NUR 210 RN Health Assessment HESI NGN

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Free NUR 210 RN Health Assessment HESI NGN Questions

1. Which method should the nurse use to assess response to painful stimuli for a client with a marked reduction in the level of consciousness (LOC)?

A. Use aromatic spirits of peppermint.
B. Shake and call the client's name.
C. Press firmly on the center of the sternum.
D. Run a pointed object up the sole of the foot.

Explanation

When assessing a client with a decreased level of consciousness, the nurse uses progressive stimulation techniques to evaluate response. After no response to verbal or light tactile stimulation, the next step is to apply a central painful stimulus, such as pressing firmly on the sternum. This maneuver assesses the client’s ability to respond to pain and helps determine the depth of unconsciousness. The response (purposeful withdrawal, posturing, or no reaction) is then documented using the Glasgow Coma Scale.

History and Physical
The client is a 76-year-old female who arrived at the emergency department (ED) via ambulance from an assisted living facility after a fall. The client called for help using her medical alert necklace. Reports feeling dizzy and lightheaded for the past two days. Client is unable to recall the events that led up to the fall and states, "I do not know how long I was down." Past medical history includes chronic obstructive pulmonary disease (COPD), hypertension (HTN), and carotid artery stenosis. Smokes half a pack of cigarettes daily for 40 years. Attempted to quit smoking five years ago after a right carotid endarterectomy.
Nurses' Notes
1620
Received report from triage nurse. Client returning from computed tomography (CT) department. The client is alert and oriented to person, place, time, and situation. Unable to recall details of her fall. Heart rhythm regular. Lung sounds are diminished throughout. Placed on oxygen 1 L/minute via nasal cannula. Bruising noted to left arm and small laceration on the left chin from the fall. Pain rated 3 on a scale of 0 to 10. Carotid
ultrasound performed at bedside. Laboratory
specimens drawn. Preparing the client for
transfer to the stroke unit, calling to ascertain
readiness to receive client and room number.
1640
Transferred client to the stroke unit from the
ED as prescribed. Situation, background,
assessment, recommendation (SBAR) report
given.
1655
Received client from emergency department
(ED). Admitted and oriented to the stroke unit.
Vital signs taken.
Flow Sheet
1600
Vital signs on arrival
· Temperature: 98.9° F (37.1° C) orally
. Heart rate: 101 beats/minute
· Respirations: 22 breaths/minute
· Blood pressure: 156/90 mm Hg
· Oxygen saturation: 92% on room air
1635
Vital signs
· Temperature: 98.6° F (37° C) orally
. Heart rate: 98 beats/minute
. Respirations: 22 breaths/minute
· Blood pressure: 160/92 mm Hg
· Oxygen saturation: 93% on 1 L/minute
oxygen via nasal cannula
1700
Vital signs
· Temperature: 98.6° F (37° C) orally
. Heart rate: 100 beats/minute
· Respirations: 21 breaths/minute
· Blood pressure: 166/89 mm Hg
· Oxygen saturation: 94% on 1 L/minute
Orders
. Computed tomography (CT) of the head
· Carotid duplex ultrasound
· Complete blood count (CBC), complete
metabolic panel (CMP), prothrombin
time/international normalized ratio (PT/INR),
partial thromboplastin time (PTT), C-
reactive protein (CRP), thyroid stimulating
hormone (TSH), low density lipoprotein
(LDL), high density lipoprotein (HDL)
· Admit to the stroke unit
· Magnetic resonance imaging (MRI) of brain
Imaging Studies
· Computed tomography (CT) of brain:
Negative.
· Carotid ultrasound: Left carotid 80%
stenosis.
The nurse is admitting the client to the stroke unit and preparing to
complete a focused neurological assessment.
Which assessment(s) should the nurse conduct? Select all that apply.

Level of consciousness
Romberg’s test
Pupil size
Glasgow Coma Scale
Cranial nerves
Muscle tone
Brudzinski reflexes

Explanation

The Correct Answers are:

A. Level of consciousness, C. Pupil size, D. Glasgow Coma Scale, E. Cranial nerves, and F. Muscle tone.

Detailed Explanation:

A. Level of consciousness:

This is one of the most critical components of a neurological assessment. Changes in consciousness may indicate worsening cerebral perfusion or evolving neurological deficits following a possible cerebrovascular event. Monitoring alertness, orientation, and responsiveness provides early clues to deterioration.

C. Pupil size:

Assessing pupil size, shape, and reactivity to light helps identify cranial nerve (CN) III involvement or increased intracranial pressure. Unequal or sluggish pupils may signal neurological compromise.

D. Glasgow Coma Scale:

The Glasgow Coma Scale (GCS) objectively measures eye opening, verbal, and motor responses to quantify neurological function. This standardized scale helps track changes in neurological status over time and detect subtle deterioration.

