NUR 102 HEALTH ASSESSMENT EXAM 2 HEAD-TO-TOE ASSESSMENT QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |STUDY GUIDE|
INSTANT DOWNLOAD PDF
Core Domains
*- General Survey and Vital Signs*
*- Head, Eyes, Ears, Nose, and Mouth Assessment*
*- Neck and Thyroid Assessment*
*- Cardiovascular and Respiratory Assessment*
*- Abdominal and Gastrointestinal Assessment*
*- Neurological and Musculoskeletal Assessment*
*- Skin, Hair, and Nails Assessment*
*- Extremities and Peripheral Vascular Assessment*
*- Genitourinary and Rectal Assessment Basics*
*- Documentation and Professional Standards*
Introduction
,This comprehensive health assessment exam is designed to evaluate nursing students' and professionals'
mastery of systematic head-to-toe physical assessment techniques. The exam assesses critical skills including
vital signs measurement, inspection, palpation, percussion, and auscultation across all body systems.
Through 100 multiple-choice and scenario-based questions, candidates demonstrate their ability to identify
normal versus abnormal findings, prioritize assessment actions, and apply clinical decision-making in real-
world patient care situations. Emphasis is placed on practical application, regulatory compliance, ethical
considerations, and professional standards essential for safe and effective nursing practice.
SECTION ONE: QUESTIONS 1–100
Question 1
During a general survey, what is the FIRST thing a nurse should assess when entering a patient's room?
A. Vital signs
B. General appearance and signs of illness
C. Vital axis posture
D. Skin color
🟢 Correct answer: B
🔴 RATIONALE: The general survey begins immediately upon entering the room, with general appearance and
signs of illness being the first observational assessment. This provides immediate clues about the patient's
overall health status before proceeding to specific measurements.
,Question 2
A patient's blood pressure reads 145/92 mmHg. How should this be classified?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
🟢 Correct answer: C
🔴 RATIONALE: According to current guidelines, blood pressure 130-139/80-89 mmHg is Elevated, while
140-179/90-119 mmHg indicates Stage 1 hypertension. This patient's 145/92 mmHg falls within Stage 1
hypertension range.
Question 3
Which cranial nerve is tested when asking a patient to shrug their shoulders against resistance?
A. CN III (Oculomotor)
B. CN V (Trigeminal)
C. CN VII (Facial)
D. CN XI (Spinal Accessory)
, 🟢 Correct answer: D
🔴 RATIONALE: CN XI (Spinal Accessory) controls the trapezius muscle, which is tested by asking the patient
to shrug shoulders against resistance. This is a key component of neurological assessment during head-to-toe
examination.
Question 4
When assessing the abdomen, what is the correct order of examination techniques?
A. Palpation, Percussion, Auscultation, Inspection
B. Inspection, Auscultation, Percussion, Palpation
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Palpation, Percussion, Auscultation
🟢 Correct answer: B
🔴 RATIONALE: The correct abdominal examination sequence is Inspection → Auscultation → Percussion →
Palpation. Palpation is done last to avoid altering bowel sounds that would be heard during auscultation if
palpation occurred first.
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |STUDY GUIDE|
INSTANT DOWNLOAD PDF
Core Domains
*- General Survey and Vital Signs*
*- Head, Eyes, Ears, Nose, and Mouth Assessment*
*- Neck and Thyroid Assessment*
*- Cardiovascular and Respiratory Assessment*
*- Abdominal and Gastrointestinal Assessment*
*- Neurological and Musculoskeletal Assessment*
*- Skin, Hair, and Nails Assessment*
*- Extremities and Peripheral Vascular Assessment*
*- Genitourinary and Rectal Assessment Basics*
*- Documentation and Professional Standards*
Introduction
,This comprehensive health assessment exam is designed to evaluate nursing students' and professionals'
mastery of systematic head-to-toe physical assessment techniques. The exam assesses critical skills including
vital signs measurement, inspection, palpation, percussion, and auscultation across all body systems.
Through 100 multiple-choice and scenario-based questions, candidates demonstrate their ability to identify
normal versus abnormal findings, prioritize assessment actions, and apply clinical decision-making in real-
world patient care situations. Emphasis is placed on practical application, regulatory compliance, ethical
considerations, and professional standards essential for safe and effective nursing practice.
SECTION ONE: QUESTIONS 1–100
Question 1
During a general survey, what is the FIRST thing a nurse should assess when entering a patient's room?
A. Vital signs
B. General appearance and signs of illness
C. Vital axis posture
D. Skin color
🟢 Correct answer: B
🔴 RATIONALE: The general survey begins immediately upon entering the room, with general appearance and
signs of illness being the first observational assessment. This provides immediate clues about the patient's
overall health status before proceeding to specific measurements.
,Question 2
A patient's blood pressure reads 145/92 mmHg. How should this be classified?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
🟢 Correct answer: C
🔴 RATIONALE: According to current guidelines, blood pressure 130-139/80-89 mmHg is Elevated, while
140-179/90-119 mmHg indicates Stage 1 hypertension. This patient's 145/92 mmHg falls within Stage 1
hypertension range.
Question 3
Which cranial nerve is tested when asking a patient to shrug their shoulders against resistance?
A. CN III (Oculomotor)
B. CN V (Trigeminal)
C. CN VII (Facial)
D. CN XI (Spinal Accessory)
, 🟢 Correct answer: D
🔴 RATIONALE: CN XI (Spinal Accessory) controls the trapezius muscle, which is tested by asking the patient
to shrug shoulders against resistance. This is a key component of neurological assessment during head-to-toe
examination.
Question 4
When assessing the abdomen, what is the correct order of examination techniques?
A. Palpation, Percussion, Auscultation, Inspection
B. Inspection, Auscultation, Percussion, Palpation
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Palpation, Percussion, Auscultation
🟢 Correct answer: B
🔴 RATIONALE: The correct abdominal examination sequence is Inspection → Auscultation → Percussion →
Palpation. Palpation is done last to avoid altering bowel sounds that would be heard during auscultation if
palpation occurred first.
