NUR 210 RN Health Assessment HESI NGN
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Free NUR 210 RN Health Assessment HESI NGN Questions
1. When assessing a 24-year-old bodybuilder, the nurse is unable to palpate an apical pulse. Which action should the nurse implement?
- A. Question the client about steroid use.
- B. Dim the lights in the examination room.
- C. Continue with the cardiac examination.
- D. Position the client in high Fowler's position.
Explanation
In a muscular or obese individual, the apical impulse (point of maximal impulse, PMI) may not be palpable due to thick chest musculature or increased chest wall density. This is a normal finding and not necessarily an indication of a cardiac abnormality. The nurse should therefore continue with the cardiac examination, using auscultation to assess the apical pulse and heart sounds instead of palpation.
2. During an assessment for jugular vein distension of a client with right-sided heart failure (HF), the nurse observes distension bilaterally using tangential lighting with the client in a semi-Fowler’s position. Which action should the nurse take next?
- A. Document the findings as observed.
- B. Position the client supine and repeat the assessment.
- C. Flex the client’s neck with a pillow and repeat assessment.
- D. Repeat without using the lighting.
Explanation
Jugular vein distension (JVD) observed bilaterally in a semi-Fowler’s position (30–45 degrees) indicates increased venous pressure, a classic finding in right-sided heart failure. Tangential lighting is the correct method to visualize JVD, and the semi-Fowler’s position is appropriate for accuracy. Because the technique and findings are correct, the nurse should document the results as observed and report them according to facility policy for correlation with other heart failure indicators.
3. The nurse is performing a cranial nerve exam on an older adult client. The nurse notes that the client has a reduced upward gaze, a decreased corneal reflex, a high-frequency hearing loss, and a reduced gag reflex. Which action should the nurse take next?
- A. Implement neurological (neuro) vital signs every 2 hours to detect Cushing's triad.
- B. Assess the spinal reflexes for demyelination symptoms.
- C. Review past history for any episodes of a cerebral cortex lesion.
- D. Continue the assessment of the next pairs of cranial nerves.
Explanation
The findings described—reduced upward gaze (cranial nerve III), decreased corneal reflex (cranial nerve V or VII), high-frequency hearing loss (cranial nerve VIII), and reduced gag reflex (cranial nerve IX or X)—are common age-related changes in older adults and do not necessarily indicate an acute neurological deficit. Therefore, the nurse should continue assessing the remaining cranial nerves to complete the neurological examination and document baseline findings.
4. During a health assessment for a young adult female client's gynecological annual screening, the client reports amenorrhea. The nurse calculates the client's body mass index (BMI) as 16 kg/m² (normal: 18 to 24.9 kg/m²). Which finding should the nurse document in the electronic medical record (EMR) that indicates an expected rationale for this condition?
- A. Increased calcium intake with 3 glasses of nonfat milk daily.
- B. Reports a history of chronic urinary tract infections (UTI).
- C. Received an implanted intrauterine device (IUD) last month.
- D. Trains for competition and runs 12 miles every day.
Explanation
Amenorrhea in women with a low BMI and high physical activity levels is commonly due to exercise-induced hypothalamic dysfunction. Excessive exercise combined with low body fat disrupts the hypothalamic-pituitary-ovarian axis, leading to decreased estrogen and menstrual suppression. This condition is often part of the female athlete triad, which includes amenorrhea, low energy availability, and decreased bone density. Documenting the client’s intense training pattern helps identify the physiological cause of amenorrhea.
5. An older adult client with a recent history of a cerebrovascular accident (CVA) presents with right hemiparesis. The nurse tests the deep tendon reflexes on the right side and elicits a brisk 4+ response. Which interpretation of this finding is accurate?
- A. Absent or sluggish response consistent with a lower motor neuron lesion.
- B. A normal reflex response.
- C. Flaccid paralysis.
- D. Hyperactive response consistent with an upper motor neuron disorder.
