Exam 1: NR304 / NR 304 (Latest Update 2025 / 2026) Health Assessment II | Weeks 1-3

1. During the health history, a man tells you he has trouble in starting his urine stream when he arrives at the toilet. This symptom is known as:

a. Urgency.

b. Dribbling.

c. Frequency.

d. Hesitancy.

d. Hesitancy.

2. A parent of three biologic daughters has a 10-year-old boy the family adopted at age 2 years. The parent is learning about raising boys and asks you the first physical sign of puberty in the male genitalia:

a. Testes and scrotum begin to enlarge.

b. Penis enlarges and lengthens.

c. Dark coarse hair grows over entire pubis.

d. Scrotal skin assumes same pigment as the abdomen and thighs.

a. Testes and scrotum begin to enlarge.

3. During the health history, a 64-year-old man tells you he "never has sex anymore." Check the following appropriate follow-up questions you could use that are associated with withdrawal from sex. Select all that apply.

a. "Have you been told about any side effects of your medications?"

b. "Let's ask your provider for a blood test to detect decreased sperm production."

c. "Would you say you have had feelings of depression in the last few months?"

d. "How many alcohol drinks do you have each day?"

e. "This is an expected outcome in aging men."

f. "Have you experienced the loss of your spouse or your partner?"

a. "Have you been told about any side effects of your medications?"

c. "Would you say you have had feelings of depression in the last few months?"

d. "How many alcohol drinks do you have each day?"

f. "Have you experienced the loss of your spouse or your partner?"

4. A mother and father in the 7th month of their first pregnancy ask you about the benefits of circumcising their expected baby boy. Check all the facts you can share to help them with their decision.

a. In the United States, circumcising baby boys is a proven way to prevent HIV transmission later in life.

b. Removal of the foreskin decreases the incidence of urinary tract infections in very young infants.

c. Most surgical risks of infant circumcision are minor and treatable.

d. In the United States, circumcision protects against acquiring human papillomavirus and syphilis later in life.

b. Removal of the foreskin decreases the incidence of urinary tract infections in very young infants.

c. Most surgical risks of infant circumcision are minor and treatable.

5. You perform a genital examination on a 48-year-old man and note deeply pigmented wrinkled scrotal skin, with multiple, yellowish, 1-cm, firm, nontender nodules. What would be your next most appropriate action?

a. Ask about any family history of testicular cancer in the father or brothers.

b. Consider these sebaceous follicles an expected finding and proceed with the examination.

c. Assess the scrotum using transillumination.

d. Obtain a detailed history focusing on any scrotal abnormalities the man has noticed.

b. Consider these sebaceous follicles an expected finding and proceed with the examination.

6. You perform a genital examination on a 25-year-old man and palpate testes that feel ovoid and movable yet somewhat sensitive to compression. What is your next most appropriate action?

a. Ask another examiner to repeat the examination.

b. Search for subcutaneous plaques that may be painful.

c. Ask the man if he has noticed anything unusual in his own exams.

d. Consider this an expected finding and proceed with the examination.

d. Consider this an expected finding and proceed with the examination.

7. You are an advanced provider about to inspect and palpate a 55-year-old man for a suspected inguinal hernia. What is your best instruction to prepare this man?

a. "Hold your breath and cough when I ask you to."

b. "I will ask you to bear down when my gloved finger is in the inguinal canal."

c. "I will ask you to turn you head and cough when my gloved finger is in the inguinal canal."

d. "Please assume a lying-down position on the exam table for the hernia check."

b. "I will ask you to bear down when my gloved finger is in the inguinal canal."

8. You are about to examine the genitalia of a 93-year-old man who has an adhesion of the prepuce of the head of the penis, making the foreskin impossible to retract. You recognize this as:

a. Paraphimosis.

b. Phimosis.

c. Smegma.

d. Dyschezia.

b. Phimosis.

9. During assessment of a newborn baby boy, you note the urethral meatus is positioned ventrally, on the underside of the penis. Your next best action is to: Select all that apply.

a. Notice if the penis is straight or curved.

b. Note that this is consistent with uncircumcised baby boys and proceed with the exam.

c. Assure the parents that they can proceed with the planned circumcision at this time.

d. Ask a physician or AP provider to repeat the examination.

a. Notice if the penis is straight or curved.

and

d. Ask a physician or AP provider to repeat the examination.

