The nurse is performing a neurological assessment and notes that the patient has a positive Romberg sign. What does this finding indicate?
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HESI RN · Assessing Vital Signs
Question 2 of 60
The nurse is performing a physical assessment and observes that the patient has a barrel-shaped chest. This finding is most commonly associated with which condition?
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Question 3 of 60
The nurse is auscultating the abdomen and hears high-pitched, tinkling sounds. What does this finding most likely indicate?
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Question 4 of 60
The nurse needs to increase heat conservation in a newborn. Which action will the nurse take?
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HESI RN · Assessing Vital Signs
Question 5 of 60
The nurse is performing an assessment on an adult. The adult's vital signs are normal, and capillary refill time is 5 seconds. What should the nurse do next?
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Question 6 of 60
During a musculoskeletal assessment, the nurse notes that the patient has limited range of motion in the hip. What is the next step in the assessment?
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Question 7 of 60
When listening to a patient's breath sounds, the nurse is unsure of a sound that is heard. The nurse's next action should be to:
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Question 8 of 60
A nurse is assessing a client's radial pulse and finds it to be 50 beats per minute. What action should the nurse take?
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HESI RN · Assessing Vital Signs
Question 9 of 60
A patient comes to the clinic and states that he has noticed that his skin is redder than normal. The nurse understands that this condition is due to hyperemia and knows that it can be caused by:
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Question 10 of 60
During auscultation of the heart, the nurse hears a murmur. What instrument should be used to further assess this murmur?
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HESI RN · Assessing Vital Signs
Question 11 of 60
An adult patient with a history of allergies comes to the clinic complaining of wheezing and difficulty in breathing when working in his yard. The assessment findings include tachypnea, the use of accessory neck muscles, prolonged expiration, intercostal retractions, decreased breath sounds, and expiratory wheezes. The nurse interprets that these assessment findings are consistent with:
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Question 12 of 60
The patient is being admitted to the emergency department following a motor vehicle accident. His jaw is broken, and he has several broken teeth. He is ashen, and his skin is cool and diaphoretic. To obtain an accurate temperature, the nurse uses which of the following routes?
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Question 13 of 60
A 26-year-old violinist comes to your clinic, complaining of anxiety. He is a first chair violinist in the local symphony orchestra and has started having symptoms during performances, such as sweating, shaking, and hyperventilating. It has gotten so bad that he has thought about giving up his first chair status so he does not have to play the solo during one of the movements. He says that he never has these symptoms during rehearsals or when he is practicing. He denies having any of these symptoms at any other time. His past medical history is unremarkable. He denies any tobacco use, drug use, or alcohol abuse. His parents are both healthy. On examination you see a young man who appears worried. His vital signs and physical examination are unremarkable. What type of anxiety disorder best describes his situation?
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Question 14 of 60
A young man feels something in his scrotum and comes to you for clarification. On your examination, you note what feels like a 'bag of worms' in the left scrotum, superior to the testicles. Which of the following is most likely?
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Question 15 of 60
Which of these statements describes the closure of the valves in a normal cardiac cycle?
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Question 16 of 60
A physical therapist observes a patient completing a treadmill exercise test. The patient's blood pressure rises significantly during exercise. The therapist should recognize this as:
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Question 17 of 60
A pregnant woman states that she is concerned about her gums because she has noticed they are swollen and have started bleeding. What would be an appropriate response by the nurse?
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Question 18 of 60
A physical therapist completes an examination on a five-year-old boy diagnosed with Duchenne muscular dystrophy. The referral indicates that the boy was diagnosed with the disease less than one year ago. Assuming a normal progression, which of the following would be expected?
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HESI RN · Assessing Vital Signs
Question 19 of 60
A nurse is assessing a client's vital signs. Which vital sign reflects the number of times the heart beats per minute?
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Question 20 of 60
The salivary gland that is the largest and located in the cheek in front of the ear is the _____gland.
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Question 21 of 60
A patient's blood pressure is 118/82 mm Hg. He asks the nurse, "What do the numbers mean?" The nurse's best reply is:
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Question 22 of 60
A nurse is conducting a health assessment. How will the information collected from the patient be used?
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Question 23 of 60
During an examination of a child, the nurse considers that physical growth is the best index of a child's:
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Question 24 of 60
A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon?
