BSN 246 HESI
Health Assessment V2 EXAM
Nightingale College
Actual Qs & Verified Ans to Pass the Exam
This Hesi test contains:
passing score Guarantee
Format Set of Multiple-choice
questions with incorporating Next
Generation NCLEX (NGN) and Case scenarios
questions
Expert-Verified Explanations & Solutions
,### 1. Where should the nurse place the bell of the stethoscope when
auscultating for a carotid artery bruit?
Answer Choices:
A. Over mid-chest above the heart.
B. Posterior neck at the nape of the neck.
C. Lateral neck, just under the mandible towards lymph nodes.
D. Directly over the trachea in the suprasternal notch.
Correct Answer: C
Expert Rationale:
The carotid artery runs laterally beside the trachea, under the mandible,
near lymph nodes. Using the stethoscope bell here allows detection of low-
pitched sounds like bruits, indicating turbulent blood $low. The chest, nape,
or trachea are inappropriate locations.
---
### 2. For assessing adventitious lung sounds after pneumonia
treatment, which technique should the nurse use?
Answer Choices:
A. Use bell over lower lobes.
B. Have client lie $lat while listening anterior chest.
C. Press diaphragm $irmly on skin over each lung $ield.
D. Shave chest hair before auscultation.
,Correct Answer: C
Expert Rationale:
The diaphragm, pressed $irmly against the skin, best transmits high-pitched
lung sounds, including adventitious sounds. All lung $ields should be
auscultated systematically, side to side, anteriorly and posteriorly. The bell is
not ideal for lung sounds; shaving chest hair is unnecessary.
### 3. A 29-year-old male client presents reporting a persistent dry
cough for 6 weeks and expresses concern about “maybe lung cancer.”
Which documentation best captures the client’s chief complaint?
Answer Choices:
A. Presents with a hacking non-productive cough of 6 weeks duration.
B. Describe having a "body-wracking dry cough" of 6 weeks duration.
C. Expresses concern of "lung cancer" symptoms for last 6 weeks.
D. Young adult male presents with fears that he has "lung cancer": Describe
having a "body-wracking dry cough" of 6 weeks duration.
Correct Answer: B
Expert Rationale:
The chief complaint (CC) should directly re$lect the patient’s own description
of their symptoms, not include interpretations or diagnoses (e.g., "lung
cancer"). Option B captures the verbatim symptom in the patient’s words
("body-wracking dry cough") and duration, which is essential for accurate
, and objective documentation. Documenting fears or diagnostic concerns
belongs in the psychosocial or review of systems but not in the CC.
---
### 4. A 75-year-old client post-CVA with right hemiparesis shows a
brisk 4+ deep tendon re1lex on the right side. What does this 1inding
indicate?
Answer Choices:
A. A normal re$lex response.
B. Absent or sluggish response consistent with a lower motor neuron lesion.
C. Flaccid paralysis.
D. Hyperactive response consistent with an upper motor neuron disorder.
Correct Answer: D
Expert Rationale:
A brisk 4+ re$lex indicates hyperre$lexia, usually seen in upper motor neuron
lesions such as stroke (CVA). This $inding shows abnormal increased re$lex
activity on the affected side, consistent with central nervous system
impairment. Lower motor neuron lesions typically cause diminished or
absent re$lexes; $laccid paralysis is a clinical $inding, not a re$lex description.
---
Health Assessment V2 EXAM
Nightingale College
Actual Qs & Verified Ans to Pass the Exam
This Hesi test contains:
passing score Guarantee
Format Set of Multiple-choice
questions with incorporating Next
Generation NCLEX (NGN) and Case scenarios
questions
Expert-Verified Explanations & Solutions
,### 1. Where should the nurse place the bell of the stethoscope when
auscultating for a carotid artery bruit?
Answer Choices:
A. Over mid-chest above the heart.
B. Posterior neck at the nape of the neck.
C. Lateral neck, just under the mandible towards lymph nodes.
D. Directly over the trachea in the suprasternal notch.
Correct Answer: C
Expert Rationale:
The carotid artery runs laterally beside the trachea, under the mandible,
near lymph nodes. Using the stethoscope bell here allows detection of low-
pitched sounds like bruits, indicating turbulent blood $low. The chest, nape,
or trachea are inappropriate locations.
---
### 2. For assessing adventitious lung sounds after pneumonia
treatment, which technique should the nurse use?
Answer Choices:
A. Use bell over lower lobes.
B. Have client lie $lat while listening anterior chest.
C. Press diaphragm $irmly on skin over each lung $ield.
D. Shave chest hair before auscultation.
,Correct Answer: C
Expert Rationale:
The diaphragm, pressed $irmly against the skin, best transmits high-pitched
lung sounds, including adventitious sounds. All lung $ields should be
auscultated systematically, side to side, anteriorly and posteriorly. The bell is
not ideal for lung sounds; shaving chest hair is unnecessary.
### 3. A 29-year-old male client presents reporting a persistent dry
cough for 6 weeks and expresses concern about “maybe lung cancer.”
Which documentation best captures the client’s chief complaint?
Answer Choices:
A. Presents with a hacking non-productive cough of 6 weeks duration.
B. Describe having a "body-wracking dry cough" of 6 weeks duration.
C. Expresses concern of "lung cancer" symptoms for last 6 weeks.
D. Young adult male presents with fears that he has "lung cancer": Describe
having a "body-wracking dry cough" of 6 weeks duration.
Correct Answer: B
Expert Rationale:
The chief complaint (CC) should directly re$lect the patient’s own description
of their symptoms, not include interpretations or diagnoses (e.g., "lung
cancer"). Option B captures the verbatim symptom in the patient’s words
("body-wracking dry cough") and duration, which is essential for accurate
, and objective documentation. Documenting fears or diagnostic concerns
belongs in the psychosocial or review of systems but not in the CC.
---
### 4. A 75-year-old client post-CVA with right hemiparesis shows a
brisk 4+ deep tendon re1lex on the right side. What does this 1inding
indicate?
Answer Choices:
A. A normal re$lex response.
B. Absent or sluggish response consistent with a lower motor neuron lesion.
C. Flaccid paralysis.
D. Hyperactive response consistent with an upper motor neuron disorder.
Correct Answer: D
Expert Rationale:
A brisk 4+ re$lex indicates hyperre$lexia, usually seen in upper motor neuron
lesions such as stroke (CVA). This $inding shows abnormal increased re$lex
activity on the affected side, consistent with central nervous system
impairment. Lower motor neuron lesions typically cause diminished or
absent re$lexes; $laccid paralysis is a clinical $inding, not a re$lex description.
---
