NR 509 Advanced Physical Assessment – Week 2 Quiz

A mother brings her two month old daughter in for an examination says “my daughter rolled over against the wall and now I have noticed that she has the spot soft on the top of her head, is there something terribly wrong?” The FNP‘s best response would be:
During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most likely results from:
The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects Damage to:
When examining the face, the FNP is aware that the two pairs of salivary gland‘s that are accessible to examination are the _____ glands
A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by____
When examining a patient’s cranial nerve function, the FNP remembers that the muscles in the neck that are innervated by CN XI are the: NR 509 Advanced Physical Assessment.
The patient’s laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the _____ gland
A patient says that she has recently noticed a lump in the front of her neck below her “Adams apple” that seems to be getting bigger. During the assessment, the finding that leaves the FNP to suspect that this may not be a cancerous thyroid nodule is that the lump:
The FNP notices that the patient’s submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, the FNP would assess the patient’s:
The FNP is aware that the four areas in the body were lymph nodes accessible are the:
A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The FNP should know that floaters are usually not significant and are caused by:
The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP proceed?
A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The FNP interprets these results to indicate that:
A patient is unable to read even the largest letters on the Snellen chart. The FNP should take which action next:
A patient’s vision is reported as 20/80 in each eye. The FNP interprets this finding to mean that NR 509 Advanced Physical Assessment
When performing the corneal light reflex assessment, the FNP notes that the light is reflected at 2 o’clock in each eye. The FNP should
The FNP is performing the diagnostic positions test. Normal findings would be which of these results?
During an assessment of the sclera of an African-American patient, the FNP would consider which of these an expected finding?
A 60-year-old man is at the clinic for an examination. The FNP suspects that he has ptosis of one eye. How should the FNP check for this?
The FNP is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale gray and swollen. What would be the most appropriate question to ask the patient?
The FNP is palpating the sinus areas. If the findings are normal, then the patient should report which sensation? NR 509 Advanced Physical Assessment.
During an oral assessment of a 30-year-old African-American patient, the FNP notices bluish lips and a dark line along the gingival margin. What would the FNP do in response to these findings
During an assessment of a 20-year-old patient with a three day history of nausea and vomiting the FNP notices dry mucous and deep vertical fissures on the tongue. These findings are reflective of:
The FNP is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate FNP reflects a correct understanding of tactile fremitus?
The FNP student is reviewing physical assessment findings of the HEENT system associated with pregnancy. Which statement by the graduate FNP reflects a correct understanding of expected HEENT changes associated with pregnancy? During pregnancy: NR 509 Advanced Physical Assessment.

NR 509 Advanced Physical Assessment – Week 2 Quiz Review – (Jarvis 8,9,13,14,15,16,18), (Swartz 4,6,7,8,9,10)

What does dullness when percussing lung fields: Jarvis pg 427
Facial sensation controlled by which CN: Jarvis 283,
Know what two salivary glands are accessible during exam
What CN is being … when pt shrugs shoulders Jarvis 646
What muscles are being …. when …. CN 11 (spinal accessory nerve)
Concern for malignant nodules versus benign lymph nodule
Know what you’d do next if you palpated a submental lymph node: Jarvis pg 253
Define visual acuity
Know what to do if your patient can’t read the largest number on the Snellen chart: Jarvis 289
Example of good visual acuity : Jarvis 289
Example of poor visual acuity: Jarvis 289
What is …. with corneal light reflex-
Know normal variances of sclera : Jarvis 283
Know how to check for Ptosis: Jarvis 292
What does ptosis indicate: Jarvis 292
NR 509 Advanced Physical Assessment
Nasal fissure of pt with chronic allergies : Jarvis 271
Acute allergies : Jarvis p 363 .
What is an abnormal palpation of sinuses: Jarvis 362
Normal palpation of sinuses
Know normal variations in gingival margin
Know what a dehydrated oral cavity will look like: Jarvis 387
What is tactile fremitus, how do you test for it and what does it indicate. Jarvis 425

CLICK HERE TO ORDER NR 509 Advanced Physical Assessment
A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The FNP examined her hand and will expect a fracture if the girl complains: NR 509 Advanced Physical Assessment.
A patient has been diagnosed with osteoporosis and asked the FNP “what is osteoporosis?” The FNP explains to the patient that osteoporosis is defined as:
Patient states, “I can hear a crunching or grating sound when I kneel”. She also states “that it is very difficult to get out of bed in the morning because of stiffness and pain in my joints”. The FNP should assess for signs of what problem?
When taking the history on a patient with a seizure disorder the FNP assesses whether the patient has an aura. Which of these would be the best question for obtaining this information?
The FNP is teaching a class on osteoporosis prevention to a group of post menopausal women. A participant shows that she needs more instruction when she states I will:
The FNP is performing a neurological assessment on a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork the FNP notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patella. Given this information what would the FNP suspect?
And 80-year-old woman is visiting the clinic for a check up. She states “I can’t walk as much as I used to”. The FNP is observing from motor dysfunction in her hip and should have her:
The FNP is testing the function of cranial nerve XI. Which of these best describes the response the FNP should expect if the nerve is intact? The patient:
A 50-year-old woman is in a clinic for weakness in her left arm and leg that she noticed for the past week. The FNP should perform which type of neurologic examination?
During the neurological assessment of a healthy 35-year-old patient the FNP asks him to relax his muscles completely. The FNP then moves each extremity through full range of motion. Which of these results would the FNP expect to find?
A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain. The FNP tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. NR 509 Advanced Physical Assessment This shift and posture is known as:
A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasm’s. The FNP should suspect:
A professional tennis player comes into the clinic complaining of a sore elbow. The FNP will assess for tenderness at the:
The FNP suspect that a patient has carpal tunnel syndrome and wants to perform the Phalens test. To perform this task the FNP should instruct the patient to:
During the history a patient tells the FNP that “it feels like the room is spinning around me”. The FNP would document this as:
The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception the FNP decides to complete the test as quickly as possible. When the FNP applies the sharp point of a pin on his arm several times he is only able to identify these as one very sharp prick. What would be the most accurate explanation for this?
An 85-year-old patient comments during his annual physical that “he seems to be getting shorter as he ages”. The FNP should explain that decrease height occurs with aging because:
A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for a while, and then gets worse again if he sits for long periods of time. The FNP should assess for other signs of what problem?
When the FNP asks a 68-year-old patient to stand with feet together and arms at his side with his eyes closed he starts to sway and moves his feet farther apart. The FNP would document this finding as: NR 509 Advanced Physical Assessment
During an assessment of the cranial nerves the FNP finds the following asymmetry when the patient smiles or frowns, uneven lifting of eyebrows, sagging of lower eyelids, and escape of air when the FNP presses against the right path cheek. This would indicate dysfunction of which of these cranial nerves?
The FNP is teaching a class on osteoporosis prevention to a group of postmenopausal women which of these actions is the best way to prevent or delay bone loss in this group?
In obtaining a history on a 74 year old patient the FNP notes that he drinks alcohol daily and that he has noticed a tremor in his hands that affects his ability to hold thing. With this information what should the FNP‘s response be?
During a history of a 78-year-old man his wife states that “he occasionally has problems with short-term memory loss and confusion. He can’t even remember how to button his shirt”. In doing the assessment of his sensory system which action of the FNP‘s is most appropriate?
While obtaining a history of a 3 month old infant from the mother the FNP asks about the infants ability to suck and grass the mothers finger. What is the FNP assessing?
The FNP is doing an assessment on a 29-year-old woman who visits the clinic complaining of always dropping things and falling down. While testing rapid alternating movements the FNP notices that the woman is unable to pat both her knees. Her response is very slow and she misses frequently. What should the FNP suspect? NR 509 Advanced Physical Assessment.

