1
HESI Health Assessment| UPDATE|
COMPLETE FREQUENTLY TESTED
QUESTIONS WITH VERIFIED
ANSWERS|GET IT 100% ACCURATE!!
What is gamma globulin and when is it used? - (ANSWER)Gamma globulin, which
is an immune globulin, contains most of the antibodies circulating in the blood.
When injected into an individual, it prevents a specific antigen from entering a
host cell. So the antigen is neutralized by the antibodies gamma globulin supplies.
Used when a pt is exposed to Hep A
A nurse is obtaining a health history from the newly admitted client who has
chronic pain in the knee. What should the nurse include in the pain assessment?
Select all that apply.
1
Pain history, including location, intensity, and quality of pain
2
Client's purposeful body movement in arranging the papers on the bedside table
3
Pain pattern, including precipitating and alleviating factors
4
Vital signs, such as increased blood pressure and heart rate
5
The client's family statement about increases in pain with ambulation -
(ANSWER)1 & 3
,2
Why not others?? Physiological responses such as elevated blood pressure and
heart rate are most likely to be absent in the client with chronic pain. Pain is a
subjective experience, and therefore the nurse has to ask the client directly
instead of accepting the statement of the family members.
Pressure Ulcers and stages - (ANSWER)stage I pressure ulcer- an area of
persistent redness with no break in skin integrity.
stage II pressure ulcer-partial-thickness wound with skin loss involving the
epidermis, dermis, or both; the ulcer is superficial and may present as an
abrasion, blister, or shallow crater
stage III pressure ulcer- full-thickness tissue loss with visible subcutaneous fat.
Bone, tendon, and muscle are not exposed.
stage IV- full thickness tissue loss with exposed bone, tendon, muscle, bone
(slough or eschar may be present within wound bed)
unstageable- contains necrotic tissue, necrotic tissue must be removed before the
wound can be staged.
While assessing a client's skin, a nurse notices that the skin is dry. What is the
probable etiology of the condition? Select all that apply. - (ANSWER)The use of
hard soap and frequent bathing may result in dry skin. A skin allergy may result in
skin rashes, but not dry skin. Using tanning pills and petroleum products may
result in skin cancer.
The community nurse is assessing an elderly client who lives alone at home. the
client refrains from physical activity for fear of falling when walking. Which
,3
interventions by the nurse are most beneficial to promote a healthy lifestyle? -
(ANSWER)Encourage the client to wear nonskid shoes.
Suggest that the client use an assistive device.
Help the client rearrange furniture in the house.
Which features distinguish nursing diagnoses from medical diagnoses? Select all
that apply.
1
Nursing diagnoses involve the client when possible.
2
Nursing diagnoses are based on results of diagnostic tests and procedures.
3
Nursing diagnoses are the identification of a disease condition in the client.
4
Nursing diagnoses involve the sorting of health problems within the nursing
domain.
5
Nursing diagnoses involve clinical judgment about the client's response to health
problems. - (ANSWER)Nursing diagnoses involve (client participation) the client
when possible.
Nursing diagnoses involve the sorting of health problems within the nursing
domain.
Nursing diagnoses involve clinical judgment about the client's response to health
problems.
, 4
WRONG ANSWER:
Nursing diagnoses are based on results of diagnostic tests and procedures.
WRONG ANSWER:
Nursing diagnoses are the identification of a disease condition in the client.
A 50-year-old client with a 30-year history of smoking reports a chronic cough and
shortness of breath related to chronic obstructive pulmonary disease (COPD). The
clinical data on admission are as follows: a heart rate of 100, a blood pressure of
138/82, a respiratory rate of 32, a tympanic temperature 36.8 °C, and an oxygen
saturation of 80%. Which vital signs obtained by the nurse during the therapy
indicates a positive outcome? Select all that apply.
1
Radial pulse: 70
2
Temperature: 37 °C
3
Respiratory rate: 14
4
Blood pressure: 110/70
5
Oxygen saturation: 96% - (ANSWER)3,4,5
HESI Health Assessment| UPDATE|
COMPLETE FREQUENTLY TESTED
QUESTIONS WITH VERIFIED
ANSWERS|GET IT 100% ACCURATE!!
