NUR 103 – Health Assessment FINAL EXAM 2026-2027
LATEST UPDATED VERSION QUESTIONS AND ANSWERS
A nurse working on a surgical floor observes an unlicensed assistive personnel (UAP) completing
assigned tasks. Which situation requires the nurse to intervene?
A. turning a client who is 24 hours post-op laminectomy
B. bathing a bedridden client who has bilateral leg amputations
C. assisting a client who is 16 hours post-op hemorrhoidectomy out of bed
D. repositioning a client who is 12 hours post-op partial hysterectom
A. turning a client who is 24 hours post-op laminectomy
A client was diagnosed with having right subarachnoid hemorrhage. The nurse should plan to place the
client in which position?
A. with the head of the bed elevated
B. on the right side
C. on the left side
D. flat in bed
A. with the head of the bed elevated
The nurse is reviewing the medical record for a client in a long-term care facility. The nurse notes an
entry by the primary care physician indicating the client is colorblind. The nurse understands this
condition results from a problem with which structure(s) of the eye?
A. Rods
B. Cones
C. Lens
D. Aqueous humor
B. Cones
,A client is newly diagnosed with myasthenia gravis. When reinforcing education what should the nurse
indicate as the cause of this disease?
A. a postviral illness characterized by ascending paralysis
B. loss of the myelin sheath surrounding peripheral nerves
C. inability of basal ganglia to produce sufficient dopamine
D. destruction of acetylcholine receptors, causing muscle weakness
D. destruction of acetylcholine receptors, causing muscle weakness
A home health nurse visits a client who's taking pilocarpine, a miotic agent, to treat glaucoma. The
nurse notes that the client's pilocarpine solution is cloudy. What should the nurse do first?
A. Advise the client to discard the drug because it may have undergone chemical changes or become
contaminated.
B. Advise the client to obtain a fresh container of pilocarpine solution to avoid omitting prescribed
doses.
C. Observe the client or a family member administer the drug to determine possible contamination
sources.
D. Advise the client to keep the container closed tightly and protected from light.
A. Advise the client to discard the drug because it may have undergone chemical changes or become
contaminated.
The nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding should
the nurse consider abnormal?
A. More back pain than the first postoperative day
B. Paresthesia in the dermatomes near the wounds
C. Urine retention or incontinence
D. Temperature of 99.2° F (37.3° C)
,C. Urine retention or incontinence
A young child has had multiple ear infections and is brought to the clinic screaming and holding the
right ear. Which most common complication related to acute otitis media does the nurse expect this
client is experiencing?
A. eardrum perforation
B. hearing loss
C. meningitis
D. tympanosclerosis
A. eardrum perforation
A client with quadriplegia is apprehensive and flushed, with a blood pressure of 210/100 mm Hg and
heart rate of 50 beats/minute. Which nursing intervention should be done first?
A. Place the client flat in bed.
B. Check patency of the indwelling urinary catheter.
C. Give one sublingual nitroglycerin tablet.
D. Raise the head of the bed immediately to 90 degrees.
D. Raise the head of the bed immediately to 90 degrees.
A client accidentally splashes chemicals into his eye. The nurse knows that eye irrigation with plain tap
water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this
first-aid treatment?
, A. To hasten formation of scar tissue
B. To prevent vision loss
C. To eliminate the need for medical care
D. To serve as a stopgap measure until help arrives
B. To prevent vision loss
A client is diagnosed with a conductive hearing loss. After performing the Weber's test, where will the
nurse document that this client heard sounds?
A. On the affected side by bone conduction
B. On the unaffected side
C. Longer through bone than air conduction
D. By neither air nor bone conduction
A. On the affected side by bone conduction
A client with quadriplegia is in spinal shock. What should the nurse expect?
A. Absence of reflexes along with flaccid extremities
B. Positive Babinski's reflex along with spastic extremities
C. Hyperreflexia along with spastic extremities
D. Spasticity of all four extremities
A. Absence of reflexes along with flaccid extremities
A client's chronic, progressive hearing loss results from excess bone formation around the oval window,
which impedes normal stapes movement and prevents sound transmission. The nursing student is
researching the disorder. What is the clinical terminology for this correctable middle ear disorder that
the student would utilize in her research?
