HESI Health Assessment Nightingale College Exam
AND DETAILED ANSWERS | 100% VERIFIED
CORRECT | GRADE A+
1. A 45-year-old patient with a history of chronic obstructive pulmonary disease (COPD) presents
with increased shortness of breath and purulent sputum. On auscultation, you note decreased
breath sounds at the right base with inspiratory crackles. The patient's oxygen saturation is 89%
on room air. Which of the following assessment findings would most strongly indicate the need for
immediate chest tube placement?
A. Hyperresonance on percussion of the right chest
B. Tracheal deviation to the left
C. Dullness to percussion at the right base
D. Egophony over the right lower lobe
Answer: B
Rationale: Tracheal deviation away from the affected side is a sign of tension pneumothorax, which
requires immediate decompression with a chest tube. Hyperresonance suggests simple pneumothorax
but not necessarily tension. Dullness and egophony are more consistent with consolidation or pleural
effusion.
2. During a cardiac assessment, you note a high-pitched, blowing diastolic murmur at the left
sternal border, best heard with the patient leaning forward and at end-expiration. Which valvular
abnormality is most consistent with this finding?
A. Mitral stenosis
B. Aortic regurgitation
C. Tricuspid regurgitation
D. Pulmonic stenosis
Answer: B
Rationale: Aortic regurgitation produces a high-pitched, blowing diastolic murmur at the left sternal
border, accentuated by leaning forward and end-expiration. Mitral stenosis has a low-pitched diastolic
rumble. Tricuspid regurgitation is systolic. Pulmonic stenosis is systolic.
3. A patient presents with acute onset of severe, colicky right flank pain radiating to the groin,
associated with nausea and hematuria. On abdominal examination, there is no rebound or
guarding. Which physical examination maneuver is most likely to reproduce the pain?
A. Murphy's sign
B. McBurney's point tenderness
C. Costovertebral angle (CVA) tenderness
D. Psoas sign
Page 1
,Answer: C
Rationale: Costovertebral angle tenderness is classic for renal colic due to ureteral obstruction.
Murphy's sign suggests cholecystitis. McBurney's point and psoas sign are associated with appendicitis.
4. A patient with diabetes mellitus has a nonhealing ulcer on the plantar surface of the foot. The
wound is deep, with exposed tendon, and there is surrounding erythema and edema. The patient's
white blood cell count is 15,000/mm³. Which assessment finding is most critical to determine the
need for urgent surgical intervention?
A. Ankle-brachial index (ABI) of 0.9
B. Presence of palpable pedal pulses
C. Probing to bone with a sterile instrument
D. Wound culture positive for Staphylococcus aureus
Answer: C
Rationale: Probing to bone is highly suggestive of osteomyelitis, which often requires surgical
debridement. An ABI of 0.9 is normal. Palpable pulses indicate adequate perfusion. Positive culture
alone does not dictate surgical urgency.
5. A patient with cirrhosis and ascites undergoes paracentesis. The fluid is cloudy with a white
blood cell count of 800 cells/L (80% neutrophils). Which of the following is the most appropriate
interpretation?
A. Transudative ascites due to portal hypertension
B. Spontaneous bacterial peritonitis (SBP)
C. Malignant ascites
D. Pancreatic ascites
Answer: B
Rationale: Cloudy fluid with neutrophil count >250 cells/¼L is diagnostic of SBP. Transudative ascites is
typically clear with low WBC. Malignant ascites often has higher protein and cytology. Pancreatic
ascites has elevated amylase.
6. A patient with suspected hypothyroidism has a TSH of 15 mIU/L (normal 0.5-5.0) and a free T4
of 0.6 ng/dL (normal 0.8-1.8). Which additional assessment finding would most strongly suggest
Hashimoto's thyroiditis as the underlying cause?
A. Presence of a thyroid bruit
B. Elevated thyroglobulin antibodies
C. Low radioactive iodine uptake
D. Increased thyroxine-binding globulin
Answer: B
Rationale: Elevated thyroglobulin and thyroid peroxidase antibodies are hallmarks of Hashimoto's
thyroiditis. A thyroid bruit suggests Graves' disease. Low uptake can occur in various conditions. TBG
affects total T4 but not the diagnosis.
