NUR 2092/NUR2092 Exam 1 V3 | Health
Assessment Q&A with Rationale |
Rasmussen University
1. Which of the following describes subjective data?
A. The patient’s blood pressure is 120/80 mmHg.
B. The patient states they have a ‘throbbing’ headache.
C. The nurse observes the patient is grimacing.
D. The laboratory results show a high white blood cell count.
Answer: B
Rationale: Subjective data consists of information provided by the patient that cannot be
independently verified by the nurse. In this scenario, the patient’s description of a
headache is a personal experience. Objective data, on the other hand, consists of
measurable findings like blood pressure or lab results.
2. During an interview, the nurse asks, ‘Can you tell me more about your shortness of
breath?’ This is an example of:
A. A closed-ended question.
B. A biased question.
C. A leading question.
D. An open-ended question.
,Answer: D
Rationale: Open-ended questions encourage the patient to provide a narrative and express
their feelings or concerns in detail. This technique is essential during the initial phase of a
health history interview to gather broad information. Closed-ended questions would
typically result in a simple ‘yes’ or ‘no’ response.
3. Which physical assessment technique involves the use of the sense of touch to assess
texture, temperature, and moisture?
A. Inspection
B. Percussion
C. Palpation
D. Auscultation
Answer: C
Rationale: Palpation is the use of the hands to touch and feel specific body characteristics
such as organ size or skin texture. It follows inspection and provides deeper clinical
information about the physical state of the patient. Different parts of the hand are used for
different assessments, such as the dorsal side for temperature.
4. When assessing a patient’s radial pulse, what is the standard procedure for an adult with a
regular rhythm?
A. Count for 15 seconds and multiply by 4.
B. Count for 30 seconds and multiply by 2.
, C. Count for 60 seconds always.
D. Count for 10 seconds and multiply by 6.
Answer: B
Rationale: Counting the pulse for 30 seconds and multiplying by two is the standard
clinical practice for regular rhythms. If the rhythm is irregular, the nurse must count for a
full minute to ensure accuracy. This method balances efficiency with clinical precision in an
acute care setting.
5. What is the priority action when a nurse enters a room and finds a patient struggling to
breathe?
A. Perform a focused assessment on the respiratory system.
B. Check the patient’s ID band.
C. Complete a full head-to-toe assessment.
D. Review the patient’s medical history for allergies.
Answer: A
Rationale: In an emergent situation, the nurse must perform a focused assessment to
address the immediate life-threatening concern. Airway, breathing, and circulation take
priority over non-urgent historical data collection. Once the patient is stabilized, a more
comprehensive assessment can be completed.
Assessment Q&A with Rationale |
Rasmussen University
1. Which of the following describes subjective data?
A. The patient’s blood pressure is 120/80 mmHg.
B. The patient states they have a ‘throbbing’ headache.
C. The nurse observes the patient is grimacing.
D. The laboratory results show a high white blood cell count.
Answer: B
Rationale: Subjective data consists of information provided by the patient that cannot be
independently verified by the nurse. In this scenario, the patient’s description of a
headache is a personal experience. Objective data, on the other hand, consists of
measurable findings like blood pressure or lab results.
2. During an interview, the nurse asks, ‘Can you tell me more about your shortness of
breath?’ This is an example of:
A. A closed-ended question.
B. A biased question.
C. A leading question.
D. An open-ended question.
,Answer: D
Rationale: Open-ended questions encourage the patient to provide a narrative and express
their feelings or concerns in detail. This technique is essential during the initial phase of a
health history interview to gather broad information. Closed-ended questions would
typically result in a simple ‘yes’ or ‘no’ response.
3. Which physical assessment technique involves the use of the sense of touch to assess
texture, temperature, and moisture?
A. Inspection
B. Percussion
C. Palpation
D. Auscultation
Answer: C
Rationale: Palpation is the use of the hands to touch and feel specific body characteristics
such as organ size or skin texture. It follows inspection and provides deeper clinical
information about the physical state of the patient. Different parts of the hand are used for
different assessments, such as the dorsal side for temperature.
4. When assessing a patient’s radial pulse, what is the standard procedure for an adult with a
regular rhythm?
A. Count for 15 seconds and multiply by 4.
B. Count for 30 seconds and multiply by 2.
, C. Count for 60 seconds always.
D. Count for 10 seconds and multiply by 6.
Answer: B
Rationale: Counting the pulse for 30 seconds and multiplying by two is the standard
clinical practice for regular rhythms. If the rhythm is irregular, the nurse must count for a
full minute to ensure accuracy. This method balances efficiency with clinical precision in an
acute care setting.
5. What is the priority action when a nurse enters a room and finds a patient struggling to
breathe?
A. Perform a focused assessment on the respiratory system.
B. Check the patient’s ID band.
C. Complete a full head-to-toe assessment.
D. Review the patient’s medical history for allergies.
Answer: A
Rationale: In an emergent situation, the nurse must perform a focused assessment to
address the immediate life-threatening concern. Airway, breathing, and circulation take
priority over non-urgent historical data collection. Once the patient is stabilized, a more
comprehensive assessment can be completed.
