NR414 Exam 2: Health Assessment Across the Lifespan V2
Updated and Latest Questions and Correct Answers- Regis
University
1. Which assessment technique should be performed first when examining the abdomen of
a patient?
A. Palpation
B. Inspection
C. Percussion
D. Auscultation
Correct Answer: B
Explanation: The nurse must always begin with inspection to observe visual abnormalities. Following
inspection, auscultation is performed to listen for bowel sounds. Percussion and palpation are performed
last in the abdominal assessment sequence. This order prevents the manipulation of bowel sounds by
manual contact. Inspection involves looking at the skin color and abdominal contour. The nurse also
checks for any visible pulsations or masses. Proper sequencing ensures the most accurate clinical data is
collected. Altering the order could result in false-positive findings regarding bowel activity. Nurses
should document findings for each quadrant of the abdomen. Consistency in technique is vital for
professional nursing practice standards.
2. When assessing an older adult, which skin finding is considered a normal part of the aging
process?
A. Cherry angiomas
B. Increased skin elasticity
C. Turgor that returns instantly
D. Thickening of the dermis
Correct Answer: A
Explanation: Aging causes a decrease in the overall elasticity of the skin. Cherry angiomas are small, red,
benign vascular lesions commonly seen in seniors. They are considered a normal age-related finding
rather than a pathology. The dermis actually becomes thinner as a person ages over time. Skin turgor
typically decreases due to a loss of subcutaneous fat. This makes the skin appear more fragile and prone
to bruising. Nurses should distinguish between normal aging and signs of skin cancer. Documentation of
these lesions helps track changes in the patient’s condition. Senile lentigines or ‘age spots’ are also
common in this population. Understanding these changes prevents unnecessary alarm for the elderly
patient.
,3. A nurse hears a high-pitched, scratchy sound at the left lower sternal border; this is likely:
A. Pericardial friction rub
B. S4 heart sound
C. S3 heart sound
D. Mitral valve murmur
Correct Answer: A
Explanation: A pericardial friction rub is a hallmark sign of pericarditis. It is described as a high-pitched,
scratchy, or leathery sound. The sound is best heard with the diaphragm at the apex. It occurs when the
inflamed layers of the pericardium rub together. The nurse should ask the patient to hold their breath. If
the sound persists, it is cardiac rather than pleural. S3 and S4 sounds are lower in pitch than rubs.
Murmurs usually have a blowing or swooshing quality to them. Friction rubs can be transient and vary
with the patient’s position. This finding requires prompt notification to the healthcare provider for
evaluation.
4. What is the primary purpose of using the Snellen chart during a physical exam?
A. To check for color blindness
B. To assess visual acuity
C. To assess near vision
D. To measure intraocular pressure
Correct Answer: B
Explanation: Visual acuity is the measure of the eye’s ability to see. The Snellen chart is the standard tool
for distance vision testing. The patient stands exactly 20 feet away from the wall chart. Results are
recorded as a fraction, such as 20/20 or 20/40. The numerator represents the distance the patient is
from the chart. The denominator indicates the distance at which a normal eye sees. Near vision is
typically assessed using a handheld Jaeger card. Color blindness is usually tested with Ishihara plates in a
clinic. Intraocular pressure is measured using a tonometer by an eye specialist. Regular screening helps
detect refractive errors in the general population.
5. In the PQRST mnemonic for pain assessment, what does the ‘Q’ represent?
A. Quantity
B. Quivering
C. Quickness
D. Quality
Correct Answer: D
, Explanation: Pain assessment is often referred to as the fifth vital sign. The ‘Q’ in PQRST stands for the
quality of pain. Nurses ask patients to describe the sensation they are feeling. Common descriptors
include sharp, dull, burning, or even stabbing sensations. Quality helps the clinician identify the potential
source of the pain. For instance, burning pain often suggests a neuropathic or nerve issue. This subjective
data is crucial for developing an effective care plan. Proper assessment ensures that interventions are
tailored to the patient’s needs. The mnemonic provides a systematic approach to evaluating complex
symptoms. Documentation must reflect the specific words used by the patient.
6. Which breath sound is considered normal when heard over the majority of the lung
fields?
A. Bronchial
B. Bronchovesicular
C. Adventitious
D. Vesicular
Correct Answer: D
Explanation: Vesicular breath sounds are soft and low-pitched in their character. They are heard over
the peripheral lung fields where air flows. Inspiration is longer than expiration when listening to
vesicular sounds. Bronchial sounds are heard over the trachea and are louder. Bronchovesicular sounds
are heard over the major bronchi and mid-chest. Adventitious sounds refer to abnormal sounds like
crackles or wheezes. Recognizing normal sounds is a fundamental skill for nursing students. The nurse
uses the diaphragm of the stethoscope for lung auscultation. Lung fields should be compared side-to-side
in a ladder pattern. Correct identification helps in diagnosing pneumonia or chronic lung disease.
7. Which developmental stage is associated with Erikson’s ‘Industry vs. Inferiority’?
A. Toddler
B. Preschooler
C. School-age child
D. Adolescent
Correct Answer: C
Explanation: Erikson’s stages describe the psychosocial development of individuals across time. The
school-age stage typically ranges from ages 6 to 12. Children at this stage strive to master new academic
skills. Success leads to a sense of industry and personal competence. Failure or lack of support can lead to
feelings of inferiority. Teachers and peers play a significant role in this development. Nurses should
assess if the child is meeting these milestones. Developmental assessments are integrated into every
pediatric physical examination. Encouragement and positive reinforcement are key for children in this
group. Understanding these stages helps the nurse communicate more effectively with children.
