NURS 5220 Advanced Health Assessment Test
ri ri ri ri ri ri
1 Expanded Study Guide ri ri ri
Module 1 + Module 2: SOAP/Diagnostic Reasoning, Growth & Measurement, Skin, Head/Neck, Lymph, Eyes,
ri ri ri ri ri ri ri ri ri ri ri ri ri ri
ENT, Chest/Lungs, Heart, and Blood Vessels
ri ri ri ri ri
Includes a 100-question practice test with answers and rationales after each question
ri ri ri ri ri ri ri ri ri ri ri
Howritoriuserithisriguide:riReadritheriblueprintrifirst,rithenristudyrieachribody-
systemrisection.riMemorizeritheriexamrisequence,rinormalrifindings,riabnormalrifindings,riredriflags,riandrilifespanrivariations.riAfterrieachrisection
,riquizriyourselfribyricoveringritheri"rapidrirecall"ritables.riFinishriwithritheri100-questionripracticeritest.
TestriArea ActualriTest Approx.ri%riofriExa PracticeriQsriinrithisrig
riQuestions m uide
SOAPriandriDiagnosticriReasoning 8 12% 12
GrowthriandriMeasurement 2 3% 3
Skin,riHair,riandriNails 8 12% 12
HeadriandriNeck 5 8% 8
LymphaticriSystem 5 8% 8
Eyes 5 8% 8
Ear,riNose,riandriThroat 10 15% 15
ChestriandriLung 10 15% 15
Heart 10 15% 15
BloodriVessels 2 3% 4
Total 65 100% 100
Examripearl:riTheritestriisrinotriopenribook.riYourribestrireturnrionristudyritimeriisrimemorizingripatterns:risubjectiverivsriobjective,riexam
sequence,rinormalrivsriabnormalrifindings,riandriwhichriabnormalrifindingripointsritoriwhichricondition.
NURSri5220riAdvancedriHealthriAssessmentri-riTestri1riExpandedriStudyriGuide
,1. Module 1 Foundations: SOAP, History, and Diagnostic Reasoning
ri ri ri ri ri ri ri
Subjective vs Objective Data
ri ri ri
Category Meaning Examples Testritrap
Subjective Whatritheripatientristates,rireports,rifeels,ri "Myrichestrihurts."riPainri8/10.riNausearixr i Painriscoreriisrisubjectiverievenritho
believes,riorridescribes.riSymptomsriliveri 3ridays.riFamilyrihistoryriofriMI.riMedicationri ughriitriisriarinumber.riItriisriwhatritheripa
here. userireportedribyripatient. tientrisays.
Objective Whatritheriexaminerriobserves,rimeasure BPri160/92.riRRri26.riSpO2ri88%. Dorinotriputripatientriquotes,ri
s,ripalpates,ripercusses,riauscultates,riorriv Wheezingriheard.riRashri4ricmrixri3ricm.riCBC symptomridescriptions,riorri
erifiesriwithridiagnostics. riresult. patient-
reportedrihistoryriinriObjecti
ve.
High-yieldritestritargets:
• Subjectiveri=risymptoms,ripatientristatements,riCC,riHPI,riPMH,riFH,riSH,riROS.
• Objectiveri=riphysicalriexam,rivitalrisigns,riobservedribehavior,rimeasurements,rilabs,riimaging,ridiagnosticriresults.
• Assessmentri=ridiagnosis,riworkingridiagnosis,ridifferentials,rirule-outs,ririskrifactors,rihealthrimaintenancerineeds.
• Planri=ritests,ritreatments,rieducation,rireferrals,rifollow-up,riandrihealthrimaintenance.
SOAP Note Structure
ri ri
SOAPriElement Whatribelongsrithere Commonriexamples
Sri-riSubjective Chiefriconcern,riHPI,riROS,riPMH,rimedications,riallergies,rifa "Coughriforri4ridays."riReportsrifever.riDeniesrichestripain.
milyrihistory,risocialrihistory,ripatientrigoalsriandriconcerns. riSmokerrixri20riyears.
Ori-riObjective Generalrisurvey,rivitals,riphysicalriexamrifindings,riobjectiverim Tri101.3riF,riHRri112,ricracklesriRLL,riCXRriinfiltrate.
easurements,rilabs,riimaging,riscreeningriresults.
