NURS120 Health Assessment Practice Exam Study Guide Updated 2026 🩺📘 |
Verified Questions and Answers with Detailed Rationales | Comprehensive Physical
Assessment, Head-to-Toe Examination Techniques, Vital Signs Measurement,
Patient History and Interviewing Skills, Inspection Palpation Percussion
Auscultation, Normal vs Abnormal Findings, Documentation and Charting, Clinical
Judgment, NCLEX-Style Assessment Questions | Complete Exam Prep Resource for
Nursing Students Success
Question 1: Which of the following best describes the primary purpose of a
comprehensive health assessment?
A. To confirm a specific medical diagnosis
B. To establish baseline data for future comparisons
C. To fulfill insurance documentation requirements
D. To prescribe medications based on symptoms
CORRECT ANSWER: B. To establish baseline data for future comparisons
Rationale: A comprehensive health assessment aims to collect holistic baseline data
about a patient’s physical, psychological, social, and functional status. This information
serves as a reference point for detecting changes over time, planning care, and
evaluating outcomes.
Question 2: During inspection, which of the following is primarily assessed?
A. Tissue texture
B. Organ size
C. Visual appearance and behavior
D. Presence of tenderness
CORRECT ANSWER: C. Visual appearance and behavior
Rationale: Inspection is the first step in physical assessment and involves using vision
(and sometimes hearing and smell) to observe general appearance, posture, skin color,
movement, and other visible signs without touching the patient.
Question 3: What is the correct sequence of techniques used during abdominal
assessment?
A. Inspection, palpation, percussion, auscultation
B. Auscultation, inspection, percussion, palpation
C. Inspection, auscultation, percussion, palpation
D. Palpation, percussion, inspection, auscultation
CORRECT ANSWER: C. Inspection, auscultation, percussion, palpation
Rationale: Abdominal assessment follows a modified sequence to avoid altering bowel
sounds. Auscultation is performed after inspection but before percussion and
palpation, which could stimulate bowel activity and distort findings.
,Question 4: Which cranial nerve is tested by assessing the patient’s ability to shrug
their shoulders against resistance?
A. Cranial Nerve V (Trigeminal)
B. Cranial Nerve VII (Facial)
C. Cranial Nerve XI (Accessory)
D. Cranial Nerve XII (Hypoglossal)
CORRECT ANSWER: C. Cranial Nerve XI (Accessory)
Rationale: The spinal accessory nerve (CN XI) innervates the trapezius and
sternocleidomastoid muscles. Shoulder shrugging tests trapezius strength, while head
turning against resistance tests the sternocleidomastoid.
Question 5: A patient presents with jaundice. Which organ system is most likely
involved?
A. Cardiovascular
B. Endocrine
C. Hepatobiliary
D. Renal
CORRECT ANSWER: C. Hepatobiliary
Rationale: Jaundice results from elevated bilirubin levels, often due to liver dysfunction,
bile duct obstruction, or hemolysis. The hepatobiliary system (liver, gallbladder, bile
ducts) is central to bilirubin metabolism and excretion.
Question 6: Which of the following is a normal finding during percussion of the
lungs?
A. Dullness over the majority of the lung fields
B. Hyperresonance over the apices
C. Resonance over healthy lung tissue
D. Flatness at the lung bases
CORRECT ANSWER: C. Resonance over healthy lung tissue
Rationale: Healthy lung tissue produces a resonant sound on percussion—low-pitched,
hollow, and moderately loud. Dullness suggests consolidation or fluid; hyperresonance
may indicate air trapping (e.g., emphysema).
Question 7: When assessing capillary refill, what duration is considered normal in a
healthy adult?
A. Less than 1 second
B. Less than 3 seconds
C. Less than 5 seconds
D. Less than 10 seconds
CORRECT ANSWER: B. Less than 3 seconds
, Rationale: Capillary refill time reflects peripheral perfusion. A return of color within 3
seconds after blanching a nail bed is normal in adults; longer times may indicate poor
circulation or shock.
