NSG 3160 EXAM 2 /ACTUAL NSG 3160 EXAM 2
HEALTH ASSESSMENT EXAM ACTUAL TEST
BANK 2026/2027 PRACTICE QUESTIONS AND
STUDY GUIDE COMPLETE ACCURATE EXAM
REAL QUESTIONS AND CORRECT VERIFIED
ANSWERS WITH DETAILED RATIONALES
(RELIABLE ANSWERS)
1. The nurse just received report on the neurological unit. Which of the
following findings would be of most concern?
A. Patient with chronic dementia A&Ox1
B. Patient with a head injury who does not remember what was
happening before or during the injury
C. Patient reporting headache, denies any injury, no external
abnormalities noted
D. Patient reporting generalized weakness
Correct Answer: B
Rationale: A patient with a head injury who cannot remember events
before or during the injury is experiencing retrograde amnesia, which is
concerning and indicates potential neurological compromise. While
dementia (A) is chronic, and headache with no injury (C) or generalized
weakness (D) may still warrant evaluation, neither is as urgent as a new
memory deficit following trauma, which signals possible intracranial
injury requiring prompt assessment.
,2. Patient reports having a head injury while out with friends and
reporting ETOH intake. Which of the following statements would
concern you the most?
A. "I was being goofy and tripped."
B. "My legs feel unsteady."
C. "I am having trouble focusing."
D. "It is hard to swallow when taking a drink."
Correct Answer: D
Rationale: Difficulty swallowing (dysphagia) is a priority finding as it
indicates potential brainstem involvement or cranial nerve dysfunction,
which can compromise the airway (ABCs). This is more concerning than
unsteady gait, trouble focusing, or the mechanism of injury.
3. Which of the following statements made by the student nurse requires
further education?
A. "One method to assess cranial nerve V would be to have the person
puff their cheeks. Then press on their cheeks to ensure the air escapes
equally bilaterally."
B. "To assess the acoustic, or vestibulocochlear, nerve would be to
administer the whisper test. An expected finding is for the patient to
correctly repeat at least four of the six phrases."
C. "When assessing the pupil, if the patient has an increased ICP
there will be a sudden, unilateral, dilated, and nonreactive change in
the pupils."
,D. "To assess cranial nerve XII, ask the patient to protrude their tongue,
ensuring no tremors or wasting are present, and that the tongue is
midline."
Correct Answer: C
Rationale: Increased intracranial pressure (ICP) typically causes a
bilateral, not unilateral, change in pupils. A sudden, unilateral, dilated,
and nonreactive pupil is more characteristic of cranial nerve III
(oculomotor nerve) compression, which can occur with herniation
syndromes. The student's statement about ICP requires further education
as it inaccurately describes the pupillary findings associated with
increased ICP.
4. While practicing the Romberg Test, which of the following
statements, if made by the student nurse, would show understanding
of this test?
A. "An expected finding for this test is negative. If negative, the
patient will not sway, or become unbalanced and fall."
B. "An expected finding for this test is positive. If positive, the patient
will not sway, or become unbalanced and fall."
C. "An unexpected finding for this test is negative. If negative, the
patient will not sway, or become unbalanced and fall."
D. "An unexpected finding for this test is positive. If positive, the patient
will not sway, or become unbalanced and fall."
Correct Answer: A
Rationale: The Romberg test assesses balance and proprioception. A
negative (normal) finding means the patient can stand with feet together,
arms at sides, and eyes closed for approximately 20 seconds without
, swaying or falling. A positive finding indicates an inability to maintain
balance, suggesting cerebellar or vestibular dysfunction.
5. Mental status is defined as:
A. A patient's emotional and cognitive function
B. The patient's conscious, mood, and affect
C. General intelligence
D. Patient's perception
Correct Answer: A
Rationale: Mental status refers to a patient's emotional and cognitive
functioning. Assessment of mental status includes areas such as level of
consciousness, orientation, attention, memory, language, thought
processes, mood, affect, judgment, and insight. It provides information
about how the patient is thinking, feeling, perceiving, and responding to
the environment.
6. When assessing a patient's level of consciousness, which finding
indicates the greatest impairment?
A. The patient is awake and responds appropriately to questions.
B. The patient is drowsy but awakens easily when spoken to.
C. The patient opens the eyes only after a painful stimulus and responds
minimally.
