Wilkes University
1 MAXE · 005 GSN
W
Passan School of Nursing
EST. 1933
UNITY AMIDST DIVERSITY
NSG 500 Exam 1 — Summer 2025
A DVA N C E D H E A LT H A SS E SS M E N T: T E C H N I Q U E S , S K I N , H E A D & N E C K
INSTITUTION Wilkes University COURSE CODE NSG 500
PROGRAM Master of Science in Nursing — FNP ACADEMIC YEAR Summer 2025
EXAM TITLE NSG 500 Exam 1 — Summer 2025 TOTAL QUESTIONS 85 Questions
COURSE TITLE Advanced Health Assessment FORMAT Multiple Choice — Select the Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Assessment techniques (inspection, palpation, percussion, auscultation), skin lesions, lymph node evaluation, thyroid assessment,
headache types, pain assessment, and pregnancy-related skin changes are all testable content.
▸ ABCDEs of melanoma, primary and secondary skin lesions, infectious conditions, and newborn assessment are emphasized.
▸ Correct answers and clinical rationales appear below each question for comprehensive exam preparation.
▸ All content reflects advanced health assessment standards and NSG 500 course objectives.
SECTION I — ADVANCED HEALTH ASSESSMENT: INTERVIEWING THROUGH
Questions 1 – 85
DERMATOLOGY
1. The four steps of physical assessment, in correct order, are:
A. Auscultation, percussion, palpation, inspection
B. Inspection, palpation, percussion, auscultation
C. Palpation, inspection, auscultation, percussion
D. Percussion, auscultation, inspection, palpation
CORRECT ANSWER B — Inspection, palpation, percussion, auscultation
RATIONALE The standard sequence for physical assessment is: Inspection (observation — using eyes and nose to gather
data about color, moisture, odor, hygiene, gait, stance), Palpation (using hands and fingers to gather
information through touch — texture, temperature, moisture, tenderness), Percussion (striking one object
against another to produce vibrations and sound waves — resonance), and Auscultation (listening to sounds,
typically with a stethoscope). The exception to this order is the abdominal exam, where auscultation should
be performed BEFORE palpation and percussion to avoid altering bowel sounds. Choice A reverses the order.
Choice C and D are incorrect sequences. This systematic approach ensures comprehensive data collection
and is foundational to advanced health assessment.
,2. If a patient isn't giving you the answers you're looking for, what's the best way to get the needed information?
A. Continue asking open-ended questions until they answer
B. Use direct questions or qualifier questions to focus the patient on specific information
C. Skip the topic and return to it later
D. Ask a family member instead
CORRECT ANSWER B — Use direct questions or qualifier questions
RATIONALE When open-ended questions ("Tell me about your pain") yield vague or off-target responses, the skilled
interviewer transitions to direct or qualifier questions: "Is the pain sharp or dull?" "Does it radiate
anywhere?" "On a scale of 1–10, how severe is it?" This focused approach helps patients provide specific,
clinically useful information without leading them to a particular answer. Continuing open-ended questions
(Choice A) may be frustrating for both parties. Skipping the topic (Choice C) may miss critical information.
Family members (Choice D) should supplement, not replace, the patient's own report when possible. The
NSG 500 emphasizes adapting interview technique to the clinical situation — starting broad, then narrowing
as needed.
3. Inspection as an assessment technique includes observing all of the following EXCEPT:
A. Color, moisture, and odor
B. Hygiene and clothing
C. Gait and stance
D. Deep tendon reflexes
CORRECT ANSWER D — Deep tendon reflexes
RATIONALE Inspection is the process of observation — using eyes and nose to gather data. It includes observing color,
moisture, odor, hygiene, clothing, gait, stance, ease of movement, and whether the patient makes eye
contact. Deep tendon reflexes (Choice D) are assessed using a percussion (reflex) hammer — this is a
separate technique, not part of inspection. Inspection begins the moment you first see the patient and
continues throughout the examination. It is the most underutilized yet information-rich assessment
technique. The NSG 500 emphasizes that inspection requires intentional, systematic observation — noting
both obvious findings and subtle cues about the patient's overall health status, emotional state, and
functional abilities.
