PN Vital Signs Assessment

HESI RN · PN Vital Signs Assessment

Question 1 of 63

The nurse is preparing to assess a patient's abdomen by palpation. How should the nurse proceed?

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HESI RN · PN Vital Signs Assessment

Question 2 of 63

During an assessment, the nurse notices that a patient's left arm is swollen from the shoulder down to the fingers, with nonpitting brawny edema. The right arm is normal. The patient had a left-sided mastectomy 1 year ago. The nurse suspects which problem?

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HESI RN · PN Vital Signs Assessment

Question 3 of 63

The technique that uses ultrasound to deliver medications through the skin is which of the following?

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HESI RN · PN Vital Signs Assessment

Question 4 of 63

Which of the following patients should have their vital signs monitored at least every 4 hours?

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HESI RN · PN Vital Signs Assessment

Question 5 of 63

Which of the following occurs in respiratory distress?

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HESI RN · PN Vital Signs Assessment

Question 6 of 63

The nurse is assessing a patient's heart sounds and notes that the patient has a S3 heart sound. What condition is most likely associated with this finding?

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HESI RN · PN Vital Signs Assessment

Question 7 of 63

Compression of which nerve is commonly misdiagnosed as lateral epicondylitis?

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HESI RN · PN Vital Signs Assessment

Question 8 of 63

A 4-month-old child is at the clinic for a well-baby check-up and immunizations. Which of these actions is most appropriate when the nurse is assessing an infant's vital signs?

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HESI RN · PN Vital Signs Assessment

Question 9 of 63

A 22-year-old unemployed roofer presents to your clinic, complaining of pain in his testicle and penis. He states the pain began last night and has steadily become worse. He states it hurts when he urinates and he has not attempted intercourse since the pain began. He has tried Tylenol and ibuprofen without improvement. He denies any fever or night sweats. His past medical history is unremarkable. He has had four previous sexual partners and has had a new partner for the last month. She is on oral contraceptives so he has not used condoms. His parents are both in good health. On examination you see a young man lying on his side. He appears mildly ill. His temperature is 100.2 and his blood pressure, respirations, and pulse are normal. On visualization of the penis he is circumcised, with no lesions or discharge from the meatus. Visualization of the scrotal skin appears unremarkable. Palpation of the testes shows severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness when you palpate the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges being noted with bearing down. His prostate examination is unremarkable. Urine analysis shows white blood cells and bacteria. What diagnosis of the male genitalia is most likely in this case?

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HESI RN · PN Vital Signs Assessment

Question 10 of 63

Monique is a 33-year-old administrative assistant who has had intermittent lower abdominal pain approximately one week a month for the past year. It is not related to her menses. She notes relief with defecation, and a change in form and frequency of her bowel movements with these episodes. Which of the following is most likely?

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HESI RN · PN Vital Signs Assessment

Question 11 of 63

A student nurse assesses a blood pressure on an adult and finds it to be 140/86. What term is used for the top number (140)?

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HESI RN · PN Vital Signs Assessment

Question 12 of 63

The nurse is preparing to examine a 4-year-old child. Which action is appropriate for this age group?

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HESI RN · PN Vital Signs Assessment

Question 13 of 63

A nurse palpates the pulse of a patient and documents the following: 6/6/12 pulse 85 and regular, 3+, and equal in radial, popliteal, and dorsalis pedis. What does the number 3+ represent?

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HESI RN · PN Vital Signs Assessment

Question 14 of 63

The rectal temperature, a core temperature, is considered to be one of the most accurate routes. In which cases would taking a rectal temperature be contraindicated?

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HESI RN · PN Vital Signs Assessment

Question 15 of 63

Which of the following lymph node groups is most commonly involved in breast cancer?

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HESI RN · PN Vital Signs Assessment

Question 16 of 63

Which of the following is the most appropriate method for assessing skin turgor?

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HESI RN · PN Vital Signs Assessment

Question 17 of 63

A physical therapist observes a patient performing a deep squat. Which muscle group is MOST active during the ascent phase?

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HESI RN · PN Vital Signs Assessment

Question 18 of 63

What diagnostic test is the 'gold standard' for evaluation of the rotator cuff?