Question 8: Which technique is used to assess for tactile fremitus?
A. Asking the patient to say “99” while palpating the chest
B. Percussing symmetrically over lung fields
C. Listening for bronchial breath sounds
D. Observing for intercostal retractions
CORRECT ANSWER: A. Asking the patient to say “99” while palpating the chest
Rationale: Tactile fremitus is vibration felt on the chest wall when the patient speaks.
Increased fremitus suggests lung consolidation; decreased fremitus may occur with
pleural effusion or pneumothorax.
Question 9: What does PERRLA stand for in a neurological assessment?
A. Pupils Equal, Round, Reactive to Light and Accommodation
B. Pulse Equal, Regular, Respirations Light and Active
C. Pressure Even, Reflexes Responsive, Lungs Aerated
D. Pain Evaluated, Eyes Rested, Limbs Aligned
CORRECT ANSWER: A. Pupils Equal, Round, Reactive to Light and Accommodation
Rationale: PERRLA is a standard acronym describing normal pupillary response: both
pupils should be equal in size, round, and constrict appropriately when exposed to light
and during near-vision focus (accommodation).
Question 10: Which of the following best describes orthostatic hypotension?
A. Elevated blood pressure when lying down
B. A drop in systolic BP ≥20 mm Hg upon standing
C. Irregular heart rhythm during position change
D. Increased pulse pressure with exertion
CORRECT ANSWER: B. A drop in systolic BP ≥20 mm Hg upon standing
Rationale: Orthostatic hypotension is defined as a significant drop in blood pressure
(≥20 mm Hg systolic or ≥10 mm Hg diastolic) within 3 minutes of standing, often
accompanied by dizziness or syncope due to impaired autonomic regulation.
Question 11: In which quadrant is the liver primarily located?
A. Left lower quadrant
B. Right upper quadrant
C. Left upper quadrant
D. Right lower quadrant
CORRECT ANSWER: B. Right upper quadrant
Verified Questions and Answers with Detailed Rationales | Comprehensive Physical
Assessment, Head-to-Toe Examination Techniques, Vital Signs Measurement,
Patient History and Interviewing Skills, Inspection Palpation Percussion
Auscultation, Normal vs Abnormal Findings, Documentation and Charting, Clinical
Judgment, NCLEX-Style Assessment Questions | Complete Exam Prep Resource for
Nursing Students Success
Question 1: Which of the following best describes the primary purpose of a
comprehensive health assessment?
A. To confirm a specific medical diagnosis
B. To establish baseline data for future comparisons
C. To fulfill insurance documentation requirements
D. To prescribe medications based on symptoms
CORRECT ANSWER: B. To establish baseline data for future comparisons
Rationale: A comprehensive health assessment aims to collect holistic baseline data
about a patient’s physical, psychological, social, and functional status. This information
serves as a reference point for detecting changes over time, planning care, and
evaluating outcomes.
Question 2: During inspection, which of the following is primarily assessed?
A. Tissue texture
B. Organ size
C. Visual appearance and behavior
D. Presence of tenderness
CORRECT ANSWER: C. Visual appearance and behavior
Rationale: Inspection is the first step in physical assessment and involves using vision
(and sometimes hearing and smell) to observe general appearance, posture, skin color,
movement, and other visible signs without touching the patient.
Question 3: What is the correct sequence of techniques used during abdominal
assessment?
A. Inspection, palpation, percussion, auscultation
B. Auscultation, inspection, percussion, palpation
C. Inspection, auscultation, percussion, palpation
D. Palpation, percussion, inspection, auscultation
CORRECT ANSWER: C. Inspection, auscultation, percussion, palpation
Rationale: Abdominal assessment follows a modified sequence to avoid altering bowel
sounds. Auscultation is performed after inspection but before percussion and
palpation, which could stimulate bowel activity and distort findings.
