NR 304 Final Exam – Chamberlain Health Assessment II: Comprehensive
2026/2027 Questions, Correct Answers & Detailed Rationales
1. A nurse is performing the general survey of an adult patient. When does the general
survey begin?
A. After the complete physical examination
B. After the patient is placed in the examination room
C. When the nurse first encounters and observes the patient
D. After the patient's vital signs are obtained
Answer: C. When the nurse first encounters and observes the patient
Rationale: The general survey begins at first contact. The nurse observes overall appearance,
level of consciousness, posture, body structure, mobility, behavior, and signs of distress
throughout the encounter.
2. A patient arrives in the clinic with severe shortness of breath. Which finding requires the
most immediate attention?
A. Respiratory rate of 18/min
B. Mild dry cough
C. Noisy respirations with obvious respiratory distress
D. Respiratory rate of 16/min
Answer: C. Noisy respirations with obvious respiratory distress
Rationale: Signs of respiratory distress indicate a potentially compromised airway or impaired
ventilation and require immediate assessment and intervention.
3. A nurse obtains a patient's pulse oximetry reading of 90% on room air. The patient is
also tachypneic and has shallow respirations. What is the priority nursing action?
A. Document the findings and reassess next week
B. Ask about the patient's favorite activity
C. Assess respiratory status promptly and intervene according to the patient's condition
D. Obtain the patient's family history first
Answer: C. Assess respiratory status promptly and intervene according to the patient's
condition
,Rationale: Low oxygen saturation accompanied by abnormal respirations may indicate impaired
oxygenation. The nurse should promptly assess airway, breathing, lung sounds, mental status,
and other relevant findings.
4. A nurse is assessing the health history of a patient. What is the primary purpose of the
health history?
A. To replace the physical examination
B. To obtain only objective findings
C. To collect subjective information about the patient's health and concerns
D. To establish a medical diagnosis without further assessment
Answer: C. To collect subjective information about the patient's health and concerns
Rationale: The health history provides subjective information about the patient's current
concerns, past and present health, medications, family history, psychosocial factors, and
functional status.
5. Which finding is considered objective data?
A. "I feel dizzy."
B. "My chest hurts."
C. "I have been tired for three days."
D. Blood pressure of 150/92 mm Hg
Answer: D. Blood pressure of 150/92 mm Hg
Rationale: Objective data are findings that can be observed, measured, or verified by the
examiner, such as vital signs, physical findings, and laboratory results.
6. A patient reports, "I have had chest pain for two hours." This statement represents
which type of data?
A. Objective data
B. Laboratory data
C. Subjective data
D. Diagnostic data
Answer: C. Subjective data
,Rationale: Subjective data are symptoms and experiences reported by the patient that cannot be
directly measured by the examiner.
7. During assessment, the nurse identifies several findings that are related to the patient's
respiratory problem and groups them together. Which nursing-process activity is being
performed?
A. Evaluation
B. Implementation
C. Analysis of assessment data
D. Discharge planning
Answer: C. Analysis of assessment data
Rationale: During analysis, the nurse organizes and clusters relevant assessment findings to
identify patterns and formulate appropriate nursing diagnoses.
8. A nurse reassesses a patient after implementing interventions to determine whether the
expected outcomes have been achieved. Which phase of the nursing process is being used?
A. Assessment
B. Diagnosis
C. Planning
D. Evaluation
Answer: D. Evaluation
Rationale: Evaluation involves reassessing the patient and determining whether established
goals and outcomes were met and whether the plan of care needs modification.
9. A nurse is assessing an adult patient's posture. Which finding is generally expected?
A. Severe lateral spinal curvature
B. Inability to maintain balance
C. An erect posture with appropriate alignment
D. Constant forward flexion
Answer: C. An erect posture with appropriate alignment
, Rationale: Normal adult posture generally demonstrates an erect, balanced position with
appropriate alignment. Abnormal curvature or marked difficulty maintaining posture requires
further assessment.
10. A nurse assesses a patient's skin during the general survey. Which finding should be
documented as an objective observation?
A. "Patient feels embarrassed."
B. "Patient reports feeling cold."
C. Skin is warm, dry, and intact
D. "Patient states the skin is uncomfortable."
Answer: C. Skin is warm, dry, and intact
Rationale: Skin temperature, moisture, integrity, color, lesions, and other observable
characteristics are objective findings.
11. A nurse is assessing a patient with peripheral arterial disease. Which symptom is
commonly associated with early peripheral arterial disease?
A. Generalized edema
B. Intermittent claudication
C. Severe venous ulceration
D. Warm, flushed extremities
Answer: B. Intermittent claudication
Rationale: Intermittent claudication is ischemic muscle pain that occurs with activity and
improves with rest. It is a classic manifestation of peripheral arterial disease.
12. A patient with peripheral arterial disease asks how to maintain warmth in the lower
extremities. Which instruction is appropriate?
A. Apply a heating pad directly to the legs
B. Place the legs above the heart for prolonged periods
C. Keep the environment comfortably warm and avoid direct sources of heat
D. Apply ice packs several times daily
Answer: C. Keep the environment comfortably warm and avoid direct sources of heat
2026/2027 Questions, Correct Answers & Detailed Rationales
1. A nurse is performing the general survey of an adult patient. When does the general
survey begin?
