Physical Assessment in Nursing Test
Questions
Course Introduction
Physical Assessment in Nursing is a foundational course designed to equip nursing students with the knowledge and practical skills necessary to conduct comprehensive and systematic assessments of patients across the lifespan. Emphasizing a holistic approach, the course covers techniques for collecting and interpreting health histories, performing head-to-toe physical examinations, and utilizing diagnostic tools to identify normal and abnormal findings. Students learn to integrate data from various assessment methods, including inspection, palpation, percussion, and auscultation, to formulate accurate nursing diagnoses and care plans. Through a combination of lectures, simulations, and hands-on clinical experiences, students develop critical thinking, communication, and documentation skills essential for effective patient care in diverse healthcare settings.
Recommended Textbook
Health Assessment for Nursing Practice 6th Edition by Wilson
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24 Chapters
634 Verified Questions
634 Flashcards
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Chapter 1: Introduction to Health Assessment
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14 Verified Questions
14 Flashcards
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Sample Questions
Q1) A community organization sponsors a health fair to increase awareness of colon cancer. At the health fair, colorectal cancer screening kits are distributed, and health care professionals answer questions, take blood pressure, and distribute literature. What level of health prevention is being implemented by this community organization?
A) Primary
B) Secondary
C) Tertiary
D) Risk factor
Answer: B
Q2) After collecting the data, the nurse begins data analysis with which action?
A) Clustering data
B) Documenting subjective data
C) Reporting information to other health team members
D) Documenting objective information
Answer: A
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3
Chapter 2: Obtaining a Health History
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32 Verified Questions
32 Flashcards
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Sample Questions
Q1) Which questions are pertinent for a nurse to ask a patient while performing a review of the cardiovascular system? (Select all that apply.)
A) Do you remember what your last cholesterol value was?
B) Have you had chest pain or shortness of breath?
C) Do you have trouble breathing when you lie down?
D) Are your feet cold, numb, or do they change color?
E) How much do you weigh?
F) Have you noticed edema in your ankles at the end of the day?
Answer: B, C, D, F
Q2) Which questions are pertinent to ask when obtaining a symptom analysis from a patient who reports breathing problems? (Select all that apply.)
A) How long have you had this problem with your breathing?
B) Do you have a family history of breathing problems?
C) Does this breathing problem come and go or is it constant?
D) What do you do to make your breathing better?
E) How does this breathing problem affect your work or daily activities?
F) How many packs of cigarettes do you smoke a day?
Answer: A, C, D, E
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Chapter 3: Techniques and Equipment for Physical Assessment
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31 Verified Questions
31 Flashcards
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Sample Questions
Q1) A nurse is using the finger pads to palpate a patient's dorsalis pedis pulses and is unable to feel any pulses. Which action is appropriate for the nurse to perform next?
A) Document that the dorsalis pedis pulses are not palpable.
B) Have the patient stand and try again to palpate the pulses.
C) Use a Doppler to detect the presence of the pulses.
D) Palpate the dorsalis pedis pulses using the ulnar surface of the hand.
Answer: C
Q2) What assessment data do nurses obtain through striking a hand directly against the flank or costovertebral angle of a patient's body?
A) Fluid in the lungs
B) Tenderness over the kidneys
C) Air in the abdomen
D) Tenderness over the liver
Answer: B
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5
Chapter 4: General Inspection and Measurement of Vital Signs
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Sample Questions
Q1) The temperature of a patient is measured every 6 hours at 6 AM, 12 PM, 6 PM, and 12 AM. Which temperature reading is expected to be low due to a normal variation?
A) The measurement at 6 AM
B) The measurement at 12 PM
C) The measurement at 6 PM
D) The measurement at 12 AM
Q2) A nurse notices that the patient has gained 11 lb. If this increase in weight is related to fluid retention, the patient is retaining approximately how many liters of fluid?
A) 1 L
B) 5 L
C) 11 L
D) 24 L
Q3) Which body system does the nurse assess primarily by inspection?
A) Respiratory
B) Gastrointestinal
C) Skin
D) Cardiovascular
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Page 6
Chapter 5: Cultural Assessment
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14 Flashcards
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Sample Questions
Q1) A male nurse is assigned to the care of a gay male with alcoholism. This sexual orientation is inconsistent with the beliefs of the nurse. What actions, if any, can the nurse take to provide patient-centered care to this patient?