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HESI RN · PN Vital Signs Assessment

Question 19 of 63

Which joint is the most common site for heterotopic ossification in burn patients?

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HESI RN · PN Vital Signs Assessment

Question 20 of 63

The nurse is teaching a review class on the lymphatic system. A participant shows correct understanding of the material with which statement?

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HESI RN · PN Vital Signs Assessment

Question 21 of 63

The nurse is assessing a patient's abdomen and notes that the patient has a firm, non-tender mass. What is the next step in the assessment?

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HESI RN · PN Vital Signs Assessment

Question 22 of 63

Which statement is NOT true regarding myositis ossificans of the hip?

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HESI RN · PN Vital Signs Assessment

Question 23 of 63

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 ____.

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HESI RN · PN Vital Signs Assessment

Question 24 of 63

A woman is leaving on a trip to Hawaii and has come in for a checkup. During the examination the nurse learns that she has diabetes and takes oral hypoglycemic agents. The patient needs to be concerned about which possible effect of her medications?

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HESI RN · PN Vital Signs Assessment

Question 25 of 63

The nurse is caring for a patient who complains of feeling light-headed and 'woozy.' The nurse checks the patient's pulse and finds that it is irregular. The patient's blood pressure is 100/72. It was 113/80 an hour earlier. What should the nurse do?

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HESI RN · PN Vital Signs Assessment

Question 26 of 63

What is the best method for the nurse to assess for cyanosis in a dark-skinned patient?

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HESI RN · PN Vital Signs Assessment

Question 27 of 63

The nurse notices that a school-aged child has bluish-white, red-based spots in her mouth that are elevated approximately 1 to 3 mm. What other signs would the nurse expect to find in this patient?

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HESI RN · PN Vital Signs Assessment

Question 28 of 63

A client arrives in the emergency department with and is diagnosed with ischemic stroke. A possible treatment option is tissue plasminogen activator (t-PA) administration. Which is the priority nursing assessment?

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HESI RN · PN Vital Signs Assessment

Question 29 of 63

During a neurological assessment, the nurse observes that the patient has difficulty walking on their toes. What condition is most likely associated with this finding?

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HESI RN · PN Vital Signs Assessment

Question 30 of 63

A patient rehabilitating from a spinal cord injury is able to direct their own care but is dependent on others for all activities of daily living. The patient's injury would be classified as:

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HESI RN · PN Vital Signs Assessment

Question 31 of 63

A physical therapist using an electrical stimulation device attempts to quantify several characteristics of a monophasic waveform. When measuring phase charge, the standard unit of measure is the:

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HESI RN · PN Vital Signs Assessment

Question 32 of 63

A physical therapist examines a patient with a history of recurrent lateral ankle sprains. Which special test would BEST assess ligamentous integrity?

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HESI RN · PN Vital Signs Assessment

Question 33 of 63

A Normal body temperature can range from...

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HESI RN · PN Vital Signs Assessment

Question 34 of 63

A nurse is assessing a client's blood pressure and finds it to be different in the two arms. What action should the nurse take?

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HESI RN · PN Vital Signs Assessment

Question 35 of 63

A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is 26.0 kg/m2. He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit?

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HESI RN · PN Vital Signs Assessment

Question 36 of 63

For the following situations, state the type of data collection you would perform (i.e., complete database, focused or problem-centered database, follow-up database, emergency database). c. first visit to a health care provider for a checkup

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HESI RN · PN Vital Signs Assessment

Question 37 of 63

A 30-year-old man presents with a complaint of frequent headaches. He describes them as severe and one-sided, lasting 30 minutes to an hour. He reports that the headaches are often associated with eye watering and nasal congestion. What is the most likely diagnosis?

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HESI RN · PN Vital Signs Assessment

Question 38 of 63

During an assessment of a healthy adult, where would the nurse expect to palpate the apical impulse?

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HESI RN · PN Vital Signs Assessment

Question 39 of 63

The nurse is assessing a patient who may have hearing loss. Which of these statements is true concerning air conduction?

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HESI RN · PN Vital Signs Assessment

Question 40 of 63

The nurse is taking temperatures in a clinic with a TMT. Which statement is true regarding use of the TMT?

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HESI RN · PN Vital Signs Assessment

Question 41 of 63

What is the primary purpose of assessing for rebound tenderness during an abdominal examination?