Page 2
,7. During a neurological assessment, a patient is unable to identify a familiar object placed in their
hand when their eyes are closed, but can describe its texture and temperature. Which cortical area
is most likely affected?
A. Primary somatosensory cortex
B. Primary motor cortex
C. Sensory association cortex
D. Prefrontal cortex
Answer: C
Rationale: The inability to recognize objects by touch (astereognosis) despite intact primary sensation
indicates a lesion in the sensory association cortex (parietal lobe). Primary somatosensory cortex
processes basic touch, not recognition. Motor and prefrontal areas are not involved.
8. A patient presents with fatigue, arthralgias, and a malar rash. Laboratory results show anemia,
thrombocytopenia, and a positive antinuclear antibody (ANA) test with a titer of 1:640. Which
additional test is most specific to confirm the diagnosis?
A. Anti-double-stranded DNA (anti-dsDNA) antibodies
B. Rheumatoid factor
C. Anti-cyclic citrullinated peptide (anti-CCP) antibodies
D. C-reactive protein (CRP)
Answer: A
Rationale: Anti-dsDNA antibodies are highly specific for systemic lupus erythematosus (SLE).
Rheumatoid factor and anti-CCP are associated with rheumatoid arthritis. CRP is nonspecific.
9. A patient with chronic kidney disease (stage 4) has a serum potassium of 6.2 mEq/L. The
electrocardiogram (ECG) shows peaked T waves. Which assessment finding would be most
indicative of a life-threatening emergency requiring immediate intervention?
A. Presence of U waves
B. Prolonged PR interval
C. Widened QRS complex
D. ST segment depression
Answer: C
Rationale: Widened QRS complex in hyperkalemia indicates severe cardiac conduction delay, which can
progress to ventricular fibrillation. Peaked T waves are early signs. U waves suggest hypokalemia. PR
prolongation and ST depression are less specific.
10. A patient with suspected pulmonary embolism has a Wells' score of 6. A D-dimer test is
elevated. Which of the following imaging studies is the most appropriate next step to confirm the
diagnosis?
A. Ventilation-perfusion (V/Q) scan
B. CT pulmonary angiography (CTPA)
C. Chest X-ray
D. Echocardiography
Page 3
, Answer: B
Rationale: CTPA is the first-line imaging for suspected pulmonary embolism in patients with high pretest
probability and elevated D-dimer. V/Q scan is used if CTPA is contraindicated (e.g., renal impairment).
Chest X-ray is not diagnostic. Echocardiography can show right ventricular strain but is not
confirmatory.
11. A patient presents with sudden onset of severe, tearing chest pain radiating to the back,
accompanied by a difference in blood pressure between arms. Which assessment finding is most
critical to identify immediately?
A. A new aortic regurgitation murmur
B. Pulsus paradoxus of 12 mm Hg
C. A pericardial friction rub
D. Elevated jugular venous pressure with Kussmaul sign
Answer: A
Rationale: A new aortic regurgitation murmur suggests aortic root dilation, a hallmark of aortic
dissection. Pulsus paradoxus (B) and Kussmaul sign (D) indicate cardiac tamponade, which is less
likely. Pericardial rub (C) suggests pericarditis, not dissection.
12. A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas
showing pH 7.32, PaCO2 58 mm Hg, PaO2 70 mm Hg, HCO3- 30 mEq/L. Which acid-base
disorder is present?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory acidosis and metabolic acidosis
Answer: B
Rationale: Elevated PaCO2 (58) indicates respiratory acidosis. Elevated HCO3- (30) suggests metabolic
compensation, which occurs in chronic respiratory acidosis. Acute would have normal HCO3-.
Metabolic alkalosis (C) would have high pH. Mixed disorder (D) would have lower HCO3-.
13. During a cardiac assessment, you auscultate a high-pitched, holosystolic murmur at the apex
that radiates to the axilla. Which maneuver would increase the intensity of this murmur?
A. Straining during Valsalva maneuver
B. Rapid squatting
C. Handgrip exercise
D. Standing from a squatting position
Answer: C
Rationale: The murmur described is mitral regurgitation. Handgrip increases afterload, which increases
regurgitant flow and murmur intensity. Valsalva (A) decreases preload and reduces murmur. Squatting
(B) increases preload but also afterload; however, handgrip is more specific. Standing (D) decreases
preload.
