HEALTH ASSESSMENT EXAM 2 2026/2027 | 250
HIGH-YIELD QUESTIONS & VERIFIED ANSWERS |
LATEST TESTBANK | RECENT & MOST TESTED
TOPICS | A+ PREPARATION
The nurse is preparing to assess the remote memory of a client who has a diagnosis of
early stage Alzheimer's disease. Which question would be most appropriate for the nurse
to use?
A) Can you tell me what you have eaten in the last 24 hours?
B) When did you get your first job?
C) What did you do last evening?
D) How are an apple and orange the same? - correct answer-B) When did you get your first job?
When assessing the mental status of a 67-year-old woman, the nurse detects some
difficulty with free-flow of thought and the woman's ability to follow directions. Which of
the following would the nurse do first?
A) Use a geriatric depression scale
B) Refer for further medical evaluation
C) Assess the client's vision and hearing
D) Refer the client to social services for home assistance - correct answer-C) Assess the client's vision
and hearing
The nurse utilizes the Depression Questionnaire on a client who has recently moved to a
long-term care facility. The total score is 22. Which of the following would be most
appropriate for the nurse to do next?
A) Refer for further evaluation
B) Evaluate benefits vs risks of a mental health label
C) Assess further for dementia
D) Document this as a normal score - correct answer-A) Refer for further evaluation
The nurse notes that an older adult client is wearing multiple layers of clothing on a warm
fall day. Which of the following would be the nurse's priority assessment at this time?
,A) Asking whether the client often feels cold
B) Assessing the client's developmental level
C) Reviewing the client's culture for possible influence
D) Observing the client's overall hygiene - correct answer-A) Asking whether the client often feels
cold
A nurse is working in a clinic in a low-income neighborhood and assesses as female adult
client who states that she has a urinary tract infection. The nurse notes that the client is
unkempt, wearing stained clothing, and has a strong body odor. The client mentions that
she was evicted from her apartment two weeks ago. Which nursing diagnosis would the
nurse most likely identify for this client?
A) Caregiver role stain related to fatigue
B) Impaired skin integrity related to neurologic deficits
C) Deficit fluid volume related to possible urinary tract infection
D) Self-care deficit related to possible homelessness - correct answer-D) Self-care deficit related to
possible homelessness
When preparing to obtain information about a client's mental and psychosocial status,
which of the following would the nurse need to do first?
A) Question the patient about his or her usual lifestyle and behaviors
B) Perform a neurologic examination to determine any deficits
C) Check the client's level of consciousness for changes
D) Explain the purpose of the exam and types of questions - correct answer-D) Explain the purpose
of the exam and types of questions
A nursing student has been assigned to the care of a client whose history suggests the
need for mental status assessment. This client most likely has a history of health problems
affecting what body system?
A) Respiratory
B) Neurologic
C) Cardiovascular
D) Renal - correct answer-B) Neurologic
,The nurse begins the physical examination of newly admitted client by assessing the
client's mental status. What is the nurse's best rationale for performing the mental status
exam early in the assessment?
A) The client will be less anxious early, providing the nurse with more accurate and reliable data
B) The exam can provide clues about the validity of the client's responses now and throughout
C) The exam provides data about mental health problems that the client may be afraid to report
D) The client's fears about having a serious illness may be alleviated by the results of the exam -
correct answer-B) The exam can provide clues about the validity of the client's responses now and
throughout
A client's recent episode of becoming lost near his home has prompted the nurse to use
the Saint Louis University Mental Status (SLUMS) Assessment Tool. The nurse should
begin this assessment by asking what question?
A) How would you respond if someone said that you might have dementia?
B)Can I ask you some questions about your memory?
C) Do you generally consider yourself to be an intelligent person?
D) I want to ask you some questions to see if you have Alzheimer's - correct answer-B) Can I ask you
some questions about your memory?
Assessment of a client who has suffered a recent stroke reveals that he is unresponsive to
all stimuli and his eyes remain closed. The nurse documents the clients level of
consciousness as which of the following?
A) Obtunded
B) Stupor
C) Coma
D) Lethargy - correct answer-C) Coma
An emergency department nurse has utilized the Confusion Assessment Method (CAM) in
the assessment of a 79 year old client with a new onset of urinary incontinence. This
assessment tool will allow the nurse to confirm the presence of what health problem?
A) Delirium
B) Vascular dementia
, C) Schizophrenia
D) Psychosis - correct answer-A) Delirium
The nurse is assessing a client using the Glasgow Coma Scale following an acute
hypoglycemic episode and obtains a score of 14. The nurse interprets this as indicating
which of the following?
A) Deep coma
B) Coma
C) Obtunded
D) Alert and oriented - correct answer-D) Alert and oriented
A woman brings her 69 year old husband to the clinic for an evaluation because he has
become increasingly forgetful. Which of the following would lea the nurse to suspect that
the client has Alzheimer's disease? Select all that apply
A) He repeats the same story, word for word, over and over again
B) He took a fall when he was replacing a lightbulb last month
C) I have to balance the checkbook now because he just won't do it
D) If I don't tell him when to shower, he won't and will fight me on it
E) He got lost lasting to the pharmacy around the corning the other day - correct answer-A) He
repeats the same story, word for word, over and over again
C) I have to balance the checkbook now because he just won't do it
D) If I don't tell him when to shower, he won't and will fight me on it
E) He got lost lasting to the pharmacy around the corning the other day
As part of a mental status assessment, the nurse asks a client to draw the face of a clock.
This will allow the nurse to assess which of the following domains of mental status?
A) Concentration and orientation
B) Perceptions and thought processes
C) Visual perceptual and constructional ability
D) Expressions and feelings - correct answer-C) Visual perceptual and constructional ability
HIGH-YIELD QUESTIONS & VERIFIED ANSWERS |
LATEST TESTBANK | RECENT & MOST TESTED
TOPICS | A+ PREPARATION
The nurse is preparing to assess the remote memory of a client who has a diagnosis of
early stage Alzheimer's disease. Which question would be most appropriate for the nurse
to use?
A) Can you tell me what you have eaten in the last 24 hours?
B) When did you get your first job?
C) What did you do last evening?
D) How are an apple and orange the same? - correct answer-B) When did you get your first job?
When assessing the mental status of a 67-year-old woman, the nurse detects some
difficulty with free-flow of thought and the woman's ability to follow directions. Which of
the following would the nurse do first?
A) Use a geriatric depression scale
B) Refer for further medical evaluation
C) Assess the client's vision and hearing
D) Refer the client to social services for home assistance - correct answer-C) Assess the client's vision
and hearing
The nurse utilizes the Depression Questionnaire on a client who has recently moved to a
long-term care facility. The total score is 22. Which of the following would be most
appropriate for the nurse to do next?
A) Refer for further evaluation
B) Evaluate benefits vs risks of a mental health label
C) Assess further for dementia
D) Document this as a normal score - correct answer-A) Refer for further evaluation
The nurse notes that an older adult client is wearing multiple layers of clothing on a warm
fall day. Which of the following would be the nurse's priority assessment at this time?
,A) Asking whether the client often feels cold
B) Assessing the client's developmental level
C) Reviewing the client's culture for possible influence
D) Observing the client's overall hygiene - correct answer-A) Asking whether the client often feels
cold
A nurse is working in a clinic in a low-income neighborhood and assesses as female adult
client who states that she has a urinary tract infection. The nurse notes that the client is
unkempt, wearing stained clothing, and has a strong body odor. The client mentions that
she was evicted from her apartment two weeks ago. Which nursing diagnosis would the
nurse most likely identify for this client?
A) Caregiver role stain related to fatigue
B) Impaired skin integrity related to neurologic deficits
C) Deficit fluid volume related to possible urinary tract infection
D) Self-care deficit related to possible homelessness - correct answer-D) Self-care deficit related to
possible homelessness
When preparing to obtain information about a client's mental and psychosocial status,
which of the following would the nurse need to do first?
A) Question the patient about his or her usual lifestyle and behaviors
B) Perform a neurologic examination to determine any deficits
C) Check the client's level of consciousness for changes
D) Explain the purpose of the exam and types of questions - correct answer-D) Explain the purpose
of the exam and types of questions
A nursing student has been assigned to the care of a client whose history suggests the
need for mental status assessment. This client most likely has a history of health problems
affecting what body system?
A) Respiratory
B) Neurologic
C) Cardiovascular
D) Renal - correct answer-B) Neurologic
,The nurse begins the physical examination of newly admitted client by assessing the
client's mental status. What is the nurse's best rationale for performing the mental status
exam early in the assessment?
A) The client will be less anxious early, providing the nurse with more accurate and reliable data
B) The exam can provide clues about the validity of the client's responses now and throughout
C) The exam provides data about mental health problems that the client may be afraid to report
D) The client's fears about having a serious illness may be alleviated by the results of the exam -
correct answer-B) The exam can provide clues about the validity of the client's responses now and
throughout
A client's recent episode of becoming lost near his home has prompted the nurse to use
the Saint Louis University Mental Status (SLUMS) Assessment Tool. The nurse should
begin this assessment by asking what question?
A) How would you respond if someone said that you might have dementia?
B)Can I ask you some questions about your memory?
C) Do you generally consider yourself to be an intelligent person?
D) I want to ask you some questions to see if you have Alzheimer's - correct answer-B) Can I ask you
some questions about your memory?
Assessment of a client who has suffered a recent stroke reveals that he is unresponsive to
all stimuli and his eyes remain closed. The nurse documents the clients level of
consciousness as which of the following?
A) Obtunded
B) Stupor
C) Coma
D) Lethargy - correct answer-C) Coma
An emergency department nurse has utilized the Confusion Assessment Method (CAM) in
the assessment of a 79 year old client with a new onset of urinary incontinence. This
assessment tool will allow the nurse to confirm the presence of what health problem?
A) Delirium
B) Vascular dementia
, C) Schizophrenia
D) Psychosis - correct answer-A) Delirium
The nurse is assessing a client using the Glasgow Coma Scale following an acute
hypoglycemic episode and obtains a score of 14. The nurse interprets this as indicating
which of the following?
A) Deep coma
B) Coma
C) Obtunded
D) Alert and oriented - correct answer-D) Alert and oriented
A woman brings her 69 year old husband to the clinic for an evaluation because he has
become increasingly forgetful. Which of the following would lea the nurse to suspect that
the client has Alzheimer's disease? Select all that apply
A) He repeats the same story, word for word, over and over again
B) He took a fall when he was replacing a lightbulb last month
C) I have to balance the checkbook now because he just won't do it
D) If I don't tell him when to shower, he won't and will fight me on it
E) He got lost lasting to the pharmacy around the corning the other day - correct answer-A) He
repeats the same story, word for word, over and over again
C) I have to balance the checkbook now because he just won't do it
D) If I don't tell him when to shower, he won't and will fight me on it
E) He got lost lasting to the pharmacy around the corning the other day
As part of a mental status assessment, the nurse asks a client to draw the face of a clock.
This will allow the nurse to assess which of the following domains of mental status?
A) Concentration and orientation
B) Perceptions and thought processes
C) Visual perceptual and constructional ability
D) Expressions and feelings - correct answer-C) Visual perceptual and constructional ability
