BSN 246 HESI Health Assessment V1 NIGHTINGALE COLLEGE
EXAM LATEST 150 QUESTIONS AND 100% Verified ANSWERS
JUST RELEASED
Which condition is indicated by a fluorescent, yellow-green color when the nurse uses a Wood's lamp
toexamine a client's skin lesions? - answer>>Fungal infection.
A client with dark skin is reporting a painful and itching area on the lower left leg. What should the
nurse look for when assessing this client's skin for inflammation? - answer>>Change in consistency.
A client reports pain when taking a deep breath. Which lung auscultation sound should the nurse
anticipate hearing? - answer>>Pleural friction rub
A nurse is completing a nutritional assessment with a client. What is the easiest method for the nurse
to use to get information about the client's nutritional intake? - answer>>24-hour dietary recall
The nurse palpates a weak pedal pulse in the client's right foot. Which assessment findings should the
RN document that are consistent with diminished peripheral circulation? (Select all that apply.) -
answer>>Diminished hair on legs.
Skin cool to touch.
The nurse is completing a physical assessment of a client who feel from a tree. The client's abdomen is
soft with hyperactive bowel sounds in all four quadrants. Which assessment technique should the
nurse implement when evaluating the client's spleen? - answer>>Percuss the splenic area as the client
takes a deep breath.
The nurse enters an examination room to conduct a routine health assessment on an adolescent
female client, who is accompanied by her mother. Which action by the nurse is likely to facilitate
accurate responses to personal and social history questions? - answer>>Request that the mother leave
the exam room.
,While performing a mental status exam (MSE), the nurse asks a client to remember three unrelated
words and repeat them later. The client was able to repeat the words as directed. Which computer
documentation is accurate? - answer>>"Short-term memory is intact."
Which technique should the nurse implement when performing a Weber test? - answer>>Place a
vibrating tuning fork midline on top of the head
Which technique should the nurse use to assess a client for scoliosis? - answer>>Observe spine while
the client is erect and bent forward
Which term should the nurse use to document in the client's medical record for a high-pitched scratchy
sound during auscultation of the heart? - answer>>Friction rub
While performing a head-to-toe assessment, the nurse assesses the client's pupillary accommodation.
During the second portion of the test, the nurse notes that the client's pupils constrict and there is
convergence of the axes of the eyes. What action should the nurse implement next? -
answer>>Document a normal finding.
The nurse performs the Weber and Rinne tests to assess which cranial nerve? - answer>>VIII -
vestibulocochlear
The nurse uses a tongue depressor to assess a client's mouth. Which structure should the nurse be
able to visualize? - answer>>Pharynx
As a part of a routine health assessment, the nurse assesses the kidneys as part of the abdominal
assessment. Which assessment finding should the nurse conclude is normal when palpating the client's
right kidney? - answer>>A round smooth mass that slides between the fingers.
A client reports lower abdominal pain and a feeling of pressure in the bladder. Which assessment
finding indicates acute urinary retention? - answer>>Dull sound percussed over bladder.
, *Clients with acute urinary retention may present with lower abdominal pain and bladder distension.
Percussion (tapping on the body wall) is performed to detect differences in pitch. A dull sound
produced when percussing a distended urinary bladder is an indication of urinary retention.
The nurse examines the skin of an older adult client. Which skin variation is considered a normal
finding for a client in this age group? - answer>>Lentigines.
*Lentigines or commonly referred to as liver spots are irregularly shaped dark spots on the skin caused
by aging and extensive sun exposure. This skin variation is a normal finding in an older adult client.
During a client's routine well-woman physical exam, the nurse examines the breasts. Which
assessment technique should the nurse implement to evaluate for any abnormal lumps? -
answer>>With both arms at client's side, lift one arm and palpate the axilla.
The nurse is completing a physical exam on an adult client. Which thyroid finding is considered
normal? - answer>>Gland is not palpable.
How should the nurse assess for lower extremity edema in a client who has been diagnosed with heart
failure? - answer>>Measure bilateral ankle circumference with a non-stretchable tape measure.
A client has come to the clinic for a routine health assessment. What is the best assessment question
for the nurse to ask a client after observing tophi on the client's ear cartilage? - answer>>Have you had
sudden and severe pain in the toes or feet?
During the interview portio of the health assessment, a nurse notes the person's posture, physical
appearance, and ability to converse. How should the nurse document these findings? -
answer>>Objective.
The nurse is assessing a client who reports having shoulder pain. Which sign is the best indicator of a
rotator cuff tear? - answer>>Inability to slowly lower the arm when abducted.
