BSN 246 HESI Health Assessment EXAM NEWEST ACTUAL EXAM
BSN 246 HESI HEALTH ASSESSMENT EXAM NEWEST ACTUAL
EXAM COMPLETE 200 QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND
NEW VERSION!!
The registered nurse (RN) is caring for an older client who has been bedridden for
two weeks. Which assessment findings indicate to the RN that the client is
developing a complication related to immobility?
A. Decreased pedal pulses.
B. Edema in upper extremities.
C. Loss of appetite for food.
D. Stiffness in right ankle joint. - Correct Answer-D. Stiffness in right ankle joint.
Rationale
Stiffness in joints is an early sign of contractures and muscle atrophy related to
inactivity and immobility.
The registered nurse (RN) is caring for a client with aplastic anemia who is
hospitalized for weight loss and generalized weakness. Laboratory values show a
white blood count (WBC) of 2,500/mm3 and a platelet countof 160,000/mm3.
Which intervention is the primary focus in the client's plan of care for the RN to
implement?
A. Assist with frequent ambulation.
B. Encourage visitors to visit.
C. Maintain strict protective precautions.
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, BSN 246 HESI Health Assessment EXAM NEWEST ACTUAL EXAM
D. Avoid peripheral injections. - Correct Answer-C. Maintain strict protective
precautions.
Rationale
The client should be under strict protective transmission precautions because
the WBC values are low and normal WBC levels are 4,000-10,000/mm3, so the
client is an increased high risk for infection.
The registered nurse (RN) is teaching a client who is being discharged after
treatment of tuberculosis (TB). Which cultural issues should the RN assess when
preparing the client for discharge? (Select all that apply.)
A. Native language.
B. Education level.
C. Type of lifestyle.
D. Financial resources.
E. Previous medical history. - Correct Answer-A. Native language.
B. Education level.
C. Type of lifestyle.
D. Financial resources.
Rationale
To ensure compliance the client's native language, education level, lifestyle, and
financial resources should be considered when preparing the client's discharge
instructions about the continuation of treatment for TB.
2|Page
, BSN 246 HESI Health Assessment EXAM NEWEST ACTUAL EXAM
An older client is admitted to the hospital with severe diarrhea. The registered
nurse (RN) is completing an assessment and notes the client has dry mucous
membranes and poor skin turgor. Which assessment data should the RN gather to
determine if the client has a fluid volume deficit?
A. Lower extremity edema.
B. Orthostatic hypotension.
C. Elevated blood pressure.
D. Cheyne-Stokes respirations. - Correct Answer-B. Orthostatic hypotension.
Rationale
Orthostatic hypotension can be a sign of fluid volume deficit in an older client
who has experienced severe diarrhea.
The registered nurse (RN) is caring for a client who has a closed head injury from a
motor vehicle collision. Which finding should the RN assess the client for the risk
of diabetes insipidus (DI)?
A. High fever.
B. Low blood pressure.
C. Muscle rigidity.
D. Polydipsia. - Correct Answer-D. Polydipsia.
Rationale
A characteristic finding of DI is excretion of large quantities of urine (5 to
20L/day), and most clients compensate for fluid loss by drinking large amounts
of water (polydipsia). DI can occur when there has been damage or injury to the
pituitary gland or hypothalamus as a result of head trauma, tumor or an illness
3|Page
, BSN 246 HESI Health Assessment EXAM NEWEST ACTUAL EXAM
such as meningitis. This damage interrupts the ADH production, storage and
release causing the excessive urination and thirst.
The registered nurse (RN) is teaching a client who is newly diagnosed with
emphysema how to perform pursed lip breathing. What is the primary reason for
teaching the client this method of breathing?
A. Decreases respiratory rate.
B. Increases O2 saturation throughout the body.
C. Conserves energy while ambulating.
D. Promotes CO2 elimination. - Correct Answer-D. Promotes CO2 elimination.
Rationale
Pursed lip breathing helps eliminate CO2 by increasing positive pressure within
the alveoli increasing the surface area of the alveoli making it easier for the O2
and CO2 gas exchange to occur .
The registered nurse (RN) is administering haloperidol 0.5 mg IM PRN to a client
for the first time. What side effects should the RN assess the client for during the
initial dose?