Ari-riAssessment Bestriexplanationriforritheripatientridata,ridifferentials,rirule- Community-
outs,riclinicalriimpression,rihealthririsks. acquiredripneumoniarivsriviralribronchitis;ridehydrationriris
k.
Pri-riPlan Diagnostics,ritherapeutics,rieducation,rireferrals,risafetyriinstr CXR,riCBC,riantibioticsriifriindicated,rihydration,rireturnripre
uctions,rifollow-upriinterval,riprevention. cautions,rifollow-upriinri48rihours.
Examripearl:riSOAPriisribothriarithinkingriprocessriandriaridocumentationriformat.riArigoodriSOAPrinoterishouldritellriarichronologicalristoryriand
showriwhyritheriassessmentriandriplanrimatchritheridata.
Building the History
ri ri
• Startriwithriidentifiersriandrichiefriconcern,rithenrimoveriintoriHPI,riPMH,rifamilyrihistory,ripersonal/socialrihistory,riandriROS.
• Chiefriconcernrishouldriberiinritheripatient'sriownriwordsriandrishouldrifocusritherivisit.
• HPIriisrisymptomrianalysis.riItritellsritheristoryriofritheripresentriproblemristartingrifromritherilastritimeritheripatientrifeltriwell.
• Useriopen-endedriquestionsrifirst,rithenridirectriquestions.riAvoidrileadingriquestions.
• Verifyriandrisummarizeriwhatriyouriheardribeforerimovingrion.
History Purpose Examplesriofriwhatritoriask
riArea
CC Reasonriforriseekingricare,riusuallyribriefrian "Whatribringsriyouriinritoday?"ri"Whatriisribotheringriyouritherimost?"
driinripatientriwords.
HPI Analyzericurrentriproblemriandridifferentiat Onset,rilocation,riduration,richaracter,riaggravatingrifactors,rirelievingrifactors,ritiming/trea
eripossiblericauses. tments,riseverity,riassociatedrisymptoms.
PMH Identifyripriorriconditionsriandririskrifacto Medications,riallergiesriandrireactions,riimmunizations,risurgeries,rihospitalizations,ritran
rs. sfusions,riadult/childhoodriillness,riscreeningritests.
FH Identifyrigenetic/familialripatterns. Threerigenerations;riageriandrihealth/deathriofrirelatives;ricancersribeforeriageri50;riMI,riHT
N,ridiabetes,ristroke,rithyroid,riasthma.
SH Identifyrilifestyle,rienvironmental,riandri Occupation,riexposures,rihousing,risafety,ritobacco,rialcohol,ridrugs,rimilitaryrihistory,ritrav
access-to-careririsks. el,risexualrihistory,rispirituality,rifinances,riaccessritoricare.
ROS Inventoryrisymptomsrisystem-by- General,riskin,riHEENT,rilymph,richest/lungs,riheart,riGI,riGU,riMSK,rineuro,ripsych.
systemriandriidentifyrioverlookedri
problems.
Memoryrihook:riHPIri=ritheristoryriofrithisriproblem.riPMH/FH/SHri=ritheririskribackground.riROSri=risystemriinventory.
NURSri5220riAdvancedriHealthriAssessmentri-riTestri1riExpandedriStudyriGuide
, HPI Symptom Analysis
ri ri
Variable Whatriitrimeans Example
Timing/onset Whenriitristarted,risuddenrivsrigradual,riduration,rifrequency Startedrisuddenlyri2rihoursriago;rioccursridailyriafterribreakfas
,riconstantrivsriintermittent. t.
Location Exactrisite,rigeneralizedrivsrilocalized,riradiation. Substernalripainriradiatingritorileftriarm.
Quality Natureriofrisymptom. Sharp,ridull,risqueezing,rithrobbing,riburning,ristabbing,ricoli
cky.
Quantity/severity Magnituderiandrieffectrionrifunction. Painri8/10;rihadritoristopridriving.
Setting Context,ritriggers,riactivity,riexposure,rienvironment,rimecha Afterriclimbingristairs;riafterrisickricontact;riafterrifall.
nism.
