HESI Health Assessment Actual Practice Exam:
Nightingale College Complete Test Preparation
for 2026/2027 Academic Year
DOMAIN 1: HEALTH HISTORY & COMMUNICATION (Q1-15)
1. When interviewing an elderly patient with hearing impairment, the nurse
demonstrates effective communication by:
A. Speaking loudly directly into the patient's ear
B. Using complex medical terminology for precision
C. Facing the patient, speaking clearly at moderate pace, using written cues if needed
D. Asking family members to answer all questions to save time
Correct Answer: C
Rationale: C is correct. For patients with hearing impairment, nurses should face the
patient directly for lip-reading, speak clearly at moderate pace without shouting, and use
written communication if needed. Speaking loudly into the ear (A) can distort sound and
invade personal space. Medical terminology (B) may confuse patients. Having family
answer (D) violates patient autonomy and confidentiality.
2. The nurse is using the OLD CARTS mnemonic to assess a patient's abdominal pain.
When assessing "A" (aggravating/alleviating factors), the most comprehensive question
is:
A. "What makes the pain better?"
B. "What makes the pain worse?"
C. "What makes the pain better or worse, and what have you tried for relief?"
D. "Is the pain constant or intermittent?"
Correct Answer: C
,Rationale: C is correct. The "A" in OLD CARTS (Onset, Location, Duration, Character,
Aggravating/Alleviating, Radiation, Timing, Severity) should assess both aggravating
and alleviating factors and include self-treatment attempts. Asking only about what
helps (A) or worsens (B) is incomplete. Question D addresses timing, not
aggravating/alleviating factors.
3. During a health history interview with a patient recently diagnosed with diabetes, the
nurse notes the patient avoiding eye contact and giving short answers. The most
appropriate nursing response is to:
A. Continue with the standard questions to complete the assessment efficiently
B. Confront the patient about their negative attitude
C. Acknowledge the patient's feelings and ask about their concerns regarding the
diagnosis
D. Document noncompliance and notify the provider immediately
Correct Answer: C
Rationale: C is correct. Nonverbal cues of avoidance and short answers often indicate
anxiety or emotional distress. The nurse should use therapeutic communication to
acknowledge feelings and explore concerns about the diagnosis. Continuing
mechanically (A) misses emotional needs. Confrontation (B) damages rapport. Labeling
as noncompliance (D) is premature and judgmental.
4. When obtaining a medication history, the nurse includes all prescription drugs,
over-the-counter medications, and:
A. Only herbal supplements recommended by the physician
B. All herbal supplements, vitamins, and complementary therapies
C. Only medications taken in the past week
D. Only medications the patient believes are important
Correct Answer: B
Rationale: C is correct. A comprehensive medication history includes all substances
that can affect health or interact with treatments: prescription drugs, OTC medications,
,herbal supplements, vitamins, and complementary therapies. Limiting to
physician-recommended supplements (A) misses potentially harmful self-treatment.
One week (D) misses chronic medications. Patient-selected importance (D) is
unreliable.
5. The nurse is conducting a review of systems with a patient who has limited health
literacy. To ensure accurate data collection, the nurse should:
A. Use medical terminology to maintain professional standards
B. Ask yes/no questions only to keep the interview brief
C. Use plain language, provide examples, and verify understanding through teach-back
D. Focus only on the system related to the current chief complaint
Correct Answer: C
Rationale: C is correct. For patients with limited health literacy, nurses must use plain
language, provide concrete examples (e.g., "trouble breathing when walking up stairs"),
and verify understanding using teach-back method. Medical terminology (A) creates
confusion. Yes/no questions (B) limit data quality. Focusing on one system (D) may
miss important health information.
6. When assessing pain in a nonverbal patient with advanced dementia, the nurse
should use which assessment approach?
