BSN 246 HESI Health
Assessment Exam V2
1. When assessing a patient’s respiratory system, which of the following is the most
accurate method to determine oxygenation status?
A) Pulse oximetry
B) Respiratory rate count
C) Auscultation of breath sounds
D) Inspection of chest movement
Answer: A) Pulse oximetry
,2. During an abdominal assessment, the nurse palpates the abdomen and feels a
firm, fixed mass in the left lower quadrant. What should the nurse do next?
A) Document the finding and proceed with the exam
B) Apply firm pressure to try to reduce the mass
C) Immediately notify the healthcare provider
D) Ask the patient about any pain or discomfort associated with the mass
Answer: D) Ask the patient about any pain or discomfort associated with the mass
3. The nurse is preparing to assess cranial nerve VII. Which action is appropriate?
A) Ask the patient to shrug their shoulders against resistance
B) Ask the patient to smile and raise their eyebrows
C) Test the patient’s ability to hear whispered words
D) Assess the patient’s tongue for symmetry and strength
Answer: B) Ask the patient to smile and raise their eyebrows
4. What is the normal range for an adult’s resting heart rate?
A) 30-50 beats per minute
B) 50-70 beats per minute
C) 60-100 beats per minute
D) 100-120 beats per minute
Answer: C) 60-100 beats per minute
5. Which of the following findings would be considered abnormal during a
musculoskeletal assessment?
A) Full range of motion without pain
B) Symmetrical muscle strength bilaterally
C) Crepitus during joint movement
D) Slight tremor in the hands at rest
,Answer: C) Crepitus during joint movement
6. The nurse is auscultating bowel sounds. Which of the following would indicate
decreased bowel activity?
A) 5-30 clicks and gurgles per minute
B) Loud, high-pitched rushing sounds
C) Absent bowel sounds after listening for 5 minutes
D) Regular rhythmic sounds every 10 seconds
Answer: C) Absent bowel sounds after listening for 5 minutes
7. Fill in the blank:
The nurse uses a stethoscope to auscultate heart sounds and assess for murmurs.
8. Which of the following assessment findings is consistent with chronic arterial
insufficiency? (Select all that apply)
A) Thin, shiny skin
B) Hair loss on the legs
C) Warm, swollen lower extremities
D) Intermittent claudication
E) Dependent rubor (redness when legs are lowered)
Answer: A) Thin, shiny skin
B) Hair loss on the legs
D) Intermittent claudication
E) Dependent rubor (redness when legs are lowered)
9. When assessing a patient’s mental status, which tool is most appropriate?
A) Glasgow Coma Scale
B) Apgar Score
C) Mini-Mental State Examination (MMSE)
D) Braden Scale
, Answer: C) Mini-Mental State Examination (MMSE)
10. The nurse is assessing the pupillary light reflex. Which cranial nerves are
primarily involved?
A) CN II and CN III
B) CN V and CN VII
C) CN VIII and CN IX
D) CN X and CN XI
Answer: A) CN II and CN III11. When assessing skin turgor, the nurse should:
A) Pinch the skin on the forehead and note how quickly it returns to place
B) Pinch the skin on the forearm and observe for redness
C) Press firmly on a bony prominence for 5 seconds and release
D) Inspect for color changes on the palms of the hands
Answer: A) Pinch the skin on the forehead and note how quickly it returns to place
12. Which of the following findings indicates a normal lymph node during palpation?
A) Enlarged, tender, and fixed
B) Small, round, mobile, and non-tender
C) Hard, irregular, and fixed
D) Soft, fluctuant, and erythematous
Answer: B) Small, round, mobile, and non-tender
13. What is the correct sequence for performing a head-to-toe physical assessment?
A) Inspection, percussion, palpation, auscultation
B) Inspection, palpation, percussion, auscultation
C) Inspection, auscultation, palpation, percussion
D) Inspection, palpation, auscultation, percussion
Assessment Exam V2
1. When assessing a patient’s respiratory system, which of the following is the most
accurate method to determine oxygenation status?
