NSG3160 / NSG 3160 — Health Assessment Exam 3 (2026/2027) Galen College of Nursing
NSG3160 / NSG 3160 — Health Assessment
Exam 3 — 100 Questions & 100% Correct Answers ()
Galen College of Nursing · Comprehensive Physical Assessment & Clinical Judgment Application · Cognitive Distribution: 30%
Recall / 50% Application / 20% Analysis · Passing Score: 70%
Section 1: Head, Neck, and Neurological Assessment (Q1–Q20)
Q1: A 52-year-old client presents with a palpable, fixed, hard left supraclavicular lymph node (Virchow's
node). Which condition is most strongly suspected based on this finding?
A. Right-sided heart failure
B. Gastric cancer with abdominal metastasis [CORRECT]
C. Benign breast fibroadenoma
D. Acute viral pharyngitis
Correct Answer: B
Rationale: An enlarged, hard, fixed left supraclavicular lymph node (Virchow's node) is a classic sentinel sign of
abdominal malignancy, most commonly gastric cancer, due to lymphatic drainage via the thoracic duct. Right-sided heart
failure produces jugular venous distension rather than a hard fixed node, fibroadenoma is a benign breast mass not
involving Virchow's node, and viral pharyngitis produces tender cervical (tonsillar) nodes rather than a hard fixed
supraclavicular node.
Q2: While assessing the thyroid gland, the nurse auscultates a bruit over the thyroid lobe. The nurse
recognizes this finding is most indicative of:
A. Hypothyroidism with decreased vascularity
B. Normal thyroid physiology in adults
C. Hyperthyroidism with increased vascularity [CORRECT]
D. Tracheal compression from a nodule
Correct Answer: C
Rationale: An audible bruit over the thyroid indicates increased vascularity typical of hyperthyroidism (Graves' disease)
due to proliferative blood flow. Hypothyroidism is associated with decreased vascularity, the normal thyroid is silent on
auscultation, and a nodule would more likely produce tracheal deviation or asymmetry on palpation rather than a bruit.
Q3: The nurse is preparing to palpate the carotid arteries. Which technique is correct and safest for this
assessment?
A. Palpate both arteries simultaneously to compare amplitude
B. Palpate one artery at a time to prevent cerebral ischemia [CORRECT]
C. Palpate both arteries after the client performs Valsalva
D. Auscultate for bruit only if palpation reveals a thrill
Correct Answer: B
Page 1 · 100 Questions · Passing Score 70%
,NSG3160 / NSG 3160 — Health Assessment Exam 3 (2026/2027) Galen College of Nursing
Rationale: Palpating only one carotid artery at a time is mandatory to avoid simultaneously reducing bilateral cerebral
blood flow, which can precipitate syncope or stroke. Simultaneous palpation is contraindicated, Valsalva reduces cardiac
output and confounds findings, and bruits should be auscultated routinely in older adults or those with cardiovascular risk
regardless of thrill presence.
Q4: A nurse assesses jugular venous pressure (JVP) and notes sustained jugular venous distension (JVD)
with the head of bed elevated to 45 degrees. The nurse interprets this finding as most consistent with:
A. Left-sided heart failure
B. Right-sided heart failure [CORRECT]
C. Superior vena cava syndrome only
D. Hypovolemia
Correct Answer: B
Rationale: Sustained JVD at 45-degree elevation reflects elevated central venous pressure, which is the hallmark of
right-sided heart failure (or cor pulmonale). Left-sided heart failure produces pulmonary congestion rather than JVD;
hypovolemia produces flat neck veins; SVC syndrome causes facial and upper extremity edema rather than isolated JVD.
Q5: A client presents with tracheal deviation to the right side. The nurse recognizes this finding is most
consistent with:
A. Right-sided pneumothorax
B. Left-sided tension pneumothorax [CORRECT]
C. Bilateral lobar pneumonia
D. Chronic bronchitis
Correct Answer: B
Rationale: Tracheal deviation occurs TOWARD the side of a pneumothorax (simple) and AWAY from the side of a
tension pneumothorax. With tracheal deviation to the right, the tension pneumothorax is on the left, pushing the trachea
and mediastinum away from the affected side. Bilateral pneumonia and chronic bronchitis do not produce tracheal
deviation, and a right pneumothorax would deviate the trachea left if tension or right if simple.
