NSG 3160 HEALTH ASSESSMENT EXAM
2 QUESTIONS AND ANSWERS
1. During a respiratory assessment, the nurse notes a ‘dull’ percussion note over the left
lower lobe. Which condition is most likely associated with this finding?
A. Lobar pneumonia
B. Emphysema
C. Pneumothorax
D. Normal lung tissue
Answer: A
Conceptual Explanation: Dullness replaces resonance when fluid or solid tissue replaces
air-containing lung or occupies the pleural space, such as in lobar pneumonia, pleural
effusion, or a tumor.
2. When assessing tactile fremitus, the nurse should expect to find increased fremitus in
which of the following patients?
A. A patient with bronchial obstruction
B. A patient with advanced emphysema
C. A patient with a large pleural effusion
,D. A patient with pulmonary edema
Answer: D
Conceptual Explanation: Increased tactile fremitus occurs with conditions that increase
the density of lung tissue, such as consolidation in pneumonia or pulmonary edema,
because sound travels better through solid/fluid-filled mediums.
3. A nurse is performing a cardiac assessment and identifies a murmur heard during the
diastolic phase of the cardiac cycle. This could indicate:
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Pulmonic stenosis
Answer: A
Conceptual Explanation: Diastolic murmurs occur between S2 and S1. Mitral stenosis and
aortic regurgitation are common diastolic murmurs. Aortic stenosis and mitral
regurgitation are systolic murmurs.
4. Which technique should the nurse use to identify the upper border of the liver during an
abdominal assessment?
A. Deep palpation in the right upper quadrant
B. Light palpation in the epigastric region
, C. Percussion starting in the area of lung resonance
D. Auscultation for the scratch test
Answer: C
Conceptual Explanation: To identify the upper border of the liver, the nurse percusses
down the right midclavicular line from resonance to dullness, typically starting around the
5th intercostal space.
5. A patient presents with a ‘positive Murphy sign’. The nurse understands this is indicative of
which condition?
A. Appendicitis
B. Ascites
C. Splenomegaly
D. Cholecystitis
Answer: D
Conceptual Explanation: Murphy sign is tested by having the patient take a deep breath
while the nurse’s hand is held under the liver border. Pain that causes the patient to stop
inspiration abruptly indicates inflammation of the gallbladder (cholecystitis).
6. The nurse is testing a patient’s Cranial Nerve VII. Which action should the nurse ask the
patient to perform?
A. Smile and puff out cheeks
2 QUESTIONS AND ANSWERS
1. During a respiratory assessment, the nurse notes a ‘dull’ percussion note over the left
lower lobe. Which condition is most likely associated with this finding?
A. Lobar pneumonia
B. Emphysema
C. Pneumothorax
D. Normal lung tissue
Answer: A
Conceptual Explanation: Dullness replaces resonance when fluid or solid tissue replaces
air-containing lung or occupies the pleural space, such as in lobar pneumonia, pleural
effusion, or a tumor.
2. When assessing tactile fremitus, the nurse should expect to find increased fremitus in
which of the following patients?
A. A patient with bronchial obstruction
B. A patient with advanced emphysema
C. A patient with a large pleural effusion
,D. A patient with pulmonary edema
Answer: D
Conceptual Explanation: Increased tactile fremitus occurs with conditions that increase
the density of lung tissue, such as consolidation in pneumonia or pulmonary edema,
because sound travels better through solid/fluid-filled mediums.
3. A nurse is performing a cardiac assessment and identifies a murmur heard during the
diastolic phase of the cardiac cycle. This could indicate:
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Pulmonic stenosis
Answer: A
Conceptual Explanation: Diastolic murmurs occur between S2 and S1. Mitral stenosis and
aortic regurgitation are common diastolic murmurs. Aortic stenosis and mitral
regurgitation are systolic murmurs.
4. Which technique should the nurse use to identify the upper border of the liver during an
abdominal assessment?
A. Deep palpation in the right upper quadrant
B. Light palpation in the epigastric region
, C. Percussion starting in the area of lung resonance
D. Auscultation for the scratch test
Answer: C
Conceptual Explanation: To identify the upper border of the liver, the nurse percusses
down the right midclavicular line from resonance to dullness, typically starting around the
5th intercostal space.
5. A patient presents with a ‘positive Murphy sign’. The nurse understands this is indicative of
which condition?
A. Appendicitis
B. Ascites
C. Splenomegaly
D. Cholecystitis
Answer: D
Conceptual Explanation: Murphy sign is tested by having the patient take a deep breath
while the nurse’s hand is held under the liver border. Pain that causes the patient to stop
inspiration abruptly indicates inflammation of the gallbladder (cholecystitis).
6. The nurse is testing a patient’s Cranial Nerve VII. Which action should the nurse ask the
patient to perform?
A. Smile and puff out cheeks
