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NSG 3160 / NSG3160 Final Exam ( 2026 – 2027 New
edition) Health Assessment Review | Questions &
Answers | Guaranteed Grade A- Galen
Q. Mental status is defined as
A.) A pt's emotional & cognitive function B.) The pt's conscious, mood, and affect C.) General Intelligence D.) Pt's perception ANSWER A.) A pt's emotional & cognitive function
Q. A mental disorder is best defined as
A.) Presence of phobia B.) A lack of rational thought and abstract researching C.) Extreme behavior that is usually associated with stress D.) Remote memory from years ago may be impacted ANSWER C.) Extreme behavior that is usually associated with stress
Q. The A, B, C, and T of the mental health assessment is
A.) Attitude, behavior, cleanliness, talk/speech B.) Appearance, behavior, cognition, and thought C.) Airway, breathing, circulation D.) Ability, beliefs, culture, traditions ANSWER B.) Appearance, behavior, cognition, and thought
Q. Which of the following best describes a pt's appearance?
A.) Posture is erect and body movement is voluntary B.) Pt is oriented x C.) Pt is awake, alert, and aware and responds appropriately D.) GAD score > 3 ANSWER A.) Posture is erect and body movement is voluntary
Q. One method a nurse can use to assess recent memory
A.) Assess a pt's ability to complete a thought without wandering B.) Ask pt for a 24 hour diet recall C.) Ask about pt's first job D.) Perform 4 unrelated words test ANSWER B.) Ask pt for a 24 hour diet recall
Q. Recent memory deficit can occur with delirium and dementia
A.) True B.) False ANSWER A.) True
Q. A nurse can assess a pt's attention span by giving a series of directions to follow and note correct sequence
performed A.) True B.) False ANSWER A.) True
Q. Obtunded means
A.) Drifts off to sleep when not stimulated B.) Responds only to persistent shaking or pain C.) Will wake with loud shouting or vigorous shake D.) No response to pain or any external stimuli ANSWER C.) Will wake with loud shouting or vigorous shake
Q. Expressive aphasia is also known as
A.) Broca aphasia B.) Global aphasia C.) Wernicke aphasia D.) Receptive aphasia ANSWER A.) Broca aphasia
Q. Delirium is a chronic progressive loss of cognitive and intellectual functions
A.) True B.) False ANSWER B.) False
Q. Hypochondriasis means
A.) Person believes they are God B.) Person feels "They are out to get me" C.) Morbid fear of their lack of health or a fear of having cancer D.) Irrational fear of an object ANSWER C.) Morbid fear of their lack of health or a fear of having cancer
Q. Which substance displays signs of intoxication of reddened eyes, relaxation, suspicious
A.) Cocaine B.) Nicotine C.) Cannabis D.) Opiates ANSWER C.) Cannabis
Q. Which substance displays signs of intoxication of pinpoint pupils, decreased pulse, and BP
A.) Cocaine B.) Nicotine C.) Cannabis D.) Opitaes ANSWER D.) Opitaes
Q. Which substance displays signs of intoxication of pupillary dilation, chills, and nausea
A.) Cocaine B.) Nicotine C.) Cannabis D.) Opiates ANSWER A.) Cocaine
Q. Which areas on the body are lymph nodes NOT easily palpated?
A.) Head, neck, inguinal B.) Breast and neck C.) Axillae and arm D.) Popliteal and inguinal ANSWER B.) Breast and neck
A cluster headache A.) May be caused by alcohol and napping B.) Are described as throbbing C.) Can occur several times a month D.) Is usually retro-orbital A.) May be caused by alcohol and napping Is non-tenderness or tenderness an indication of malignancy? A.) Non-tenderness B.) Tenderness A.) Non-tenderness What does the Whisper Voice Test detect? A.) High frequency or high tone loss B.) Ear formation development C.) Memory recall D.) Amount of cerumen in the ear canal A.) High frequency or high tone loss Which of the following is NOT true of the external ear? A.) Called Pinna B.) Terminates at the eardrum C.) Consists of movable cartilage D.) Tunnels through temporal bone D.) Tunnels through temporal bone Which of the following is NOT true of cerumen? A.) Wax forms sticky barrier B.) Is part of the middle ear C.) Helps keep foreign bodies from entering tympanic membrane D.) Migrates out with chewing and talking B.) Is part of the middle ear What color is the normal color of the tympanic membrane? A.) White B.) Pale yellow C.) Pearly gray D.) Pink C.) Pearly gray
Lymphatic drainage of the external ear flows to A.) Parotid, mastoid, superficial cervical B.) Submental submandibular C.) Postauricular, eustachian tube D.) Mastoid, preauricular, deep cervical chain A.) Parotid, mastoid, superficial cervical Which is NOT true of the middle ear? A.) It is a tiny air-filled cavity B.) Protected by the tympanic membrane C.) Contains 3 ossicles or 3 bones D.) Contains the cochlea D.) Contains the cochlea The sounds amplitude means A.) The pitch B.) The vibration C.) The loudness D.) The fibers C.) The loudness Normal pathway of hearing is A.) Air conduction B.) Water conduction C.) Bone conduction A.) Air conduction What causes presbycusis? A.) Nerve degeneration that occurs with aging B.) Too much cerumen in the ear canal C.) Bright light D.) The room is spinning A.) Nerve degeneration that occurs with aging While completing health hx, to evaluate pt's mental status, the nurse must observe A.) Appearance, behavior, cognition, thought process B.) Ask pt's family about coping skills C.) The presence of phobias D.) Perform an IQ test