EXAM LATEST 150 QUESTIONS AND 100% Verified ANSWERS
JUST RELEASED
Which condition is indicated by a fluorescent, yellow-green color when the nurse uses a Wood's lamp
toexamine a client's skin lesions? - answer>>Fungal infection.
A client with dark skin is reporting a painful and itching area on the lower left leg. What should the
nurse look for when assessing this client's skin for inflammation? - answer>>Change in consistency.
A client reports pain when taking a deep breath. Which lung auscultation sound should the nurse
anticipate hearing? - answer>>Pleural friction rub
A nurse is completing a nutritional assessment with a client. What is the easiest method for the nurse
to use to get information about the client's nutritional intake? - answer>>24-hour dietary recall
The nurse palpates a weak pedal pulse in the client's right foot. Which assessment findings should the
RN document that are consistent with diminished peripheral circulation? (Select all that apply.) -
answer>>Diminished hair on legs.
Skin cool to touch.
The nurse is completing a physical assessment of a client who feel from a tree. The client's abdomen is
soft with hyperactive bowel sounds in all four quadrants. Which assessment technique should the
nurse implement when evaluating the client's spleen? - answer>>Percuss the splenic area as the client
takes a deep breath.
The nurse enters an examination room to conduct a routine health assessment on an adolescent
female client, who is accompanied by her mother. Which action by the nurse is likely to facilitate
accurate responses to personal and social history questions? - answer>>Request that the mother leave
the exam room.
,While performing a mental status exam (MSE), the nurse asks a client to remember three unrelated
words and repeat them later. The client was able to repeat the words as directed. Which computer
documentation is accurate? - answer>>"Short-term memory is intact."
Which technique should the nurse implement when performing a Weber test? - answer>>Place a
vibrating tuning fork midline on top of the head
Which technique should the nurse use to assess a client for scoliosis? - answer>>Observe spine while
the client is erect and bent forward
Which term should the nurse use to document in the client's medical record for a high-pitched scratchy
sound during auscultation of the heart? - answer>>Friction rub
While performing a head-to-toe assessment, the nurse assesses the client's pupillary accommodation.
During the second portion of the test, the nurse notes that the client's pupils constrict and there is
convergence of the axes of the eyes. What action should the nurse implement next? -
answer>>Document a normal finding.
The nurse performs the Weber and Rinne tests to assess which cranial nerve? - answer>>VIII -
vestibulocochlear
The nurse uses a tongue depressor to assess a client's mouth. Which structure should the nurse be
able to visualize? - answer>>Pharynx
As a part of a routine health assessment, the nurse assesses the kidneys as part of the abdominal
assessment. Which assessment finding should the nurse conclude is normal when palpating the client's
right kidney? - answer>>A round smooth mass that slides between the fingers.
A client reports lower abdominal pain and a feeling of pressure in the bladder. Which assessment
finding indicates acute urinary retention? - answer>>Dull sound percussed over bladder.
, *Clients with acute urinary retention may present with lower abdominal pain and bladder distension.
Percussion (tapping on the body wall) is performed to detect differences in pitch. A dull sound
produced when percussing a distended urinary bladder is an indication of urinary retention.
The nurse examines the skin of an older adult client. Which skin variation is considered a normal
finding for a client in this age group? - answer>>Lentigines.
*Lentigines or commonly referred to as liver spots are irregularly shaped dark spots on the skin caused
by aging and extensive sun exposure. This skin variation is a normal finding in an older adult client.
During a client's routine well-woman physical exam, the nurse examines the breasts. Which
assessment technique should the nurse implement to evaluate for any abnormal lumps? -
answer>>With both arms at client's side, lift one arm and palpate the axilla.
The nurse is completing a physical exam on an adult client. Which thyroid finding is considered
normal? - answer>>Gland is not palpable.
How should the nurse assess for lower extremity edema in a client who has been diagnosed with heart
failure? - answer>>Measure bilateral ankle circumference with a non-stretchable tape measure.
A client has come to the clinic for a routine health assessment. What is the best assessment question
for the nurse to ask a client after observing tophi on the client's ear cartilage? - answer>>Have you had
sudden and severe pain in the toes or feet?
During the interview portio of the health assessment, a nurse notes the person's posture, physical
appearance, and ability to converse. How should the nurse document these findings? -
answer>>Objective.
The nurse is assessing a client who reports having shoulder pain. Which sign is the best indicator of a
rotator cuff tear? - answer>>Inability to slowly lower the arm when abducted.
