BSN 246 HESI Health Assessment: 150 Practice Questions & Answers with Detailed Rationales for the
2026 Update – Essential Review for Nursing Students Preparing for the HESI Exit Exam.
Questions 1–15 (Respiratory & Thoracic – Version 2)
1. A client with severe emphysema has a barrel chest. What is the primary cause of this deformity?
A) Scoliosis
B) Chronic hyperinflation and loss of lung elasticity
C) Pleural effusion
D) Kyphosis
Correct Answer: B) Chronic hyperinflation and loss of lung elasticity
Explanation: Air trapping increases AP diameter → barrel chest. Scoliosis/kyphosis are spinal
deformities.
2. The nurse auscultates fine, late-inspiratory crackles in a client with dyspnea. This is most
consistent with:
A) Asthma
B) Pulmonary fibrosis
C) Chronic bronchitis
D) Pneumothorax
Correct Answer: B) Pulmonary fibrosis
Explanation: Fine, late inspiratory crackles (velcro-like) suggest interstitial lung disease (fibrosis).
Asthma = wheezing.
3. A client’s chest x-ray shows hyperlucent lungs with flat diaphragms. The nurse expects which
assessment finding?
A) Decreased tactile fremitus
B) Increased tactile fremitus
C) Dullness to percussion
D) Bronchial breath sounds
Correct Answer: A) Decreased tactile fremitus
Explanation: Hyperinflation (COPD) decreases vibration transmission. Increased fremitus =
consolidation.
,4. The nurse suspects a tension pneumothorax after chest tube dislodgement. Which finding is
most specific?
A) Hypotension and tracheal deviation
B) Fever and cough
C) Bradypnea
D) Productive cough
Correct Answer: A) Hypotension and tracheal deviation
Explanation: Tension pneumothorax causes hypotension (impaired venous return), tracheal
deviation away from affected side, and JVD.
5. A client has a respiratory rate of 30 with deep, gasping breaths. This pattern is called:
A) Cheyne-Stokes
B) Kussmaul breathing
C) Biot’s breathing
D) Apneustic breathing
Correct Answer: B) Kussmaul breathing
Explanation: Kussmaul = deep, rapid, labored breathing (metabolic acidosis – DKA, renal failure).
Cheyne-Stokes = cyclic.
6. The nurse notes paradoxical chest wall movement (one side moves in during inspiration). This
indicates:
A) Asthma exacerbation
B) Flail chest (multiple rib fractures)
C) Pneumonia
D) Pleural effusion
Correct Answer: B) Flail chest (multiple rib fractures)
Explanation: Paradoxical movement indicates a flail segment. Associated with pulmonary contusion.
7. A post-operative client has decreased breath sounds at the right base. The nurse should first:
A) Call the provider
B) Encourage deep breathing and incentive spirometry
C) Order a chest x-ray
D) Suction the airway
Correct Answer: B) Encourage deep breathing and incentive spirometry
Explanation: Post-op atelectasis is common. Non-invasive interventions first (IS, cough, early mobility).
,8. The nurse hears a grating sound over the chest wall during breathing. This is:
A) Wheeze
B) Pleural friction rub
C) Crackles
D) Stridor
Correct Answer: B) Pleural friction rub
Explanation: Rub is a grating/scratching sound from inflamed pleura (pleurisy, PE, pneumonia). Heard
best at lower lateral chest.
9. A client with a history of smoking has a chronic cough with mucopurulent sputum for 3 months
each year for 2 years. This meets criteria for:
A) Asthma
B) Chronic bronchitis
C) Emphysema
D) Bronchiectasis
Correct Answer: B) Chronic bronchitis
Explanation: Clinical definition: productive cough for ≥3 months in ≥2 consecutive years.
10. The nurse palpates the trachea and finds it shifted to the left. This is most concerning for:
A) Left-sided tension pneumothorax
B) Right-sided tension pneumothorax
C) Atelectasis
D) Normal finding
Correct Answer: B) Right-sided tension pneumothorax
Explanation: Trachea deviates away from tension pneumothorax. Right-sided pneumothorax shifts
trachea to left.