E. Cranial nerves:

Testing the cranial nerves evaluates brainstem and cerebral function. It identifies deficits such as facial droop, dysarthria, or visual disturbances, which are key indicators of stroke or carotid artery impairment.

F. Muscle tone:

Assessing muscle tone and strength detects weakness, rigidity, or flaccidity on one side of the body — common in stroke patients. These findings help determine the location and extent of neurological injury.

3. Which focused assessment technique should the nurse use for a client admitted with possible dehydration?

A. Grasp skin fold of the posterior forearm.
B. Press skin over a bony prominence.
C. Measure the circumference of the calf.
D. Check hands for parchment-like appearance.

Explanation

To assess for dehydration, the nurse evaluates skin turgor by gently grasping and releasing a fold of skin—commonly on the posterior forearm or sternum. If the skin remains tented or slowly returns to its normal position, this indicates poor skin elasticity caused by fluid loss or dehydration. This method provides a quick, reliable bedside assessment of fluid balance.

4. While completing a health assessment for a client with peripheral vascular disease (PVD), which assessment technique is most important for the nurse to implement?

A. Palpate and document quality of distal pulses.
B. Measure ankle-brachial index (ABI).
C. Document thickened toe nails.
D. Measure and record dependent ankle edema.

Explanation

For a client with peripheral vascular disease (PVD), the most important assessment is to palpate and document the quality of distal pulses (e.g., dorsalis pedis and posterior tibial pulses). This technique helps determine arterial blood flow to the extremities and identifies early signs of ischemia or worsening circulation. Weak or absent pulses indicate impaired perfusion, which requires prompt intervention to prevent tissue necrosis or ulceration.

5. A client sustained a subconjunctival hemorrhage. The presence of which set of symptoms indicate that the client needs to be seen for further evaluation by an ophthalmologist?

A. Acute pain, change in visual acuity, and foreign body sensation.
B. Bilateral itchy, red eyes with watery discharge.
C. Diminished ability to focus on close work and excessive illumination required.
D. Frequent burning, irritation, and tearing of the eyes.

Explanation

A subconjunctival hemorrhage is typically painless and resolves without treatment. However, if the client experiences acute eye pain, changes in visual acuity, or a foreign body sensation, these signs suggest a more serious underlying condition such as corneal abrasion, uveitis, or globe injury. These symptoms require urgent ophthalmologic evaluation to prevent potential vision loss or complications.

6. The nurse begins a client's musculoskeletal assessment. While using the technique of inspection, the nurse assesses for which possible finding(s)? Select all that apply.

A. Crepitus.
B. Osteopenia.
C. Atrophy.
D. Kyphosis.
E. Contracture.

Explanation

C. Atrophy: Atrophy refers to a visible decrease in muscle size or bulk, often due to disuse, immobilization, or neurological impairment. During inspection, the nurse can identify atrophy by comparing the symmetry of muscle groups on both sides of the body. The affected muscles may appear smaller or sunken compared to the opposite side. D. Kyphosis: Kyphosis is an exaggerated outward curvature of the thoracic spine, creating a “humpback” appearance. The nurse observes this spinal deformity by inspecting the patient’s posture from the side. It is commonly seen in older adults due to osteoporosis or degenerative changes but may also occur in younger individuals with poor posture. E. Contracture: A contracture is a visible shortening or tightening of muscles, tendons, or ligaments that leads to restricted joint movement. It can result from prolonged immobility, neurological injury, or scar tissue formation. During inspection, the nurse may notice abnormal limb positioning or joint stiffness that limits normal range of motion.

7. History and Physical

The client is a 76-year-old female who arrived at the emergency department (ED) via ambulance from an assisted living facility after a fall. The client called for help using her medical alert necklace. Reports feeling dizzy and lightheaded for the past two days. Client is unable to recall the events that led up to the fall and states, "I do not know how long I was down." Past medical history includes chronic obstructive pulmonary disease (COPD), hypertension (HTN), and carotid artery stenosis. Smokes half a pack of cigarettes daily for 40 years. Attempted to quit smoking five years ago after a right carotid endarterectomy.

Nurses' Notes
1620
Received report from triage nurse. Client returning from computed tomography (CT) department. The client is alert and oriented to person, place, time, and situation. Unable to recall details of her fall. Heart rhythm regular. Lung sounds are diminished throughout. Placed on oxygen 1 L/minute via nasal cannula. Bruising noted to left arm and small laceration on the left chin from the fall. Pain rated 3 on a scale of 0 to 10. Carotid ultrasound performed at bedside. Laboratory specimens drawn. Preparing the client for transfer to the stroke unit, calling to ascertain readiness to receive client and room number.

