hesi health assessment test bank 2023 -Nurselytic

Correct Answer: A

Rationale: The correct answer is A (3 years old) because the Nipissing District Developmental Screen is specifically designed for children aged 1 month to 6 years to assess their developmental milestones. It focuses on various areas of development appropriate for this age group, such as motor skills, language, social interaction, and cognitive abilities. Using this tool with a 3-year-old child allows for early identification of potential developmental delays or concerns.

Incorrect choices:
B (16 years old) - The Nipissing District Developmental Screen is not intended for children above 6 years old.
C (8 years old with a developmental delay) - The tool is primarily for early screening, not for children already identified with developmental delays.
D (Having difficulty with gross motor skills) - While this child may benefit from assessment, the Nipissing Screen is a comprehensive tool for overall development, not just specific skill deficits.

Correct Answer: B

Rationale: The correct answer is B. When a client is moving towards illness and premature death, signs and symptoms typically start to manifest. These can include physical changes, abnormal lab results, or new onset of health issues. This serves as a direct indication of the client's deteriorating health status.

Choices A, C, and D are incorrect because stopping wellness-promoting activities (
A) could simply be due to lack of motivation, starting to exercise (
C) may not necessarily indicate illness progression, and verbalizing anxiety over medication costs (
D) is not a direct indicator of impending illness and premature death.

Correct Answer: B

Rationale: The correct answer is B because reducing alcohol consumption and limiting sodium intake are both crucial lifestyle modifications for managing hypertension. Alcohol can raise blood pressure, while excess sodium can contribute to hypertension. By prioritizing these changes, the patient can better control their blood pressure.


Choice A is incorrect because increasing sodium intake can worsen hypertension due to fluid retention.
Choice C is incorrect as decreasing physical activity can lead to weight gain and worsen hypertension.
Choice D is incorrect as processed foods are often high in sodium and unhealthy fats, which can negatively impact blood pressure.

Correct Answer: C

Rationale: The correct answer is C: Monitor blood pressure. When a client presents with acute abdominal pain, monitoring blood pressure is crucial as it can help assess for potential complications like hypovolemic shock or internal bleeding. Changes in blood pressure may indicate worsening condition and prompt the need for immediate intervention.

Monitoring vital signs (
A) is important but blood pressure takes precedence in this scenario. Assessing abdominal tenderness (
B) is valuable but does not directly address potential life-threatening issues. Monitoring for dehydration (
D) is also important but not the most immediate concern in the case of acute abdominal pain.

Correct Answer: B

Rationale: The correct answer is B: Deep vein thrombosis (DVT). Patients with a history of stroke are at increased risk for DVT due to immobility and potential damage to blood vessels. The nurse should monitor for signs such as swelling, pain, and redness in the extremities. Pneumonia (
A) can occur post-stroke but is not the most common complication. Hypoglycemia (
C) is more relevant for diabetic patients. Hypertension (
D) is a common comorbidity in stroke patients but monitoring for DVT is crucial due to its immediate life-threatening implications.