HESI EXAM QUESTIONS HEALTH ASSESSMENT
A woman has come to the clinic to seek help with a substance abuse problem.
She admits to using cocaine just before arriving. Which of these assessment
findings would the nurse expect to find when examining this woman?
Somnolence.
Pacing.
Apathy.
Constricted pupils.
Pacing
Which assessment finding is not concerning for an older patient?
Increasing pain
Cannot remember home address
Heart rate of 122
Unlabored but shallow breathing
Unlabored but shallow breaths
Nurse Aryonna is percussing an adult patient's lung fields and hears
"hyperresonance". This patient has a history of COPD, heart disease, anxiety, and
acute pancreatitis. Nurse Aryonna understands that
This would be a normal finding for this patient
This is a normal finding depending upon the percussion technique used by the
provider
This is an abnormal finding as hyperresonance is only heard in children
This is an abnormal finding as hyper resonance should only be heard in the
abdomen
This would be a normal finding for this patient
A nurse is assisting a client with orthostatic hypotension. He suspects the
dosage of the patients new antihypertensive medication is too high. What data
should he collect next to confirm this?
A blood pressure every 5 minutes
LOC after the patient stands up
Respirations to ensure the patient is not experiencing hypoventilation
Patients height and weight
Patients height and weight
During percussion of a patient's abdomen, the nurse notes a drumlike quality of
the sounds across the quadrants. This type of sound indicates:
Air-filled areas.
Presence of dense organs.
Presence of a tumor.
Constipation.
,Air-filled areas.
A nurse is assessing four patients today. Which patients would the nurse expect
to see lordosis? Select all that apply.
A 67 year old man who was diagnosed with COPD 4 years ago and continues to
smoke
A toddler recently diagnosed with Diabetes Mellitus
You Answered
A 59 year old woman who recently fell and is experiencing hip and back pain
A woman pregnant with her first child who is experiencing high blood pressure
A toddler recently diagnosed with Diabetes Mellitus
A woman pregnant with her first child who is experiencing high blood pressure
Before auscultating a client's abdomen for the presence of bowel sounds, the
nurse should:
Auscultate over a tightly pulled gown to ensure the patient does not get chilled.
Check the temperature of the room and ensure the patient is warm.
Ensure that the bell side of the stethoscope is turned to the "on" position.
Warm the endpiece of the stethoscope by placing it in warm water.
Check the temperature of the room and ensure the patient is warm.
Hugh has brought his wife Dorthy in for Mental Status Exam. Dorthy's husband
tells you that her memory problems have been going on for about 6 months. She
often tells long stories about her day-to-day activities, and he knows she is not
telling the truth. She also forgets the names of things. For example, when she
wants a key, she asks her husband "Give me that thing you open the door with."
What is Dorthy experiencing? Select all that apply.
Echolalia
Flight of Ideas
Word Salad
Neologism
Confabulation
Circumlocution
Confabulation
Circumlocution
When assessing a client's radial pulse, what should the nurse recall about the
pulse force?
Full/bounding pulses are common with fluid volume deficit.
Pulse force is typically recorded on a 0- to 2-point scale
A pulse should be palpated for a full minute to properly assess the pulse force.
Pulse force is a reflection of the heart's stroke volume.
Pulse force is a reflection of the heart's stroke volume.
The nurse is preparing to perform a physical assessment. Which statement
describes best practice?
,The nurse follows the same sequence for patients of all ages and conditions.
The nurse examines painful areas first to get it out of the way.
The nurse performs the examination from the left, right, head, and foot of the bed.
The nurse organizes the exam to ensure the patient doesn't change positions too
much.
The nurse organizes the exam to ensure the patient doesn't change positions too much.
The nurse is administering a Mini-Cog test to a 72-year-old woman presenting for
a well check. The patient draws a clock with an incorrect time and is able to recall
only one word. This result suggests which finding?
Psychiatric illness.
This is a normal finding for older adults.
Attention disorder.
Cognitive impairment.
Cognitive impairment.
The nurse is preparing to obtain a rectal temperature on a comatose adult. What
technique should the nurse use?
Subtract 3 degrees before documenting a rectal temperature.
Insert the thermometer with the client in the Fowler's position.
Use a lubricated blunt tip thermometer.
Insert the thermometer 2 to 3 inches into the rectum.
Use a lubricated blunt tip thermometer.
A 20-year-old construction worker has been brought into the emergency
department with heat stroke. For the mental status examination, what is the
priority nursing assessment?