A) No action is necessary at this time.
B) Examine his own feelings about alcoholism and homosexuality.
C) Determine the patient's degree of risk for contracting the human immunodeficiency virus.
D) Discuss homosexuality and alcoholism with the patient.
Q2) A nurse can improve cultural awareness with which behavior?
A) Being sensitive to differences between the cultures of the nurse and patient
B) Making generalizations about various ethnic and cultural groups
C) Learning everything about the various cultural groups in the nurse's city
D) Taking a foreign language class
Q3) Which question is most effective in assessing a patient's personal beliefs about health and illness?
A) "What or who do you believe controls your health?"
B) "Do you see your health care provider annually?"
C) "Do you have specific beliefs about health and illness?"
D) "Who makes the health decisions in your family?"
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Page 7
Chapter 6: Pain Assessment
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15 Flashcards
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Sample Questions
Q1) The nurse is performing a symptom analysis of a patient with pain. Which questions below are appropriate for a symptom analysis? (Select all that apply.)
A) Have you had any other symptoms such as nausea, vomiting, and sweating?
B) Where is the pain located?
C) Have you had a pain like this before?
D) What does the pain feel like?
E) What do you do to make your pain better?
F) In your culture, how are you encouraged to express your pain?
Q2) Which patient has pain caused by abnormal processing of sensory input from the peripheral nervous system?
A) The patient who has aching pain from muscle strain
B) The patient who has burning pain along the sciatic nerve
C) The patient who has cramping pain from a tumor in the colon
D) The patient who has throbbing pain from arthritis
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Chapter 7: Mental Health Assessment
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17 Verified Questions
17 Flashcards
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Sample Questions
Q1) An elderly patient was admitted with pneumonia and a fever of 104.5° F. At the time of admission he was confused, disoriented, restless, and tried to slap the nurse who started an intravenous line. His daughter stated, "Just yesterday he was perfectly fine, except for a cold. I can't believe he is acting this way now." Within a few days, his erratic behavior subsided and his daughter was relieved that he was "back to normal." The nurse recognizes that this patient was exhibiting signs of which disorder?
A) Dementia
B) Delirium
C) Panic attack
D) Alcohol withdrawal
Q2) A nurse screens every adult and adolescent patient for alcohol consumption. Which patient drinks more than recommended?
A) The man who reports drinking three beers and one shot of whiskey each day
B) The woman who reports drinking two glasses of wine and two vodka martinis each day
C) The older adult man who reports drinking one glass of sherry before going to bed each night
D) The woman who reports drinking one glass of wine with dinner each day.
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Page 9
Chapter 8: Nutritional Assessment
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22 Verified Questions
22 Flashcards
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Sample Questions
Q1) A patient who keeps his fat consumption at 10% of his total caloric intake is at risk for deficiency of which nutrient(s)?
A) Iron
B) Vitamins A, D, and K
C) Zinc
D) B and C vitamins
Q2) During a physical examination, the nurse notes that the patient's skin is dry and flaking, with patches of eczema, and suspects a nutritional deficiency. What additional data should the nurse expect to find to confirm the suspicion?
A) Hair loss and hair that is easily removed from the scalp
B) Inflammation of the tongue and fissured tongue
C) Inflammation of peripheral nerves, and numbness and tingling in extremities
D) Fissures and inflammation of the mouth
Q3) Which patient needs to be taught about how diet and exercise can lower lipids to reduce the risk for coronary artery disease?
A) A woman with a high-density lipoprotein (HDL) level of 53 mg/dl
B) A man with an HDL level of 43 mg/dl
C) A woman with a low-density lipoprotein (LDL) level of 125 mg/dl
D) A man with an LDL level of 200 mg/dl
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Page 10
Chapter 9: Skin, Hair, and Nails
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30 Verified Questions
30 Flashcards
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Sample Questions
Q1) What findings does a nurse expect when inspecting and palpating a patient's nails?
A) A nail base angle of not more than 90 degrees.
B) Whitish to clear nails in darker-skinned patients.
C) Nail surface is smooth and rounded.
D) Transverse depression running across the nails.
Q2) A patient is visiting an urgent care center after being hit in the back with a baseball.
Upon examination, the nurse notes a flat, nonblanchable spot 2.25 cm wide that is reddish-purple in color. How does the nurse document this lesion?
