BSN 246 HESI HEALTH
ASSESSMENT V1/ACTUAL
EXAM 2025/2026–
NIGHTINGALE COLLEGE
[Document subtitle]
What’s included;
150+ HESI-style practice questions covering key
Health Assessment concepts.
Highlighted correct answers for quick and
efficient review
Clear rationales explaining why each answer is
correct to strengthen understanding
Covers essential topics including cardiovascular,
respiratory, hematology, pharmacology, acid-
base balance, patient safety, and nursing
priorities
A valuable study companion for BSN 246 Health
Assessment students.
,1 A client with chest pain, dizziness, and vomiting for the last 2 hours is admitted for
evaluation for Acute Coronary Syndrome (ACS). Which cardiac biomarker should the
registered nurse (RN) anticipate to be elevated if the client experienced myocardial
damage?
Creatine Kinase (CK-MB).
Serum troponin.
Myoglobin.
Ischemia modified albumin. :AnswerSerum troponin.
rationale
Troponin is the most sensitive and specific test for myocardial damage. Troponin
elevation is more specific than CK-MB.
2. The registered nurse (RN) is developing the plan of care for a client who is
admitted for alcohol detoxification. Which goal should be most important for the RN to
primarily focus the client's care?
The client maintains optimal nutritional status.
The client will remain alert and oriented.
The client will remain free from injury.
The client will remain alcohol free during hospitalization. :AnswerThe client will
remain free from injury.
Rationale
The client is at highest risk for injury due to altered cognitive and sensory disturbances
as well as delirium tremors during withdrawal. Remaining free from injury is the most
important goal for the acute phase of alcohol withdrawal.
3. 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?
Assist with frequent ambulation.
Encourage visitors to visit.
,Maintain strict protective precautions.
Avoid peripheral injections. :AnswerMaintain 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.
4 The registered nurse (RN) assesses a client's results for arterial blood gases who has
emphysema. Which finding is consistent with respiratory acidosis? pH 7.32, pCO2 46
mmHg, HCO3 24 MEq/L. pH 7.45 , pCO2 37 mmHg, HCO3 24 mEq/L. pH 7.34, pCO2 36
mmHg, HCO3 21 mEq/L. pH 7.46, pCO2 35 mmHg, HCO3 28 mEq/L. :AnswerpH 7.32,
pCO2 46 mmHg, HCO3 24 MEq/L.
Rationale
Normal ABG ranges are pH 7.35 to 7.45; pCO2 35 to 45 mmHg; HCO3 21 to 28 mEq/L,
and pO2 80 to 100 mmHg. An ABG of pH 7.32, pCO2 46 mmHg, HCO3 24 MEq/L
represents a client with respiratory acidosis which is characterized by :Answerlow pH,
pCO2higher than normal, and HCO3 within normal limits.
5. The registered nurse (RN) is caring for a client who has taken atenolol for 2 years.
The healthcare provider recently changed the medication to enalaprilto manage the
client's blood pressure. Which instruction should the RN provide the client regarding the
new medication?
Take the medication at bedtime.
Report presence of increased bruising.
Check pulse before taking medication.
Rise slowly when getting out of bed or chair. :AnswerRise slowly when getting out of bed
or chair.
Rationale
The client's new medication is an angiotensin-converting enzyme (ACE) inhibitor, which
has the side effect oforthostatic hypotension. Instructing the client to rise slowly from a
, sitting or lying down position is important to teach the client to avoid dizziness and
potentially falling.
6. The registered nurse (RN) places an ice pack on a middle school student who
comes to the school clinic complaining of a sprained ankle. Which therapeutic response
should the RN anticipate?
Reduced pain and minimized brusing.
Lowering of body core temperature.
Increased circulation around injury.
Reabsorption of edema at injury. :AnswerReduced pain and minimized brusing.
Rationale
Cold applications produce a topical anesthetic effect to reduce pain as well as constricts
blood vessels to minimize bruising.
7 Which action should the registered nurse (RN) implement to complete an assessment
for a client while using an interpreter?
Ask closed-ended questions with the assistance of the interpreter.
Maintain eye contact with the client while listening to the translation.
Instruct interpreter to answer questions from interpreter's point of view. Protect the
client's privacy by asking a limited number of questions. :AnswerMaintain eye contact
with the client while listening to the translation.
Rationale
When completing an assessment, the RN should maintain eye contact with the client to
gather additional information from the client's nonverbal cues.
8. The registered nurse (RN) is assessing common complications related to a client's
recent diagnosis, systemic lupus erythematosus (SLE). Which symptom should the RN
instruct the client to report immediately?
Fever related to infection.
Weight loss and anorexia.
Depressed mood.
Break in tissue integrity. :AnswerFever related to infection.
