HESI RN Health Assessment Exam V2
ACTUAL EXAM 2026/2027 | HESI
Health Assessment | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: General Survey & Vital Signs (Questions 1–8)
Q1: The nurse is performing a general survey on a newly admitted patient. Which finding should the
nurse consider a priority to investigate further?
A. The patient appears older than their stated age.
B. The patient is wearing a sweater despite the room temperature being 72°F.
C. The patient’s posture is stooped and guarding their abdomen.
D. The patient maintains persistent eye contact without blinking.
Correct Answer: C
Rationale: A stooped posture with guarding of the abdomen suggests acute pain or distress, which could
indicate an abdominal emergency (e.g., peritonitis) requiring immediate intervention. Option A is
subjective and often related to lifestyle/genetics. Option B may indicate a cold intolerance (e.g.,
hypothyroidism) but is not an acute emergency. Option D may be culturally based or related to anxiety,
but does not indicate immediate physical instability like guarding.
Q2: The nurse is measuring vital signs on a 72-year-old patient. Which age-related change requires the
nurse to adjust assessment techniques or interpretation?
A. Increased elasticity of arterial walls leading to lower blood pressure.
B. Decreased thoracic expansion resulting in shallow respirations.
C. Orthostatic hypotension due to decreased baroreceptor sensitivity.
,D. Increased basal metabolic rate leading to tachycardia.
Correct Answer: C
Rationale: Older adults experience a stiffening of the baroreceptors, leading to a blunted response to
position changes, which causes orthostatic hypotension. The nurse should allow the patient to sit up
slowly and dangle legs before standing. Option A is incorrect; arterial walls stiffen (arteriosclerosis),
leading to increased systolic BP. Option B is a musculoskeletal change but doesn't typically alter the
fundamental technique of counting respirations. Option D is incorrect; BMR decreases with age, often
leading to a lower heart rate.
Q3: Exhibit Question
The nurse reviews the following vital signs documented in the electronic health record for a 68-year-old
male:
Blood Pressure: 168/90 mmHg
Heart Rate: 88 bpm and irregular
Respiratory Rate: 22 breaths/min
Temperature: 99.2°F (oral)
Oxygen Saturation: 94% on room air
Based on the exhibit, which finding is the most critical for the nurse to report to the provider
immediately?
A. Blood Pressure of 168/90 mmHg.
B. Heart Rate of 88 bpm and irregular.
C. Respiratory Rate of 22 breaths/min.
D. Oxygen Saturation of 94%.
Correct Answer: B
Rationale: An irregular heart rate in an older adult suggests Atrial Fibrillation, which places the patient at
high risk for stroke and embolic events. While the BP is elevated (Stage 2 Hypertension), it is chronic in
, nature. The irregularity indicates a new potential arrhythmia requiring immediate confirmation via ECG.
RR of 22 is slightly elevated but stable. SpO2 of 94% is on the lower border of normal for an older adult
but not an emergency.
Q4: The nurse is assessing a patient’s pain using the PQRST method. Which question addresses the "R"
component of the assessment?
A. "Does the pain feel sharp or burning?"
B. "What were you doing when the pain started?"
C. "Does the pain move anywhere else?"
D. "How does the pain affect your daily activities?"
Correct Answer: C
Rationale: The "R" in PQRST stands for Region/Radiation. Asking if the pain moves elsewhere assesses
radiation. Option A assesses Quality (Q). Option B assesses Provocation/Palliation (P) or Onset. Option D
assesses Severity (S) or impact on quality of life.
Q5: Select All That Apply (SATA) The nurse is assessing a patient for orthostatic hypotension. Which
steps are essential to performing this assessment correctly?
A. Measure the blood pressure and pulse in the supine position immediately after the patient stands up.
[CORRECT] -> Incorrect step. You measure supine, then stand, then measure standing.
B. Have the patient rest in the supine position for at least 3 minutes before taking the initial reading.
[CORRECT]
C. Instruct the patient to change positions quickly to stimulate the baroreceptors.
D. Measure blood pressure and pulse immediately after the patient stands up, and again after 1 to 3
minutes. [CORRECT]
E. Document a drop in systolic BP of 20 mmHg or more as a positive finding. [CORRECT]
Correct Answers: B, D, E
Rationale:
ACTUAL EXAM 2026/2027 | HESI
Health Assessment | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: General Survey & Vital Signs (Questions 1–8)
Q1: The nurse is performing a general survey on a newly admitted patient. Which finding should the
nurse consider a priority to investigate further?