A) As an angioma
B) As purpura
C) As petechiae
D) As ecchymosis
Q3) How does the nurse recognize jaundice in a dark-skinned patient?
A) Inspect the conjunctiva for ashen-gray color.
B) Inspect the nail beds for a deeper brown or purple skin tone.
C) Inspect the palms and soles for yellowish-green color.
D) Inspect the oral mucous membrane for yellow color.
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Page 11
Chapter 10: Head, Eyes, Ears, Nose, and Throat
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75 Verified Questions
75 Flashcards
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Sample Questions
Q1) When inspecting a patient's posterior wall of the pharynx and tonsils, a nurse documents which finding as abnormal?
A) Both tonsils have a smooth surface.
B) Left and right tonsils meet at the midline.
C) Left and right tonsils extend beyond the posterior pillars.
D) Both tonsils have a glistening appearance.
Q2) A patient has had an infected facial wound for more than 3 months. How does the nurse expect the patient's enlarged lymph nodes to feel?
A) Soft, edematous, and tender
B) Round, tender, and movable
C) Hard, nontender, and nonmobile
D) Irregularly shaped, tender, and firm
Q3) A patient reports a history of snorting cocaine and is concerned about his bloody nasal drainage. What does the nurse expect to see on inspection of his nose?
A) Deviated septum
B) Pale turbinates
C) Perforated nasal septum
D) Localized erythema and edema
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12
Chapter 11: Lungs and Respiratory System
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Sample Questions
Q1) A patient is suspected of having a lung consolidation. A nurse uses the three techniques for assessing vocal resonance in this patient. What is the expected finding among the three procedures that will help eliminate consolidation as a problem?
A) The nurse documents clearly hearing the patient say "99."
B) The nurse documents hearing muffled sounds when the patient says "1-2-3."
C) The nurse documents hearing no sounds when the patient says "e-e-e."
D) The nurse documents clearly hearing the patient say "a-a-a."
Q2) A nurse palpating the chest of a patient finds increased fremitus bilaterally. What is the significance of this finding?
A) An expected finding
B) Chronic obstructive pulmonary disease
C) Bilateral pneumonia
D) Bilateral pneumothorax
Q3) A patient tells the nurse that he has smoked 1 \(\frac{1}{2}\) packs of cigarettes a day for 14 years. The number of packs the nurse should record in the medical record is ___ pack-years.
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Page 13
Chapter 12: Heart and Peripheral Vascular System
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32 Verified Questions
32 Flashcards
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Sample Questions
Q1) While assessing edema on a male patient's lower leg, the nurse notices that there is a slight imprint of his fingers where he palpated the patient's leg. How does the nurse document this finding?
A) No edema
B) 1+ edema
C) 2+ edema
D) 3+ edema
Q2) Where does a nurse place a stethoscope to auscultate the mitral valve area? Choose the letter that corresponds to the correct stethoscope placement.
A) A
B) B
C) D
D) E
Q3) When assessing a patient with aortic valve stenosis, the nurse should palpate for which abnormality to detect a thrill?
A) Sustained thrust of the heart against the chest wall during systole
B) Visible sinking of the tissues between and around the ribs
C) Fine, palpable vibration felt over the precordium
D) Bounding pulse noted bilaterally
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Page 14
Chapter 13: Abdomen and Gastrointestinal System
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38 Verified Questions
38 Flashcards
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Sample Questions
Q1) When inspecting a patient's abdomen, which finding does the nurse note as normal?
A) Engorgement of veins around the umbilicus
B) Sudden bulge at the umbilicus when coughing
C) Visible peristalsis in all quadrants
D) Silver-white striae extending from the umbilicus
Q2) When auscultating a patient's abdomen using the bell of the stethoscope, the nurse hears soft, low-pitched murmurs over the right and left upper midline. What do these sounds indicate?
A) Expected peristalsis
B) Femoral artery stenosis
C) Renal artery stenosis
D) Hyperactive bowel sounds
Q3) What sound does a nurse expect to hear when using the bell of the stethoscope over the epigastric area of the abdomen of a healthy patient?
A) Bowel sounds
B) Venous hum
C) Soft, low-pitched murmur
D) No sounds
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Chapter 14: Musculoskeletal System
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27 Verified Questions
27 Flashcards
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Sample Questions
Q1) When a nurse asks a patient to place the right arm behind the back, so that the back of the hand is touching the lower spine, the nurse is testing for which range of motion?