Mood.
Attention span.
Level of consciousness.
Recent memory.
Level of consciousness.
An adult client presents to the emergency department with "shoulder pain." When
assessing the severity of the pain, which question by the nurse is appropriate?
"How does pain limit your activities?"
"What does your pain feel like?"
"How would you rate your pain on a scale of 0 to 10?"
"What makes your pain better or worse?"
"How would you rate your pain on a scale of 0 to 10?"
A patient is in the intensive care unit (ICU) 2 days post-appendectomy. He is
agitated, confused, hallucinating, and exhibiting a coarse tremor of his hands.
The nurse suspects that the patient is experiencing withdrawal symptoms from
which substance?
Opiates.
, Nicotine.
Cannabis.
Alcohol.
Alcohol
A patient has been admitted to the ICU after he was found unconscious in an
alley. The next day, the nurse closely monitors him for symptoms of opiate
withdrawal, including which of the following? Select all that apply.
Pinpoint pupils.
Decreased respirations.
Bradycardia.
Fever.
Muscle and joint pains.
Anxiety.
Fever.
Muscle and joint pains.
Anxiety
An adolescent comes to the clinic wearing combat boots and a lace nightgown
over her other clothes. Her hair is dyed pink. She has several piercings in her
nares and ears and is wearing heavy black makeup. The nurse concludes that:
The patient is mentally intact.
She likely has a manic syndrome.
More information is needed to assess her mental status.
She is trying to shock people.
More information is needed to assess her mental status.
A nurse notices a suspicious abdominal bruise on a nonverbal child. What is the
nurses next best action?
Ask the caregiver how the bruise occured
Review the child's chart to see if this bruising has happened before
Contact the authorities immediately
Start an injury map
Ask the caregiver how the bruise occured
During a mental status assessment, which question by the nurse would best
assess a person's judgment?
"What are the similarities between an apple and a pear?"
"Where are you right now?"
"Do you feel that you are being watched, followed, or controlled?"
"What are your health goals?"
"What are your health goals?"
A concussed patient is admitted to the unit after an automobile accident. The
nurse begins the mental status examination (MSE) and finds that the patient is
lethargic with dysarthric speech. The nurse's best approach at this time is to:
A woman has come to the clinic to seek help with a substance abuse problem.
She admits to using cocaine just before arriving. Which of these assessment
findings would the nurse expect to find when examining this woman?
Somnolence.
Pacing.
Apathy.
Constricted pupils.
Pacing
Which assessment finding is not concerning for an older patient?
Increasing pain
Cannot remember home address
Heart rate of 122
Unlabored but shallow breathing
Unlabored but shallow breaths
Nurse Aryonna is percussing an adult patient's lung fields and hears
"hyperresonance". This patient has a history of COPD, heart disease, anxiety, and
acute pancreatitis. Nurse Aryonna understands that
This would be a normal finding for this patient
This is a normal finding depending upon the percussion technique used by the
provider
This is an abnormal finding as hyperresonance is only heard in children
This is an abnormal finding as hyper resonance should only be heard in the
abdomen
This would be a normal finding for this patient
A nurse is assisting a client with orthostatic hypotension. He suspects the
dosage of the patients new antihypertensive medication is too high. What data
should he collect next to confirm this?
A blood pressure every 5 minutes
LOC after the patient stands up
Respirations to ensure the patient is not experiencing hypoventilation
Patients height and weight
Patients height and weight
During percussion of a patient's abdomen, the nurse notes a drumlike quality of
the sounds across the quadrants. This type of sound indicates:
Air-filled areas.
Presence of dense organs.
Presence of a tumor.
Constipation.
,Air-filled areas.
A nurse is assessing four patients today. Which patients would the nurse expect
to see lordosis? Select all that apply.
A 67 year old man who was diagnosed with COPD 4 years ago and continues to
smoke
A toddler recently diagnosed with Diabetes Mellitus
You Answered
A 59 year old woman who recently fell and is experiencing hip and back pain
A woman pregnant with her first child who is experiencing high blood pressure
A toddler recently diagnosed with Diabetes Mellitus
A woman pregnant with her first child who is experiencing high blood pressure
Before auscultating a client's abdomen for the presence of bowel sounds, the
nurse should:
Auscultate over a tightly pulled gown to ensure the patient does not get chilled.
Check the temperature of the room and ensure the patient is warm.
