HESI 1 - V1 and V2 REVIEW - Health Assessment 1 Exam Questions with Solutions
The nurse is performing a thoracic assessment on a client with chronic asthma and hyperinflation of the lungs. Which finding should be expected for this client? - ANS Barrel chest
The nurse is assessing bowel sound...
HESI
1
-
V1
and
V2
REVIEW
-
Health
Assessment
1
The
nurse
is
performing
a
thoracic
assessment
on
a
client
with
chronic
asthma
and
hyperinflation
of
the
lungs.
Which
finding
should
be
expected
for
this
client?
-
ANS
Barrel
chest
The
nurse
is
assessing
bowel
sounds
for
a
hospitalized
client.
The
nurse
has
heard
bowel
sounds
in
the
right
upper
quadrant.
What
action
should
the
nurse
take
next?
-
ANS
Note
the
character
and
frequency
of
bowel
sounds
During
inspection
of
a
client's
mouth
and
pharynx,
the
nurse
places
a
tongue
blade
on
the
back
of
the
tongue
which
causes
the
client
to
gag.
After
removing
the
tongue
blade,
what
action
should
the
nurse
take?
-
ANS
Document
an
intact
gag
reflex.
When
teaching
a
client
how
to
perform
a
monthly
breast
self-assessment,
the
nurse
should
tell
the
client
that
it
is
most
important
to
assess
which
part
of
the
breast
more
closely
for
changes?
-
ANS
Upper
outer
quadrant.
The
nurse
is
assessing
a
postmenopausal
client
who
has
a
BMI
of
32.
The
client
has
a
chest
measurement
of
42
inches,
waist
measurement
of
45
inches,
and
hip
measurement
of
50
inches.
What
important
message
should
the
nurse
explain
to
the
client
to
promote
health
promotion?
-
ANS
A
waist
circumference
is
greater
than
35
inches
in
women
puts
you
at
higher
risk
for
type
2
diabetes
and
heart
disease."
The
nurse
performs
a
physical
assessment
on
an
older
female
client.
Which
change
from
the
prior
exam
may
be
an
indication
of
osteoporosis?
-
ANS
Height
reduction
of
1.5
inches.
While
conducting
an
interview
to
obtain
a
health
history,
the
nurse
notices
that
the
client
pauses
frequently
and
looks
at
the
nurse
expectantly.
Which
response
is
best
for
the
nurse
to
provide?
-
ANS
Sit
quietly
to
allow
the
client
to
respond
comfortably.
A
client
is
in
the
clinical
for
a
yearly
physical
examination.
Which
action
should
the
nurse
take
when
preparing
to
examine
the
client's
abdomen?
-
ANS
Ask
the
client
to
urinate
before
beginning
the
examination.
Which
respiratory
condition
should
the
nurse
document
after
measuring
a
respiratory
rate
of
8
breaths/minute?
-
ANS
Bradypnea. Which
procedure
should
the
nurse
use
to
assessfor
a
pulse
deficit?
-
ANS
Measure
the
apical
pulse
and
compare
it
to
the
peripheral
pulse.
*A
pulse
deficit
is
a
palpable
difference
between
the
apical
pulse
at
the
point
of
maximal
impulse
and
the
radial
pulse
palpated
at
the
wrist.
A
client
has
been
diagnosed
with
bilateral
lower
lobe
atelectasis.
What
percussion
sound
should
the
nurse
expect
to
hear
when
percussing
over
the
client's
lower
lobes?
-
ANS
Dull,
thud-like.
A
client
is
being
assessed
upon
admission
to
the
medical-surgical
unit.
The
nurse
is
preparing
to
complete
a
head-to-toe
assessment
and
will
begin
at
the
head
of
the
client.
Which
technique
should
the
nurse
use
to
begin
the
assessment?
-
ANS
Inspect
the
hair
and
skin.
The
nurse
is
assessing
a
healthy
young
adult
during
an
annual
physical
examination.
Which
assessment
technique
should
the
nurse
implement
when
palpating
the
abdominal
aorta?
-
ANS
Deep
palpation
above
and
to
the
left
of
the
umbilicus.
The
nurse
is
conducting
a
family
history
as
part
of
the
assessment
interview.
Which
action
should
the
nurse
take
to
ensure
that
sufficient
information
about
the
client's
blood
relatives
is
obtained?
-
ANS
Document
at
least
3
generations
of
the
client's
family
medical
history.
The
nurse
is
testing
the
client's
shoulders
for
range
of
motion.
What
should
the
nurse
document
to
record
normal
internal
rotation?
-
ANS
Range
of
90
degrees
when
the
hands
are
placed
at
the
small
of
the
back.
A
client
presents
with
a
rash
along
the
occipital
area
of
the
hairline
and
reports
intense
itching.
How
should
the
nurse
begin
the
objective
part
of
the
examination?
-
ANS
Inspect
the
scalp
looking
for
nits.
The
nurse
is
assessing
a
client's
range
of
motion
as
the
client
bends
the
right
knee
up
to
the
chest
while
keeping
the
left
leg
straight,
but
is
unable
to
keep
the
left
thigh
on
the
table.
The
assessment
is
repeated
for
the
left
knee,
and
the
client
is
unable
to
keep
the
right
thigh
on
the
table.
How
should
the
nurse
document
this
finding?
-
ANS
A
flexion
deformity
referred
to
as
a
positive
Thomas
test.
During
a
skin
asssessment,
the
nurse
notes,
round
and
discrete
lesions
that
are
dark
red
in
color
and
will
not
blanch.
The
lesions
range
from
1
to
3
mm
in
size.
What
is
the
first
question
the
nurse
should
ask
the
client?
-
ANS
Have
you
notice
any
irregular
bleeding
A
client
with
progressive
hearing
loss
appears
distressed
when
the
registered
nurse
(RN)
asks
open-ended
questions
about
the
client's
health
history.
Which
forms
of
communication
should
the
RN
use?
-
ANS
Face
the
client
so
the
client
can
see
the
RN's
mouth.
Check
if
the
client's
hearing
aides
are
working
properly.
Reduce
environmental
noise
surrounding
the
client.
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