BSN 246 HESI Health Assessment: 150 Practice Questions & Answers with Detailed Rationales for the
2026 Update – Essential Review for Nursing Students Preparing for the HESI Exit Exam.
Questions 1–15 (Respiratory – Version 3)
1. A client with pneumonia has bronchial breath sounds heard over the periphery of the lung. This
is:
A) Normal
B) Abnormal, indicating consolidation
C) Expected in asthma
D) A sign of pneumothorax
Correct Answer: B) Abnormal, indicating consolidation
Explanation: Bronchial breath sounds are normally heard only over the trachea. Over peripheral lung =
consolidation (pneumonia).
2. The nurse notes a client’s sputum is thick, green, and foul-smelling. This suggests:
A) Viral bronchitis
B) Bacterial infection (e.g., pneumonia, bronchiectasis)
C) Asthma
D) Pulmonary edema
Correct Answer: B) Bacterial infection (e.g., pneumonia, bronchiectasis)
Explanation: Purulent (green/yellow) sputum indicates bacterial infection. Foul smell suggests
anaerobic infection or bronchiectasis.
3. A client with a pulmonary embolism is likely to have which assessment finding?
A) Sudden onset of pleuritic chest pain and hypoxia
B) Barrel chest
C) Clubbing of fingers
D) Productive cough for months
Correct Answer: A) Sudden onset of pleuritic chest pain and hypoxia
Explanation: PE classically presents with acute dyspnea, pleuritic pain, tachypnea, hypoxia. Barrel chest
= COPD.
4. The nurse assesses a client’s respiratory effort and notes nasal flaring and intercostal retractions.
This indicates:
,A) Normal breathing
B) Increased work of breathing (respiratory distress)
C) Sleep apnea
D) Cheyne-Stokes respiration
Correct Answer: B) Increased work of breathing (respiratory distress)
Explanation: Nasal flaring, retractions, and accessory muscle use are signs of respiratory distress.
5. A client with a chest tube has continuous bubbling in the water seal chamber. The nurse should:
A) Document as normal
B) Clamp the tube immediately
C) Assess for an air leak
D) Increase suction
Correct Answer: C) Assess for an air leak
Explanation: Continuous bubbling in water seal chamber (not suction chamber) indicates an air leak.
Intermittent bubbling with exhalation is normal.
6. The nurse percusses a client’s lung fields and notes dullness over the left lower lobe. This is most
consistent with:
A) Pneumothorax
B) Pleural effusion or consolidation
C) COPD
D) Asthma
Correct Answer: B) Pleural effusion or consolidation
Explanation: Dullness = fluid or solid tissue (effusion, pneumonia, tumor). Hyperresonance = air
(pneumothorax, COPD).
7. A client with a history of smoking has a chronic cough with blood-streaked sputum. The nurse
prioritizes:
A) Smoking cessation teaching
B) Evaluation for lung cancer
C) Prescription for antitussive
D) Chest physiotherapy
Correct Answer: B) Evaluation for lung cancer
Explanation: Hemoptysis in a smoker requires ruling out lung cancer (bronchoscopy, CT). Smoking
cessation is important but not the immediate priority.
,8. The nurse auscultates a client’s lungs and hears crackles that do not clear with coughing. This
suggests:
A) Bronchitis
B) Pulmonary edema or fibrosis
C) Atelectasis that cleared
D) Normal finding
Correct Answer: B) Pulmonary edema or fibrosis
Explanation: Crackles that persist after coughing suggest pulmonary edema (HF) or interstitial fibrosis.
Atelectatic crackles clear with deep breathing.
9. A client with COPD has a chronic cough and thick secretions. The most effective intervention to
promote airway clearance is:
A) Encouraging sips of water
B) Adequate hydration and humidification
C) Antitussive medications
D) Strict bed rest
Correct Answer: B) Adequate hydration and humidification
Explanation: Hydration thins secretions. Antitussives suppress cough (harmful in COPD). Mobilization
also helps.