NR 509 Week 3 Quiz (Version 2)

What piece of equipment can be used to test for peripheral neuropathy
How would you test for Romberg sign
Diagnosis for patient with complaint of room spinning
Know expected postural changes in pregnancy
Know what the phalen’s test is and how to conduct it
Hands back to back for 60 secs looking for development of
Positive Phalen’s test
Older pt that can’t remember to tie shoes in order to assess this you first want to?
What is loss of bone density
Disease that is accompanied by joint pain in the morning that improves with movement and worsens with sitting
What is summation effect and what does it mean
Know what is normal findings in passive ROM
… evaluate a pt with migraines in regard to if they have an aura
Know abnormal finding of rotator cuff
Know the type of neuro exam to complete on a pt presenting with one sided weakness
Understand tennis elbow
Know common reflexes at various ages
What tremors improve with ETOH
Understand CN 11
What concerns exist when pt is slow with RAM
R/O MS NR 509 Advanced Physical Assessment
Know education for pts on exercises that help to prevent osteoporosis
What does hip abduction reveal
A 35-year-old man is seen in the clinic for an infection in his left foot. Which of these findings should the FNP expect to see during an assessment of this patient?
The direction of blood flow through the heart is best described by which of these
In assessing the carotid artery’s of an older patient with cardiovascular disease, the FNP would
When listening to heart sounds the FNP knows that the valve closures that can be heard best at the base of the heart are
The sack that surrounds and protects the heart is called the
When assessing a newborn infant who is five minutes old the FNP knows that which of these statements would be true?
The FNP is performing an assessment on an adult. The adults vital signs are normal and capillary refill is five seconds. What should the FNP do next?
During an assessment of an older adult the FNP should expect to notice which finding as normal physiologic change associated with aging process NR 509 Advanced Physical Assessment?
The mother of a three month old infant states that her baby has not been gaining weight. With further questioning the FNP finds that the infant falls asleep after nursing and wakes up after a short amount of time hungry again. What other information with the FNP want to have?
In assessing a patient’s major risk factors for heart disease which would the FNP want to include when taking a history?
The FNP is … the pulses of a patient who has been admitted for untreated hyperthyroidism. The FNP should expect to find a____pulse
A patient complains of leg pain that wakes him at night. He states that he has been having problems with his legs. ….. his legs when they are … and disappears when he dangles them. He recently noticed a sore on the inner aspect of his right ankle. On the basis of this history information the FNP interprets that the patient is most likely experiencing
During an assessment the FNP uses the profile sign to detect
Which of these statements describes the closure of the valves in a normal cardiac cycle?
When performing a peripheral vascular assessment on a patient the FNP is unable to palpate the ulnar pulses. The patient skin is warm and capillary refill is normal. The FNP should next
A 67-year-old patient states that he “recently began have pain in his left calf when climbing the 10 stairs to his apartment”. This pain is relieved by sitting for about two minutes then he’s able to resume activities. The FNP interprets this patient is most likely experiencing
In assessing a 70-year-old man the FNP finds the following blood pressure 140/100 mmHg, heart rate 104 and slightly irregular, split S2. Which of these findings can… by expected hemodynamic changes related to age?
The FNP is examining the lymphatic system of a healthy three year old child. Which finding should the FNP expect?
The FNP is preparing to perform modified Allen test. Which is an appropriate reason for this test?
A 25-year-old woman is in her fifth month of pregnancy has a blood pressure of 100/70 mmHg. In reviewing her previous exam the FNP notes that her blood pressure in her second month was 124/80 mmHg. When evaluating this change what does the FNP know to be true?
Findings from an … of a 70-year-old patient with swelling in his ankles include jugular venous pusations, 5 cm above the sternal angle when the head of his bed is …. 45°. The FNP knows that this finding indicate:
The component of the conduction system referred to as the pacemaker of the heart is the
The FNP is reviewing anatomy and physiology of the heart. Which statement best … by atrial kick?
A 45-year-old man is in the clinic for a routine physical. During history the patient states he has been having difficulty sleeping. I’ll be sleeping great and then I wake up and feel like I can’t catch my breath. The FNP‘s best response to this would be
When assessing a patient the FNP notes that the left femoral pulse as diminished 1+/4+. What should the FNP do next?
An older patient has been diagnosed with pernicious anemia. The FNP knows that this condition could be related to NR 509 Advanced Physical Assessment
….. examining a patient who tells the FNP “I sure sweat a lot especially on my face and feet but it doesn’t have an odor”. The FNP knows that this could … related to
During an abdominal assessment the FNP elicits tenderness on light palpation in the right lower quadrant. The FNP interprets that this finding could indicate a disorder which of these structures?
An Inuit visiting Nevada from anchorage has come to the clinic in July during the hottest part of the day. It so happens that the clinics air conditioning is broken and the temperature is very hot. The FNP knows that which of these statements is true about the Inuit sweating tendencies?
The FNP notices that a patient has black, tarry stool and recalls that a possible cause would …
….. an abdominal …. deep palpation is used to determine
The FNP is assessing the abdomen of an aging adult. Which of these statements regarding an aging adult and abdominal assessment is true?
During examination the FNP finds that a patient has excessive dryness of the skin. The best term to describe this condition is
A FNP notices that a patient has ascites, which indicates the presence of
The FNP is performing percussion during an abdominal assessment. Percussion notes during the abdominal assessment may include
The FNP is caring for a black child who has … with marasmus. The FNP would expect to find the
… patient’s medical record that the patient has a lesion that is confluent in nature. On examination the FNP would expect to find
The FNP is assessing the abdomen of a pregnant woman who is complaining of having acid indigestion all the time. The FNP knows that esophageal reflux during pregnancy can cause
The patient has abdominal borborygmi. The FNP knows that this term refers to
A patient has a terrible itch for several months that he … scratching continuously. On examination the FNP might expect to find
During aging process, the hair can look gray or white and begin to feel thin and fine. The FNP knows that this occurs because of a decrease in number of functioning
The FNP notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding the FNP would report this as a
During an abdominal assessment the FNP would consider which of these findings as normal?
A 52 -year-old Woman has a papule on her nose that has a rounded pearly border and a central red ulcer. She said she first noticed it several months ago and that it is slowly growing larger. The FNP suspects which condition? NR 509 Advanced Physical Assessment
The FNP is listening to bowel sounds. Which of these statements is true about bowel sounds?
The FNP is watching a new graduate FNP perform auscultation of a patient abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation proceeds percussion and palpitation of the abdomen?
A patient is complaining of a sharp pain along the costovertebral angles. The FNP knows that this symptom is most often indicative of
The patient is … of having inflammation of the gallbladder or cholecystitis. The FNP should conduct which of these techniques to assess for this condition?
A newborn infant is in the clinic for a well baby check. The FNP observes the infant for possibility of fluid loss because of which these factors?
During an assessment of a newborn infant, the FNP recalls that pyloric stenosis would … manifested by

