Practice Question
The nurse assesses a client with a sleep pattern disturbance. While developing a plan of care (POC), which assessment data should the nurse obtain first?
Answer Choices:
Correct Answer:
Usual bed time and time of awakenings.
Rationale:
💎 The first step in assessing sleep disturbances is to establish a baseline sleep pattern.
💎 This helps identify whether the issue is insomnia, fragmented sleep, or early awakening.
💎 Causes like allergies, caffeine, nocturia are explored later.
💎 Understanding sleep patterns directs further questioning.
💎 Initial assessment builds rapport and avoids overwhelming the patient.
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This question is from ☑️HESI RN Health Assessment spring 2025. 7.11.2025 which contains 60 questions.
More Questions from This Exam
To assess for the presence of kyphosis, which action should the nurse take?
Answer Choices:
A. Observe the client's overall body posture.
B. Review findings of client's bone density exam.
C. Guide the client through active range oi motion.
D. Palpate joints for tenderness and edema.
In completing a physical assessment of a young adult, the clinic nurse observes muscular atrophy of the right thigh and calf to gather additional data related to this finding, which action should the nurse take?
Answer Choices:
A. Compare muscle strength bilaterally.
B. Calculate the body mass index (BMI).
C. Obtain vital signs and oxygen saturation.
D. Measure degree of skin elasticity.
The nurse is assessing a client for a goiter and is unable to observe the thyroid gland. Which action should the nurse take?
Answer Choices:
A. Palpate deeply and firmly over the location of the thyroid gland.
B. Ask the client to swallow while palpating along the sides of the trachea.
C. Defer the thyroid exam and observe the client for signs of myxedema.
D. Document that thyroid gland size is normal with no visible goiter.
While the nurse is taking a health history, the client announces, "l dont have time for this. This is a waste of time. I need treatment." Which response is best for the nurse to provide?
Answer Choices:
A. Ignore the angry outburst and continue with the history questions.
B. "You sound angry. Would you like to tell me about it?"
C. Move closer and place a hand on the client's shoulder to demonstrate concern.
D. "l am sorry you feel that way. Perhaps you'd like to return when you have more time.
The nurse assesses a male client who is brought to the emergency department (ED) by his family who believes he is having a heart attack. Which finding is the best indicator that a client is experiencing an acute myocardial infarction (AMI)?
Answer Choices:
A. Anterior thorax pain that radiates between the scapulae.
B. Pain in the neck, jaw, or medial side of the left arm.
C. Chest pain that intensifies upon chest excursion.
D. Localized sternal border pain intensified by palpation.
From Exam
☑️HESI RN Health Assessment spring 2025. 7.11.2025
60 Questions
View Full Exam Start PracticingQuestion Details
- Category: RN Nursing Exam(s)
- Subcategory: HESI Exam(s)
- Domain: 🏡HESI-Health Assessment
- Answer Choices: 4
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