BSN 246 HESI Health Assessment
Package Complete Exam Bundle Actual
Exam 2026/2027 | Complete Exam-Style
Questions | 100% Verified – Detailed
Rationales – Pass Guaranteed – A+
Graded
1. A nurse assesses skin turgor on an older adult’s sternum. The skin
remains tented for 3 seconds. What is the correct interpretation?
A) Normal age-related finding
B) Severe dehydration
C) Malnutrition
D) Hyperthyroidism
Correct: A – Normal age-related finding
Rationale: Older adults lose skin elasticity, so tenting may persist up to
3–5 seconds even with normal hydration. Dehydration is still possible
but not confirmed by this finding alone.
2. During a Weber test, the patient reports hearing the tone louder in the
right ear. What does this suggest?
A) Normal finding
B) Right sensorineural loss
C) Left conductive loss
D) Right conductive loss
Correct: D – Right conductive loss
,Rationale: In conductive loss, sound lateralizes to the affected ear
because background noise is reduced. In sensorineural loss, sound
lateralizes to the better ear.
3. A patient has non-blanching purple spots on the forearms. The nurse
documents this as:
A) Ecchymosis
B) Petechiae
C) Purpura
D) Angioma
Correct: C – Purpura
*Rationale: Purpura are non-blanching purple spots >0.5 cm. Petechiae
are smaller (<3 mm). Ecchymosis is a bruise from trauma.*
4. To assess extraocular movements (EOMs), the nurse asks the patient
to:
A) Follow a penlight in six cardinal directions
B) Look straight ahead while penlight is shone
C) Close eyes and report number of fingers shown
D) Touch nose then examiner’s finger
Correct: A – Follow a penlight in six cardinal directions
Rationale: Six cardinal directions test cranial nerves III, IV, and VI. The
other options test peripheral vision, acuity, or coordination.
5. A patient cannot move the eye laterally (toward the ear). Which
cranial nerve is likely affected?
A) CN III (Oculomotor)
B) CN IV (Trochlear)
C) CN VI (Abducens)
D) CN II (Optic)
Correct: C – CN VI (Abducens)
,Rationale: CN VI abducts the eye. CN III controls other movements and
pupil. CN IV controls downward/inward gaze. CN II is vision.
6. The nurse notes a respiratory rate of 10 breaths/minute in an adult.
What is the correct term?
A) Tachypnea
B) Bradypnea
C) Apnea
D) Hyperpnea
Correct: B – Bradypnea
*Rationale: Bradypnea = <12 breaths/min. Tachypnea = >20. Apnea =
no breathing. Hyperpnea = increased depth.*
7. A patient has an audible inspiratory crowing sound. The nurse
immediately:
A) Notifies the provider
B) Continues full respiratory assessment
C) Checks oxygen saturation
D) Auscultates lung fields
Correct: A – Notifies the provider
Rationale: Stridor = upper airway obstruction; this is an emergency.
Provider notification is priority before further assessment.
8. Which finding is consistent with chronic COPD?
A) Pectus excavatum
B) Barrel chest
C) Pigeon chest
D) Flail chest
Correct: B – Barrel chest
Rationale: Barrel chest (AP diameter = lateral) from chronic air
trapping in COPD. Pectus excavatum = sunken sternum.
, 9. Wheezes heard primarily during expiration indicate:
A) Pulmonary edema
B) Atelectasis
C) Narrowed airways
D) Pleural effusion
Correct: C – Narrowed airways
Rationale: Expiratory wheezing = narrowed airways (asthma, COPD).
Crackles suggest fluid. Absent sounds suggest atelectasis or effusion.
10. The point of maximal impulse (PMI) is normally located at:
A) 2nd ICS, left sternal border
B) 4th ICS, midclavicular line
C) 5th ICS, midclavicular line
D) 5th ICS, anterior axillary line
Correct: C – 5th ICS, midclavicular line
Rationale: Normal PMI is 5th ICS at MCL. Displacement suggests
cardiomegaly or other pathology.
11. To assess for a pulse deficit, the nurse should:
A) Palpate radial and brachial simultaneously
B) Auscultate apical while palpating radial
C) Use Doppler over dorsalis pedis
D) Compare lying and standing HR
Correct: B – Auscultate apical while palpating radial
Rationale: Pulse deficit = difference between apical and radial rates,
indicating ineffective cardiac contractions (e.g., A-fib).
