Download University of Pennsylvania 2025 H.E.S.I Physical Assessment Practice Exam with 120 Qs and more Exams Nursing in PDF only on Docsity!
University of Pennsylvania 2025 HESI Physical
Assessment Practice Exam with 120 Detailed
Questions , Answers and Rationales for Nursing
Student Success
On inspection of a patient's hands, the nurse notices ulnar deviation and swan-neck deformities bilaterally and correlates this finding with which disorder? a. Osteoarthritis b. Osteoporosis c. Rheumatoid arthritis d. Gout - - correct ans- - Ans C A The findings are consistent with rheumatoid arthritis. B The findings are consistent with rheumatoid arthritis. C Ulnar deviation, swan-neck, and boutonnière deformities of interphalangeal joints are manifestations of rheumatoid arthritis. D The findings are consistent with rheumatoid arthritis. With the patient lying supine, a nurse raises the patient's leg to flex the hip. The patient complains of pain when the leg is raised to 40 degrees. The nurse correlates this finding with which disorder? a. Lumbar nerve compression b. Cervical disk herniation c. Osteoarthritis d. Bursitis - - correct ans- - Ans A
A To evaluate for nerve root irritation or lumbar disk herniation, perform straight leg raises. Pain in the back of the leg with 30 to 60 degrees of elevation indicates pressure on a lumbar peripheral nerve by an intervertebral disk. B Straight leg raises evaluate for herniated disks, but not in the cervical disks in the neck. C Osteoarthritis is a degenerative disease of articular cartilage that affects weight- bearing joints such as vertebrae, hips, knees, and ankles. Straight leg raises is not a technique to assess for osteoarthritis. D Bursa become inflamed by constant friction around joints and may be precipitated by arthritis or injury. The hip is a common site, but not vertebrae. Manifestations include painful range of motion, point tenderness, and erythema of the affected joint. With the patient in a supine position, how does a nurse test the external rotation of the patient's right hip? a. Asking the patient to move the right leg laterally with the right knee straight b. Asking the patient to flex the right knee and turn medially toward the left side (inward) c. Asking the patient to place the right heel on the left patella d. Asking the patient to raise the right leg straight up and perpendicular to the body - - correct ans- - Ans C A Moving the right leg laterally with the right knee straight assesses abduction of the right hip. B Flexing the right knee and turning medially toward the left side (inward) internally rotates the right hip. C Placing the right heel on the left patella externally rotates the right hip. D Raising the right leg straight up and perpendicular to the body flexes the right hip. What movement from the patient does a nurse request to assess for hyperextension of the hip? a. Raise one leg at a time while lying prone. b. Raise one leg at a time while lying supine. c. Move one leg at a time laterally, away from midline, while lying prone.
d. Hold pressure to the radial and ulnar pulses and watch for blanching. - - correct ans-
- Ans C A This is not the correct technique for Phalen sign. B This is not the correct technique for Phalen sign. C This is the correct technique for Phalen sign. D This is the technique for Allen's test, which is used to detect arterial circulation of the hand, rather than Phalen sign, which is used to test for carpel tunnel syndrome. In teaching the group of patients about osteoporosis, the nurse identifies which one of these participants as having the highest risk for this disease? a. A small-boned, thin white American woman b. An American Indian man who smokes c. A Hispanic woman who has completed menopause d. An African American man with a family history of osteoporosis - - correct ans- - Ans A A A small-boned, thin white American woman has three risk factors for osteoporosis: female gender, white race, and small body size. B This patient has one risk factor: smoking. C This patient has two risk factors: female gender and menopause. D This patient has one risk factor: family history. Which findings are expected from a musculoskeletal assessment of a left-handed healthy adult? Select all that apply. a. Cervical concave, thoracic convex, and lumbar concave contours of the spine b. Muscle strength of 3/5 bilaterally c. Circumference of left upper arm larger than right upper arm d. Lumbar and thoracic spine flexion of 75 degrees e. External rotation and abduction of left arm of 90 degrees
f. Flexion of right and left knees of 90 degrees - - correct ans- - ANS: A, C, D, E Correct: Cervical concave, thoracic convex, and lumbar concave contours of the spine are expected findings of the spine. The circumference of the left upper arm larger than the right upper arm is considered an expected finding because this patient is left- handed, which may account for the increase in circumference. Lumbar and thoracic spine flexion of 75 degrees is an expected finding of the spine. Ninety-degree external rotation and abduction of the left arm is an expected finding of the spine. Incorrect: The expected muscle strength is 5/5. The expected flexion is 120 degrees. Nurses inquire about lifestyle behaviors of patients with risk factors for osteoarthritis. Which risk factors for osteoarthritis does the nurse ask about? Select all that apply. a. Estrogen deficiency b. Physical inactivity c. Overuse of joints d. Smoking e. Obesity f. Age - - correct ans- - ANS: B, C, E Correct: Lack of exercise weakens muscles that support joints. Overuse of joints damages cartilage in joints. Being overweight puts stress on joints. Incorrect: Estrogen deficiency, smoking, and age are risk factors for osteoporosis rather than osteoarthritis. Which movements does a nurse expect to find when assessing the hip range of motion of a healthy person? Select all that apply. a. Pronation and supination b. Flexion and extension c. Internal and external rotation d. Adduction and abduction e. Hyperextension - - correct ans- - ANS: B, C, D, E Correct: These are all expected motions for the hip joint. Incorrect: Pronation and supination are not expected motions for the hip joint.