ASSESSMENT V1/ACTUAL
EXAM 2025/2026–
NIGHTINGALE COLLEGE
[Document subtitle]
What’s included;
150+ HESI-style practice questions covering key
Health Assessment concepts.
Highlighted correct answers for quick and
efficient review
Clear rationales explaining why each answer is
correct to strengthen understanding
Covers essential topics including cardiovascular,
respiratory, hematology, pharmacology, acid-
base balance, patient safety, and nursing
priorities
A valuable study companion for BSN 246 Health
Assessment students.
,1 A client with chest pain, dizziness, and vomiting for the last 2 hours is admitted for
evaluation for Acute Coronary Syndrome (ACS). Which cardiac biomarker should the
registered nurse (RN) anticipate to be elevated if the client experienced myocardial
damage?
Creatine Kinase (CK-MB).
Serum troponin.
Myoglobin.
Ischemia modified albumin. :AnswerSerum troponin.
rationale
Troponin is the most sensitive and specific test for myocardial damage. Troponin
elevation is more specific than CK-MB.
2. The registered nurse (RN) is developing the plan of care for a client who is
admitted for alcohol detoxification. Which goal should be most important for the RN to
primarily focus the client's care?
The client maintains optimal nutritional status.
The client will remain alert and oriented.
The client will remain free from injury.
The client will remain alcohol free during hospitalization. :AnswerThe client will
remain free from injury.
Rationale
The client is at highest risk for injury due to altered cognitive and sensory disturbances
as well as delirium tremors during withdrawal. Remaining free from injury is the most
important goal for the acute phase of alcohol withdrawal.
3. 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?
Assist with frequent ambulation.
Encourage visitors to visit.
,Maintain strict protective precautions.
Avoid peripheral injections. :AnswerMaintain 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.
4 The registered nurse (RN) assesses a client's results for arterial blood gases who has
emphysema. Which finding is consistent with respiratory acidosis? pH 7.32, pCO2 46
mmHg, HCO3 24 MEq/L. pH 7.45 , pCO2 37 mmHg, HCO3 24 mEq/L. pH 7.34, pCO2 36
mmHg, HCO3 21 mEq/L. pH 7.46, pCO2 35 mmHg, HCO3 28 mEq/L. :AnswerpH 7.32,
pCO2 46 mmHg, HCO3 24 MEq/L.
Rationale
Normal ABG ranges are pH 7.35 to 7.45; pCO2 35 to 45 mmHg; HCO3 21 to 28 mEq/L,
and pO2 80 to 100 mmHg. An ABG of pH 7.32, pCO2 46 mmHg, HCO3 24 MEq/L
represents a client with respiratory acidosis which is characterized by :Answerlow pH,
pCO2higher than normal, and HCO3 within normal limits.
5. The registered nurse (RN) is caring for a client who has taken atenolol for 2 years.
The healthcare provider recently changed the medication to enalaprilto manage the
client's blood pressure. Which instruction should the RN provide the client regarding the
new medication?
Take the medication at bedtime.
Report presence of increased bruising.
Check pulse before taking medication.
Rise slowly when getting out of bed or chair. :AnswerRise slowly when getting out of bed
or chair.
Rationale
The client's new medication is an angiotensin-converting enzyme (ACE) inhibitor, which
has the side effect oforthostatic hypotension. Instructing the client to rise slowly from a
, sitting or lying down position is important to teach the client to avoid dizziness and
potentially falling.
6. The registered nurse (RN) places an ice pack on a middle school student who
comes to the school clinic complaining of a sprained ankle. Which therapeutic response
should the RN anticipate?
Reduced pain and minimized brusing.
Lowering of body core temperature.
Increased circulation around injury.
Reabsorption of edema at injury. :AnswerReduced pain and minimized brusing.
Rationale
Cold applications produce a topical anesthetic effect to reduce pain as well as constricts
blood vessels to minimize bruising.
7 Which action should the registered nurse (RN) implement to complete an assessment
for a client while using an interpreter?
Ask closed-ended questions with the assistance of the interpreter.
Maintain eye contact with the client while listening to the translation.
Instruct interpreter to answer questions from interpreter's point of view. Protect the
client's privacy by asking a limited number of questions. :AnswerMaintain eye contact
with the client while listening to the translation.
Rationale
When completing an assessment, the RN should maintain eye contact with the client to
gather additional information from the client's nonverbal cues.
8. The registered nurse (RN) is assessing common complications related to a client's
recent diagnosis, systemic lupus erythematosus (SLE). Which symptom should the RN
instruct the client to report immediately?
Fever related to infection.
Weight loss and anorexia.
Depressed mood.
Break in tissue integrity. :AnswerFever related to infection.