NR 509 Advanced Physical Assessment – Week 5 Quiz: Skin, Hair, Abdomen

Question: The FNP is assessing the abdomen of an aging adult. Which of these statements regarding the agind adult and abdominal assessment is true?
Question: The FNP notices that a patient has had a black tarry stool and recalls that a possible cause would be
Question: The FNP knows that during an abdominal assessment deep palpitation is used to determine
Question: A patient has abdominal borboygmi. The FNP knows that this term refers to
Question: During an abdominal assessment, the FNP would consider which of these findings as normal? NR 509 Advanced Physical Assessment
Question: The FNP is caring for a black child who has been diagnosed with marasmus. The FNP would expect to find the
Question: An Inuit visiting Nevada from Anchorage has come to the clinic in July during the hottest part of the day. It so happens that the clinic’s air conditioning is broken and the temperature is very hot. The FNP knows that which of these statements is true about the Inuit sweating tendencies?
Question: The FNP is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include:
Question: During an abdominal assessment, the FNP elicits tenderness on light palpation in the right lower quadrant. The FNP interprets that this finding could indicate a disorder of which of these structures NR 509 Advanced Physical Assessment?
Question: A patient has a terrible itch for several months that he has been scratching continuously. On examination, the FNP might expect to find
Question: The FNP is listening to bowel sounds. Which of these statements is true of bowel sounds?
Question: A patient is complaining of a sharp pain along the costovertebral angles. The FNP knows that this symptom is most often indicative of
Question: The FNP notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding, the FNP would report this as a
Question: A patient is suspected of having inflammation of the gallbladder, or cholecystitis. The FNP should conduct which of these techniques to assess for this condition?
Question: The FNP just noted from a patient’s medical record that the patient has a lesion that is confluent in nature. On examination, the FNP would expect to find
Question: During an examination, the FNP finds that a patient has excessive dryness of skin. The best term to describe this condition is
Question: An older patient has been diagnosed with pernicious anemia. The FNP knows that this condition could be related to NR 509 Advanced Physical Assessment
Question: A 52 year old woman has a papule on her nose that has rounded, pearly borders and a central red ulcer. She said she first noticed it several months ago and that it has slowly grown larger. The FNP suspects which condition?
Question: The FNP is watching a new graduate FNP perform auscultation of a patient’s abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen?
Question: A newborn infant is in the clinic for a well-baby check. The FNP observes the infant for the possibility of fluid loss because of which of these factors?