12. A carotid bruit is most consistent with:
A) Normal laminar flow
B) Turbulent flow from narrowing
C) Venous hum
D) Hyperdynamic circulation
Package Complete Exam Bundle Actual
Exam 2026/2027 | Complete Exam-Style
Questions | 100% Verified – Detailed
Rationales – Pass Guaranteed – A+
Graded
1. A nurse assesses skin turgor on an older adult’s sternum. The skin
remains tented for 3 seconds. What is the correct interpretation?
A) Normal age-related finding
B) Severe dehydration
C) Malnutrition
D) Hyperthyroidism
Correct: A – Normal age-related finding
Rationale: Older adults lose skin elasticity, so tenting may persist up to
3–5 seconds even with normal hydration. Dehydration is still possible
but not confirmed by this finding alone.
2. During a Weber test, the patient reports hearing the tone louder in the
right ear. What does this suggest?
A) Normal finding
B) Right sensorineural loss
C) Left conductive loss
D) Right conductive loss
Correct: D – Right conductive loss
,Rationale: In conductive loss, sound lateralizes to the affected ear
because background noise is reduced. In sensorineural loss, sound
lateralizes to the better ear.
3. A patient has non-blanching purple spots on the forearms. The nurse
documents this as:
A) Ecchymosis
B) Petechiae
C) Purpura
D) Angioma
Correct: C – Purpura
*Rationale: Purpura are non-blanching purple spots >0.5 cm. Petechiae
are smaller (<3 mm). Ecchymosis is a bruise from trauma.*
4. To assess extraocular movements (EOMs), the nurse asks the patient
to:
A) Follow a penlight in six cardinal directions
B) Look straight ahead while penlight is shone
C) Close eyes and report number of fingers shown
D) Touch nose then examiner’s finger
Correct: A – Follow a penlight in six cardinal directions
Rationale: Six cardinal directions test cranial nerves III, IV, and VI. The
other options test peripheral vision, acuity, or coordination.
5. A patient cannot move the eye laterally (toward the ear). Which
cranial nerve is likely affected?
A) CN III (Oculomotor)
B) CN IV (Trochlear)
C) CN VI (Abducens)
D) CN II (Optic)
Correct: C – CN VI (Abducens)
,Rationale: CN VI abducts the eye. CN III controls other movements and
pupil. CN IV controls downward/inward gaze. CN II is vision.
6. The nurse notes a respiratory rate of 10 breaths/minute in an adult.
What is the correct term?
A) Tachypnea
B) Bradypnea
C) Apnea
D) Hyperpnea
Correct: B – Bradypnea
*Rationale: Bradypnea = <12 breaths/min. Tachypnea = >20. Apnea =
no breathing. Hyperpnea = increased depth.*
7. A patient has an audible inspiratory crowing sound. The nurse
immediately:
A) Notifies the provider
B) Continues full respiratory assessment
C) Checks oxygen saturation
D) Auscultates lung fields
Correct: A – Notifies the provider
Rationale: Stridor = upper airway obstruction; this is an emergency.
Provider notification is priority before further assessment.
8. Which finding is consistent with chronic COPD?
A) Pectus excavatum
B) Barrel chest
C) Pigeon chest
D) Flail chest
Correct: B – Barrel chest
Rationale: Barrel chest (AP diameter = lateral) from chronic air
trapping in COPD. Pectus excavatum = sunken sternum.
, 9. Wheezes heard primarily during expiration indicate:
A) Pulmonary edema
B) Atelectasis
C) Narrowed airways
D) Pleural effusion
Correct: C – Narrowed airways
Rationale: Expiratory wheezing = narrowed airways (asthma, COPD).
Crackles suggest fluid. Absent sounds suggest atelectasis or effusion.
10. The point of maximal impulse (PMI) is normally located at:
A) 2nd ICS, left sternal border
B) 4th ICS, midclavicular line
C) 5th ICS, midclavicular line
D) 5th ICS, anterior axillary line
Correct: C – 5th ICS, midclavicular line
Rationale: Normal PMI is 5th ICS at MCL. Displacement suggests
cardiomegaly or other pathology.
11. To assess for a pulse deficit, the nurse should:
A) Palpate radial and brachial simultaneously
B) Auscultate apical while palpating radial
C) Use Doppler over dorsalis pedis
D) Compare lying and standing HR
Correct: B – Auscultate apical while palpating radial
Rationale: Pulse deficit = difference between apical and radial rates,
indicating ineffective cardiac contractions (e.g., A-fib).
12. A carotid bruit is most consistent with:
A) Normal laminar flow
B) Turbulent flow from narrowing
C) Venous hum
D) Hyperdynamic circulation
