Health Assessment Denver School of Nursing
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Free Health Assessment Denver School of Nursing Questions
During a routine health assessment, a nurse is performing a tongue examination on a 60-year-old client. The nurse observes the following:
The tongue appears moist, pink, and has a thin, white coating that is evenly distributed.
The papillae on the tongue are uniform and appear normal.
The client is able to protrude the tongue and move it laterally without difficulty or discomfort.
The nurse notes that the ventral surface of the tongue is smooth, with no visible lesions or swelling.
Which of the following findings would the nurse document as normal based on this examination
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Tongue is moist, pink, thinly coated, papillae are uniform, and the client moves the tongue freely without pain.
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Tongue appears pale, with a thick white coating, papillae are atrophic, and client has difficulty moving the tongue.
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Tongue is dry with a thick yellow coating and decreased mobility, and client reports soreness.
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Tongue has a red, inflamed appearance with a thick white coating and lesions on the ventral surface.
Explanation
Correct Answer A: Tongue is moist, pink, thinly coated, papillae are uniform, and the client moves the tongue freely without pain.
Explanation:
A healthy tongue should be moist, pink, and may have a thin white coating that is evenly distributed. Uniform papillae are a sign of normal texture and taste bud health. The client’s ability to move the tongue laterally and protrude it without discomfort suggests intact function of the hypoglossal nerve (CN XII). The ventral surface should be smooth and free of lesions or swelling. All of these findings are consistent with a normal oral examination.
Why the other options are incorrect:
B) Tongue appears pale, with a thick white coating, papillae are atrophic, and client has difficulty moving the tongue.
A pale tongue with a thick white coating and atrophic papillae may indicate anemia, fungal infection (like oral candidiasis), or nutritional deficiencies, especially if mobility is impaired.
C) Tongue is dry with a thick yellow coating and decreased mobility, and client reports soreness.
A dry, yellow-coated tongue with soreness and reduced mobility could suggest dehydration, infection, or inflammation such as glossitis.
D) Tongue has a red, inflamed appearance with a thick white coating and lesions on the ventral surface.
A red, inflamed tongue with thick white coating and lesions is abnormal and may be seen in oral thrush, viral infections, or other pathological conditions requiring further evaluation.
The nurse palpates a thrill over the client's precordium during a cardiac assessment. What is the most appropriate action for the nurse to take
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Attempt to relieve the thrill by palpating the area more firmly to assess for changes.
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Document the thrill as a normal finding and continue with the assessment
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Ignore the finding if the client is not experiencing any pain or discomfort.
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Report the thrill to the healthcare provider as it indicates turbulent blood flow.
Explanation
Correct Answer D: Report the thrill to the healthcare provider as it indicates turbulent blood flow.
Explanation:
A thrill is a palpable vibration over the precordium and is never a normal finding. It usually indicates turbulent blood flow, often associated with murmurs due to valvular defects or other cardiac abnormalities. The nurse should report it to the healthcare provider for further evaluation.
Why the other options are incorrect:
A) Attempt to relieve the thrill by palpating more firmly:
This is inappropriate. A thrill is a clinical finding—not something to "relieve" by palpation.
B) Document as a normal finding:
A thrill is not normal and should not be documented as such.
C) Ignore the finding if no pain is present:
Even if the client has no pain, a thrill still indicates an underlying issue that requires attention.
A nurse is assessing a client who presents with ear pain, fever, and a feeling of fullness in the ear. The client also reports difficulty hearing. Upon examination, the nurse notes that the ear canal is clear and there is no redness or swelling. The tympanic membrane is red, bulging, and there is fluid behind the ear drum. Based on these findings, which condition does the nurse most likely suspect
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Otitis media
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Otitis externa
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Sinusitis
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Mastoiditis
Explanation
Correct Answer A: Otitis media
Explanation:
Otitis media is an infection or inflammation of the middle ear. It is commonly characterized by:
Ear pain (otalgia)
Fever
Sensation of fullness
Hearing difficulty
Red, bulging tympanic membrane
Presence of fluid behind the eardrum
In this case, the clear ear canal and bulging red tympanic membrane with fluid behind it are classic signs of acute otitis media.
Why the other options are incorrect:
B) Otitis externa:
Also known as "swimmer’s ear," this is an inflammation of the external auditory canal, often presenting with redness, swelling, and tenderness of the canal itself, which is not present here.
C) Sinusitis:
Sinusitis involves inflammation of the sinuses, not the ear. While it can cause referred ear pressure or pain, it does not involve tympanic membrane changes.
D) Mastoiditis:
A complication of untreated otitis media, mastoiditis involves infection of the mastoid bone behind the ear. It typically presents with swelling and tenderness over the mastoid process, which is not noted in this case.
The nurse notes the following data from the head-to-toe examination of a client: 2+ pedal pulse, full sensation, and color changes in a client’s right leg (see photo). Based on this data, the nurse suspects
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Dependent rubor
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Peripheral Arterial Disease (PAD)
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Diabetic neuropathy
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Chronic venous insufficiency
Explanation
Correct Answer D: Chronic venous insufficiency
Explanation:
The image shows brownish discoloration around the ankle and lower leg, consistent with hemosiderin staining, which is a classic sign of chronic venous insufficiency. This occurs when veins in the lower legs are unable to efficiently return blood to the heart, leading to pooling of blood, edema, and skin changes. The presence of a 2+ pedal pulse and intact sensation further supports a venous issue rather than arterial or neurologic.
Why the other options are incorrect:
A) Dependent rubor:
This is a red-purple discoloration that appears when the leg is in a dependent position due to arterial insufficiency, not the chronic brown staining seen here.
B) Peripheral Arterial Disease (PAD):
PAD often presents with diminished or absent pulses, cool skin, pallor, and possibly pain with walking (claudication)—not with the discoloration shown in the photo.
C) Diabetic neuropathy:
This primarily affects sensation and may lead to foot ulcers due to loss of protective feeling, but it does not cause the discoloration evident in the image.
A nurse is performing a skin assessment on a client and notices a new, irregularly shaped mole with uneven borders, multiple colors, and a diameter greater than 6 mm on the client's back. The client has a family history of skin cancer. Based on these findings, which of the following is the most likely diagnosis
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Malignant melanoma
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Squamous cell carcinoma
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Basal cell carcinoma
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Seborrheic keratosis
Explanation
Correct Answer A: Malignant melanoma
Explanation:
A) Malignant melanoma is the most aggressive form of skin cancer and often arises from a new or changing mole. It is commonly identified using the ABCDE criteria:
Asymmetry: One half is unlike the other
Border: Irregular, notched, or blurred edges
Color: Multiple colors or uneven pigmentation
Diameter: Greater than 6 mm (about the size of a pencil eraser)
Evolving: Changes in size, shape, or symptoms (itching, bleeding)
The nurse’s description matches these warning signs, especially in a client with a family history of skin cancer, putting them at higher risk.
Why the other options are incorrect:
B) Squamous cell carcinoma:
Usually presents as a scaly, red, crusted lesion or nodule, often on sun-exposed areas. It’s less likely to appear as a multicolored, irregular mole.
C) Basal cell carcinoma:
Often appears as a pearly or waxy bump, sometimes with visible blood vessels. It typically grows slowly and does not show the color variation or irregular borders seen in melanoma.
D) Seborrheic keratosis:
A benign lesion that looks "stuck-on," with a waxy or wart-like appearance, often tan, brown, or black. It does not exhibit the malignant features described in this case.
A client with a history of peripheral arterial disease (PAD) and leg numbness and tingling is being seen in the clinic. Which statement made by the client is most consistent with PAD
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Wearing my compression socks at work helps a lot.
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Walking or elevating my legs makes them feel better.
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My legs are so swollen and heavy at the end of the day.
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My foot often falls asleep during the day
Explanation
Correct Answer D: My foot often falls asleep during the day.
Explanation:
Clients with peripheral arterial disease (PAD) often experience numbness, tingling, or a "falling asleep" sensation in the legs or feet due to reduced blood flow and nerve ischemia. This is especially common during periods of inactivity or when legs are elevated, as blood flow to distal extremities decreases further.
Why the other options are incorrect:
A) Wearing my compression socks at work helps a lot.
Compression stockings are not recommended for PAD because they can further restrict arterial blood flow to the extremities.
B) Walking or elevating my legs makes them feel better.
PAD pain usually worsens with walking (claudication) and elevation, and improves with rest and dependent positioning (legs down).
C) My legs are so swollen and heavy at the end of the day.
This is more typical of venous insufficiency, not PAD. PAD is associated with cool, pale, or thin skin and diminished pulses, not significant swelling.
The nurse is conducting a respiratory assessment on a newly admitted client with a history of chronic obstructive pulmonary disease (COPD). Which of the following findings is most likely to be observed
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Barrel-shaped chest
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Bradypnea with shallow respirations
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Clear breath sounds bilaterally
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Inspiratory pleural friction rub
Explanation
Correct Answer A: Barrel-shaped chest
Explanation:
A barrel-shaped chest is a classic physical finding in clients with COPD, especially those with emphysema. It results from chronic lung hyperinflation, which increases the anterior-posterior diameter of the chest, giving it a rounded, barrel-like appearance.