11. A client with pneumonia has egophony (“E” sounds like “A” on auscultation). This occurs due to:
A) Pleural effusion
B) Lung consolidation
C) Bronchospasm
D) Hyperinflation
Correct Answer: B) Lung consolidation
Explanation: Consolidated tissue transmits higher-frequency sounds better, changing “E” to “A.”
, 12. The nurse assesses a client with severe asthma and notes absent breath sounds in the right lung
with no wheezing. This indicates:
A) Improvement
B) Silent chest (impending respiratory failure)
C) Pneumonia
D) Pleural effusion
Correct Answer: B) Silent chest (impending respiratory failure)
Explanation: Silent chest in asthma = severe airflow limitation – no air movement. Emergency!
13. A client’s pulse oximetry is 89% on 2L nasal cannula. The nurse should:
A) Decrease oxygen to 1L
B) Increase oxygen to 4L and reassess
C) Remove oxygen
D) Call respiratory therapy only
Correct Answer: B) Increase oxygen to 4L and reassess
Explanation: Titrate oxygen to maintain SpO2 ≥92% (or per target). Hypoxemia requires escalation.
14. A client with COPD has an SpO2 of 88% on 2L. Which statement indicates understanding of
oxygen therapy?
A) “I should use as much oxygen as possible.”
B) “My oxygen should be titrated to keep my SpO2 at 88-92%.”
C) “High oxygen is always better.”
D) “I only need oxygen at night.”
Correct Answer: B) My oxygen should be titrated to keep my SpO2 at 88-92%
Explanation: COPD target SpO2 88-92% to avoid CO2 retention. High flow can suppress hypoxic drive.
15. The nurse percusses hyperresonance over a client’s right lung. This suggests:
A) Pneumonia
B) Pneumothorax or severe COPD
C) Pleural effusion
D) Lung cancer
Correct Answer: B) Pneumothorax or severe COPD
Explanation: Hyperresonance = increased air (pneumothorax, hyperinflation). Dullness = fluid/mass.
2026 Update – Essential Review for Nursing Students Preparing for the HESI Exit Exam.
Questions 1–15 (Respiratory & Thoracic – Version 2)
1. A client with severe emphysema has a barrel chest. What is the primary cause of this deformity?
A) Scoliosis
B) Chronic hyperinflation and loss of lung elasticity
C) Pleural effusion
D) Kyphosis
Correct Answer: B) Chronic hyperinflation and loss of lung elasticity
Explanation: Air trapping increases AP diameter → barrel chest. Scoliosis/kyphosis are spinal
deformities.
2. The nurse auscultates fine, late-inspiratory crackles in a client with dyspnea. This is most
consistent with:
A) Asthma
B) Pulmonary fibrosis
C) Chronic bronchitis
D) Pneumothorax
Correct Answer: B) Pulmonary fibrosis
Explanation: Fine, late inspiratory crackles (velcro-like) suggest interstitial lung disease (fibrosis).
Asthma = wheezing.
3. A client’s chest x-ray shows hyperlucent lungs with flat diaphragms. The nurse expects which
assessment finding?
A) Decreased tactile fremitus
B) Increased tactile fremitus
C) Dullness to percussion
D) Bronchial breath sounds
Correct Answer: A) Decreased tactile fremitus
Explanation: Hyperinflation (COPD) decreases vibration transmission. Increased fremitus =
consolidation.
,4. The nurse suspects a tension pneumothorax after chest tube dislodgement. Which finding is
most specific?
A) Hypotension and tracheal deviation
B) Fever and cough
C) Bradypnea
D) Productive cough
Correct Answer: A) Hypotension and tracheal deviation
Explanation: Tension pneumothorax causes hypotension (impaired venous return), tracheal
deviation away from affected side, and JVD.
5. A client has a respiratory rate of 30 with deep, gasping breaths. This pattern is called:
A) Cheyne-Stokes
B) Kussmaul breathing
C) Biot’s breathing
D) Apneustic breathing
Correct Answer: B) Kussmaul breathing
Explanation: Kussmaul = deep, rapid, labored breathing (metabolic acidosis – DKA, renal failure).
