NURS 320 – Health Assessment & Pathophysiology for
Nursing Practice Institution: Typical U.S. Nursing
Program (e.g., South College, Chamberlain, Walden)
Exam: Actual Exam Practice Set (150 Questions)
Format: Multiple Choice with Answer + Explanation
Update: 2025/2026
Question 1
A nurse is assessing a patient's jugular veins. The patient is positioned supine with the head of
bed elevated to 30 degrees. The nurse notes visible jugular venous distention (JVD) extending
to the angle of the jaw. What does this finding indicate?
A) Normal finding in supine position
B) Decreased central venous pressure
C) Elevated central venous pressure (rightsided heart failure)
D) Dehydration
Answer: C
Explanation: JVD above the level of the clavicle with HOB at 3045 degrees indicates elevated
CVP, often due to rightsided heart failure, fluid overload, or pericardial effusion.
Question 2
During a respiratory assessment, a nurse auscultates fine crackles at the lung bases that do not
clear with coughing. These sounds are most consistent with:
A) Atelectasis
B) Asthma
C) Pulmonary edema or early heart failure
D) Emphysema
Answer: C
Explanation: Fine crackles (rales) that do not clear with coughing are characteristic of
pulmonary edema (fluid in alveoli) or interstitial lung disease. Atelectatic crackles clear with
coughing.
Question 3
A patient has a positive Murphy's sign. The nurse understands this indicates:
,A) Appendicitis
B) Acute cholecystitis
C) Pancreatitis
D) Peptic ulcer disease
Answer: B
Explanation: Murphy's sign is pain and inspiratory arrest when palpating the right upper
quadrant (gallbladder area) during deep inspiration. It is classic for acute cholecystitis.
Question 4
A nurse assesses a patient's pupils. Both pupils are 4 mm and react briskly to light. This finding
is:
A) Abnormal – anisocoria
B) Normal
C) Abnormal – miosis
D) Abnormal – mydriasis
Answer: B
Explanation: Normal pupils are 2–6 mm, equal, round, and reactive to light and accommodation
(PERRLA). Miosis is constriction (<2 mm); mydriasis is dilation (>6 mm).
Question 5
During a cardiovascular assessment, the nurse palpates a thrill at the left sternal border. A thrill
is best described as:
A) A buzzing or vibrating sensation felt on palpation
B) A visible pulsation
C) An audible murmur
D) A palpable pulse deficit
Answer: A
Explanation: A thrill is a palpable vibration caused by turbulent blood flow, often associated with
a grade IV–VI heart murmur. Bruits are audible; thrills are palpable.
Question 6
A nurse is assessing a patient's skin turgor. Which finding indicates severe dehydration?
A) Skin immediately returns to normal position when pinched
B) Skin remains tented for several seconds after being pinched
C) Skin is warm and dry
,D) Skin is cool and clammy
Answer: B
Explanation: Poor skin turgor (tenting) indicates dehydration. Normal turgor is immediate return
of skin to position. Cool, clammy skin suggests shock or hypoperfusion.
Question 7
A patient reports chest pain that worsens with inspiration and improves when leaning forward.
The nurse suspects:
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
Answer: B
Explanation: Pericarditis causes pleuritic chest pain that worsens with inspiration and improves
when leaning forward (relieves pericardial friction). It may also have a pericardial friction rub on
auscultation.
Question 8
A nurse auscultates a patient's abdomen and hears highpitched, tinkling bowel sounds. This
finding is most consistent with:
A) Paralytic ileus
B) Early bowel obstruction
C) Normal bowel sounds
D) Peritonitis
Answer: B
Explanation: Highpitched, tinkling bowel sounds suggest increased peristalsis trying to push
contents past a partial obstruction. Paralytic ileus causes absent/hypoactive sounds.
Question 9
A patient's capillary refill time (CRT) is 5 seconds in the fingertips. What does this indicate?
A) Normal perfusion
B) Decreased peripheral perfusion (possible shock or dehydration)
C) Hyperthyroidism
D) Venous insufficiency
, Answer: B
Explanation: Normal CRT is <2 seconds. Prolonged CRT (>3 seconds) indicates decreased
peripheral perfusion from hypovolemia, shock, or peripheral vascular disease.
Question 10
A nurse is assessing a patient's cranial nerve IX (glossopharyngeal) and X (vagus). How should
the nurse test these nerves?
A) Ask the patient to smile and raise eyebrows
B) Ask the patient to swallow and say "ah" while observing uvula elevation
C) Ask the patient to shrug shoulders against resistance
D) Ask the patient to stick out the tongue
Answer: B
Explanation: CN IX and X are tested together by having the patient swallow (gag reflex) and say
"ah" – the uvula should rise midline. CN VII tests facial movement; CN XI tests trapezius/SCM;
CN XII tests tongue movement.
Question 11
During a breast examination, a nurse palpates a fixed, hard, nontender, irregular mass in the
upper outer quadrant. This finding is most suspicious for:
A) Fibroadenoma
B) Breast cyst
C) Breast malignancy
D) Fibrocystic changes
Answer: C
Explanation: Malignant breast masses are typically hard, fixed, irregular, and nontender.
Fibroadenomas are mobile, round, and rubbery. Cysts are smooth, round, and often tender.
Question 12
A nurse is assessing a patient for orthostatic hypotension. The patient's supine BP is 120/80
mmHg. Upon standing, the BP is 100/60 mmHg with dizziness. What is the priority nursing
action?