A. Ask family members to estimate the patient's pain level
B. Use the numeric rating scale with visual aids
C. Utilize a validated behavioral pain assessment tool like PAINAD or Abbey Pain Scale
D. Assume the patient cannot feel pain due to cognitive impairment
Correct Answer: C
Rationale: C is correct. Nonverbal patients with dementia require validated behavioral
pain assessment tools such as PAINAD (Pain Assessment in Advanced Dementia) or
Abbey Pain Scale, which assess behavioral indicators like breathing, vocalization, facial
expression, and body language. Family estimates (A) are subjective. Numeric scales (B)
require cognitive ability. Assuming no pain (D) is a dangerous misconception.
, 7. The nurse is conducting a cultural assessment and learns the patient uses traditional
healing practices. The most appropriate nursing response is to:
A. Discourage these practices as potentially harmful
B. Ignore the practices if they don't interfere with medical treatment
C. Ask respectful questions about the practices and integrate safe cultural preferences
into the plan of care
D. Document the practices as noncompliance with Western medicine
Correct Answer: C
Rationale: C is correct. Culturally competent nursing care requires respectful inquiry
about traditional practices and integration of safe cultural preferences into the care plan
when possible. Discouraging practices (A) damages trust and rapport. Ignoring
practices (B) misses opportunities for holistic care. Documenting as noncompliance (D)
is ethnocentric and judgmental.
8. During a sexual health history, a patient becomes uncomfortable and refuses to
answer questions. The nurse should:
A. Skip the sexual health section and document "patient refused"
B. Acknowledge the discomfort, explain the relevance to health, and offer to return to
the topic later
C. Insist on completing the questions because they are required
D. Ask more specific questions to get the necessary information quickly
Correct Answer: B
Rationale: B is correct. When patients show discomfort with sensitive topics, nurses
should validate feelings, explain medical relevance (e.g., STI screening, medication
interactions), and offer flexibility to return later. Skipping entirely (A) misses important
health data. Insisting (C) violates patient autonomy. More specific questions (D)
increase discomfort.
9. The nurse is using the CAGE questionnaire to screen for alcohol use. Which question
represents the "E" (Eye-opener) component?
Nightingale College Complete Test Preparation
for 2026/2027 Academic Year
DOMAIN 1: HEALTH HISTORY & COMMUNICATION (Q1-15)
1. When interviewing an elderly patient with hearing impairment, the nurse
demonstrates effective communication by:
A. Speaking loudly directly into the patient's ear
B. Using complex medical terminology for precision
C. Facing the patient, speaking clearly at moderate pace, using written cues if needed
D. Asking family members to answer all questions to save time
Correct Answer: C
Rationale: C is correct. For patients with hearing impairment, nurses should face the
patient directly for lip-reading, speak clearly at moderate pace without shouting, and use
written communication if needed. Speaking loudly into the ear (A) can distort sound and
invade personal space. Medical terminology (B) may confuse patients. Having family
answer (D) violates patient autonomy and confidentiality.
2. The nurse is using the OLD CARTS mnemonic to assess a patient's abdominal pain.
When assessing "A" (aggravating/alleviating factors), the most comprehensive question
is:
A. "What makes the pain better?"
B. "What makes the pain worse?"
C. "What makes the pain better or worse, and what have you tried for relief?"
D. "Is the pain constant or intermittent?"
Correct Answer: C
,Rationale: C is correct. The "A" in OLD CARTS (Onset, Location, Duration, Character,
Aggravating/Alleviating, Radiation, Timing, Severity) should assess both aggravating
and alleviating factors and include self-treatment attempts. Asking only about what
helps (A) or worsens (B) is incomplete. Question D addresses timing, not
aggravating/alleviating factors.
3. During a health history interview with a patient recently diagnosed with diabetes, the
nurse notes the patient avoiding eye contact and giving short answers. The most
appropriate nursing response is to:
A. Continue with the standard questions to complete the assessment efficiently
B. Confront the patient about their negative attitude
C. Acknowledge the patient's feelings and ask about their concerns regarding the
diagnosis
D. Document noncompliance and notify the provider immediately
Correct Answer: C
Rationale: C is correct. Nonverbal cues of avoidance and short answers often indicate
anxiety or emotional distress. The nurse should use therapeutic communication to
acknowledge feelings and explore concerns about the diagnosis. Continuing
mechanically (A) misses emotional needs. Confrontation (B) damages rapport. Labeling
as noncompliance (D) is premature and judgmental.