A. The patient appears older than their stated age.
B. The patient is wearing a sweater despite the room temperature being 72°F.
C. The patient’s posture is stooped and guarding their abdomen.
D. The patient maintains persistent eye contact without blinking.
Correct Answer: C
Rationale: A stooped posture with guarding of the abdomen suggests acute pain or distress, which could
indicate an abdominal emergency (e.g., peritonitis) requiring immediate intervention. Option A is
subjective and often related to lifestyle/genetics. Option B may indicate a cold intolerance (e.g.,
hypothyroidism) but is not an acute emergency. Option D may be culturally based or related to anxiety,
but does not indicate immediate physical instability like guarding.
Q2: The nurse is measuring vital signs on a 72-year-old patient. Which age-related change requires the
nurse to adjust assessment techniques or interpretation?
A. Increased elasticity of arterial walls leading to lower blood pressure.
B. Decreased thoracic expansion resulting in shallow respirations.
C. Orthostatic hypotension due to decreased baroreceptor sensitivity.
,D. Increased basal metabolic rate leading to tachycardia.
Correct Answer: C
Rationale: Older adults experience a stiffening of the baroreceptors, leading to a blunted response to
position changes, which causes orthostatic hypotension. The nurse should allow the patient to sit up
slowly and dangle legs before standing. Option A is incorrect; arterial walls stiffen (arteriosclerosis),
leading to increased systolic BP. Option B is a musculoskeletal change but doesn't typically alter the
fundamental technique of counting respirations. Option D is incorrect; BMR decreases with age, often
leading to a lower heart rate.
Q3: Exhibit Question
The nurse reviews the following vital signs documented in the electronic health record for a 68-year-old
male:
Blood Pressure: 168/90 mmHg
Heart Rate: 88 bpm and irregular
Respiratory Rate: 22 breaths/min
Temperature: 99.2°F (oral)
Oxygen Saturation: 94% on room air
Based on the exhibit, which finding is the most critical for the nurse to report to the provider
immediately?
A. Blood Pressure of 168/90 mmHg.
B. Heart Rate of 88 bpm and irregular.
C. Respiratory Rate of 22 breaths/min.
D. Oxygen Saturation of 94%.
Correct Answer: B
Rationale: An irregular heart rate in an older adult suggests Atrial Fibrillation, which places the patient at
high risk for stroke and embolic events. While the BP is elevated (Stage 2 Hypertension), it is chronic in
, nature. The irregularity indicates a new potential arrhythmia requiring immediate confirmation via ECG.
RR of 22 is slightly elevated but stable. SpO2 of 94% is on the lower border of normal for an older adult
but not an emergency.
Q4: The nurse is assessing a patient’s pain using the PQRST method. Which question addresses the "R"
component of the assessment?
A. "Does the pain feel sharp or burning?"
B. "What were you doing when the pain started?"
C. "Does the pain move anywhere else?"
D. "How does the pain affect your daily activities?"
Correct Answer: C
Rationale: The "R" in PQRST stands for Region/Radiation. Asking if the pain moves elsewhere assesses
radiation. Option A assesses Quality (Q). Option B assesses Provocation/Palliation (P) or Onset. Option D
assesses Severity (S) or impact on quality of life.
Q5: Select All That Apply (SATA) The nurse is assessing a patient for orthostatic hypotension. Which
steps are essential to performing this assessment correctly?
A. Measure the blood pressure and pulse in the supine position immediately after the patient stands up.
[CORRECT] -> Incorrect step. You measure supine, then stand, then measure standing.
B. Have the patient rest in the supine position for at least 3 minutes before taking the initial reading.
[CORRECT]
C. Instruct the patient to change positions quickly to stimulate the baroreceptors.
D. Measure blood pressure and pulse immediately after the patient stands up, and again after 1 to 3
minutes. [CORRECT]
E. Document a drop in systolic BP of 20 mmHg or more as a positive finding. [CORRECT]
Correct Answers: B, D, E
Rationale:
