Clinical Reasoning
(Health Assessment)
Final Test Review
(Questions & Solutions)
2025
1
,Multiple Choice
1. When assessing a patient with suspected pneumonia, which
finding MOST strongly supports the diagnosis?
A. Hyperresonance on percussion
B. Increased tactile fremitus
C. Inspiratory wheezes
D. Decreased breath sounds
ANS: B. Increased tactile fremitus
Rationale: Increased fremitus suggests lung consolidation, common
in pneumonia.
2. During a neuro exam, a patient demonstrates a positive Babinski
sign. This finding indicates:
A. Normal finding in adults
B. Upper motor neuron lesion
C. Peripheral neuropathy
D. Lower motor neuron lesion
ANS: B. Upper motor neuron lesion
Rationale: The Babinski sign is pathologic in adults and suggests an
upper motor neuron lesion.
3. Which symptom is MOST indicative of left-sided heart failure during
assessment?
A. Jugular venous distention
B. Hepatomegaly
C. Crackles in the lungs
D. Lower extremity edema
ANS: C. Crackles in the lungs
Rationale: Crackles indicate pulmonary congestion, which is
characteristic of left-sided heart failure.
2
, 4. Which assessment finding should the nurse report immediately in a
patient with chest trauma?
A. Bruising over the sternum
B. Paradoxical chest movement
C. Mild tachypnea
D. Absent apical impulse
ANS: B. Paradoxical chest movement
Rationale: This suggests flail chest, which may compromise
ventilation and requires emergency intervention.
5. When performing a focused abdominal assessment for
appendicitis, which finding is most specific?
A. Generalized abdominal pain
B. Positive Murphy’s sign
C. Rebound tenderness in right lower quadrant
D. Abdominal distention
ANS: C. Rebound tenderness in right lower quadrant
Rationale: This is a classic sign of appendicitis.
Fill-in-the-Blank
6. The ____________ sequence is used to assess cranial nerve function
during a neurological exam.
ANS: “head-to-toe”
Rationale: A systematic head-to-toe sequence ensures all cranial
nerves are evaluated.
7. The presence of S3 heart sound in an adult typically signifies
_____________.
ANS: heart failure
Rationale: S3 in adults can indicate fluid overload due to heart failure.
8. The assessment technique used to compare vibration intensity on
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