HESI EAQ Health Assessment

When gathering data for a client's health history, which intellectual factor would the nurse consider as a dimension?

Attention span

Arrange the sequence of events occurring during a fever in chronological order.

Immune system responses triggered, The set point of the hypothalamus is raised, body temperature is increased, pyrogens are destroyed, heat loss responses are initiated.

Upon noticing a client with heart disease, has digital cyanosis, which site would the nurse assess to confirm cyanosis?

Lips

The nurse assesses the client's nails and finds a slight convex curve at the angle from the skin to nail base of about 160 degrees. Which condition would the nurse suspect?

Normal finding

Which position would the nurse utilize when assessing the muscular skeletal system? But contraindicated for clients experiencing chronic, obstructive respiratory disease?

Prone position

Which site would be safer and less expensive for temperature measurement of a human?

Skin, axilla

In which situation would the nurse consider family members as the primary source of information?

The client is an infant or child, Brought in as an emergency, the client is critically ill and disoriented

Which example would be a normal blood pressure of a 12 year old client?

110/65 mmHg

Which respiratory rate was the nurse expect for a 2 year old child?

30 breaths per minute

In which order were the nurse performed the steps of the nursing diagnostic process?

Assess the client's health status, validate the data w/ other sources, interpret meaning of the data & look for defining characteristics, cluster data, identify client's needs, formulates nursing diagnosis

When assessing a patient from raw nutrition, the nurse would monitor for an increase in liver enzymes and a decrease in which water soluble vitamin?

Biotin, niacin, folic acid, ribiflavin, vitamin C

What information obtained during the client's health history would the nurse classify as biographical information?

Clients age, type of insurance, occupation status

Which condition for the nurse suspect when a client who underwent a physical examination two days ago reports itching?

Contact Dermatitis

Which physical change would the nurse observe in a client with malnutrition?

Hypotension, dry dull hair, abdominal edema, delayed wound healing, depletion of muscle mass

Which factor would the nurse assess for a client reporting constipation?

Diet, fluid intake, use of laxatives, day of last bowel movement, use of opioid pain medications

During an assessment, which finding prompts the nurse to don a protective gown

Excessive wound drainage

When assessing a client's blood pressure obtained via the client's unsupported left arm, which reading error were the nurse expect?

False high reading

To prevent an adverse outcome while providing care for a client experiencing diarrhea, which client data with the nurse closely monitor?

Fluid and electrolyte balance.

After assessing we must go functionality of a client, the nurse's assigns a grade of f, fair on the Lovett scale, which statement describes the muscle functionality of this client?

Full range of motion with gravity

Which condition is the nurse trying to prevent when teaching a client undergoing diuretic therapy to avoid working in the garden on hot, summer days?

Heatstroke

Beginning with the highest priority needs, as defined by maslow, in which a sending order with the hierarchy of needs occur?

Physiological needs, safety and security, love and belonging needs, self-esteem, self-actualization

Which physiologic symptom would the nurse associate with the clients sleep deprivation?

Pitosis and blurred vision, decreased auditory alertness

Which physical assessment of the skin indicates the client is addicted to phencyclidine?

Red and dry skin

After assessing the vital signs and med history of a client admitted to the hospital experiencing chills and fever, the nurse concludes the fever pattern is remittent. Which assessment binding led to this conc

The clients favor spikes and falls without a return to a normal temperature

When developing a nursing diagnosis for a client after surgery, the nurse documents the related to factor as first time surgery, which assessment activity enabled the nurse to draw this conclusion?

The nurse to ask the client to explain the surgery

While assessing the client's peoples and health care professional notices the pupillary dilation, which drug causes this condition?

atropine

When assessing a client with hepatitis a with which substance would the nursery particularly careful to prevent transmission of the disease?

fecal matter