2020/2021 HESI HEALTH ASSESSMENT NURSING RN V1 100 Questions with answers 1. During a mental status examination, the nurse wants to assess a patient’s affect. The nurse should ask the patient which question? 2. The nurse is planning to assess new memory with a patient. The best way for the nurse to do this would be to: 3. A 45-year-old woman is at the clinic for a mental status assessment. In giving her the Four Unrelated Words Test, the nurse would be concerned if she could not ____ four unrelated words ____. 4. During a mental status assessment, which question by the nurse would best assess a person’s judgment? 5. Which of these individuals would the nurse consider at highest risk for a suicide attempt? 6. When reviewing the use of alcohol by older adults, the nurse notes that older adults have several characteristics that can increase the risk of alcohol use. Which would increase the bioavailability of alcohol in the blood for longer periods in the older adult? 7. During an assessment, the nurse asks a female patient, “How many alcoholic drinks do you have a week?” Which answer by the patient would indicate at-risk drinking? 8. The nurse is asking an adolescent about illicit substance abuse. The adolescent answers, “Yes, I’ve used marijuana at parties with my friends.” What is the next question the nurse should ask? 9. The nurse has completed an assessment on a patient who came to the clinic for a leg injury. As a result of the assessment, the nurse has determined that the patient has at-risk alcohol use. Which action by the nurse is most appropriate at this time? 10. A patient is brought to the emergency department. He is restless, has dilated pupils, is sweating, has a runny nose and tearing eyes, and complains of muscle and joint pains. His girlfriend thinks he has influenza, but she became concerned when his temperature went up to 39.4° C. She admits that he has been a heavy drug user, but he has been trying to stop on his own. The nurse suspects that the patient is experiencing withdrawal symptoms from which substance? 11. Patient taking ipratropium reports nausea, blurred vision, has, insomnia after using the inhaler. RN action to implement 12. A patient has suddenly developed shortness of breath and appears to be in significant respiratory distress. After calling the physician and placing the patient on oxygen, which of these actions is the best for the nurse to take when further assessing the patient? 13. The nurse is teaching a class on basic assessment skills. Which of these statements is true regarding the stethoscope and its use? 14. The nurse is preparing to use a stethoscope for auscultation. Which statement is true regarding the diaphragm of the stethoscope? The diaphragm: 15. Before auscultating the abdomen for the presence of bowel sounds on a patient, the nurse should: 16. While measuring a patient’s blood pressure, the nurse recalls that certain factors, such as __________, help determine blood pressure. 17. A nurse is helping at a health fair at a local mall. When taking blood pressures on a variety of people, the nurse keeps in mind that: 8. The nurse notices a colleague is preparing to check the blood pressure of a patient who is obese by using a standard-sized blood pressure cuff. The nurse should expect the reading to: 19. A student is late for his appointment and has rushed across campus to the health clinic. The nurse should: 20. Hypoptysis (new cough) or changes in persistent cough 21. The nurse is assessing a patient’s pain. The nurse knows that the most reliable indicator of pain would be the: 22. A patient has had arthritic pain in her hips for several years since a hip fracture. She is able to move around in her room and has not offered any complaints so far this morning. However, when asked, she states that her pain is “bad this morning” and rates it at an 8 on a 1-to-10 scale. What does the nurse suspect? The patient: 23. The nurse is reviewing the principles of pain. Which type of pain is due to an abnormal processing of the pain impulse through the peripheral or central nervous system? 24. The nurse hears bilateral loud, long, and low tones when percussing over the lungs of a 4-year-old child. The nurse should: 25. When assessing the quality of a patient’s pain, the nurse should ask which question? 26. When assessing a patient’s pain, the nurse knows that an example of visceral pain would

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