In assessing a patient with damage to the occipital lobe, the nurse correlates which clinical manifestation to this injury? a. Intentional tremors b. Visual changes c. Decreased hearing d. Inability to formulate words - - correct ans- - ANS: B Feedback A Intentional tremors are caused by cerebellar problems. B The occipital lobe contains the visual cortex. C The temporal lobe contains the auditory cortex. D The ability to formulate words comes from the Broca area in the frontal lobe. While obtaining a symptom analysis from a patient who has an inner ear infection, the nurse helps the patient distinguish between dizziness and vertigo. Which description by the patient indicates vertigo? a. "I felt lightheaded when I stood up." b. "I just could not keep my balance when I sat up." c. "It seemed that the room was spinning around." d. "I was afraid that I was going to lose consciousness." - - correct ans- - ANS: C Feedback A This is a description of dizziness that is often associated with transient ischemia attacks. B This is a description of disequilibrium, a form of dizziness. C This report is consistent with vertigo because it includes a sensation of motion. D This is a description of presyncope, a form of dizziness.
While obtaining a symptom analysis from a patient who had a transient ischemic attack, the nurse helps the patient distinguish between dizziness and vertigo. Which description by the patient indicates dizziness? a. "I felt lightheaded when I stood up." b. "It felt like I was on a merry-go-round." c. "The room seemed to be spinning around." d. "My body felt like it was revolving and could not stop." - - correct ans- - ANS: A Feedback A This is a description of dizziness that is often associated with transient ischemia attacks. B This report is consistent with objective vertigo because it includes a sensation of motion. C This report is consistent with objective vertigo because it includes a sensation of motion. D This report is consistent with subjective vertigo because it includes a sensation of one's body rotating in space. Which patient behavior indicates to the nurse that the patient's facial cranial nerve (CN VII) is intact? a. The patient's eyes move to the left, right, up, down, and obliquely. b. The patient moistens the lips with the tongue. c. The sides of the mouth are symmetric when the patient smiles. d. The patient's eyelids blink periodically. - - correct ans- - ANS: C Feedback A This finding represents movement of the extraocular muscles, which are controlled by the oculomotor, trochlear, and abducens cranial nerves (CN III, IV, and VI, respectively). B This finding represents movement of the tongue, which is controlled by the hypoglossal cranial nerve (CN XII).
d. The patient is emotionally liable and cries easily, which interferes with the ability to communicate. - - correct ans- - ANS: C Feedback A The inability to translate ideas into meaningful speech or writing is termed expressive aphasia or nonfluent aphasia and is associated with lesions in the Broca area in the frontal lobe. B This speech pattern is more consistent with patients who have involvement of muscles of speech rather than neurologic deficits. C This deficit is called receptive aphasia or fluent aphasia and is associated with lesions in the Wernicke area in the temporal lobe. D This speech pattern is not relevant to this patient. What is the earliest and most sensitive indication of altered cerebral function? a. Unequal pupils b. Loss of deep tendon reflexes c. Paralysis on one side of the body d. Change in level of consciousness - - correct ans- - ANS: D Feedback A Pupillary function represents function of the oculomotor cranial nerve and the midbrain. B Deep tendon reflexes represent function of the spinal cord and reflex arcs. C Movement represents function of the spinal cord and posterior frontal lobe. D Maintaining consciousness represents the functions of and communication between the frontal lobe and reticular activating system. A patient reports having difficulty swallowing. Based on this information, how does the nurse assess the cranial nerve related to swallowing? a. Ask the patient about feeling the blunt end of a paper clip along the jaw line.