10. The nurse notes a client’s oxygen saturation drops from 94% to 88% when walking to the
bathroom. This is called:
A) Resting hypoxemia
B) Exertional desaturation
C) Hyperoxia
D) Normal response
Correct Answer: B) Exertional desaturation
Explanation: A drop in SpO2 with activity indicates exertional desaturation (common in COPD, ILD).
May need increased oxygen with activity.
11. A client with suspected rib fracture has paradoxical movement of the chest wall. The nurse
should:
A) Apply a tight binder
B) Notify the provider immediately (flail chest)
C) Encourage deep breathing
D) Discharge home
, Correct Answer: B) Notify the provider immediately (flail chest)
Explanation: Paradoxical movement = flail chest (≥2 adjacent ribs fractured in ≥2 places). May need
ventilation. Emergency.
12. The nurse assesses a client with a tracheostomy and notes bloody secretions. The most likely
cause is:
A) Normal finding
B) Suctioning trauma or infection
C) Pulmonary embolism
D) Heart failure
Correct Answer: B) Suctioning trauma or infection
Explanation: Bloody secretions in tracheostomy often due to suctioning trauma, granuloma, or
infection. Assess need for humidification.
13. A client with asthma uses a peak flow meter. Which finding indicates that the action plan should
be activated (yellow zone)?
A) 90% of personal best
B) 60% of personal best
C) 100% of personal best
D) 40% of personal best
Correct Answer: B) 60% of personal best
Explanation: Yellow zone = 50-80% of personal best (caution, worsening asthma). Red zone = <50%.
Green = >80%.
14. The nurse palpates tactile fremitus and finds it increased over the right lower lobe. This
suggests:
A) Pneumothorax
B) Consolidation (pneumonia)
C) Pleural effusion
D) Emphysema
Correct Answer: B) Consolidation (pneumonia)
Explanation: Increased fremitus = dense tissue (consolidation). Decreased = air trapping or fluid.
15. A client is receiving non-invasive positive pressure ventilation (BiPAP). The nurse notes a large
air leak around the mask. The first action is:
A) Increase pressure settings
2026 Update – Essential Review for Nursing Students Preparing for the HESI Exit Exam.
Questions 1–15 (Respiratory – Version 3)
1. A client with pneumonia has bronchial breath sounds heard over the periphery of the lung. This
is:
A) Normal
B) Abnormal, indicating consolidation
C) Expected in asthma
D) A sign of pneumothorax
Correct Answer: B) Abnormal, indicating consolidation
Explanation: Bronchial breath sounds are normally heard only over the trachea. Over peripheral lung =
consolidation (pneumonia).
2. The nurse notes a client’s sputum is thick, green, and foul-smelling. This suggests:
A) Viral bronchitis
B) Bacterial infection (e.g., pneumonia, bronchiectasis)
C) Asthma
D) Pulmonary edema
Correct Answer: B) Bacterial infection (e.g., pneumonia, bronchiectasis)
Explanation: Purulent (green/yellow) sputum indicates bacterial infection. Foul smell suggests
anaerobic infection or bronchiectasis.
3. A client with a pulmonary embolism is likely to have which assessment finding?
A) Sudden onset of pleuritic chest pain and hypoxia
B) Barrel chest
C) Clubbing of fingers
D) Productive cough for months
Correct Answer: A) Sudden onset of pleuritic chest pain and hypoxia
Explanation: PE classically presents with acute dyspnea, pleuritic pain, tachypnea, hypoxia. Barrel chest
= COPD.
4. The nurse assesses a client’s respiratory effort and notes nasal flaring and intercostal retractions.
This indicates:
,A) Normal breathing
B) Increased work of breathing (respiratory distress)
C) Sleep apnea
D) Cheyne-Stokes respiration
Correct Answer: B) Increased work of breathing (respiratory distress)
Explanation: Nasal flaring, retractions, and accessory muscle use are signs of respiratory distress.
