NSG121/NSG 121 Final Exam V2 | Health
Assessment Q&A with Rationale | Herzing
University
1. A nurse is performing a general survey on a new patient. Which observation is considered
part of the physical appearance component?
A. Level of consciousness and facial features
B. Gait and range of motion
C. Mood and affect
D. Use of assistive devices
Correct Answer: A
Rationale: The physical appearance component of the general survey includes assessing
the patient’s age, sex, level of consciousness, and skin color. Facial features should be
symmetric and appropriate for the context. Other options like gait belong to mobility, while
mood belongs to behavior assessment.
2. When assessing a patient’s pain, the nurse asks, ‘What makes the pain better or worse?’
Which part of the PQRST mnemonic does this represent?
A. Region/Radiation
B. Quality/Quantity
C. Provocation/Palliative
,D. Severity Scale
Correct Answer: C
Rationale: The ‘P’ in PQRST stands for Provocation or Palliative factors, which identifies
what triggers or relieves the pain. This helps the nurse understand the environmental or
physical factors influencing the patient’s discomfort. Understanding these factors is crucial
for developing an effective pain management plan.
3. The nurse is using the ABCDE rule to assess a suspicious skin lesion. What does the ‘D’
represent?
A. Density of the lesion
B. Depth of the tissue
C. Discoloration patterns
D. Diameter greater than 6 mm
Correct Answer: D
Rationale: The ‘D’ in the melanoma assessment mnemonic stands for Diameter, specifically
looking for lesions larger than 6 mm. This is roughly the size of a pencil eraser and is a
warning sign for malignancy. Early detection of size changes is vital for successful skin
cancer intervention.
4. During a physical examination, the nurse notes a patient’s skin is very thin, shiny, and lacks
hair on the lower legs. This finding is most consistent with which condition?
A. Chronic arterial insufficiency
, B. Acute lymphedema
C. Chronic venous insufficiency
D. Venous stasis ulceration
Correct Answer: A
Rationale: Thin, shiny skin and hair loss on the extremities are classic signs of chronic
arterial insufficiency due to poor oxygenation. These changes occur because the tissues are
not receiving adequate nutrient-rich blood flow. In contrast, venous issues usually present
with edema and brownish discoloration.
5. Which technique should the nurse use to palpate the cervical lymph nodes of a patient?
A. Using the finger pads in a circular motion
B. Applying firm deep pressure with the palms
C. Using the dorsal surface of the hands
D. Using a light tapping motion with one finger
Correct Answer: A
Rationale: The correct technique for lymph node palpation is using the pads of the fingers
in a gentle, circular motion. This allows the nurse to feel for the size, shape, and mobility of
the nodes without causing discomfort. Normal nodes are typically non-palpable or small,
soft, and mobile in adults.
Assessment Q&A with Rationale | Herzing
University
1. A nurse is performing a general survey on a new patient. Which observation is considered
part of the physical appearance component?
A. Level of consciousness and facial features
B. Gait and range of motion
C. Mood and affect
D. Use of assistive devices
Correct Answer: A
Rationale: The physical appearance component of the general survey includes assessing
the patient’s age, sex, level of consciousness, and skin color. Facial features should be
symmetric and appropriate for the context. Other options like gait belong to mobility, while
mood belongs to behavior assessment.
2. When assessing a patient’s pain, the nurse asks, ‘What makes the pain better or worse?’
Which part of the PQRST mnemonic does this represent?
A. Region/Radiation
B. Quality/Quantity
C. Provocation/Palliative
,D. Severity Scale
Correct Answer: C
Rationale: The ‘P’ in PQRST stands for Provocation or Palliative factors, which identifies
what triggers or relieves the pain. This helps the nurse understand the environmental or
physical factors influencing the patient’s discomfort. Understanding these factors is crucial
for developing an effective pain management plan.
3. The nurse is using the ABCDE rule to assess a suspicious skin lesion. What does the ‘D’
represent?
A. Density of the lesion
B. Depth of the tissue
C. Discoloration patterns
D. Diameter greater than 6 mm
Correct Answer: D
Rationale: The ‘D’ in the melanoma assessment mnemonic stands for Diameter, specifically
looking for lesions larger than 6 mm. This is roughly the size of a pencil eraser and is a
warning sign for malignancy. Early detection of size changes is vital for successful skin
cancer intervention.
4. During a physical examination, the nurse notes a patient’s skin is very thin, shiny, and lacks
hair on the lower legs. This finding is most consistent with which condition?
A. Chronic arterial insufficiency
, B. Acute lymphedema
C. Chronic venous insufficiency
D. Venous stasis ulceration
Correct Answer: A
Rationale: Thin, shiny skin and hair loss on the extremities are classic signs of chronic
arterial insufficiency due to poor oxygenation. These changes occur because the tissues are
not receiving adequate nutrient-rich blood flow. In contrast, venous issues usually present
with edema and brownish discoloration.
5. Which technique should the nurse use to palpate the cervical lymph nodes of a patient?
A. Using the finger pads in a circular motion
B. Applying firm deep pressure with the palms
C. Using the dorsal surface of the hands
D. Using a light tapping motion with one finger
Correct Answer: A
Rationale: The correct technique for lymph node palpation is using the pads of the fingers
in a gentle, circular motion. This allows the nurse to feel for the size, shape, and mobility of
the nodes without causing discomfort. Normal nodes are typically non-palpable or small,
soft, and mobile in adults.
