NSG3160 Health Assessment Exam 1 Version 1
Questions with Correct Answers and Expert
Explanation for Each Question
1. Which of the following findings is categorized as subjective data during a health
assessment?
A. A blood pressure reading of 140/90 mmHg.
B. A palpable mass noted in the left lower quadrant.
C. The patient’s report of a dull, aching pain in the hip.
D. Presence of fine crackles on auscultation of the lungs.
Correct Answer: C
Expert Explanation: Subjective data consists of information that the patient tells
the nurse about their own perceptions and feelings. This includes symptoms such as
pain, nausea, or emotional distress that cannot be directly observed. In contrast,
objective data are observable and measurable findings like vital signs or physical
exam results. The patient’s report of hip pain is a personal experience and cannot be
independently verified by the nurse. Correctly identifying subjective data is
essential for completing a comprehensive health history.
2. What is the primary purpose of the ‘Evaluation’ phase of the nursing process?
A. To collect baseline data from the patient and family.
,B. To implement nursing interventions planned for the patient.
C. To determine the effectiveness of the nursing care plan.
D. To identify specific nursing diagnoses and patient needs.
Correct Answer: C
Expert Explanation: The evaluation phase is the final step where the nurse
compares the patient’s current status with the desired outcomes. It involves
determining whether the goals set during the planning phase were met, partially
met, or not met at all. If goals are not achieved, the nurse must reassess the patient
and revise the care plan accordingly. This continuous loop ensures that the nursing
care remains relevant to the patient’s changing health status. Evaluation is a critical
component of clinical reasoning that drives quality improvement in patient care.
3. During a physical examination, the nurse uses the dorsum of the hand to assess
which characteristic?
A. Skin texture and moisture levels.
B. Presence of organ masses or tenderness.
C. Body temperature on the skin surface.
D. Vibrations such as tactile fremitus.
Correct Answer: C
,Expert Explanation: The dorsum, or back of the hand, is thinner and more sensitive
to temperature variations than the palms. Nurses utilize this specific part of the
hand during palpation to detect warmth or coolness in the extremities. While the
finger pads are better for fine tactile discrimination, the back of the hand is the
standard for thermal assessment. This technique helps in identifying localized
inflammation or systemic fever. Understanding which part of the hand to use
ensures accuracy during the physical assessment process.
4. Which communication technique is most effective for encouraging a patient to
share more detailed information?
A. Asking open-ended questions like ‘Tell me more about your symptoms.’
B. Providing the patient with medical jargon to explain their condition.
C. Using closed-ended questions that require a yes or no answer.
D. Interrupting the patient to clarify facts as they speak.
Correct Answer: A
Expert Explanation: Open-ended questions allow patients to express themselves in
their own words without being restricted by specific choices. This technique
encourages the patient to provide a narrative description of their health concerns
and feelings. It helps the nurse gather a more complete health history by uncovering
details that might be missed with closed questions. Effective communication is a
, cornerstone of therapeutic relationships and patient-centered care. By using these
questions, the nurse demonstrates an interest in the patient’s unique perspective.
5. When assessing an adult’s blood pressure, what is the significance of using a cuff
that is too narrow for the arm size?
A. The reading will be falsely high.
B. The reading will be falsely low.
C. It will have no effect on the systolic pressure.
D. The diastolic pressure will be impossible to hear.
Correct Answer: A
Expert Explanation: Selecting the correct blood pressure cuff size is critical for
ensuring the accuracy of the measurement. A cuff that is too small or narrow
requires more pressure to compress the artery, resulting in a falsely elevated
reading. Conversely, a cuff that is too wide will provide a reading that is inaccurately
low. Proper sizing should cover about 40% of the arm’s circumference and 80% of
the arm’s length. Ensuring correct technique prevents errors in clinical reasoning
and unnecessary medical interventions.
6. Which component of the health history involves a head-to-toe check of all body
systems to ensure no symptoms were missed?