A) Pronation of the elbow
B) Hyperextension of the elbow
C) Internal rotation and adduction of the shoulder
D) External rotation and abduction of the shoulder
Q2) 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
Q3) When assessing the neck of a healthy adult, a nurse expects which findings?
A) A convex contour of the posterior cervical spine
B) Bending of the head to the right and left (ear to shoulder) 15 degrees
C) Turning the chin to the right shoulder and then the left shoulder
D) Hyperextension of the head 30 degrees from midline
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Chapter 15: Neurologic System
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34 Verified Questions
34 Flashcards
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Sample Questions
Q1) 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.
Q2) 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.
Q3) 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
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Chapter 16: Breasts and Axillae
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Sample Questions
Q1) The nurse would give immediate attention to the patient who presents with which complaint?
A) Bilateral breast swelling
B) Unilateral nipple discharge
C) A breast lump that changes during the menstrual cycle
D) Unequal breast size
Q2) A nurse becomes suspicious that a patient may have breast cancer based on which abnormal finding?
A) An irregularly shaped hard mass in one breast
B) Bilateral, small, nontender nodes close to the surface
C) Multiple rubbery-feeling lumps with well-defined borders
D) A mobile, firm lump located in the upper outer quadrant of the left breast
Q3) A nurse is performing a breast examination of a patient who complains of pain in both breasts that occurs around the time of her menstrual period. The nurse expects which findings during the breast examination?
A) Masses in the breasts that are round, soft, mobile, and well-delineated
B) Masses in the breasts that are round, firm, mobile, and well-delineated
C) Masses in the breasts that are irregular, hard, and fixed
D) Breast tissue that is red, edematous, tender, and warm to the touch
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Page 18
Chapter 17: Reproductive System and the Perineum
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40 Verified Questions
40 Flashcards
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Sample Questions
Q1) After a rectal examination of a patient with obstructive jaundice, the nurse expects the stool to be what color?
A) Tan
B) Pale yellow
C) Black
D) Bright red
Q2) A patient with testicular torsion is experiencing which abnormality?
A) Abnormal dilation and tortuosity of the veins along the spermatic cord
B) Twisting of the testicle and spermatic cord
C) A cystic mass filled with sperm and seminal fluid in the epididymis
D) An accumulation of fluid in the scrotum
Q3) During the initial inspection of the female genitalia, the nurse recognizes which finding as normal?
A) The labia minora are hair-covered and lying within the labia majora.
B) The cervical os in the multiparous woman has the shape of a small circle.
C) The vaginal vestibule lies between the labia minora and contains the urinary meatus.
D) The openings of Skene and Bartholin glands are visible posteriorly.
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Chapter 18: Developmental Assessment Throughout the Life Span
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Sample Questions
Q1) A nurse asks a 15-year-old boy to think of an explanation for a simple puzzle. When he is unable to come up with any answer at all, the nurse recognizes that he may not yet have successfully mastered which of Piaget's levels of cognitive development?
A) Sensorimotor
B) Preoperational
C) Concrete operations
D) Formal operations
Q2) A nurse is assessing a preschooler who is able to draw a three-part human figure, hop on one foot, and recognize three colors. The nurse recognizes these characteristics as consistent for what age?
A) 3 years old
B) 4 years old
C) 5 years old
D) 6 years old
Q3) During middle adulthood, which immunization may be recommended?
A) PPV (pneumococcal pneumonia vaccine)
B) Hepatitis B virus vaccine, third dose
C) Human papillomavirus (HPV)
D) Td (tetanus and diphtheria toxoids)
Page 20
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Chapter 19: Assessment of the Infant, Child, and Adolescent
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Sample Questions
Q1) What finding does a nurse expect when assessing a 1-month-old's eyes and vision?
A) The newborn distinguishes most colors
B) Tears when the newborn cries
C) The newborn following a bright toy or light
D) The newborn's blink reflex is present
Q2) Which tool is most appropriate for testing the vision of a 5-year-old child?
A) Denver II test
B) Snellen E chart
C) Allen picture cards
D) Snellen standard chart
Q3) A 4-year-old child has had a tonsillectomy and the nurse is preparing to ask him about his pain. Which technique is the most appropriate method for pain assessment for this patient?