A) Pulse oximetry
B) Respiratory rate count
C) Auscultation of breath sounds
D) Inspection of chest movement
Answer: A) Pulse oximetry
,2. During an abdominal assessment, the nurse palpates the abdomen and feels a
firm, fixed mass in the left lower quadrant. What should the nurse do next?
A) Document the finding and proceed with the exam
B) Apply firm pressure to try to reduce the mass
C) Immediately notify the healthcare provider
D) Ask the patient about any pain or discomfort associated with the mass
Answer: D) Ask the patient about any pain or discomfort associated with the mass
3. The nurse is preparing to assess cranial nerve VII. Which action is appropriate?
A) Ask the patient to shrug their shoulders against resistance
B) Ask the patient to smile and raise their eyebrows
C) Test the patient’s ability to hear whispered words
D) Assess the patient’s tongue for symmetry and strength
Answer: B) Ask the patient to smile and raise their eyebrows
4. What is the normal range for an adult’s resting heart rate?
A) 30-50 beats per minute
B) 50-70 beats per minute
C) 60-100 beats per minute
D) 100-120 beats per minute
Answer: C) 60-100 beats per minute
5. Which of the following findings would be considered abnormal during a
musculoskeletal assessment?
A) Full range of motion without pain
B) Symmetrical muscle strength bilaterally
C) Crepitus during joint movement
D) Slight tremor in the hands at rest
,Answer: C) Crepitus during joint movement
6. The nurse is auscultating bowel sounds. Which of the following would indicate
decreased bowel activity?
A) 5-30 clicks and gurgles per minute
B) Loud, high-pitched rushing sounds
C) Absent bowel sounds after listening for 5 minutes
D) Regular rhythmic sounds every 10 seconds
Answer: C) Absent bowel sounds after listening for 5 minutes
7. Fill in the blank:
The nurse uses a stethoscope to auscultate heart sounds and assess for murmurs.
8. Which of the following assessment findings is consistent with chronic arterial
insufficiency? (Select all that apply)
A) Thin, shiny skin
B) Hair loss on the legs
C) Warm, swollen lower extremities
D) Intermittent claudication
E) Dependent rubor (redness when legs are lowered)
Answer: A) Thin, shiny skin
B) Hair loss on the legs
D) Intermittent claudication
E) Dependent rubor (redness when legs are lowered)
9. When assessing a patient’s mental status, which tool is most appropriate?
A) Glasgow Coma Scale
B) Apgar Score
C) Mini-Mental State Examination (MMSE)
D) Braden Scale
, Answer: C) Mini-Mental State Examination (MMSE)
10. The nurse is assessing the pupillary light reflex. Which cranial nerves are
primarily involved?
A) CN II and CN III
B) CN V and CN VII
C) CN VIII and CN IX
D) CN X and CN XI
Answer: A) CN II and CN III11. When assessing skin turgor, the nurse should:
A) Pinch the skin on the forehead and note how quickly it returns to place
B) Pinch the skin on the forearm and observe for redness
C) Press firmly on a bony prominence for 5 seconds and release
D) Inspect for color changes on the palms of the hands
Answer: A) Pinch the skin on the forehead and note how quickly it returns to place
12. Which of the following findings indicates a normal lymph node during palpation?
A) Enlarged, tender, and fixed
B) Small, round, mobile, and non-tender
C) Hard, irregular, and fixed
D) Soft, fluctuant, and erythematous
Answer: B) Small, round, mobile, and non-tender
13. What is the correct sequence for performing a head-to-toe physical assessment?
A) Inspection, percussion, palpation, auscultation
B) Inspection, palpation, percussion, auscultation
C) Inspection, auscultation, palpation, percussion
D) Inspection, palpation, auscultation, percussion
