Health Assessment HESI EXAM 2024/25 Which procedure should the nurse use to assess for a pulse deficit? - ANSWER Measure the apical pulse and compare it to the peripheral pulse Following abdominal auscultation of a client who is admitted for signs of splenomegaly, which additional assessment should the nurse use to verify splenomegaly? - ANSWER Percussion 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? - ANSWER Deep palpation above and to the left of the umbilicus A client reports a recent onset of nausea and vomiting - ANSWER Ask whether the client has been in a foreign country recently.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? - ANSWER "Have you noticed any unusual bleeding?" 1 / 3
How should the nurse assess for lower extremity edema in a client who has been diagnosed with heart failure? - ANSWER Measure bilateral ankle circumference with a non-stretchable tape measure Which technique should the nurse use to assess a client for scoliosis? - ANSWER Observe spine while the client is erect and bent forward.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? - ANSWER Sit quietly to allow the client to respond comfortably.A client has come to the clinic for a routine health assessment. What is the best assessment question for the nurse to ask a client after observing tophi on the client's ear cartilage? - ANSWER Have you had sudden and severe pain in the toes or feet?The nurse observes peristaltic movement in the left lower quadrant of a client's abdomen.Which further assessment of the area should the nurse perform? - ANSWER Observe the direction of movement 2 / 3
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? - ANSWER Document an intact gag reflex The nurse uses a tongue depressor to assess a client's mouth. Which structure should the nurse be able to visualize? - ANSWER Pharynx During cardiac auscultation, the nurse hears a split in the second heart sound when listening at the second left intercostal space of a male client. To assess this sound more fully, what action should the nurse implement? - ANSWER Listen to the sound while observing the client's respirations While performing a head-to-toe assessment, the nurse assesses the client's pupillary accommodation. During the second portion of the test, the nurse notes that the client's pupils constrict and there is convergence of the axes of the eyes. What action should the nurse implement next? - ANSWER Document a normal finding As a part of a routine health assessment, the nurse assesses the kidneys as part of the abdominal assessment. Which assessment finding should the nurse conclude is normal when palpating the client's right kidney? - ANSWER A round smooth mass that slides between the fingers
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