10. A 1-month-old, uncircumcised boy comes to your clinic for a well-baby check-up. How would you proceed with the genital exam?

a. Elicit the cremasteric reflex.

b. Assess the glans for redness or lesions.

c. Avoid retracting the foreskin.

d. Note any dirt or smegma that has collected under the foreskin.

c. Avoid retracting the foreskin.

11. You are teaching a 19-year-old how to perform a testicular self-examination. Which of the following statements is your most appropriate?

a. "A good time to examine your testicles is just before you take a shower."

b. "If you notice an enlarged testicle or a firm lump, call your health care provider."

c. "The testicle is egg shaped, feels soft, and has a spongy consistency."

d. "Perform testicular self-exam at least once a week."

b. "If you notice an enlarged testicle or a firm lump, call your health care provider."

12. A 62-year-old man states his doctor told him he has an "inguinal hernia." He asks you to explain what a hernia is. Your best response is:

a. Tell him not to worry and that most men his age develop hernias.

b. Explain that a hernia is often the result of growth abnormalities that developed before he was born.

c. Refer him to his physician for additional information because they made the initial diagnosis.

d. Explain that a hernia is a loop of bowel protruding through a weak spot in the belly muscles.

d. Explain that a hernia is a loop of bowel protruding through a weak spot in the belly muscles.

13. You are caring for a person with jaundice from hepatitis. You expect the person's urine to be:

a. Orange in color.

b. Red from blood in urine.

c. Normal, clear yellow.

d. Dark gray in color.

a. Orange in color.

When assessing a young adult male, which statement made by the client indicates the need for more education?

"Pain with urination may be a sign I have a sexually transmitted infection."

"Condoms are unnecessary as long as the female partner is taking birth control pills."

"Stress can make it difficult for men to get an erection."

"Men can get breast cancer."

"Condoms are unnecessary as long as the female partner is taking birth control pills."

The examiner is performing a focused reproductive interview with a 55-year-old male client. Which client statement indicates a need for more male reproductive health education?

"I know that smoking increases my risk of bladder cancer."

"As I get older, my urine stream is not as strong."

"Because I am circumcised, I am at higher risk of getting sexually transmitted infections."

"I have less testosterone than I used to."

"Because I am circumcised, I am at higher risk of getting sexually transmitted infections."

It is recommended to do a testicular self-exam _______ Adolescent males should begin testicular self-examinations by the age of ______

Monthly, 14

What occupation is most likely to lead to urinary stasis / UTI in a male?

Occupations including construction and truck driving

Environmental factors affecting Male urinary health:

High mineral content in water placed client at risk for the development of renal calculi,

so does a can a diet high in grapefruit

Chronic medical conditions affected male urinary health

Dementia, Alzheimer's disease, Parkinson's disease, and medications used to treat these diseases often disrupt urinary function.

Common manifestations include incontinence, retention, frequency or urgency, and skin breakdown

Whats included in a Male wellness exam?

Breast exam, physical inspection of reproductive organs, GU system, urine specimen, lymph nodes of the inguinal area

What are diagnostic tests used when assessing the genitourinary and reproductive system of a male?

Ultrasound, creatinine, testosterone, prostate specific antigen, and cystoscopy

What age does puberty begin with males?

9-13 (depending on development and culture)

Some newborns may produce a thin discharge from their nipples or experience enlarged breast tissue due to higher estrogen levels from the mother.

This is a NORMAL finding

What causes erectile dysfunction in young adult males?

Usually stress or medication

Older adult male considerations

Testicular Cancer risk INCREASES

Testosterone DECREASES

ED is more likely due to decline in cardiovascular health

What can bedwetting of children older than 6 indicate?

Sexual abuse

During the assessment of a 4-week-old infant, you note the response in this photo as you move your finger up lateral side of foot. What is your next action?

a. This response should have disappeared by this age; alert another examiner.

b. Move on with the examination; this is an expected response.

c. Ask the parent if they were informed of any concerns at the birth of the baby.

d. Test for nuchal rigidity to assess for suspected infection of meninges.

e. Measure pulse oximetry to determine level of oxygen to tissues.

b. Move on with the examination; this is an expected response.

