NR-302 – Health Assessment II Advanced Physical
Examination Study Guide, Clinical Assessment
Techniques, Diagnostic Skills, Patient Evaluation, and
Comprehensive Review
Question 1
A nurse is preparing to examine a patient's skin using palpation. Which part of the
hand is BEST for assessing skin temperature?
A) Fingertips
B) Dorsal surface of the hand
C) Palmar surface of the hand
D) Ulnar surface of the hand
E) Thumb and index finger
Answer: B) Dorsal surface of the hand
Rationale: The dorsal (back) surface of the hand is most sensitive to temperature
because the skin is thinner and contains more temperature-sensitive nerve endings.
Fingertips are best for fine tactile discrimination (texture, pulses, lymph nodes).
The palmar surface is used for general palpation. The ulnar surface is best for
detecting vibration.
Question 2
A 58-year-old male presents with acute onset of severe, tearing chest pain radiating
to the back. His blood pressure is 160/90 mmHg in the right arm and 100/60
mmHg in the left arm. What is the priority differential diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with tearing chest/back pain and
asymmetric blood pressures due to differential involvement of the subclavian
,arteries. Myocardial infarction pain is more often substernal pressure; pulmonary
embolism presents with dyspnea/pleuritic pain; pericarditis pain is sharp and
positional.
Question 3
A nurse observes a flat, circumscribed lesion less than 1 cm in diameter that is a
change in skin color only. This should be documented as a:
A) Papule
B) Nodule
C) Macule
D) Vesicle
E) Pustule
Answer: C) Macule
Rationale: A macule is a flat, nonpalpable change in skin color, <1 cm (e.g.,
freckle, petechiae). A patch is >1 cm. A papule is elevated, solid, <1 cm. A nodule
is solid, elevated, >1 cm. A vesicle is elevated, fluid-filled, <1 cm. A pustule is
elevated and pus-filled.
Question 4
A patient has a skin lesion with irregular borders, asymmetry, color variation, and
a diameter of 7 mm. The nurse should:
A) Document as a benign nevus
B) Recognize these as ABCDE features of melanoma and report to the provider
C) Apply topical antibiotic
D) Reassure the patient it is a normal age-related change
E) Schedule follow-up in 6 months
Answer: B) Recognize these as ABCDE features of melanoma and report to
the provider
Rationale: The ABCDE rule for melanoma: A – Asymmetry, B – Border
irregularity, C – Color variation, D – Diameter >6 mm, E – Evolving. Any lesion
with these features requires immediate provider evaluation and possible biopsy.
,Question 5
A 34-year-old woman reports episodic palpitations, sweating, headache, and
anxiety. During an episode, her blood pressure is 210/110 mmHg. Between
episodes, the exam is normal. Which diagnosis should the nurse prioritize?
A) Panic disorder
B) Pheochromocytoma
C) Hyperthyroidism
D) Mitral valve prolapse
Answer: B) Pheochromocytoma
Rationale: Pheochromocytoma (adrenal medulla tumor) causes paroxysmal
hypertension, headache, palpitations, and diaphoresis. Panic disorder does not
cause severe hypertension. Hyperthyroidism causes persistent tachycardia, not
episodic. MVP may cause palpitations but not severe BP spikes.
Question 6
What is the correct order of the four physical examination techniques from least to
most invasive?
A) Palpation, Inspection, Percussion, Auscultation
B) Inspection, Palpation, Percussion, Auscultation
C) Inspection, Auscultation, Palpation, Percussion
D) Auscultation, Inspection, Percussion, Palpation
Answer: C) Inspection, Auscultation, Palpation, Percussion
Rationale: For abdominal assessment, the order is Inspection, Auscultation,
Percussion, Palpation because palpation and percussion can alter bowel sounds.
For other systems, the order is Inspection, Palpation, Percussion, Auscultation. The
general principle is to use the least invasive technique first to avoid altering
findings.
Question 7
A 72-year-old male with a history of hypertension presents with acute onset of
right-sided weakness and aphasia. His symptoms began 90 minutes ago. What is
the most time-sensitive diagnostic step?
, A) Lumbar puncture
B) Non-contrast head CT
C) EEG
D) Carotid ultrasound
Answer: B) Non-contrast head CT
Rationale: For acute stroke, a non-contrast head CT is the first test to rule out
hemorrhage before thrombolytics. The time window for tPA is within 3-4.5 hours.
Lumbar puncture is for meningitis/SAH after imaging. EEG is for seizures. Carotid
ultrasound is not emergent.
Question 8
A nurse is assessing a patient's liver span. Which technique should be used to
accurately determine liver size?
A) Inspection only
B) Auscultation for bruits
C) Percussion of the liver borders
D) Deep palpation in the right upper quadrant
Answer: C) Percussion of the liver borders
Rationale: Percussion is the most accurate technique for determining liver span.
The nurse percusses from the right midclavicular line, starting below the umbilicus
and moving upward until dullness is detected (inferior border), then from the lung
area downward until dullness is detected (superior border). The distance between
these points is the liver span (normally 6-12 cm).
Question 9
A 45-year-old homeless client presents with cough, night sweats, weight loss, and
hemoptysis. Which finding on chest auscultation is most consistent with advanced
tuberculosis?
