NR 509 Immersion Exam Test Question and Answers
Introduction
Answer: ___________, my name is ____________, I will be doing your exam today. I'll begin with
inspecting your face. I'll note that I don't see any discolorations or lesions & the head is midline &
symmetrical.
Lymph nodes
Answer: Next, I'll palpate the lymph nodes. I'll begin with the preauricular lymph nodes, right in front of
the ear, and post auricular, right behind the ear. Then I will palpate her occipital lymph nodes in the
back of the head. And then I'm going to move forward and palpate the tonsillar lymph nodes. Come
under the jawline, the submandibular lymph nodes, and the submental. Now I will go to the anterior
cervical lymph nodes, and the posterior cervical lymph nodes. And I will end with the supraclavicular
lymph nodes right about the clavicles. I do not feel any enlargement, and they are equal bilaterally.
Face
Answer: I'm testing trigeminal nerve, which is cranial nerve # 5. Palpating over the masseter muscle as
the pt clenches the jaw. I don't feel any distortions & my pt has great strength. Now, I'm testing the
sensory portion of the trigeminal nerve. I'll ask my pt to close your eyes & let me know where you feel
my touch. (>> Forehead, right cheek, left cheek, chin, nose)
Next, I'll test the facial nerve, which is cranial nerve # 7. I'm going to ask you to do some facial
expressions. I'm going to have you smile, next, frown for me. Now raise your eyebrows & puff up your
cheeks, pucker your lips. I notice all expressions have bilateral symmetry.
Ears
Answer: Now, I'm going to inspect the ears. I'm looking for nodules or skin lesions. They're both
symmetrical, no nodules or skin lesions are noted. I'm going to look inside the ear canal with the
otoscope. I see that the external auditory canal is clear, there's no swelling, redness, drainage or
cerumen. The tympanic membrane is pearly gray & there is no effusion in the middle ear. I'll do the
other ear. Looking into the external auditory canal. I see there is no swelling, redness, drainage, or
cerumen. Pt's tympanic membrane is pearly gray & there's no effusion in the middle ear. Next, I'm going
to palpate pinna for any nodules or tenderness. Now the tragus. No nodules or tenderness are noted.
Acustic nerve CN8
Answer: I will be testing your acoustic nerve, which is cranial nerve # 8, which is hearing. I'll be
performing a whisper test. I want you to cover one of your ears & I will stand behind you, cover my
mouth & whisper 3 words & I want you to repeat them to me (1, 2, 3) & let's do the other side (4, 5, 6).
Hearing is intact bilaterally.
Eyes
Answer: I'm going to assess the pt's eyes. I'm going to look at the conjunctiva. I notice that they're pink
& clear, no drainage or lesions & the sclera is white & clear. I'm going to test cranial nerve # 2, the optic
nerve, covering central vision. Using the Snellen eye pocket chart, I'm going to stand 6 ft away & ask the
pt to cover 1 eye & read the lowest line possible (LTFPH). Repeat with the other eye. Now with both
eyes. The pt has normal vision, 20/20 in the L eye, R eye, & both eyes.
Cranial nerve 2
, Answer: I'll continue with cranial nerve # 2, the optic nerve, this time assessing peripheral vision. Please
stand, so we can be at the same eye level. I'm going to ask the pt to look straight ahead & not move
their head ((hands right above shoulders, move hands in "come" motion)) Can you see my hands now?
>> Let me know when you do>> I'm going to cover above, ((w/hands on either side of face, move
hands)) Do you see them now? >> Let me know when you do>> Now from below ((hands on pt sides,
bring hands upward)) Do you see them now? >> Let me know when you do. The pt's peripheral vision is
normal. Again, I'm checking cranial nerve # 2, the optic nerve for pupil response to light. I'm using the
ophthalmoscope head & turning on my light. Please look at my nose. I notice that the pupil constricts. I
will check the other eye. The pupils are about 2-3 mm's & both respond to light equally.
Cranial nerves 3,4,&6
Answer: Next, I'm going to be checking cranial nerves # 3, the ocular motor, cranial nerve # 4, the
trochlear, & cranial nerve # 6, the abducens. I will choose an H pattern to assess the extraocular muscles
of the eye. If you'll follow my finger, with your eyes only. All EOMs are intact equally.
Nose
Answer: I'm going to inspect the nose. I see that it's midline, there's no obstruction, fracture or swelling.
