Head-to-Toe 3.0 Test Questions and

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Head-to-Toe 3.0 Test Questions and Answers | Latest Version | 2025/2026 | Correct & Verified

Which action should the nurse take first when beginning a head-to-toe assessment?✔✔ A. Perform hand hygiene and introduce themselves

• Take vital signs
• Ask the client to change into a gown
• Inspect the chest

What is the best position for assessing the client’s lungs from the back?

• Supine

✔✔ B. Sitting upright

• Left lateral
• Trendelenburg

During the general survey, which observation is most appropriate?✔✔ A. The client’s posture, hygiene, and level of consciousness

• The client’s heart sounds 1 / 3

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• The abdominal shape
• Pupil response

Which of the following is the correct order of physical assessment techniques (except for the abdomen)?✔✔ A. Inspection, palpation, percussion, auscultation

• Percussion, palpation, inspection, auscultation
• Palpation, auscultation, inspection, percussion
• Inspection, percussion, auscultation, palpation

What is the correct order for abdominal assessment?

• Inspection, percussion, palpation, auscultation
• Palpation, percussion, inspection, auscultation

✔✔ C. Inspection, auscultation, percussion, palpation

• Auscultation, inspection, percussion, palpation

Which cranial nerve is assessed when the client sticks out their tongue?

• Cranial nerve V 2 / 3

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• Cranial nerve III

✔✔ C. Cranial nerve XII

• Cranial nerve X

When should the nurse assess for skin turgor?✔✔ A. During the integumentary portion of the assessment to check hydration

• During the head inspection
• Only during vital signs
• After lung auscultation

What is the best location to check capillary refill?

• Upper arms

✔✔ B. Fingertips

• Nose
• Abdomen

What should the nurse do when palpating the carotid arteries?✔✔ A. Palpate one side at a time to avoid compromising circulation

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