NR 509 Week 5 Quiz Review

Tenderness in RLQ is concerning for
Inuit people tend to sweat more on face than trunk and extremities when exposed to heat
spot on face with round pearly boarder with central red lesion concerning for
Murphy sign= positive with deep palpation causes pain on inspiration
NR 509 Advanced Physical Assessment
Why do you auscultate first in abd assessment
Tympany in the umbilical area
Pt with decreased gastric secretions is at increase
Another name for hyperactive bowels
Black tarry stool concerning
Lichenification caused by
A papule is
Older adults have
CVA tenderness
Confluent lesions
Dryness of the skin
Newborns are at greater risk of fluid loss
High pitched irregular bowel sounds
Changes in hair texture and color of an AA child with Marasmus
Know how to assess for enlarged organs in the abd region
Know three sounds heard in percussion
A woman has come to the clinic to seek help with a substance-abuse problem. She admits to using cocaine just before arrival. Which of these assessment findings would the FNP expect to find when examining the woman?
A 63-year-old Chinese American man enters the office with complaints of chest pain, shortness of breath, and palpitations. Which statement most accurately reflect the FNPs best course of action?
The FNP is planning to assess new memory with the patient. The best way for the FNP to do this would be NR 509 Advanced Physical Assessment
During the health history the FNP asks a female patient “how many alcoholic drinks do you have a week?” Which answer by the patient would indicate at risk drinking?
Symptoms such as pain are often influenced by a person’s cultural heritage. Which of the following is a true statement regarding pain?
The FNP suspect abuse when a 10-year-old child is taken to the urgent care center for leg injury. The best way to document the history and physical findings is to
During a mental status assessment, which question by the FNP would best assess a persons judgment?
The FNP is performing a mental status assessment on a five-year-old girl. Her parents are undergoing a bitter divorce and are worried about the effect it is having on their daughter. Which action or statement might leave FNP to be concerned about the girls mental status?
During mental status examination, the FNP wants to assess a patient’s affect. The FNP should ask the patient which question?
During an examination FNP notices a patterned injury on a patients back. Which of these would cause such an injury? NR 509 Advanced Physical Assessment
The FNP is aware that intimate partner violence screening should occur with which situation?
Which statement is best for the FNP to use when preparing to administer the abuse assessment screen?
The FNP is conducting a class on alcohol and the effects of alcohol on the body. How many standard drinks (each containing 12 g alcohol) Per day are associated with increased deaths from cirrhosis, cancers of the mouth, esophagus and injuries in men?
A woman who has just discovered that she is pregnant is in the clinic for her first obstetric visit. She asked the FNP how many drinks a day safe for my baby? The FNP‘s best response is
The FNP is performing the Denver II screen test on a 12 month old infant during a routine well child visit. The FNP should tell the infants parents that the Denver II
Which term refers to a one produced by tearing or splitting of body tissue usually from blunt impact of a bony surface
When reviewing the use of alcohol by older adults the FNP notes that the older adults have several characteristics that can increase the risk of alcohol use which would increase the bioavailability of alcohol in the blood for longer periods of time in the older adult?
The FNP is reviewing concepts of cultural aspects of pain. Which statement is
true regarding pain?
The FNP is planning to assess a child using behavioral checklist. This tool is most appropriate for a(an)
The FNP is assessing orientation in a 79-year-old patient. Which of these responses … leave the FNP to … that the patient is … ?
As a mandatory reporter of elder abuse, which of these must be present before an FNP notifies the authorities?
A 30-year-old female patient is describing feelings of hopelessness and depression. She has attempted self-mutilation and has a history of prior suicide attempts. She describes difficulty sleeping at night and has lost 10 pounds in the past month. Which of these statements or questions is the FNP‘s best response in this situation?
For persons age 12 years and older which of these illicit substances was one of the most commonly used?

NR 509 Advanced Physical Assessment

Which of these individuals would the FNP consider at highest risk for suicide attempt?
The FNP is …. a patient who has … for cirrhosis of the liver secondary to chronic alcohol use. During the physical … the FNP looks for cardiac problems that are … with chronic heavy use of alcohol such as
During an examination of an aging male the FNP recognizes that normal changes to expect would be:
During a health history, a 22-year-old woman asks “can I get that vaccine for HPV? I have gentle warts and I’d like them to go away!” What is the FNP‘s best response?
During a speculum inspection of the vagina the FNP would expect to see what at the end of the vaginal canal?
A 62-year-old man is experiencing fever, chills, malaise, urinary frequency and urgency. He also reports urethral discharge and a dull aching pain in the perineal and rectal area. The symptoms are most consistent with which of the following?
When performing a genital examination on a 25-year-old man the FNP notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information the FNP would:
The mother of a 10-year-old boy asks the FNP to discuss the recognition of puberty. The FNP should reply by saying:
The uterus is usually … tilting forward and superior to the bladder. This position is known as
A male patient with possible fertility problems asks the FNP where sperm is produced. The FNP knows that sperm production occurs in NR 509 Advanced Physical Assessment
A 15-year-old boy is seen in the clinic for complaints of dull pain and pulling in the scrotal area. On examination the FNP palpates a soft, irregular mass posterior to and above the testes on the left. This mass collapses when the patient is supine in refills when he is up right. This description is consistent with:
In performing an assessment of a woman’s axillary lymph system the FNP should assess which of these nodes?
A patient contacts the office and tells the FNP that she is worried about her 10-year-old daughter having breast cancer. She describes a unilateral enlargement of the right breast with associated tenderness. She is worried because the left breast is not enlarged. What would be the FNP‘s best response?
An 11-year-old girl is in the clinic for a sports physical. The FNP notices that she has begun to develop breasts, and during the conversation the girl reveals that she is worried about her development. …. which of these techniques to best assist the young girl in understanding the expected sequence for development? The FNP should:
A 54-year-old woman who has just completed menopause is in the clinic today for yearly physical examination. Which of these statements should the FNP include in patient education? A post menopausal woman:
A 62-year-old man states that his doctor told him that he has an inguinal hernia. He asks the FNP to explain what a hernia is……:
NR 509 Advanced Physical Assessment When performing a genital assessment on a middle-age man, the FNP notices multiple soft, moist, painless papules in the shape of cauliflower like patches scattered across the shaft of the penis. These lesions are characteristics of:
If a patient reports a recent breast infection, then the FNP should expect to find_____node enlargement
A 9-year-old girl is in the clinic for a sports physical. After some initial shyness she finally asked “am I normal? I don’t seem to need a bra yet, but I have some friends who do. What if I never get breasts?” The FNP‘s best response would be:
Which of these statements about the testes this true?
During an examination FNP observes a female patients vestibule and expect to see the
A 14-year-old girl is anxious about not having reached menarche. When taking history, the FNP should ascertain which of the following? The age:
A woman who is 22 weeks pregnant has a vaginal infection. She tells the FNP that she is afraid that the infection will hurt the fetus. The FNP knows that which of these statements is true?
In performing a breast examination the FNP knows that it is especially important to examine the upper outer quadrant of the breast. The reason for this is that the upper outer quadrant
An accessory glandular structure for the male genital organs is the
Which of these statements is true regarding the penis?
A woman who is 8 weeks pregnant is in the clinic for a check up. The FNP reads on her chart that her cervix is … cyanotic. The FNP knows that the woman is exhibiting____sign and _____sign

Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #1 and the MSN Essential I. NR 509 Advanced Physical Assessment.

PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE

Page 1 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
Nursing Assessment
1. Part of Nursing Process
2. Nurses use physical assessment skills to:
a) Develop (obtain baseline data) and expand the data base from which subsequent phases of the nursing process can evolve
b) To identify and manage a variety of patient problems (actual and potential)
c) Evaluate the effectiveness of nursing care
d) Enhance the nurse-patient relationship
e) Make clinical judgments
Gathering Data
Subjective data – Said by the client (S)
Objective data – Observed by the nurse (O)
Document: SOAPIER
Assessment Techniques: The order of techniques is as follows (A-D) except for the abdomen where you inspect then auscultate
A. Inspection – critical observation
1. Take time to ―observe‖ with eyes, ears, nose (all senses)
2. Use good lighting
3. Look at color, shape, symmetry, position
4. Odors from skin, breath, wound
5. Develop and use nursing instincts
6. Inspection is done alone and in combination with other assessment techniques
B. Palpation – light and deep touch
1. Back of hand (dorsal aspect) to assess skin temperature
2. Fingers to assess texture, moisture, areas of tenderness
3. Assess size, shape, and consistency of lesions
C. Percussion – sounds produced by striking body surface
1. Produces different notes depending on underlying mass (dull, resonant, flat, tympani)
2. Used to determine size and shape of underlying structures by establishing their borders and indicates if tissue is air-filled, fluid-filled, or solid
D. Auscultation – listening to sounds produced by the body
1. Direct auscultation – sounds are audible without stethoscope
2. Indirect auscultation – uses stethoscope
3. Know how to use stethoscope properly (practice)
4. Fine-tune your ears to pick up subtle changes (practice)

