NUR 101/NUR101 Final Exam V2 | Health
Assessment Q&A with Rationale | Fortis College
1. When performing a physical assessment, which technique should the nurse always perform
first, except when assessing the abdomen?
A. Palpation
B. Percussion
C. Inspection
D. Auscultation
Correct Answer: C
Explanation: Inspection is always the first step in a physical examination as it involves
observing the patient for symmetry, color, and abnormalities. It provides the initial
baseline data before physical contact is made with the patient. Following this sequence
ensures that the nurse does not miss obvious visual cues.
2. A patient reports ‘throbbing pain’ in the right knee. Which type of data does this
represent?
A. Objective data
B. Secondary data
C. Primary data
D. Subjective data
,Correct Answer: D
Explanation: Subjective data consists of information that the patient tells the nurse, such
as feelings, perceptions, or descriptions of pain. Since the nurse cannot ‘see’ or ‘measure’
the throb directly, it relies on the patient’s report. Understanding the difference between
subjective and objective data is fundamental to accurate health documentation.
3. While assessing a patient’s abdomen, in what order should the nurse perform the
assessment techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Auscultation, Inspection, Palpation, Percussion
C. Percussion, Auscultation, Inspection, Palpation
D. Inspection, Auscultation, Percussion, Palpation
Correct Answer: D
Explanation: For the abdominal assessment, the sequence is altered to prevent the
stimulation of bowel sounds by palpation or percussion. By auscultating immediately after
inspection, the nurse hears the bowel sounds in their natural state. This ensures the clinical
findings accurately reflect the patient’s current gastrointestinal motility.
4. A nurse is assessing a patient’s peripheral pulses and finds them difficult to palpate and
weak. How should the nurse document this finding?
A. 0
B. 2+
, C. 3+
D. 1+
Correct Answer: D
Explanation: On a standard 0 to 4+ scale, a 1+ pulse is described as weak, thready, or
diminished. A 2+ pulse is considered normal, while 3+ and 4+ indicate bounding or
increased force. Accurate grading is essential for monitoring cardiovascular changes and
fluid status in the clinical setting.
5. When assessing the lungs of a patient with pneumonia, the nurse hears high-pitched,
popping sounds during inspiration. What are these sounds called?
A. Wheezes
B. Rhonchi
C. Stridor
D. Crackles
Correct Answer: D
Explanation: Crackles, formerly known as rales, are adventitious lung sounds caused by
fluid in the small airways or the sudden opening of collapsed alveoli. They are typically
heard during inspiration and are common in conditions like pneumonia or heart failure.
Distinguishing these from wheezes, which are musical and caused by narrowing, is a
critical nursing skill.
Assessment Q&A with Rationale | Fortis College
1. When performing a physical assessment, which technique should the nurse always perform
first, except when assessing the abdomen?
A. Palpation
B. Percussion
C. Inspection
D. Auscultation
Correct Answer: C
Explanation: Inspection is always the first step in a physical examination as it involves
observing the patient for symmetry, color, and abnormalities. It provides the initial
baseline data before physical contact is made with the patient. Following this sequence
ensures that the nurse does not miss obvious visual cues.
2. A patient reports ‘throbbing pain’ in the right knee. Which type of data does this
represent?
A. Objective data
B. Secondary data
C. Primary data
D. Subjective data
,Correct Answer: D
Explanation: Subjective data consists of information that the patient tells the nurse, such
as feelings, perceptions, or descriptions of pain. Since the nurse cannot ‘see’ or ‘measure’
the throb directly, it relies on the patient’s report. Understanding the difference between
subjective and objective data is fundamental to accurate health documentation.
3. While assessing a patient’s abdomen, in what order should the nurse perform the
assessment techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Auscultation, Inspection, Palpation, Percussion
C. Percussion, Auscultation, Inspection, Palpation
D. Inspection, Auscultation, Percussion, Palpation
Correct Answer: D
Explanation: For the abdominal assessment, the sequence is altered to prevent the
stimulation of bowel sounds by palpation or percussion. By auscultating immediately after
inspection, the nurse hears the bowel sounds in their natural state. This ensures the clinical
findings accurately reflect the patient’s current gastrointestinal motility.
4. A nurse is assessing a patient’s peripheral pulses and finds them difficult to palpate and
weak. How should the nurse document this finding?
A. 0
B. 2+
, C. 3+
D. 1+
Correct Answer: D
Explanation: On a standard 0 to 4+ scale, a 1+ pulse is described as weak, thready, or
diminished. A 2+ pulse is considered normal, while 3+ and 4+ indicate bounding or
increased force. Accurate grading is essential for monitoring cardiovascular changes and
fluid status in the clinical setting.
5. When assessing the lungs of a patient with pneumonia, the nurse hears high-pitched,
popping sounds during inspiration. What are these sounds called?
A. Wheezes
B. Rhonchi
C. Stridor
D. Crackles
Correct Answer: D
Explanation: Crackles, formerly known as rales, are adventitious lung sounds caused by
fluid in the small airways or the sudden opening of collapsed alveoli. They are typically
heard during inspiration and are common in conditions like pneumonia or heart failure.
Distinguishing these from wheezes, which are musical and caused by narrowing, is a
critical nursing skill.
