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2024 HESI HEALTH ASSESSMENT PREP PRACTICE EXAM QUESTIONS WITH CORRECT ANSWERS
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2024 HESI HEALTH ASSESSMENT PREP PRACTICE EXAM QUESTIONS WITH CORRECT ANSWERS
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2024 HESI HEALTH ASSESSMENTPREP PRACTICE EXAM QUESTIONS
WITH CORRECT ANSWERS
2. During an interview, the nurse states, "You mentioned shortness of breath.
Tell me more about that." Which verbal skill is used with this statement?
A) Reflection
B) Facilitation
C) Direct question
D) Open-ended question - CORRECT-ANSWERSD) Open-ended question
Page: 32 The open-ended question asks for narrative information. It states
the topic to be discussed but only in general terms. The nurse should use it
to begin the interview, to introduce a new section of questions, and
whenever the person introduces a new topic.
116. During the neurologic assessment of a "healthy" 35-year-old patient,
the nurse asks him to relax his muscles completely. The nurse then moves
each extremity through full range of motion. Which of these results would
the nurse expect to find?
A) Firm, rigid resistance to movement
B) Mild, even resistance to movement
C) Hypotonic muscles as a result of total relaxation
D) Slight pain with some directions of movement - CORRECT-ANSWERSB)
Mild, even resistance to movement
Page: 637. Tone is the normal degree of tension (contraction) in voluntarily
relaxed muscles. It shows a mild resistance to passive stretch. Normally, the
nurse will notice a mild, even resistance to movement. The other responses
are not correct.
117. When the nurse asks a 68-year-old patient to stand with feet together
and arms at his side with his eyes closed, he starts to sway and moves his
feet farther apart. The nurse would document this finding as a(n):
A) ataxia.
B) lack of coordination.
C) negative Homans' sign.
D) positive Romberg sign. - CORRECT-ANSWERSD) positive Romberg sign.
,Page: 638. Abnormal findings for Romberg test include swaying, falling, and
widening base of feet to avoid falling. Positive Romberg sign is loss of
balance that is increased by closing of the eyes. Ataxia is uncoordinated or
unsteady gait. Homans' sign is used to test the legs for deep vein
thrombosis.
118. During the history of a 78-year-old man, his wife states that he
occasionally has problems with short-term memory loss and confusion: "He
can't even remember how to button his shirt." In doing the assessment of his
sensory system, which action by the nurse is most appropriate?
A) The nurse would not do this part of the examination because results would
not be valid.
B) The nurse would perform the tests, knowing that mental status does not
affect sensory ability.
C) The nurse would proceed with the explanations of each test, making sure
the wife understands.
D) Before testing, the nurse would assess the patient's mental status and
ability to follow directions at this time. - CORRECT-ANSWERSD) Before
testing, the nurse would assess the patient's mental status and ability to
follow directions at this time.
The nurse should ensure validity of the sensory system testing by making
sure the patient is alert, cooperative, comfortable, and has an adequate
attention span. Otherwise, the nurse may obtain misleading and invalid
results.
119. In assessing a 70-year-old patient who has had a recent
cerebrovascular accident, the nurse notices right-sided weakness. What
might the nurse expect to find when testing his reflexes on the right side?
A) Lack of reflexes
B) Normal reflexes
C) Diminished reflexes
D) Hyperactive reflexes - CORRECT-ANSWERSD) Hyperactive reflexes
Hyperreflexia is the exaggerated reflex seen when the monosynaptic reflex
arc is released from the influence of higher cortical levels. This occurs with
upper motor neuron lesions (e.g., a cerebrovascular accident). The other
responses are incorrect
120. During the assessment of an 80-year-old patient, the nurse notices that
his hands show tremors when he reaches for something and his head is
always nodding. There is no associated rigidity with movement. Which of
these statements is most accurate?
,A) These are normal findings resulting from aging.
B) These could be related to hyperthyroidism.
C) These are the result of Parkinson disease.
D) This patient should be evaluated for a cerebellar lesion. - CORRECT-
ANSWERSA) These are normal findings resulting from aging.
Page: 659. Senile tremors occasionally occur. These benign tremors include
an intention tremor of the hands, head nodding (as if saying yes or no), and
tongue protrusion. Tremors associated with Parkinson disease include
rigidity, slowness, and weakness of voluntary movement. The other
responses are incorrect.
121. While the nurse is taking the history of a 68-year-old patient who
sustained a head injury 3 days earlier, he tells the nurse that he is on a
cruise ship and is 30 years old. The nurse knows that this finding is indicative
of:
A) a great sense of humor.
B) uncooperative behavior.
C) inability to understand questions.
D) decreased level of consciousness. - CORRECT-ANSWERSD) decreased
level of consciousness.
Pages: 660-661. A change in consciousness may be subtle. The nurse should
notice any decreasing level of consciousness, disorientation, memory loss,
uncooperative behavior, or even complacency in a previously combative
person. The other responses are incorrect.
122. The nurse is caring for a patient who has just had neurosurgery. To
assess for increased intracranial pressure, what would the nurse include in
the assessment?
A) Cranial nerves, motor function, and sensory function
B) Deep tendon reflexes, vital signs, and coordinated movements
C) Level of consciousness, motor function, pupillary response, and vital signs
D) Mental status, deep tendon reflexes, sensory function, and pupillary
response - CORRECT-ANSWERSC) Level of consciousness, motor function,
pupillary response, and vital signs
Pages: 660-661. Some hospitalized persons have head trauma or a
neurologic deficit from a systemic disease process. These people must be
monitored closely for any improvement or deterioration in neurologic status
and for any indication of increasing intracranial pressure. The nurse should
use an abbreviation of the neurologic examination in the following sequence:
level of consciousness, motor function, pupillary response, and vital signs.
, 123. During an assessment of a 22-year-old woman who has a head injury
from a car accident 4 hours ago, the nurse notices the following change:
pupils were equal, but now the right pupil is fully dilated and nonreactive,
left pupil is 4 mm and reacts to light. What does finding this suggest?
A) Injury to the right eye
B) Increased intracranial pressure
C) Test was not performed accurately
D) Normal response after a head injury - CORRECT-ANSWERSB) Increased
intracranial pressure
Pages: 662-663. In a brain-injured person, a sudden, unilateral, dilated, and
nonreactive pupil is ominous. Cranial nerve III runs parallel to the brainstem.
When increasing intracranial pressure pushes the brainstem down (uncal
herniation), it puts pressure on cranial nerve III, causing pupil dilation. The
other responses are incorrect.
124. The nurse knows that determining whether a person is oriented to his or
her surroundings will test the functioning of which of these structures?
A) Cerebrum
B) Cerebellum
C) Cranial nerves
D) Medulla oblongata - CORRECT-ANSWERSA) Cerebrum
Pages: 621-622 | Page: 660. The cerebral cortex is responsible for thought,
memory, reasoning, sensation, and voluntary movement. The other options
structures are not responsible for a person's level of consciousness.
1. 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. - CORRECT-ANSWERSA) Note-taking
may impede the nurse's observation of the patient's nonverbal behaviors.
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