Aggravating/alleviating Whatrimakesribetterriorriworse. Worseriwithriexertion;ribetterriwithrirestriorribelching.
Associatedrifactors Symptomsrithatricomeriwithritherichiefriconcern. Nausea,ridiaphoresis,rifever,rirash,riphotophobia.
Examripearl:riPertinentripositivesrisupportriaridiagnosis.riPertinentrinegativesrihelprilowerriaridiagnosisrionritheridifferential.riBothriarerineeded
inrigoodridiagnosticrireasoning.
Diagnostic Reasoning Process
ri ri
1. Createriaridifferentialridiagnosisrilist:riallrireasonableripossibilitiesriforritherichiefriconcern.
2. AskrimorerifocusedriquestionsriusingritherisevenriHPIrivariables.
3. Sortripertinentripositivesriandripertinentrinegativesriforrieachripossibleridiagnosis.
4. Assignriprobabilityribasedrionriclusters,ritrends,ritimericourse,riexposures,rifamily/seasonalripatterns,riandririskrifactors.
5. Useritheriphysicalriexamritorisupportriorriweakenridiagnoses.
6. Orderritestsrionlyriwhenritheriresultriwillrihelpriruleriin,riruleriout,riorriguideriaction.
7. Chooseritheriassessment/diagnosisrithatribestriexplainsritherihistoryriplusriphysicalrifindings.
High-yieldritestritargets:
• Redriflagri=rifindingrisuggestingriariseriousriconditionrineedingriurgentrievaluation.
• Pathognomonicri=rifindingrisoricharacteristicriitripointsristronglyritorioneridiagnosis.
• Rulingrioutriisriasriimportantriasrirulingriin.
• Avoidritheribiasritrap:ridorinotrilabelritheripatientriorricloseriyourrimindritooriearly.
• Commonrithingsricommonlyrihappen,ributrialwaysriconsiderritheribadristuff.
2. Growth, Measurement, Vital Signs, and Pain
ri ri ri ri ri
Temperature
• Bodyritemperatureriisriregulatedribyritherihypothalamus.
• Feverriresponse/pyrexiariisritriggeredribyriendogenousripyrogensriandriprostaglandins.
• Theribodyrigeneratesriheatrithroughrishiveringriandrivasoconstriction.
• Theribodyricoolsrithroughrivasodilationriandrievaporationriofriperspiration.
• Expectedritemperaturerirange:ri97.2riFritori99.9riFri(36.2riCritori37.7riC).
• Feverriisrigenerallyritemperaturerigreaterrithanri100.4riF;riaxillaryrifeverrithresholdrimayriberilower.
• Feverriinri0ritori90ridaysriofriliferineedsriimmediaterievaluation.riOverri90ridaysriwithritemperatureri>105riFrineedsrievaluation.
Pulse, Respirations, and Blood Pressure
ri ri ri ri
Vitalrisign Whatriitrirepresents Keyriexamripoints
Pulse Heartriraterigeneratedribyriventricularricontrac Apicalripulseripreferredriinriinfants/children.riAssessrirate,rirhythm,ricontour,riampl
tionripushingriaripressureriwaverithroughriarteri itude.riAdultriaverageri60-100ribpm.riIrregularrirhythm:ricountrifullri60riseconds.
es.
Respiratoryrirate Ventilationripatternricreatedribyridiaphragm/i Adultrinormalri12-
ntercostalrimuscleriactivity. 20ribreaths/min.riAssessriworkriofribreathing:riretractions,rinasalriflaring,ristrido
r,rigrunting.riTachypneari=rifasterrithanrinormal;ribradypneari=rislowerrithanrino
rmal.
Bloodripressure Peripheralrimeasureriofricardiovascularrifun Systolicri=riventricularricontraction;ridiastolicri=riperipheralriresistanceriduringrir
ction;riforceriofribloodriagainstriarterialriwall. elaxation.riPulseripressureri=risystolicriminusridiastolic.riUseriproperricuffrisize.
riRoutineriBPribeginsriaroundriageri3.
Memoryrihook:riPulseripressureri=ritoprinumberriminusribottomrinumber.riExample:ri120/80ri=ripulseripressureri40.