Updated and Latest Questions and Correct Answers- Regis
University
1. Which assessment technique should be performed first when examining the abdomen of
a patient?
A. Palpation
B. Inspection
C. Percussion
D. Auscultation
Correct Answer: B
Explanation: The nurse must always begin with inspection to observe visual abnormalities. Following
inspection, auscultation is performed to listen for bowel sounds. Percussion and palpation are performed
last in the abdominal assessment sequence. This order prevents the manipulation of bowel sounds by
manual contact. Inspection involves looking at the skin color and abdominal contour. The nurse also
checks for any visible pulsations or masses. Proper sequencing ensures the most accurate clinical data is
collected. Altering the order could result in false-positive findings regarding bowel activity. Nurses
should document findings for each quadrant of the abdomen. Consistency in technique is vital for
professional nursing practice standards.
2. When assessing an older adult, which skin finding is considered a normal part of the aging
process?
A. Cherry angiomas
B. Increased skin elasticity
C. Turgor that returns instantly
D. Thickening of the dermis
Correct Answer: A
Explanation: Aging causes a decrease in the overall elasticity of the skin. Cherry angiomas are small, red,
benign vascular lesions commonly seen in seniors. They are considered a normal age-related finding
rather than a pathology. The dermis actually becomes thinner as a person ages over time. Skin turgor
typically decreases due to a loss of subcutaneous fat. This makes the skin appear more fragile and prone
to bruising. Nurses should distinguish between normal aging and signs of skin cancer. Documentation of
these lesions helps track changes in the patient’s condition. Senile lentigines or ‘age spots’ are also
common in this population. Understanding these changes prevents unnecessary alarm for the elderly
patient.
,3. A nurse hears a high-pitched, scratchy sound at the left lower sternal border; this is likely:
A. Pericardial friction rub
B. S4 heart sound
C. S3 heart sound
D. Mitral valve murmur
Correct Answer: A
Explanation: A pericardial friction rub is a hallmark sign of pericarditis. It is described as a high-pitched,
scratchy, or leathery sound. The sound is best heard with the diaphragm at the apex. It occurs when the
inflamed layers of the pericardium rub together. The nurse should ask the patient to hold their breath. If
the sound persists, it is cardiac rather than pleural. S3 and S4 sounds are lower in pitch than rubs.
Murmurs usually have a blowing or swooshing quality to them. Friction rubs can be transient and vary
with the patient’s position. This finding requires prompt notification to the healthcare provider for
evaluation.
4. What is the primary purpose of using the Snellen chart during a physical exam?
A. To check for color blindness
B. To assess visual acuity
C. To assess near vision
D. To measure intraocular pressure
Correct Answer: B
Explanation: Visual acuity is the measure of the eye’s ability to see. The Snellen chart is the standard tool
for distance vision testing. The patient stands exactly 20 feet away from the wall chart. Results are
recorded as a fraction, such as 20/20 or 20/40. The numerator represents the distance the patient is
from the chart. The denominator indicates the distance at which a normal eye sees. Near vision is
typically assessed using a handheld Jaeger card. Color blindness is usually tested with Ishihara plates in a
clinic. Intraocular pressure is measured using a tonometer by an eye specialist. Regular screening helps
detect refractive errors in the general population.
5. In the PQRST mnemonic for pain assessment, what does the ‘Q’ represent?
A. Quantity
B. Quivering
C. Quickness
D. Quality
Correct Answer: D
, Explanation: Pain assessment is often referred to as the fifth vital sign. The ‘Q’ in PQRST stands for the
quality of pain. Nurses ask patients to describe the sensation they are feeling. Common descriptors
include sharp, dull, burning, or even stabbing sensations. Quality helps the clinician identify the potential
source of the pain. For instance, burning pain often suggests a neuropathic or nerve issue. This subjective
data is crucial for developing an effective care plan. Proper assessment ensures that interventions are
tailored to the patient’s needs. The mnemonic provides a systematic approach to evaluating complex
symptoms. Documentation must reflect the specific words used by the patient.
6. Which breath sound is considered normal when heard over the majority of the lung
fields?
A. Bronchial
B. Bronchovesicular
C. Adventitious
D. Vesicular
Correct Answer: D
Explanation: Vesicular breath sounds are soft and low-pitched in their character. They are heard over
the peripheral lung fields where air flows. Inspiration is longer than expiration when listening to
vesicular sounds. Bronchial sounds are heard over the trachea and are louder. Bronchovesicular sounds
are heard over the major bronchi and mid-chest. Adventitious sounds refer to abnormal sounds like
crackles or wheezes. Recognizing normal sounds is a fundamental skill for nursing students. The nurse
uses the diaphragm of the stethoscope for lung auscultation. Lung fields should be compared side-to-side
in a ladder pattern. Correct identification helps in diagnosing pneumonia or chronic lung disease.
7. Which developmental stage is associated with Erikson’s ‘Industry vs. Inferiority’?
A. Toddler
B. Preschooler
C. School-age child
D. Adolescent
Correct Answer: C
Explanation: Erikson’s stages describe the psychosocial development of individuals across time. The
school-age stage typically ranges from ages 6 to 12. Children at this stage strive to master new academic
skills. Success leads to a sense of industry and personal competence. Failure or lack of support can lead to
feelings of inferiority. Teachers and peers play a significant role in this development. Nurses should
assess if the child is meeting these milestones. Developmental assessments are integrated into every
pediatric physical examination. Encouragement and positive reinforcement are key for children in this
group. Understanding these stages helps the nurse communicate more effectively with children.
