HESI Health Assessment Exam % Correct Test Bank |Verified And Updated| GUARANTEED PASS

1. Which is an example of data a nurse would collect during a physical examination? a. The client’s lack of hair and shiny skin over both shins b. The client’s stated concern about lack of money for prescriptions c. The client’s complaints of tingling sensations in the feet d. The client’s mother’s statements that the client has been very nervous lately 2. During an interview, the client answers questions quietly and appears sad. While answering questions about her marriage, she begins to cry. The appropriate response by the nurse would be to say. a. “Don’t cry I’ll come back when you’ve settled down” b. “I only have a few more questions to go, then I’ll leave you alone for a while?” c. “Everyone has ups and downs in their marriage. What problems are you having?” d. “I see that you are upset, is there something you’d like discuss?” 3. Select the example of an open-ended question from those below. a. “Have you experienced this pain before?” b. “Do you have someone to help you at home?” c. “How many times a day do you use your inhaler?” d. “What were you doing when you left the pain?” 4. When performing a skin assessment of an adult client, the nurse expects what finding?” a. Reddened are does not blanch when gentle pressure is applied b. Indentation of the finger in the skin after palpation c. Flaking or scaling of the skin d. Return of skin to its original position when pinched up slightly 5. In a report, a nurse learns that a client has a macular rash and expects to find: a. Elevated, firm, well-defined lesions less than 1 cm in diameter (papula) b. Depressed, firm, or scaly, rough lesions greater than 1 cm in diameter (vesicula) c. Elevated, fluid-filled lesions less than 1 cm in diameter d. Flat, well-defined, small lesions less than 1 cm in diameter (macula) 6. A nurse notices multiple lesions on a client’s back that are 0.5 cm in width, elevated, circumscribed, and filled with serous fluid. The nurse documents these lesions as: a. Macules b. Patches c. Vesicles d. Bullae 7. While taking a history, the nurse observes that the client’s facial cranial nerve is intact based on which behaviors of the client? a. The client’s eyes move to the left, right up, down and obliquely during conversation b. The client moistens the lips with the tongue c. The sides of the mouth are symmetric when the client smiles d. The client’s eyelids blink periodically 8. To assess jaw movement of an adult client, the nurses uses which technique? (V) SALIO DE NUEVO a. Asking the client to open the mouth and the passively moving the client’s open jaw from side to side b. Placing two fingers in front of each ear and asking the client to slowly open and close the mouth c. Asking the client to open the mouth and to resist the nurse’s attempt to close the mouth d. Using the pads of all fingers to feel along the mandible for tenderness and nodules 9. In preparing to assess visual acuity with a Snellen chart, the nurse instructs the client to: a. Remove eyeglasses before attempting to read the lowest line b. Stand 10 feet from the chart and read the first line aloud c. Hold a white card over one eye and read the smallest possible line d. Squint if necessary to improve ability to read the largest letters 10. While using a Snellen visual acuity chart, the nurse records that the client’s vision is 20/40, meaning that: (II) a. A client’s vision is about half what is normally expected b. A client can see the 20/40 line on chart while wearing glasses or contact lenses c. A client with normal vision can see the 20/40 line on the chart at 40 feet d. A client can see at 40 feet what a client with normal vision can see at 20 feet 11. In assessing a client’s visual acuity using the Snellen chart, the nurse is assessing which cranial nerve? (II) a. Optic cranial nerve b. Oculomotor cranial nerve c. Abducens cranial nerve d. Trochlear cranial nerve 12. During an eye assessment, a nurse asks the client to cover one eye with a card as the nurse covers his or her eye directly opposite the client’s covered eye. The nurse moves an object into the field of vision and asks the client to tell when the objects can be seen. This assessment technique collects what data about the client’s eyes? (II) a. Symmetry of extraocular muscles b. Visual acuity in the uncovered eye c. Peripheral vision of the uncovered eye d. Consensual reaction of the uncovered 13. During an eye assessment