A. Bradykinesia.
B. Dystonia.
C. Somatization.
D. Akathisia. - Correct Answer-B. Dystonia.
Rationale
4|Page
BSN 246 HESI HEALTH ASSESSMENT EXAM NEWEST ACTUAL
EXAM COMPLETE 200 QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND
NEW VERSION!!
The registered nurse (RN) is caring for an older client who has been bedridden for
two weeks. Which assessment findings indicate to the RN that the client is
developing a complication related to immobility?
A. Decreased pedal pulses.
B. Edema in upper extremities.
C. Loss of appetite for food.
D. Stiffness in right ankle joint. - Correct Answer-D. Stiffness in right ankle joint.
Rationale
Stiffness in joints is an early sign of contractures and muscle atrophy related to
inactivity and immobility.
The registered nurse (RN) is caring for a client with aplastic anemia who is
hospitalized for weight loss and generalized weakness. Laboratory values show a
white blood count (WBC) of 2,500/mm3 and a platelet countof 160,000/mm3.
Which intervention is the primary focus in the client's plan of care for the RN to
implement?
A. Assist with frequent ambulation.
B. Encourage visitors to visit.
C. Maintain strict protective precautions.
1|Page
, BSN 246 HESI Health Assessment EXAM NEWEST ACTUAL EXAM
D. Avoid peripheral injections. - Correct Answer-C. Maintain strict protective
precautions.
Rationale
The client should be under strict protective transmission precautions because
the WBC values are low and normal WBC levels are 4,000-10,000/mm3, so the
client is an increased high risk for infection.
The registered nurse (RN) is teaching a client who is being discharged after
treatment of tuberculosis (TB). Which cultural issues should the RN assess when
preparing the client for discharge? (Select all that apply.)
A. Native language.
B. Education level.
C. Type of lifestyle.
D. Financial resources.
E. Previous medical history. - Correct Answer-A. Native language.
B. Education level.
C. Type of lifestyle.
D. Financial resources.
Rationale
To ensure compliance the client's native language, education level, lifestyle, and
financial resources should be considered when preparing the client's discharge
instructions about the continuation of treatment for TB.
2|Page
, BSN 246 HESI Health Assessment EXAM NEWEST ACTUAL EXAM
An older client is admitted to the hospital with severe diarrhea. The registered
nurse (RN) is completing an assessment and notes the client has dry mucous
membranes and poor skin turgor. Which assessment data should the RN gather to
determine if the client has a fluid volume deficit?
A. Lower extremity edema.
B. Orthostatic hypotension.
C. Elevated blood pressure.
D. Cheyne-Stokes respirations. - Correct Answer-B. Orthostatic hypotension.
Rationale
Orthostatic hypotension can be a sign of fluid volume deficit in an older client
who has experienced severe diarrhea.
The registered nurse (RN) is caring for a client who has a closed head injury from a
motor vehicle collision. Which finding should the RN assess the client for the risk
of diabetes insipidus (DI)?
A. High fever.
B. Low blood pressure.
C. Muscle rigidity.
D. Polydipsia. - Correct Answer-D. Polydipsia.
Rationale
A characteristic finding of DI is excretion of large quantities of urine (5 to
20L/day), and most clients compensate for fluid loss by drinking large amounts
of water (polydipsia). DI can occur when there has been damage or injury to the
pituitary gland or hypothalamus as a result of head trauma, tumor or an illness
3|Page
, BSN 246 HESI Health Assessment EXAM NEWEST ACTUAL EXAM
such as meningitis. This damage interrupts the ADH production, storage and
release causing the excessive urination and thirst.
The registered nurse (RN) is teaching a client who is newly diagnosed with
emphysema how to perform pursed lip breathing. What is the primary reason for
teaching the client this method of breathing?
A. Decreases respiratory rate.
B. Increases O2 saturation throughout the body.
C. Conserves energy while ambulating.
D. Promotes CO2 elimination. - Correct Answer-D. Promotes CO2 elimination.
Rationale
Pursed lip breathing helps eliminate CO2 by increasing positive pressure within
the alveoli increasing the surface area of the alveoli making it easier for the O2
and CO2 gas exchange to occur .
The registered nurse (RN) is administering haloperidol 0.5 mg IM PRN to a client
for the first time. What side effects should the RN assess the client for during the
initial dose?
A. Bradykinesia.
B. Dystonia.
C. Somatization.
D. Akathisia. - Correct Answer-B. Dystonia.
Rationale
4|Page
