Head-to-Toe Assessment Script Exam
2025 Questions and Answers
My name is Stacey and I'm a student nurse. I'm going to be conducting your head-
to-toe examination. Do you have any questions for me today? -
....ANSWER ...-Okay, let's get started then. Can you state your full name for
me? And what is your data of birth? (Go wash hands)
I'm going to take your vital signs now. Let me first estimate your blood pressure
and we'll come back to that. Your pulse is ______ and your respirations are
_______/minute. Your temperature is ___________. Now I'm going to take
blood pressure. Your blood pressure is ________________ -
....ANSWER ...-I'm going to be observing the patient's skin throughout the
exam. May I remove your glasses? Your facial features look symmetrical. (Put on
gloves)The scalp does not have any lesions or pest inhabitants. Remove gloves and
gel hands.
I'm going to feeling for any lumps or tenderness in your face. Does this hurt? Now
I'm going to check your sinuses. Does this hurt?(press up under eyebrows) How
about this (press up under zygomatic). Let's check your to see that your jaw is
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
, working smoothly (press at TMJ). Good, I don't feel any clicking or crepitus and
your jaw opens smoothly. - ....ANSWER ...-Now I'm going to test facial
sensation with this cotton ball. I'm going to have you shut your eyes and tell me
"now" when you feel the cotton on your skin like this (brush cotton on pts arm).
Can you shut your eyes please? (brush cotton on forehead, cheek and mandible).
Good, you can open your eyes now. (palpate temporalis) Can you clench your jaw?
Good. (palpate masseter) Clench again. Good. Your facial sensations are intact and
your have good jaw strength so I know that your 5th cranial nerve is intact.
Now we're going to test your facial nerve. Can you make a frown? a smile? show
your teeth? and now puff out the cheeks. Good. The nerve is intact. -
....ANSWER ...-I'm going to take a look your eyes now. (look for any
redness or assymetry in eyes). Can you shut your eyes for a moment. Good, the
eyes, lids and lashes are all healthy.
Now I'm going to test eye muscles. Can you follow my finger as I pass through the
six positions? (Hold at extreme left and right) Ok, and now just look at a point
behind my head as I shine this light. Good, your eye muscles are healthy and I did
not see any sign of lazy eye. The cranial nerves 3, 4 and 6 controlling eye moments
are all intact. - ....ANSWER ...-Let's take a look at the cornea(light side to
front). Good. Looks smooth and round with no scratches. (Pull down bottom lid)
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
2025 Questions and Answers
My name is Stacey and I'm a student nurse. I'm going to be conducting your head-
to-toe examination. Do you have any questions for me today? -
....ANSWER ...-Okay, let's get started then. Can you state your full name for
me? And what is your data of birth? (Go wash hands)
I'm going to take your vital signs now. Let me first estimate your blood pressure
and we'll come back to that. Your pulse is ______ and your respirations are
_______/minute. Your temperature is ___________. Now I'm going to take
blood pressure. Your blood pressure is ________________ -
....ANSWER ...-I'm going to be observing the patient's skin throughout the
exam. May I remove your glasses? Your facial features look symmetrical. (Put on
gloves)The scalp does not have any lesions or pest inhabitants. Remove gloves and
gel hands.
I'm going to feeling for any lumps or tenderness in your face. Does this hurt? Now
I'm going to check your sinuses. Does this hurt?(press up under eyebrows) How
about this (press up under zygomatic). Let's check your to see that your jaw is
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
, working smoothly (press at TMJ). Good, I don't feel any clicking or crepitus and
your jaw opens smoothly. - ....ANSWER ...-Now I'm going to test facial
sensation with this cotton ball. I'm going to have you shut your eyes and tell me
"now" when you feel the cotton on your skin like this (brush cotton on pts arm).
Can you shut your eyes please? (brush cotton on forehead, cheek and mandible).
Good, you can open your eyes now. (palpate temporalis) Can you clench your jaw?
Good. (palpate masseter) Clench again. Good. Your facial sensations are intact and
your have good jaw strength so I know that your 5th cranial nerve is intact.
Now we're going to test your facial nerve. Can you make a frown? a smile? show
your teeth? and now puff out the cheeks. Good. The nerve is intact. -
....ANSWER ...-I'm going to take a look your eyes now. (look for any
redness or assymetry in eyes). Can you shut your eyes for a moment. Good, the
eyes, lids and lashes are all healthy.
Now I'm going to test eye muscles. Can you follow my finger as I pass through the
six positions? (Hold at extreme left and right) Ok, and now just look at a point
behind my head as I shine this light. Good, your eye muscles are healthy and I did
not see any sign of lazy eye. The cranial nerves 3, 4 and 6 controlling eye moments
are all intact. - ....ANSWER ...-Let's take a look at the cornea(light side to
front). Good. Looks smooth and round with no scratches. (Pull down bottom lid)
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