2. You are supervising a student caring for a 46-year-old man admitted to hospital with hypothermia following a boating accident. He was in the water 6 hours before rescue, wearing a floating device keeping his head out of water. You expect the student to know control of body temperature is located in:

a. Wernicke's area

b. The thalamus.

c. The cerebellum.

d. The hypothalamus.

d. The hypothalamus.

3. During the neurologic exam, you place a key in the person's hand with their eyes closed and ask them to identify the object. This measures the ability of:

a. Stereognosis.

b. Graphesthesia

c. Two-point discrimination

d. Kinesthesia.

a. Stereognosis.

4. During an outpatient examination, you ask the person to stand with feet together, arms at sides, eyes closed, and hold position about 20 seconds. This text demonstrates intactness of:

a. Cerebral cortex.

b. Cerebral medulla

c. Motor system

d. Cerebellum

d. Cerebellum

5. Mr. G. is a 54-year-old man with parkinsonism. Which description of his speech would contribute to the expected findings?

a. A garbled manner

b. Loud, urgent

c. Slow, monotonous

d. Word confusion

c. Slow, monotonous

6. Which of the following are correct examination techniques when testing the biceps reflex? Select all that apply.

a. Locate and place your thumb on the person's biceps tendon.

b. Strike the tendon just above the outside of the elbow.

c. Expect the forearm to extend slightly in response to strike of reflex hammer.

d. With the reflex hammer, strike over the target in person's antecubital fossa.

e. Tell the person to let the arm "just go dead" as you suspend it by holding the upper arm.

a. Locate and place your thumb on the person's biceps tendon.

and

d. With the reflex hammer, strike over the target in person's antecubital fossa.

7. During the examination of a 91-year-old woman, you note that the hands have a tremor as she reaches for her purse, and her head has a small yes-no nodding. There is no associated rigidity with movement. Which is your most accurate assessment?

a. These are expected findings due to aging.

b. These findings are associated with parkinsonism

c. These findings are associated to Alzheimer disease.

d. This woman should be referred to a neurologic specialist.

a. These are expected findings due to aging.

8. You are testing the DTRs of a 30-year-old woman. When striking the quadriceps reflex, you are unable to elicit a response. What is your next most appropriate action?

a. Ask the woman to lock her fingers and "pull."

b. Complete the exam, then test these reflexes again.

c. Refer the woman to a specialist for further testing.

d. Document these reflexes as "0" on a scale of 0 to 4+.

a. Ask the woman to lock her fingers and "pull."

9. You test superficial reflexes on a 36-year-old woman. When you stroke up the lateral side of the sole and across the ball of the foot, you notice plantar flexion of the toes. How would you document this finding?

a. Positive Babinski sign.

b. Plantar reflex abnormal

c. Plantar reflex present

d. Plantar reflex absent

C. planter reflex present

10. A 21-year-old woman has a head injury secondary to a blow on the head and is unconscious. During your assessment, what are the expected findings when you test her deep tendon reflexes?

a. Reflexes will be normal.

b. You will be unable to elicit any deep tendon reflexes.

c. All deep tendon reflexes are diminished by present.

d Some deep tendon reflexes are present depending on area of injury.

a. Reflexes will be normal.

11. A fully alert normal person has a Glasgow Coma Scale of 15. Which assessments listed below contribute to the total score of the GCS? Check all that apply.

a. Pupils equal and react to light and accommodation.

b. Person's eyes open spontaneously during the assessment.

c. Person wiggles the fingers when asked to do so.

d. Person's blood pressure and pulse rate are within normal limits.

e. Person is oriented to self, place, and time.

b. Person's eyes open spontaneously during the assessment.

c. Person wiggles the fingers when asked to do so.

e. Person is oriented to self, place, and time.

