BSN 246 HESI HEALTH ASSESSMENT
EXAM V2 COMPREHENSIVE
QUESTIONS AND ANSWERS
1. During a cardiovascular assessment, the nurse notes a blowing, swishing sound while
auscultating the carotid artery. This finding is most likely indicative of:
A. Normal blood flow
B. A heart murmur
C. A bruit
D. Venous hum
Answer: C
Conceptual Explanation: A bruit is a blowing, swishing sound indicating blood flow
turbulence, often due to narrowing (stenosis) of the artery.
2. When assessing a patient’s abdomen, in which order should the nurse perform the physical
examination techniques?
A. Inspection, Auscultation, Percussion, Palpation
B. Inspection, Palpation, Percussion, Auscultation
C. Auscultation, Inspection, Palpation, Percussion
,D. Palpation, Percussion, Auscultation, Inspection
Answer: A
Conceptual Explanation: For the abdomen, auscultation is performed before percussion
and palpation to prevent the stimulation of bowel sounds, which would lead to an
inaccurate assessment.
3. A patient exhibits a positive Romberg test. The nurse interprets this as a deficiency in
which system?
A. Extrapyramidal system
B. Cerebellar function or proprioception
C. Lower motor neuron pathway
D. Oculomotor nerve function
Answer: B
Conceptual Explanation: A positive Romberg sign occurs when a patient loses balance
when closing their eyes, indicating a problem with proprioception or vestibular/cerebellar
function.
4. The nurse is testing a patient’s cranial nerves. Which nerve is being assessed when the
patient is asked to shrug their shoulders against resistance?
A. CN IX (Glossopharyngeal)
B. CN XI (Spinal Accessory)
, C. CN X (Vagus)
D. CN XII (Hypoglossal)
Answer: B
Conceptual Explanation: Cranial Nerve XI, the Spinal Accessory nerve, innervates the
trapezius and sternocleidomastoid muscles; shrugging tests its motor function.
5. While percussing the lungs of a patient with chronic obstructive pulmonary disease (COPD),
the nurse expects to hear which sound?
A. Hyperresonance
B. Tympany
C. Dullness
D. Resonance
Answer: A
Conceptual Explanation: Hyperresonance is a lower-pitched, booming sound found when
too much air is present, such as in emphysema or COPD.
6. The nurse uses the ‘ABCDE’ mnemonic to assess a patient’s skin lesion for potential
melanoma. What does the ‘E’ stand for?
A. Elevation
B. Evolution
C. Erythema
EXAM V2 COMPREHENSIVE
QUESTIONS AND ANSWERS
1. During a cardiovascular assessment, the nurse notes a blowing, swishing sound while
auscultating the carotid artery. This finding is most likely indicative of:
A. Normal blood flow
B. A heart murmur
C. A bruit
D. Venous hum
Answer: C
Conceptual Explanation: A bruit is a blowing, swishing sound indicating blood flow
turbulence, often due to narrowing (stenosis) of the artery.
2. When assessing a patient’s abdomen, in which order should the nurse perform the physical
examination techniques?
A. Inspection, Auscultation, Percussion, Palpation
B. Inspection, Palpation, Percussion, Auscultation
C. Auscultation, Inspection, Palpation, Percussion
,D. Palpation, Percussion, Auscultation, Inspection
Answer: A
Conceptual Explanation: For the abdomen, auscultation is performed before percussion
and palpation to prevent the stimulation of bowel sounds, which would lead to an
inaccurate assessment.
3. A patient exhibits a positive Romberg test. The nurse interprets this as a deficiency in
which system?
A. Extrapyramidal system
B. Cerebellar function or proprioception
C. Lower motor neuron pathway
D. Oculomotor nerve function
Answer: B
Conceptual Explanation: A positive Romberg sign occurs when a patient loses balance
when closing their eyes, indicating a problem with proprioception or vestibular/cerebellar
function.
4. The nurse is testing a patient’s cranial nerves. Which nerve is being assessed when the
patient is asked to shrug their shoulders against resistance?
A. CN IX (Glossopharyngeal)
B. CN XI (Spinal Accessory)
, C. CN X (Vagus)
D. CN XII (Hypoglossal)
Answer: B
Conceptual Explanation: Cranial Nerve XI, the Spinal Accessory nerve, innervates the
trapezius and sternocleidomastoid muscles; shrugging tests its motor function.
5. While percussing the lungs of a patient with chronic obstructive pulmonary disease (COPD),
the nurse expects to hear which sound?
A. Hyperresonance
B. Tympany
C. Dullness
D. Resonance
Answer: A
Conceptual Explanation: Hyperresonance is a lower-pitched, booming sound found when
too much air is present, such as in emphysema or COPD.
6. The nurse uses the ‘ABCDE’ mnemonic to assess a patient’s skin lesion for potential
melanoma. What does the ‘E’ stand for?
A. Elevation
B. Evolution
C. Erythema