I'll begin by inserting the speculum of the otoscope inside the nose. I see pink & moist turbinates & the
septum is midline, straight & there's no deviation. On the other side, I see a straight septum, the
turbinates are pink & moist. There's no swelling or bogginess.
Next, I'll palpate the pt's sinuses beginning with the frontal sinuses. Let me know if you feel any
tenderness. The maxillary sinuses, tenderness? No tenderness noted.
Mouth
Answer: Now, I'm going to inspect the throat & mouth. The lips, I see they are pink & moist. Can you
open your mouth? I don't see any signs of decay or cracks in the teeth. The gums look pink & there is no
redness or swelling. The buccal mucosa on both sides is moist & pink. Upper hard & soft palates are
intact, pink & moist. The tongue is smooth, pink & moist. If you'll lift your tongue up, please. I don't see
any nodules or drainage & it's pink & moist on the floor of the mouth. Now I'll look at the posterior
pharynx & it's pink & there is no post nasal drainage. ((Grade tonsils if present, +1 normal or +2 mid-line,
bilateral))
Cranial nerve 9, 10 & 12
Answer: Cranial nerve # 9 the glossopharyngeal, which is the gag reflex & I won't not be testing for that.
I'll check cranial nerve # 10, which is the vagus nerve. I'll have the pt go ahead & open your mouth again
((w/my light shining in pt mouth)) & say "ahhh" The uvula rises symmetrically with phonation. Then we
have cranial nerve #12, the hypoglossal. I'll have you stick your tongue out & move it side to side.
Next, I'm palpating the TMJ. I'm palpating both sides. Please open your mouth & close. Do you have any
tenderness? I don't feel any subluxation, crepitus, clicking, or tenderness.
Neck and Throat
Answer: There are no deformities in the neck & it's symmetrical. Next, I'll palpate the trachea; it's
midline. Now, I'll palpate the thyroid gland. by finding the cricoid process. With one hand in the
suprasternal notch, right here, with the other hand.And I will put my fingers on either side, between
those two points, landmarks, and I'm actually gonna retract a little bit on one side and ask her to
swallow. And I'm feeling the thyroid as it rises for size in any nodules. And now, when we retract on the
opposite side, and ask her to swallow. No nodules noted.
Introduction
Answer: ___________, my name is ____________, I will be doing your exam today. I'll begin with
inspecting your face. I'll note that I don't see any discolorations or lesions & the head is midline &
symmetrical.
Lymph nodes
Answer: Next, I'll palpate the lymph nodes. I'll begin with the preauricular lymph nodes, right in front of
the ear, and post auricular, right behind the ear. Then I will palpate her occipital lymph nodes in the
back of the head. And then I'm going to move forward and palpate the tonsillar lymph nodes. Come
under the jawline, the submandibular lymph nodes, and the submental. Now I will go to the anterior
cervical lymph nodes, and the posterior cervical lymph nodes. And I will end with the supraclavicular
lymph nodes right about the clavicles. I do not feel any enlargement, and they are equal bilaterally.
Face
Answer: I'm testing trigeminal nerve, which is cranial nerve # 5. Palpating over the masseter muscle as
the pt clenches the jaw. I don't feel any distortions & my pt has great strength. Now, I'm testing the
sensory portion of the trigeminal nerve. I'll ask my pt to close your eyes & let me know where you feel
my touch. (>> Forehead, right cheek, left cheek, chin, nose)
Next, I'll test the facial nerve, which is cranial nerve # 7. I'm going to ask you to do some facial
expressions. I'm going to have you smile, next, frown for me. Now raise your eyebrows & puff up your
cheeks, pucker your lips. I notice all expressions have bilateral symmetry.
Ears
Answer: Now, I'm going to inspect the ears. I'm looking for nodules or skin lesions. They're both
symmetrical, no nodules or skin lesions are noted. I'm going to look inside the ear canal with the
otoscope. I see that the external auditory canal is clear, there's no swelling, redness, drainage or
cerumen. The tympanic membrane is pearly gray & there is no effusion in the middle ear. I'll do the
other ear. Looking into the external auditory canal. I see there is no swelling, redness, drainage, or
cerumen. Pt's tympanic membrane is pearly gray & there's no effusion in the middle ear. Next, I'm going
to palpate pinna for any nodules or tenderness. Now the tragus. No nodules or tenderness are noted.
