CANADIAN PHYSICAL
EXAMINATION & HEALTH
ASSESSMENT / LEWIS'S
MEDICAL-SURGICAL
NURSING
Comprehensive Practice Examination
Instructions: This examination consists of 20 multiple-choice questions drawn from
both textbooks. Each question is followed by the correct answer and a detailed
rationale. Select the single best answer for each question.
SECTION 1: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT
(Jarvis, 4th Canadian Edition)
Question 1
A nurse is assessing a patient who reports feeling "warm, nauseated, and nervous."
Which type of data is the nurse collecting?
A. Objective data
B. Subjective data
C. Reflective data
D. Introspective data
,Answer: B
Rationale: Subjective data are what the patient says about themselves during history
taking. The patient's report of feeling warm, nauseated, and nervous represents their
personal perception and cannot be directly observed by the nurse. Objective data are
what the health professional observes by inspecting, percussing, palpating, and
auscultating during the physical examination. The terms "reflective" and "introspective"
are not used to describe data types in nursing assessment .
Question 2
A nurse is listening to a patient's breath sounds and is unsure of a sound heard. What is
the most appropriate action?
A. Immediately notify the patient's most responsible practitioner
B. Document the sound exactly as it was heard
C. Validate the data by asking a coworker to listen to the breath sounds
D. Assess again in 20 minutes to note whether the sound is still present
Answer: C
Rationale: When unsure of a sound heard while listening to a patient's breath sounds,
the nurse should validate the data to ensure accuracy. If the nurse has less experience in
an area, asking an expert to listen is the appropriate validation technique. Immediate
notification of the practitioner is premature without confirmed findings. Documentation
should occur after validation. Waiting 20 minutes delays appropriate assessment and
intervention .
,Question 3
A mother brings her newborn for assessment and asks, "Is there something wrong with
my baby? His head seems so big." Which statement is true regarding the relative
proportions of the head and trunk of the newborn?
A. At birth, the head is one fifth the total length
B. Head circumference should be greater than chest circumference at birth
C. The head size reaches 90% of its final size when the child is 3 years old
D. When the anterior fontanel closes at 2 months, the head will be more proportioned
to the body
Answer: B
Rationale: In the newborn, head circumference is normally greater than chest
circumference at birth. This is a normal finding because the brain grows rapidly during
fetal development and early infancy. The head is approximately one fourth (not one
fifth) of the total body length at birth. Head size reaches 90% of final size by age 6, not
3. The anterior fontanel normally closes between 9 and 18 months, not 2 months .
Question 4
During a well-baby checkup, the nurse notices that a 1-week-old infant's face looks
small compared with his cranium, which seems enlarged. On further examination, the
nurse also notices dilated scalp veins and downcast or "setting sun" eyes. The nurse
suspects which condition?
A. Craniotabes
B. Microcephaly
C. Hydrocephalus
D. Caput succedaneum
, Answer: C
Rationale: The combination of an enlarged cranium, dilated scalp veins, and "setting
sun" eyes (downward deviation of the eyes) is classic for hydrocephalus, which results
from impaired circulation and absorption of cerebrospinal fluid. Craniotabes refers to
softening of the skull bones. Microcephaly presents with a small head circumference,
not an enlarged one. Caput succedaneum is edema of the scalp present at birth that
crosses suture lines .
Question 5
A patient has come in for an examination and states, "I have this spot in front of my ear
lobe on my cheek that seems to be getting bigger and is tender." The nurse notes
swelling below the angle of the jaw and suspects that it could be an inflammation of
the:
A. Thyroid gland
B. Parotid gland
C. Occipital lymph node
D. Submental lymph node
Answer: B
Rationale: The parotid gland is located in front of the ear, extending down behind the
angle of the jaw. Inflammation of the parotid gland (parotitis) presents with swelling and
tenderness in this area. The thyroid gland is located in the anterior neck. The occipital
lymph nodes are at the base of the skull posteriorly. The submental lymph nodes are
located under the chin .