D. The patient is awake but confused about the date.
Correct Answer: C
HEALTH ASSESSMENT EXAM ACTUAL TEST
BANK 2026/2027 PRACTICE QUESTIONS AND
STUDY GUIDE COMPLETE ACCURATE EXAM
REAL QUESTIONS AND CORRECT VERIFIED
ANSWERS WITH DETAILED RATIONALES
(RELIABLE ANSWERS)
1. The nurse just received report on the neurological unit. Which of the
following findings would be of most concern?
A. Patient with chronic dementia A&Ox1
B. Patient with a head injury who does not remember what was
happening before or during the injury
C. Patient reporting headache, denies any injury, no external
abnormalities noted
D. Patient reporting generalized weakness
Correct Answer: B
Rationale: A patient with a head injury who cannot remember events
before or during the injury is experiencing retrograde amnesia, which is
concerning and indicates potential neurological compromise. While
dementia (A) is chronic, and headache with no injury (C) or generalized
weakness (D) may still warrant evaluation, neither is as urgent as a new
memory deficit following trauma, which signals possible intracranial
injury requiring prompt assessment.
,2. Patient reports having a head injury while out with friends and
reporting ETOH intake. Which of the following statements would
concern you the most?
A. "I was being goofy and tripped."
B. "My legs feel unsteady."
C. "I am having trouble focusing."
D. "It is hard to swallow when taking a drink."
Correct Answer: D
Rationale: Difficulty swallowing (dysphagia) is a priority finding as it
indicates potential brainstem involvement or cranial nerve dysfunction,
which can compromise the airway (ABCs). This is more concerning than
unsteady gait, trouble focusing, or the mechanism of injury.
3. Which of the following statements made by the student nurse requires
further education?
A. "One method to assess cranial nerve V would be to have the person
puff their cheeks. Then press on their cheeks to ensure the air escapes
equally bilaterally."
B. "To assess the acoustic, or vestibulocochlear, nerve would be to
administer the whisper test. An expected finding is for the patient to
correctly repeat at least four of the six phrases."
C. "When assessing the pupil, if the patient has an increased ICP
there will be a sudden, unilateral, dilated, and nonreactive change in
the pupils."
,D. "To assess cranial nerve XII, ask the patient to protrude their tongue,
ensuring no tremors or wasting are present, and that the tongue is
midline."
Correct Answer: C
Rationale: Increased intracranial pressure (ICP) typically causes a
bilateral, not unilateral, change in pupils. A sudden, unilateral, dilated,
and nonreactive pupil is more characteristic of cranial nerve III
(oculomotor nerve) compression, which can occur with herniation
syndromes. The student's statement about ICP requires further education
as it inaccurately describes the pupillary findings associated with
increased ICP.
4. While practicing the Romberg Test, which of the following
statements, if made by the student nurse, would show understanding
of this test?
A. "An expected finding for this test is negative. If negative, the
patient will not sway, or become unbalanced and fall."
B. "An expected finding for this test is positive. If positive, the patient
will not sway, or become unbalanced and fall."
C. "An unexpected finding for this test is negative. If negative, the
patient will not sway, or become unbalanced and fall."
D. "An unexpected finding for this test is positive. If positive, the patient
will not sway, or become unbalanced and fall."
Correct Answer: A
Rationale: The Romberg test assesses balance and proprioception. A
negative (normal) finding means the patient can stand with feet together,
arms at sides, and eyes closed for approximately 20 seconds without
, swaying or falling. A positive finding indicates an inability to maintain
balance, suggesting cerebellar or vestibular dysfunction.
5. Mental status is defined as:
A. A patient's emotional and cognitive function
B. The patient's conscious, mood, and affect
C. General intelligence
D. Patient's perception
Correct Answer: A
Rationale: Mental status refers to a patient's emotional and cognitive
functioning. Assessment of mental status includes areas such as level of
consciousness, orientation, attention, memory, language, thought
processes, mood, affect, judgment, and insight. It provides information
about how the patient is thinking, feeling, perceiving, and responding to
the environment.
6. When assessing a patient's level of consciousness, which finding
indicates the greatest impairment?
A. The patient is awake and responds appropriately to questions.
B. The patient is drowsy but awakens easily when spoken to.
C. The patient opens the eyes only after a painful stimulus and responds
minimally.
D. The patient is awake but confused about the date.
Correct Answer: C