Page 4
AND DETAILED ANSWERS | 100% VERIFIED
CORRECT | GRADE A+
1. A 45-year-old patient with a history of chronic obstructive pulmonary disease (COPD) presents
with increased shortness of breath and purulent sputum. On auscultation, you note decreased
breath sounds at the right base with inspiratory crackles. The patient's oxygen saturation is 89%
on room air. Which of the following assessment findings would most strongly indicate the need for
immediate chest tube placement?
A. Hyperresonance on percussion of the right chest
B. Tracheal deviation to the left
C. Dullness to percussion at the right base
D. Egophony over the right lower lobe
Answer: B
Rationale: Tracheal deviation away from the affected side is a sign of tension pneumothorax, which
requires immediate decompression with a chest tube. Hyperresonance suggests simple pneumothorax
but not necessarily tension. Dullness and egophony are more consistent with consolidation or pleural
effusion.
2. During a cardiac assessment, you note a high-pitched, blowing diastolic murmur at the left
sternal border, best heard with the patient leaning forward and at end-expiration. Which valvular
abnormality is most consistent with this finding?
A. Mitral stenosis
B. Aortic regurgitation
C. Tricuspid regurgitation
D. Pulmonic stenosis
Answer: B
Rationale: Aortic regurgitation produces a high-pitched, blowing diastolic murmur at the left sternal
border, accentuated by leaning forward and end-expiration. Mitral stenosis has a low-pitched diastolic
rumble. Tricuspid regurgitation is systolic. Pulmonic stenosis is systolic.
3. A patient presents with acute onset of severe, colicky right flank pain radiating to the groin,
associated with nausea and hematuria. On abdominal examination, there is no rebound or
guarding. Which physical examination maneuver is most likely to reproduce the pain?
A. Murphy's sign
B. McBurney's point tenderness
C. Costovertebral angle (CVA) tenderness
D. Psoas sign
Page 1
,Answer: C
Rationale: Costovertebral angle tenderness is classic for renal colic due to ureteral obstruction.
Murphy's sign suggests cholecystitis. McBurney's point and psoas sign are associated with appendicitis.
4. A patient with diabetes mellitus has a nonhealing ulcer on the plantar surface of the foot. The
wound is deep, with exposed tendon, and there is surrounding erythema and edema. The patient's
white blood cell count is 15,000/mm³. Which assessment finding is most critical to determine the
need for urgent surgical intervention?
A. Ankle-brachial index (ABI) of 0.9
B. Presence of palpable pedal pulses
C. Probing to bone with a sterile instrument
D. Wound culture positive for Staphylococcus aureus
Answer: C
Rationale: Probing to bone is highly suggestive of osteomyelitis, which often requires surgical
debridement. An ABI of 0.9 is normal. Palpable pulses indicate adequate perfusion. Positive culture
alone does not dictate surgical urgency.
5. A patient with cirrhosis and ascites undergoes paracentesis. The fluid is cloudy with a white
blood cell count of 800 cells/L (80% neutrophils). Which of the following is the most appropriate
interpretation?
A. Transudative ascites due to portal hypertension
B. Spontaneous bacterial peritonitis (SBP)
C. Malignant ascites
D. Pancreatic ascites
Answer: B
Rationale: Cloudy fluid with neutrophil count >250 cells/¼L is diagnostic of SBP. Transudative ascites is
typically clear with low WBC. Malignant ascites often has higher protein and cytology. Pancreatic
ascites has elevated amylase.
6. A patient with suspected hypothyroidism has a TSH of 15 mIU/L (normal 0.5-5.0) and a free T4
of 0.6 ng/dL (normal 0.8-1.8). Which additional assessment finding would most strongly suggest
Hashimoto's thyroiditis as the underlying cause?
A. Presence of a thyroid bruit
B. Elevated thyroglobulin antibodies
C. Low radioactive iodine uptake
D. Increased thyroxine-binding globulin
Answer: B
Rationale: Elevated thyroglobulin and thyroid peroxidase antibodies are hallmarks of Hashimoto's
thyroiditis. A thyroid bruit suggests Graves' disease. Low uptake can occur in various conditions. TBG
affects total T4 but not the diagnosis.
