NUR 101/NUR101 Exam 1 V3 | Health
Assessment Q&A with Rationale | Fortis
College
1. The nurse is collecting data during the initial interview. Which of the following is
considered subjective data?
A. The patient’s blood pressure is 140/90 mmHg.
B. The patient’s skin is warm and dry.
C. The patient states, ‘I have a sharp pain in my chest.’
D. The nurse observes the patient grimacing.
Correct Answer: C
Expert Explanation: Subjective data includes information provided by the patient that
cannot be measured by the nurse. This includes symptoms, feelings, and perceptions
shared during the interview. Objective data, conversely, is what the nurse observes, feels,
or measures during the physical examination.
2. When performing a physical assessment, in which order should the nurse assess the
abdomen?
A. Inspection, Auscultation, Percussion, Palpation
B. Inspection, Palpation, Percussion, Auscultation
C. Auscultation, Inspection, Palpation, Percussion
,D. Percussion, Auscultation, Inspection, Palpation
Correct Answer: A
Expert Explanation: The abdomen is assessed using the sequence of inspection,
auscultation, percussion, and then palpation. This specific order is necessary because
palpation and percussion can stimulate bowel sounds and alter the findings of auscultation.
By auscultating first, the nurse ensures a more accurate assessment of the patient’s natural
bowel activity.
3. The nurse is using the ‘PQRST’ mnemonic to assess a patient’s pain. What does the ‘Q’
represent in this tool?
A. Quantity
B. Quickness of onset
C. Quelling factors
D. Quality
Correct Answer: D
Expert Explanation: The ‘Q’ in PQRST stands for Quality, which refers to how the patient
describes the pain sensation. Examples of quality include terms like ‘burning,’ ‘stabbing,’
‘dull,’ or ‘aching.’ Understanding the quality of pain helps the healthcare provider narrow
down the potential cause of the discomfort.
, 4. A nurse is measuring a blood pressure and uses a cuff that is too small for the patient’s
arm. What effect will this have on the reading?
A. The blood pressure reading will be falsely low.
B. The cuff size does not affect the blood pressure reading.
C. The systolic pressure will be high, and diastolic will be low.
D. The blood pressure reading will be falsely high.
Correct Answer: D
Expert Explanation: Using a blood pressure cuff that is too small or too narrow for the
patient’s arm size will result in a falsely high reading. This occurs because the cuff must be
inflated more to compress the artery effectively. Conversely, a cuff that is too large will
yield a falsely low reading.
5. Which part of the hand is most sensitive to vibrations and should be used during
palpation?
A. Ulnar surface or base of the fingers
B. Dorsal surface (back of the hand)
C. Fingertips
D. The palm of the hand
Correct Answer: A
Assessment Q&A with Rationale | Fortis
College
1. The nurse is collecting data during the initial interview. Which of the following is
considered subjective data?
A. The patient’s blood pressure is 140/90 mmHg.
B. The patient’s skin is warm and dry.
C. The patient states, ‘I have a sharp pain in my chest.’
D. The nurse observes the patient grimacing.
Correct Answer: C
Expert Explanation: Subjective data includes information provided by the patient that
cannot be measured by the nurse. This includes symptoms, feelings, and perceptions
shared during the interview. Objective data, conversely, is what the nurse observes, feels,
or measures during the physical examination.
2. When performing a physical assessment, in which order should the nurse assess the
abdomen?
A. Inspection, Auscultation, Percussion, Palpation
B. Inspection, Palpation, Percussion, Auscultation
C. Auscultation, Inspection, Palpation, Percussion
,D. Percussion, Auscultation, Inspection, Palpation
Correct Answer: A
Expert Explanation: The abdomen is assessed using the sequence of inspection,
auscultation, percussion, and then palpation. This specific order is necessary because
palpation and percussion can stimulate bowel sounds and alter the findings of auscultation.
By auscultating first, the nurse ensures a more accurate assessment of the patient’s natural
bowel activity.
3. The nurse is using the ‘PQRST’ mnemonic to assess a patient’s pain. What does the ‘Q’
represent in this tool?
A. Quantity
B. Quickness of onset
C. Quelling factors
D. Quality
Correct Answer: D
Expert Explanation: The ‘Q’ in PQRST stands for Quality, which refers to how the patient
describes the pain sensation. Examples of quality include terms like ‘burning,’ ‘stabbing,’
‘dull,’ or ‘aching.’ Understanding the quality of pain helps the healthcare provider narrow
down the potential cause of the discomfort.
, 4. A nurse is measuring a blood pressure and uses a cuff that is too small for the patient’s
arm. What effect will this have on the reading?
A. The blood pressure reading will be falsely low.
B. The cuff size does not affect the blood pressure reading.
C. The systolic pressure will be high, and diastolic will be low.
D. The blood pressure reading will be falsely high.
Correct Answer: D
Expert Explanation: Using a blood pressure cuff that is too small or too narrow for the
patient’s arm size will result in a falsely high reading. This occurs because the cuff must be
inflated more to compress the artery effectively. Conversely, a cuff that is too large will
yield a falsely low reading.
5. Which part of the hand is most sensitive to vibrations and should be used during
palpation?
A. Ulnar surface or base of the fingers
B. Dorsal surface (back of the hand)
C. Fingertips
D. The palm of the hand
Correct Answer: A
