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Summary Immersion Notes - NR509 / NR 509 (Latest
2025) : Advanced Physical Assessment - Chamberlain
1 inspection of face/head .....ANSWER.....note the face is
symmetrical without discoloration or lesions. next I inspect the
head noting it is midline and symmetrical.
2 palpating lymph nodes for tenderness and enlargement.
.....ANSWER.....begin with pre articular, in front of the ears, move
to postauricular, behind the ears. Then occipital, at the base of
the posterior scalp, the tonsils lymph nodes, near the angle of the
jaw. Then the submandibular and submental nodes. Next palpate
the anterior cervical and posterior lymph nodes. And lastly the
supraclavicular lymph nodes. Note that there is no swelling and
they are equal bilat.
3 Test cranial nerve #5 the trigeminal nerve.
.....ANSWER.....Motor component. I will palpate over the massiter
muscle while she clenches her jaw. Note distortions and strength.
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Sensory- I will have her close her eyes and tell me where I am
touching. (touch areas of face)
4 Test CN #7 facial nerve .....ANSWER.....I will have her do some
facial expressions. raise eyebrows, smile, frown, puff out cheeks,
pucker lips. Note symmetry and strength of these.
5 Inspect EARS .....ANSWER.....Look for swelling, redness, nodules,
symmetry. inspect the auditory canal for redness, clear, no
swelling, no drainage, no cerumen, Tympanic membrane pearly
gray, no effusion.
6 Palpate Ears .....ANSWER.....palp pinnas for nodules or
tenderness. palp tragus
7 Test CN #8 vestibulocochlear nerve .....ANSWER.....Perform
whisper test. cover one ear then the other. provider covers mouth.
8 Inspect EYES .....ANSWER.....Look at lids, conjunctiva- pink,
clear, no lesions, no drainag; sclera- white
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9 Test CN #2 Optic Nerve which controls central, peripheral
vision and pupil response .....ANSWER.....Snellen eye chart- have
pt cover one eye, read the lowest line, cover the other eye and
read lowest line, read lowest line with both eyes "20/20 in right,
left and both eyes." Test peripheral vision with hands at side of
head. "peripheral vision is intact". Check pupillary response to
light. "pupils are 2-3mm are reactive and appropriate response
to light"
10 Test CN #3 occulomotor, CN #4 Trochlear and CN #6
Abducens which control extraocular movement
.....ANSWER....."Follow my finger with just eyes# and move in "H"
pattern. "All EOMs intact"
11 Nose exam inspect .....ANSWER.....symmetrical and no
deformities. Use otoscope push nose to side and up. "Turbinates
mucous membranes are pink and moist. No bogginess no
drainage. not obstructed septum is straight"
Summary Immersion Notes - NR509 / NR 509 (Latest
2025) : Advanced Physical Assessment - Chamberlain
1 inspection of face/head .....ANSWER.....note the face is
symmetrical without discoloration or lesions. next I inspect the
head noting it is midline and symmetrical.
2 palpating lymph nodes for tenderness and enlargement.
.....ANSWER.....begin with pre articular, in front of the ears, move
to postauricular, behind the ears. Then occipital, at the base of
the posterior scalp, the tonsils lymph nodes, near the angle of the
jaw. Then the submandibular and submental nodes. Next palpate
the anterior cervical and posterior lymph nodes. And lastly the
supraclavicular lymph nodes. Note that there is no swelling and
they are equal bilat.
3 Test cranial nerve #5 the trigeminal nerve.
.....ANSWER.....Motor component. I will palpate over the massiter
muscle while she clenches her jaw. Note distortions and strength.
,Page 2 of 26
Sensory- I will have her close her eyes and tell me where I am
touching. (touch areas of face)
4 Test CN #7 facial nerve .....ANSWER.....I will have her do some
facial expressions. raise eyebrows, smile, frown, puff out cheeks,
pucker lips. Note symmetry and strength of these.
5 Inspect EARS .....ANSWER.....Look for swelling, redness, nodules,
symmetry. inspect the auditory canal for redness, clear, no
swelling, no drainage, no cerumen, Tympanic membrane pearly
gray, no effusion.
6 Palpate Ears .....ANSWER.....palp pinnas for nodules or
tenderness. palp tragus
7 Test CN #8 vestibulocochlear nerve .....ANSWER.....Perform
whisper test. cover one ear then the other. provider covers mouth.
8 Inspect EYES .....ANSWER.....Look at lids, conjunctiva- pink,
clear, no lesions, no drainag; sclera- white
, Page 3 of 26
9 Test CN #2 Optic Nerve which controls central, peripheral
vision and pupil response .....ANSWER.....Snellen eye chart- have
pt cover one eye, read the lowest line, cover the other eye and
read lowest line, read lowest line with both eyes "20/20 in right,
left and both eyes." Test peripheral vision with hands at side of
head. "peripheral vision is intact". Check pupillary response to
light. "pupils are 2-3mm are reactive and appropriate response
to light"
10 Test CN #3 occulomotor, CN #4 Trochlear and CN #6
Abducens which control extraocular movement
.....ANSWER....."Follow my finger with just eyes# and move in "H"
pattern. "All EOMs intact"
11 Nose exam inspect .....ANSWER.....symmetrical and no
deformities. Use otoscope push nose to side and up. "Turbinates
mucous membranes are pink and moist. No bogginess no
drainage. not obstructed septum is straight"