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HESI RN · PN Vital Signs Assessment

Question 42 of 63

The nurse needs to obtain a radial pulse from a patient. What must the nurse do to obtain a correct measurement?

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HESI RN · PN Vital Signs Assessment

Question 43 of 63

A nurse is using inspection as an assessment technique. What does the nurse use during inspection?

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HESI RN · PN Vital Signs Assessment

Question 44 of 63

In an individual with otitis externa, which of these signs would the nurse expect to find on assessment?

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HESI RN · PN Vital Signs Assessment

Question 45 of 63

A 60-year-old woman presents with pain in her knees and hips that is worse with activity and improves with rest. On examination, she has decreased range of motion and crepitus in the affected joints. Which of the following is the most likely diagnosis?

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HESI RN · PN Vital Signs Assessment

Question 46 of 63

96.0 to 99.5 degrees Fahrenheit is the normal temperature range of which age group?

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HESI RN · PN Vital Signs Assessment

Question 47 of 63

A heart rate measurement, or pulse, can be taken at which pulse point?

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HESI RN · PN Vital Signs Assessment

Question 48 of 63

The client after having a haemorrhagic stroke has residual dysphagia. When a diet order is initiated, the nurse avoids doing which of the following?

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HESI RN · PN Vital Signs Assessment

Question 49 of 63

The nurse is performing a cardiovascular assessment and auscultates a grade 3/6 murmur at the left lower sternal border. What should the nurse do next?

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HESI RN · PN Vital Signs Assessment

Question 50 of 63

Where is the lesion if a patient presents with isolated infraspinatus weakness and atrophy?

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HESI RN · PN Vital Signs Assessment

Question 51 of 63

A woman is in the family planning clinic seeking birth control information. She states that her breasts "change all month long" and that she is worried that this is unusual. What is the nurse's best response? The nurse should tell her that:

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HESI RN · PN Vital Signs Assessment

Question 52 of 63

A patient comes into the clinic complaining of facial pain, fever, and malaise. On examination, the nurse notes swollen turbinates and purulent discharge from the nose. The patient also complains of a dull, throbbing pain in his cheeks and teeth on the right side and pain when the nurse palpates the areas. The nurse recognizes that this patient has:

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HESI RN · PN Vital Signs Assessment

Question 53 of 63

In using verbal responses to assist the patient's narrative, some responses focus on the patient's frame of reference and some focus on the health care provider's perspective. An example of a verbal response that focuses on the health care provider's perspective would be:

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HESI RN · PN Vital Signs Assessment

Question 54 of 63

During an assessment of a 20-year-old patient with a 3-day history of nausea and vomiting, the nurse notices dry mucosa and deep vertical fissures in the tongue. These findings are reflective of:

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HESI RN · PN Vital Signs Assessment

Question 55 of 63

You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a patient with known peripheral vascular disease in the legs. Which of the following aspects is important to note when you perform your examination?

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HESI RN · PN Vital Signs Assessment

Question 56 of 63

When inspecting the anterior chest of an adult, the nurse should include which assessment?

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HESI RN · PN Vital Signs Assessment

Question 57 of 63

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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HESI RN · PN Vital Signs Assessment

Question 58 of 63

A patient states during the interview that she noticed a new lump in the shower a few days ago. It was on her left breast near her axilla. The nurse should plan to:

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HESI RN · PN Vital Signs Assessment

Question 59 of 63

A 30-year-old woman presents with a complaint of shortness of breath and a dry cough. She has a history of frequent sinus infections. What is the most likely diagnosis?

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HESI RN · PN Vital Signs Assessment

Question 60 of 63

What is the primary purpose of performing percussion over the costovertebral angle during a physical examination?

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HESI RN · PN Vital Signs Assessment

Question 61 of 63

Which finding during a peripheral vascular assessment is most concerning?

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HESI RN · PN Vital Signs Assessment

Question 62 of 63

The nurse is performing an abdominal assessment and detects a pulsatile mass in the midline of the abdomen. What condition is most likely associated with this finding?

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HESI RN · PN Vital Signs Assessment

Question 63 of 63

The nurse is caring for a patient who has an elevated temperature. The nurse understands that

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