b. Observe the rising of the soft palate when the patient says "Ahh." c. Observe the symmetry of the face when the patient talks. d. Assess taste on the anterior part of the tongue. - - correct ans- - ANS: B Feedback A This tests the sensory function of the trigeminal cranial nerve (CN V). B This tests the glossopharyngeal cranial nerve (CN IX), which is involved in swallowing. The nurse must correlate difficulty swallowing with the cranial nerves involved with that function and how to test it. The cranial nerves involved are IX, X, and XII. C This tests the motor function of the facial cranial nerve (CN VII). D This tests the sensory portion of the facial cranial nerve (CN VII). A patient reports having difficulty swallowing. Based on this information, how does the nurse assess the appropriate cranial nerve? a. Ask the patient to stick out the tongue and move it in all directions. b. Ask the patient to move the head to the right and left. c. Observe the symmetry of the face when the patient talks. d. Assess for taste on the anterior part of the tongue. - - correct ans- - ANS: A Feedback A This tests the hypoglossal cranial nerve (CN XII) that is involved in swallowing. The nurse must correlate difficulty swallowing with the cranial nerves involved with that function and how to test them. The cranial nerves involved are IX, X, and XII. B This tests the function of the spinal accessory cranial nerve (CN XI). C This tests the motor function of the facial cranial nerve (CN VII). D This tests the sensory portion of the facial cranial nerve (CN VII). In assessing a patient's deep tendon reflexes, a nurse finds a patient has a 4+ triceps response. How does the nurse interpret this finding? a. A hyperactive response
b. Diminished to absent flexion of the elbow c. Diminished to absent extension of the elbow d. Diminished to absent adduction of the upper arm - - correct ans- - ANS: C Feedback A Diminished to absent pronation of the arm is an abnormal response from the brachioradial deep tendon reflex that is innervated from C5 to C6. B Diminished to absent flexion of the elbow is an abnormal response from the biceps deep tendon reflex that is innervated from C5 to C6. C Diminished to absent extension of the elbow is an abnormal response from the triceps deep tendon reflex that is innervated from C6, C7, and C8. D Diminished to absent adduction of the upper arm is not a response of any deep tendon reflex. A nurse holds the patient's relaxed left arm, with elbow flexed at a 90-degree angle, in one hand. The nurse palpates and then strikes the appropriate tendon just above the elbow with either end of the reflex hammer. What is the expected response for this deep tendon reflex? a. Flexion of the left elbow b. Pronation of the left forearm c. Supination of the left arm d. Extension of the left elbow - - correct ans- - ANS: D Feedback A Flexion of the left elbow would be a normal response for the biceps deep tendon reflex. B Pronation of the left forearm would be a normal response for the brachioradialis deep tendon reflex. C Supination of the left arm is not a response of any deep tendon reflex. D Extension of the left elbow is the normal response of the triceps deep tendon reflex.
A nurse holds the patient's relaxed arm with the elbow flexed at a 90-degree angle, places a thumb over the appropriate tendon in the antecubital fossa, and strikes the thumb with the pointed end of the reflex hammer. What is the expected response for this deep tendon reflex? a. Flexion of the left elbow b. Pronation of the left forearm c. Supination of the left arm d. Extension of the left elbow - - correct ans- - ANS: D Feedback A Pronation of the left forearm is a normal response for the brachioradialis deep tendon reflex. B Supination of the left arm is not a response of any deep tendon reflex. C Extension of the left elbow is the normal response of the triceps deep tendon reflex. D Flexion of the left elbow is a normal response for the biceps deep tendon reflex. How does a nurse test the brachioradial deep tendon reflex? a. Uses the end of the handle on the reflex hammer to stroke the lateral aspect of the sole of the patient's foot from heel to ball b. Asks the patient to slightly pronate the relaxed forearm into the nurse's hand and strikes the appropriate tendon with the reflex hammer c. Holds the patient's relaxed arm with the elbow flexed at a 90-degree angle in one hand, and palpates and strikes the appropriate tendon just above the elbow with the flat end of the reflex hammer d. Holds the patient's relaxed arm with the elbow flexed at a 90-degree angle, places a thumb over the appropriate tendon in the antecubital fossa, and strikes the thumb with the pointed end of the reflex hammer - - correct ans- - ANS: B Feedback A This is the technique to test plantar flexion, the Babinski reflex. B This is the technique to assess the brachioradial deep tendon reflex.