Why the other options are incorrect:
B) Bradypnea with shallow respirations:
Clients with COPD often exhibit tachypnea and use of accessory muscles, not typically bradypnea.
C) Clear breath sounds bilaterally:
Breath sounds in COPD are usually diminished, and may include wheezes or crackles due to mucus or airway obstruction.
D) Inspiratory pleural friction rub:
This is associated with pleuritis or pleural effusion, not COPD. It presents as a grating sound, not typical in chronic COPD.
The nurse is assessing a client's carotid arteries. Which of the following actions should the nurse take to ensure a safe and accurate assessment of the carotid arteries
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Auscultate the carotid artery to assess the pulse rate more accurately.
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Palpate both carotid arteries simultaneously to check for symmetry.
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Auscultate for bruits using the bell of the stethoscope.
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Palpate the carotid arteries while the client is lying flat in bed.
Explanation
Correct Answer C: Auscultate for bruits using the bell of the stethoscope.
Explanation:
When assessing the carotid arteries, the nurse should auscultate for bruits—which are abnormal "whooshing" sounds indicating turbulent blood flow from narrowing or plaque buildup. The bell of the stethoscope is used because bruits are low-pitched sounds.
Why the other options are incorrect:
A) Auscultate to assess pulse rate:
Pulse rate should be assessed by palpation, not auscultation of the carotid artery.
B) Palpate both carotid arteries simultaneously:
This is unsafe and can reduce blood flow to the brain, risking syncope (fainting).
D) Palpate while client is lying flat in bed:
The client should be in a sitting or slightly elevated position to properly assess the carotids and reduce risk of obstructing airflow or circulation.
A nurse is assessing an elderly client who reports experiencing a blind spot in the center of their vision. Which condition is most likely present
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Macular degeneration
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Glaucoma
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Diabetic retinopathy
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Cataracts
Explanation
Correct Answer A: Macular degeneration
Explanation:
A) Macular degeneration affects the macula, the central portion of the retina responsible for sharp, central vision. In age-related macular degeneration (AMD), clients often report a central blind spot, blurring, or distortion, especially when reading or focusing on fine details. Peripheral vision typically remains intact.
Why the other options are incorrect:
B) Glaucoma:
Glaucoma damages the optic nerve, often leading to peripheral vision loss first. It typically does not cause central blind spots until the disease is advanced.
C) Diabetic retinopathy:
This condition causes patchy or fluctuating vision, blurred vision, or floaters, but it does not typically present with a single central blind spot early on.
D) Cataracts:
Cataracts cause generalized blurring, glare, and cloudy vision, but not a distinct blind spot. The lens becomes opaque, leading to overall vision reduction rather than localized loss.
A nurse is performing a physical examination on a client presenting with nasal congestion, sneezing, and a runny nose. The client reports that these symptoms occur seasonally and are accompanied by itchy eyes. Upon nasal inspection, the nurse notes that the turbinates are pale, swollen, and boggy, and there is clear, watery nasal discharge. Based on these physical findings, what type of rhinitis is most likely
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Allergic rhinitis, with pale, swollen turbinates and clear nasal discharge
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Infectious rhinitis, with swollen turbinates and yellow-green discharge
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Acute rhinitis, with red, inflamed turbinates and purulent discharge
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Chronic rhinitis, with thickened, dry turbinates and no discharge
Explanation
Correct Answer A: Allergic rhinitis, with pale, swollen turbinates and clear nasal discharge
Explanation:
A) Allergic rhinitis typically presents with pale, boggy, and swollen turbinates, along with clear, watery nasal discharge, sneezing, nasal congestion, and itchy or watery eyes. These symptoms often occur seasonally (in response to pollen or other allergens) and are due to a hypersensitivity reaction involving histamine release.
B) Infectious rhinitis, with swollen turbinates and yellow-green discharge:
Infectious rhinitis (commonly from a cold or virus) usually presents with mucopurulent (yellow or green) nasal discharge, and erythematous (red) turbinates, not pale ones. It is often accompanied by systemic signs such as fever or malaise.
C) Acute rhinitis, with red, inflamed turbinates and purulent discharge:
This describes the early phase of viral rhinitis, not allergic rhinitis. It includes red, swollen nasal mucosa, not pale, and the discharge may become thicker and discolored as the infection progresses.
D) Chronic rhinitis, with thickened, dry turbinates and no discharge:
Chronic rhinitis may cause dryness, crusting, and thickened nasal mucosa, but it does not present with the clear discharge and itching seen in allergic rhinitis. This option does not match the client’s reported symptoms or physical findings.
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