NURS 217 FINAL EXAM 2025 MUST KNOW TO PASS HEALTH
ASSESSMENT IN NURSING JULIE POLANIC VERIFIED STUDY
GUIDE
Parts of the CNS (24)
Includes the brain and spinal cord
Peripheral nervous system (24)
Nerves from outside of the brain and spinal cord
Deep tendon reflexes (24)
0 = No response
1 = Diminished
2 = Normal
3 = Brisker than average
4 = Hyperactive
Measured: Biceps, triceps, brachioradialis, patellar, Achilles
Aging changes (24)
•General atrophy and a steady loss of neuron structure in the brain and spinal cord
•Nerve conduction decreases between 5-10%, making reaction time slower
•Motor strength and agility decrease
•Decrease in cerebral blood flow and O2 consumption causes dizziness, loss of balance and risk for falls
•Essential (senile) tremors- intention tremor of the hand, head nodding and tongue protrusion (benign)
Cranial nerves (24)
,CN I Olfactory nerve
•Occlude nostril, have patient close eyes then present with an aromatic substance
-> Coffee, vanilla, peppermint, cinnamon (some familiar scent)
CN II Optic nerve
•Visual acuity and visual fields
-> Snellen eye chart and peripheral vision
CN III, IV and VI Oculomotor, Trochlear and Abducens
•Palpebral fissures are equal
•Check pupils for size, equality, direct and consensual light reaction and accommodation
•Assess gaze with diagnostic position test
CN V Trigeminal
•Test motor function
-> Assess muscles by palpating temporal and masseter muscles as patient clenches teeth
•Sensory function
-> Test light sensation by touching patient’s forehead, cheeks and chin with patient’s eyes closed
CN VII Facial nerve
•Motor function- note mobility and symmetry as patient responds
-> Instruct patient to smile, frown, tightly close eyes, while you try to open them, lift eyebrows, show
teeth and puff cheeks
, CN VIII Acoustic nerve (Vestibulocochlear)
•Tests hearing acuity during normal conversation and the whisper test
CN IX and X Glossopharyngeal and Vagus
•Use a tongue blade to depress the tongue, as the patient says “ahhh” uvula should rise
•Check gag reflex
CN XI Spinal Accessory nerve
•Check strength of neck by asking patient to turn head to the side against resistance applied to side of
chin or face
•Have patient shrug shoulders against resistance
What happens during inspection?
Compare right and left sides, checking for symmetry
CVA (24)
Place hand over 12th rib at costovertebral angle in back
Thump the hand with the other fist.
Patient should feel no pain, just a thud
HPV Vaccine (27)
Prevents cervical cancer
•Routine vaccination recommended for males and females ages 11and12 years (2 doses)
•Series can be initiated as young as age 9
•Vaccine is also recommended for females age 13-26 and males age 13-21 who have not received the
vaccine or completed the series (vaccine given on or after 15th birthday, series of 3 injections)
ASSESSMENT IN NURSING JULIE POLANIC VERIFIED STUDY
GUIDE
Parts of the CNS (24)
Includes the brain and spinal cord
Peripheral nervous system (24)
Nerves from outside of the brain and spinal cord
Deep tendon reflexes (24)
0 = No response
1 = Diminished
2 = Normal
3 = Brisker than average
4 = Hyperactive
Measured: Biceps, triceps, brachioradialis, patellar, Achilles
Aging changes (24)
•General atrophy and a steady loss of neuron structure in the brain and spinal cord
•Nerve conduction decreases between 5-10%, making reaction time slower
•Motor strength and agility decrease
•Decrease in cerebral blood flow and O2 consumption causes dizziness, loss of balance and risk for falls
•Essential (senile) tremors- intention tremor of the hand, head nodding and tongue protrusion (benign)
Cranial nerves (24)
,CN I Olfactory nerve
•Occlude nostril, have patient close eyes then present with an aromatic substance
-> Coffee, vanilla, peppermint, cinnamon (some familiar scent)
CN II Optic nerve
•Visual acuity and visual fields
-> Snellen eye chart and peripheral vision
CN III, IV and VI Oculomotor, Trochlear and Abducens
•Palpebral fissures are equal
•Check pupils for size, equality, direct and consensual light reaction and accommodation
•Assess gaze with diagnostic position test
CN V Trigeminal
•Test motor function
-> Assess muscles by palpating temporal and masseter muscles as patient clenches teeth
•Sensory function
-> Test light sensation by touching patient’s forehead, cheeks and chin with patient’s eyes closed
CN VII Facial nerve
•Motor function- note mobility and symmetry as patient responds
-> Instruct patient to smile, frown, tightly close eyes, while you try to open them, lift eyebrows, show
teeth and puff cheeks
, CN VIII Acoustic nerve (Vestibulocochlear)
•Tests hearing acuity during normal conversation and the whisper test
CN IX and X Glossopharyngeal and Vagus
•Use a tongue blade to depress the tongue, as the patient says “ahhh” uvula should rise
•Check gag reflex
CN XI Spinal Accessory nerve
•Check strength of neck by asking patient to turn head to the side against resistance applied to side of
chin or face
•Have patient shrug shoulders against resistance
What happens during inspection?
Compare right and left sides, checking for symmetry
CVA (24)
Place hand over 12th rib at costovertebral angle in back
Thump the hand with the other fist.
Patient should feel no pain, just a thud
HPV Vaccine (27)
Prevents cervical cancer
•Routine vaccination recommended for males and females ages 11and12 years (2 doses)
•Series can be initiated as young as age 9
•Vaccine is also recommended for females age 13-26 and males age 13-21 who have not received the
vaccine or completed the series (vaccine given on or after 15th birthday, series of 3 injections)