A) Asking him if the pain hurts "a little or a lot"
B) Asking him to rate the pain on a scale of 0 to 10
C) Using the visual analog scale to rate the pain
D) Using the Wong/Baker FACES rating scale
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Chapter 20: Assessment of the Pregnant Patient
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Sample Questions
Q1) A patient at 20 weeks of gestation is concerned about a discharge from her nipples. What is the nurse's appropriate response to this patient?
A) "That is expected. It is milk production that begins at the onset of pregnancy."
B) "A nipple discharge is unusual. I advise you to consult your obstetrician."
C) "I suggest you decrease your fluid intake for several days to see if this makes a difference."
D) "After the first trimester a thin, yellow fluid called colostrum may be secreted from the nipples."
Q2) What is the meaning of "G5, T1, P0, A3, L1" found in a patient's history?
A) One birth at term
B) Three living children
C) Five grown children
D) One delivery not at term
Q3) A nurse documents as abnormal which finding of a pregnant patient?
A) Facial swelling in a woman who is 20 weeks pregnant
B) 1+ pitting ankle edema in a woman who is 26 weeks pregnant
C) Pinkish-red blotches of the hands in a woman at 32 weeks gestation
D) Blotchy, brownish pigmentation of the face in a woman at 36 weeks gestation
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Chapter 21: Assessment of the Older Adult
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Sample Questions
Q1) During an office visit, a 78-year-old woman is upset because her height is "2 inches less than it was when I was 40!" How does the nurse explain this change to the patient?
A) "Reduced height may occur as you age due to shortening of the vertebrae."
B) "You may be experiencing this height change due to arthritis."
C) "You need to improve your posture by performing stretching exercises."
D) "This is a rare occurrence and warrants having a bone density test."
Q2) What expected physiologic changes of aging put older adults at risk for respiratory infections? (Select all that apply.)
A) Breath sounds are bronchovesicular in the peripheral lung.
B) Alveoli are less elastic.
C) Weak intercostal muscles reduce effective coughing.
D) Mucous membranes drier
E) Curvature of the spine limits chest wall expansion.
F) Cough reflex is impaired due to deceased sensitivity of receptors.
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23
Chapter 22: Conducting a Head-to-Toe Examination
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Sample Questions
Q1) Which techniques does a nurse use routinely to collect data when assessing a patient's anterior thorax? (Select all that apply.)
A) Palpation of the thorax for fremitus
B) Inspection of the skin for color, intactness, lesions, and scars
C) Auscultation of breath sounds bilaterally
D) Auscultation of heart sounds for rate, rhythm, frequency, and S1 and S2
E) Palpation of the anterior chest wall for thoracic expansion
F) Inspection of respiratory movement for symmetry and ease of respiration
Q2) Which data does a nurse collect during the general survey when meeting a patient for the first time? (Select all that apply.)
A) Gait
B) Muscle strength
C) Heart sounds
D) Hearing and speech abilities
E) Mood or affect
F) Position of the trachea
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Chapter 23: Documenting the Comprehensive Health Assessment
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Sample Questions
Q1) A patient reports she has shortness of breath and peripheral edema. Under which category does the nurse document these data?
A) Review of systems
B) Present health status
C) Past health history
D) Functional ability
Q2) The nurse documents which data under the category of present health status?
A) Counts on her friends in stressful times
B) "I only sleep for 2 to 3 hours a night and use diphenhydramine for sleep."
C) Has a physical examination and flu vaccination annually
D) "I feel good about myself most of the time."
Q3) Which documentation by a nurse is most descriptive?
A) Heart sounds normal.
B) Few ectopic beats heard during auscultation.
C) S1 murmur is heard at second right sternal border.
D) Pulse within normal limits.
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25
Chapter 24: Adapting Health Assessment to the Hospitalized Patient
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Sample Questions
Q1) What data do nurses collect when assessing a patient's wound? (Select all that apply.)
A) Skin turgor
B) Width, length, and depth
C) Presence of pulsations
D) Wound color
E) Presence of edema
F) Drainage color
Q2) A nurse uses the Glasgow Coma Scale to assess which patient?
A) The patient who has a new onset of quadriplegia
B) The patient who has tonic-clonic seizures
C) The patient who requires stimuli for responses
D) The patient who has dementia
Q3) Development of which complication is considered a never event?
A) Fever
B) Atelectasis
C) Pressure ulcer
D) Thrombophlebitis
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