Health Assessment HESI Elsevier| 311 questions| with
complete solutions
SOAP modified format Correct Answer: Subjective
Objective
Assessment
Plan
What is the correct order for vital signs Correct Answer: T, P, RR, BP, extremity, pt position,
SPO2
Normal oral temp range Correct Answer: 96.4 - 99.1 F
Febrile Correct Answer: With fever
Afebrile Correct Answer: Without fever
Hyperthermia symptoms Correct Answer: 1) Cessation of shivering
2) Bradycardia
3) Decrease in respiratory minute volume
What is the least accurate method of assessing temperature Correct Answer: axillary
Which patients are contraindicated for rectal temperature readings Correct Answer: Patients
with increased HR
Pulse deficit Correct Answer: - Difference between apical peripheral pulse
Pulse amplitude scale Correct Answer: 0 = no pulse
1 = diminished, weak
2 = normal and expected
3 = full or strong
4 = bounding
Which pulses are assessed during a routine physical assessment? Correct Answer: 1) Apical
2) Radial
3) Dorsalis pedis
4) Posterior tibialis
Normal heart rate in resting adult Correct Answer: 60 to 100 bpm
When is it normal for someone to have a rapid heart rate over 100 bpm Correct Answer:
Someone with anxiety and right after exercise
Eupnea Correct Answer: Normal RR, rhythm and depth
,Normal SPO2 value Correct Answer: 95-100%
What level is poor oxygenation Correct Answer: below 90%
Systolic BP Correct Answer: Maximum pressure on the artery during ventricular contraction
Diastolic BP Correct Answer: Resting pressure during ventricular filling
Pulse pressure Correct Answer: Difference between systolic and diastolic
Stroke volume Correct Answer: Amount of blood ejected with each beat
How does age affect BP Correct Answer: BP increases with age
What BP is pre hypertensive? Correct Answer: BP over 120/80
What extremities should you avoid taking a BP in Correct Answer: Extremities with IV lines,
invasive lines, history of mastectomy/lymph node issues
Orthostatic hypertension Correct Answer: - Decreased BP with change in position
- Drop in SBP of 25 mmHg or DBP of 10 mmHG
- Symptoms
1) Dizziness
2) Weakness
3) Blurred vision
4) Syncope
5) Changes in BP/HR
- Causes
1) Hypovolemia
2) Impaired vasoconstriction
3) Medications
What is the main objective of the health history Correct Answer: - To gather accurate
information to provide immediate care
- Establish rapport with the client
What questions should you begin with for a health history interview Correct Answer: Open
ended questions
Approaching Sensitive Issues Correct Answer: - Use language that is understandable.
- Do not apologize for broaching the issue.
- Ensure privacy.
- Be direct and firm.
- Do not preach.
- Do not push too hard.
,CAGE questionnaire
alcohol Correct Answer: Cutting down
Annoyance
Guilty feeling
Eye-openers
- Helps diagnose alcoholism
TACE questionnaire Correct Answer: T - how many drinks does it TAKE to make you feel right
A - Have people ANNOYED you by criticizing your drinking
C - Have you felt you out to cut down on your drinking
E - Have you had an EYE -OPENER first thing in the morning
CRAFFT questionnaire Correct Answer: - Screening tool for alcohol and substance abuse in
adolescents
Car
Relax
Alone
Forget
Friends
Trouble
HITS questionnaire Correct Answer: The wording of the question is "In the last year how often
did your partner:
1) Hurt you physically?"
2) Insult or talk down to you?"
3) Threaten you with physical harm?"
4) Scream or curse at you?"
FICA Correct Answer: Faith
Importance and Influence
Community
Address/action in care
Format of interview Correct Answer: Chief Complain
History of Present Illness
Past medical history
Past surgical history
Family history
Social History
Review of Systems
Past medical history Correct Answer: 1) Allergies
2) Childhood and adult illnesses
3) Immunizations
, 4) Diagnostic and lab results
Symptom analysis tool Correct Answer: OLDCARTS
Onset,
Location/radiation,
Duration, Character,
Aggrevating factors,
Reliving factors,
Timing and Severity
Complete history is done when? Correct Answer: Most often recorded the first time you see the
patient
Problem (or focused) history Correct Answer: Taken when a problem is acute so that only the
need of the moment is given full attention
Interim history Correct Answer: - Designed to chronicle events that have occurred since your
last meeting with the patient
- Substance determined by nature of problem and need of the moment
- Should always be complemented by the patient's previous medical record
Transduction of pain Correct Answer: Action potential moves to the spinal cord
Transmission of pain Correct Answer: Pain impulse moves from spinal cord to the brain
Modulation of pain Correct Answer: Neurons from the brain stem release neurotransmitters that
block the pain impulse
Steps in pain Correct Answer: 1) Noxious stimuli and transduction
2) Transmission
3) Perception of pain
4) Modulation
Neuropathic pain Correct Answer: - Pain within nervous system
- Abnormal processing of pain from nerve fibers
- Often chronic
Visceral pain Correct Answer: - Originates from larger internal organs
- Often described as crampy
- Physical pain based on site of organ
Somatic pain Correct Answer: Originates from MS system
Referred pain Correct Answer: Pain is felt from a different site other than where it originates
