucose is contraindicated, potassium is monitored
but not the first action, and bicarbonate is rarely used unless pH is critically low.
Question 4
A client with a traumatic brain injury has an intracranial pressure (ICP) of 18 mmHg and a mean
arterial pressure (MAP) of 80 mmHg. What is the cerebral perfusion pressure (CPP)?
A. 62 mmHg
B. 98 mmHg
C. 80 mmHg
D. 98 mmHg
Rationale: CPP is calculated as MAP minus ICP: 80 mmHg - 18 mmHg = 62 mmHg. A CPP of
60–100 mmHg is normal; however, this value is borderline low, indicating a need for close
monitoring to prevent cerebral ischemia.
Question 5
A client with sepsis is receiving norepinephrine to maintain MAP >65 mmHg. The nurse notes a
urine output of 10 mL/hr. What should the nurse do next?
A. Increase the norepinephrine dose.
B. Administer a fluid bolus.
C. Notify the healthcare provider.
D. Insert a urinary catheter.
Rationale: Oliguria (10 mL/hr) in sepsis suggests renal hypoperfusion despite vasopressor
support. Notifying the provider is the priority to evaluate the need for fluid resuscitation or
alternative interventions. Increasing norepinephrine may worsen vasoconstriction, a catheter is
likely in place, and fluids require a prescription.
, 3
Question 6
A client with chronic kidney disease is prescribed erythropoietin. What should the nurse monitor
to evaluate its effectiveness?
A. Serum potassium levels.
B. Blood urea nitrogen (BUN).
C. Hemoglobin levels.
D. Serum creatinine levels.
Rationale: Erythropoietin stimulates red blood cell production to treat anemia in CKD.
Hemoglobin levels are monitored to assess effectiveness. Potassium, BUN, and creatinine reflect
kidney function, not erythropoietin response.
Question 7
A client with asthma is prescribed albuterol via nebulizer. After treatment, the nurse notes a heart
rate of 120 bpm and tremors. What should the nurse do?
A. Discontinue the nebulizer treatment.
B. Monitor the client closely.
C. Administer a beta-blocker.
D. Notify the provider immediately.
Rationale: Tachycardia and tremors are common side effects of albuterol, a beta-agonist.
Monitoring closely is appropriate unless symptoms escalate. Discontinuing treatment or
administering a beta-blocker (contraindicated in asthma) is inappropriate, and notification is
unnecessary for expected side effects.
Question 8
A client with a new tracheostomy is coughing and has difficulty speaking. The nurse notes
oxygen saturation of 88%. What is the first action?
A. Suction the tracheostomy.
B. Increase oxygen flow rate.
C. Assess tracheostomy patency.
D. Administer a bronchodilator.
Rationale: Hypoxemia (88%) and coughing suggest possible tracheostomy obstruction.
Assessing patency (e.g., checking for mucus plugs or dislodgement) is the first step. Suctioning
or increasing oxygen may follow, but assessment guides intervention. Bronchodilators are not
indicated without evidence of bronchospasm.
, 4
Question 9
A client with cirrhosis is admitted with hematemesis. The nurse notes a BP of 80/50 mmHg and
a heart rate of 130 bpm. What is the priority intervention?
A. Administer IV proton pump inhibitor.
B. Initiate IV fluid resuscitation.
C. Prepare for endoscopic banding.
D. Administer vitamin K IV.
Rationale: Hematemesis, hypotension, and tachycardia indicate acute variceal bleeding and
hypovolemic shock. IV fluid resuscitation is the priority to restore volume and stabilize
hemodynamics. PPI, banding, and vitamin K are important but secondary to addressing shock.
Question 10
A client with schizophrenia is prescribed clozapine. What is the most critical adverse effect to
monitor?
A. Weight gain.
B. Sedation.
C. Agranulocytosis.
D. Hypertension.
Rationale: Agranulocytosis, a severe reduction in white blood cells, is a life-threatening adverse
effect of clozapine, requiring regular WBC monitoring. Weight gain and sedation are common
but less critical, and hypertension is not typical.
Question 11
A client post-op day 1 after a colectomy has absent bowel sounds and no flatus. What should the
nurse do?
A. Encourage ambulation.
B. Administer a laxative.
C. Continue to monitor.
D. Insert a nasogastric tube.
Rationale: Absent bowel sounds and no flatus on post-op day 1 are expected due to
postoperative ileus. Continued monitoring is appropriate, as bowel function typically returns
within 2–3 days. Ambulation may help later, but laxatives or NG tubes are not indicated without
complications.