Explanation
A 4+ deep tendon reflex indicates a hyperactive response with possible clonus. This finding is characteristic of an upper motor neuron lesion, such as one resulting from a cerebrovascular accident (CVA). Damage to the upper motor neurons removes inhibitory control over lower motor neurons, resulting in exaggerated reflexes, muscle spasticity, and increased tone on the affected side. These findings are consistent with right-sided hemiparesis following a stroke.
6. Which assessment technique should the nurse use to confirm the presence of papilledema in a client with a rapidly decreasing level of consciousness?
- A. Percussion.
- B. Inspection.
- C. Palpation.
- D. Auscultation.
Explanation
Papilledema refers to swelling of the optic disc caused by increased intracranial pressure. It is identified through inspection of the optic disc using an ophthalmoscope. The nurse or healthcare provider visually examines the optic disc for signs such as blurred disc margins, elevated appearance, and engorged retinal veins. Detecting papilledema confirms rising intracranial pressure, which is a neurological emergency requiring prompt intervention.
7. The nurse is assessing the perianal area of a female client who reports she has chronic constipation and has bright red blood on the toilet paper after having a bowel movement. Which finding should the nurse report to the healthcare provider (HCP) that is most consistent with the client's report?
- A. Presence of dried brown stool around the perianal area.
- B. Anus is moist, hairless, and has pigmented sphincter folds.
- C. Flabby skin sac around the anal orifice that is painless.
- D. Shiny blue skin sacs around anal opening and a linear split.
Explanation
Bright red blood after defecation, especially in a client with chronic constipation, is commonly associated with hemorrhoids or an anal fissure. The description of shiny blue skin sacs suggests external hemorrhoids, which can become inflamed or thrombosed, while a linear split indicates a fissure caused by straining or passage of hard stool. Both conditions cause pain and bleeding during or after bowel movements and should be reported for further evaluation and management.
8. The nurse is evaluating a client's hearing who reports hearing best in the left ear although words are muffled during conversation at a social gathering. Based on this finding, which assessment should the nurse implement?
- A. Inspect the external ear canals.
- B. Determine ability to maintain balance with eyes closed.
- C. Ask client if he has tinnitus.
- D. Differentiate ability to hear high and low pitched sounds.
Explanation
The client’s report of muffled hearing in noisy environments suggests possible sensorineural hearing loss, which affects the inner ear or auditory nerve. This type of hearing loss makes it especially difficult to distinguish words in background noise. The nurse should therefore differentiate the client’s ability to hear high- and low-pitched tones, such as during a Weber or Rinne test, to help determine the type and extent of hearing loss. High-frequency sounds are often lost first in sensorineural impairment.
9. When entering a male client's room, the nurse observes that he is splinting his chest with a pillow. Which follow-up assessment should the nurse complete?
- A. Body temperature.
- B. Apical-radial pulse deficit.
- C. Numeric pain intensity scale.
- D. Anteroposterior (AP) chest diameter.
Explanation
Chest splinting—holding a pillow or arm against the chest—is a common behavioral cue indicating pain, particularly after thoracic surgery, trauma, or respiratory difficulty such as pleurisy or pneumonia. The nurse should immediately assess the client’s pain level using a numeric intensity scale (0–10) to determine severity, location, and characteristics. Accurate pain assessment is essential for timely pain management and to prevent complications such as shallow breathing or atelectasis.
10. The nurse is assessing a client's skeletal muscle movements and strength. Which action should the nurse instruct the client to perform to evaluate prime-mover muscle groups?
- A. Perform sets of passive range of motion.
- B. Hold arms straight forward with eyes closed.
- C. Flex and hold as opposing force is applied.
- D. Stand on each foot without assistance.
Explanation
To assess prime-mover (agonist) muscle strength, the nurse instructs the client to actively flex a muscle group and maintain resistance while the nurse applies an opposing force. This evaluates both strength and coordination of the primary muscles responsible for movement. Comparing bilateral strength allows the nurse to detect weakness, asymmetry, or neuromuscular impairment. This is a standard technique for assessing muscle strength on a 0–5 scale.
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