B.) Earbuds C.) Bell C.) Bell The diaphragm of the stethoscope is used to detect A.) Bruit sound B.) Normal S1 and S2 sounds C.) Murmur sound D.) Whooshing sound B.) Normal S1 and S2 sounds When using a snellen chart, what does 20/10 mean? A.) Pt reads at 20 feet when normal person reads at 10 feets B.) Normal person reads 20 feet and pt reads at 10 feet C.) Pt reads at 10 feet when normal person reads at 20 feet D.) Pt is legally blind A.) Pt reads at 20 feet when normal person reads at 10 feets Approximate means A.) Line up close to equally B.) Distal C.) Opposite D.) Lateral A.) Line up close to equally The area for storing milk in the breast are: A.) Lactiferous sinuses B.) Lobules C.) Alveoli D.) Montgomery glands A.) Lactiferous sinuses What is the most common site of breast tumors: A.) Lower outer quadrant B.) Upper inner quadrant C.) Lower inner quadrant D.) Upper outer quadrant D.) Upper outer quadrant 13 - year-old girl being examined questions the asymmetry of her breasts. The best response from the nurse is:
A.) "I will give you a referral for a mammogram." B.) "One breast normally may grow faster than the other during development." C.) "You will probably have fibrocystic disease when you are older." D.) "This may be an indication of hormonal imbalance. Re-check in 6 months." B.) "One breast normally may grow faster than the other during development." A major characteristic of dementia is: A.) Sudden onset of symptoms B.) Impairment of short- and long-term memory C.) Substance-induced D.) Hallucinations B.) Impairment of short- and long-term memory When teaching the breast self-examination, you would inform the woman that the best time to conduct breast self-exam is: A.) On the 4th to 7th day of the cycle B.) Just before the menstrual period. C.) At the onset of the menstrual period. D.) On the 14th day of the menstrual cycle. A.) On the 4th to 7th day of the cycle What is the current recommendation for women 40 to 44 yrs and older for breast cancer screening with mammography: A.) Twice a year B.) Only baseline examination needed unless the woman has symptoms C.) May begin every year D.) Every 2 years C.) May begin every year A bimanual technique may be the preferred approach for a woman: A.) Who has felt a change in the breast during self-examination B.) With pendulous breasts C.) Who is having the first breast examination by a health care provider D.) Who is pregnant B.) With pendulous breasts The best position to inspect a female patient's breasts for retraction is: A.) Sitting with hand pushing onto hips B.) One arm at the side, the other arm elevated C.) Lying supine with arms at the sides
A.) Unilateral, obvious venous pattern B.) Nipple retraction C.) Peau d'orange D.) Blue vascular pattern over both breasts D.) Blue vascular pattern over both breasts Pt's 2nd day in acute care, patient complains about the "bugs" on clean bed. Example of: A.) Higher intellectual function B.) Thought processes C.) Orientation D.) Perception D.) Perception Which woman should not be referred to a provider for further evaluation: A.) A 25-y/o with asymmetric breasts and inversion of nipples since adolescence B.) 48-y/o has a 6-mth history of reddened, sore left nipple and areolar area C.) 64-y/o with ulcerated area at tip of right nipple; no masses, tenderness D.) A 26-year-old with multiple nodules palpated in each breast A.) A 25-y/o with asymmetric breasts and inversion of nipples since adolescence Patient with seizure disorder wants to be an airline pilot. A nurse may question patients: A.) Attention span B.) Thought processes C.) Recent memory D.) Judgement D.) Judgement One way to asses cognitive function and to screen dementia is with: A.) The Denver II B.) The proverb interpretation test C.) The older adult behavioral checklist D.) The mini-cog D.) The mini-cog You are performing a mental status examination, Which assessments would be most appropriate: A.) Examining a patient's EEG B.) Observing the patient as he or she takes an IQ test: C.) Observing the patient and inferring health or dysfunction D.) Examining the patient's response to a specific set of questions C.) Observing the patient and inferring health or dysfunction