Page 2
,7. During a neurological assessment, a patient is unable to identify a familiar object placed in their
hand when their eyes are closed, but can describe its texture and temperature. Which cortical area
is most likely affected?
A. Primary somatosensory cortex
B. Primary motor cortex
C. Sensory association cortex
D. Prefrontal cortex
Answer: C
Rationale: The inability to recognize objects by touch (astereognosis) despite intact primary sensation
indicates a lesion in the sensory association cortex (parietal lobe). Primary somatosensory cortex
processes basic touch, not recognition. Motor and prefrontal areas are not involved.
8. A patient presents with fatigue, arthralgias, and a malar rash. Laboratory results show anemia,
thrombocytopenia, and a positive antinuclear antibody (ANA) test with a titer of 1:640. Which
additional test is most specific to confirm the diagnosis?
A. Anti-double-stranded DNA (anti-dsDNA) antibodies
B. Rheumatoid factor
C. Anti-cyclic citrullinated peptide (anti-CCP) antibodies
D. C-reactive protein (CRP)
Answer: A
Rationale: Anti-dsDNA antibodies are highly specific for systemic lupus erythematosus (SLE).
Rheumatoid factor and anti-CCP are associated with rheumatoid arthritis. CRP is nonspecific.
9. A patient with chronic kidney disease (stage 4) has a serum potassium of 6.2 mEq/L. The
electrocardiogram (ECG) shows peaked T waves. Which assessment finding would be most
indicative of a life-threatening emergency requiring immediate intervention?
A. Presence of U waves
B. Prolonged PR interval
C. Widened QRS complex
D. ST segment depression
Answer: C
Rationale: Widened QRS complex in hyperkalemia indicates severe cardiac conduction delay, which can
progress to ventricular fibrillation. Peaked T waves are early signs. U waves suggest hypokalemia. PR
prolongation and ST depression are less specific.
10. A patient with suspected pulmonary embolism has a Wells' score of 6. A D-dimer test is
elevated. Which of the following imaging studies is the most appropriate next step to confirm the
diagnosis?
A. Ventilation-perfusion (V/Q) scan
B. CT pulmonary angiography (CTPA)
C. Chest X-ray
D. Echocardiography
Page 3
, Answer: B
Rationale: CTPA is the first-line imaging for suspected pulmonary embolism in patients with high pretest
probability and elevated D-dimer. V/Q scan is used if CTPA is contraindicated (e.g., renal impairment).
Chest X-ray is not diagnostic. Echocardiography can show right ventricular strain but is not
confirmatory.
11. A patient presents with sudden onset of severe, tearing chest pain radiating to the back,
accompanied by a difference in blood pressure between arms. Which assessment finding is most
critical to identify immediately?
A. A new aortic regurgitation murmur
B. Pulsus paradoxus of 12 mm Hg
C. A pericardial friction rub
D. Elevated jugular venous pressure with Kussmaul sign
Answer: A
Rationale: A new aortic regurgitation murmur suggests aortic root dilation, a hallmark of aortic
dissection. Pulsus paradoxus (B) and Kussmaul sign (D) indicate cardiac tamponade, which is less
likely. Pericardial rub (C) suggests pericarditis, not dissection.
12. A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas
showing pH 7.32, PaCO2 58 mm Hg, PaO2 70 mm Hg, HCO3- 30 mEq/L. Which acid-base
disorder is present?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory acidosis and metabolic acidosis
Answer: B
Rationale: Elevated PaCO2 (58) indicates respiratory acidosis. Elevated HCO3- (30) suggests metabolic
compensation, which occurs in chronic respiratory acidosis. Acute would have normal HCO3-.
Metabolic alkalosis (C) would have high pH. Mixed disorder (D) would have lower HCO3-.
13. During a cardiac assessment, you auscultate a high-pitched, holosystolic murmur at the apex
that radiates to the axilla. Which maneuver would increase the intensity of this murmur?
A. Straining during Valsalva maneuver
B. Rapid squatting
C. Handgrip exercise
D. Standing from a squatting position
Answer: C
Rationale: The murmur described is mitral regurgitation. Handgrip increases afterload, which increases
regurgitant flow and murmur intensity. Valsalva (A) decreases preload and reduces murmur. Squatting
(B) increases preload but also afterload; however, handgrip is more specific. Standing (D) decreases
preload.
Page 4