What is gamma globulin and when is it used? - (ANSWER)Gamma globulin, which
is an immune globulin, contains most of the antibodies circulating in the blood.
When injected into an individual, it prevents a specific antigen from entering a
host cell. So the antigen is neutralized by the antibodies gamma globulin supplies.
Used when a pt is exposed to Hep A
A nurse is obtaining a health history from the newly admitted client who has
chronic pain in the knee. What should the nurse include in the pain assessment?
Select all that apply.
1
Pain history, including location, intensity, and quality of pain
2
Client's purposeful body movement in arranging the papers on the bedside table
3
Pain pattern, including precipitating and alleviating factors
4
Vital signs, such as increased blood pressure and heart rate
5
The client's family statement about increases in pain with ambulation -
(ANSWER)1 & 3
,2
Why not others?? Physiological responses such as elevated blood pressure and
heart rate are most likely to be absent in the client with chronic pain. Pain is a
subjective experience, and therefore the nurse has to ask the client directly
instead of accepting the statement of the family members.
Pressure Ulcers and stages - (ANSWER)stage I pressure ulcer- an area of
persistent redness with no break in skin integrity.
stage II pressure ulcer-partial-thickness wound with skin loss involving the
epidermis, dermis, or both; the ulcer is superficial and may present as an
abrasion, blister, or shallow crater
stage III pressure ulcer- full-thickness tissue loss with visible subcutaneous fat.
Bone, tendon, and muscle are not exposed.
stage IV- full thickness tissue loss with exposed bone, tendon, muscle, bone
(slough or eschar may be present within wound bed)
unstageable- contains necrotic tissue, necrotic tissue must be removed before the
wound can be staged.
While assessing a client's skin, a nurse notices that the skin is dry. What is the
probable etiology of the condition? Select all that apply. - (ANSWER)The use of
hard soap and frequent bathing may result in dry skin. A skin allergy may result in
skin rashes, but not dry skin. Using tanning pills and petroleum products may
result in skin cancer.
The community nurse is assessing an elderly client who lives alone at home. the
client refrains from physical activity for fear of falling when walking. Which
,3
interventions by the nurse are most beneficial to promote a healthy lifestyle? -
(ANSWER)Encourage the client to wear nonskid shoes.
Suggest that the client use an assistive device.
Help the client rearrange furniture in the house.
Which features distinguish nursing diagnoses from medical diagnoses? Select all
that apply.
1
Nursing diagnoses involve the client when possible.
2
Nursing diagnoses are based on results of diagnostic tests and procedures.
3
Nursing diagnoses are the identification of a disease condition in the client.
4
Nursing diagnoses involve the sorting of health problems within the nursing
domain.
5
Nursing diagnoses involve clinical judgment about the client's response to health
problems. - (ANSWER)Nursing diagnoses involve (client participation) the client
when possible.
Nursing diagnoses involve the sorting of health problems within the nursing
domain.
Nursing diagnoses involve clinical judgment about the client's response to health
problems.
, 4
WRONG ANSWER:
Nursing diagnoses are based on results of diagnostic tests and procedures.
WRONG ANSWER:
Nursing diagnoses are the identification of a disease condition in the client.
A 50-year-old client with a 30-year history of smoking reports a chronic cough and
shortness of breath related to chronic obstructive pulmonary disease (COPD). The
clinical data on admission are as follows: a heart rate of 100, a blood pressure of
138/82, a respiratory rate of 32, a tympanic temperature 36.8 °C, and an oxygen
saturation of 80%. Which vital signs obtained by the nurse during the therapy
indicates a positive outcome? Select all that apply.
1
Radial pulse: 70
2
Temperature: 37 °C
3
Respiratory rate: 14
4
Blood pressure: 110/70
5
Oxygen saturation: 96% - (ANSWER)3,4,5