A) Administer IV fluids immediately
B) Have the patient lie back down and document the finding
C) Increase the patient's antihypertensive medication
D) Notify the provider after discharging the patient
Nursing Practice Institution: Typical U.S. Nursing
Program (e.g., South College, Chamberlain, Walden)
Exam: Actual Exam Practice Set (150 Questions)
Format: Multiple Choice with Answer + Explanation
Update: 2025/2026
Question 1
A nurse is assessing a patient's jugular veins. The patient is positioned supine with the head of
bed elevated to 30 degrees. The nurse notes visible jugular venous distention (JVD) extending
to the angle of the jaw. What does this finding indicate?
A) Normal finding in supine position
B) Decreased central venous pressure
C) Elevated central venous pressure (rightsided heart failure)
D) Dehydration
Answer: C
Explanation: JVD above the level of the clavicle with HOB at 3045 degrees indicates elevated
CVP, often due to rightsided heart failure, fluid overload, or pericardial effusion.
Question 2
During a respiratory assessment, a nurse auscultates fine crackles at the lung bases that do not
clear with coughing. These sounds are most consistent with:
A) Atelectasis
B) Asthma
C) Pulmonary edema or early heart failure
D) Emphysema
Answer: C
Explanation: Fine crackles (rales) that do not clear with coughing are characteristic of
pulmonary edema (fluid in alveoli) or interstitial lung disease. Atelectatic crackles clear with
coughing.
Question 3
A patient has a positive Murphy's sign. The nurse understands this indicates:
,A) Appendicitis
B) Acute cholecystitis
C) Pancreatitis
D) Peptic ulcer disease
Answer: B
Explanation: Murphy's sign is pain and inspiratory arrest when palpating the right upper
quadrant (gallbladder area) during deep inspiration. It is classic for acute cholecystitis.
Question 4
A nurse assesses a patient's pupils. Both pupils are 4 mm and react briskly to light. This finding
is:
A) Abnormal – anisocoria
B) Normal
C) Abnormal – miosis
D) Abnormal – mydriasis
Answer: B
Explanation: Normal pupils are 2–6 mm, equal, round, and reactive to light and accommodation
(PERRLA). Miosis is constriction (<2 mm); mydriasis is dilation (>6 mm).
Question 5
During a cardiovascular assessment, the nurse palpates a thrill at the left sternal border. A thrill
is best described as:
A) A buzzing or vibrating sensation felt on palpation
B) A visible pulsation
C) An audible murmur
D) A palpable pulse deficit
Answer: A
Explanation: A thrill is a palpable vibration caused by turbulent blood flow, often associated with
a grade IV–VI heart murmur. Bruits are audible; thrills are palpable.
Question 6
A nurse is assessing a patient's skin turgor. Which finding indicates severe dehydration?
A) Skin immediately returns to normal position when pinched
B) Skin remains tented for several seconds after being pinched
C) Skin is warm and dry
,D) Skin is cool and clammy
Answer: B
Explanation: Poor skin turgor (tenting) indicates dehydration. Normal turgor is immediate return
of skin to position. Cool, clammy skin suggests shock or hypoperfusion.
Question 7
A patient reports chest pain that worsens with inspiration and improves when leaning forward.
The nurse suspects:
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
Answer: B
Explanation: Pericarditis causes pleuritic chest pain that worsens with inspiration and improves
when leaning forward (relieves pericardial friction). It may also have a pericardial friction rub on
auscultation.
Question 8
A nurse auscultates a patient's abdomen and hears highpitched, tinkling bowel sounds. This
finding is most consistent with:
A) Paralytic ileus
B) Early bowel obstruction
C) Normal bowel sounds
D) Peritonitis
Answer: B
Explanation: Highpitched, tinkling bowel sounds suggest increased peristalsis trying to push
contents past a partial obstruction. Paralytic ileus causes absent/hypoactive sounds.
Question 9
A patient's capillary refill time (CRT) is 5 seconds in the fingertips. What does this indicate?
A) Normal perfusion
B) Decreased peripheral perfusion (possible shock or dehydration)
C) Hyperthyroidism
D) Venous insufficiency
, Answer: B
Explanation: Normal CRT is <2 seconds. Prolonged CRT (>3 seconds) indicates decreased
peripheral perfusion from hypovolemia, shock, or peripheral vascular disease.
Question 10
A nurse is assessing a patient's cranial nerve IX (glossopharyngeal) and X (vagus). How should
the nurse test these nerves?
A) Ask the patient to smile and raise eyebrows
B) Ask the patient to swallow and say "ah" while observing uvula elevation
C) Ask the patient to shrug shoulders against resistance
D) Ask the patient to stick out the tongue
Answer: B
Explanation: CN IX and X are tested together by having the patient swallow (gag reflex) and say
"ah" – the uvula should rise midline. CN VII tests facial movement; CN XI tests trapezius/SCM;
CN XII tests tongue movement.
Question 11
During a breast examination, a nurse palpates a fixed, hard, nontender, irregular mass in the
upper outer quadrant. This finding is most suspicious for:
A) Fibroadenoma
B) Breast cyst
C) Breast malignancy
D) Fibrocystic changes
Answer: C
Explanation: Malignant breast masses are typically hard, fixed, irregular, and nontender.
Fibroadenomas are mobile, round, and rubbery. Cysts are smooth, round, and often tender.
Question 12
A nurse is assessing a patient for orthostatic hypotension. The patient's supine BP is 120/80
mmHg. Upon standing, the BP is 100/60 mmHg with dizziness. What is the priority nursing
action?
A) Administer IV fluids immediately
B) Have the patient lie back down and document the finding
C) Increase the patient's antihypertensive medication
D) Notify the provider after discharging the patient