Olfactory 1

smell

Optic 2

vision

Oculomotor Nerve (III)

Extraocular movement, pupil constriction, down and inward movement of the eye

Trochlear 4 IV

Down and inward movement of the eye

Trigeminal 5

Mastication and sensation of face, scalp, cornea

Abducens 6 (VI)

lateral eye movement

Facial 7 (VII)

Tasting on the anterior two thirds of tongue, closing eyes

Acoustic 8 (VIII)

Hearing and equilibrium

Glossopharyngeal 9 (IX)

Phonation, swallowing, tasting on the posterior third of tongue

Vegas 10 (x)

Talking, swallowing, and sensory information from pharynx and carotid sinus

Spinal accessory 11 (XI)

Movement of trapezius and sternomastoid muscles

Hypoglossal 12 (XII)

tongue movement

1. You are caring for a 52-year-old woman with a 5-year history of rheumatoid arthritis. As you complete the musculoskeletal assessment, you identify the following assessment and history findings that are expected deviations with rheumatoid arthritis. Select all that apply.

a. Symmetric joint involvement.

b. Unilateral joint involvement.

c. Lymphadenopathy.

d. Increased appetite.

e. Weight gain.

f. Fatigue.

g. Hard, bony protuberances.

h. Ulnar drift.

i. Bone spur.

j. Anorexia.

a. Symmetric joint involvement.

c. Lymphadenopathy.f. Fatigue.

f. Fatigue.

h. Ulnar drift.

j. Anorexia.

2. Identify the appropriate order for the development of the normal spinal curvature from infancy to adulthood. Not all choices will be used.

1. Posterior curve in lumbar region.

2. C shaped curvature of spine.

3. Lateral s-shaped curve develops.

4. Anterior curve in lumbar region.

5. Anterior curve in cervical neck region.

6. Spinal curvature disappears.

2. C shaped curvature of spine. (1)

5. Anterior curve in cervical neck region. (2)

4. Anterior curve in lumbar region.(3)

3. You are providing osteoporosis education to a 67-year-old female who is at your clinic for her annual check-up. She has no chronic medical conditions, and her last bone mineral density was normal. Important teaching:

a. Its recommended that you have a DEXA scan to check for osteoporosis every 2 to 5 years. You'll want to continue to eat a healthy diet, exercise at least twice a week, and drink no more than one standard drink per day.

b. Your last BMD was normal. Continue to maintain a healthy weight and avoid all alcohol. I'd like to check your vitamin D levels to ensure you are getting enough in your diet. Given your age, you should consume at least 1000 mg of calcium/day.

C. Your last BMD was normal. It's important that you continue to eat a healthy diet and maintain a healthy weight. You should exercise at least five times each week and consider a combination of cardiovascular, balance, and strength training.

C. Your last BMD was normal. It's important that you continue to eat a healthy diet and maintain a healthy weight. You should exercise at least five times each week and consider a combination of cardiovascular, balance, and strength training.

4. You are assessing a patient with a suspected rotator cuff tear. What assessment findings do you expect if the rotator cuff is torn? Select all that apply.

a. Upright positioning.

b. Hunched position.

c. Limited adduction.

d. Atrophy of shoulder girdle.

e. Fluctuant to palpation.

f. Limited abduction.

g. Positive arm drop test.

b. Hunched position.

f. Limited abduction.

g. Positive arm drop test.

Flexion

bending a joint

Extension

Straightening of a joint

Abduction

Movement away from the midline of the body

Adduction

Movement toward the midline of the body

Pronation

turning the palm downward

Supination

turning the palm upward (HOLDING SOUP)

Circumduction

moving the arm in a circle around the shoulder

Inversion

Turning the sole of the foot inward at the ankle

Eversion

moving the sole of the foot outward at the ankle

Rotation

Moving head on its axis

protraction

moving a body part forward and parallel to the ground

retraction

moving a body part backward and parallel to the ground

Elevation

raising a body part

depression

lowering a body part

An f. Raising a body part 81-year-old woman has come for a health examination. As you complete the assessment, you notice several changes in the musculoskeletal system. Mark each change as expected or not expected with normal healthy aging.

Expected

Flexion in hips

Flexion in knees

Boggy metacarpophalangeal joints

Not expected

Kyphosis

Lordosis

Osteoarthritis

Identify which assessment findings are expected in each group. Some findings may be expected in multiple groups.