Acustic nerve CN8
Answer: I will be testing your acoustic nerve, which is cranial nerve # 8, which is hearing. I'll be
performing a whisper test. I want you to cover one of your ears & I will stand behind you, cover my
mouth & whisper 3 words & I want you to repeat them to me (1, 2, 3) & let's do the other side (4, 5, 6).
Hearing is intact bilaterally.
Eyes
Answer: I'm going to assess the pt's eyes. I'm going to look at the conjunctiva. I notice that they're pink
& clear, no drainage or lesions & the sclera is white & clear. I'm going to test cranial nerve # 2, the optic
nerve, covering central vision. Using the Snellen eye pocket chart, I'm going to stand 6 ft away & ask the
pt to cover 1 eye & read the lowest line possible (LTFPH). Repeat with the other eye. Now with both
eyes. The pt has normal vision, 20/20 in the L eye, R eye, & both eyes.
Cranial nerve 2
, Answer: I'll continue with cranial nerve # 2, the optic nerve, this time assessing peripheral vision. Please
stand, so we can be at the same eye level. I'm going to ask the pt to look straight ahead & not move
their head ((hands right above shoulders, move hands in "come" motion)) Can you see my hands now?
>> Let me know when you do>> I'm going to cover above, ((w/hands on either side of face, move
hands)) Do you see them now? >> Let me know when you do>> Now from below ((hands on pt sides,
bring hands upward)) Do you see them now? >> Let me know when you do. The pt's peripheral vision is
normal. Again, I'm checking cranial nerve # 2, the optic nerve for pupil response to light. I'm using the
ophthalmoscope head & turning on my light. Please look at my nose. I notice that the pupil constricts. I
will check the other eye. The pupils are about 2-3 mm's & both respond to light equally.
Cranial nerves 3,4,&6
Answer: Next, I'm going to be checking cranial nerves # 3, the ocular motor, cranial nerve # 4, the
trochlear, & cranial nerve # 6, the abducens. I will choose an H pattern to assess the extraocular muscles
of the eye. If you'll follow my finger, with your eyes only. All EOMs are intact equally.
Nose
Answer: I'm going to inspect the nose. I see that it's midline, there's no obstruction, fracture or swelling.
I'll begin by inserting the speculum of the otoscope inside the nose. I see pink & moist turbinates & the
septum is midline, straight & there's no deviation. On the other side, I see a straight septum, the
turbinates are pink & moist. There's no swelling or bogginess.
Next, I'll palpate the pt's sinuses beginning with the frontal sinuses. Let me know if you feel any
tenderness. The maxillary sinuses, tenderness? No tenderness noted.
Mouth
Answer: Now, I'm going to inspect the throat & mouth. The lips, I see they are pink & moist. Can you
open your mouth? I don't see any signs of decay or cracks in the teeth. The gums look pink & there is no
redness or swelling. The buccal mucosa on both sides is moist & pink. Upper hard & soft palates are
intact, pink & moist. The tongue is smooth, pink & moist. If you'll lift your tongue up, please. I don't see
any nodules or drainage & it's pink & moist on the floor of the mouth. Now I'll look at the posterior
pharynx & it's pink & there is no post nasal drainage. ((Grade tonsils if present, +1 normal or +2 mid-line,
bilateral))
Cranial nerve 9, 10 & 12
Answer: Cranial nerve # 9 the glossopharyngeal, which is the gag reflex & I won't not be testing for that.
I'll check cranial nerve # 10, which is the vagus nerve. I'll have the pt go ahead & open your mouth again
((w/my light shining in pt mouth)) & say "ahhh" The uvula rises symmetrically with phonation. Then we
have cranial nerve #12, the hypoglossal. I'll have you stick your tongue out & move it side to side.
Next, I'm palpating the TMJ. I'm palpating both sides. Please open your mouth & close. Do you have any
tenderness? I don't feel any subluxation, crepitus, clicking, or tenderness.
Neck and Throat
Answer: There are no deformities in the neck & it's symmetrical. Next, I'll palpate the trachea; it's
midline. Now, I'll palpate the thyroid gland. by finding the cricoid process. With one hand in the
suprasternal notch, right here, with the other hand.And I will put my fingers on either side, between
those two points, landmarks, and I'm actually gonna retract a little bit on one side and ask her to
swallow. And I'm feeling the thyroid as it rises for size in any nodules. And now, when we retract on the
opposite side, and ask her to swallow. No nodules noted.