ORDER NR 509 Advanced Physical Assessment

PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE

Page 2 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
5. Describe sound characteristics (frequency, pitch intensity, duration, quality) (practice)
6. Flat diaphragm picks up high-pitched respiratory sounds best
7. Bell picks up low pitched sounds such as heart murmurs
8. Practice using BOTH diaphragms
General Assessment
A general survey is an overall review or first impression a nurse has of a person’s well being. This is done head to toe, or cephalo-caudal, lateral to lateral, proximal
to distal, and front to back. General surveying is visual observation and encompasses the following.
Appearance appears to be reported age;
sexual development appropriate;
alert & oriented;
facial features symmetric;
no signs of acute distress
Body structure/mobility weight and height within normal range (refer to Center for Disease Control and Prevention (CDC) Body Mass Index (BMI)
[adult] or BMI-for-age and gender forms [children]);
body parts equal bilaterally;
stands erect,
sits comfortably;
gait is coordinated;
walk is smooth and well balanced;
full mobility of joints
Behavior maintains eye contact with appropriate expressions;
comfortable and cooperative;
speech clear;
clothing appropriate to climate;
looks clean and fit;
appears clean and well-groomed
Deviations from what would generally be considered to be normal or expected should be documented and may require further evaluation or action, including a
report and/or referral.
Standardized and routine screening such as audiometric screening, scoliosis and vision screening using the Snellen Test are usually discussed in General Survey
areas.
***When taking the exam—there are questions about what should cause concern—think about the nurse action being incorrect
PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE
Page 3 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
Health History
A patient history should be done as indicated by the age specific prevention guidelines, usually set forth by Center for Disease Control and Prevention, American
Medical Association, American Association of Pediatrics, and National Association of Pediatric Nurse Practitioners. The Healthy People website
(www.healthypeople.gov) provides an excellent source to determine benchmarks for healthy living across the life span.
A comprehensive history, including chief complaint or reason for the visit, a complete review of systems, and a complete past family and/or social history should be
obtained on the first encounter with a patient, regardless of setting and by a registered nurse. The history should be age and sex appropriate and include all the
necessary questions to enable an adequate delivery of services according to prevention guidelines, scope of practice, patient need, visit requirement, and/or request.
Usually, completing a provider based Health History and Physical Examination Form will assist in the assessment of the patient’s past and current health and
behavior risk status. Certain health problems, which may be identified on a health history, are more common in specific age groups and gender.
An interval history (including an update of complaints, reason for visit, review of systems and past family and/or social history) should be done. Usually family
health histories are completed across three generations looking specifically for patterns in genetic issues that negatively impact quality of life.
The health history gives picture of the patient’s current health and behavior risk status. Additional information than what is on a form may be required depending on
the specialized service(s) to be provided or if the person presents with special needs or conditions. So a health history maybe may be problem focused, expanded
problem focused, detailed, or comprehensive. Regardless, documentation must be completed for each visit and/or assessment.
Physical Examination
A comprehensive physical examination should be performed according to age specific preventive health guidelines. American Medical Association clinical practice
guidelines recognize the following body areas and organ systems for purpose of the examination:
Body Areas: Head (including the face); Neck; Chest (including breasts and axillae); Abdomen; genitalia, groin, buttocks; Back (including spine); and each
extremity.
Organ Systems: Constitutional (vital signs, general appearance), Eyes, Ear, Nose, Throat; Cardiovascular; Gastrointestinal; Genitourinary;
Musculoskeletal; Dermatological; Neurological; Psychiatric; Hematological/lymphatic/immunological
Integumentary: Both overall body and organ systems should have skin assessments integrated into them. Integument includes skin, hair and nails.
Inspect: skin color and uniformity of color, moisture, hair pattern, rashes, lesions, pallor, edema
Palpate: temperature, turgor, lesions, edema
Percussion and auscultation: rarely used on skin
Terminology: pallor, cyanosis, edema, ecchymosis, macule, papule, cyanosis, jaundice, types of edema, vitiligo, hirsutism, alopecia, etc.
Normal and abnormal findings should be recorded on a health history and physical examination form.
PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE
Page 4 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
Measurements
Body measurements include length or height, weight, and head circumference for children from birth to 36 months of age. Thereafter, body measurements include
height and weight. The assessment of hearing, speech and vision are also measurements of an individual’s function in these areas. The Denver Development
Screening Test measures an infant’s and young child’s gross motor, language, fine motor-adaptive and personal-social development milestones. If developmental
delay is suspected based on an assessment of a parent’s development/behavior concern or if delays are suspected after a screening of development benchmarks, a
written referral is to a physician or pediatric nurse practitioner is imperative.
A patient’s measurements can be compared with a standard, expected, or predictable measurement for age and gender. Deviation from standards helps identify
significant conditions requiring close monitoring or referral to a physician or pediatric nurse practitioner.
The significance of measurements and actions to take when they deviate from normal expectations are age-specific.
Procedures for Measuring
Height. Obtain height by measuring the recumbent length of children less than 2 years of age and children between 2 and 3 who cannot stand unassisted. A
measuring board with a stationary headboard and a sliding vertical foot piece is ideal, but a tape measure can also be used. Lay the child flat against the center
of the board. The head should be held against the headboard by the parent or an assistant and the knees held so that the hips and knees are extended. The foot
piece is moved until it is firmly against the child’s heels. Read and record the measurement to the nearest 1/8 inch. A modified technique in home settings is to
lay the child flat and straight where the head should be held by the parent and the knees held so that the hips and knees are extended, mark the flat surface at the
top of the head and tip of the heels. Move child and measure the distance between the marks with a tape measure. Read and record the measurement to the
nearest 1/8 inch.
Obtain a standing height on children greater than 2 to 3 years of age, adolescents, and adults, using a portable stadiometer. The patient is to be wearing only
