D222 NURS 3640
Comprehensive Health Assessment
Objective Assessment
Prep
2025
Multiple Choice
A 65-year-old patient presents with sudden onset of right-sided weakness and
slurred speech. During the neurological assessment, which cranial nerve should
you assess first to evaluate facial symmetry?
a) CN I
b) CN III
c) CN VII
d) CN IX
Answer: c) CN VII
Rationale: CN VII controls facial muscles, so assessing it helps evaluate facial
symmetry, common in stroke cases.
When conducting a respiratory assessment on a patient with COPD, the nurse
notes barrel chest and diminished breath sounds. What is the most appropriate
technique to assess for hyperresonance?
a) Palpation
b) Auscultation
c) Percussion
d) Inspection
,Answer: c) Percussion
Rationale: Percussion helps detect hyperresonance, indicative of trapped air in
COPD.
A patient’s skin appears yellowish. To confirm jaundice during a full health
assessment, which area should the nurse examine first?
a) Oral mucosa
b) Sclera of the eyes
c) Palms
d) Toenails
Answer: b) Sclera of the eyes
Rationale: The sclera is a reliable site to detect jaundice before yellowing occurs
in other areas.
During cardiac auscultation, a nurse detects a systolic murmur between the 5th
intercostal space at the midclavicular line. Which valve is most likely involved?
a) Aortic valve
b) Pulmonic valve
c) Mitral valve
d) Tricuspid valve
Answer: c) Mitral valve
Rationale: The mitral valve is assessed at this location and is prone to systolic
murmurs like mitral regurgitation.
Which lab test should the nurse review before performing a comprehensive
health assessment that includes invasive procedures like biopsies?
a) Complete Blood Count (CBC)
b) Electrolyte panel
c) Prothrombin time (PT) and INR
d) Liver function test
Answer: c) Prothrombin time (PT) and INR
Rationale: These tests assess coagulation status to minimize bleeding risks
during procedures.
True/False
T/F: Auscultation should always precede palpation during an abdominal
assessment.
Answer: True
Rationale: Palpation can alter bowel sounds; auscultation is done first to
, accurately hear bowel activity.
T/F: A comprehensive health assessment includes an evaluation of the patient’s
psychological status as well as physical health.
Answer: True
Rationale: Holistic assessment covers mental, emotional, and physical health to
address patient needs fully.
T/F: The presence of a palpable 4 cm liver edge below the right costal margin is
considered normal.
Answer: False
Rationale: The liver edge typically should not be palpable more than 1-2 cm
below the costal margin; 4 cm suggests hepatomegaly.
T/F: In assessing older adults, diminished deep tendon reflexes are a normal
finding.
Answer: True
Rationale: Reflexes often decrease with age due to nerve conduction changes.
T/F: A nurse should measure blood pressure immediately after the patient has
smoked a cigarette due to nicotine’s vasodilating effect.
Answer: False
Rationale: Nicotine causes vasoconstriction that can elevate blood pressure;
measurement should be delayed to avoid false readings.
Identify two specific assessment techniques used to evaluate peripheral vascular
health in the lower extremities.
Answer: Inspection for skin color changes and temperature; palpation of
peripheral pulses (e.g., dorsalis pedis and posterior tibial pulses).
Rationale: These techniques help assess blood flow and detect peripheral artery
disease.
What is the significance of the presence of “clubbing” in a patient’s nails during
a health assessment?
Answer: Clubbing suggests chronic hypoxia, often related to pulmonary or
cardiac pathology.
Rationale: Chronic low oxygen levels lead to changes in nail beds.
Describe how you would assess the range of motion (ROM) in the shoulder
Comprehensive Health Assessment
Objective Assessment
Prep
2025
Multiple Choice
A 65-year-old patient presents with sudden onset of right-sided weakness and
slurred speech. During the neurological assessment, which cranial nerve should
you assess first to evaluate facial symmetry?
a) CN I
b) CN III
c) CN VII
d) CN IX
Answer: c) CN VII
Rationale: CN VII controls facial muscles, so assessing it helps evaluate facial
symmetry, common in stroke cases.
When conducting a respiratory assessment on a patient with COPD, the nurse
notes barrel chest and diminished breath sounds. What is the most appropriate
technique to assess for hyperresonance?
a) Palpation
b) Auscultation
c) Percussion
d) Inspection
,Answer: c) Percussion
Rationale: Percussion helps detect hyperresonance, indicative of trapped air in
COPD.
A patient’s skin appears yellowish. To confirm jaundice during a full health
assessment, which area should the nurse examine first?
a) Oral mucosa
b) Sclera of the eyes
c) Palms
d) Toenails
Answer: b) Sclera of the eyes
Rationale: The sclera is a reliable site to detect jaundice before yellowing occurs
in other areas.
During cardiac auscultation, a nurse detects a systolic murmur between the 5th
intercostal space at the midclavicular line. Which valve is most likely involved?
a) Aortic valve
b) Pulmonic valve
c) Mitral valve
d) Tricuspid valve
Answer: c) Mitral valve
Rationale: The mitral valve is assessed at this location and is prone to systolic
murmurs like mitral regurgitation.
Which lab test should the nurse review before performing a comprehensive
health assessment that includes invasive procedures like biopsies?
a) Complete Blood Count (CBC)
b) Electrolyte panel
c) Prothrombin time (PT) and INR
d) Liver function test
Answer: c) Prothrombin time (PT) and INR
Rationale: These tests assess coagulation status to minimize bleeding risks
during procedures.
True/False
T/F: Auscultation should always precede palpation during an abdominal
assessment.
Answer: True
Rationale: Palpation can alter bowel sounds; auscultation is done first to
, accurately hear bowel activity.
T/F: A comprehensive health assessment includes an evaluation of the patient’s
psychological status as well as physical health.
Answer: True
Rationale: Holistic assessment covers mental, emotional, and physical health to
address patient needs fully.
T/F: The presence of a palpable 4 cm liver edge below the right costal margin is
considered normal.
Answer: False
Rationale: The liver edge typically should not be palpable more than 1-2 cm
below the costal margin; 4 cm suggests hepatomegaly.
T/F: In assessing older adults, diminished deep tendon reflexes are a normal
finding.
Answer: True
Rationale: Reflexes often decrease with age due to nerve conduction changes.
T/F: A nurse should measure blood pressure immediately after the patient has
smoked a cigarette due to nicotine’s vasodilating effect.
Answer: False
Rationale: Nicotine causes vasoconstriction that can elevate blood pressure;
measurement should be delayed to avoid false readings.
Identify two specific assessment techniques used to evaluate peripheral vascular
health in the lower extremities.
Answer: Inspection for skin color changes and temperature; palpation of
peripheral pulses (e.g., dorsalis pedis and posterior tibial pulses).
Rationale: These techniques help assess blood flow and detect peripheral artery
disease.
What is the significance of the presence of “clubbing” in a patient’s nails during
a health assessment?
Answer: Clubbing suggests chronic hypoxia, often related to pulmonary or
cardiac pathology.
Rationale: Chronic low oxygen levels lead to changes in nail beds.
Describe how you would assess the range of motion (ROM) in the shoulder
