Exam Instructions
Format: This exam contains multiple case studies representing HESI-style clinical
scenarios. Each case study is followed by questions that assess clinical judgment,
including recognizing cues, a
...
Exam Instructions
Format: This exam contains multiple case studies representing HESI-style clinical
scenarios. Each case study is followed by questions that assess clinical judgment,
including recognizing cues, analyzing information, prioritizing hypotheses,
generating solutions, taking actions, and evaluating outcomes.
Time: Take this exam in a quiet environment, allowing approximately 3-4 hours
for completion.
Question Types: Multiple choice, select all that apply, ordered response,
matrix/grid, and bow-tie formats.
Case Study 1: Adult Medical-Surgical – Pneumonia with
Complication
Scenario: Margaret Chen, a 72-year-old female, presents to the emergency department
with fever, productive cough of green sputum, and shortness of breath for the past 4
days. She reports fatigue, unintentional weight loss of 8 pounds over the past month,
and intermittent palpitations. Medical history includes hypertension and osteoarthritis.
Medications: lisinopril 10 mg daily, ibuprofen 400 mg PRN. Vital signs: BP 148/90, HR
126, RR 28, SpO2 91% on room air, temperature 102.2°F (39.0°C). Physical assessment
reveals crackles in right lower lobe, tachycardia, and diaphoresis.
Question 1 (Recognize Cues)
The nurse reviews the initial assessment data. Which findings are most concerning and
require immediate follow-up? (Select all that apply.)
A. Heart rate 126 bpm
B. Temperature 102.2°F (39.0°C)
C. Oxygen saturation 91% on room air
D. Weight loss of 8 pounds over past month
E. Productive cough with green sputum
F. Crackles in right lower lobe
Answer & Rationale: A, C. Tachycardia (126 bpm) (A) indicates physiologic stress and
may signal impending sepsis or cardiac decompensation. Hypoxemia (SpO2 91%) (C)
indicates inadequate oxygenation requiring immediate intervention. Fever (B) and
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