Gynecomastia is: A.) Cancer of the male breast B.) Presence of supernumerary breast on the male chest C.) Presence of mast cells in the male breast D.) Enlargement of the male breast D.) Enlargement of the male breast What is a priority assessment for aging adults: A.) Irrational thinking patterns B.) General intelligence C.) Phobias D.) Sensory perceptive abilities D.) Sensory perceptive abilities Which is the first physical change associated with puberty in girls: A.) Breast bud development B.) Areolar elevation C.) Height spurt D.) Pubic hair development A.) Breast bud development To assess for early jaundice, you will assess: A.) Nail beds B.) All visible skin surfaces C.) Lips D.) Sclera and hard palate D.) Sclera and hard palate Checking for skin temperature is best accomplished by using: A.) The ventral surface of the hands B.) The dorsal surface of the hands C.) The palmar surface of the hands D.) The fingertips B.) The dorsal surface of the hands Assessing a patient's skin turgor is done to assess which clinical finding: A.) Vitiligo B.) Edema C.) Scleroderma
A.) the world is spinning B.) the room is spinning C.) a buildup of cerumen D.) you are spinning B.) the room is spinning Otis media is common in A.) American Indians B.) African Americans C.) Pierced ears D.) Children D.) Children What does the Romberg test assess? A.) Articulation B.) Agility C.) Balance D.) Taste C.) Balance Cranial nerve VIII impacts A.) convergence B.) taste C.) accomodation D.) acoustics D.) acoustics What does not cause sensorineural (perceptive) hearing loss? A.) damage to auditory area of cerebral cortex B.) texting with your friend C.) pathology of the inner ear D.) CN VIII damage B.) texting with your friend What does the appearance of bright red ear drum mean? A.) infection in middle ear B.) cerumen or pus C.) blood behind eardrum D.) perforation A.) infection in middle ear
The nurse is caring for a pt that is hearing impaired. Which will facilitate communication? A.) clean out earwax B.) speak directly into impaired ear C.) speak in a normal tone D.) speak loudly C.) speak in a normal tone Which of the following lymph node cannot be palpated on the head/neck? A.) jugulodigastric B.) supra auricular C.) preauricular D.) postauricular B.) supra auricular Which of the following describes an acute infection? A.) tonsils that are absent B.) tonsils that are 3+ with large white spots C.) tonsils that are 1+ with excess exudate D.) tonsils that are 4+ and pale B.) tonsils that are 3+ with large white spots The breast is composed of all of the following except A.) connective tissue B.) fibrous tissue C.) glandular tissue D.) adipose tissue A.) connective tissue Which of the following is suspicious for breast cancer? A.) tenderness B.) bruising C.) dimple D.) asymmetrical size C.) dimple When is skin assessment best performed? A.) With older adults B.) Only when pt complains of a rash C.) Continuously throughout exam
Yellowish skin color due to rising amounts of bilirubin, first noted in sclera & hard & soft palate JAUNDICE solely a color change, flat and circumscribed, often less than 1 cm; ex - FRECKLES, flat nevi, hypopigmentation, peteciae, measles, scarlet fever MACULE Solid, raised legion, less than 1 cm caused by superficial thickening of the epidermis, ex: mole PAPULE A plateau-like, disc-shaped lesion, ex: psoriasis PLAQUE An elevated cavity containing free fluid that is less than 1 cm in diameter is a(n): A. wheal. B. vesicle. C. bulla. D. edema. B. VESICLE (ex: herpes simplex) Define Bulla > fluid-filled sac larger than 1 cm, superficial in epidermis, thin-walled, ruptures easily ex: burn blister prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen) Lichenification Petechiae tiny round dark-red hemorrhages, 103mm, caused by bleeding from superficial capillaries. PURPURA confluent and extensive patches of petechia and ecchymosis, > 3mm, flat w/ red to purple areas Brown-black pigmented areas, or linear bands along the nail edge of dark-skinned people LINEAR PIGMENTATION The snellen chart is used to assess this nerve CN II - OPTIC, VISUAL ACUITY This test is the "A" in PEERLA
ACCOMODATION: look forward CNI Olfactory Nerve Damage to this nerve affects smell What is the name of CN VIII? ACOUSTIC Go behind patient, can you occlude the tragus This nerve innervates the lateral rectus muscle & turns the eyes from side to side ABDUCENS (PG.396) 8TH EDITION TRIGEMINAL (CNV-5) "TRI CHEWING" CN V: Check patients ability to feel light touch on face using wisp of cotton on forehead, cheek & jaw on EACH side. TEST FOR? pain sensation by touch the tip of a safety pin to same 3 areas. TESTING MOTOR COMPONENT: Have the patient clench teeth while you palpate the temporal & masseter muscles. CNVII (7 FACIAL) Patient can you smile for me? Can you frown? Puff your cheeks. The term used for a Deviated Gaze STRABISMUS NYASTAGMUS back and forth oscillation of the eyes: involuntary eye shaking Yellow waxy material that lubricates and protects the ear canal known as an antibacterial that traps foreign bodies CERUMEN Dry, flaky white wax is found in East Asians and American Indians TRUE OR FALSE? TRUE Tinnitus ringing in the ears