C The CN VI (abducens nerve) supplies lateral eye movement. D The CN VII (facial nerve) supplies movement of facial expression muscles except the jaw, closes the eyes, and allows labial speech sounds (b, m, w, and rounded vowels). A nurse who is assessing a patient's eyes finds that the pupils are equal, round, and react to light and accommodation (PERRLA). These findings verify the expected functioning of which cranial nerve? a. Optic cranial nerve (CN II) b. Oculomotor cranial nerve (CN III) c. Trochlear cranial nerve (CN IV) d. Abducens cranial nerve (CN VI) - - correct ans- - ANS: B Feedback A The optic cranial nerve (CN II) provides vision. B The oculomotor cranial nerve (CN III) provides these eye functions. C The trochlear cranial nerve (CN IV) provides eye movement downward and inward. D The abducens cranial nerve (CN VI) provides lateral eye movement. In assessing a patient with a tumor in the pons, the nurse expects to find which abnormalities due to pressure on cranial nerves? a. Dilated pupils and ptosis b. Facial asymmetry and impaired hearing c. Difficulty swallowing d. Impaired gag reflex - - correct ans- - ANS: B Feedback A These abnormalities represent pressure on the oculomotor (CN III) that exits from the midbrain.
B These abnormalities represent pressure on the facial and acoustic cranial nerves. The nurse correlates the cranial nerves that exit from the pons which are trigeminal (CN V), abducens (CN VI), facial (CN VII), and acoustic (CN VIII). C This abnormality represents pressure on the three cranial nerves that affect swallowing: glossopharyngeal (CN IX), vague (CN X), and hypoglossal (CN XII). These cranial nerves exit the brainstem in the medulla oblongata. D This reflex is controlled by the vagus cranial nerve (CN IX), which exits the brainstem in the medulla oblongata. The nurse assesses the glossopharyngeal nerve (CN IX) by testing which reflex? a. Corneal reflex b. Gag reflex c. Blink reflex d. Cough reflex - - correct ans- - ANS: B Feedback A The corneal reflex is controlled by the trigeminal cranial nerve (CN V). B Movement of the posterior pharynx and gag reflex test is controlled by the glossopharyngeal cranial nerve (CN IX). C The blink reflex is another name for the corneal reflex. D The cough reflex is controlled from the medulla oblongata. Which cranial nerve is assessed when a nurse asks a patient to stick out the tongue and move it side to side? a. Vagus nerve (CN X) b. Facial nerve (CN VII) c. Abducens nerve (CN VI) d. Hypoglossal nerve (CN XII) - - correct ans- - ANS: D Feedback
a. Sways slightly and maintains upright posture with feet together b. Is unable to stand upright after turning around in a circle once c. Steps sideways when standing with feet together and eyes closed d. Has to move arms horizontally to maintain balance - - correct ans- - ANS: A Feedback A Maintaining balance indicates function of the cerebellum in the Romberg test. B Losing balance is an abnormal response, but turning in a circle is not a part of the Romberg test. C This is an abnormal response for the Romberg test (a positive Romberg test). D This is an abnormal response for the Romberg test (a positive Romberg test). The nurse asks the patient to stand with feet together, arms resting at the sides, with eyes open and then with the eyes closed. Which response by the patient indicates a problem in the cerebellum? a. Maintains balance when eyes are open, but loses balance with eyes closed b. Is unable to stand upright after turning around in a circle once c. Steps sideways when standing with feet together and eyes closed d. Sways slightly and maintains upright posture with feet together - - correct ans- - ANS: C Feedback A This is an abnormal response, but is indicative of a proprioceptive problem rather than a cerebellar problem. B Losing balance is an abnormal response, but turning in a circle is not a part of the Romberg test. C This is an abnormal response documented as a "positive Romberg" and indicates cerebellar dysfunction. D This is an expected response documented as a "negative Romberg," indicating appropriate cerebellar function for balance.
What is the patient's expected response when the nurse is assessing graphesthesia? a. Lies supine and runs one heel along the opposite shin b. Identifies a familiar object placed in the hands c. Describes where a sensation of a vibrating tuning fork is felt d. Identifies a letter or number drawn in the hand - - correct ans- - ANS: D Feedback A This activity tests cerebellar function of the lower extremities. B This is a test of stereognosis that tests the function of the parietal lobe and sensory tracts. C This is a test of vibratory sense that tests sensory tracts. D This is a test of graphesthesia that assesses the parietal lobe and sensory tracts. What is the patient's expected response when the nurse is assessing stereognosis? a. Identifies an object placed in the hand b. Distinguishes numbers or letters traced in the palm of the hand c. Touches the index finger of the nondominant hand to the nose d. Walks heel to toe in a straight line - - correct ans- - ANS: A Feedback A A nurse tests stereognosis by asking the patient to close his or her eyes and placing a small, familiar object in the patient's hand, asking him or her to identify it. Stereognosis tests sensory nerve tracts and parietal lobe function. B This activity tests graphesthesia, a test of sensory nerve tracts and parietal lobe function. C This activity tests cerebellar function of the upper extremities. D This activity tests cerebellar function of the lower extremities.