socks or be bare foot. Have the patient stand with head, shoulder blades, buttocks, and heels touching the wall. The knees are to be straight and feet flat on the
floor, and the patient is asked to look straight ahead. The flat surface of the stadiometer is lowered until it touches the crown of the head, compress the hair. A
measuring rod attached to a weight scale should not be used.
Under some conditions a recumbent length can be obtained for a two year old. If so it should be plotted on the birth to 36 months growth chart. In other
situations a standing height may be obtained for a two year old. Under this condition, plot the finding on the CDC for BMI for age and gender, 2 to 18 year
growth chart. After plotting measurements for children on age and gender specific growth charts, evaluate, educate and refer according to findings.
Weight. Balance beam or digital scales should be used to weigh patients of all ages. Spring type scales are not acceptable. CDC recommends that all scales
should be zero balanced and calibrated. Scales must be checked for accuracy on an annual basis and calibrated in accordance with manufacturer’s instructions.
Prior to obtaining weight measurements, make sure the scale is ―zeroed‖. Weigh infants wearing only a dry diaper or light undergarments. Weigh children
after removing outer clothing and shoes. Weigh adolescents and adults with the patient wearing minimal clothing. Place the patient in the middle of the scale.
Read the measurement and record results immediately. Scales should be calibrated annually. Plot measurements on age and gender specific growth charts and
evaluate accordingly
PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE
Page 5 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
Body Mass Index. The Body Mass Index (BMI) is a measure that can help determine if a person is at risk for a weight-related illness. Instructions for
obtaining the BMI are included within the chart in this section for adults. To calculate BMI for children, see BMI Tables for Children and Adolescents for
guidance.
Head Circumference. Obtain head circumference measurement on children from birth to 36 months of age by extending a non-stretchable measuring tape
around the broadest part of the child’s head. For greatest accuracy, the tape is placed three times, with a reading taken at the right side, at the left side, and at
the mid-forehead, and the greatest circumference is plotted. The tape should be pulled to adequately compress the hair.
Vital Signs. Vital signs, generally described as the measurement of temperature, pulse, respirations and blood pressure, give an immediate picture of a person’s
current state of health and well being. Normal and abnormal ranges with management guidelines follow for children and adults.
Equipment Needed
• A Stethoscope
• A Blood Pressure Cuff
• A Watch Displaying Seconds
• A Thermometer
General Considerations
• The patient should not have had alcohol, tobacco, caffeine, or performed vigorous exercise within 30 minutes of the exam.
• Ideally the patient should be sitting with feet on the floor and their back supported. The examination room should be quiet and the patient comfortable.
• History of hypertension, slow or rapid pulse, and current medications should always be obtained.
Temperature
Temperature can be measured is several different ways:
• Oral with a glass, paper, or electronic thermometer (normal 98.6F/37C)
• Axillary with a glass or electronic thermometer (normal 97.6F/36.3C)
• Rectal or “core” with a glass or electronic thermometer (normal 99.6F/37.7C)
• Aural (the ear) with an electronic thermometer (normal 99.6F/37.7C)
Of these, axillary is the least and rectal is the most accurate.
Respiration
1. Best done immediately after taking the patient’s pulse. Do not announce that you are measuring respirations
2. Without letting go of the patients wrist begin to observe the patient’s breathing. Is it normal or labored?
3. Count breaths for 15 seconds and multiply this number by 4 to yield the breaths per minute.
4. In adults, normal resting respiratory rate is between 14-20 breaths/minute. Rapid respiration is called tachypnea.
PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE
Page 6 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
Pulse
1. Sit or stand facing your patient.
2. Grasp the patient’s wrist with your free (non-watch bearing) hand (patient’s right with your right or patient’s left with your left). There is no reason for the
patient’s arm to be in an awkward position, just imagine you’re shaking hands.
3. Compress the radial artery with your index and middle fingers.
Note whether the pulse is regular or irregular:
Regular – evenly spaced beats, may vary slightly with respiration
Regularly Irregular – regular pattern overall with “skipped” beats
Irregularly Irregular – chaotic, no real pattern, very difficult to measure rate accurately
 Count the pulse for 15 seconds and multiply by 4.
 Always count for a full minute if the pulse is irregular.
 Record the rate and rhythm.
Interpretation
1. A normal adult heart rate is between 60 and 100 beats per minute (see below for children).
2. A pulse greater than 100 beats/minute is defined to be tachycardia. Pulse less than 60 beats/minute is defined to be bradycardia. Tachycardia and bradycardia
are not necessarily abnormal. Athletes tend to be bradycardic at rest (superior conditioning). Tachycardia is a normal response to stress or exercise.
Blood Pressure. Blood pressure (BP) is the pressure by circulating blood on the walls of blood vessels. Arterial refers systemic circulation. During each
heartbeat, blood pressure varies between a maximum systolic and a minimum diastolic pressure. The blood pressure in the circulation is principally due to the
pumping action of the heart. Differences in mean blood pressure are responsible for blood flow from one location to another during circulation. The rate of mean
blood flow depends on the resistance to flow presented by the blood vessels. Mean blood pressure decreases as the circulating blood moves away from the heart
through arteries, capillaries and veins due to viscous losses of energy. Mean blood pressure drops over the whole circulation, although most of the fall occurs
along the small arteries and arterioles. Gravity affects blood pressure via hydrostatic forces (e.g., during standing) and valves in veins, breathing, and pumping
from contraction of skeletal muscles also influence blood pressure in veins.
The measurement blood pressure without further specification usually refers to the systemic arterial pressure measured at a person’s upper arm and is a measure
of the pressure in the brachial artery, major artery in the upper arm. A person’s blood pressure is usually expressed in terms of the systolic pressure over
diastolic pressure and is measured in millimetres of mercury (mmHg).
Interpretation
 Higher blood pressures are normal during exertion or other stress. Systolic blood pressures below 80 may be a sign of serious illness or shock.
 Blood pressure should be taken in both arms on the first encounter. If there is more than 10 mmHg difference between the two arms, use the arm with the
higher reading for subsequent measurements. It is frequently helpful to retake the blood pressure near the end of the visit. Earlier pressures may be higher
due to the “white coat” effect.
 Always recheck “unexpected” blood pressures yourself.
 It is frequently helpful to retake the blood pressure near the end of the visit. Earlier pressures may be higher due to the “white coat” effect.