,Question 4: Which cranial nerve is tested by assessing the patient’s ability to shrug
their shoulders against resistance?
A. Cranial Nerve V (Trigeminal)
B. Cranial Nerve VII (Facial)
C. Cranial Nerve XI (Accessory)
D. Cranial Nerve XII (Hypoglossal)
CORRECT ANSWER: C. Cranial Nerve XI (Accessory)
Rationale: The spinal accessory nerve (CN XI) innervates the trapezius and
sternocleidomastoid muscles. Shoulder shrugging tests trapezius strength, while head
turning against resistance tests the sternocleidomastoid.
Question 5: A patient presents with jaundice. Which organ system is most likely
involved?
A. Cardiovascular
B. Endocrine
C. Hepatobiliary
D. Renal
CORRECT ANSWER: C. Hepatobiliary
Rationale: Jaundice results from elevated bilirubin levels, often due to liver dysfunction,
bile duct obstruction, or hemolysis. The hepatobiliary system (liver, gallbladder, bile
ducts) is central to bilirubin metabolism and excretion.
Question 6: Which of the following is a normal finding during percussion of the
lungs?
A. Dullness over the majority of the lung fields
B. Hyperresonance over the apices
C. Resonance over healthy lung tissue
D. Flatness at the lung bases
CORRECT ANSWER: C. Resonance over healthy lung tissue
Rationale: Healthy lung tissue produces a resonant sound on percussion—low-pitched,
hollow, and moderately loud. Dullness suggests consolidation or fluid; hyperresonance
may indicate air trapping (e.g., emphysema).
Question 7: When assessing capillary refill, what duration is considered normal in a
healthy adult?
A. Less than 1 second
B. Less than 3 seconds
C. Less than 5 seconds
D. Less than 10 seconds
CORRECT ANSWER: B. Less than 3 seconds
, Rationale: Capillary refill time reflects peripheral perfusion. A return of color within 3
seconds after blanching a nail bed is normal in adults; longer times may indicate poor
circulation or shock.
Question 8: Which technique is used to assess for tactile fremitus?
A. Asking the patient to say “99” while palpating the chest
B. Percussing symmetrically over lung fields
C. Listening for bronchial breath sounds
D. Observing for intercostal retractions
CORRECT ANSWER: A. Asking the patient to say “99” while palpating the chest
Rationale: Tactile fremitus is vibration felt on the chest wall when the patient speaks.
Increased fremitus suggests lung consolidation; decreased fremitus may occur with
pleural effusion or pneumothorax.
Question 9: What does PERRLA stand for in a neurological assessment?
A. Pupils Equal, Round, Reactive to Light and Accommodation
B. Pulse Equal, Regular, Respirations Light and Active
C. Pressure Even, Reflexes Responsive, Lungs Aerated
D. Pain Evaluated, Eyes Rested, Limbs Aligned
CORRECT ANSWER: A. Pupils Equal, Round, Reactive to Light and Accommodation
Rationale: PERRLA is a standard acronym describing normal pupillary response: both
pupils should be equal in size, round, and constrict appropriately when exposed to light
and during near-vision focus (accommodation).
Question 10: Which of the following best describes orthostatic hypotension?
A. Elevated blood pressure when lying down
B. A drop in systolic BP ≥20 mm Hg upon standing
C. Irregular heart rhythm during position change
D. Increased pulse pressure with exertion
CORRECT ANSWER: B. A drop in systolic BP ≥20 mm Hg upon standing
Rationale: Orthostatic hypotension is defined as a significant drop in blood pressure
(≥20 mm Hg systolic or ≥10 mm Hg diastolic) within 3 minutes of standing, often
accompanied by dizziness or syncope due to impaired autonomic regulation.
Question 11: In which quadrant is the liver primarily located?
A. Left lower quadrant
B. Right upper quadrant
C. Left upper quadrant
D. Right lower quadrant
CORRECT ANSWER: B. Right upper quadrant
