Physical Assessment exam 1
What are the primary components of a health assessment? - ANSHistory: subjective data ( what patient
tells you)
Physical examination: objective data (what you can observe)
Documentation of data: Paper/ EHR
What are the 5 types of health assessment? - ANS1. Comprehensive assessment
2.Problem based / focused assessment
3. Episodic/ follow up
4. Shift assessment
5. Screening assessment/ examination
What is a comprehensive assessment consist of ? - ANSdetailed history and physical examination
What does a problem based assessment consist of ? - ANShistory and examination limited to a specific
problem of complaint
What does an episodic assessment consist of? - ANSusually done when a patient is following up with a
healthcare provider
What is a screening assessment ? - ANSa short examination focused on disease detection. usually
conducted in health fairs.
What are the 3 phases of an interview? - ANS- introduction: introduces self/ prepare patient for what to
expect/ purpose and process
- Discussion: keep patient centered
,- Summary : main points/ allow clarification/ relay gathered data/ provide closure
What are the components of health history that a nurse is looking for? - ANS- biographic data
-reason for seeking care
-history for present illness
-present health status
-personal & psychosocial history
-review of systems
What is considered the single most important action in reducing the transmition of an infection? -
ANShand hygiene
What is palpitation? - ANSinvolves the using of hands to feel texture, size, shape , consistency, pulsation
and location of certain parts of the patiens body
What is the difference between light and deep palpation? - ANS-light is used to asses skin and
tenderness - 1 cm in depth
-deep is used to determine size and contour of an organ - 4 cm
What is bimanual palpation? - ANSApplication of pressure to a structure with One hand Manipulating
the tissue while the Other hand Supporst the structures on the opposite side (ex. floor of mouth)
Why should light palpation precede deep palpation? - ANSA deep palpation could cause tenderness or
disrupt fluid which could interfere with the collection of data
What is percussion used for? - ANSTo evaluate size, borders and consistency of internal organs - Detect
tenderness - To detect air, fluid or solids in a tissue. Percussion produces a sound that indicates
characteristics of the underlying organ tissue. Deep tendon reflexes are elicited w/ a percussion hammer.
What is the difference between direct and indirect percussion? - ANS-Direct: uses one hand directly
against the patients body- used to evaluate sinus, or tenderness in kidney
, -Indirect: Requires both hands and is prepared by different methods depending on areas of the body
being assessed
What is auscultation? - ANSlistening to body sounds
What should occur first in an assessment auscultation or precautions? - ANSprecautions
What does having the patient in the sitting position allow the nurse to assess ? - ANSThe head, neck,
back, posterior thorax, lungs, anterior thorax, breast. vital signs, upper thorax
What is the supine position? - ANSlying on the back allows for access to pulse sites
What is the dorsal recumbent position? - ANSWhen patients are on their back with knees flexed and
soles of the feet flat on the bed.- used for abdominal assessment
What is the lithotomy position used for? - ANSexamination of the vagina, pelvic, & rectum but feet are
place in stirrups
What is the sims position used for? - ANSexamination of the vagina and rectum, to measure rectal
temperature, for flexible sigmoidoscopy, and enema
What is the prone position? - ANSlying face down
What is the lateral recumbent position used for? - ANSdetecting heart mumurs
What is the Knee-Chest Position used for? - ANSrectum
How does a stethoscope work? - ANSIt blocks out extraneous sounds, NOT a magnifier.
What are the parts of the stethoscope ? - ANSearpiece, binaurals, diaphram, bell, head
What are the primary components of a health assessment? - ANSHistory: subjective data ( what patient
tells you)
Physical examination: objective data (what you can observe)
Documentation of data: Paper/ EHR
What are the 5 types of health assessment? - ANS1. Comprehensive assessment
2.Problem based / focused assessment
3. Episodic/ follow up
4. Shift assessment
5. Screening assessment/ examination
What is a comprehensive assessment consist of ? - ANSdetailed history and physical examination
What does a problem based assessment consist of ? - ANShistory and examination limited to a specific
problem of complaint
What does an episodic assessment consist of? - ANSusually done when a patient is following up with a
healthcare provider
What is a screening assessment ? - ANSa short examination focused on disease detection. usually
conducted in health fairs.
What are the 3 phases of an interview? - ANS- introduction: introduces self/ prepare patient for what to
expect/ purpose and process
- Discussion: keep patient centered
,- Summary : main points/ allow clarification/ relay gathered data/ provide closure
What are the components of health history that a nurse is looking for? - ANS- biographic data
-reason for seeking care
-history for present illness
-present health status
-personal & psychosocial history
-review of systems
What is considered the single most important action in reducing the transmition of an infection? -
ANShand hygiene
What is palpitation? - ANSinvolves the using of hands to feel texture, size, shape , consistency, pulsation
and location of certain parts of the patiens body
What is the difference between light and deep palpation? - ANS-light is used to asses skin and
tenderness - 1 cm in depth
-deep is used to determine size and contour of an organ - 4 cm
What is bimanual palpation? - ANSApplication of pressure to a structure with One hand Manipulating
the tissue while the Other hand Supporst the structures on the opposite side (ex. floor of mouth)
Why should light palpation precede deep palpation? - ANSA deep palpation could cause tenderness or
disrupt fluid which could interfere with the collection of data
What is percussion used for? - ANSTo evaluate size, borders and consistency of internal organs - Detect
tenderness - To detect air, fluid or solids in a tissue. Percussion produces a sound that indicates
characteristics of the underlying organ tissue. Deep tendon reflexes are elicited w/ a percussion hammer.
What is the difference between direct and indirect percussion? - ANS-Direct: uses one hand directly
against the patients body- used to evaluate sinus, or tenderness in kidney
, -Indirect: Requires both hands and is prepared by different methods depending on areas of the body
being assessed
What is auscultation? - ANSlistening to body sounds
What should occur first in an assessment auscultation or precautions? - ANSprecautions
What does having the patient in the sitting position allow the nurse to assess ? - ANSThe head, neck,
back, posterior thorax, lungs, anterior thorax, breast. vital signs, upper thorax
What is the supine position? - ANSlying on the back allows for access to pulse sites
What is the dorsal recumbent position? - ANSWhen patients are on their back with knees flexed and
soles of the feet flat on the bed.- used for abdominal assessment
What is the lithotomy position used for? - ANSexamination of the vagina, pelvic, & rectum but feet are
place in stirrups
What is the sims position used for? - ANSexamination of the vagina and rectum, to measure rectal
temperature, for flexible sigmoidoscopy, and enema
What is the prone position? - ANSlying face down
What is the lateral recumbent position used for? - ANSdetecting heart mumurs
What is the Knee-Chest Position used for? - ANSrectum
How does a stethoscope work? - ANSIt blocks out extraneous sounds, NOT a magnifier.
What are the parts of the stethoscope ? - ANSearpiece, binaurals, diaphram, bell, head