the nurse asks the client to keep the head stationary and by moving the eyes only follow the nurse’s finger as it moves side to side, up and down, and obliquely. This assessment technique collects what data about the client’s eyes? a. Function of cranial nerves oculomotor (III), trochlear (IV), and abducens (VI) b. Visual acuity c. Peripheral vision of the uncovered d. Consensual reaction of the uncovered eye 14. How does a nurse assess the functions of cranial nerves III, VI and IV that innervate the muscles of the eye? a. By assessing peripheral vision b. By noting the symmetry of the corneal light reflex c. By assessing the cardinal fields of gaze d. By performing the cover-uncover test 15. A nurse shines a light in the right pupil to test constriction and notices that the left pupil constricts as well. Based on these data, the nurse should: (III) a. Documents this finding as an abnormal finding b. Assess the client for accommodation c. Document this finding as a consensual reaction PUPIL LIGTH REFLEX d. Assess the client’s corneal light reflex 16. During an eye examination of an Asian client, a nurse notices an involuntary rhythmical, horizontal movement of the client’s eyes and documents this finding as: a. An expected racial variation b. Nystagmus c. Exophthalmos d. Myopia 17. During the Weber test, a nurse determines that the client hears the sound of a tuning fork equally in each ear. Based on this finding the appropriate response of the nurse is to: (VIII) a. Repeat the test again using 2000 Hz tuning fork b. Tell the client that this represents a normal finding c. Refer the client for additional testing of the client’s hearing abnormality d. Perform a Rinne test to confirm the findings of this Weber test 17.a) During a hearing assessment, the nurse finds that sound lateralizes to the client’s left ear with the Weber and Rinne tests. What should the nurse conclude from this finding? The patient has: a. A conductive hearing loss in the right ear. b. Lateralization is a normal finding with the Weber test. c. Either a sensorineural or conductive hearing loss. d. The steps in assessing the patient’s hearing were done incorrectly. 18. How does the nurse perform a Weber test to assess hearing function? The nurse: (VIII) a. Whispers several words to the client and requests that the client repeat the words heard b. Places a vibrating tuning fork in the middle of the head and asks the client if the sound is heard the same in both ears or if it is louder in one ear than the other c. Places a set of headphones over both ears, plays several tones, and asks the client to identify the sounds d. Places a vibrating tuning fork on the mastoid process until the client no longer hears a sound, and then moves it in front of the ear until the client no longer hears a sound (RINNE TEST) NOTE: WEBER TEST (CONDUCTIVE HEANING LOSS) 19. How does the nurse perform a Rinne test of hearing function? The nurse: (VIII) a. Whispers several words to the client and requests that the client repeat the words heard b. Places a vibrating tuning fork in the middle of the head and asks the client if the sounds is head the same in both ears or if it is louder in one ear than the other c. Places a set of headphones over both ears, plays several tones, and asks the client to identify the sounds d. Places a vibrating tuning fork on the mastoid process until the client no longer hears a sound, and then moves it in front of the ear until the client no longer hears a sound 20. A client is being seen in the clinic for suspected nasal obstruction from a foreign body. The nurse recognizes which finding as most consistent with this diagnosis? (I) a. Unilateral foul-smelling drainage b. Bilateral purulent green-yellow discharge c. Bilateral bloody discharge d. Unilateral watery discharge 21. A nurse suspects the client has an infection of the maxillary sinuses and will confirm this suspicion by: a. Using a flashlight to illuminate the floor of the mouth b. Pressing gently with both thumbs into the eyebrow ridges c. Applying firm pressure with the thumbs below the cheekbones d. Standing behind the client and asking him to slowly rotate his head 22. When inspecting a client’s nasal mucous membrane, which finding does the nurse expect to see? a. Deep pink turbinates b. Red, edematous mucous membranes c. Septum that angles to the left d. Clear exudate 23. In assessing a client’s mouth, a nurse observes the rising of the soft palate when the client