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NUR 216 EXAM 1 Spring-Summer 2025 Arizona College Of
Nursing (Modules 1-3) Complete Question And Answer
Spring/Summer 2025 – Arizona College of Nursing
1. A 72-year-old patient is admitted with dyspnea. The nurse performs
a focused assessment. Which type of health database is most
appropriate for this patient?
A. Complete (total health) database
B. Problem-centered database
C. Follow-up database
D. Emergency database
: Answer : B. Problem-centered database
Rationale: A problem-centered (or focused) database is used for a
limited or short-term problem, targeting one body system or cue
complex. A complete database is used in primary care for a full health
picture; an emergency database is reserved for life-threatening
situations requiring rapid data collection.
2. During a health history interview, the patient states, “I have this
burning pain in my chest that gets worse when I lie down after
eating.” This information is an example of:
A. Objective data
B. The chief complaint
C. Past medical history
D. A review of systems
pg. 1
,2
: Answer : B. The chief complaint
Rationale: The chief complaint (or reason for seeking care) is a brief,
spontaneous statement in the patient’s own words describing the
primary reason for the visit. Objective data are measurable findings;
past medical history and review of systems are separate components.
3. Which of the following is an example of an open-ended question
the nurse should use during a health history?
A. “Does your pain radiate to your left arm?”
B. “Tell me about the discomfort you’ve been feeling in your chest.”
C. “Is your pain sharp or dull?”
D. “Do you have any family history of heart disease?”
: Answer : B. “Tell me about the discomfort you’ve been feeling in
your chest.”
Rationale: Open-ended questions invite the patient to describe their
experience in their own words, providing richer subjective data. The
other options are closed-ended or leading questions.
4. A patient is admitted with a severe headache and neck stiffness.
The nurse flexes the patient’s neck and observes involuntary flexion
of both hips and knees. This is known as:
A. Positive Kernig sign
B. Positive Brudzinski sign
C. Positive Babinski sign
D. Negative nuchal rigidity
: Answer : B. Positive Brudzinski sign
*Rationale: Brudzinski sign is involuntary hip/knee flexion with passive
neck flexion, indicating meningeal irritation. Kernig sign is
pg. 2
,3
pain/resistance when the knee is extended from a 90° hip flexion.
Babinski sign is a plantar reflex.*
5. Which of the following vital sign findings would the nurse identify
as hypotension in an adult?
A. Blood pressure 110/70 mm Hg
B. Blood pressure 88/56 mm Hg with dizziness and tachycardia
C. Blood pressure 130/88 mm Hg
D. Blood pressure 100/60 mm Hg in a young athlete
: Answer : B. Blood pressure 88/56 mm Hg with dizziness and
tachycardia
*Rationale: Hypotension is defined as blood pressure lower than 90/60
mm Hg accompanied by symptoms such as dizziness, tachycardia, and
decreased urine output. Isolated low readings without symptoms may
be normal for that individual.*
6. The nurse is counting a patient’s respiratory rate. To obtain the
most accurate measurement, the nurse should:
A. Inform the patient that respirations are being counted
B. Count for 15 seconds and multiply by 4
C. Continue to hold the wrist after counting the pulse and count for 30
seconds to a full minute
D. Ask the patient to breathe deeply during the count
: Answer : C. Continue to hold the wrist after counting the pulse and
count for 30 seconds to a full minute
Rationale: The patient may consciously alter their breathing pattern if
aware; the nurse should maintain the position of pulse counting and
pg. 3
,4
unobtrusively count respirations. For any irregularity, a full minute is
recommended.
7. A patient with a history of chronic obstructive pulmonary disease
(COPD) has an SpO₂ of 88% on room air. The nurse understands that
this patient’s acceptable oxygen saturation target is:
A. 95–100%
B. 92–95%
C. 88–92%
D. 80–85%
: Answer : C. 88–92%
Rationale: In chronic CO₂ retainers (COPD), excessive oxygen can
suppress the hypoxic drive and cause CO₂ narcosis. The target SpO₂ is
typically 88–92% to balance hypoxia risk with CO₂ retention.