,4. What is the best way to ask a patient to share their story?
A. Use direct, yes/no questions for efficiency
B. Use open-ended questions that invite the patient to describe their experience in their own words
C. Provide a written questionnaire
D. Ask the patient's family member to explain
CORRECT ANSWER B — Use open-ended questions
RATIONALE Open-ended questions ("Tell me what brought you in today," "Describe how this has been affecting you")
invite patients to share their narrative in their own words, providing rich, contextual information that closed-
ended questions miss. This approach builds rapport, demonstrates respect for the patient's perspective, and
often reveals concerns or symptoms the clinician might not think to ask about. Direct yes/no questions
(Choice A) are useful later for clarification but should not be the starting point. Written questionnaires
(Choice C) supplement but do not replace the therapeutic conversation. Family input (Choice D) is valuable
but secondary to the patient's own account. The NSG 500 emphasizes patient-centered interviewing as
foundational to accurate diagnosis and therapeutic relationships.
5. When palpating, the ulnar surface of the hand is best used for:
A. Detecting vibration
B. Assessing temperature
C. Measuring organ size
D. Evaluating skin texture
CORRECT ANSWER A — Detecting vibration
RATIONALE Different parts of the hand are specialized for different palpation functions: the ulnar surface (side of the
hand along the fifth finger) is most sensitive to vibration — used to detect tactile fremitus and thrills. The
dorsal surface (back of the hand) is best for assessing temperature (Choice B). The palmar surface (finger
pads) is best for assessing texture, consistency, and organ size (Choices C and D). This specificity is because
different sensory receptors are distributed differently across the hand. The NSG 500 emphasizes using the
appropriate hand surface for each assessment purpose to maximize diagnostic accuracy — a skilled
examiner consciously selects which part of the hand to use based on what they are trying to detect.
, 6. Percussion tones from loudest to quietest are:
A. Flatness, dullness, resonance, hyperresonance, tympany
B. Tympany, hyperresonance, resonance, dullness, flatness
C. Resonance, tympany, dullness, flatness, hyperresonance
D. Hyperresonance, resonance, tympany, dullness, flatness
CORRECT ANSWER B — Tympany, hyperresonance, resonance, dullness, flatness
RATIONALE Percussion tones follow a density gradient: the denser the tissue, the quieter the percussion note. From
loudest to quietest: Tympany (loud, drum-like — heard over air-filled stomach), Hyperresonance (very loud,
booming — abnormal, indicates hyperinflation), Resonance (loud, hollow — normal lung tissue), Dullness
(soft, thud-like — over liver or consolidated lung), Flatness (very soft — over muscle or bone). This principle
is fundamental: air-filled structures produce louder, lower-pitched sounds; solid structures produce quieter,
higher-pitched sounds. Choice A reverses the order. The NSG 500 emphasizes that understanding this
density-sound relationship allows clinicians to identify organ boundaries, detect fluid or air in abnormal
locations, and assess conditions like pneumonia (dullness) or pneumothorax (hyperresonance).
7. Auscultation should be performed last in all exams EXCEPT:
A. Cardiac exams
B. Abdominal exams — auscultation should precede palpation and percussion to avoid altering bowel sounds
C. Respiratory exams
D. Musculoskeletal exams
CORRECT ANSWER B — Abdominal exams
RATIONALE The standard assessment sequence is Inspection → Palpation → Percussion → Auscultation. The critical
exception is the abdominal exam, where auscultation is performed BEFORE palpation and percussion. The
reason: palpation and percussion can stimulate peristalsis and alter bowel sounds, potentially masking
abnormalities. The correct abdominal sequence is: Inspection → Auscultation → Percussion → Palpation.
For cardiac (Choice A), respiratory (Choice C), and musculoskeletal (Choice D) exams, the standard sequence
applies — auscultation is performed after palpation and percussion. The NSG 500 emphasizes this exception
as a key clinical distinction — performing abdominal assessment in the wrong order can produce misleading
findings and compromise diagnostic accuracy.