NURSri5220riAdvancedriHealthriAssessmentri-riTestri1riExpandedriStudyriGuide
ri ri ri ri ri ri
1 Expanded Study Guide ri ri ri
Module 1 + Module 2: SOAP/Diagnostic Reasoning, Growth & Measurement, Skin, Head/Neck, Lymph, Eyes,
ri ri ri ri ri ri ri ri ri ri ri ri ri ri
ENT, Chest/Lungs, Heart, and Blood Vessels
ri ri ri ri ri
Includes a 100-question practice test with answers and rationales after each question
ri ri ri ri ri ri ri ri ri ri ri
Howritoriuserithisriguide:riReadritheriblueprintrifirst,rithenristudyrieachribody-
systemrisection.riMemorizeritheriexamrisequence,rinormalrifindings,riabnormalrifindings,riredriflags,riandrilifespanrivariations.riAfterrieachrisection
,riquizriyourselfribyricoveringritheri"rapidrirecall"ritables.riFinishriwithritheri100-questionripracticeritest.
TestriArea ActualriTest Approx.ri%riofriExa PracticeriQsriinrithisrig
riQuestions m uide
SOAPriandriDiagnosticriReasoning 8 12% 12
GrowthriandriMeasurement 2 3% 3
Skin,riHair,riandriNails 8 12% 12
HeadriandriNeck 5 8% 8
LymphaticriSystem 5 8% 8
Eyes 5 8% 8
Ear,riNose,riandriThroat 10 15% 15
ChestriandriLung 10 15% 15
Heart 10 15% 15
BloodriVessels 2 3% 4
Total 65 100% 100
Examripearl:riTheritestriisrinotriopenribook.riYourribestrireturnrionristudyritimeriisrimemorizingripatterns:risubjectiverivsriobjective,riexam
sequence,rinormalrivsriabnormalrifindings,riandriwhichriabnormalrifindingripointsritoriwhichricondition.
NURSri5220riAdvancedriHealthriAssessmentri-riTestri1riExpandedriStudyriGuide
,1. Module 1 Foundations: SOAP, History, and Diagnostic Reasoning
ri ri ri ri ri ri ri
Subjective vs Objective Data
ri ri ri
Category Meaning Examples Testritrap
Subjective Whatritheripatientristates,rireports,rifeels,ri "Myrichestrihurts."riPainri8/10.riNausearixr i Painriscoreriisrisubjectiverievenritho
believes,riorridescribes.riSymptomsriliveri 3ridays.riFamilyrihistoryriofriMI.riMedicationri ughriitriisriarinumber.riItriisriwhatritheripa
here. userireportedribyripatient. tientrisays.
Objective Whatritheriexaminerriobserves,rimeasure BPri160/92.riRRri26.riSpO2ri88%. Dorinotriputripatientriquotes,ri
s,ripalpates,ripercusses,riauscultates,riorriv Wheezingriheard.riRashri4ricmrixri3ricm.riCBC symptomridescriptions,riorri
erifiesriwithridiagnostics. riresult. patient-
reportedrihistoryriinriObjecti
ve.
High-yieldritestritargets:
• Subjectiveri=risymptoms,ripatientristatements,riCC,riHPI,riPMH,riFH,riSH,riROS.
• Objectiveri=riphysicalriexam,rivitalrisigns,riobservedribehavior,rimeasurements,rilabs,riimaging,ridiagnosticriresults.
• Assessmentri=ridiagnosis,riworkingridiagnosis,ridifferentials,rirule-outs,ririskrifactors,rihealthrimaintenancerineeds.
• Planri=ritests,ritreatments,rieducation,rireferrals,rifollow-up,riandrihealthrimaintenance.
SOAP Note Structure
ri ri
SOAPriElement Whatribelongsrithere Commonriexamples
Sri-riSubjective Chiefriconcern,riHPI,riROS,riPMH,rimedications,riallergies,rifa "Coughriforri4ridays."riReportsrifever.riDeniesrichestripain.
milyrihistory,risocialrihistory,ripatientrigoalsriandriconcerns. riSmokerrixri20riyears.
Ori-riObjective Generalrisurvey,rivitals,riphysicalriexamrifindings,riobjectiverim Tri101.3riF,riHRri112,ricracklesriRLL,riCXRriinfiltrate.
easurements,rilabs,riimaging,riscreeningriresults.
