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HESI Milestone Exam Testbank 2024/2025 Verified Exam Sets
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HESI Milestone Exam Testbank 2024/2025 Verified Exam Sets
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,HESI Milestone ExamLevels of Health Promotion -
✔️primary, secondary, tertiary
Application Examples of Levels of Promotion -
✔️primary- weight loss, diet, smoking cessation
Secondary- papsmears, mammograms, testicular exams
Tertiary- medication therapy, surgical treatment, physical therapy, teaching foot care
education to diabetic care
Primary -
✔️promotes health and preventing development of disease process or injury
Secondary -
✔️screening for early detection of disease
Tertiary -
✔️begins after illness is diagnosed and treatment. Aims to prevent long-term
consequences of chronic illnesses or disabilities
Nursing Assessments -
✔️Comprehensive- (Head to Toe) = Can be done inpatient and through primary care
(Physical assessment- annual exam)
Focused- Health and physical hx of specific problem.- ex. Sick visit
Emergency- crisis, life threatening. ex. airway, breathing, injury, disability, exposure,
med reconciliation
Phases of Interview process -
✔️Pre-interaction, beginning, working (open and close ended questions), closing
Data sources -
✔️Primary- individual patient
Secondary- chart info, family members
Purposes of Documentation -
✔️verbal communication, SBAR, written document
Lifespan Nutritional Considerations - Nutrition: Pregnant Women -
, ✔️need additional 300-500 cal/day (whole foods
Lifespan Nutritional Considerations - Nutrition: infants/children -
✔️infants/children: whole milk for ages 2-5 fat intake-brain development
Lifespan Nutritional Considerations - Nutrition: Older -
✔️BMR declines, Vitamin D supplements, Problems: decreased thirst, increase risk for
osteoarthritis, osteoporosis, dementia, obesity, social isolation
General Survey -
✔️mental note of overall health (hygiene/appearance). Assessing pain: documentation,
OLDCARTS/OPQRST. Aggravating and alleviating factors, pain goal and funtional goal
Assessing Pain - Documentation -
✔️Acute vs. Chronic-Location
Priority -
✔️Priority pain: stones (kidney, gallbladder, calcium and/or struvite), myocardial
infarcation (HA), burns and sickle cell
Heart Rate Elevated -
✔️above 100 beats per minute
Blood Pressure- Normal -
✔️above systolic- 120-129, diastolic- less than 80,
Blood Pressure- elevated -
✔️Hypertension: Stage 1: 130-139 or 80-89, Stage Hypertension 2: more than 140, or
greater than or equal to 90
When should BP be taken? -
✔️after patient rests for 5 minutues or 30 minutes after caffeine, smoking
Assessment of the Head and Neck -
✔️Inspect, palpate, auscultate
Infection -
✔️If nodes are palpable, warm, tender = infection
Assessment of the Ear - Techniques -
✔️Adults: up and back
Children: down and back
, Assessment of the Ear - Techniques Part 2 -
✔️observe behavioral responses to speech, inspect ear formation (size, shape & any
malformation to the auricle, condition)
Perform whisper test & Rinne test. Pt plug one ear at a time
Perform weber test (evaluate unilateral hearing loss
Assessing the Chest -
✔️inspect, palpate, percuss, auscultate
Assessing Lung Sounds - Technique -
✔️IPPA- inspect, palpate, percuss, auscultate
Normal Lung Sounds -
✔️Normal: bronchial (heard anteriorly) over larynx and trachea (INSPIRIATION slightly
shorter than expiration),
Bronchiovesicular (heard anteriorly and posteriorly)INSPIRATION AND EXPIRATION
EQUAL ,
Vesicular (heard both) lower lungs, low pitch, INSPIRATION GREATER THAN
EXPIRATION)
Abnormal lung sounds: Rhonchi -
✔️low- heard mainly in expiration when pt is breathing out (made up of one sound-
whistle or whine and high pitch, musical instrument sound MULTIPLE sounds- mainly
heard in expiration CONDITION: PNEUMONIA
abnormal lung sounds: stridor -
✔️airway obstruction, high pitch whispering or gas (CROUP, EMERGENCY,
EPIGLOTTIS)
Abnormal lung sounds: Crackles -
✔️coarse(low pitch, wet sound)
fine (high pitch, doesnt clear w/cough, crackling of fire sound)
CONDITION:RESPIRATORY EDEMA/OBSTRUCTIVE DISEASE
Abnormal lung sounds: Pleural Friction Rub -
✔️Pleural friction rub (low pitch, harsh grating sound)
Assessment of the Respiratory System -
✔️tachypnea- rapid breathing
bradypnea- slow breathing
Normally, respirations are quiet and nonlabored, and occur at a rate of 12 to 20 times
each minute in healthy adults. Note any flaring of the nostrils, muscular retractions,
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