HESI A2 Critical Thinking Excellence 2024/2025 –
Realistic V1–V3 Questions
Introduction
This document provides 80 unique HESI A2 Critical Thinking practice questions, focusing
on clinical judgment, patient safety, delegation, and prioritization. Each question includes
four answer choices, the correct answer marked, and a logical rationale to support nursing
students preparing for the HESI A2 exam (Versions 1–3). The content is formatted for
easy PDF export using LaTeX.
Clinical Judgment (20 Questions)
1. A patient with chest pain is admitted. Which assessment finding requires immediate
action?
A) Blood pressure 140/90 mmHg
B) Heart rate 88 bpm
C) Oxygen saturation 88% (Correct)
D) Temperature 99.2°F
Rationale: Oxygen saturation of 88% indicates hypoxemia, a critical condition
requiring immediate intervention, such as supplemental oxygen, to prevent tissue
damage. The other findings are less urgent.
2. A nurse observes a patient with difficulty breathing. What is the first action?
A) Administer pain medication
B) Check oxygen saturation (Correct)
C) Elevate the legs
D) Offer a glass of water
Rationale: Checking oxygen saturation assesses respiratory status, guiding further
interventions. Pain medication, leg elevation, or water are not priorities for breath-
ing difficulty.
3. A patient reports sudden vision loss in one eye. What should the nurse do first?
A) Notify the physician (Correct)
B) Administer eye drops
C) Cover the eye with a patch
D) Check blood glucose
Rationale: Sudden vision loss is a medical emergency, requiring immediate physi-
cian notification for timely diagnosis and treatment, such as for stroke or retinal
1
, detachment.
4. A patient with diabetes has a blood glucose of 450 mg/dL. What is the priority
action?
A) Administer insulin as ordered (Correct)
B) Offer a high-carbohydrate snack
C) Encourage oral fluids
D) Check blood pressure
Rationale: Hyperglycemia (450 mg/dL) requires insulin to lower blood glucose and
prevent complications like diabetic ketoacidosis. Snacks, fluids, or blood pressure
checks are secondary.
5. A patient with a new cast reports numbness in the toes. What should the nurse
do?
A) Elevate the limb
B) Apply ice to the cast
C) Notify the physician (Correct)
D) Encourage ambulation
Rationale: Numbness suggests possible neurovascular compromise, requiring imme-
diate physician notification to assess for complications like compartment syndrome.
6. A patient with heart failure gains 4 pounds in 24 hours. What is the likely cause?
A) Increased appetite
B) Fluid retention (Correct)
C) Muscle gain
D) Medication side effect
Rationale: Rapid weight gain in heart failure is typically due to fluid retention,
indicating worsening condition. Appetite, muscle gain, or medications are less
likely causes.
7. A patient with a fever of 102°F is shivering. What is the best intervention?
A) Apply a cooling blanket
B) Administer acetaminophen (Correct)
C) Increase room temperature
D) Remove all blankets
Rationale: Acetaminophen reduces fever, addressing the cause of shivering. Cooling
blankets or removing blankets may worsen chills, and room temperature adjustment
is less effective.
8. A patient post-surgery reports severe pain at the incision site. What should the
nurse assess first?
A) Vital signs (Correct)
B) Pain scale rating
C) Incision appearance
D) Last pain medication dose
Rationale: Vital signs assess for systemic issues like infection or shock, which could
accompany severe pain. Pain scale, incision, and medication history are assessed
next.
9. A patient with asthma is wheezing and anxious. What is the priority action?
A) Administer a bronchodilator (Correct)
2
Realistic V1–V3 Questions
Introduction
This document provides 80 unique HESI A2 Critical Thinking practice questions, focusing
on clinical judgment, patient safety, delegation, and prioritization. Each question includes
four answer choices, the correct answer marked, and a logical rationale to support nursing
students preparing for the HESI A2 exam (Versions 1–3). The content is formatted for
easy PDF export using LaTeX.
Clinical Judgment (20 Questions)
1. A patient with chest pain is admitted. Which assessment finding requires immediate
action?
A) Blood pressure 140/90 mmHg
B) Heart rate 88 bpm
C) Oxygen saturation 88% (Correct)
D) Temperature 99.2°F
Rationale: Oxygen saturation of 88% indicates hypoxemia, a critical condition
requiring immediate intervention, such as supplemental oxygen, to prevent tissue
damage. The other findings are less urgent.
2. A nurse observes a patient with difficulty breathing. What is the first action?
A) Administer pain medication
B) Check oxygen saturation (Correct)
C) Elevate the legs
D) Offer a glass of water
Rationale: Checking oxygen saturation assesses respiratory status, guiding further
interventions. Pain medication, leg elevation, or water are not priorities for breath-
ing difficulty.
3. A patient reports sudden vision loss in one eye. What should the nurse do first?
A) Notify the physician (Correct)
B) Administer eye drops
C) Cover the eye with a patch
D) Check blood glucose
Rationale: Sudden vision loss is a medical emergency, requiring immediate physi-
cian notification for timely diagnosis and treatment, such as for stroke or retinal
1
, detachment.
4. A patient with diabetes has a blood glucose of 450 mg/dL. What is the priority
action?
A) Administer insulin as ordered (Correct)
B) Offer a high-carbohydrate snack
C) Encourage oral fluids
D) Check blood pressure
Rationale: Hyperglycemia (450 mg/dL) requires insulin to lower blood glucose and
prevent complications like diabetic ketoacidosis. Snacks, fluids, or blood pressure
checks are secondary.
5. A patient with a new cast reports numbness in the toes. What should the nurse
do?
A) Elevate the limb
B) Apply ice to the cast
C) Notify the physician (Correct)
D) Encourage ambulation
Rationale: Numbness suggests possible neurovascular compromise, requiring imme-
diate physician notification to assess for complications like compartment syndrome.
6. A patient with heart failure gains 4 pounds in 24 hours. What is the likely cause?
A) Increased appetite
B) Fluid retention (Correct)
C) Muscle gain
D) Medication side effect
Rationale: Rapid weight gain in heart failure is typically due to fluid retention,
indicating worsening condition. Appetite, muscle gain, or medications are less
likely causes.
7. A patient with a fever of 102°F is shivering. What is the best intervention?
A) Apply a cooling blanket
B) Administer acetaminophen (Correct)
C) Increase room temperature
D) Remove all blankets
Rationale: Acetaminophen reduces fever, addressing the cause of shivering. Cooling
blankets or removing blankets may worsen chills, and room temperature adjustment
is less effective.
8. A patient post-surgery reports severe pain at the incision site. What should the
nurse assess first?
A) Vital signs (Correct)
B) Pain scale rating
C) Incision appearance
D) Last pain medication dose
Rationale: Vital signs assess for systemic issues like infection or shock, which could
accompany severe pain. Pain scale, incision, and medication history are assessed
next.
9. A patient with asthma is wheezing and anxious. What is the priority action?
A) Administer a bronchodilator (Correct)
2