5. A client with a chest tube has continuous bubbling in the water seal chamber. The nurse should:
A) Document as normal
B) Clamp the tube immediately
C) Assess for an air leak
D) Increase suction
Correct Answer: C) Assess for an air leak
Explanation: Continuous bubbling in water seal chamber (not suction chamber) indicates an air leak.
Intermittent bubbling with exhalation is normal.
6. The nurse percusses a client’s lung fields and notes dullness over the left lower lobe. This is most
consistent with:
A) Pneumothorax
B) Pleural effusion or consolidation
C) COPD
D) Asthma
Correct Answer: B) Pleural effusion or consolidation
Explanation: Dullness = fluid or solid tissue (effusion, pneumonia, tumor). Hyperresonance = air
(pneumothorax, COPD).
7. A client with a history of smoking has a chronic cough with blood-streaked sputum. The nurse
prioritizes:
A) Smoking cessation teaching
B) Evaluation for lung cancer
C) Prescription for antitussive
D) Chest physiotherapy
Correct Answer: B) Evaluation for lung cancer
Explanation: Hemoptysis in a smoker requires ruling out lung cancer (bronchoscopy, CT). Smoking
cessation is important but not the immediate priority.
,8. The nurse auscultates a client’s lungs and hears crackles that do not clear with coughing. This
suggests:
A) Bronchitis
B) Pulmonary edema or fibrosis
C) Atelectasis that cleared
D) Normal finding
Correct Answer: B) Pulmonary edema or fibrosis
Explanation: Crackles that persist after coughing suggest pulmonary edema (HF) or interstitial fibrosis.
Atelectatic crackles clear with deep breathing.
9. A client with COPD has a chronic cough and thick secretions. The most effective intervention to
promote airway clearance is:
A) Encouraging sips of water
B) Adequate hydration and humidification
C) Antitussive medications
D) Strict bed rest
Correct Answer: B) Adequate hydration and humidification
Explanation: Hydration thins secretions. Antitussives suppress cough (harmful in COPD). Mobilization
also helps.
10. The nurse notes a client’s oxygen saturation drops from 94% to 88% when walking to the
bathroom. This is called:
A) Resting hypoxemia
B) Exertional desaturation
C) Hyperoxia
D) Normal response
Correct Answer: B) Exertional desaturation
Explanation: A drop in SpO2 with activity indicates exertional desaturation (common in COPD, ILD).
May need increased oxygen with activity.
11. A client with suspected rib fracture has paradoxical movement of the chest wall. The nurse
should:
A) Apply a tight binder
B) Notify the provider immediately (flail chest)
C) Encourage deep breathing
D) Discharge home
, Correct Answer: B) Notify the provider immediately (flail chest)
Explanation: Paradoxical movement = flail chest (≥2 adjacent ribs fractured in ≥2 places). May need
ventilation. Emergency.
12. The nurse assesses a client with a tracheostomy and notes bloody secretions. The most likely
cause is:
A) Normal finding
B) Suctioning trauma or infection
C) Pulmonary embolism
D) Heart failure
Correct Answer: B) Suctioning trauma or infection
Explanation: Bloody secretions in tracheostomy often due to suctioning trauma, granuloma, or
infection. Assess need for humidification.
13. A client with asthma uses a peak flow meter. Which finding indicates that the action plan should
be activated (yellow zone)?
A) 90% of personal best
B) 60% of personal best
C) 100% of personal best
D) 40% of personal best
Correct Answer: B) 60% of personal best
Explanation: Yellow zone = 50-80% of personal best (caution, worsening asthma). Red zone = <50%.
Green = >80%.
14. The nurse palpates tactile fremitus and finds it increased over the right lower lobe. This
suggests:
A) Pneumothorax
B) Consolidation (pneumonia)
C) Pleural effusion
D) Emphysema
Correct Answer: B) Consolidation (pneumonia)
Explanation: Increased fremitus = dense tissue (consolidation). Decreased = air trapping or fluid.
15. A client is receiving non-invasive positive pressure ventilation (BiPAP). The nurse notes a large
air leak around the mask. The first action is:
A) Increase pressure settings
