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NIGHTINGALE BSN 246 HESI HEALTH
ASSESSMENT LATEST UPDATE THIS YEAR (2026-
2027) ALL 300 QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
1. A patient's uvula rises midline when she says "ahh" and she has a positive gag reflex. The
nurse has just tested which cranial nerves?
A) CN IX, X
B) CN IX, XII
C) CN X, XII
D) CN XI, XII
Answer: A
CN IX (glossopharyngeal) and CN X (vagus) control the gag reflex and uvular elevation; CN XII
controls tongue movement, and CN XI controls shoulder shrug.
2. A patient is unable to stick out his tongue. Which cranial nerve is involved?
A) CN I (Olfactory)
B) CN V (Trigeminal)
C) CN XI (Spinal Accessory)
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D) CN XII (Hypoglossal)
Answer: D
CN XII (hypoglossal) innervates the tongue muscles for protrusion, retraction, and side-to-side
movement.
3. A patient is unable to shrug her shoulders against resistance. Which cranial nerve should
the nurse suspect is impaired?
A) CN IX
B) CN X
C) CN XI
D) CN XII
Answer: C
CN XI (spinal accessory) innervates the sternocleidomastoid and trapezius muscles, controlling
shoulder shrug and head rotation.
4. During a health history interview, which question is an example of an open-ended
question?
A) "Are you experiencing any pain?"
B) "Do you have a history of diabetes?"
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C) "Tell me about your health concerns."
D) "Is your appetite good?"
Answer: C
Open-ended questions allow clients to describe concerns in their own words; closed-ended
questions elicit yes/no or short answers.
5. A client pauses frequently during the health history interview and looks at the nurse
expectantly. What is the nurse's best response?
A) Ask if they need clarification
B) Sit quietly to allow the client to respond comfortably
C) Repeat the question more slowly
D) Move on to the next question
Answer: B
Sitting quietly allows the client time to process and respond; rushing or interrupting increases
anxiety and disrupts information flow.
6. Which question is most appropriate for assessing a client's health literacy?
A) "How much schooling have you completed?"
B) "How confident are you filling out medical forms by yourself?"
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C) "Do you have difficulty reading?"
D) "Can you read this prescription label to me?"
Answer: B
The Single-Item Literacy Screener (SILS) question "How confident are you filling out medical
forms by yourself?" is a validated health literacy assessment tool.
7. A client states, "I have been feeling sad for the past two months." Which question is most
appropriate to screen for depression?
A) "Have you felt down, depressed, or hopeless?"
B) "Are you stressed about anything?"
C) "Do you have a history of depression?"
D) "Are you sleeping well?"
Answer: A
The PHQ-2 asks, "Over the past 2 weeks, have you felt down, depressed, or hopeless?" and
"Have you had little interest or pleasure in doing things?"
8. A client reports a history of domestic violence. What is the most appropriate initial
response?
A) "What happened?"
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NIGHTINGALE BSN 246 HESI HEALTH
ASSESSMENT LATEST UPDATE THIS YEAR (2026-
2027) ALL 300 QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
1. A patient's uvula rises midline when she says "ahh" and she has a positive gag reflex. The
nurse has just tested which cranial nerves?
A) CN IX, X
B) CN IX, XII
C) CN X, XII
D) CN XI, XII
Answer: A
CN IX (glossopharyngeal) and CN X (vagus) control the gag reflex and uvular elevation; CN XII
controls tongue movement, and CN XI controls shoulder shrug.
2. A patient is unable to stick out his tongue. Which cranial nerve is involved?
A) CN I (Olfactory)
B) CN V (Trigeminal)
C) CN XI (Spinal Accessory)
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, Page 2 of 155
D) CN XII (Hypoglossal)
Answer: D
CN XII (hypoglossal) innervates the tongue muscles for protrusion, retraction, and side-to-side
movement.
3. A patient is unable to shrug her shoulders against resistance. Which cranial nerve should
the nurse suspect is impaired?
A) CN IX
B) CN X
C) CN XI
D) CN XII
Answer: C
CN XI (spinal accessory) innervates the sternocleidomastoid and trapezius muscles, controlling
shoulder shrug and head rotation.
4. During a health history interview, which question is an example of an open-ended
question?
A) "Are you experiencing any pain?"
B) "Do you have a history of diabetes?"
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, Page 3 of 155
C) "Tell me about your health concerns."
D) "Is your appetite good?"
Answer: C
Open-ended questions allow clients to describe concerns in their own words; closed-ended
questions elicit yes/no or short answers.
5. A client pauses frequently during the health history interview and looks at the nurse
expectantly. What is the nurse's best response?
A) Ask if they need clarification
B) Sit quietly to allow the client to respond comfortably
C) Repeat the question more slowly
D) Move on to the next question
Answer: B
Sitting quietly allows the client time to process and respond; rushing or interrupting increases
anxiety and disrupts information flow.
6. Which question is most appropriate for assessing a client's health literacy?
A) "How much schooling have you completed?"
B) "How confident are you filling out medical forms by yourself?"
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, Page 4 of 155
C) "Do you have difficulty reading?"
D) "Can you read this prescription label to me?"
Answer: B
The Single-Item Literacy Screener (SILS) question "How confident are you filling out medical
forms by yourself?" is a validated health literacy assessment tool.
7. A client states, "I have been feeling sad for the past two months." Which question is most
appropriate to screen for depression?
A) "Have you felt down, depressed, or hopeless?"
B) "Are you stressed about anything?"
C) "Do you have a history of depression?"
D) "Are you sleeping well?"
Answer: A
The PHQ-2 asks, "Over the past 2 weeks, have you felt down, depressed, or hopeless?" and
"Have you had little interest or pleasure in doing things?"
8. A client reports a history of domestic violence. What is the most appropriate initial
response?
A) "What happened?"
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