Assessment Finding

Infant

Varus position of feet/legs (flexible)

Valgus position of feet/legs (flexible)

Toddler

Varus position of feet/legs (flexible)

Valgus position of feet/legs (flexible)

Lordosis

Preschool/school age

Varus position of feet/legs (flexible)

Valgus position of feet/legs (flexible)

Pregnant woman

Lordosis

Cervical flexion

The client comes to the clinic with reports of bilateral swelling and pain in the DIP joints in her fingers. She also complains of fatigue and weight loss for the past year. VS: HR 86 bpm, regular, RR 18 bpm, unlabored, Temperature 100.5°F, BP 110/78. Upon physical examination, the DIP joints are tender and warm with a limited range of motion bilaterally. Full ROM in all other joints. Muscle strength—able to maintain flexion against resistance. Atrophy is noted in the interosseous muscles of the hands bilaterally.

Given the above information, select the correct term to fill in each blank.

The client most likely has _________________ which is a/an ___________________ typically involving ____________________ joints in the ___________and ___________.

The client most likely has rheumatoid arthritis which is an inflammatory condition typically involving symmetric joints in the feet and hands

the correct order of steps in assessing a person for scoliosis:

1. Position self behind client so full spine is visible.

2. Note level of shoulders, scapulae, and iliac crests.

3. Ask client to bend at the waist and reach for toes.

4. Note level of shoulders, ribs, and iliac crests while they are bent forward.

That was it <<

Assessment of the musculoskeletal systems uses i______ and _________.

Inspection, Palpation

Which factors have a positive impact on bone health? Select all that apply.

Exercise

Proteins

Calcium

Vitamin D

Smoking

Exercise

Proteins

Calcium

Vitamin D

A client presents to the emergency room with an injured right ankle. Besides a musculoskeletal assessment, which assessment should be completed?

Cardiac

Respiratory

Neurovascular

Abdominal

Neurovascular

musculoskeletal system consists of:

Joints, muscles and Bones

Subjective data to collect during a musculoskeletal assessment (Joints)

Do you have any current or a history of diseases or issues with your joints? Any pain?

Do you have any stiffness, swelling, or heat in your joints?

Have you had a recent tick bite?

Do you have any limitations of movement in a joint?

Subjective data to collect during a musculoskeletal assessment (Muscles)

Do you have any current or a history of diseases or issues with your muscles? Any pain?

Do you have any problems with muscle cramps?

Do you have weakness in your muscles?

Subjective data to collect during a musculoskeletal assessment (Bone)

Do you have any current or a history of diseases or issues with your bones? Any pain?

Do you have any bone deformities?

Have you had any past accidents or injuries that affected the bones?

Key facts to recall when assessing the musculoskeletal system.

Know the normal range of motion for joints to avoid overstressing these joints.

Stop if the client reports pain.

Use a head-to-toe approach to the exam, comparing one side to the other.

Provide rest breaks for older adults and people with a history of chronic diseases during the exam.

During a musculoskeletal assessment, if the client complains of pain, the nurse should (continue or stop) the assessment.

Stop

Grading system for ROM 0-5

5-Full ROM against gravity, full resistance

4-Full ROM against gravity, some resistance

3-Full ROM with gravity

2-Full ROM with gravity eliminated (passive motion)

1-Slight contraction

0-No contraction

Dupuytren's contracture

Inability to extend fourth and fifth fingers

Degenerative joint disease:

thickened synovial fluid, fragmented connective tissue, and scarring with joint calcification

Carpal tunnel syndrome

pain, tingling, numbness of the thumb and forefinger, weakness when grasping or making a fist

Bursitis:

localized joint pain with swelling, heat, and redness (often in the knee)

Gout

a type of arthritis caused by uric acid crystal deposits in the joints

Scleroderma

damage to the skin, blood vessels, and joints caused by collagen build-up

Ulnar deviation:

metacarpophalangeal and interphalangeal joint inflammation, leading to the hand turning outward

Hallux valgus

big toe abnormally adducted at the metatarsophalangeal joint

Which statement made by the client requires further education?

"I have a low-sodium diet."

"I have never smoked."

"I don't usually wear a bike helmet when riding."

"I exercise every day for at least 30 minutes."

"I don't usually wear a bike helmet when riding."

A 67-year-old female (pronouns: she/her/hers) is in for her annual visit and the nurse is completing the assessment. The client states she cannot take walks outside with the frequency she had in the past because it hurts to walk.