Q6: Which cranial nerve is being tested when the nurse asks the client to protrude the tongue and observes
for deviation?
A. CN V (Trigeminal)
B. CN VII (Facial)
C. CN X (Vagus)
D. CN XII (Hypoglossal) [CORRECT]
Correct Answer: D
Rationale: CN XII (Hypoglossal) controls tongue movement; a lesion causes the tongue to deviate TOWARD the affected
side on protrusion. CN V controls mastication and facial sensation, CN VII controls facial muscles (not the tongue), and
CN X controls palatal and swallowing function. Testing the tongue specifically isolates the hypoglossal nerve.
Q7: A client presents with drooping of the right corner of the mouth and inability to wrinkle the right
forehead. The nurse identifies this as:
A. CN VII (Facial) lower motor neuron lesion [CORRECT]
Page 2 · 100 Questions · Passing Score 70%
,NSG3160 / NSG 3160 — Health Assessment Exam 3 (2026/2027) Galen College of Nursing
B. CN XII (Hypoglossal) lesion
C. CN V (Trigeminal) motor lesion
D. CN X (Vagus) lesion
Correct Answer: A
Rationale: Drooping of the mouth corner with forehead involvement indicates a peripheral (lower motor neuron) CN VII
facial nerve lesion, since the upper face receives bilateral cortical innervation and is spared in central (UMN) lesions. CN
XII lesions affect the tongue, CN V motor lesions affect chewing, and CN X lesions affect swallowing and voice — none
of these alter the forehead or mouth corner.
Q8: The nurse performs the Rinne test and documents: bone conduction > air conduction in the left ear.
This finding indicates which type of hearing loss?
A. Sensorineural hearing loss in the left ear
B. Conductive hearing loss in the left ear [CORRECT]
C. Normal hearing in the left ear
D. Bilateral mixed hearing loss
Correct Answer: B
Rationale: In the Rinne test, a negative result (BC > AC) indicates conductive hearing loss because bone conduction
bypasses the outer/middle ear pathology. In sensorineural loss, AC > BC but both are reduced; normal hearing has AC >
BC; mixed loss is best identified with the Weber test plus audiometry, not by isolated Rinne BC > AC.
Q9: When performing the Weber test, the nurse places a vibrating tuning fork at midline of the forehead.
The client reports hearing the sound louder in the LEFT ear. The nurse recognizes this as:
A. Sensorineural loss in the right ear
B. Conductive loss in the left ear [CORRECT]
C. Sensorineural loss in the left ear
D. Bilateral normal hearing
Correct Answer: B
Rationale: Weber lateralization to the affected ear indicates conductive loss (the affected ear is less distracted by ambient
noise, so bone-conducted sound is perceived as louder). Sensorineural loss causes lateralization to the OPPOSITE (better)
ear. Lateralizing left therefore indicates either left conductive loss or right sensorineural loss; combined with the distractor
logic, conductive loss in left is the matching pattern.
Q10: A nurse documents a deep tendon reflex (DTR) as '3+'. Which of the following best describes this
grade?
A. Absent reflex
B. Hypoactive reflex
C. Brisker than average; may or may not be pathologic [CORRECT]
D. Hyperactive with clonus
Correct Answer: C
Rationale: On the 0–4+ DTR scale, 3+ is brisker-than-average and may be normal in anxious individuals or may indicate
early upper motor neuron disease. 0 = absent, 1+ = hypoactive, 4+ = hyperactive with clonus. Recording 3+ accurately
directs further evaluation for symmetric vs. asymmetric hyperreflexia.
Page 3 · 100 Questions · Passing Score 70%
, NSG3160 / NSG 3160 — Health Assessment Exam 3 (2026/2027) Galen College of Nursing
Q11: A 68-year-old client demonstrates a positive Babinski sign on the right foot. The nurse interprets this
finding as:
A. A normal variant in older adults
B. An upper motor neuron lesion of the corticospinal tract [CORRECT]
C. A lower motor neuron lesion of L4–L5
D. A finding consistent with peripheral neuropathy
Correct Answer: B
Rationale: A positive Babinski response (up-going toe with fanning of other toes) in adults indicates an upper motor
neuron lesion affecting the corticospinal tract. It is normal in infants up to ~12–24 months but pathologic in adults. Lower
motor neuron lesions produce absent reflexes, and peripheral neuropathy typically produces diminished or absent
responses rather than positive Babinski.
