HESI Physical
Assessment Exam Practice 2025 – All-in-One Prep
Guide for Nursing Students with Realistic
Questions
1. In reviewing the patient's record, the nurse notes air in the subcutaneous tissue. What
validates crepitus?
a. Asymmetric expansion of the chest wall on inhalation
b. Increased transmission of vocal vibrations on auscultation
c. Crackling sensation under the skin of the chest on palpation
d. Coarse grating sounds heard over the mediastinum on inspiration ✅ Correct Answer: c
Rationale: Crepitus is identified by a crackling sensation on palpation due to air trapped in
subcutaneous tissue. It does not produce audible sounds.
2. Which patient should the nurse assess first?
a. The patient whose respiratory rate is 26 breaths per minute and whose trachea deviates
to the right
b. The patient who has pleuritic chest pain, bilateral crackles, a productive cough of yellow
sputum, and fever
c. The patient who is short of breath, using pursed-lip breathing, and in a tripod position
d. The patient whose respiratory rate is 20 breaths/min, and has 8-word dyspnea and
expiratory wheezes
✅ Correct Answer: a
Rationale: This patient has signs of a tension pneumothorax, a medical emergency. Tracheal
deviation is a critical sign of high intrathoracic pressure causing mediastinal shift. Immediate
attention is required.
3. Which vocal resonance finding helps eliminate lung consolidation as a problem?
a. Nurse hears patient say "99" clearly
b. Nurse hears muffled "1-2-3"
,c. No sounds heard when patient says "e-e-e"
d. Nurse hears patient say "a-a-a" clearly ✅ Correct Answer: b
Rationale: Muffled vocal sounds (like "1-2-3") indicate normal lung tissue, whereas clear
transmission suggests consolidation such as pneumonia.
4. A nurse examines a patient with pleural effusion and finds decreased fremitus. What
additional abnormal finding is expected? a. Increase in anteroposterior to lateral ratio b.
Hyperresonance over affected area
c. Absent breath sounds in the affected area
d. Increased vocal fremitus over the affected area ✅ Correct Answer: c
Rationale: Pleural effusion impairs sound transmission and fremitus, leading to absent or
decreased breath sounds in the affected area.
5. Which technique best assesses thoracic expansion in a suspected chest wall injury?
a. Hands on lateral thorax, observe lateral movement
b. Thumbs at T9–T10, observe lateral thumb movement during deep breath
c. Thumbs at T7–T8, observe during exhalation
d. Palms on shoulders, observe symmetric movement ✅ Correct Answer: b
Rationale: Placing thumbs at T9–T10 and observing for symmetric expansion during deep
breathing is the correct method for evaluating thoracic expansion.
6. What vocal resonance confirms right lower lobe consolidation?
a. Clear and loud "99" on bronchophony
b. No vocal sounds
c. Indistinct "e-e-e"
d. Muffled "1-2-3" on whispered pectoriloquy
✅ Correct Answer: a
Rationale: Clear and loud vocalizations over an area indicate consolidation such as in
pneumonia. Normal lung tissue muffles these sounds.
7. During respiratory assessment of a patient with a moderate left pneumothorax, what is
expected?
,a. Increased fremitus
b. Tracheal deviation to the left
c. Hyporesonant tones
d. Distant to absent breath sounds ✅ Correct Answer: d
Rationale: Air in the pleural space reduces sound transmission, resulting in distant or absent
breath sounds over the affected lung.
8. Where are bronchovesicular breath sounds normally heard?
a. Lower lobes
b. Over the trachea
c. Lung apices
d. Near the sternal border ✅ Correct Answer: d
Rationale: Bronchovesicular sounds are normally heard around the sternum, centrally in the
anterior chest.
9. Equal anteroposterior and lateral chest diameter suggests what additional finding? a.
Increased vocal fremitus
b. Dull percussion tones
c. Decreased breath sounds
d. Sharp chest pain on inspiration ✅ Correct Answer: c
Rationale: A barrel chest suggests air trapping (e.g., in emphysema), which typically results in
decreased breath sounds.
10. A patient has edema and redness around the nail of the index finger. Which history best
explains the condition?
a. Family history of liver disease
b. Recent scabies outbreak
c. Works full-time as a dishwasher
d. Wart removal 2 years ago ✅ Correct Answer: c
Rationale: Constant exposure to moisture and irritants (like in dishwashing) is a risk for
paronychia, causing redness and edema.
, 11. Multiple pustules and comedones in a 16-year-old are due to activity of which glands? a.
Epidermal cells
b. Eccrine glands
c. Apocrine glands
d. Sebaceous glands ✅ Correct Answer: d
Rationale: Sebaceous glands secrete sebum and are involved in acne formation, which
includes comedones and pustules.
12. Best site to assess jaundice in a patient with darkly pigmented skin? a. Sclera b.
Genitalia
c. Fingernails
d. Not assessable
✅ Correct Answer: a
Rationale: Scleral icterus is the most reliable sign of jaundice, regardless of skin tone.
13. Itchy insect bite-like red raised lesions on legs and groin—how should they be
documented? a. Wheals b. Bullae
c. Tumors
d. Plaques
✅ Correct Answer: a
Rationale: Wheals are transient, itchy, elevated lesions commonly seen with allergic
reactions and insect bites.
14. Multiple red circular lesions with central clearing over abdomen—what pattern is this?
a. Gyrate and linear
b. Annular and generalized
c. Iris and discrete
d. Oval and clustered
✅ Correct Answer: b
Rationale: Annular refers to ring-shaped lesions with central clearing; generalized refers to
widespread distribution.