1 MAXE · 005 GSN
W
Passan School of Nursing
EST. 1933
UNITY AMIDST DIVERSITY
NSG 500 Exam 1 — Summer 2025
A DVA N C E D H E A LT H A SS E SS M E N T: T E C H N I Q U E S , S K I N , H E A D & N E C K
INSTITUTION Wilkes University COURSE CODE NSG 500
PROGRAM Master of Science in Nursing — FNP ACADEMIC YEAR Summer 2025
EXAM TITLE NSG 500 Exam 1 — Summer 2025 TOTAL QUESTIONS 85 Questions
COURSE TITLE Advanced Health Assessment FORMAT Multiple Choice — Select the Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Assessment techniques (inspection, palpation, percussion, auscultation), skin lesions, lymph node evaluation, thyroid assessment,
headache types, pain assessment, and pregnancy-related skin changes are all testable content.
▸ ABCDEs of melanoma, primary and secondary skin lesions, infectious conditions, and newborn assessment are emphasized.
▸ Correct answers and clinical rationales appear below each question for comprehensive exam preparation.
▸ All content reflects advanced health assessment standards and NSG 500 course objectives.
SECTION I — ADVANCED HEALTH ASSESSMENT: INTERVIEWING THROUGH
Questions 1 – 85
DERMATOLOGY
1. The four steps of physical assessment, in correct order, are:
A. Auscultation, percussion, palpation, inspection
B. Inspection, palpation, percussion, auscultation
C. Palpation, inspection, auscultation, percussion
D. Percussion, auscultation, inspection, palpation
CORRECT ANSWER B — Inspection, palpation, percussion, auscultation
RATIONALE The standard sequence for physical assessment is: Inspection (observation — using eyes and nose to gather
data about color, moisture, odor, hygiene, gait, stance), Palpation (using hands and fingers to gather
information through touch — texture, temperature, moisture, tenderness), Percussion (striking one object
against another to produce vibrations and sound waves — resonance), and Auscultation (listening to sounds,
typically with a stethoscope). The exception to this order is the abdominal exam, where auscultation should
be performed BEFORE palpation and percussion to avoid altering bowel sounds. Choice A reverses the order.
Choice C and D are incorrect sequences. This systematic approach ensures comprehensive data collection
and is foundational to advanced health assessment.
,2. If a patient isn't giving you the answers you're looking for, what's the best way to get the needed information?
A. Continue asking open-ended questions until they answer
B. Use direct questions or qualifier questions to focus the patient on specific information
C. Skip the topic and return to it later
D. Ask a family member instead
CORRECT ANSWER B — Use direct questions or qualifier questions
RATIONALE When open-ended questions ("Tell me about your pain") yield vague or off-target responses, the skilled
interviewer transitions to direct or qualifier questions: "Is the pain sharp or dull?" "Does it radiate
anywhere?" "On a scale of 1–10, how severe is it?" This focused approach helps patients provide specific,
clinically useful information without leading them to a particular answer. Continuing open-ended questions
(Choice A) may be frustrating for both parties. Skipping the topic (Choice C) may miss critical information.
Family members (Choice D) should supplement, not replace, the patient's own report when possible. The
NSG 500 emphasizes adapting interview technique to the clinical situation — starting broad, then narrowing
as needed.
3. Inspection as an assessment technique includes observing all of the following EXCEPT:
A. Color, moisture, and odor
B. Hygiene and clothing
C. Gait and stance
D. Deep tendon reflexes
CORRECT ANSWER D — Deep tendon reflexes
RATIONALE Inspection is the process of observation — using eyes and nose to gather data. It includes observing color,
moisture, odor, hygiene, clothing, gait, stance, ease of movement, and whether the patient makes eye
contact. Deep tendon reflexes (Choice D) are assessed using a percussion (reflex) hammer — this is a
separate technique, not part of inspection. Inspection begins the moment you first see the patient and
continues throughout the examination. It is the most underutilized yet information-rich assessment
technique. The NSG 500 emphasizes that inspection requires intentional, systematic observation — noting
both obvious findings and subtle cues about the patient's overall health status, emotional state, and
functional abilities.