Cheyne-Stokes = cyclic.
6. The nurse notes paradoxical chest wall movement (one side moves in during inspiration). This
indicates:
A) Asthma exacerbation
B) Flail chest (multiple rib fractures)
C) Pneumonia
D) Pleural effusion
Correct Answer: B) Flail chest (multiple rib fractures)
Explanation: Paradoxical movement indicates a flail segment. Associated with pulmonary contusion.
7. A post-operative client has decreased breath sounds at the right base. The nurse should first:
A) Call the provider
B) Encourage deep breathing and incentive spirometry
C) Order a chest x-ray
D) Suction the airway
Correct Answer: B) Encourage deep breathing and incentive spirometry
Explanation: Post-op atelectasis is common. Non-invasive interventions first (IS, cough, early mobility).
,8. The nurse hears a grating sound over the chest wall during breathing. This is:
A) Wheeze
B) Pleural friction rub
C) Crackles
D) Stridor
Correct Answer: B) Pleural friction rub
Explanation: Rub is a grating/scratching sound from inflamed pleura (pleurisy, PE, pneumonia). Heard
best at lower lateral chest.
9. A client with a history of smoking has a chronic cough with mucopurulent sputum for 3 months
each year for 2 years. This meets criteria for:
A) Asthma
B) Chronic bronchitis
C) Emphysema
D) Bronchiectasis
Correct Answer: B) Chronic bronchitis
Explanation: Clinical definition: productive cough for ≥3 months in ≥2 consecutive years.
10. The nurse palpates the trachea and finds it shifted to the left. This is most concerning for:
A) Left-sided tension pneumothorax
B) Right-sided tension pneumothorax
C) Atelectasis
D) Normal finding
Correct Answer: B) Right-sided tension pneumothorax
Explanation: Trachea deviates away from tension pneumothorax. Right-sided pneumothorax shifts
trachea to left.
11. A client with pneumonia has egophony (“E” sounds like “A” on auscultation). This occurs due to:
A) Pleural effusion
B) Lung consolidation
C) Bronchospasm
D) Hyperinflation
Correct Answer: B) Lung consolidation
Explanation: Consolidated tissue transmits higher-frequency sounds better, changing “E” to “A.”
, 12. The nurse assesses a client with severe asthma and notes absent breath sounds in the right lung
with no wheezing. This indicates:
A) Improvement
B) Silent chest (impending respiratory failure)
C) Pneumonia
D) Pleural effusion
Correct Answer: B) Silent chest (impending respiratory failure)
Explanation: Silent chest in asthma = severe airflow limitation – no air movement. Emergency!
13. A client’s pulse oximetry is 89% on 2L nasal cannula. The nurse should:
A) Decrease oxygen to 1L
B) Increase oxygen to 4L and reassess
C) Remove oxygen
D) Call respiratory therapy only
Correct Answer: B) Increase oxygen to 4L and reassess
Explanation: Titrate oxygen to maintain SpO2 ≥92% (or per target). Hypoxemia requires escalation.
14. A client with COPD has an SpO2 of 88% on 2L. Which statement indicates understanding of
oxygen therapy?
A) “I should use as much oxygen as possible.”
B) “My oxygen should be titrated to keep my SpO2 at 88-92%.”
C) “High oxygen is always better.”
D) “I only need oxygen at night.”
Correct Answer: B) My oxygen should be titrated to keep my SpO2 at 88-92%
Explanation: COPD target SpO2 88-92% to avoid CO2 retention. High flow can suppress hypoxic drive.
15. The nurse percusses hyperresonance over a client’s right lung. This suggests:
A) Pneumonia
B) Pneumothorax or severe COPD
C) Pleural effusion
D) Lung cancer
Correct Answer: B) Pneumothorax or severe COPD
Explanation: Hyperresonance = increased air (pneumothorax, hyperinflation). Dullness = fluid/mass.