Ari-riAssessment Bestriexplanationriforritheripatientridata,ridifferentials,rirule- Community-
outs,riclinicalriimpression,rihealthririsks. acquiredripneumoniarivsriviralribronchitis;ridehydrationriris
k.
Pri-riPlan Diagnostics,ritherapeutics,rieducation,rireferrals,risafetyriinstr CXR,riCBC,riantibioticsriifriindicated,rihydration,rireturnripre
uctions,rifollow-upriinterval,riprevention. cautions,rifollow-upriinri48rihours.
Examripearl:riSOAPriisribothriarithinkingriprocessriandriaridocumentationriformat.riArigoodriSOAPrinoterishouldritellriarichronologicalristoryriand
showriwhyritheriassessmentriandriplanrimatchritheridata.
Building the History
ri ri
• Startriwithriidentifiersriandrichiefriconcern,rithenrimoveriintoriHPI,riPMH,rifamilyrihistory,ripersonal/socialrihistory,riandriROS.
• Chiefriconcernrishouldriberiinritheripatient'sriownriwordsriandrishouldrifocusritherivisit.
• HPIriisrisymptomrianalysis.riItritellsritheristoryriofritheripresentriproblemristartingrifromritherilastritimeritheripatientrifeltriwell.
• Useriopen-endedriquestionsrifirst,rithenridirectriquestions.riAvoidrileadingriquestions.
• Verifyriandrisummarizeriwhatriyouriheardribeforerimovingrion.
History Purpose Examplesriofriwhatritoriask
riArea
CC Reasonriforriseekingricare,riusuallyribriefrian "Whatribringsriyouriinritoday?"ri"Whatriisribotheringriyouritherimost?"
driinripatientriwords.
HPI Analyzericurrentriproblemriandridifferentiat Onset,rilocation,riduration,richaracter,riaggravatingrifactors,rirelievingrifactors,ritiming/trea
eripossiblericauses. tments,riseverity,riassociatedrisymptoms.
PMH Identifyripriorriconditionsriandririskrifacto Medications,riallergiesriandrireactions,riimmunizations,risurgeries,rihospitalizations,ritran
rs. sfusions,riadult/childhoodriillness,riscreeningritests.
FH Identifyrigenetic/familialripatterns. Threerigenerations;riageriandrihealth/deathriofrirelatives;ricancersribeforeriageri50;riMI,riHT
N,ridiabetes,ristroke,rithyroid,riasthma.
SH Identifyrilifestyle,rienvironmental,riandri Occupation,riexposures,rihousing,risafety,ritobacco,rialcohol,ridrugs,rimilitaryrihistory,ritrav
access-to-careririsks. el,risexualrihistory,rispirituality,rifinances,riaccessritoricare.
ROS Inventoryrisymptomsrisystem-by- General,riskin,riHEENT,rilymph,richest/lungs,riheart,riGI,riGU,riMSK,rineuro,ripsych.
systemriandriidentifyrioverlookedri
problems.
Memoryrihook:riHPIri=ritheristoryriofrithisriproblem.riPMH/FH/SHri=ritheririskribackground.riROSri=risystemriinventory.
NURSri5220riAdvancedriHealthriAssessmentri-riTestri1riExpandedriStudyriGuide
, HPI Symptom Analysis
ri ri
Variable Whatriitrimeans Example
Timing/onset Whenriitristarted,risuddenrivsrigradual,riduration,rifrequency Startedrisuddenlyri2rihoursriago;rioccursridailyriafterribreakfas
,riconstantrivsriintermittent. t.
Location Exactrisite,rigeneralizedrivsrilocalized,riradiation. Substernalripainriradiatingritorileftriarm.
Quality Natureriofrisymptom. Sharp,ridull,risqueezing,rithrobbing,riburning,ristabbing,ricoli
cky.
Quantity/severity Magnituderiandrieffectrionrifunction. Painri8/10;rihadritoristopridriving.
Setting Context,ritriggers,riactivity,riexposure,rienvironment,rimecha Afterriclimbingristairs;riafterrisickricontact;riafterrifall.
nism.
Aggravating/alleviating Whatrimakesribetterriorriworse. Worseriwithriexertion;ribetterriwithrirestriorribelching.
