NUR 245 Exam 4: Health Assessment and Promotion –
Questions & Answers with Rationale
TABLE OF CONTENTS
1. Health Assessment Fundamentals
2. Health History and Interviewing
3. Physical Examination Techniques
4. Vital Signs and Pain Assessment
5. Cardiovascular Assessment
6. Respiratory Assessment
7. Neurologic Assessment
8. Gastrointestinal and Genitourinary Assessment
9. Musculoskeletal and Skin Assessment
10.Health Promotion and Disease Prevention
11.Older Adult, Cultural, and Psychosocial Assessment
12.Integrated Assessment and Clinical Judgment
SECTION I — HEALTH ASSESSMENT FUNDAMENTALS
1. What is the primary purpose of a comprehensive health assessment?
A. To diagnose every disease
B. To collect information about the client's health status
C. To prescribe medications
D. To replace laboratory testing
Answer: B. To collect information about the client's health status
,Rationale: Health assessment provides systematic information about physical,
psychological, social, cultural, and functional health status. It supports clinical
judgment and planning of care.
2. Which component of assessment involves collecting information directly
from the client?
A. Objective data
B. Subjective data
C. Laboratory data
D. Diagnostic data
Answer: B. Subjective data
Rationale: Subjective data are symptoms or experiences reported by the
client, such as pain, nausea, fatigue, or dizziness.
3. Which is an example of objective data?
A. "I feel short of breath."
B. "My pain is severe."
C. Respiratory rate of 28/min
D. "I feel dizzy."
Answer: C. Respiratory rate of 28/min
Rationale: Objective data are observable or measurable findings obtained
through examination, observation, or diagnostic testing.
4. Which assessment finding is subjective?
A. Blood pressure 150/90 mmHg
B. Temperature 38.5°C
C. Client reports nausea
D. Oxygen saturation 91%
Answer: C. Client reports nausea
Rationale: Nausea is a symptom reported by the client and therefore
represents subjective data.
,5. Which action should the nurse take first when beginning a physical
assessment?
A. Perform painful procedures
B. Introduce themselves and verify the client's identity
C. Begin auscultation immediately
D. Ask the client to remove all clothing
Answer: B. Introduce themselves and verify the client's identity
Rationale: Proper identification and introduction establish safety,
professionalism, and rapport before assessment begins.
6. Which principle is important when performing a physical assessment?
A. Compare findings bilaterally when appropriate
B. Examine only the symptomatic area
C. Ignore normal variations
D. Avoid documenting negative findings
Answer: A. Compare findings bilaterally when appropriate
Rationale: Comparing corresponding areas helps identify asymmetry and
abnormal findings.
7. What is the purpose of obtaining a baseline assessment?
A. To establish a reference for future comparison
B. To eliminate the need for reassessment
C. To determine insurance coverage
D. To replace the client's health history
Answer: A. To establish a reference for future comparison
Rationale: Baseline findings allow nurses to identify changes in a client's
condition over time.
8. Which finding should the nurse consider when interpreting assessment
data?
, A. The client's age and developmental stage
B. Only the client's diagnosis
C. Only laboratory results
D. The nurse's personal expectations
Answer: A. The client's age and developmental stage
Rationale: Normal assessment findings vary with age and developmental
stage.
9. Which action best promotes accurate assessment data?
A. Ask leading questions
B. Use clear, open-ended questions
C. Interrupt frequently
D. Assume the client's answer
Answer: B. Use clear, open-ended questions
Rationale: Open-ended questions encourage clients to describe their
experiences in their own words.
10. Which finding requires the nurse to validate the assessment?
A. An unexpected abnormal finding
B. A normal pulse
C. A routine demographic detail
D. A documented allergy confirmed by the client
Answer: A. An unexpected abnormal finding
Rationale: Unexpected findings should be reassessed or validated to
determine whether they are accurate before clinical decisions are made.
