NUR 550 CORRECT EXAMS QUESTIONS AND
ANSWERS SET A+
✔✔Red Flags Neck - ✔✔Any enlarged or tender nodules if unexplained should call for
reexamination of the regions they drain and careful assessment of lymph nodes
elsewhere to determine whether process is regional or systemic
-Palpation of enlarged supraclavicular nodes should warrant further investigation
Tender nodes= infection/inflammation Hard or Fixed nodes=suggest malignancy
✔✔Neck: Trachea and Thyroid - ✔✔Inspect and palpate the trachea for any deviation :
masses or mediastinal shift could make trachea asymmetrical.
Inspect Thyroid : region below cricoid cartilage note contour and symmetry.
Steps for Palpating Thyroid Gland (Posterior Approach) Bates' text page 263.Thyroid
isthmus is overlying the second, third, and fourth tracheal rings /patient sips water as
provider palpates thyroid from posterior approach.
Why does the patient sip water during this assessment?
Note size, shape, consistency, nodules or tenderness
✔✔Objective Assessment of Trachea and Thyroid - ✔✔Inspect the trachea for any
deviations • Palpate for any deviations of the trachea • Inspect the neck for the thyroid
gland • Observe the patient swallowing • Palpate the thyroid gland- noting size, shape,
and consistency
✔✔Eye Physical Assessment - ✔✔•External Examination: - Inspect eyebrows for size,
extension, and hair texture - Inspect orbital area for edema, puffiness, and sagging
tissue below orbit • Eyelid inspection - Inspect closed lid for fasciculations and tremors -
Check ability to close completely/open widely - Observe margin for flakiness, redness,
and swelling - Look for eyelashes - Note eye opening • Ptosis - Note any eversion or
inversion of lids
Eyelid palpation - Palpate for nodules - Palpate the eye itself through closed lids •
Conjunctivae inspection - Usually unapparent, clear, and free of erythema - Inspect
,lower portion by pulling down lower lid - Upper lid is inspected only if foreign body is in
the eye. - Look for redness/exudate - Look for pterygium • Abnormal growth of
conjunctiva that extends over the cornea from the limbus
*Cornea -Examine clarity of the cornea by shining light on it. • Cornea is normally
avascular; blood vessels should not be present. -Test sensitivity (cranial nerve V) by
touching the cornea with a cotton wisp to elicit blink (cranial nerve VII). -Inspect for
corneal arcus (arcus senilis). • Composed of lipids deposited in the periphery of the
cornea
*Iris and pupil -Inspect iris for pattern, color, and shape -Test for direct/consensual light
response -Test pupils for accommodation •The pupils should constrict when the eyes
focus on the near object -Estimate pupil size and compare for equality
• Lens -Inspect for transparency/clarity • Sclera -Examine to ensure that it is white -
Inspect for senile hyaline plaque • Lacrimal apparatus - Inspect lacrimal gland - Palpate
lower orbital rim near inner canthus
✔✔Visual Acuity - ✔✔Snellen eye chart - 20 feet from chart - Cover one eye - 20/20
normal - client can read what the normal person can read at 20 feet • Myopia - Impaired
far vision - 20/40 - larger the bottom number the poorer the vision • Presbyopia -
Impaired near vision > 45 y.o., ↓ accommodation
Near Vision Acuity: -Use Rosenbaum pocket screener -Each eye tested individually
✔✔External Eye Exam - ✔✔Extraocular Eye Muscles: • Test eye movements using six
cardinal fields of gaze. - Check for nystagmus - Note lid lag - Note exposure of sclera
above iris • Use corneal light reflex to test extraocular muscle balance - If imbalanced,
perform cover-uncover test
✔✔Red Eye - ✔✔Conjunctivitis • Subconjunctival hemorrhage • Corneal abrasion or
infection • Acute iritis • Glaucoma
✔✔Internal Eye Exam - ✔✔Inspection of interior eye with ophthalmoscope permits
visualization of: - Optic disc - Arteries - Veins - Retina • Adequate pupil dilation is often
necessary
Ophthalmoscopic Examination: • Visualize red reflex - Opacities appear as black
densities • Examine - Fundus - Vascular supply - Disc margins - Macula
Look for unexpected findings such as: - Myelinated nerve fibers - Papilledema -
Glaucomatous cupping - Drusen bodies - Cotton wool bodies - Hemorrhages
✔✔External Ear Exam - ✔✔External ear: - Angle of attachment and position - Inspect
the auricles and mastoid area for size, shape, symmetry, landmarks, color, position, and
deformities or lesions, or inflammation - Drainage: clear, blood, or purulent •External ear
canal: - Color, drainage, lesions, lumps, and foreign objects - Inflammation - Swelling
External ear: - Consistency and tenderness •External ear canal: - Patency - Palpate
tragus, mastoid, and helix for tenderness, swelling, nodules
, ✔✔Internal Ear Exam - ✔✔Otoscopic Exam visualize auditory canal and tympanic
membrane
Know proper hand position on otoscope to ensure patient safety during procedure.