Associatedrifactors Symptomsrithatricomeriwithritherichiefriconcern. Nausea,ridiaphoresis,rifever,rirash,riphotophobia.
Examripearl:riPertinentripositivesrisupportriaridiagnosis.riPertinentrinegativesrihelprilowerriaridiagnosisrionritheridifferential.riBothriarerineeded
inrigoodridiagnosticrireasoning.
Diagnostic Reasoning Process
ri ri
1. Createriaridifferentialridiagnosisrilist:riallrireasonableripossibilitiesriforritherichiefriconcern.
2. AskrimorerifocusedriquestionsriusingritherisevenriHPIrivariables.
3. Sortripertinentripositivesriandripertinentrinegativesriforrieachripossibleridiagnosis.
4. Assignriprobabilityribasedrionriclusters,ritrends,ritimericourse,riexposures,rifamily/seasonalripatterns,riandririskrifactors.
5. Useritheriphysicalriexamritorisupportriorriweakenridiagnoses.
6. Orderritestsrionlyriwhenritheriresultriwillrihelpriruleriin,riruleriout,riorriguideriaction.
7. Chooseritheriassessment/diagnosisrithatribestriexplainsritherihistoryriplusriphysicalrifindings.
High-yieldritestritargets:
• Redriflagri=rifindingrisuggestingriariseriousriconditionrineedingriurgentrievaluation.
• Pathognomonicri=rifindingrisoricharacteristicriitripointsristronglyritorioneridiagnosis.
• Rulingrioutriisriasriimportantriasrirulingriin.
• Avoidritheribiasritrap:ridorinotrilabelritheripatientriorricloseriyourrimindritooriearly.
• Commonrithingsricommonlyrihappen,ributrialwaysriconsiderritheribadristuff.
2. Growth, Measurement, Vital Signs, and Pain
ri ri ri ri ri
Temperature
• Bodyritemperatureriisriregulatedribyritherihypothalamus.
• Feverriresponse/pyrexiariisritriggeredribyriendogenousripyrogensriandriprostaglandins.
• Theribodyrigeneratesriheatrithroughrishiveringriandrivasoconstriction.
• Theribodyricoolsrithroughrivasodilationriandrievaporationriofriperspiration.
• Expectedritemperaturerirange:ri97.2riFritori99.9riFri(36.2riCritori37.7riC).
• Feverriisrigenerallyritemperaturerigreaterrithanri100.4riF;riaxillaryrifeverrithresholdrimayriberilower.
• Feverriinri0ritori90ridaysriofriliferineedsriimmediaterievaluation.riOverri90ridaysriwithritemperatureri>105riFrineedsrievaluation.
Pulse, Respirations, and Blood Pressure
ri ri ri ri
Vitalrisign Whatriitrirepresents Keyriexamripoints
Pulse Heartriraterigeneratedribyriventricularricontrac Apicalripulseripreferredriinriinfants/children.riAssessrirate,rirhythm,ricontour,riampl
tionripushingriaripressureriwaverithroughriarteri itude.riAdultriaverageri60-100ribpm.riIrregularrirhythm:ricountrifullri60riseconds.
es.
Respiratoryrirate Ventilationripatternricreatedribyridiaphragm/i Adultrinormalri12-
ntercostalrimuscleriactivity. 20ribreaths/min.riAssessriworkriofribreathing:riretractions,rinasalriflaring,ristrido
r,rigrunting.riTachypneari=rifasterrithanrinormal;ribradypneari=rislowerrithanrino
rmal.
Bloodripressure Peripheralrimeasureriofricardiovascularrifun Systolicri=riventricularricontraction;ridiastolicri=riperipheralriresistanceriduringrir
ction;riforceriofribloodriagainstriarterialriwall. elaxation.riPulseripressureri=risystolicriminusridiastolic.riUseriproperricuffrisize.
riRoutineriBPribeginsriaroundriageri3.
Memoryrihook:riPulseripressureri=ritoprinumberriminusribottomrinumber.riExample:ri120/80ri=ripulseripressureri40.
NURSri5220riAdvancedriHealthriAssessmentri-riTestri1riExpandedriStudyriGuide
