HESI Critical Thinking Final Exam
2025/2026 – Verified Scenario Q&A
1. Scenario: 68-year-old male, COPD exacerbation, 50-pack-year history, admitted from
ER. Current vital signs: RR 34, SpO₂ 87% on 2 L/min NC, using accessory muscles,
audible wheezes bilaterally, speaking in 2–3 word sentences. Priority nursing action:
A. Increase oxygen to 6 L/min immediately B. Administer albuterol/ipratropium
nebulizer treatment stat C. Obtain portable chest X-ray D. Apply BiPAP at 10/5 cm H₂O
Correct Answer: BRationale & Judgment: Reversible bronchospasm is the immediate
cause of hypoxia. GOLD 2025 guidelines: SABA + SAMA nebulizer is first-line therapy
before escalating oxygen or NIV in known CO₂ retainers. Increasing O₂ without
bronchodilation risks worsening hypercapnia.
2. Scenario: 28-year-old G2P1, 6 hours postpartum after vaginal delivery, suddenly
complains of severe shortness of breath, tachycardia 124, BP 88/52, SpO₂ 89%. Right
calf is tender with positive Homan’s sign. Most likely diagnosis and immediate action:
A. Pulmonary embolism → Activate rapid response, 100% NRB mask, prepare for
heparin bolus B. Postpartum hemorrhage → Perform fundal massage C. Peripartum
cardiomyopathy → Order urgent echocardiogram D. Anxiety attack → Administer
lorazepam Correct Answer: ARationale: Classic PE presentation in high-risk
postpartum patient. Mortality >50% if untreated in first hour. Rapid response ensures
anticoagulation pathway and possible thrombolysis.
3. Scenario: Shift report: • Rm 301: Post-op day 2, pain 7/10 • Rm 302: New onset 9/10
substernal chest pain, diaphoretic, nausea • Rm 303: Type 1 DM, glucose 380 mg/dL •
Rm 304: Discharge by 1100 First patient to assess: A. Rm 301 B. Rm 302 C. Rm 303
D. Rm 304 Correct Answer: BRationale: Acute coronary syndrome is the only
immediately life-threatening condition (ABC priority).
4. Scenario: 19-year-old type 1 diabetic found unresponsive by roommate. Glucometer 32
mg/dL. Patent 20-gauge IV in place. Best immediate intervention: A. Give oral glucose
gel B. Administer 50 mL of 50% dextrose IV push C. Give glucagon 1 mg IM D. Wait
15 minutes and recheck Correct Answer: BRationale: ADA 2025: IV access present →
D50W is fastest and most reliable route for unconscious hypoglycemia.
5. Scenario: Client 3 hours post-total thyroidectomy reports perioral tingling and hand
cramps. Positive Chvostek and Trousseau signs noted. Priority action: A. Recheck
ionized calcium in 4 hours B. Notify surgeon stat and prepare IV calcium gluconate
at bedside C. Encourage dairy intake D. Apply warm compress to neck Correct
Answer: BRationale: Hypocalcemia → risk of laryngospasm and airway loss. Calcium
gluconate must be immediately available.
6. Scenario: 54-year-old with cirrhosis and massive ascites presents with fever 102.1°F,
diffuse abdominal pain, and new-onset confusion. Most critical diagnostic test to
obtain immediately: A. Abdominal ultrasound with Doppler B. Diagnostic
2025/2026 – Verified Scenario Q&A
1. Scenario: 68-year-old male, COPD exacerbation, 50-pack-year history, admitted from
ER. Current vital signs: RR 34, SpO₂ 87% on 2 L/min NC, using accessory muscles,
audible wheezes bilaterally, speaking in 2–3 word sentences. Priority nursing action:
A. Increase oxygen to 6 L/min immediately B. Administer albuterol/ipratropium
nebulizer treatment stat C. Obtain portable chest X-ray D. Apply BiPAP at 10/5 cm H₂O
Correct Answer: BRationale & Judgment: Reversible bronchospasm is the immediate
cause of hypoxia. GOLD 2025 guidelines: SABA + SAMA nebulizer is first-line therapy
before escalating oxygen or NIV in known CO₂ retainers. Increasing O₂ without
bronchodilation risks worsening hypercapnia.
2. Scenario: 28-year-old G2P1, 6 hours postpartum after vaginal delivery, suddenly
complains of severe shortness of breath, tachycardia 124, BP 88/52, SpO₂ 89%. Right
calf is tender with positive Homan’s sign. Most likely diagnosis and immediate action:
A. Pulmonary embolism → Activate rapid response, 100% NRB mask, prepare for
heparin bolus B. Postpartum hemorrhage → Perform fundal massage C. Peripartum
cardiomyopathy → Order urgent echocardiogram D. Anxiety attack → Administer
lorazepam Correct Answer: ARationale: Classic PE presentation in high-risk
postpartum patient. Mortality >50% if untreated in first hour. Rapid response ensures
anticoagulation pathway and possible thrombolysis.
3. Scenario: Shift report: • Rm 301: Post-op day 2, pain 7/10 • Rm 302: New onset 9/10
substernal chest pain, diaphoretic, nausea • Rm 303: Type 1 DM, glucose 380 mg/dL •
Rm 304: Discharge by 1100 First patient to assess: A. Rm 301 B. Rm 302 C. Rm 303
D. Rm 304 Correct Answer: BRationale: Acute coronary syndrome is the only
immediately life-threatening condition (ABC priority).
4. Scenario: 19-year-old type 1 diabetic found unresponsive by roommate. Glucometer 32
mg/dL. Patent 20-gauge IV in place. Best immediate intervention: A. Give oral glucose
gel B. Administer 50 mL of 50% dextrose IV push C. Give glucagon 1 mg IM D. Wait
15 minutes and recheck Correct Answer: BRationale: ADA 2025: IV access present →
D50W is fastest and most reliable route for unconscious hypoglycemia.
5. Scenario: Client 3 hours post-total thyroidectomy reports perioral tingling and hand
cramps. Positive Chvostek and Trousseau signs noted. Priority action: A. Recheck
ionized calcium in 4 hours B. Notify surgeon stat and prepare IV calcium gluconate
at bedside C. Encourage dairy intake D. Apply warm compress to neck Correct
Answer: BRationale: Hypocalcemia → risk of laryngospasm and airway loss. Calcium
gluconate must be immediately available.
6. Scenario: 54-year-old with cirrhosis and massive ascites presents with fever 102.1°F,
diffuse abdominal pain, and new-onset confusion. Most critical diagnostic test to
obtain immediately: A. Abdominal ultrasound with Doppler B. Diagnostic