Use otoscope: Grasp auricle firmly and and pull it upward, backward and slightly away
from head > hold otoscope between thumb and fingers and brace your hand against the
patient's face. Your hand and instrument can then detect unexpected movements by the
patient. Light points toward floor.
Narrate the characteristics of the tympanic membrane. For example, pearly gray
tympanic membrane or reddened, edematous tympanic membrane with otitis media.
Note color and exudate.
✔✔Otoscopic Exam - ✔✔
✔✔Ear Exam - ✔✔Normal Exam: - External auditory canals patent and clear of debris
or drainage. - Tympanic membrane clear translucent with pearly gray and intact; cone of
light visualized in right ear at 5 o'clock and 7 o'clock in left ear
✔✔Hearing Acuity Tests - ✔✔Gross hearing: screening for hearing deficits; not
measure of the degree of loss • (Whispered) Voice Test - Test: Examiner whispers 2
syllable words slowly as client masks other sounds by pushing tragus in and out -
Normal: Client repeats each word correctly
✔✔Air and Bone Conduction - ✔✔BC is tested • Test: Vibrating tuning fork is placed on
the midline of skull • Normal: Should hear tone equally in both ears • Abnormal: -
Unilateral conductive • Sound lateralized to impaired ear - Unilateral sensorineural •
Sound lateralized to good ear
AC is compared to BC • Test: - Stem of the vibrating tuning fork is placed on the
mastoid process - Patient indicates when vibrating sound ends - Quickly move fork next
to ear canal, sound should continue - Patient indicates when vibration discontinues •
Normal: AC > BC; AC should be twice as long as BC • Abnormal: - Conductive • BC =
AC or BC > AC - Sensorineural • AC > BC
✔✔Mouth and Oropharynx - Inspection & Palpation - ✔✔• Lips - Note color, moisture,
lumps, ulcers, cracking, or scaliness • Oral Buccal Mucosa - Note color, moisture,
ulcers, and nodules - Stenson ducts, Fordyce spots • Gums and teeth - Note color,
presence, and position of teeth, occlusion, alignment
Roof of mouth - Note color • Tongue and floor of mouth - Note color and texture, ulcers,
nodules, coating, lesions - Ask patient to extend; deviation, tremor, limitation of
movement - Frenulum
• Oropharynx: - Soft palate - Anterior and posterior pillars - Uvula - Tonsils - Pharynx •
Note color, symmetry, presence of exudate, swelling, ulceration, or tonsillar
enlargement • Elicit gag reflex (cranial nerves IX and X)
ANSWERS SET A+
✔✔Red Flags Neck - ✔✔Any enlarged or tender nodules if unexplained should call for
reexamination of the regions they drain and careful assessment of lymph nodes
elsewhere to determine whether process is regional or systemic
-Palpation of enlarged supraclavicular nodes should warrant further investigation
Tender nodes= infection/inflammation Hard or Fixed nodes=suggest malignancy
✔✔Neck: Trachea and Thyroid - ✔✔Inspect and palpate the trachea for any deviation :
masses or mediastinal shift could make trachea asymmetrical.
Inspect Thyroid : region below cricoid cartilage note contour and symmetry.
Steps for Palpating Thyroid Gland (Posterior Approach) Bates' text page 263.Thyroid
isthmus is overlying the second, third, and fourth tracheal rings /patient sips water as
provider palpates thyroid from posterior approach.
Why does the patient sip water during this assessment?
Note size, shape, consistency, nodules or tenderness
✔✔Objective Assessment of Trachea and Thyroid - ✔✔Inspect the trachea for any
deviations • Palpate for any deviations of the trachea • Inspect the neck for the thyroid
gland • Observe the patient swallowing • Palpate the thyroid gland- noting size, shape,
and consistency
✔✔Eye Physical Assessment - ✔✔•External Examination: - Inspect eyebrows for size,
extension, and hair texture - Inspect orbital area for edema, puffiness, and sagging
tissue below orbit • Eyelid inspection - Inspect closed lid for fasciculations and tremors -
Check ability to close completely/open widely - Observe margin for flakiness, redness,
and swelling - Look for eyelashes - Note eye opening • Ptosis - Note any eversion or
inversion of lids
Eyelid palpation - Palpate for nodules - Palpate the eye itself through closed lids •
Conjunctivae inspection - Usually unapparent, clear, and free of erythema - Inspect
,lower portion by pulling down lower lid - Upper lid is inspected only if foreign body is in
the eye. - Look for redness/exudate - Look for pterygium • Abnormal growth of
conjunctiva that extends over the cornea from the limbus
*Cornea -Examine clarity of the cornea by shining light on it. • Cornea is normally
avascular; blood vessels should not be present. -Test sensitivity (cranial nerve V) by
touching the cornea with a cotton wisp to elicit blink (cranial nerve VII). -Inspect for
corneal arcus (arcus senilis). • Composed of lipids deposited in the periphery of the