How should the nurse respond?

"Tell me what happens when you walk."

"We should talk to your partner about this."

"Don't worry. You will be fine; we will help you enjoy walking again."

"You should go outside, mind over matter."

"Tell me what happens when you walk."

A 67-year-old female (pronouns: she/her/hers) is in for her annual visit and the nurse is completing the assessment. The client states she cannot take walks outside with the frequency she had in the past because it hurts to walk.

Analyzing Cues

Which findings discovered by the nurse during a complete health history and physical assessment may contribute to this older adult's ability to walk? Select all that apply.

Recently diagnosed with decreased bone density

1.5 inches shorter than 1 year ago

Reduced range of motion of the joints

Clicking and crepitus when bending knees

Decrease in bone prominences

Recently diagnosed with decreased bone density

1.5 inches shorter than 1 year ago

Reduced range of motion of the joints

Clicking and crepitus when bending knees

A 67-year-old female (pronouns: she/her/hers) is in for her annual visit and the nurse is completing the assessment. The client states she cannot take walks outside with the frequency she had in the past because it hurts to walk.

Prioritizing Hypothesis

Which assessment findings would the nurse expect for this client? Select all that apply

Increased constipation

Pain with ambulation

Skin breakdown

Decrease in the frequency of walks

Vision changes

Increased constipation

Pain with ambulation

Decrease in the frequency of walks

A 67-year-old female (pronouns: she/her/hers) is in for her annual visit and the nurse is completing the assessment. The client states she cannot take walks outside with the frequency she had in the past because it hurts to walk.

Taking Action

The assessment findings for this client include: pain with ambulation, a decrease in the frequency of walks, and constipation. Based on these findings, for each nursing action below, indicate if it is or is not a priority action that the nursing will perform right away.

Psych consultation for expressed sadness of decreased ambulation

Examination for stated pain with ambulation

Smoking cessation class for smoking habits

Examination for stated pain with ambulation

A 67-year-old female (pronouns: she/her/hers) is in for her annual visit and the nurse is completing the assessment. The client states she cannot take walks outside with the frequency she had in the past because it hurts to walk.

Evaluating Outcomes

The nurse is providing education to the client about musculoskeletal impairments and interventions. Which statement made by the client indicates comprehension of the education about this condition? Select all that apply.

"I won't sit for long periods of time."

"I will add calcium rich foods to my diet."

"Smoking is my guilty pleasure."

"I will eat a whole foods diet."

"I will walk every day for at least 30 minutes."

"I won't sit for long periods of time."

"I will add calcium rich foods to my diet."

"I will eat a whole foods diet."

"I will walk every day for at least 30 minutes."

Focused Assessment

A client presents to the emergency department (ED) with an obvious deformity of the right forearm due to an accident. Which items should the nurse include in the neurovascular assessment? Select all that apply.

Gait

Skin color

Sensation

Strength

Pulses

Skin color

Sensation

Pulses

Infants

spina bifida

congenital hip dislocation

Children

scoliosis

Pregnancy

softening of pubis joints

waddling gait

Older Adults

osteoporosis

kyphosis

osteoarthritis

Commonly found by age group

Identify the risk factors for scoliosis in the list below.

Age

Occupation

Family history

Gender

Smoking

Age

Family history

Gender

Identify the assessment data the nurse may find if a client has scoliosis.

Uneven shoulders

Back pain

Decreased strength

Headache

Flaccid muscles

Curvature of the pelvis

Uneven gait

Muscle spasms

Leaning to one side

Signs and symptoms of scoliosis include uneven shoulders, back pain, uneven gait, muscle spasms, and leaning to one side.

Scoliosis is the curvature of the spine, not the pelvis. It does not cause headaches, flaccid muscles, or decreased strength.

A client with scoliosis asks the nurse how physical therapy will help with breathing. Which response by the nurse is correct?

"Physical therapy will teach you to shallow breathe."

"Exercising causes you to breathe heavily."

"Certain exercises can help expand the rib cage, increasing lung capacity."

"The exercises will teach the lungs to support the spine."

"Certain exercises can help expand the rib cage, increasing lung capacity."