HESI Exit Exam Critical Thinking and Clinical
Judgment Practice Questions
80 Case-Based NCLEX-Style Questions for Exam Preparation
1. Medical-Surgical Nursing Scenarios
1. A 65-year-old patient with chest pain is admitted to the emergency department.
The ECG shows ST elevation, and vital signs are BP 100/60 mmHg, HR 110 bpm,
RR 24/min. What should the nurse do next?
A. Administer nitroglycerin sublingually
B. Notify the healthcare provider immediately
C. Encourage deep breathing exercises
D. Document the findings
Correct Answer: B. Notify the healthcare provider immediately
2. A 50-year-old patient with COPD reports increased dyspnea and wheezing. Oxygen
saturation is 88% on 2 L/min nasal cannula. What should the nurse do next?
A. Increase oxygen to 6 L/min
B. Administer a rescue inhaler as prescribed
C. Place the patient in a supine position
D. Restrict fluid intake
Correct Answer: B. Administer a rescue inhaler as prescribed
3. A 72-year-old patient post-hip replacement reports sudden shortness of breath and
chest pain. Vital signs are BP 130/80 mmHg, HR 120 bpm, RR 28/min. What
should the nurse do next?
A. Encourage ambulation
B. Administer oxygen and notify the provider
C. Apply warm compresses
D. Document the symptoms
Correct Answer: B. Administer oxygen and notify the provider
4. A 45-year-old patient with type 1 diabetes has a blood glucose of 50 mg/dL and is
diaphoretic. What should the nurse do next?
A. Administer insulin
B. Give 15 g of carbohydrates
C. Restrict all fluids
D. Monitor for 30 minutes
Correct Answer: B. Give 15 g of carbohydrates
5. A 60-year-old patient with a history of stroke suddenly develops slurred speech and
right-sided weakness. What should the nurse do next?
A. Reassure the patient
B. Activate the stroke team
C. Administer aspirin
D. Encourage oral fluids
1
, Correct Answer: B. Activate the stroke team
6. A 55-year-old patient with cirrhosis reports abdominal pain and distension. The
nurse notes ascites. What should the nurse do next?
A. Measure abdominal girth
B. Encourage a high-sodium diet
C. Restrict all fluids
D. Administer a diuretic immediately
Correct Answer: A. Measure abdominal girth
7. A 68-year-old patient with heart failure has a weight gain of 3 kg in 2 days and
crackles in the lungs. What should the nurse do next?
A. Restrict oxygen therapy
B. Notify the healthcare provider
C. Encourage high-sodium foods
D. Document the weight
Correct Answer: B. Notify the healthcare provider
8. A 40-year-old patient with rheumatoid arthritis reports severe joint pain and swelling.
What should the nurse do next?
A. Apply cold packs
B. Encourage high-impact exercise
C. Administer analgesics as prescribed
D. Restrict all movement
Correct Answer: C. Administer analgesics as prescribed
9. A 75-year-old patient with a urinary catheter develops fever and cloudy urine. What
should the nurse do next?
A. Irrigate the catheter
B. Obtain a urine culture
C. Restrict fluid intake
D. Document the findings
Correct Answer: B. Obtain a urine culture
10. A 62-year-old patient with atrial fibrillation on warfarin has a nosebleed that won’t
stop. What should the nurse do next?
A. Apply pressure and notify the provider
B. Administer vitamin K
C. Encourage nose blowing
D. Document the episode
Correct Answer: A. Apply pressure and notify the provider
2. Pediatric Nursing Scenarios
11. A 4-year-old child with asthma is wheezing and has an oxygen saturation of 90%.
What should the nurse do next?
A. Administer a bronchodilator as prescribed
B. Encourage oral fluids
C. Place in a supine position
2
Judgment Practice Questions
80 Case-Based NCLEX-Style Questions for Exam Preparation
1. Medical-Surgical Nursing Scenarios
1. A 65-year-old patient with chest pain is admitted to the emergency department.
The ECG shows ST elevation, and vital signs are BP 100/60 mmHg, HR 110 bpm,
RR 24/min. What should the nurse do next?
A. Administer nitroglycerin sublingually
B. Notify the healthcare provider immediately
C. Encourage deep breathing exercises
D. Document the findings
Correct Answer: B. Notify the healthcare provider immediately
2. A 50-year-old patient with COPD reports increased dyspnea and wheezing. Oxygen
saturation is 88% on 2 L/min nasal cannula. What should the nurse do next?
A. Increase oxygen to 6 L/min
B. Administer a rescue inhaler as prescribed
C. Place the patient in a supine position
D. Restrict fluid intake
Correct Answer: B. Administer a rescue inhaler as prescribed
3. A 72-year-old patient post-hip replacement reports sudden shortness of breath and
chest pain. Vital signs are BP 130/80 mmHg, HR 120 bpm, RR 28/min. What
should the nurse do next?
A. Encourage ambulation
B. Administer oxygen and notify the provider
C. Apply warm compresses
D. Document the symptoms
Correct Answer: B. Administer oxygen and notify the provider
4. A 45-year-old patient with type 1 diabetes has a blood glucose of 50 mg/dL and is
diaphoretic. What should the nurse do next?
A. Administer insulin
B. Give 15 g of carbohydrates
C. Restrict all fluids
D. Monitor for 30 minutes
Correct Answer: B. Give 15 g of carbohydrates
5. A 60-year-old patient with a history of stroke suddenly develops slurred speech and
right-sided weakness. What should the nurse do next?
A. Reassure the patient
B. Activate the stroke team
C. Administer aspirin
D. Encourage oral fluids
1
, Correct Answer: B. Activate the stroke team
6. A 55-year-old patient with cirrhosis reports abdominal pain and distension. The
nurse notes ascites. What should the nurse do next?
A. Measure abdominal girth
B. Encourage a high-sodium diet
C. Restrict all fluids
D. Administer a diuretic immediately
Correct Answer: A. Measure abdominal girth
7. A 68-year-old patient with heart failure has a weight gain of 3 kg in 2 days and
crackles in the lungs. What should the nurse do next?
A. Restrict oxygen therapy
B. Notify the healthcare provider
C. Encourage high-sodium foods
D. Document the weight
Correct Answer: B. Notify the healthcare provider
8. A 40-year-old patient with rheumatoid arthritis reports severe joint pain and swelling.
What should the nurse do next?
A. Apply cold packs
B. Encourage high-impact exercise
C. Administer analgesics as prescribed
D. Restrict all movement
Correct Answer: C. Administer analgesics as prescribed
9. A 75-year-old patient with a urinary catheter develops fever and cloudy urine. What
should the nurse do next?
A. Irrigate the catheter
B. Obtain a urine culture
C. Restrict fluid intake
D. Document the findings
Correct Answer: B. Obtain a urine culture
10. A 62-year-old patient with atrial fibrillation on warfarin has a nosebleed that won’t
stop. What should the nurse do next?
A. Apply pressure and notify the provider
B. Administer vitamin K
C. Encourage nose blowing
D. Document the episode
Correct Answer: A. Apply pressure and notify the provider
2. Pediatric Nursing Scenarios
11. A 4-year-old child with asthma is wheezing and has an oxygen saturation of 90%.
What should the nurse do next?
A. Administer a bronchodilator as prescribed
B. Encourage oral fluids
C. Place in a supine position
2