complete solutions
SOAP modified format Correct Answer: Subjective
Objective
Assessment
Plan
What is the correct order for vital signs Correct Answer: T, P, RR, BP, extremity, pt position,
SPO2
Normal oral temp range Correct Answer: 96.4 - 99.1 F
Febrile Correct Answer: With fever
Afebrile Correct Answer: Without fever
Hyperthermia symptoms Correct Answer: 1) Cessation of shivering
2) Bradycardia
3) Decrease in respiratory minute volume
What is the least accurate method of assessing temperature Correct Answer: axillary
Which patients are contraindicated for rectal temperature readings Correct Answer: Patients
with increased HR
Pulse deficit Correct Answer: - Difference between apical peripheral pulse
Pulse amplitude scale Correct Answer: 0 = no pulse
1 = diminished, weak
2 = normal and expected
3 = full or strong
4 = bounding
Which pulses are assessed during a routine physical assessment? Correct Answer: 1) Apical
2) Radial
3) Dorsalis pedis
4) Posterior tibialis
Normal heart rate in resting adult Correct Answer: 60 to 100 bpm
When is it normal for someone to have a rapid heart rate over 100 bpm Correct Answer:
Someone with anxiety and right after exercise
Eupnea Correct Answer: Normal RR, rhythm and depth
,Normal SPO2 value Correct Answer: 95-100%
What level is poor oxygenation Correct Answer: below 90%
Systolic BP Correct Answer: Maximum pressure on the artery during ventricular contraction
Diastolic BP Correct Answer: Resting pressure during ventricular filling
Pulse pressure Correct Answer: Difference between systolic and diastolic
Stroke volume Correct Answer: Amount of blood ejected with each beat
How does age affect BP Correct Answer: BP increases with age
What BP is pre hypertensive? Correct Answer: BP over 120/80
What extremities should you avoid taking a BP in Correct Answer: Extremities with IV lines,
invasive lines, history of mastectomy/lymph node issues
Orthostatic hypertension Correct Answer: - Decreased BP with change in position
- Drop in SBP of 25 mmHg or DBP of 10 mmHG
- Symptoms
1) Dizziness
2) Weakness
3) Blurred vision
4) Syncope
5) Changes in BP/HR
- Causes
1) Hypovolemia
2) Impaired vasoconstriction
3) Medications
What is the main objective of the health history Correct Answer: - To gather accurate
information to provide immediate care
- Establish rapport with the client
What questions should you begin with for a health history interview Correct Answer: Open
ended questions
Approaching Sensitive Issues Correct Answer: - Use language that is understandable.
- Do not apologize for broaching the issue.
- Ensure privacy.
- Be direct and firm.
- Do not preach.
- Do not push too hard.
,CAGE questionnaire
alcohol Correct Answer: Cutting down
Annoyance
Guilty feeling
Eye-openers
- Helps diagnose alcoholism
TACE questionnaire Correct Answer: T - how many drinks does it TAKE to make you feel right
A - Have people ANNOYED you by criticizing your drinking
C - Have you felt you out to cut down on your drinking
E - Have you had an EYE -OPENER first thing in the morning
CRAFFT questionnaire Correct Answer: - Screening tool for alcohol and substance abuse in
adolescents
Car
Relax
Alone
Forget
Friends
Trouble
HITS questionnaire Correct Answer: The wording of the question is "In the last year how often
did your partner:
1) Hurt you physically?"
2) Insult or talk down to you?"
3) Threaten you with physical harm?"
4) Scream or curse at you?"
FICA Correct Answer: Faith
Importance and Influence
Community
Address/action in care
Format of interview Correct Answer: Chief Complain
History of Present Illness
Past medical history
Past surgical history
Family history
Social History
Review of Systems
Past medical history Correct Answer: 1) Allergies
2) Childhood and adult illnesses
3) Immunizations
, 4) Diagnostic and lab results
Symptom analysis tool Correct Answer: OLDCARTS
Onset,
Location/radiation,
Duration, Character,
Aggrevating factors,
Reliving factors,
Timing and Severity
Complete history is done when? Correct Answer: Most often recorded the first time you see the
patient
Problem (or focused) history Correct Answer: Taken when a problem is acute so that only the
need of the moment is given full attention
Interim history Correct Answer: - Designed to chronicle events that have occurred since your
last meeting with the patient
- Substance determined by nature of problem and need of the moment
- Should always be complemented by the patient's previous medical record
Transduction of pain Correct Answer: Action potential moves to the spinal cord
Transmission of pain Correct Answer: Pain impulse moves from spinal cord to the brain
Modulation of pain Correct Answer: Neurons from the brain stem release neurotransmitters that
block the pain impulse
Steps in pain Correct Answer: 1) Noxious stimuli and transduction
2) Transmission
3) Perception of pain
4) Modulation
Neuropathic pain Correct Answer: - Pain within nervous system
- Abnormal processing of pain from nerve fibers
- Often chronic
Visceral pain Correct Answer: - Originates from larger internal organs
- Often described as crampy
- Physical pain based on site of organ
Somatic pain Correct Answer: Originates from MS system
Referred pain Correct Answer: Pain is felt from a different site other than where it originates