Ensure that the bell side of the stethoscope is turned to the "on" position.
Warm the endpiece of the stethoscope by placing it in warm water.
Check the temperature of the room and ensure the patient is warm.
Hugh has brought his wife Dorthy in for Mental Status Exam. Dorthy's husband
tells you that her memory problems have been going on for about 6 months. She
often tells long stories about her day-to-day activities, and he knows she is not
telling the truth. She also forgets the names of things. For example, when she
wants a key, she asks her husband "Give me that thing you open the door with."
What is Dorthy experiencing? Select all that apply.
Echolalia
Flight of Ideas
Word Salad
Neologism
Confabulation
Circumlocution
Confabulation
Circumlocution
When assessing a client's radial pulse, what should the nurse recall about the
pulse force?
Full/bounding pulses are common with fluid volume deficit.
Pulse force is typically recorded on a 0- to 2-point scale
A pulse should be palpated for a full minute to properly assess the pulse force.
Pulse force is a reflection of the heart's stroke volume.
Pulse force is a reflection of the heart's stroke volume.
The nurse is preparing to perform a physical assessment. Which statement
describes best practice?
,The nurse follows the same sequence for patients of all ages and conditions.
The nurse examines painful areas first to get it out of the way.
The nurse performs the examination from the left, right, head, and foot of the bed.
The nurse organizes the exam to ensure the patient doesn't change positions too
much.
The nurse organizes the exam to ensure the patient doesn't change positions too much.
The nurse is administering a Mini-Cog test to a 72-year-old woman presenting for
a well check. The patient draws a clock with an incorrect time and is able to recall
only one word. This result suggests which finding?
Psychiatric illness.
This is a normal finding for older adults.
Attention disorder.
Cognitive impairment.
Cognitive impairment.
The nurse is preparing to obtain a rectal temperature on a comatose adult. What
technique should the nurse use?
Subtract 3 degrees before documenting a rectal temperature.
Insert the thermometer with the client in the Fowler's position.
Use a lubricated blunt tip thermometer.
Insert the thermometer 2 to 3 inches into the rectum.
Use a lubricated blunt tip thermometer.
A 20-year-old construction worker has been brought into the emergency
department with heat stroke. For the mental status examination, what is the
priority nursing assessment?
Mood.
Attention span.
Level of consciousness.
Recent memory.
Level of consciousness.
An adult client presents to the emergency department with "shoulder pain." When
assessing the severity of the pain, which question by the nurse is appropriate?
"How does pain limit your activities?"
"What does your pain feel like?"
"How would you rate your pain on a scale of 0 to 10?"
"What makes your pain better or worse?"
"How would you rate your pain on a scale of 0 to 10?"
A patient is in the intensive care unit (ICU) 2 days post-appendectomy. He is
agitated, confused, hallucinating, and exhibiting a coarse tremor of his hands.
The nurse suspects that the patient is experiencing withdrawal symptoms from
which substance?
Opiates.
, Nicotine.
Cannabis.
Alcohol.
Alcohol
A patient has been admitted to the ICU after he was found unconscious in an
alley. The next day, the nurse closely monitors him for symptoms of opiate
withdrawal, including which of the following? Select all that apply.
Pinpoint pupils.
Decreased respirations.
Bradycardia.
Fever.
Muscle and joint pains.
Anxiety.
Fever.
Muscle and joint pains.
Anxiety
An adolescent comes to the clinic wearing combat boots and a lace nightgown
over her other clothes. Her hair is dyed pink. She has several piercings in her
nares and ears and is wearing heavy black makeup. The nurse concludes that:
The patient is mentally intact.
She likely has a manic syndrome.
More information is needed to assess her mental status.
She is trying to shock people.
More information is needed to assess her mental status.
A nurse notices a suspicious abdominal bruise on a nonverbal child. What is the
nurses next best action?
Ask the caregiver how the bruise occured
Review the child's chart to see if this bruising has happened before
Contact the authorities immediately
Start an injury map
Ask the caregiver how the bruise occured
During a mental status assessment, which question by the nurse would best
assess a person's judgment?
"What are the similarities between an apple and a pear?"
"Where are you right now?"
"Do you feel that you are being watched, followed, or controlled?"
"What are your health goals?"
"What are your health goals?"
A concussed patient is admitted to the unit after an automobile accident. The
nurse begins the mental status examination (MSE) and finds that the patient is
lethargic with dysarthric speech. The nurse's best approach at this time is to:
