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Patient Assessment Competency Exam
— Code: NUR-ASSESS | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is assessing a patient who reports new-onset shortness of breath.
Which finding requires the most immediate intervention?
A. Respiratory rate of 24/min
B. Oxygen saturation of 91%
C. Use of accessory muscles with inability to speak full sentences
D. Mild bilateral expiratory wheezing
Answer: C. Use of accessory muscles with inability to speak full sentences
Rationale: Inability to speak full sentences with accessory-muscle use indicates
significant respiratory distress and possible impending respiratory failure. This
finding takes priority over isolated mild tachypnea or wheezing.*
, 2. During a neurological assessment, a patient suddenly develops unequal
pupils and decreasing level of consciousness. What should the nurse
suspect?
A. Hypoglycemia
B. Increased intracranial pressure
C. Peripheral neuropathy
D. Orthostatic hypotension
Answer: B. Increased intracranial pressure
Rationale: Acute pupillary asymmetry combined with declining consciousness
can indicate increased intracranial pressure or brain herniation and requires
immediate evaluation.*
3. Which assessment finding most strongly suggests hypovolemic shock?
A. Bounding peripheral pulses
B. Warm, flushed skin
C. Tachycardia with cool, clammy skin
D. Bradycardia with hypertension
Answer: C. Tachycardia with cool, clammy skin
Rationale: Hypovolemia activates sympathetic compensation, producing
tachycardia and peripheral vasoconstriction that causes cool, clammy skin.*
4. A patient with chest pain has a blood pressure of 86/54 mmHg, heart rate
118/min, and cool skin. Which assessment finding is most concerning?
A. Pain score of 7/10
B. Heart rate of 118/min
C. Hypotension with signs of poor perfusion
D. Patient reports anxiety
Answer: C. Hypotension with signs of poor perfusion
,Rationale: Hypotension accompanied by cool skin suggests inadequate tissue
perfusion and possible cardiogenic or other forms of shock.*
5. When assessing peripheral pulses, which documentation is most clinically
useful?
A. Pulses present
B. Pulses normal
C. Radial pulses 2+ bilaterally and equal
D. Good circulation
Answer: C. Radial pulses 2+ bilaterally and equal
Rationale: Specific documentation of pulse location, strength, symmetry, and
grading provides objective information that can be compared over time.*
6. A patient with diabetes becomes confused and diaphoretic. Which
assessment should the nurse perform first?
A. Assess bowel sounds
B. Check capillary blood glucose
C. Assess deep tendon reflexes
D. Obtain a full nutritional history
Answer: B. Check capillary blood glucose
Rationale: Confusion and diaphoresis are classic manifestations of
hypoglycemia. Rapid glucose assessment is appropriate because untreated
hypoglycemia can rapidly become life-threatening.*
7. Which finding is most characteristic of left-sided heart failure?
A. Jugular venous distention
B. Dependent peripheral edema
C. Pulmonary crackles and dyspnea
D. Enlarged liver
Answer: C. Pulmonary crackles and dyspnea
, Rationale: Left ventricular dysfunction causes pulmonary congestion, producing
dyspnea, orthopnea, and crackles. Right-sided failure more commonly produces
systemic venous congestion.*
8. Which assessment technique should generally be performed first when
examining the abdomen?
A. Palpation
B. Percussion
C. Auscultation
D. Deep palpation
Answer: C. Auscultation
Rationale: Palpation and percussion can alter bowel sounds. Therefore, the
abdomen is generally assessed using inspection, auscultation, percussion, and
palpation.*
9. A patient has severe abdominal pain and a rigid, board-like abdomen. What
does this finding suggest?
A. Constipation
B. Peritonitis
C. Gastroesophageal reflux
D. Functional bowel disorder
Answer: B. Peritonitis
Rationale: A rigid abdomen with severe pain can indicate peritoneal irritation
and requires urgent evaluation for conditions such as perforation or intra-
abdominal infection.*
10.Which assessment finding is most consistent with dehydration?
A. Bounding pulse
B. Moist mucous membranes
C. Orthostatic blood pressure changes
D. Increased urine output
Patient Assessment Competency Exam
— Code: NUR-ASSESS | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is assessing a patient who reports new-onset shortness of breath.
Which finding requires the most immediate intervention?
A. Respiratory rate of 24/min
B. Oxygen saturation of 91%
C. Use of accessory muscles with inability to speak full sentences
D. Mild bilateral expiratory wheezing
Answer: C. Use of accessory muscles with inability to speak full sentences
Rationale: Inability to speak full sentences with accessory-muscle use indicates
significant respiratory distress and possible impending respiratory failure. This
finding takes priority over isolated mild tachypnea or wheezing.*
, 2. During a neurological assessment, a patient suddenly develops unequal
pupils and decreasing level of consciousness. What should the nurse
suspect?
A. Hypoglycemia
B. Increased intracranial pressure
C. Peripheral neuropathy
D. Orthostatic hypotension
Answer: B. Increased intracranial pressure
Rationale: Acute pupillary asymmetry combined with declining consciousness
can indicate increased intracranial pressure or brain herniation and requires
immediate evaluation.*
3. Which assessment finding most strongly suggests hypovolemic shock?
A. Bounding peripheral pulses
B. Warm, flushed skin
C. Tachycardia with cool, clammy skin
D. Bradycardia with hypertension
Answer: C. Tachycardia with cool, clammy skin
Rationale: Hypovolemia activates sympathetic compensation, producing
tachycardia and peripheral vasoconstriction that causes cool, clammy skin.*
4. A patient with chest pain has a blood pressure of 86/54 mmHg, heart rate
118/min, and cool skin. Which assessment finding is most concerning?
A. Pain score of 7/10
B. Heart rate of 118/min
C. Hypotension with signs of poor perfusion
D. Patient reports anxiety
Answer: C. Hypotension with signs of poor perfusion
,Rationale: Hypotension accompanied by cool skin suggests inadequate tissue
perfusion and possible cardiogenic or other forms of shock.*
5. When assessing peripheral pulses, which documentation is most clinically
useful?
A. Pulses present
B. Pulses normal
C. Radial pulses 2+ bilaterally and equal
D. Good circulation
Answer: C. Radial pulses 2+ bilaterally and equal
Rationale: Specific documentation of pulse location, strength, symmetry, and
grading provides objective information that can be compared over time.*
6. A patient with diabetes becomes confused and diaphoretic. Which
assessment should the nurse perform first?
A. Assess bowel sounds
B. Check capillary blood glucose
C. Assess deep tendon reflexes
D. Obtain a full nutritional history
Answer: B. Check capillary blood glucose
Rationale: Confusion and diaphoresis are classic manifestations of
hypoglycemia. Rapid glucose assessment is appropriate because untreated
hypoglycemia can rapidly become life-threatening.*
7. Which finding is most characteristic of left-sided heart failure?
A. Jugular venous distention
B. Dependent peripheral edema
C. Pulmonary crackles and dyspnea
D. Enlarged liver
Answer: C. Pulmonary crackles and dyspnea
, Rationale: Left ventricular dysfunction causes pulmonary congestion, producing
dyspnea, orthopnea, and crackles. Right-sided failure more commonly produces
systemic venous congestion.*
8. Which assessment technique should generally be performed first when
examining the abdomen?
A. Palpation
B. Percussion
C. Auscultation
D. Deep palpation
Answer: C. Auscultation
Rationale: Palpation and percussion can alter bowel sounds. Therefore, the
abdomen is generally assessed using inspection, auscultation, percussion, and
palpation.*
9. A patient has severe abdominal pain and a rigid, board-like abdomen. What
does this finding suggest?
A. Constipation
B. Peritonitis
C. Gastroesophageal reflux
D. Functional bowel disorder
Answer: B. Peritonitis
Rationale: A rigid abdomen with severe pain can indicate peritoneal irritation
and requires urgent evaluation for conditions such as perforation or intra-
abdominal infection.*
10.Which assessment finding is most consistent with dehydration?
A. Bounding pulse
B. Moist mucous membranes
C. Orthostatic blood pressure changes
D. Increased urine output