11. Which assessment technique involves looking at the client?
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
Questions & Answers with Rationale
TABLE OF CONTENTS
1. Health Assessment Fundamentals
2. Health History and Interviewing
3. Physical Examination Techniques
4. Vital Signs and Pain Assessment
5. Cardiovascular Assessment
6. Respiratory Assessment
7. Neurologic Assessment
8. Gastrointestinal and Genitourinary Assessment
9. Musculoskeletal and Skin Assessment
10.Health Promotion and Disease Prevention
11.Older Adult, Cultural, and Psychosocial Assessment
12.Integrated Assessment and Clinical Judgment
SECTION I — HEALTH ASSESSMENT FUNDAMENTALS
1. What is the primary purpose of a comprehensive health assessment?
A. To diagnose every disease
B. To collect information about the client's health status
C. To prescribe medications
D. To replace laboratory testing
Answer: B. To collect information about the client's health status
,Rationale: Health assessment provides systematic information about physical,
psychological, social, cultural, and functional health status. It supports clinical
judgment and planning of care.
2. Which component of assessment involves collecting information directly
from the client?
A. Objective data
B. Subjective data
C. Laboratory data
D. Diagnostic data
Answer: B. Subjective data
Rationale: Subjective data are symptoms or experiences reported by the
client, such as pain, nausea, fatigue, or dizziness.
3. Which is an example of objective data?
A. "I feel short of breath."
B. "My pain is severe."
C. Respiratory rate of 28/min
D. "I feel dizzy."
Answer: C. Respiratory rate of 28/min
Rationale: Objective data are observable or measurable findings obtained
through examination, observation, or diagnostic testing.
4. Which assessment finding is subjective?
A. Blood pressure 150/90 mmHg
B. Temperature 38.5°C
C. Client reports nausea
D. Oxygen saturation 91%
Answer: C. Client reports nausea
Rationale: Nausea is a symptom reported by the client and therefore
represents subjective data.
,5. Which action should the nurse take first when beginning a physical
assessment?
A. Perform painful procedures
B. Introduce themselves and verify the client's identity
C. Begin auscultation immediately
D. Ask the client to remove all clothing
Answer: B. Introduce themselves and verify the client's identity
Rationale: Proper identification and introduction establish safety,
professionalism, and rapport before assessment begins.
6. Which principle is important when performing a physical assessment?
A. Compare findings bilaterally when appropriate
B. Examine only the symptomatic area
C. Ignore normal variations
D. Avoid documenting negative findings
Answer: A. Compare findings bilaterally when appropriate
Rationale: Comparing corresponding areas helps identify asymmetry and
abnormal findings.
7. What is the purpose of obtaining a baseline assessment?
A. To establish a reference for future comparison
B. To eliminate the need for reassessment
C. To determine insurance coverage
D. To replace the client's health history
Answer: A. To establish a reference for future comparison
Rationale: Baseline findings allow nurses to identify changes in a client's
condition over time.
8. Which finding should the nurse consider when interpreting assessment
data?
, A. The client's age and developmental stage
B. Only the client's diagnosis
C. Only laboratory results
D. The nurse's personal expectations
Answer: A. The client's age and developmental stage
Rationale: Normal assessment findings vary with age and developmental
stage.
9. Which action best promotes accurate assessment data?
A. Ask leading questions
B. Use clear, open-ended questions
C. Interrupt frequently
D. Assume the client's answer
Answer: B. Use clear, open-ended questions
Rationale: Open-ended questions encourage clients to describe their
experiences in their own words.
10. Which finding requires the nurse to validate the assessment?
A. An unexpected abnormal finding
B. A normal pulse
C. A routine demographic detail
D. A documented allergy confirmed by the client
Answer: A. An unexpected abnormal finding
Rationale: Unexpected findings should be reassessed or validated to
determine whether they are accurate before clinical decisions are made.
11. Which assessment technique involves looking at the client?
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