EXAMINATION & HEALTH
ASSESSMENT / LEWIS'S
MEDICAL-SURGICAL
NURSING
Comprehensive Practice Examination
Instructions: This examination consists of 20 multiple-choice questions drawn from
both textbooks. Each question is followed by the correct answer and a detailed
rationale. Select the single best answer for each question.
SECTION 1: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT
(Jarvis, 4th Canadian Edition)
Question 1
A nurse is assessing a patient who reports feeling "warm, nauseated, and nervous."
Which type of data is the nurse collecting?
A. Objective data
B. Subjective data
C. Reflective data
D. Introspective data
,Answer: B
Rationale: Subjective data are what the patient says about themselves during history
taking. The patient's report of feeling warm, nauseated, and nervous represents their
personal perception and cannot be directly observed by the nurse. Objective data are
what the health professional observes by inspecting, percussing, palpating, and
auscultating during the physical examination. The terms "reflective" and "introspective"
are not used to describe data types in nursing assessment .
Question 2
A nurse is listening to a patient's breath sounds and is unsure of a sound heard. What is
the most appropriate action?
A. Immediately notify the patient's most responsible practitioner
B. Document the sound exactly as it was heard
C. Validate the data by asking a coworker to listen to the breath sounds
D. Assess again in 20 minutes to note whether the sound is still present
Answer: C
Rationale: When unsure of a sound heard while listening to a patient's breath sounds,
the nurse should validate the data to ensure accuracy. If the nurse has less experience in
an area, asking an expert to listen is the appropriate validation technique. Immediate
notification of the practitioner is premature without confirmed findings. Documentation
should occur after validation. Waiting 20 minutes delays appropriate assessment and
intervention .
,Question 3
A mother brings her newborn for assessment and asks, "Is there something wrong with
my baby? His head seems so big." Which statement is true regarding the relative
proportions of the head and trunk of the newborn?
A. At birth, the head is one fifth the total length
B. Head circumference should be greater than chest circumference at birth
C. The head size reaches 90% of its final size when the child is 3 years old
D. When the anterior fontanel closes at 2 months, the head will be more proportioned
to the body
Answer: B
Rationale: In the newborn, head circumference is normally greater than chest
circumference at birth. This is a normal finding because the brain grows rapidly during
fetal development and early infancy. The head is approximately one fourth (not one
fifth) of the total body length at birth. Head size reaches 90% of final size by age 6, not
3. The anterior fontanel normally closes between 9 and 18 months, not 2 months .
Question 4
During a well-baby checkup, the nurse notices that a 1-week-old infant's face looks
small compared with his cranium, which seems enlarged. On further examination, the
nurse also notices dilated scalp veins and downcast or "setting sun" eyes. The nurse
suspects which condition?
A. Craniotabes
B. Microcephaly
C. Hydrocephalus
D. Caput succedaneum
, Answer: C
Rationale: The combination of an enlarged cranium, dilated scalp veins, and "setting
sun" eyes (downward deviation of the eyes) is classic for hydrocephalus, which results
from impaired circulation and absorption of cerebrospinal fluid. Craniotabes refers to
softening of the skull bones. Microcephaly presents with a small head circumference,
not an enlarged one. Caput succedaneum is edema of the scalp present at birth that
crosses suture lines .
Question 5
A patient has come in for an examination and states, "I have this spot in front of my ear
lobe on my cheek that seems to be getting bigger and is tender." The nurse notes
swelling below the angle of the jaw and suspects that it could be an inflammation of
the:
A. Thyroid gland
B. Parotid gland
C. Occipital lymph node
D. Submental lymph node
Answer: B
Rationale: The parotid gland is located in front of the ear, extending down behind the
angle of the jaw. Inflammation of the parotid gland (parotitis) presents with swelling and
tenderness in this area. The thyroid gland is located in the anterior neck. The occipital
lymph nodes are at the base of the skull posteriorly. The submental lymph nodes are
located under the chin .