says “Ahh.” This expected finding reflects the function of which cranial nerve? a. Facial (VII) b. Acoustic (VIII) c. Glossopharyngeal (IX) d. Hypoglossal (XII) 23.a) Which of the following cranial nerves is appointed correct: a. Optic II, Spinal Accessory XI, Facial VII, Trochlear IV. b. Spinal Accessory X, Vestibularcochlear VIII, Hypoglossal XII, Olfatory I. c. Facial VII, Glossopharyngeal IX, Trochlear V, Trigeminal IV. d. Trochlear V, Oculomotor III, Facial VII, Hypoglossal XII. 24. When inspecting a client’s posterior wall of the pharynx and tonsils, a nurse documents which finding as abnormal? a. Both tonsils have a smooth surface b. Left and right tonsils meet at the midline c. Left and right tonsils extend beyond the posterior pillars d. Both tonsils have a glistening texture 25. A nurse assess neck movement of an adult and documents that the client’s neck muscles are within expected limits if the client: (XI) a. Is unable to resist the nurse’s attempt to move the head upright b. Bends the head to the right and left (ear to shoulder) 15 degrees (lateral bending 45 grados) c. Flexes chin toward the chest 45 degrees (normal % 40 y 60 grados) d. Hyperextends the head 30 degrees from midline (normal is 45 to 70) 25.a) A nurse assesses the neck of an adult and documents that the client’s neck muscles are within expected normal limits if the client: a. Has a convex contour of the posterior cervical spine. b. Bends the head to the right and left (ear to shoulder) 15 degrees. c. Is able to resist the nurse’s attempt to move the head upright. d. Is able to hyperextend the head 30 degrees from midline. 26. In assessing spinal accessory nerve function, the nurse requests the client to: (XI) a. Stick out the tongue and move it side to side against the resistance of a tongue blade b. Shrug the shoulders against the resistance of the nurse’s hands c. Swallow while the nurse applies gentle pressure on the thyroid gland d. Move the chin to the chest and then up toward the ceiling 27. What technique does a nurse use when palpating the right lobe of a client’s thyroid gland using the anterior approach? The nurse: a. Pushes the cricoid process to the left with the right thumb. b. Displaces the trachea to the right with the left thumb. c. Manipulates the thyroid between the thumb and index finger. d. Moves the sternocleidomastoid muscle to the right with the left thumb. 28. What instruction does a nurse give a client to facilitate palpation of the right lobe of the thyroid gland? a. “Swallow for me one time” b. “Flex your head down and to the left” c. “Rotate your head to the right for me” d. “Hold your breath for a few seconds” 29. A nurse who is palpating the lymph nodes in the anterior and posterior cervical chains places the pads of the fingers: a. In front of the ear (preauricular) b. Under the mandible (submandibular) c. On either side of the sternocleidomastoid muscle d. Along the angle of the jaw 30. Nurses inquire about life style behaviors in those clients with specific risks factors for cataracts. The characteristics labeled with numbers a, b, c are associated with risks factors for cataracts. (your answer should appear as numbers separated by commas and spaces (e.g. 1, 2, 3, 4) (Select all that apply) EN ESTA PREGUNTA SE ADICIONO EL ULTIMO INCISO a. Smoking more than 20 cigarettes a day b. Having parents with cataracts c. Chronic consumption of alcohol d. Having a chronic disease, such as diabetes mellitus e. Black American 31. The nurse is reading a family genogram. As she reads the genogram, the nurse detects an error in the symbols. Can you clarify what is this mistake: a. Two people who are married are connect by line that go down and across b. The husband on the right and the wife on the left (husband left wife right) c. Couples that are not married are depicted with a dotted line d. Children are drawn left to right, going from the oldest to the youngest 32. An intimate relationship between a man and a woman living together (not marriage) ESTA IMAGEN LA PUSE YO, PORQUE EN EL WORD ESTA ESCRITA A MANO a. Legal separation (separacion) b. Divorce (divorcio) c. Marriage (Casado) d. engagement (convivientes) 33. During the interview, the client states that she doesn’t use many drugs. The nurse’s appropriate response to this statement is: a. “Tell me about the drugs you use now” b. “To some people six or seven is not many” c. “Do you mean legal drugs or illegal ones?” d. “How often are you using these drugs?”