cornea
*Iris and pupil -Inspect iris for pattern, color, and shape -Test for direct/consensual light
response -Test pupils for accommodation •The pupils should constrict when the eyes
focus on the near object -Estimate pupil size and compare for equality
• Lens -Inspect for transparency/clarity • Sclera -Examine to ensure that it is white -
Inspect for senile hyaline plaque • Lacrimal apparatus - Inspect lacrimal gland - Palpate
lower orbital rim near inner canthus
✔✔Visual Acuity - ✔✔Snellen eye chart - 20 feet from chart - Cover one eye - 20/20
normal - client can read what the normal person can read at 20 feet • Myopia - Impaired
far vision - 20/40 - larger the bottom number the poorer the vision • Presbyopia -
Impaired near vision > 45 y.o., ↓ accommodation
Near Vision Acuity: -Use Rosenbaum pocket screener -Each eye tested individually
✔✔External Eye Exam - ✔✔Extraocular Eye Muscles: • Test eye movements using six
cardinal fields of gaze. - Check for nystagmus - Note lid lag - Note exposure of sclera
above iris • Use corneal light reflex to test extraocular muscle balance - If imbalanced,
perform cover-uncover test
✔✔Red Eye - ✔✔Conjunctivitis • Subconjunctival hemorrhage • Corneal abrasion or
infection • Acute iritis • Glaucoma
✔✔Internal Eye Exam - ✔✔Inspection of interior eye with ophthalmoscope permits
visualization of: - Optic disc - Arteries - Veins - Retina • Adequate pupil dilation is often
necessary
Ophthalmoscopic Examination: • Visualize red reflex - Opacities appear as black
densities • Examine - Fundus - Vascular supply - Disc margins - Macula
Look for unexpected findings such as: - Myelinated nerve fibers - Papilledema -
Glaucomatous cupping - Drusen bodies - Cotton wool bodies - Hemorrhages
✔✔External Ear Exam - ✔✔External ear: - Angle of attachment and position - Inspect
the auricles and mastoid area for size, shape, symmetry, landmarks, color, position, and
deformities or lesions, or inflammation - Drainage: clear, blood, or purulent •External ear
canal: - Color, drainage, lesions, lumps, and foreign objects - Inflammation - Swelling
External ear: - Consistency and tenderness •External ear canal: - Patency - Palpate
tragus, mastoid, and helix for tenderness, swelling, nodules
, ✔✔Internal Ear Exam - ✔✔Otoscopic Exam visualize auditory canal and tympanic
membrane
Know proper hand position on otoscope to ensure patient safety during procedure.
Use otoscope: Grasp auricle firmly and and pull it upward, backward and slightly away
from head > hold otoscope between thumb and fingers and brace your hand against the
patient's face. Your hand and instrument can then detect unexpected movements by the
patient. Light points toward floor.
Narrate the characteristics of the tympanic membrane. For example, pearly gray
tympanic membrane or reddened, edematous tympanic membrane with otitis media.
Note color and exudate.
✔✔Otoscopic Exam - ✔✔
✔✔Ear Exam - ✔✔Normal Exam: - External auditory canals patent and clear of debris
or drainage. - Tympanic membrane clear translucent with pearly gray and intact; cone of
light visualized in right ear at 5 o'clock and 7 o'clock in left ear
✔✔Hearing Acuity Tests - ✔✔Gross hearing: screening for hearing deficits; not
measure of the degree of loss • (Whispered) Voice Test - Test: Examiner whispers 2
syllable words slowly as client masks other sounds by pushing tragus in and out -
Normal: Client repeats each word correctly
✔✔Air and Bone Conduction - ✔✔BC is tested • Test: Vibrating tuning fork is placed on
the midline of skull • Normal: Should hear tone equally in both ears • Abnormal: -
Unilateral conductive • Sound lateralized to impaired ear - Unilateral sensorineural •
Sound lateralized to good ear
AC is compared to BC • Test: - Stem of the vibrating tuning fork is placed on the
mastoid process - Patient indicates when vibrating sound ends - Quickly move fork next
to ear canal, sound should continue - Patient indicates when vibration discontinues •
Normal: AC > BC; AC should be twice as long as BC • Abnormal: - Conductive • BC =
AC or BC > AC - Sensorineural • AC > BC
✔✔Mouth and Oropharynx - Inspection & Palpation - ✔✔• Lips - Note color, moisture,
lumps, ulcers, cracking, or scaliness • Oral Buccal Mucosa - Note color, moisture,
ulcers, and nodules - Stenson ducts, Fordyce spots • Gums and teeth - Note color,
presence, and position of teeth, occlusion, alignment
Roof of mouth - Note color • Tongue and floor of mouth - Note color and texture, ulcers,
nodules, coating, lesions - Ask patient to extend; deviation, tremor, limitation of
movement - Frenulum
• Oropharynx: - Soft palate - Anterior and posterior pillars - Uvula - Tonsils - Pharynx •
Note color, symmetry, presence of exudate, swelling, ulceration, or tonsillar
enlargement • Elicit gag reflex (cranial nerves IX and X)