Q12: While testing the corneal reflex, the nurse touches a wisp of cotton to the client's right cornea. Both
eyelids blink. Which cranial nerves are responsible for the afferent and efferent limbs of this reflex?
A. Afferent CN II; Efferent CN III
B. Afferent CN V; Efferent CN VII [CORRECT]
C. Afferent CN VII; Efferent CN V
D. Afferent CN III; Efferent CN V
Correct Answer: B
Rationale: The corneal reflex's afferent limb is the ophthalmic branch of CN V (trigeminal), and the efferent limb is CN
VII (facial) which innervates the orbicularis oculi. CN II is the optic nerve (vision, not sensation), CN III is oculomotor
(pupil/eyelid position), and reversal of afferent/efferent pairs is a common Galen exam error.
Q13: The nurse performs the Romberg test. The client stands with feet together and eyes open without
difficulty. When the client closes their eyes, marked swaying occurs. The nurse interprets this finding as:
A. Cerebellar dysfunction
B. Loss of proprioception (posterior column) [CORRECT]
C. Vestibular nerve lesion only
D. Normal age-related change
Correct Answer: B
Rationale: A positive Romberg (sway or fall only when eyes are closed) indicates proprioceptive loss in the posterior
columns of the spinal cord, because visual compensation is removed. Cerebellar ataxia produces imbalance with eyes
OPEN or closed; vestibular lesions typically produce vertigo and nystagmus rather than isolated positive Romberg; the
finding is not normal in older adults.
Q14: A client is asked to smile, puff out both cheeks, and raise both eyebrows. The nurse observes a
symmetric smile and forehead wrinkling, but the client is unable to puff out the right cheek. Which
finding is most consistent?
A. Central (UMN) CN VII lesion
B. Peripheral (LMN) CN VII lesion
C. CN V motor lesion [CORRECT]
Page 4 · 100 Questions · Passing Score 70%
NSG3160 / NSG 3160 — Health Assessment
Exam 3 — 100 Questions & 100% Correct Answers ()
Galen College of Nursing · Comprehensive Physical Assessment & Clinical Judgment Application · Cognitive Distribution: 30%
Recall / 50% Application / 20% Analysis · Passing Score: 70%
Section 1: Head, Neck, and Neurological Assessment (Q1–Q20)
Q1: A 52-year-old client presents with a palpable, fixed, hard left supraclavicular lymph node (Virchow's
node). Which condition is most strongly suspected based on this finding?
A. Right-sided heart failure
B. Gastric cancer with abdominal metastasis [CORRECT]
C. Benign breast fibroadenoma
D. Acute viral pharyngitis
Correct Answer: B
Rationale: An enlarged, hard, fixed left supraclavicular lymph node (Virchow's node) is a classic sentinel sign of
abdominal malignancy, most commonly gastric cancer, due to lymphatic drainage via the thoracic duct. Right-sided heart
failure produces jugular venous distension rather than a hard fixed node, fibroadenoma is a benign breast mass not
involving Virchow's node, and viral pharyngitis produces tender cervical (tonsillar) nodes rather than a hard fixed
supraclavicular node.
Q2: While assessing the thyroid gland, the nurse auscultates a bruit over the thyroid lobe. The nurse
recognizes this finding is most indicative of:
A. Hypothyroidism with decreased vascularity
B. Normal thyroid physiology in adults
C. Hyperthyroidism with increased vascularity [CORRECT]
D. Tracheal compression from a nodule
Correct Answer: C
Rationale: An audible bruit over the thyroid indicates increased vascularity typical of hyperthyroidism (Graves' disease)
due to proliferative blood flow. Hypothyroidism is associated with decreased vascularity, the normal thyroid is silent on
auscultation, and a nodule would more likely produce tracheal deviation or asymmetry on palpation rather than a bruit.
Q3: The nurse is preparing to palpate the carotid arteries. Which technique is correct and safest for this
assessment?