A) Vesicular breath sounds
B) Bronchial breath sounds and crackles in the upper lobes
C) Diminished breath sounds at bases
D) Wheezing throughout
Examination Study Guide, Clinical Assessment
Techniques, Diagnostic Skills, Patient Evaluation, and
Comprehensive Review
Question 1
A nurse is preparing to examine a patient's skin using palpation. Which part of the
hand is BEST for assessing skin temperature?
A) Fingertips
B) Dorsal surface of the hand
C) Palmar surface of the hand
D) Ulnar surface of the hand
E) Thumb and index finger
Answer: B) Dorsal surface of the hand
Rationale: The dorsal (back) surface of the hand is most sensitive to temperature
because the skin is thinner and contains more temperature-sensitive nerve endings.
Fingertips are best for fine tactile discrimination (texture, pulses, lymph nodes).
The palmar surface is used for general palpation. The ulnar surface is best for
detecting vibration.
Question 2
A 58-year-old male presents with acute onset of severe, tearing chest pain radiating
to the back. His blood pressure is 160/90 mmHg in the right arm and 100/60
mmHg in the left arm. What is the priority differential diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with tearing chest/back pain and
asymmetric blood pressures due to differential involvement of the subclavian
,arteries. Myocardial infarction pain is more often substernal pressure; pulmonary
embolism presents with dyspnea/pleuritic pain; pericarditis pain is sharp and
positional.
Question 3
A nurse observes a flat, circumscribed lesion less than 1 cm in diameter that is a
change in skin color only. This should be documented as a:
A) Papule
B) Nodule
C) Macule
D) Vesicle
E) Pustule
Answer: C) Macule
Rationale: A macule is a flat, nonpalpable change in skin color, <1 cm (e.g.,
freckle, petechiae). A patch is >1 cm. A papule is elevated, solid, <1 cm. A nodule
is solid, elevated, >1 cm. A vesicle is elevated, fluid-filled, <1 cm. A pustule is
elevated and pus-filled.
Question 4
A patient has a skin lesion with irregular borders, asymmetry, color variation, and
a diameter of 7 mm. The nurse should:
A) Document as a benign nevus
B) Recognize these as ABCDE features of melanoma and report to the provider
C) Apply topical antibiotic
D) Reassure the patient it is a normal age-related change
E) Schedule follow-up in 6 months
Answer: B) Recognize these as ABCDE features of melanoma and report to
the provider
Rationale: The ABCDE rule for melanoma: A – Asymmetry, B – Border
irregularity, C – Color variation, D – Diameter >6 mm, E – Evolving. Any lesion
with these features requires immediate provider evaluation and possible biopsy.
,Question 5
A 34-year-old woman reports episodic palpitations, sweating, headache, and
anxiety. During an episode, her blood pressure is 210/110 mmHg. Between
episodes, the exam is normal. Which diagnosis should the nurse prioritize?
A) Panic disorder
B) Pheochromocytoma
C) Hyperthyroidism
D) Mitral valve prolapse
Answer: B) Pheochromocytoma
Rationale: Pheochromocytoma (adrenal medulla tumor) causes paroxysmal
hypertension, headache, palpitations, and diaphoresis. Panic disorder does not
cause severe hypertension. Hyperthyroidism causes persistent tachycardia, not
episodic. MVP may cause palpitations but not severe BP spikes.
Question 6
What is the correct order of the four physical examination techniques from least to
most invasive?
A) Palpation, Inspection, Percussion, Auscultation
B) Inspection, Palpation, Percussion, Auscultation
C) Inspection, Auscultation, Palpation, Percussion
D) Auscultation, Inspection, Percussion, Palpation
Answer: C) Inspection, Auscultation, Palpation, Percussion
Rationale: For abdominal assessment, the order is Inspection, Auscultation,
Percussion, Palpation because palpation and percussion can alter bowel sounds.
For other systems, the order is Inspection, Palpation, Percussion, Auscultation. The
general principle is to use the least invasive technique first to avoid altering
findings.
Question 7
A 72-year-old male with a history of hypertension presents with acute onset of
right-sided weakness and aphasia. His symptoms began 90 minutes ago. What is
the most time-sensitive diagnostic step?
, A) Lumbar puncture
B) Non-contrast head CT
C) EEG
D) Carotid ultrasound
Answer: B) Non-contrast head CT
Rationale: For acute stroke, a non-contrast head CT is the first test to rule out
hemorrhage before thrombolytics. The time window for tPA is within 3-4.5 hours.
Lumbar puncture is for meningitis/SAH after imaging. EEG is for seizures. Carotid
ultrasound is not emergent.
Question 8
A nurse is assessing a patient's liver span. Which technique should be used to
accurately determine liver size?
A) Inspection only
B) Auscultation for bruits
C) Percussion of the liver borders
D) Deep palpation in the right upper quadrant
Answer: C) Percussion of the liver borders
Rationale: Percussion is the most accurate technique for determining liver span.
The nurse percusses from the right midclavicular line, starting below the umbilicus
and moving upward until dullness is detected (inferior border), then from the lung
area downward until dullness is detected (superior border). The distance between
these points is the liver span (normally 6-12 cm).
Question 9
A 45-year-old homeless client presents with cough, night sweats, weight loss, and
hemoptysis. Which finding on chest auscultation is most consistent with advanced
tuberculosis?
A) Vesicular breath sounds
B) Bronchial breath sounds and crackles in the upper lobes
C) Diminished breath sounds at bases
D) Wheezing throughout
