|Chamberlain College
1. Which phase of the nursing process involves the systematic collection of both
subjective and objective data?
A. Diagnosis
B. Planning
C. Assessment
D. Evaluation
Answer: C
Rationale: Assessment is the first step of the nursing process and involves collecting data
through interviews, physical exams, and records.
2. A patient tells the nurse, ‘My chest feels tight and I am short of breath.’ This
information is classified as:
A. Objective data
B. Secondary data
C. Subjective data
D. Inference
Answer: C
Rationale: Subjective data are what the person says about himself or herself during history
taking.
,3. What is the correct sequence for performing a physical assessment on most
body systems?
A. Inspection, Palpation, Percussion, Auscultation
B. Auscultation, Inspection, Palpation, Percussion
C. Palpation, Percussion, Auscultation, Inspection
D. Inspection, Auscultation, Percussion, Palpation
Answer: A
Rationale: The standard order is Inspection, Palpation, Percussion, and then Auscultation.
4. When assessing the abdomen, why is the sequence of physical assessment
modified?
A. To assess for tenderness first
B. To ensure the patient is comfortable
C. To allow for deeper palpation
D. To prevent distortion of bowel sounds
Answer: D
Rationale: For the abdomen, auscultation is done after inspection because percussion and
palpation can increase peristalsis, which would yield false bowel sounds.
5. Which part of the hand is best used for assessing skin temperature?
A. Fingertips
B. Palmar surface
C. Dorsal surface (back of the hand)
D. Ulnar surface
Answer: C
Rationale: The dorsal surface of the hands is best for determining temperature because
the skin is thinner than on the palms.
, 6. The nurse uses which technique to assess for vibrations or ‘thrills’ over the
heart?
A. Light palpation
B. Ulnar surface or base of fingers
C. Deep palpation
D. Pleximeter finger
Answer: B
Rationale: The ulnar surface or the base of the fingers is most sensitive to vibrations.
7. A ‘dull’ percussion note is typically elicited over which of the following?
A. Normal lung tissue
B. Air-filled stomach
C. Dense organs like the liver
D. Muscle or bone
Answer: C
Rationale: Dullness is heard over relatively dense organs such as the liver or spleen.
8. Which component of the stethoscope is used to hear low-pitched sounds such
as heart murmurs or extra heart sounds?
A. The diaphragm
B. The tubing
C. The bell
D. The earpieces
Answer: C
Rationale: The bell of the stethoscope is used for low-pitched sounds, while the diaphragm
is used for high-pitched sounds.