NUR 1211- MED SURG HEALTH ASSESSMENT HESI GUIDE 2023 - MIAMI DADE COLLEGE.

NUR 1211- MED SURG HEALTH ASSESSMENT HESI GUIDE 2023 - MIAMI DADE COLLEGE. 1) The nurse is taking a family history. Important diseases or problems to ask the patient about specifically include: a) Emphysema b) Head trauma c) Mental illness d) Fractured bones 2) The review of systems provides the nurse with: a) Physical findings related to each system b) Information regarding health promotion practices c) An opportunity to teach the patient medical terms d) Information necessary for the nurse to diagnose the patient’s medical problem 3) Which of these statements represents subjective data the nurse obtained from the patient regarding the patient’s skin? a) Skin appears dry. b) No obvious lesions. c) Denies color change. d) Lesion noted lateral aspect right arm. 4) In an interview, the nurse may find it necessary to take notes to aid his or her memory later. Which statement is true regarding note-taking? a) Note-taking may impede the nurse’s observation of the patient’s nonverbal behaviors. b) Note-taking allows the patient to continue at his or her own pace as the nurse records what is said. c) Note-taking allows the nurse to shift attention away from the patient, resulting in an increased comfort level. d) Note-taking allows the nurse to break eye contact with the patient, which may increase his or her level of comfort. 5) The nurse asks, “I would like to ask you some questions about your health and your usual daily activities so that we can better plan your stay here.” This question is found at the phase of the interview process. a) Summary b) Closing c) Body d) Opening or introduction NUR 1211- MED SURG HEALTH ASSESSMENT HESI GUIDE 2023 6) A woman has just entered the emergency department after being battered by her husband. The nurse needs to get some information from her to begin treatment. What is the best choice for an opening with this patient? a) “Hello, Nancy, my name is Mrs. C.” b) “Hello, Mrs. H., my name is Mrs. C. It sure is cold today!” c) “Mrs. H., my name is Mrs. C. How are you?” d) “Mrs. H., my name is Mrs. C. I’ll need to ask you a few questions about what happened.” 7) The nurse hears bilateral louder, longer, and lower tones when percussing over the lungs of a 4-year old child. What should the nurse do next? a) Palpate over the area for increased pain and tenderness. b) Ask the child to take shallow breaths and percuss over the area again. c) Refer the child immediately because of an increased amount of air in the lungs. d) Consider this a normal finding for a child this age and proceed with the examination. 8) A patient has suddenly developed shortness of breath and appears to be in significant respiratory distress. After putting a call in to the physician and placing the patient on oxygen, which of these is the best action for the nurse to take when assessing the patient further? a) Count the patient’s respirations. b) Percuss the thorax bilaterally, noting any differences in percussion tones. c) Call for a chest x-ray and wait for the results before beginning an assessment. d) Inspect the thorax for any new masses and bleeding associated with respirations. 9) The nurse is teaching a class on basic assessment skills. Which of these statements is true regarding the stethoscope and its use? a) The slope of the earpieces should point posteriorly (toward the occiput). b) The stethoscope does not magnify sound but does block out extraneous room noise. c) The fit and quality of the stethoscope are not as important as its ability to magnify sound. d) The ideal tubing length should be 22 inches to dampen distortion of sound. 10) The nurse is preparing to use a stethoscope for auscultation. Which statement is true regarding the diaphragm of the stethoscope? a) The diaphragm is used to listen for high-pitched sounds. b) The diaphragm is used to listen for low-pitched sounds. c) The diaphragm should be held lightly against the person’s skin to block out low-pitched sounds. d) The diaphragm should be held lightly against the person’s skin to listen for extra heart sounds and murmurs. 11) Before auscultating the abdomen for the presence of bowel sounds on a patient, the nurse should: a) Warm the end piece of the stethoscope by placing it in warm water b) Leave the gown on so that the patient does not get chilled during the examination c) Make sure that the bell side of the stethoscope is turned to the “on” position d) Check the temperature of the room and offer blankets to the patient if he or she feels cold 12) The nurse will use which technique of assessment to determine the presence of crepitus, swelling, and pulsations? a) Palpation b) Inspection c) Percussion d) Auscultation 13) The nurse is preparing to use an otoscope for an examination. Which statement is true regarding the otoscope? a) The otoscope is often used to direct light onto the sinuses. b) The otoscope uses a short, broad speculum to help visualize the ear. c) The otoscope is used to examine the structures of the internal ear. d) The otoscope directs light into the ear canal and onto the tympanic membrane. 14) An examiner is using an ophthalmoscope to examine a patient’s eyes. The patient has astigmatism and is nearsighted. The use of which of these techniques would indicate that the examination is being performed correctly? a) Using the large full circle of light when assessing pupils that are not dilated b) Rotating the lens selector dial to the black numbers to compensate for astigmatism c) Using the grid on the lens aperture dial to visualize the external structures of the eye d) Rotating the lens selector dial to bring the object into focus 15) The nurse is unable to palpate the right radial pulse on a patient. The best action would be to: a) Auscultate over the area with a fetoscope b) Use a goniometer to measure the pulsations c) Use a Doppler device to check for pulsations over the area d) Check for the presence of pulsations with a stethoscope 16) The nurse is preparing to perform a physical assessment. The correct action by the nurse is reflected by which statement? a) The nurse performs the examination from the left side of the bed. b) The nurse examines tender or painful areas first to help relieve the patient’s anxiety. c) The nurse follows the same examination sequence regardless of the patient’s age or condition. d) The nurse organizes the assessment so that the patient does not change positions too often. 17) A man is at the clinic for a physical examination. He states that he is “very anxious” about the physical examination. What steps can the nurse take to make him more comfortable? a) Appear unhurried and confident when examining him. b) Stay in the room when he undresses in case he needs assistance. c) Ask him to change into an examining gown and take off his undergarments. d) Defer measuring vital signs until the end of the examination, which allows him time to become comfortable.