A. After the complete physical examination
B. After the patient is placed in the examination room
C. When the nurse first encounters and observes the patient
D. After the patient's vital signs are obtained
Answer: C. When the nurse first encounters and observes the patient
Rationale: The general survey begins at first contact. The nurse observes overall appearance,
level of consciousness, posture, body structure, mobility, behavior, and signs of distress
throughout the encounter.
2. A patient arrives in the clinic with severe shortness of breath. Which finding requires the
most immediate attention?
A. Respiratory rate of 18/min
B. Mild dry cough
C. Noisy respirations with obvious respiratory distress
D. Respiratory rate of 16/min
Answer: C. Noisy respirations with obvious respiratory distress
Rationale: Signs of respiratory distress indicate a potentially compromised airway or impaired
ventilation and require immediate assessment and intervention.
3. A nurse obtains a patient's pulse oximetry reading of 90% on room air. The patient is
also tachypneic and has shallow respirations. What is the priority nursing action?
A. Document the findings and reassess next week
B. Ask about the patient's favorite activity
C. Assess respiratory status promptly and intervene according to the patient's condition
D. Obtain the patient's family history first
Answer: C. Assess respiratory status promptly and intervene according to the patient's
condition
,Rationale: Low oxygen saturation accompanied by abnormal respirations may indicate impaired
oxygenation. The nurse should promptly assess airway, breathing, lung sounds, mental status,
and other relevant findings.
4. A nurse is assessing the health history of a patient. What is the primary purpose of the
health history?
A. To replace the physical examination
B. To obtain only objective findings
C. To collect subjective information about the patient's health and concerns
D. To establish a medical diagnosis without further assessment
Answer: C. To collect subjective information about the patient's health and concerns
Rationale: The health history provides subjective information about the patient's current
concerns, past and present health, medications, family history, psychosocial factors, and
functional status.
5. Which finding is considered objective data?
A. "I feel dizzy."
B. "My chest hurts."
C. "I have been tired for three days."
D. Blood pressure of 150/92 mm Hg
Answer: D. Blood pressure of 150/92 mm Hg
Rationale: Objective data are findings that can be observed, measured, or verified by the
examiner, such as vital signs, physical findings, and laboratory results.
6. A patient reports, "I have had chest pain for two hours." This statement represents
which type of data?
A. Objective data
B. Laboratory data
C. Subjective data
D. Diagnostic data
Answer: C. Subjective data
,Rationale: Subjective data are symptoms and experiences reported by the patient that cannot be
directly measured by the examiner.
7. During assessment, the nurse identifies several findings that are related to the patient's
respiratory problem and groups them together. Which nursing-process activity is being
performed?
A. Evaluation
B. Implementation
C. Analysis of assessment data
D. Discharge planning
Answer: C. Analysis of assessment data
Rationale: During analysis, the nurse organizes and clusters relevant assessment findings to
identify patterns and formulate appropriate nursing diagnoses.
8. A nurse reassesses a patient after implementing interventions to determine whether the
expected outcomes have been achieved. Which phase of the nursing process is being used?
A. Assessment
B. Diagnosis
C. Planning
D. Evaluation
Answer: D. Evaluation
Rationale: Evaluation involves reassessing the patient and determining whether established
goals and outcomes were met and whether the plan of care needs modification.
9. A nurse is assessing an adult patient's posture. Which finding is generally expected?
A. Severe lateral spinal curvature
B. Inability to maintain balance
C. An erect posture with appropriate alignment
D. Constant forward flexion
Answer: C. An erect posture with appropriate alignment
, Rationale: Normal adult posture generally demonstrates an erect, balanced position with
appropriate alignment. Abnormal curvature or marked difficulty maintaining posture requires
further assessment.
10. A nurse assesses a patient's skin during the general survey. Which finding should be
documented as an objective observation?
A. "Patient feels embarrassed."
B. "Patient reports feeling cold."
C. Skin is warm, dry, and intact
D. "Patient states the skin is uncomfortable."
Answer: C. Skin is warm, dry, and intact
Rationale: Skin temperature, moisture, integrity, color, lesions, and other observable
characteristics are objective findings.
11. A nurse is assessing a patient with peripheral arterial disease. Which symptom is
commonly associated with early peripheral arterial disease?
A. Generalized edema
B. Intermittent claudication
C. Severe venous ulceration
D. Warm, flushed extremities
Answer: B. Intermittent claudication
Rationale: Intermittent claudication is ischemic muscle pain that occurs with activity and
improves with rest. It is a classic manifestation of peripheral arterial disease.
12. A patient with peripheral arterial disease asks how to maintain warmth in the lower
extremities. Which instruction is appropriate?
A. Apply a heating pad directly to the legs
B. Place the legs above the heart for prolonged periods
C. Keep the environment comfortably warm and avoid direct sources of heat
D. Apply ice packs several times daily
Answer: C. Keep the environment comfortably warm and avoid direct sources of heat