8. During a general survey, the nurse notices the patient is sitting in a
tripod position, leaning forward with arms braced on the knees. This
position is most often associated with:
A. Acute abdominal pain
B. Chronic obstructive pulmonary disease
C. Pericarditis
D. Meningitis
: Answer : B. Chronic obstructive pulmonary disease
Rationale: The tripod position helps recruit accessory muscles to
facilitate breathing and is commonly seen in patients with severe COPD
or acute respiratory distress. Pericarditis pain is relieved by sitting up
and leaning forward but not typically the tripod position. Meningitis
may present with opisthotonos.
pg. 4
, 5
9. A patient reports pain as “throbbing, aching, and well-localized” in
the right knee. The nurse classifies this type of pain as:
A. Visceral pain
B. Deep somatic pain
C. Cutaneous pain
D. Neuropathic pain
: Answer : B. Deep somatic pain
Rationale: Deep somatic pain originates from muscles, bones, joints, or
ligaments and is typically well-localized, aching, or throbbing. Visceral
pain is dull, cramping, and poorly localized; cutaneous pain is sharp and
superficial; neuropathic pain is burning or shooting.
10. A 45-year-old patient with diabetes reports numbness, tingling,
and a burning sensation in both feet. The nurse recognizes this as:
A. Visceral pain
B. Somatic pain
C. Neuropathic pain
D. Phantom pain
: Answer : C. Neuropathic pain
Rationale: Neuropathic pain results from damage to the peripheral or
central nervous system and is often described as burning, tingling, or
“pins and needles.” Diabetic peripheral neuropathy is a common cause.
11. The nurse is assessing a patient’s pain using the numeric rating
scale. The patient rates the pain as 8 out of 10. The nurse documents
this as the pain’s:
A. Quality
pg. 5
NUR 216 EXAM 1 Spring-Summer 2025 Arizona College Of
Nursing (Modules 1-3) Complete Question And Answer
Spring/Summer 2025 – Arizona College of Nursing
1. A 72-year-old patient is admitted with dyspnea. The nurse performs
a focused assessment. Which type of health database is most
appropriate for this patient?
A. Complete (total health) database
B. Problem-centered database
C. Follow-up database
D. Emergency database
: Answer : B. Problem-centered database
Rationale: A problem-centered (or focused) database is used for a
limited or short-term problem, targeting one body system or cue
complex. A complete database is used in primary care for a full health
picture; an emergency database is reserved for life-threatening
situations requiring rapid data collection.
2. During a health history interview, the patient states, “I have this
burning pain in my chest that gets worse when I lie down after
eating.” This information is an example of:
A. Objective data
B. The chief complaint
C. Past medical history
D. A review of systems
pg. 1
,2
: Answer : B. The chief complaint
Rationale: The chief complaint (or reason for seeking care) is a brief,
spontaneous statement in the patient’s own words describing the
primary reason for the visit. Objective data are measurable findings;
past medical history and review of systems are separate components.
3. Which of the following is an example of an open-ended question
the nurse should use during a health history?
A. “Does your pain radiate to your left arm?”
B. “Tell me about the discomfort you’ve been feeling in your chest.”
C. “Is your pain sharp or dull?”
D. “Do you have any family history of heart disease?”
: Answer : B. “Tell me about the discomfort you’ve been feeling in
your chest.”
Rationale: Open-ended questions invite the patient to describe their
experience in their own words, providing richer subjective data. The
other options are closed-ended or leading questions.
