HESI V2 health assessment
A. Presents with a hacking non-effective cough of 6 weeks duration.
B. Describe having a "body-wracking dry cough" of 6 weeks length.
C. Expresses difficulty of "lung cancer" symptoms for final 6 weeks.
D. Young person male offers with fears that he has "lung most cancers"
Correct solution is B, as evaluation system includes leader grievance that is how the affected
person describe why he is right here in the health facility or hospital and can not consist of
analysis.
A seventy five-yr-antique patron with a current history of a cerebrovascular accident (CVA)
presents with proper hemiparesis. The nurse exams the deep tendon reflexes at the right
facet and elicits a brisk four+ reaction. Which interpretation of this finding is accurate?
A. A everyday reflex reaction.
B. Absent or sluggish reaction consistent with a decrease motor neuron lesion.
C. Flaccid paralysis.
D. Hyperactive response consistent with an top motor neuron disorder.
Correct solution is D, brisk four+ reaction is correlated with hyperactive reaction.
The nurse examines a purchaser's abdomen. Which finding shows an bizarre reaction when
palpating the spleen?
A. Pain notes when palpating McBurney's point.
B. Tip of spleen palpable whilst customer is asked to forcefully exhale.
C. Rebound tenderness with compression over proper upper quadrant. D. Firm mass
palpated at backside of left rib cage.
Correct solution is D. McBurney's point is related to appendicitis and now not spleen.
In auscultating for the presence of a carotid artery bruit, the nurse places the bell of the
stethoscope at which place?
*underneath mandible towards lymph nodes. Transverse to trachea
A male purchaser arrives on the health facility for comply with-up health evaluation after
latest antibiotic treatment for pneumonia with out hospitalization. Which technique have to
the nurse put in force to evaluate for adventitious lung sounds?
A. Use the bell of the stethoscope to pay attention to the lung fields over lower lobes. B.
Have the patron lay flat even as listening to the anterior floor of the chest.
C. Press the stethoscope's diaphragm firmly at the pores and skin over every lung field.
D. Shave all chest hair which could distort sounds heard via the diaphragm.
Correct solution is C. The nurse need to listen to all lungs fields all through evaluation and
circulate backward and forward in the course of auscultation.
, A customer with streptococcus pharyngitis reviews high fever, issue swallowing and a
muffled voice. Which trouble ought to the nurse suspect?
A. Foreign frame obstruction.
B. Laryngeal polyps.
C. Peritonsillar abscess.
D. Nasal polyps
Correct answer is C. Since infections are associated with abscesses and pus.
The nurse is acquiring a health history for a client prior to a scheduled cholecystectomy.
While interviewing the consumer, which evaluation approach must the nurse use whilst
asking approximately the customer's use of illegal capsules and alcohol?
A. Obtain a drug the use of display to confirm legitimacy of customer's said records.
B. Allow the client to decline answering social questions.
C. Ask particularly approximately alcohol, marijuana, cocaine, her
D. Use the time period unlawful or illicit to explain street drug.
Correct solution is C. When interviewing the patient, questions have to be clean and
particular.
The nurse applies strain over a place of the lower abdomen where the patron reviews ache.
The patron denies pain upon palpation, however reports pain whilst the strain is released.
What action should the nurse implement?
A. Offer to administer a laxative prescribed for PRN use.
B. Obtain a prescription to catheterize the purchaser's bladder.
C. Instruct the purchaser in distraction and relation techniques.
D. Notify the healthcare company of the rebound tenderness.
Correct answer is D. As this can be a sign of appendicitis.
The nurse is assessing an ulcer on a client's lower extremity, that's probably the end result of
both venous or arterial insufficiency. Which evaluation approach need to the nurse use to
differentiate the pathophysiology causing the ulcer?
A. Measure the degree of be part of range of motion in the extremity.
B. Compare the pores and skin turgor of the customer's upper and decrease leg.
C. Observe the specific area and appearance of the ulceration.
D. Note any trade within the color of the ulcer when the leg is moved
Correct solution is C. Location and look of the ulcer could provide us the kind (venous vs
arterial)
The nurse is conducting a bodily evaluation of a younger adult. Which facts gives the quality
indication of the person's dietary repute?
