HESI 1 - V1 and V2 REVIEW - Health Assessment 1
Questions With Complete Solutions
A client comes to the clinic with a report of fever and a recent
exposure to someone who was diagnosed with meningitis.
Which nursing assessment should be completed during the
initial examination of this client? Correct Answers Level of
consciousness.
A client has been diagnosed with bilateral lower lobe atelectasis.
What percussion sound should the nurse expect to hear when
percussing over the client's lower lobes? Correct Answers Dull,
thud-like.
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? Correct
Answers Have you had sudden and severe pain in the toes or
feet?
A client has just returned from the recovery room and asks to get
out of bed to go to the bathroom. The nurse decides to obtain
orthostatic vital signs first. How will the nurse position the client
to begin this procedure? Correct Answers Lying.
A client is being assessed upon admission to the medical-
surgical unit. The nurse is preparing to complete a head-to-toe
assessment and will begin at the head of the client. Which
technique should the nurse use to begin the assessment? Correct
Answers Inspect the hair and skin.
,A client is in the clinic and is reporting lower abdominal pain
and constipation. Which information is of greatest concern to the
nurse when obtaining the health history from this client?
Correct Answers Family history of colon cancer on mother's
side.
A client is in the clinic for a routine health examination. The
nurse notices the client appears underweight. Which question is
most important for the nurse to ask when completing the health
history of this client? Correct Answers Have you experienced
sudden weight loss?
A client is in the clinical for a yearly physical examination.
Which action should the nurse take when preparing to examine
the client's abdomen? Correct Answers Ask the client to urinate
before beginning the examination.
A client is reporting chest pain. What statement made by the
client, helps the nurse to understand this client has a naturalistic
belief in the cause of illness? Correct Answers "My life is
really out of balance."
A client presents with a rash along the occipital area of the
hairline and reports intense itching. How should the nurse begin
the objective part of the examination? Correct Answers Inspect
the scalp looking for nits.
A client reports feeling increasingly fatigued for several months,
and the nurse observes that the client's lips are pale. Which
additional data should the nurse collect based on this
, presentation? Correct Answers Use of vitamin and iron
supplements.
A client reports lower abdominal pain and a feeling of pressure
in the bladder. Which assessment finding indicates acute urinary
retention? Correct Answers 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.
A client reports pain when taking a deep breath. Which lung
auscultation sound should the nurse anticipate hearing? Correct
Answers Pleural friction rub
A client states that she had a mastectomy of her left breast last
year and now experiences lymphedema. What should the nurse
expect to find when examining the client? Correct Answers
Swelling of the left arm and non-pitting edema.
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? Correct Answers
Change in consistency.
A client with progressive hearing loss appears distressed when
the registered nurse (RN) asks open-ended questions about the
client's health history. Which forms of communication should
Questions With Complete Solutions
A client comes to the clinic with a report of fever and a recent
exposure to someone who was diagnosed with meningitis.
Which nursing assessment should be completed during the
initial examination of this client? Correct Answers Level of
consciousness.
A client has been diagnosed with bilateral lower lobe atelectasis.
What percussion sound should the nurse expect to hear when
percussing over the client's lower lobes? Correct Answers Dull,
thud-like.
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? Correct
Answers Have you had sudden and severe pain in the toes or
feet?
A client has just returned from the recovery room and asks to get
out of bed to go to the bathroom. The nurse decides to obtain
orthostatic vital signs first. How will the nurse position the client
to begin this procedure? Correct Answers Lying.
A client is being assessed upon admission to the medical-
surgical unit. The nurse is preparing to complete a head-to-toe
assessment and will begin at the head of the client. Which
technique should the nurse use to begin the assessment? Correct
Answers Inspect the hair and skin.
,A client is in the clinic and is reporting lower abdominal pain
and constipation. Which information is of greatest concern to the
nurse when obtaining the health history from this client?
Correct Answers Family history of colon cancer on mother's
side.
A client is in the clinic for a routine health examination. The
nurse notices the client appears underweight. Which question is
most important for the nurse to ask when completing the health
history of this client? Correct Answers Have you experienced
sudden weight loss?
A client is in the clinical for a yearly physical examination.
Which action should the nurse take when preparing to examine
the client's abdomen? Correct Answers Ask the client to urinate
before beginning the examination.
A client is reporting chest pain. What statement made by the
client, helps the nurse to understand this client has a naturalistic
belief in the cause of illness? Correct Answers "My life is
really out of balance."
A client presents with a rash along the occipital area of the
hairline and reports intense itching. How should the nurse begin
the objective part of the examination? Correct Answers Inspect
the scalp looking for nits.
A client reports feeling increasingly fatigued for several months,
and the nurse observes that the client's lips are pale. Which
additional data should the nurse collect based on this
, presentation? Correct Answers Use of vitamin and iron
supplements.
A client reports lower abdominal pain and a feeling of pressure
in the bladder. Which assessment finding indicates acute urinary
retention? Correct Answers 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.
A client reports pain when taking a deep breath. Which lung
auscultation sound should the nurse anticipate hearing? Correct
Answers Pleural friction rub
A client states that she had a mastectomy of her left breast last
year and now experiences lymphedema. What should the nurse
expect to find when examining the client? Correct Answers
Swelling of the left arm and non-pitting edema.
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? Correct Answers
Change in consistency.
A client with progressive hearing loss appears distressed when
the registered nurse (RN) asks open-ended questions about the
client's health history. Which forms of communication should