4. A patient is admitted with a severe headache and neck stiffness.
The nurse flexes the patient’s neck and observes involuntary flexion
of both hips and knees. This is known as:
A. Positive Kernig sign
B. Positive Brudzinski sign
C. Positive Babinski sign
D. Negative nuchal rigidity
: Answer : B. Positive Brudzinski sign
*Rationale: Brudzinski sign is involuntary hip/knee flexion with passive
neck flexion, indicating meningeal irritation. Kernig sign is
pg. 2
,3
pain/resistance when the knee is extended from a 90° hip flexion.
Babinski sign is a plantar reflex.*
5. Which of the following vital sign findings would the nurse identify
as hypotension in an adult?
A. Blood pressure 110/70 mm Hg
B. Blood pressure 88/56 mm Hg with dizziness and tachycardia
C. Blood pressure 130/88 mm Hg
D. Blood pressure 100/60 mm Hg in a young athlete
: Answer : B. Blood pressure 88/56 mm Hg with dizziness and
tachycardia
*Rationale: Hypotension is defined as blood pressure lower than 90/60
mm Hg accompanied by symptoms such as dizziness, tachycardia, and
decreased urine output. Isolated low readings without symptoms may
be normal for that individual.*
6. The nurse is counting a patient’s respiratory rate. To obtain the
most accurate measurement, the nurse should:
A. Inform the patient that respirations are being counted
B. Count for 15 seconds and multiply by 4
C. Continue to hold the wrist after counting the pulse and count for 30
seconds to a full minute
D. Ask the patient to breathe deeply during the count
: Answer : C. Continue to hold the wrist after counting the pulse and
count for 30 seconds to a full minute
Rationale: The patient may consciously alter their breathing pattern if
aware; the nurse should maintain the position of pulse counting and
pg. 3
,4
unobtrusively count respirations. For any irregularity, a full minute is
recommended.
7. A patient with a history of chronic obstructive pulmonary disease
(COPD) has an SpO₂ of 88% on room air. The nurse understands that
this patient’s acceptable oxygen saturation target is:
A. 95–100%
B. 92–95%
C. 88–92%
D. 80–85%
: Answer : C. 88–92%
Rationale: In chronic CO₂ retainers (COPD), excessive oxygen can
suppress the hypoxic drive and cause CO₂ narcosis. The target SpO₂ is
typically 88–92% to balance hypoxia risk with CO₂ retention.
8. During a general survey, the nurse notices the patient is sitting in a
tripod position, leaning forward with arms braced on the knees. This
position is most often associated with:
A. Acute abdominal pain
B. Chronic obstructive pulmonary disease
C. Pericarditis
D. Meningitis
: Answer : B. Chronic obstructive pulmonary disease
Rationale: The tripod position helps recruit accessory muscles to
facilitate breathing and is commonly seen in patients with severe COPD
or acute respiratory distress. Pericarditis pain is relieved by sitting up
and leaning forward but not typically the tripod position. Meningitis
may present with opisthotonos.
pg. 4
, 5
9. A patient reports pain as “throbbing, aching, and well-localized” in
the right knee. The nurse classifies this type of pain as:
A. Visceral pain
B. Deep somatic pain
C. Cutaneous pain
D. Neuropathic pain
: Answer : B. Deep somatic pain
Rationale: Deep somatic pain originates from muscles, bones, joints, or
ligaments and is typically well-localized, aching, or throbbing. Visceral
pain is dull, cramping, and poorly localized; cutaneous pain is sharp and
superficial; neuropathic pain is burning or shooting.
10. A 45-year-old patient with diabetes reports numbness, tingling,
and a burning sensation in both feet. The nurse recognizes this as:
A. Visceral pain
B. Somatic pain
C. Neuropathic pain
D. Phantom pain
: Answer : C. Neuropathic pain
Rationale: Neuropathic pain results from damage to the peripheral or
central nervous system and is often described as burning, tingling, or
“pins and needles.” Diabetic peripheral neuropathy is a common cause.
11. The nurse is assessing a patient’s pain using the numeric rating
scale. The patient rates the pain as 8 out of 10. The nurse documents
this as the pain’s:
A. Quality
pg. 5