Assessment Exam Practice 2025 – All-in-One Prep
Guide for Nursing Students with Realistic
Questions
1. In reviewing the patient's record, the nurse notes air in the subcutaneous tissue. What
validates crepitus?
a. Asymmetric expansion of the chest wall on inhalation
b. Increased transmission of vocal vibrations on auscultation
c. Crackling sensation under the skin of the chest on palpation
d. Coarse grating sounds heard over the mediastinum on inspiration ✅ Correct Answer: c
Rationale: Crepitus is identified by a crackling sensation on palpation due to air trapped in
subcutaneous tissue. It does not produce audible sounds.
2. Which patient should the nurse assess first?
a. The patient whose respiratory rate is 26 breaths per minute and whose trachea deviates
to the right
b. The patient who has pleuritic chest pain, bilateral crackles, a productive cough of yellow
sputum, and fever
c. The patient who is short of breath, using pursed-lip breathing, and in a tripod position
d. The patient whose respiratory rate is 20 breaths/min, and has 8-word dyspnea and
expiratory wheezes
✅ Correct Answer: a
Rationale: This patient has signs of a tension pneumothorax, a medical emergency. Tracheal
deviation is a critical sign of high intrathoracic pressure causing mediastinal shift. Immediate
attention is required.
3. Which vocal resonance finding helps eliminate lung consolidation as a problem?
a. Nurse hears patient say "99" clearly
b. Nurse hears muffled "1-2-3"
,c. No sounds heard when patient says "e-e-e"
d. Nurse hears patient say "a-a-a" clearly ✅ Correct Answer: b
Rationale: Muffled vocal sounds (like "1-2-3") indicate normal lung tissue, whereas clear
transmission suggests consolidation such as pneumonia.
4. A nurse examines a patient with pleural effusion and finds decreased fremitus. What
additional abnormal finding is expected? a. Increase in anteroposterior to lateral ratio b.
Hyperresonance over affected area
c. Absent breath sounds in the affected area
d. Increased vocal fremitus over the affected area ✅ Correct Answer: c
Rationale: Pleural effusion impairs sound transmission and fremitus, leading to absent or
decreased breath sounds in the affected area.
5. Which technique best assesses thoracic expansion in a suspected chest wall injury?
a. Hands on lateral thorax, observe lateral movement
b. Thumbs at T9–T10, observe lateral thumb movement during deep breath
c. Thumbs at T7–T8, observe during exhalation
d. Palms on shoulders, observe symmetric movement ✅ Correct Answer: b
Rationale: Placing thumbs at T9–T10 and observing for symmetric expansion during deep
breathing is the correct method for evaluating thoracic expansion.
6. What vocal resonance confirms right lower lobe consolidation?
a. Clear and loud "99" on bronchophony
b. No vocal sounds
c. Indistinct "e-e-e"
d. Muffled "1-2-3" on whispered pectoriloquy
✅ Correct Answer: a
Rationale: Clear and loud vocalizations over an area indicate consolidation such as in
pneumonia. Normal lung tissue muffles these sounds.
7. During respiratory assessment of a patient with a moderate left pneumothorax, what is
expected?
,a. Increased fremitus
b. Tracheal deviation to the left
c. Hyporesonant tones
d. Distant to absent breath sounds ✅ Correct Answer: d
Rationale: Air in the pleural space reduces sound transmission, resulting in distant or absent
breath sounds over the affected lung.
8. Where are bronchovesicular breath sounds normally heard?
a. Lower lobes
b. Over the trachea
c. Lung apices
d. Near the sternal border ✅ Correct Answer: d
Rationale: Bronchovesicular sounds are normally heard around the sternum, centrally in the
anterior chest.
9. Equal anteroposterior and lateral chest diameter suggests what additional finding? a.
Increased vocal fremitus
b. Dull percussion tones
c. Decreased breath sounds
d. Sharp chest pain on inspiration ✅ Correct Answer: c
Rationale: A barrel chest suggests air trapping (e.g., in emphysema), which typically results in
decreased breath sounds.
10. A patient has edema and redness around the nail of the index finger. Which history best
explains the condition?
a. Family history of liver disease
b. Recent scabies outbreak
c. Works full-time as a dishwasher
d. Wart removal 2 years ago ✅ Correct Answer: c
Rationale: Constant exposure to moisture and irritants (like in dishwashing) is a risk for
paronychia, causing redness and edema.
, 11. Multiple pustules and comedones in a 16-year-old are due to activity of which glands? a.
Epidermal cells
b. Eccrine glands
c. Apocrine glands
d. Sebaceous glands ✅ Correct Answer: d
Rationale: Sebaceous glands secrete sebum and are involved in acne formation, which
includes comedones and pustules.
12. Best site to assess jaundice in a patient with darkly pigmented skin? a. Sclera b.
Genitalia
c. Fingernails
d. Not assessable
✅ Correct Answer: a
Rationale: Scleral icterus is the most reliable sign of jaundice, regardless of skin tone.
13. Itchy insect bite-like red raised lesions on legs and groin—how should they be
documented? a. Wheals b. Bullae
c. Tumors
d. Plaques
✅ Correct Answer: a
Rationale: Wheals are transient, itchy, elevated lesions commonly seen with allergic
reactions and insect bites.
14. Multiple red circular lesions with central clearing over abdomen—what pattern is this?
a. Gyrate and linear
b. Annular and generalized
c. Iris and discrete
d. Oval and clustered
✅ Correct Answer: b
Rationale: Annular refers to ring-shaped lesions with central clearing; generalized refers to
widespread distribution.