4. When obtaining a medication history, the nurse includes all prescription drugs,
over-the-counter medications, and:
A. Only herbal supplements recommended by the physician
B. All herbal supplements, vitamins, and complementary therapies
C. Only medications taken in the past week
D. Only medications the patient believes are important
Correct Answer: B
Rationale: C is correct. A comprehensive medication history includes all substances
that can affect health or interact with treatments: prescription drugs, OTC medications,
,herbal supplements, vitamins, and complementary therapies. Limiting to
physician-recommended supplements (A) misses potentially harmful self-treatment.
One week (D) misses chronic medications. Patient-selected importance (D) is
unreliable.
5. The nurse is conducting a review of systems with a patient who has limited health
literacy. To ensure accurate data collection, the nurse should:
A. Use medical terminology to maintain professional standards
B. Ask yes/no questions only to keep the interview brief
C. Use plain language, provide examples, and verify understanding through teach-back
D. Focus only on the system related to the current chief complaint
Correct Answer: C
Rationale: C is correct. For patients with limited health literacy, nurses must use plain
language, provide concrete examples (e.g., "trouble breathing when walking up stairs"),
and verify understanding using teach-back method. Medical terminology (A) creates
confusion. Yes/no questions (B) limit data quality. Focusing on one system (D) may
miss important health information.
6. When assessing pain in a nonverbal patient with advanced dementia, the nurse
should use which assessment approach?
A. Ask family members to estimate the patient's pain level
B. Use the numeric rating scale with visual aids
C. Utilize a validated behavioral pain assessment tool like PAINAD or Abbey Pain Scale
D. Assume the patient cannot feel pain due to cognitive impairment
Correct Answer: C
Rationale: C is correct. Nonverbal patients with dementia require validated behavioral
pain assessment tools such as PAINAD (Pain Assessment in Advanced Dementia) or
Abbey Pain Scale, which assess behavioral indicators like breathing, vocalization, facial
expression, and body language. Family estimates (A) are subjective. Numeric scales (B)
require cognitive ability. Assuming no pain (D) is a dangerous misconception.
, 7. The nurse is conducting a cultural assessment and learns the patient uses traditional
healing practices. The most appropriate nursing response is to:
A. Discourage these practices as potentially harmful
B. Ignore the practices if they don't interfere with medical treatment
C. Ask respectful questions about the practices and integrate safe cultural preferences
into the plan of care
D. Document the practices as noncompliance with Western medicine
Correct Answer: C
Rationale: C is correct. Culturally competent nursing care requires respectful inquiry
about traditional practices and integration of safe cultural preferences into the care plan
when possible. Discouraging practices (A) damages trust and rapport. Ignoring
practices (B) misses opportunities for holistic care. Documenting as noncompliance (D)
is ethnocentric and judgmental.
8. During a sexual health history, a patient becomes uncomfortable and refuses to
answer questions. The nurse should:
A. Skip the sexual health section and document "patient refused"
B. Acknowledge the discomfort, explain the relevance to health, and offer to return to
the topic later
C. Insist on completing the questions because they are required
D. Ask more specific questions to get the necessary information quickly
Correct Answer: B
Rationale: B is correct. When patients show discomfort with sensitive topics, nurses
should validate feelings, explain medical relevance (e.g., STI screening, medication
interactions), and offer flexibility to return later. Skipping entirely (A) misses important
health data. Insisting (C) violates patient autonomy. More specific questions (D)
increase discomfort.
9. The nurse is using the CAGE questionnaire to screen for alcohol use. Which question
represents the "E" (Eye-opener) component?
