A HESI exit examcase study will be a scenario with one patient introduced and then a series of related questions. To be successful, it is essential to use clinical judgment to work with information, rather than addressing each question individually. Some students are familiar with the content of nursing, but lose marks by missing details, misunderstanding the patient information or bringing a wrong assumption into the following answers. Rehearsing a standard procedure will enable you to read situations, prioritize, and make better choices with time constraints.
What a Case Study Actually Is
The case study provides a clinical history, symptoms, vital signs and pertinent laboratory information for a patient, and then includes several questions. This scenario has a number of items, so it is important to read carefully.
These questions are easier to handle if you make use of the following principles:
- Shared information: Answer all questions related to the scenario using the information.
- Individual scoring: All the questions are scored separately.
- Applied reasoning:Clinical judgment is more important than rote-learned facts.
The exam known as the HESI Exit Exam or the E2 context is typically administered in the final term of nursing school. It corresponds to the content in the NCLEX test plan, and it can be used to determine readiness for the licensure exam. It is not a nursing license, though, nor can it replace the NCLEX. Look at Mastering HESI critical thinking for extra guidance to improve reasoning skills.
The Question Types Inside a Case
There are multiple types of HESI exit exam questions that can be used in E2 HESI case studies:
- Multiple choice: You are to choose one answer.
- Multiple Response: Select all that apply. Consider every option on its own merits; do not choose options just because they seem sensible.
- Ranking/ordered response: Order actions in the proper sequence.
- Hot spot: Show a particular spot on a picture.
- Fill in the blank: type in a missing answer (may be a calculated value).
The case studies also contain laboratory tables, charts, audio clips or videos in some instances. For a question such as breathing difficulty, for instance, lung sounds, or oxygen saturation may be included.
When replying to any tab or attachment, open all of them. Information from supplements to the chart may alter the analysis of the patient’s condition.
Read the Scenario Once, Properly
Detailed reading of the scenario can save time throughout the entire question set. Skimming might result in you not getting all the information that’s important later.
While reading, come up with four points for your HESI exit exam:
- What: The problem or condition
- Why: The reason for the problem/condition
- Who: Who is the one who is presenting the problem; who is the problem’s victim?
- When: When did the problem start?
- Trend: If the patient has improved, deteriorated or remained stable
- Setting: Emergency Department, Clinic or Hospital unit
Don’t read the questions and then build the situation up at the end. If you read the case study carefully, you will get a common basis for the entire case.
This approach helps to make better clinical judgements since you can relate each question to the actual presentation of the patient rather than assumptions.
Work the Supplemental Data
There are other pieces of evidence, such as E2 laboratory tests, charts, and recordings. Understand them and don’t just learn them by heart.
The range of results is shown on the screen; laboratory ranges may differ, so always refer to the one on the screen for laboratory results. Consider trends as well as individual values. A response to an abnormal result may be different if it is improving, as opposed to a rapidly worsening one.
In charts and tables, look for unusual findings first, before looking at all rows. Listen or watch carefully for audio or video and relate what you hear or see to the case study scenario.
The goal is to include supplemental information with the patient’s story. This assists in decision-making based on clinical judgment and not just the one finding.
Prioritizing Within a Case
If the question is “what should be done first?”: Use nursing priorities:
- Airway, breathing and circulation.
- Patient and environmental safety.
- Needs of the body before the mind and before the teacher.
- Before chronic, stable, there is acute, unstable.
Patients in a bad condition will need more attention than patients in a good condition, especially if the patient is deteriorating. Likewise, in questions that involve a situation where the nurse needs to do something first, a nurse assessment might have to take place before that intervention.
Be sure to read the wording carefully. Prioritize the immediate threats, separate assessment from action and don’t select an intervention before collecting key information. See the site’s existing ADPIE, Maslow and ABCs information for detailed prioritization explanations.
Each Question Stands Alone
An important error in case studies is bringing forward a previous assumption for each of the following questions. Conditions of the patients might change, and each item should be answered according to the available information at that time.
For every question:
- Reconstruct the interpretation based on the given facts.
- Determine if the question is asking for the first answer, best answer, most likely answer or the priority answer.
- Answer the question that is being asked; do not predict the next question.
- Look for assessment and/or intervention.
The ability to re-evaluate the evidence rather than defend an earlier answer is a key aspect of strong clinical judgement. Even if you get something wrong, don’t let that taint the rest of the HESI exit exam case.
Ten Items Don’t Count
There are 10 unscored pilot items that are included in the E2; the E2 is usually said to have 160 questions. These items are included in the assessment, but cannot be reliably identified.
This also applies to a question that is not easily answered and may not count towards your mark. Try not to worry too much about one thing or make it a time-consuming mental battle to make the next thing happen.
Take your best shot, press on and work on the questions one at a time. Confirm your program’s form with your HESI exit exam, as each program could have a different configuration.
Frequently Asked Questions
How many questions are on the HESI exit exam?
The E2 is said to have 160 items, with 10 of these being pilot items (not scored). They will be non-identifiable, so check the setup of your program’s exam.
What types of questions are in a HESI case study?
Multiple-choice, multiple-response, ranking, hot spot and fill-in-the-blank questions can be used in a case study. Laboratory tables, audio or video are included for some items.
What is a passing score on the HESI exit exam?
Each nursing program has its own benchmark requirement. A few programs require around 850, and some around 900. Review the requirement and scoring guidelines written in your program.
Is the HESI exit exam the same as the NCLEX?
No. The E2 is an estimate for when the student will be prepared to take the NCLEX, the actual licensure exam. The HESI exit exam is NOT a licensing exam.
Conclusion
The HESI exit exam is designed to test care and attention to detail, clinical judgment, and prioritizing patient needs. Read each scenario carefully and examine all attachments, returning to the facts for each question and proceed to answer the following after each answer. The following are some useful habits to help you be more confident when taking on case studies. Try an online HESI practice test for extra practice.