,4. What is the best way to ask a patient to share their story?
A. Use direct, yes/no questions for efficiency
B. Use open-ended questions that invite the patient to describe their experience in their own words
C. Provide a written questionnaire
D. Ask the patient's family member to explain
CORRECT ANSWER B — Use open-ended questions
RATIONALE Open-ended questions ("Tell me what brought you in today," "Describe how this has been affecting you")
invite patients to share their narrative in their own words, providing rich, contextual information that closed-
ended questions miss. This approach builds rapport, demonstrates respect for the patient's perspective, and
often reveals concerns or symptoms the clinician might not think to ask about. Direct yes/no questions
(Choice A) are useful later for clarification but should not be the starting point. Written questionnaires
(Choice C) supplement but do not replace the therapeutic conversation. Family input (Choice D) is valuable
but secondary to the patient's own account. The NSG 500 emphasizes patient-centered interviewing as
foundational to accurate diagnosis and therapeutic relationships.
5. When palpating, the ulnar surface of the hand is best used for:
A. Detecting vibration
B. Assessing temperature
C. Measuring organ size
D. Evaluating skin texture
CORRECT ANSWER A — Detecting vibration
RATIONALE Different parts of the hand are specialized for different palpation functions: the ulnar surface (side of the
hand along the fifth finger) is most sensitive to vibration — used to detect tactile fremitus and thrills. The
dorsal surface (back of the hand) is best for assessing temperature (Choice B). The palmar surface (finger
pads) is best for assessing texture, consistency, and organ size (Choices C and D). This specificity is because
different sensory receptors are distributed differently across the hand. The NSG 500 emphasizes using the
appropriate hand surface for each assessment purpose to maximize diagnostic accuracy — a skilled
examiner consciously selects which part of the hand to use based on what they are trying to detect.
, 6. Percussion tones from loudest to quietest are:
A. Flatness, dullness, resonance, hyperresonance, tympany
B. Tympany, hyperresonance, resonance, dullness, flatness
C. Resonance, tympany, dullness, flatness, hyperresonance
D. Hyperresonance, resonance, tympany, dullness, flatness
CORRECT ANSWER B — Tympany, hyperresonance, resonance, dullness, flatness
RATIONALE Percussion tones follow a density gradient: the denser the tissue, the quieter the percussion note. From
loudest to quietest: Tympany (loud, drum-like — heard over air-filled stomach), Hyperresonance (very loud,
booming — abnormal, indicates hyperinflation), Resonance (loud, hollow — normal lung tissue), Dullness
(soft, thud-like — over liver or consolidated lung), Flatness (very soft — over muscle or bone). This principle
is fundamental: air-filled structures produce louder, lower-pitched sounds; solid structures produce quieter,
higher-pitched sounds. Choice A reverses the order. The NSG 500 emphasizes that understanding this
density-sound relationship allows clinicians to identify organ boundaries, detect fluid or air in abnormal
locations, and assess conditions like pneumonia (dullness) or pneumothorax (hyperresonance).
7. Auscultation should be performed last in all exams EXCEPT:
A. Cardiac exams
B. Abdominal exams — auscultation should precede palpation and percussion to avoid altering bowel sounds
C. Respiratory exams
D. Musculoskeletal exams
CORRECT ANSWER B — Abdominal exams
RATIONALE The standard assessment sequence is Inspection → Palpation → Percussion → Auscultation. The critical
exception is the abdominal exam, where auscultation is performed BEFORE palpation and percussion. The
reason: palpation and percussion can stimulate peristalsis and alter bowel sounds, potentially masking
abnormalities. The correct abdominal sequence is: Inspection → Auscultation → Percussion → Palpation.
For cardiac (Choice A), respiratory (Choice C), and musculoskeletal (Choice D) exams, the standard sequence
applies — auscultation is performed after palpation and percussion. The NSG 500 emphasizes this exception
as a key clinical distinction — performing abdominal assessment in the wrong order can produce misleading
findings and compromise diagnostic accuracy.