A. Chief Complaint
Questions with Correct Answers and Expert
Explanation for Each Question
1. Which of the following findings is categorized as subjective data during a health
assessment?
A. A blood pressure reading of 140/90 mmHg.
B. A palpable mass noted in the left lower quadrant.
C. The patient’s report of a dull, aching pain in the hip.
D. Presence of fine crackles on auscultation of the lungs.
Correct Answer: C
Expert Explanation: Subjective data consists of information that the patient tells
the nurse about their own perceptions and feelings. This includes symptoms such as
pain, nausea, or emotional distress that cannot be directly observed. In contrast,
objective data are observable and measurable findings like vital signs or physical
exam results. The patient’s report of hip pain is a personal experience and cannot be
independently verified by the nurse. Correctly identifying subjective data is
essential for completing a comprehensive health history.
2. What is the primary purpose of the ‘Evaluation’ phase of the nursing process?
A. To collect baseline data from the patient and family.
,B. To implement nursing interventions planned for the patient.
C. To determine the effectiveness of the nursing care plan.
D. To identify specific nursing diagnoses and patient needs.
Correct Answer: C
Expert Explanation: The evaluation phase is the final step where the nurse
compares the patient’s current status with the desired outcomes. It involves
determining whether the goals set during the planning phase were met, partially
met, or not met at all. If goals are not achieved, the nurse must reassess the patient
and revise the care plan accordingly. This continuous loop ensures that the nursing
care remains relevant to the patient’s changing health status. Evaluation is a critical
component of clinical reasoning that drives quality improvement in patient care.
3. During a physical examination, the nurse uses the dorsum of the hand to assess
which characteristic?
A. Skin texture and moisture levels.
B. Presence of organ masses or tenderness.
C. Body temperature on the skin surface.
D. Vibrations such as tactile fremitus.
Correct Answer: C
,Expert Explanation: The dorsum, or back of the hand, is thinner and more sensitive
to temperature variations than the palms. Nurses utilize this specific part of the
hand during palpation to detect warmth or coolness in the extremities. While the
finger pads are better for fine tactile discrimination, the back of the hand is the
standard for thermal assessment. This technique helps in identifying localized
inflammation or systemic fever. Understanding which part of the hand to use
ensures accuracy during the physical assessment process.
4. Which communication technique is most effective for encouraging a patient to
share more detailed information?
A. Asking open-ended questions like ‘Tell me more about your symptoms.’
B. Providing the patient with medical jargon to explain their condition.
C. Using closed-ended questions that require a yes or no answer.
D. Interrupting the patient to clarify facts as they speak.
Correct Answer: A
Expert Explanation: Open-ended questions allow patients to express themselves in
their own words without being restricted by specific choices. This technique
encourages the patient to provide a narrative description of their health concerns
and feelings. It helps the nurse gather a more complete health history by uncovering
details that might be missed with closed questions. Effective communication is a
, cornerstone of therapeutic relationships and patient-centered care. By using these
questions, the nurse demonstrates an interest in the patient’s unique perspective.
5. When assessing an adult’s blood pressure, what is the significance of using a cuff
that is too narrow for the arm size?
A. The reading will be falsely high.
B. The reading will be falsely low.
C. It will have no effect on the systolic pressure.
D. The diastolic pressure will be impossible to hear.
Correct Answer: A
Expert Explanation: Selecting the correct blood pressure cuff size is critical for
ensuring the accuracy of the measurement. A cuff that is too small or narrow
requires more pressure to compress the artery, resulting in a falsely elevated
reading. Conversely, a cuff that is too wide will provide a reading that is inaccurately
low. Proper sizing should cover about 40% of the arm’s circumference and 80% of
the arm’s length. Ensuring correct technique prevents errors in clinical reasoning
and unnecessary medical interventions.
6. Which component of the health history involves a head-to-toe check of all body
systems to ensure no symptoms were missed?
A. Chief Complaint
