Hesi Health Assessment
Questions And Answers
2024
, What is the most important assessment for the nurse to conduct following
the administration of epidural anesthesia to a client who is at 40-weeks
gestation?
A. Maternal blood pressure
B. Level of pain sensation
C. Station of preseneting part
D. Variability of fetal heart rate - ans A. Maternal blood pressure
The nurse observes that a client is experiencing melena. What serum
laboratory test should the nurse monitor in response to this finding?
A. White blood cell count WBC
B. Blood urea nitrogen BUN
C. Glucose
D. Hematocrit - ans A. White blood cell count
The nurse is performing a cranial nerve exam on an 87-year-old client. The
nurse notes that the client has a reduced upward gaze, a decreased corneal
reflex, a high frequency hearing loss, and a reduced gag reflex. What action
should the nurse take next?
A. Continue the assessment of the next pairs of cranial nerves
B. Assess the spinal reflexes for demyelination symptoms
C. Implement neural vital signs every 2 hours to detect Cushing's Triad
D. Review past history for any episodes of a cerebral cortex lesion - ans C.
Implement neural vital signs every 2 hours to detect Cushing's Triad
The nurse assesses a male client who is brought to the ED by his family
who believe he is having a heart attack. Which finding is the best indicator
that a client is experiencing an acute coronary syndrome (ACS)?
A. Chest pain that intensifies upon chest excursion
B. Localized sternal border pain intensified by palpation
C. Pain in the neck, jaw, or medial side of the left arm
D. Anterior thorax pain that radiates between the scapulae - ans C. Pain in
the neck, jaw, or medial side of the left arm
Questions And Answers
2024
, What is the most important assessment for the nurse to conduct following
the administration of epidural anesthesia to a client who is at 40-weeks
gestation?
A. Maternal blood pressure
B. Level of pain sensation
C. Station of preseneting part
D. Variability of fetal heart rate - ans A. Maternal blood pressure
The nurse observes that a client is experiencing melena. What serum
laboratory test should the nurse monitor in response to this finding?
A. White blood cell count WBC
B. Blood urea nitrogen BUN
C. Glucose
D. Hematocrit - ans A. White blood cell count
The nurse is performing a cranial nerve exam on an 87-year-old client. The
nurse notes that the client has a reduced upward gaze, a decreased corneal
reflex, a high frequency hearing loss, and a reduced gag reflex. What action
should the nurse take next?
A. Continue the assessment of the next pairs of cranial nerves
B. Assess the spinal reflexes for demyelination symptoms
C. Implement neural vital signs every 2 hours to detect Cushing's Triad
D. Review past history for any episodes of a cerebral cortex lesion - ans C.
Implement neural vital signs every 2 hours to detect Cushing's Triad
The nurse assesses a male client who is brought to the ED by his family
who believe he is having a heart attack. Which finding is the best indicator
that a client is experiencing an acute coronary syndrome (ACS)?
A. Chest pain that intensifies upon chest excursion
B. Localized sternal border pain intensified by palpation
C. Pain in the neck, jaw, or medial side of the left arm
D. Anterior thorax pain that radiates between the scapulae - ans C. Pain in
the neck, jaw, or medial side of the left arm
