NUR 643E Final Physical Exam Assessment Questions With
Complete Solutions
Head and Neck: Mouth
Inspect lips: note color, moisture, note any lumps, ulcers,
cracking or scaliness
Oral mucosa: with help of light and tongue blade inspect oral
mucosa for color, ulcers, white patches, nodules
Gums: note color of gums. Inspect gum margins for
swelling/ulceration.
Inspect teeth: note missing, discolored, miss-happen, or
abnormally positioned
Inspect roof of mouth: color and architecture
Tongue: note color and texture. Ask pt to stick out tongue. Note
asymmetry
Inspect entire oral cavity: note white/reddened areas, nodules,
ulcerations. Use gauze, gently grab tongue and pull to each side
to inspect.
Head and Neck: Throat
,Pharynx: ask pt to say ah with tongue not protruded, inspect.
Note rise of soft palate. Note color and asymmetry. Look for
exudate, swelling, ulceration
Posterior Thorax: Inspect
Inspect the skin of the posterior thorax for lumps, rash, moles, or
abnormalities in shape. Assess color and condition.
Inspect symmetry of thorax. Spine should appear in straight line.
Thorax should be symmetric, with elliptical shape and
downward sloping ribs. Scapulae are symmetrical.
Inspect thoracic expansion. Normal = symmetrical.
Assess respiratory rate and effort.
Assess AP diameter. The anteroposterior diameter should be less
than the transverse diameter. Normal APd to transverse ratio is
1:2
Posterior Thorax: Palpate
Palpate spine for straightness and tenderness.
Place thumbs at level of 10th rib, slide thumbs medially just
enough to raise a loose fold of skin between thumbs and over
spine. Ask pt to inhale deeply. Watch distance of thumbs as they
move apart during inspiration. Should be symmetric.
Posterior Thorax: Percuss
,Percuss for costovertebral angle (CVA) tenderness
CVA = angle created by 12th rib and vertebre. Place hand flat
over that space. With other hand make a fist and thump hand.
Normal = no pain with thump. Complete on both sides.
Posterior Thorax: Auscultate Lung Fields
Minimum of 8 areas posteriorly
Clean stethoscope
Have pt sitting up. Resting arms. Taking deep breath with each
location. Tell pt to stop if dizzy.
Anterior Thorax: Inspect
Inspect for lumps, rash, moles, or abnormalities in shape. Note
skin color and condition.
Anterior Thorax: Palpate
Test for skin turgor
Palpate ribs and sternum for tenderness
Anterior Thorax: Auscultate
Auscultate lung sounds and compare sides.
Anterior Thorax: Auscultate
Auscultate heart sounds. First sitting then lying down. Use both
the bell and diaphragm.
, Five areas to auscultate: (APETM)
1. Aortic area
2. Pulmonic area
3. Erb's point
4. Tricuspid area
5. Mitral area
Valve Areas:
Aortic Valve: second right interspace
Pulmonic Valve: second left interspace
Tricuspid valve: left lower sternal border or fifth left interspace
Mitral valve: Fifth interspace around midclavicular line
Normal Heart Sounds: S1 and S2
-S1 and S2: diaphragm
Abnormal:
S3 and S4
-Heard with the bell
-Occur in diastole
-S3 (Ventricular gallop) may be heard with HF or volume
overload
-S4 (atrial gallop) may be heard with CAD
Murmur: blowing, swooshing
-Occur with congenital or acquired valvular defects
-Systolic murmur: may occur with healthy heart or heart disease
-Diastolic murmur: always indicates heart disease
Complete Solutions
Head and Neck: Mouth
Inspect lips: note color, moisture, note any lumps, ulcers,
cracking or scaliness
Oral mucosa: with help of light and tongue blade inspect oral
mucosa for color, ulcers, white patches, nodules
Gums: note color of gums. Inspect gum margins for
swelling/ulceration.
Inspect teeth: note missing, discolored, miss-happen, or
abnormally positioned
Inspect roof of mouth: color and architecture
Tongue: note color and texture. Ask pt to stick out tongue. Note
asymmetry
Inspect entire oral cavity: note white/reddened areas, nodules,
ulcerations. Use gauze, gently grab tongue and pull to each side
to inspect.
Head and Neck: Throat
,Pharynx: ask pt to say ah with tongue not protruded, inspect.
Note rise of soft palate. Note color and asymmetry. Look for
exudate, swelling, ulceration
Posterior Thorax: Inspect
Inspect the skin of the posterior thorax for lumps, rash, moles, or
abnormalities in shape. Assess color and condition.
Inspect symmetry of thorax. Spine should appear in straight line.
Thorax should be symmetric, with elliptical shape and
downward sloping ribs. Scapulae are symmetrical.
Inspect thoracic expansion. Normal = symmetrical.
Assess respiratory rate and effort.
Assess AP diameter. The anteroposterior diameter should be less
than the transverse diameter. Normal APd to transverse ratio is
1:2
Posterior Thorax: Palpate
Palpate spine for straightness and tenderness.
Place thumbs at level of 10th rib, slide thumbs medially just
enough to raise a loose fold of skin between thumbs and over
spine. Ask pt to inhale deeply. Watch distance of thumbs as they
move apart during inspiration. Should be symmetric.
Posterior Thorax: Percuss
,Percuss for costovertebral angle (CVA) tenderness
CVA = angle created by 12th rib and vertebre. Place hand flat
over that space. With other hand make a fist and thump hand.
Normal = no pain with thump. Complete on both sides.
Posterior Thorax: Auscultate Lung Fields
Minimum of 8 areas posteriorly
Clean stethoscope
Have pt sitting up. Resting arms. Taking deep breath with each
location. Tell pt to stop if dizzy.
Anterior Thorax: Inspect
Inspect for lumps, rash, moles, or abnormalities in shape. Note
skin color and condition.
Anterior Thorax: Palpate
Test for skin turgor
Palpate ribs and sternum for tenderness
Anterior Thorax: Auscultate
Auscultate lung sounds and compare sides.
Anterior Thorax: Auscultate
Auscultate heart sounds. First sitting then lying down. Use both
the bell and diaphragm.
, Five areas to auscultate: (APETM)
1. Aortic area
2. Pulmonic area
3. Erb's point
4. Tricuspid area
5. Mitral area
Valve Areas:
Aortic Valve: second right interspace
Pulmonic Valve: second left interspace
Tricuspid valve: left lower sternal border or fifth left interspace
Mitral valve: Fifth interspace around midclavicular line
Normal Heart Sounds: S1 and S2
-S1 and S2: diaphragm
Abnormal:
S3 and S4
-Heard with the bell
-Occur in diastole
-S3 (Ventricular gallop) may be heard with HF or volume
overload
-S4 (atrial gallop) may be heard with CAD
Murmur: blowing, swooshing
-Occur with congenital or acquired valvular defects
-Systolic murmur: may occur with healthy heart or heart disease
-Diastolic murmur: always indicates heart disease
