HEALTH ASSESSMENT HESI
EXAM STUDY GUIDE 100%
CORRECT
REVISION GUIDE
GRADED A
1) 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.
2) 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.
3) 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.
4) 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.
5) 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
1
, 6) A woman brings her husband to the clinic for an examination. She is particularly worried
because after a recent fall, he seems to have lost a great deal of his memory of recent events.
Which statement reflects the nurse’s best course of action?
a) The nurse should plan to perform a complete mental status examination.
b) The nurse should refer him to a psychometrician.
c) The nurse should plan to integrate the mental status examination into the history and physical
examination.
d) The nurse should reassure his wife that memory loss after a physical shock is normal and
willsubside soon.
7) The nurse is conducting a patient interview. Which statement made by the patient should the
nurse explore more fully during the interview? The patient states that he:
a) “Sleeps like a baby”
b) Has no health problems
c) “Never did too good in school”
d) Currently is not taking any medication
8) A patient is admitted to the unit after an automobile accident. The nurse begins the mental
status examination and finds that the patient's speech is dysarthric and that she is lethargic. The
nurse’s best approach regarding this examination is to:
a) Plan to defer the rest of the mental status examination
b) Skip the language portion of the examination and go on to assess mood and affect
c) Do an in-depth speech evaluation and defer the mental status examination to another time
d) Go ahead and assess for suicidal thoughts because dysarthria is often accompanied by severe
depression
9) A 19-year-old woman comes to the clinic at the insistence of her brother. She is wearing
black combat boots and a black lace nightgown over the top of her other clothes. Her hair is dyed
pink with black streaks throughout. She has several pierced holes in her nares and ears and is
wearing an earring through her eyebrow and heavy black makeup. The nurse concludes:
a) She probably doesn’t have any problems at all.
b) She is just trying to shock people and her dress should be ignored.
c) She has manic syndrome because of her abnormal dress and grooming.
d) That more information should be gathered to decide whether her dress is appropriate.
10) A patient has been in the intensive care unit for 10 days. He has just been moved to the
medical surgical unit, and the admitting nurse is planning to perform a mental status
examinationon him. During the tests of cognitive function, the nurse would expect that he:
a) May display some disruption in thought content
b) Will state, “I am so relieved to be out of intensive care”
c) Will be oriented to place and person but may not be certain of the date
d) May show evidence of some clouding of his level of consciousness
11) 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
2
EXAM STUDY GUIDE 100%
CORRECT
REVISION GUIDE
GRADED A
1) 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.
2) 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.
3) 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.
4) 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.
5) 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
1
, 6) A woman brings her husband to the clinic for an examination. She is particularly worried
because after a recent fall, he seems to have lost a great deal of his memory of recent events.
Which statement reflects the nurse’s best course of action?
a) The nurse should plan to perform a complete mental status examination.
b) The nurse should refer him to a psychometrician.
c) The nurse should plan to integrate the mental status examination into the history and physical
examination.
d) The nurse should reassure his wife that memory loss after a physical shock is normal and
willsubside soon.
7) The nurse is conducting a patient interview. Which statement made by the patient should the
nurse explore more fully during the interview? The patient states that he:
a) “Sleeps like a baby”
b) Has no health problems
c) “Never did too good in school”
d) Currently is not taking any medication
8) A patient is admitted to the unit after an automobile accident. The nurse begins the mental
status examination and finds that the patient's speech is dysarthric and that she is lethargic. The
nurse’s best approach regarding this examination is to:
a) Plan to defer the rest of the mental status examination
b) Skip the language portion of the examination and go on to assess mood and affect
c) Do an in-depth speech evaluation and defer the mental status examination to another time
d) Go ahead and assess for suicidal thoughts because dysarthria is often accompanied by severe
depression
9) A 19-year-old woman comes to the clinic at the insistence of her brother. She is wearing
black combat boots and a black lace nightgown over the top of her other clothes. Her hair is dyed
pink with black streaks throughout. She has several pierced holes in her nares and ears and is
wearing an earring through her eyebrow and heavy black makeup. The nurse concludes:
a) She probably doesn’t have any problems at all.
b) She is just trying to shock people and her dress should be ignored.
c) She has manic syndrome because of her abnormal dress and grooming.
d) That more information should be gathered to decide whether her dress is appropriate.
10) A patient has been in the intensive care unit for 10 days. He has just been moved to the
medical surgical unit, and the admitting nurse is planning to perform a mental status
examinationon him. During the tests of cognitive function, the nurse would expect that he:
a) May display some disruption in thought content
b) Will state, “I am so relieved to be out of intensive care”
c) Will be oriented to place and person but may not be certain of the date
d) May show evidence of some clouding of his level of consciousness
11) 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
2