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Question 25 of 60
Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant pain. On examination of this area a rough grating noise is heard. What is this sound?
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HESI RN · Assessing Vital Signs
Question 26 of 60
Which of the following examples includes information recorded in the 'assessment' portion of the clinical record?
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HESI RN · Assessing Vital Signs
Question 27 of 60
During a cardiovascular assessment, the nurse notes a bounding peripheral pulse. What is the most likely cause of this finding?
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Question 28 of 60
Kienböck's disease involves which of the following features?
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Question 29 of 60
During a physical assessment, the nurse observes that the patient has a positive Homan's sign. What condition does this finding suggest?
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Question 30 of 60
Which of the following findings is most concerning during a skin assessment?
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Question 31 of 60
A nurse is attempting to obtain vital signs from a restless toddler who is clinging to his mother's legs and asking to go home. Which of the following would be the best nursing intervention to accomplish this task?
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Question 32 of 60
The nurse hears bilateral loud, long, and low tones when percussing over the lungs of a 4-year-old child. The nurse should:
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Question 33 of 60
The nurse is performing a cardiovascular assessment and notes a gallop rhythm on auscultation. What condition is this most likely associated with?
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HESI RN · Assessing Vital Signs
Question 34 of 60
Vital signs are measurements of...
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Question 35 of 60
What diagnostic test is the 'gold standard' for evaluation of the rotator cuff?
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Question 36 of 60
A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies. On examination, auscultation of her chest shows decreased air movement and a high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs.
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Question 37 of 60
A client who was trapped inside a car for hours after a head-on collision is rushed to the emergency department with multiple injuries. During the neurologic examination, the client responds to painful stimuli with decerebrate posturing. This finding indicates damage to which part of the brain?
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Question 38 of 60
The nurse is assessing a patient who has liver disease for jaundice. Which of these assessment findings is indicative of true jaundice?
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Question 39 of 60
A patient repeatedly seems to have difficulty coming up with a word. He says, 'I was on my way to work, and when I got there, the thing that you step into that goes up in the air was so full that I decided to take the stairs.' The nurse will note on his chart that he is using or experiencing:
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Question 40 of 60
Which of these specific measurements is the best index of a child's general health?
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Question 41 of 60
A nurse is caring for a group of patients. Which patient will the nurse see first?
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Question 42 of 60
The nurse is assessing a patient's mental status and asks the patient to recall three words. What is the nurse testing?
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Question 43 of 60
During which type of contraction is a hamstring injury most likely to occur?
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Question 44 of 60
The nurse is taking the history of a patient who may have a perforated eardrum. What would be an important question in this situation?
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Question 45 of 60
The nurse recognizes that the bell of the stethoscope is used to detect which type of sounds?
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Question 46 of 60
During a breast health interview, a patient states that she has noticed pain in her left breast. The nurse's most appropriate response to this would be:
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Question 47 of 60
Which of the following best describes objective information?
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Question 48 of 60
During the precordial assessment on an patient who is 8 months pregnant, the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line. This finding would indicate:
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Question 49 of 60
The primary muscles of respiration include the:
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Question 50 of 60
Core temperatures are not measured at:
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Question 51 of 60
A nurse is inspecting the ear canals and tympanic membranes of an 18-month-old child. How would the pinna be moved to achieve better visualization?
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Question 52 of 60
Which respiratory disease causes a restrictive, parenchymal pattern of illness?
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Question 53 of 60
You are at your family reunion playing football when your uncle takes a hit to his right lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a very remote area. What would your next step be?
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Question 54 of 60
A nurse is assessing a patient who has a fever, has an infection of a flank incision, and is in severe pain. What type of pulse rate would be likely?
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Question 55 of 60
The nurse is conducting a respiratory assessment. Which finding requires immediate attention?
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Question 56 of 60
Barriers to incorporating EBP include:
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Question 57 of 60
A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic region would you assign the symptom?
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Question 58 of 60
Which of the following is true of the HPV vaccine?
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Question 59 of 60
During a visit to the clinic, a patient states, 'The doctor just told me he thought I ought to stop smoking. He doesn't understand how hard I've tried. I just don't know the best way to do it. What should I do?' The nurse's most appropriate response in this case would be:
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Question 60 of 60
The licensed practice nurse (LPN) provides you with the change-of-shift vital signs on four of your patients. Which patient do you need to assess first?
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