Free HESI A2 Exam Practice Test

Sample HESI A2 practice questions

Try a few representative questions below. Each includes the correct answer and a short explanation — the same style you'll see in the full practice test.

1. Question 1Pharmacology & Renal Function

   A nurse is caring for a patient with a new diagnosis of type 2 diabetes mellitus. The patient is prescribed metformin 1000 mg PO BID. The patient's current lab results show an eGFR of 45 mL/min/1.73m². Based on the KDIGO guidelines, what is the most appropriate nursing action regarding the metformin prescription?

   • A.Hold metformin and consult the provider to discuss alternative antidiabetic agents or dose adjustment.(Correct)
   • B.Continue metformin as prescribed, as the eGFR is still within acceptable limits for this medication.
   • C.Administer only half the prescribed dose of metformin and educate the patient on potential side effects.
   • D.Administer the prescribed dose of metformin but monitor renal function more frequently.

   Explanation

   Metformin is contraindicated in patients with an eGFR below 30 mL/min/1.73m² and requires dose adjustment or discontinuation in those with an eGFR between 30-45 mL/min/1.73m². Since this patient's eGFR is 45, it is prudent to hold the medication and consult the provider for potential adjustment or alternative therapies, as the risk of lactic acidosis increases with declining renal function.

2. Question 2Medication Administration & Safety

   A nurse is preparing to administer an IV infusion of a medication that has a known risk of extravasation. The prescribed dose is 500 mg in 250 mL D5W to infuse over 30 minutes. The medication's recommended dilution is 2 mg/mL. The patient has a palpable radial pulse of 80 bpm, BP 110/70 mmHg, and capillary refill of 3 seconds in the affected extremity. What is the most critical nursing intervention to prevent extravasation?

   • A.Monitor the IV site for signs of infiltration and have a phentolamine mesylate antidote readily available.
   • B.Use a central venous catheter for medication administration to ensure rapid dilution.
   • C.Ensure the IV site is patent and flush the line with normal saline before and after administration.(Correct)
   • D.Administer the medication via a slower infusion rate to reduce pressure on the vein.

   Explanation

   Ensuring the IV site is patent and flushing the line before and after administration are crucial steps to confirm patency and remove residual medication, minimizing the risk of extravasation. A delayed capillary refill (3 seconds) suggests potential compromised perfusion, making careful site assessment paramount.

3. Question 3Cardiovascular Emergencies

   A 65-year-old male patient with a history of hypertension, hyperlipidemia, and a recent myocardial infarction is admitted with acute decompensated heart failure (ADHF). His current medications include lisinopril, atorvastatin, and aspirin. Upon assessment, he is dyspneic, has bilateral crackles to the mid-scapular line, and peripheral edema. His BNP is elevated at 1200 pg/mL. Which of the following is the priority pharmacological intervention for this patient?

   • A.Initiate an intravenous infusion of dobutamine.
   • B.Increase the dose of lisinopril.
   • C.Administer a loading dose of clopidogrel.
   • D.Administer a bolus of intravenous furosemide.(Correct)

   Explanation

   The priority intervention for ADHF with signs of volume overload (dyspnea, crackles, edema, elevated BNP) is to rapidly remove excess fluid. Intravenous furosemide, a loop diuretic, is the first-line treatment to achieve diuresis and reduce preload, thereby improving symptoms.

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