A. Palpate both arteries simultaneously to compare amplitude
B. Palpate one artery at a time to prevent cerebral ischemia [CORRECT]
C. Palpate both arteries after the client performs Valsalva
D. Auscultate for bruit only if palpation reveals a thrill
Correct Answer: B
Page 1 · 100 Questions · Passing Score 70%
,NSG3160 / NSG 3160 — Health Assessment Exam 3 (2026/2027) Galen College of Nursing
Rationale: Palpating only one carotid artery at a time is mandatory to avoid simultaneously reducing bilateral cerebral
blood flow, which can precipitate syncope or stroke. Simultaneous palpation is contraindicated, Valsalva reduces cardiac
output and confounds findings, and bruits should be auscultated routinely in older adults or those with cardiovascular risk
regardless of thrill presence.
Q4: A nurse assesses jugular venous pressure (JVP) and notes sustained jugular venous distension (JVD)
with the head of bed elevated to 45 degrees. The nurse interprets this finding as most consistent with:
A. Left-sided heart failure
B. Right-sided heart failure [CORRECT]
C. Superior vena cava syndrome only
D. Hypovolemia
Correct Answer: B
Rationale: Sustained JVD at 45-degree elevation reflects elevated central venous pressure, which is the hallmark of
right-sided heart failure (or cor pulmonale). Left-sided heart failure produces pulmonary congestion rather than JVD;
hypovolemia produces flat neck veins; SVC syndrome causes facial and upper extremity edema rather than isolated JVD.
Q5: A client presents with tracheal deviation to the right side. The nurse recognizes this finding is most
consistent with:
A. Right-sided pneumothorax
B. Left-sided tension pneumothorax [CORRECT]
C. Bilateral lobar pneumonia
D. Chronic bronchitis
Correct Answer: B
Rationale: Tracheal deviation occurs TOWARD the side of a pneumothorax (simple) and AWAY from the side of a
tension pneumothorax. With tracheal deviation to the right, the tension pneumothorax is on the left, pushing the trachea
and mediastinum away from the affected side. Bilateral pneumonia and chronic bronchitis do not produce tracheal
deviation, and a right pneumothorax would deviate the trachea left if tension or right if simple.
Q6: Which cranial nerve is being tested when the nurse asks the client to protrude the tongue and observes
for deviation?
A. CN V (Trigeminal)
B. CN VII (Facial)
C. CN X (Vagus)
D. CN XII (Hypoglossal) [CORRECT]
Correct Answer: D
Rationale: CN XII (Hypoglossal) controls tongue movement; a lesion causes the tongue to deviate TOWARD the affected
side on protrusion. CN V controls mastication and facial sensation, CN VII controls facial muscles (not the tongue), and
CN X controls palatal and swallowing function. Testing the tongue specifically isolates the hypoglossal nerve.
Q7: A client presents with drooping of the right corner of the mouth and inability to wrinkle the right
forehead. The nurse identifies this as:
A. CN VII (Facial) lower motor neuron lesion [CORRECT]
Page 2 · 100 Questions · Passing Score 70%
,NSG3160 / NSG 3160 — Health Assessment Exam 3 (2026/2027) Galen College of Nursing
B. CN XII (Hypoglossal) lesion
C. CN V (Trigeminal) motor lesion
D. CN X (Vagus) lesion
Correct Answer: A
Rationale: Drooping of the mouth corner with forehead involvement indicates a peripheral (lower motor neuron) CN VII
facial nerve lesion, since the upper face receives bilateral cortical innervation and is spared in central (UMN) lesions. CN
XII lesions affect the tongue, CN V motor lesions affect chewing, and CN X lesions affect swallowing and voice — none
of these alter the forehead or mouth corner.
Q8: The nurse performs the Rinne test and documents: bone conduction > air conduction in the left ear.
This finding indicates which type of hearing loss?
A. Sensorineural hearing loss in the left ear
B. Conductive hearing loss in the left ear [CORRECT]
C. Normal hearing in the left ear
D. Bilateral mixed hearing loss
Correct Answer: B
Rationale: In the Rinne test, a negative result (BC > AC) indicates conductive hearing loss because bone conduction
bypasses the outer/middle ear pathology. In sensorineural loss, AC > BC but both are reduced; normal hearing has AC >
BC; mixed loss is best identified with the Weber test plus audiometry, not by isolated Rinne BC > AC.