1640
Transferred client to the stroke unit from the ED as prescribed. Situation, background, assessment, recommendation (SBAR) report given.

1655
Received client from emergency department (ED). Admitted and oriented to the stroke unit. Vital signs taken.

Flow Sheet
1600
Vital signs on arrival
· Temperature: 98.9° F (37.1° C) orally
. Heart rate: 101 beats/minute
· Respirations: 22 breaths/minute
· Blood pressure: 156/90 mm Hg
· Oxygen saturation: 92% on room air

1635
Vital signs
· Temperature: 98.6° F (37° C) orally
. Heart rate: 98 beats/minute
. Respirations: 22 breaths/minute
· Blood pressure: 160/92 mm Hg
· Oxygen saturation: 93% on 1 L/minute oxygen via nasal cannula

1700
Vital signs
· Temperature: 98.6° F (37° C) orally
. Heart rate: 100 beats/minute
· Respirations: 21 breaths/minute
· Blood pressure: 166/89 mm Hg
· Oxygen saturation: 94% on 1 L/minute

Orders
. Computed tomography (CT) of the head
· Carotid duplex ultrasound
· Complete blood count (CBC), complete metabolic panel (CMP), prothrombin time/international normalized ratio (PT/INR), partial thromboplastin time (PTT), C-reactive protein (CRP), thyroid stimulating hormone (TSH), low density lipoprotein (LDL), high density lipoprotein (HDL)
· Admit to the stroke unit
· Magnetic resonance imaging (MRI) of brain

Imaging Studies
· Computed tomography (CT) of brain: Negative.
· Carotid ultrasound: Left carotid 80% stenosis.

The nurse is admitting the client to the stroke unit and preparing to complete a focused neurological assessment.
Which assessment(s) should the nurse conduct? Select all that apply.

A. Level of consciousness
B. Romberg’s test
C. Pupil size
D. Glasgow Coma Scale
E. Cranial nerves
F. Muscle tone
G. Brudzinski reflexes

Explanation

A. Level of consciousness: This is one of the most critical components of a neurological assessment. Changes in consciousness may indicate worsening cerebral perfusion or evolving neurological deficits following a possible cerebrovascular event. Monitoring alertness, orientation, and responsiveness provides early clues to deterioration. C. Pupil size: Assessing pupil size, shape, and reactivity to light helps identify cranial nerve (CN) III involvement or increased intracranial pressure. Unequal or sluggish pupils may signal neurological compromise. D. Glasgow Coma Scale: The Glasgow Coma Scale (GCS) objectively measures eye opening, verbal, and motor responses to quantify neurological function. This standardized scale helps track changes in neurological status over time and detect subtle deterioration. E. Cranial nerves: Testing the cranial nerves evaluates brainstem and cerebral function. It identifies deficits such as facial droop, dysarthria, or visual disturbances, which are key indicators of stroke or carotid artery impairment. F. Muscle tone: Assessing muscle tone and strength detects weakness, rigidity, or flaccidity on one side of the body — common in stroke patients. These findings help determine the location and extent of neurological injury.

The clinic nurse notices muscle atrophy in the right thigh and calf while performing a physical examination on a young adult. What steps should the nurse take to get further information about this finding?

Obtain vital signs and oxygen saturation.
Calculate the body mass index (BMI).
Measure degree of skin elasticity.
Compare muscle strength bilaterally.

Explanation

The Correct Answer is:

D. Compare muscle strength bilaterally.

Detailed Explanation:

Muscular atrophy indicates possible disuse, nerve injury, or reduced mobility. The nurse should assess muscle strength bilaterally to determine the degree of weakness and functional differences between limbs. Comparing strength on both sides provides essential data for identifying neuromuscular impairment, determining its impact on mobility, and guiding further evaluation or physical therapy interventions.

9. 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.

10. During a routine physical examination of a middle-aged female client, chest palpation is determined to be normal except for a 2-inch diameter area of crepitus over the upper right anterior chest. Which is the most accurate interpretation of this finding?

A. Crepitus is always abnormal and should be followed up with a more detailed assessment.
B. Since this client has only a small area of crepitus, it probably is not a significant finding.
C. Since a fractured rib often creates crepitus, a chest x-ray should be scheduled immediately.
D. Trapped subcutaneous air causing crepitus will be absorbed, so the finding is not significant.

Explanation

Crepitus is an abnormal crackling sensation felt under the skin, usually caused by air leaking into subcutaneous tissue (subcutaneous emphysema). This can occur from trauma, pneumothorax, or procedures such as chest tube insertion. Because it indicates air escaping from the respiratory system into the tissues, it is always an abnormal finding and requires prompt follow-up, further assessment, and possibly imaging to identify the source.

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