NR 509 Advanced Physical Assessment

PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE

Page 7 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
 Always recheck “unexpected” blood pressures yourself.
 In children, pulse and blood pressure vary with the age. The following table should serve as a rough guide:
Average Pulse and Blood Pressure in Normal Children
Age Birth 6mo 1yr 2yr 6yr 8yr 10yr
Pulse 140 130 115 110 103 100 95
Systolic BP 70 90 90 92 95 100 105
The Physical Exam
1. Head and Neck Exam
2. Eye Exam
3. Chest and Lung Exam
4. Cardiovascular Exam
5. Abdominal Exam
6. Back and Extremity Exam
7. Neurologic Exam
1. Examination of the Head and Neck
Equipment Needed
• An otoscope
• Tongue blades
• Cotton tipped applicators
• Non-latex exam gloves
General Considerations
The head and neck exam is not a single, fixed sequence. Different portions are included depending on the examiner and the situation.
Head
1. Look for scars, lumps, rashes, hair loss, or other lesions.
2. Look for facial asymmetry, involuntary movements, or edema.
3. Palpate to identify any areas of tenderness or deformity.
Ears
1. Inspect the auricles and move them around gently. Ask the patient if this is painful.
2. Palpate the mastoid process for tenderness or deformity.
3. Hold the otoscope with your thumb and fingers so that the ulnar aspect of your hand makes contact with the patient.
PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE
Page 8 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
Nose
It is often convenient to examine the nose immediately after the ears using the same speculum.
1. Tilt the patient’s head back slightly. Ask them to hold their breath for the next few seconds.
2. Insert the otoscope into the nostril, avoiding contact with the septum.
3. Inspect the visible nasal structures and note any swelling, redness, drainage, or deformity.
4. Repeat for the other side.
5. Turbinates should be pink and moist
6. Frontal sinuses are below eyebrows
7. Maxillary sinuses are below zygomatic arch
Throat
It is often convenient to examine the throat using the otoscope with the speculum removed.
1. Ask the patient to open their mouth.
2. Using a wooden tongue blade and a good light source, inspect the inside of the patients mouth including the buccal folds and under the tongue. Note any
ulcers, white patches (leucoplakia), or other lesions.
3. If abnormalities are discovered, use a gloved finger to palpate the anterior structures and floor of the mouth.
4. Inspect the posterior oropharynx by depressing the tongue and asking the patient to say “Ah.” Note any tonsilar enlargement, redness, or discharge.
Ears
1. Pull the ear upwards and backwards to straighten the canal. For children pull down and back
2. Tthe largest speculum that will fit comfortably.
3. Inspect the ear canal and middle ear structures noting any redness, drainage, or deformity.
4. Insufflate the ear and watch for movement of the tympanic membrane.
5. Repeat for the other ear.
Neck
1. Inspect the neck for asymmetry, scars, or other lesions.
2. Palpate the neck to detect areas of tenderness, deformity, or masses.
Lymph Nodes
1. Systematically palpate with the pads of your index and middle fingers for the various lymph node groups.
2. Preauricular – In front of the ear
3. Postauricular – Behind the ear
4. Occipital – At the base of the skull
5. Tonsillar – At the angle of the jaw
6. Submandibular – Under the jaw on the side
7. Submental – Under the jaw in the midline
8. Superficial (Anterior) Cervical – Over and in front of the sternomastoid muscle
9. Supraclavicular – In the angle of the sternomastoid and the clavicle
PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE
Page 9 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
10. The deep cervical chain of lymph nodes lies below the sternomastoid and cannot be palpated without getting underneath the muscle: Inform the patient that
this procedure will cause some discomfort.
11. Hook your fingers under the anterior edge of the sternomastoid muscle.
12. Ask the patient to bend their neck toward the side you are examining.
13. Move the muscle backward and palpate for the deep nodes underneath.
14. Note the size and location of any palpable nodes and whether they were soft or hard, non-tender or tender, and mobile or fixed
Thyroid Gland
1. Inspect the neck looking for the thyroid gland. Note whether it is visible and symmetrical. A visibly enlarged thyroid gland is called a goiter.
2. Move to a position behind the patient.
3. Identify the cricoid cartilage with the fingers of both hands.
4. Move downward two or three tracheal rings while palpating for the isthmus.
5. Move laterally from the midline while palpating for the lobes of the thyroid.
6. Note the size, symmetry, and position of the lobes, as well as the presence of any nodules. The normal gland is often not palpable.
Special Tests
A. Facial Tenderness
1. Ask the patient to tell you if these maneuvers causes excessive discomfort or pain.
2. Press upward under both eyebrows with your thumbs.
3. Press upward under both maxilla with your thumbs.
4. Excessive discomfort on one side or significant pain suggests sinusitis.
B. Sinus Transillumination
1. Darken the room as much as possible.
2. Place a bright otoscope or other point light source on the maxilla.
3. Ask the patient to open their mouth and look for an orange glow on the hard palate.
4. A decreased or absent glow suggests that the sinus is filled with something other than air.
C. Temporomandibular Joint
1. Place the tips of your index fingers directly in front of the tragus of each ear.
PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE
Page 10 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
2. Ask the patient to open and close their mouth.
3. Note any decreased range of motion, tenderness, or swelling.
2. Examination of the Eye
Equipment Needed
• A Snellen Eye Chart or Pocket Vision Card
• An Ophthalmoscope
Visual Acuity
In cases of eye pain, injury, or visual loss, always check visual acuity before before proceeding with the rest of the exem or putting medications in your patients
eyes.
1. Allow the patient to use their glasses or contact lens if available. You are interested in the patient’s best corrected vision.
2. Position the patient 20 feet in front of the Snellen eye chart (or hold a Rosenbaum pocket card at a 14 inch “reading” distance).
3. Have the patient cover one eye at a time with a card.
4. Ask the patient to read progressively smaller letters until they can go no further.
5. Record the smallest line the patient read successfully (20/20, 20/30, etc.)
6. Repeat with the other eye.
7. Unexpected/unexplained loss of acuity is a sign of serious ocular pathology.
Inspection
1. Observe the patient for ptosis, exophthalmos, lesions, deformities, or asymmetry.
2. Ask the patient to look up and pull down both lower eyelids to inspect the conjuntiva and sclera.
3. Next spread each eye open with your thumb and index finger. Ask the patient to look to each side and downward to expose the entire bulbar surface.
4. Note any discoloration, redness, discharge, or lesions. Note any deformity of the iris or lesion cornea.
5. If you suspect the patient has conjunctivitis, be sure to wash your hands immediately. Viral conjunctivitis is very contagious, so protect your self!
Visual Fields
Screen Visual Fields by Confrontation
1. Stand two feet in front of the patient and have them look into your eyes.
2. Hold your hands to the side half way between you and the patient.
3. Wiggle the fingers on one hand.
4. Ask the patient to indicate which side they see your fingers move.
5. Repeat two or three times to test both temporal fields.
6. If an abnormality is suspected, test the four quadrants of each eye while asking the patient to cover the opposite eye with a card.
PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE
Page 11 of 39
Adapted from the Kentucky Public Health Practice Reference, 2008 and Jarvis, C, (2011). Physical examination & health assessment. (6th Eds). Elsevier: St. Louis.MO.
by Wright State University on May 28, 2012 for the NLN Assessment Exam for Credit by Exam Test Out
Extraocular Muscles
A. Corneal Reflections
1. Shine a light from directly in front of the patient.
2. The corneal reflections should be centered over the pupils.
3. Asymmetry suggests extraocular muscle pathology.
B. Extraocular Movement (EOMs)
1. Stand or sit 3 to 6 feet in front of the patient.
2. Ask the patient to follow your finger with their eyes without moving their head.
3. Check gaze in the six cardinal directions using a cross or “H” pattern.
4. Check convergence by moving your finger toward the bridge of the patient’s nose.
5. Tests CN 3, 4, and 6
C. Pupillary Reactions
1. Pupils equal, round & reactive to light & accommodation (PERRLA).
2. Direct and consensual responses (In a normal response the eye which the light is shined has pupillary constriction (direct reflex) AND the contralateral [other]
pupil also constricts (indirect or consensual reflex). An abnormal response (no pupillary constriction) can help to localize the lesion, particularly when
interpreted with the result of vision testing. While observing the pupillary light response one should also check that the pupils are the same size.)
D. Light
1. Dim the room lights as necessary.
2. Ask the patient to look into the distance.
3. Shine a bright light obliquely into each pupil in turn.
4. Look for both the direct (same eye) and consensual (other eye) reactions.
5. Record pupil size in mm and any asymmetry or irregularity.
E. Accommodation
If the pupillary reactions to light are diminished or absent, check the reaction to accommodation (near reaction):
1. Hold your finger about 10cm from the patient’s nose.
2. Ask them to alternate looking into the distance and at your finger.
3. Observe the pupillary response in each eye.