Q9: When performing the Weber test, the nurse places a vibrating tuning fork at midline of the forehead.
The client reports hearing the sound louder in the LEFT ear. The nurse recognizes this as:
A. Sensorineural loss in the right ear
B. Conductive loss in the left ear [CORRECT]
C. Sensorineural loss in the left ear
D. Bilateral normal hearing
Correct Answer: B
Rationale: Weber lateralization to the affected ear indicates conductive loss (the affected ear is less distracted by ambient
noise, so bone-conducted sound is perceived as louder). Sensorineural loss causes lateralization to the OPPOSITE (better)
ear. Lateralizing left therefore indicates either left conductive loss or right sensorineural loss; combined with the distractor
logic, conductive loss in left is the matching pattern.
Q10: A nurse documents a deep tendon reflex (DTR) as '3+'. Which of the following best describes this
grade?
A. Absent reflex
B. Hypoactive reflex
C. Brisker than average; may or may not be pathologic [CORRECT]
D. Hyperactive with clonus
Correct Answer: C
Rationale: On the 0–4+ DTR scale, 3+ is brisker-than-average and may be normal in anxious individuals or may indicate
early upper motor neuron disease. 0 = absent, 1+ = hypoactive, 4+ = hyperactive with clonus. Recording 3+ accurately
directs further evaluation for symmetric vs. asymmetric hyperreflexia.
Page 3 · 100 Questions · Passing Score 70%
, NSG3160 / NSG 3160 — Health Assessment Exam 3 (2026/2027) Galen College of Nursing
Q11: A 68-year-old client demonstrates a positive Babinski sign on the right foot. The nurse interprets this
finding as:
A. A normal variant in older adults
B. An upper motor neuron lesion of the corticospinal tract [CORRECT]
C. A lower motor neuron lesion of L4–L5
D. A finding consistent with peripheral neuropathy
Correct Answer: B
Rationale: A positive Babinski response (up-going toe with fanning of other toes) in adults indicates an upper motor
neuron lesion affecting the corticospinal tract. It is normal in infants up to ~12–24 months but pathologic in adults. Lower
motor neuron lesions produce absent reflexes, and peripheral neuropathy typically produces diminished or absent
responses rather than positive Babinski.
Q12: While testing the corneal reflex, the nurse touches a wisp of cotton to the client's right cornea. Both
eyelids blink. Which cranial nerves are responsible for the afferent and efferent limbs of this reflex?
A. Afferent CN II; Efferent CN III
B. Afferent CN V; Efferent CN VII [CORRECT]
C. Afferent CN VII; Efferent CN V
D. Afferent CN III; Efferent CN V
Correct Answer: B
Rationale: The corneal reflex's afferent limb is the ophthalmic branch of CN V (trigeminal), and the efferent limb is CN
VII (facial) which innervates the orbicularis oculi. CN II is the optic nerve (vision, not sensation), CN III is oculomotor
(pupil/eyelid position), and reversal of afferent/efferent pairs is a common Galen exam error.
Q13: The nurse performs the Romberg test. The client stands with feet together and eyes open without
difficulty. When the client closes their eyes, marked swaying occurs. The nurse interprets this finding as:
A. Cerebellar dysfunction
B. Loss of proprioception (posterior column) [CORRECT]
C. Vestibular nerve lesion only
D. Normal age-related change
Correct Answer: B
Rationale: A positive Romberg (sway or fall only when eyes are closed) indicates proprioceptive loss in the posterior
columns of the spinal cord, because visual compensation is removed. Cerebellar ataxia produces imbalance with eyes
OPEN or closed; vestibular lesions typically produce vertigo and nystagmus rather than isolated positive Romberg; the
finding is not normal in older adults.
Q14: A client is asked to smile, puff out both cheeks, and raise both eyebrows. The nurse observes a
symmetric smile and forehead wrinkling, but the client is unable to puff out the right cheek. Which
finding is most consistent?
A. Central (UMN) CN VII lesion
B. Peripheral (LMN) CN VII lesion
C. CN V motor lesion [CORRECT]
Page 4 · 100 Questions · Passing Score 70%