A. Stapes immobilization
LATEST UPDATED VERSION QUESTIONS AND ANSWERS
A nurse working on a surgical floor observes an unlicensed assistive personnel (UAP) completing
assigned tasks. Which situation requires the nurse to intervene?
A. turning a client who is 24 hours post-op laminectomy
B. bathing a bedridden client who has bilateral leg amputations
C. assisting a client who is 16 hours post-op hemorrhoidectomy out of bed
D. repositioning a client who is 12 hours post-op partial hysterectom
A. turning a client who is 24 hours post-op laminectomy
A client was diagnosed with having right subarachnoid hemorrhage. The nurse should plan to place the
client in which position?
A. with the head of the bed elevated
B. on the right side
C. on the left side
D. flat in bed
A. with the head of the bed elevated
The nurse is reviewing the medical record for a client in a long-term care facility. The nurse notes an
entry by the primary care physician indicating the client is colorblind. The nurse understands this
condition results from a problem with which structure(s) of the eye?
A. Rods
B. Cones
C. Lens
D. Aqueous humor
B. Cones
,A client is newly diagnosed with myasthenia gravis. When reinforcing education what should the nurse
indicate as the cause of this disease?
A. a postviral illness characterized by ascending paralysis
B. loss of the myelin sheath surrounding peripheral nerves
C. inability of basal ganglia to produce sufficient dopamine
D. destruction of acetylcholine receptors, causing muscle weakness
D. destruction of acetylcholine receptors, causing muscle weakness
A home health nurse visits a client who's taking pilocarpine, a miotic agent, to treat glaucoma. The
nurse notes that the client's pilocarpine solution is cloudy. What should the nurse do first?
A. Advise the client to discard the drug because it may have undergone chemical changes or become
contaminated.
B. Advise the client to obtain a fresh container of pilocarpine solution to avoid omitting prescribed
doses.
C. Observe the client or a family member administer the drug to determine possible contamination
sources.
D. Advise the client to keep the container closed tightly and protected from light.
A. Advise the client to discard the drug because it may have undergone chemical changes or become
contaminated.
The nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding should
the nurse consider abnormal?
A. More back pain than the first postoperative day
B. Paresthesia in the dermatomes near the wounds
C. Urine retention or incontinence
D. Temperature of 99.2° F (37.3° C)
,C. Urine retention or incontinence
A young child has had multiple ear infections and is brought to the clinic screaming and holding the
right ear. Which most common complication related to acute otitis media does the nurse expect this
client is experiencing?
A. eardrum perforation
B. hearing loss
C. meningitis
D. tympanosclerosis
A. eardrum perforation
A client with quadriplegia is apprehensive and flushed, with a blood pressure of 210/100 mm Hg and
heart rate of 50 beats/minute. Which nursing intervention should be done first?
A. Place the client flat in bed.
B. Check patency of the indwelling urinary catheter.
C. Give one sublingual nitroglycerin tablet.
D. Raise the head of the bed immediately to 90 degrees.
D. Raise the head of the bed immediately to 90 degrees.
A client accidentally splashes chemicals into his eye. The nurse knows that eye irrigation with plain tap
water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this
first-aid treatment?
, A. To hasten formation of scar tissue
B. To prevent vision loss
C. To eliminate the need for medical care
D. To serve as a stopgap measure until help arrives
B. To prevent vision loss
A client is diagnosed with a conductive hearing loss. After performing the Weber's test, where will the
nurse document that this client heard sounds?
A. On the affected side by bone conduction
B. On the unaffected side
C. Longer through bone than air conduction
D. By neither air nor bone conduction
A. On the affected side by bone conduction
A client with quadriplegia is in spinal shock. What should the nurse expect?
A. Absence of reflexes along with flaccid extremities
B. Positive Babinski's reflex along with spastic extremities
C. Hyperreflexia along with spastic extremities
D. Spasticity of all four extremities
A. Absence of reflexes along with flaccid extremities
A client's chronic, progressive hearing loss results from excess bone formation around the oval window,
which impedes normal stapes movement and prevents sound transmission. The nursing student is
researching the disorder. What is the clinical terminology for this correctable middle ear disorder that
the student would utilize in her research?
A. Stapes immobilization