A. Status of present day urge for food.
B. A 24-hour weight loss program history.
C. History of a latest weight reduction.
A. Presents with a hacking non-effective cough of 6 weeks duration.
B. Describe having a "body-wracking dry cough" of 6 weeks length.
C. Expresses difficulty of "lung cancer" symptoms for final 6 weeks.
D. Young person male offers with fears that he has "lung most cancers"
Correct solution is B, as evaluation system includes leader grievance that is how the affected
person describe why he is right here in the health facility or hospital and can not consist of
analysis.
A seventy five-yr-antique patron with a current history of a cerebrovascular accident (CVA)
presents with proper hemiparesis. The nurse exams the deep tendon reflexes at the right
facet and elicits a brisk four+ reaction. Which interpretation of this finding is accurate?
A. A everyday reflex reaction.
B. Absent or sluggish reaction consistent with a decrease motor neuron lesion.
C. Flaccid paralysis.
D. Hyperactive response consistent with an top motor neuron disorder.
Correct solution is D, brisk four+ reaction is correlated with hyperactive reaction.
The nurse examines a purchaser's abdomen. Which finding shows an bizarre reaction when
palpating the spleen?
A. Pain notes when palpating McBurney's point.
B. Tip of spleen palpable whilst customer is asked to forcefully exhale.
C. Rebound tenderness with compression over proper upper quadrant. D. Firm mass
palpated at backside of left rib cage.
Correct solution is D. McBurney's point is related to appendicitis and now not spleen.
In auscultating for the presence of a carotid artery bruit, the nurse places the bell of the
stethoscope at which place?
*underneath mandible towards lymph nodes. Transverse to trachea
A male purchaser arrives on the health facility for comply with-up health evaluation after
latest antibiotic treatment for pneumonia with out hospitalization. Which technique have to
the nurse put in force to evaluate for adventitious lung sounds?
A. Use the bell of the stethoscope to pay attention to the lung fields over lower lobes. B.
Have the patron lay flat even as listening to the anterior floor of the chest.
C. Press the stethoscope's diaphragm firmly at the pores and skin over every lung field.
D. Shave all chest hair which could distort sounds heard via the diaphragm.
Correct solution is C. The nurse need to listen to all lungs fields all through evaluation and
circulate backward and forward in the course of auscultation.
, A customer with streptococcus pharyngitis reviews high fever, issue swallowing and a
muffled voice. Which trouble ought to the nurse suspect?
A. Foreign frame obstruction.
B. Laryngeal polyps.
C. Peritonsillar abscess.
D. Nasal polyps
Correct answer is C. Since infections are associated with abscesses and pus.
The nurse is acquiring a health history for a client prior to a scheduled cholecystectomy.
While interviewing the consumer, which evaluation approach must the nurse use whilst
asking approximately the customer's use of illegal capsules and alcohol?
A. Obtain a drug the use of display to confirm legitimacy of customer's said records.
B. Allow the client to decline answering social questions.
C. Ask particularly approximately alcohol, marijuana, cocaine, her
D. Use the time period unlawful or illicit to explain street drug.
Correct solution is C. When interviewing the patient, questions have to be clean and
particular.
The nurse applies strain over a place of the lower abdomen where the patron reviews ache.
The patron denies pain upon palpation, however reports pain whilst the strain is released.
What action should the nurse implement?
A. Offer to administer a laxative prescribed for PRN use.
B. Obtain a prescription to catheterize the purchaser's bladder.
C. Instruct the purchaser in distraction and relation techniques.
D. Notify the healthcare company of the rebound tenderness.
Correct answer is D. As this can be a sign of appendicitis.
The nurse is assessing an ulcer on a client's lower extremity, that's probably the end result of
both venous or arterial insufficiency. Which evaluation approach need to the nurse use to
differentiate the pathophysiology causing the ulcer?
A. Measure the degree of be part of range of motion in the extremity.
B. Compare the pores and skin turgor of the customer's upper and decrease leg.
C. Observe the specific area and appearance of the ulceration.
D. Note any trade within the color of the ulcer when the leg is moved
Correct solution is C. Location and look of the ulcer could provide us the kind (venous vs
arterial)
The nurse is conducting a bodily evaluation of a younger adult. Which facts gives the quality
indication of the person's dietary repute?
A. Status of present day urge for food.
B. A 24-hour weight loss program history.
C. History of a latest weight reduction.
